Competency-based Training Program Research Articles

A COMPREHENSIVE ANALYSIS OF COMPETENCY AND TRAINING PERSPECTIVES AMONG AIR TRAFFIC CONTROLLERS

The aim of the study was to examine air traffic controllers’ perspectives on competency, performance, and training. Analysing data from 182 participants, the results revealed a strong focus on competency with the controllers actively evaluating their skills. Notably, the experienced controllers (19+ years) displayed a heightened commitment to continuous learning, reflected in their higher participation in individual training and perception of its value for their career goals and adaptation to the evolving aviation industry. Competency-based training programs also received positive feedback across experience levels, highlighting their potential effectiveness. Moreover, training was universally perceived as key to performance throughout careers. These results highlighted the importance of fostering a culture of continuous learning within air traffic control (ATC) communities. Aviation authorities can support this by providing diverse training opportunities, including individual and competency-based programs. Future research should continue investigating the impact of technological advancements and AI/machine learning on ATC competencies, the effectiveness of competency-based training programs, and the role of individual training in competency development, ultimately ensuring the vital role of air traffic controllers in aviation safety.

A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme.

Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM). We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.

Applying a Competency-Based Medical Education Framework to Development of Residents' Feedback Skills.

Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents' skills in providing feedback to medical students. In 2018-2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.

Proposed Framework for Developing and Evaluating Total Worker Health® Education and Training Programs.

Propose a framework for developing and evaluating Total Worker Health® education and training efforts by implementing institutions. Review of Total Worker Health (TWH) information from symposia, workshops, academic offerings, and publications, along with a review of education and training development and evaluation resources applicable across various disciplines. Examples of knowledge, skills, and abilities (KSAs) for each TWH core competency, and a framework for developing and evaluating a TWH competency-based education or training program. The proposed set of KSAs and framework for developing and evaluating TWH education or training programs may inform future pilot testing of KSAs and framework by implementing institutions and help to standardize practices across the discipline. Academic, business, community, labor, and government stakeholders are encouraged to provide further input to assist in its maturation and uptake.

Abstract PO3-11-01: Single centre experience of the adoption of self-administered HER2-directed therapy in patients with breast cancer

Abstract Single centre experience of the adoption of self-administered HER2-directed therapy in patients with breast cancer Background: Programs to promote the self-administration of systemic anti-cancer therapy (SACT) offer greater convenience and shared decision making for patients with the opportunity to alleviate pressures on cancer services. Aims and Objective: The aims of this study were to quantify the uptake/acceptability of self-administration (SA) of subcutaneous trastuzumab (sc T), to evaluate safety, patients’ perception of the programme and the chair capacity released as a consequence. Methods: Patients receiving T for the treatment of HER2 +ve breast cancer were offered training in SA. The competency-based training programme, under the supervision of a chemotherapy-trained nurse, consisted of a minimum of 3 training sessions. Patients were also provided with printed and electronic material (via an App) on how to self-administer sc T, with 24/7 contact details in the event of an adverse event or device failure. Once trained and deemed competent, sc T was shipped to the patients’ home in a temperature-controlled environment, in a pre-filled syringe. All patients were assessed by telephone one day before and one day after SA using the Common Terminology Criteria for Adverse Events (CTCAE). Analysis of the total number of administrations of sc T, between February 2022 and June 2023 was conducted. A telephone survey using a validated questionnaire Self-Management Assessment scale (SMASc) was also undertaken. Results Of 46 breast cancer patients receiving single agent sc T, 32 agreed to participate in the program and were trained. 2 patients were undergoing training at data analysis. 6 patients declined and 6 were ineligible for the programme on the basis of inclusion criteria. The median age of the 32 patients that participated was 62, (range 27-77). The average distance from their home address to the cancer centre was 11.7 miles (range 3.5-27.9). 25 (78%) patients were Caucasian, 4 (13%) were Asian and 3 (9%) were of African/Caribbean origin. Patients had received an average of 10 sc injections in the hospital environment (median 5, range 1-103) before starting the training sessions. They required an average of 3 training sessions before sign-off (median 3, range 1-4). In the 32 patients studied, a total of 302 SA injections were delivered median 9 (range 1- 24) No Grade 3 or 4 CTCAE toxicities or infusion-related reactions were reported. During the 17-month period, a total of 302 hours of chair time was saved. 25 of the 32 patients responded to SMASc questionnaires utilising the six-point Likert scale. Patients reported average scores of 5.32 (median 6) and 5.56 (median 6) respectively, for questions relating to having information about their condition and sufficient training to self-administer. They felt that they had sufficient support to participate in the programme (average 5.56 median 6). 80% of the patients would recommend this programme and 88% felt they had benefited. Comments from patients themed around the value of the support provided, ease of administration and time saved. Discussion Programs such as these empower patients and carers to take a more active role in managing their condition with consequent reduced hospital attendance. Safety and acceptability for those patients who agreed to the program has been confirmed. Success of this program with sc T has enabled expansion to incorporate self-administration of Phesgo (sc trastuzumab and pertuzumab) with 31% (14/45) of the current P patient cohort enrolled onto the programme within 2 weeks of roll out and the first patients self-administering their treatment from August 2023. With the continued expansion of SACT treatments, we encourage stakeholders to consider self-administration of SACT as an option. Formulation of treatments conducive to patient self-administration is a key component to this. Citation Format: Wendy Ng, Vikash Dodhia, Amy Guppy, Stephanie Sutherland, Marlgozata Wojtas, Karen Harrold, Adisa Aolat, Tome Tapiwa, David Miles. Single centre experience of the adoption of self-administered HER2-directed therapy in patients with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-01.

Identifying Competencies of the ACT Program Nurse Using the DACUM Method

The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.

Knowledge, Attitudes, and Practices Toward Retinopathy of Prematurity Among Neonatal Intensive Care Nurses: A Cross-sectional Study.

It is important to study the awareness of retinopathy of prematurity (ROP) among neonatal care nurses in hospitals. Unfortunately, there is a lack of studies conducted among nurses on this subject in Palestine. Thus, this study purposed to assess the knowledge, attitudes, and practices toward ROP among neonatal intensive care nurses in Palestine. A cross-sectional was used to conduct this study. A convenience sampling method was utilized to recruit 289 neonate intensive care nurses working in private and governmental hospitals. The findings showed that around 48.0% of the nurses had low knowledge about preventing ROP. Most of the nurses (78%) reported a neutral attitude toward preventing ROP. Moreover, overall nurses' practices regarding ROP were fair (57.1%). There was a difference in practices regarding ROP according to the health sector (P < .05), in which the private sector had better practices compared to the governmental sector. Additionally, there was a significant difference in knowledge regarding ROP according to educational level (P < .05). Also, a significant difference was found in knowledge and practices regarding ROP according to nurses' experience. Attitudes and practices were the main significant predictors of knowledge (B = 0.153, P < .05; B = 0.172, P < .05, respectively). Knowledge and practices were the main predictors of attitudes (B = 0.126, P < .05; B = 469, P < .001), respectively. Knowledge, attitudes, and experience in neonate intensive care nurses were the main significant predictors of practices (B = 0.135, P < .05; B = 0.449, P < .001; B = 0.224, P < .05, respectively). It is necessary to develop an educational program and competency-based training programs for neonate intensive care nurses about ROP and implement preventive strategies.

Building Competitive Employees in The Digital Era With Competency-Based Training

Non-formal education is currently being intensively provided by various parties and one of them is training, this is because the digital era has created new demands for employees to have relevant and competitive skills, a mismatch between the demands of the ever-changing job market and the skills they possess. by many current employees. Therefore, efforts are needed to deal with this so that employees can survive and continue to progress. One effort that can be made is to improve one's work performance by honing skills, increasing knowledge or insight and how to behave correctly, and to answer these problems competency-based training is one solution that can be done. This article will discuss further about how to build competitive employees in the digital era with competency-based training. The research method that the author uses in this article is library research, namely by collecting various existing sources. In this article, several key points can be concluded, namely: the importance of employee development as a response to rapid changes in the digital era, competency-based training is identified as an effective approach to improving skills in accordance with job demands, competency-based training programs not only improve skills but also contribute to employee motivation and engagement, and employee development programs have the potential to have a positive impact on an organization's competitiveness in the digital era.

PENGEMBANGAN SUMBER DAYA MANUSIA UNTUK PENINGKATAN KUALITAS PEGAWAI DI PT KERETA API INDONESIA (PERSERO)

PT Kereta Api Indonesia (Persero) has established an HR development program. The company's main goal is to transform the employee perspective into a service provider perspective by fostering high-level expertise, increasing individual productivity, and enabling them to better contribute to initiatives aimed at increasing business success. The purpose of the research is to find out the HR development programs carried out by PT Kereta Api Indonesia (Persero) to improve the quality of employees. The method used is descriptive qualitative with data collection through literature study. The results showed that PT Kereta Api Indonesia (Persero) has a human resource development strategy, including a quality recruitment process by finding qualified candidates through job fairs at various prestigious universities and competency-based education and training (Diklat) programs held in stages, starting from the professional growth stage to the development of fundamental competencies through six available training venues.

Limited exposure to pancreatic ERCP during advanced endoscopy training impacts competence and performance in independent practice

Background/ObjectivesThe impact of competency-based training programs on pancreatic endoscopic retrograde cholangiopancreatography (ERCP) performance remains unclear. This study aimed to describe the learning curves of pancreatic ERCP and subsequent performance during independent practice. MethodsThis was a multicenter prospective cohort study involving advanced endoscopy trainees (AETs). In the 1st phase, trainees were assessed on every 5th ERCP using the ERCP and EUS Skills Assessment Tool (TEESAT). Cumulative sum (CUSUM) analysis of pancreatic ERCP evaluations was used to establish learning curves. During the 2nd phase (1st year of independent practice), now-graduated participants documented their performance on key ERCP quality indicators. ResultsA total of 24 AETs (20 training programs) received sufficient evaluations for CUSUM analysis. Pancreatic ERCP accounted for 14.6 % (196/1339) of all ERCPs evaluated with 45 % of pancreatic ERCPs carrying a Grade 3 level of complexity. A minority of AETs (16.7 %) performed enough pancreatic ERCPs to generate meaningful learning curves with no AETs achieving competence in pancreatic cannulation, sphincterotomy, or stone clearance during Phase 1. In Phase 2, a total of 3620 ERCPs were performed, of which 281 (7.8 %) were pancreatic ERCPs. While the overall pancreatic duct cannulation rate was 92.2 %, the native papilla pancreatic duct cannulation rate was 85.7 %, which was below the recommended 90 % threshold. ConclusionsAdvanced endoscopy training offers a low level of exposure to pancreatic ERCP, which is mirrored in independent practice, highlighting the inadequate training in pancreatic ERCP. Given the complexity of pancreatic ERCP, novel strategies are warranted to improve training in pancreatic ERCP.

Cataract surgical training in Europe: European Board of Ophthalmology survey.

To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. Countries affiliated to the European Board of Ophthalmology (EBO). Cross-sectional study of anonymous survey results. A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

Generating a Prioritized List of Operative Procedures for Simulation-based Assessment of General Surgery Trainees Through Consensus.

To develop appropriate content for high-stakes simulation-based assessments of operative competence in general surgery training through consensus. Valid methods of summative operative competence assessment are required by competency-based training programs in surgery. An online Delphi consensus study was conducted. Procedures were derived from the competency expectations outlined by the Joint Committee on Surgical Training Curriculum 2021, and subsequent brainstorming. Procedures were rated according to their perceived importance, perceived procedural risk, how frequently they are performed, and simualtion feasibility by a purposive sample of 30 surgical trainers and a 5-person steering group. A modified Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula was applied to the generated data to produce ranked procedural lists, which were returned to participants for re-prioritization. Prioritized lists were generated for simulation-based operative competence assessments at 2 key stages of training; the end of 'phase 2' prior to the development of a sub-specialty interest, and the end of 'phase 3', that is, end-of-training certification. A total of 21 and 16 procedures were deemed suitable for assessments at each of these stages, respectively. This study describes a national needs assessment approach to content generation for simulation-based assessments of operative competence in general surgery using Delphi consensus methodology. The prioritized procedural lists generated by this study can be used to further develop operative skill assessments for use in high-stakes scenarios, such as trainee progression, entrustment, and end-of-training certification, before subsequent validity testing.

A Comparative Analysis on Employee Training: Competency-based vs Traditional

The study examines competency-based and traditional based training programs, within the context of their effectiveness and impact on employee performance outcomes. Results found that employers have recognised the weakness of traditional training formats, with some placing a higher value on experience and proof of performance abilities, over academic and professional qualifications. The most prominent finding was that training formats must contain both traditional and competency-based elements. These two factors are in turn linked to directly impacting employee performance, and are suggested as being a more accurate longer term measure. The interviews revealed that employees consider that performance can be linked to and measured by a number of factors including productivity output, staff motivation, engagement, job satisfaction, retention, and customer satisfaction.

A national analysis of vascular surgery resident operative experience in peripheral artery disease

BackgroundEndovascular and hybrid interventions have played an increasingly prominent role in the treatment of peripheral arterial disease (PAD) in the past decade. This shift has prompted concerns about the adequacy of open surgical training for current surgical residents. Moreover, the recent Best Surgical Therapy in Patients With Critical Limb Ischemia trial has further emphasized the importance of open surgical techniques in the treatment of peripheral arterial disease. The purpose of this study was to examine national temporal trends in peripheral operative volume among integrated vascular surgery residents. MethodsData was obtained from the Accreditation Council for Graduate Medical Education national data reports for integrated vascular surgery residents. Case volumes for surgeon chief or surgeon junior cases were collected from academic years 2012 to 2013 and 2021 to 2022. Trends in case-mix and volume were evaluated using linear regression analysis. ResultsThe mean total vascular operative volume increased from 851.2 to 914.3 cases among graduating chief residents, with an annual growth of 8.5 ± 1.7 cases/year (R2 = 0.77; P < .0001). Major vascular case volume also increased at a rate of 5.7 ± 1.2 cases/year (R2 = 0.74; P < .001). Among operative categories, peripheral cases were the most frequent (n = 232.2 [26.6%]) and demonstrated the greatest annual growth (+8.0 ± 0.8 cases/year, R2 = 0.93; P < .001). No changes were seen in volume of open peripheral cases, including suprainguinal bypass (+0.1 ± 0.2 cases/year; R2 = 0.08; P = .40) or femoropopliteal bypass procedures (−0.1 ± 0.2 cases/year; R2 = 0.17; P = .20). Infrapopliteal bypass (+0.4 ± 0.1 cases/year; R2 = 0.48; P = .006), iliac/femoral endarterectomy (+1.3 ± 0.2 cases/year; R2 = 0.82; P < .001), and leg thromboembolectomy (+0.4 ± 0.1 cases/year; R2 = 0.64; P < .001) all demonstrated annual growth. For endovascular peripheral cases, aortoiliac revascularization (+3.4 ± 0.3 cases/year; R2 = 0.94; P < .001), femoropopliteal revascularization (+5.4 ± 0.2 cases/year; R2 = 0.98; P < .001), and tibioperoneal revascularization (+2.0 ± 0.2 cases/year; R2 = 0.92; P < .001) all increased in volume. Lower extremity amputations, including above-knee amputation (+0.6 ± 0.2 cases/year; R2 = 0.65; P < .001) and below-knee amputation (+0.9 ± 0.2 cases/year; R2 = 0.72; P < .001) also demonstrated an increase in volume. ConclusionsCurrent graduating residents have higher open and endovascular case volumes for peripheral artery disease on a national level, despite the increasing popularity of endovascular techniques. Further studies are needed to identify how these trends may impact current vascular surgery milestones. These trends may also influence the rising interest in competency-based training programs.

ASSURE 모형 기반의 ASEAN 맞춤형 역량기반 보편적건강보장 연수프로그램 개발

Purpose: This study aims to design and propose a customized international training program for ASEAN countries based on competency-based education, following the six stages of the ASSURE model design. Originality: Korea is facing an opportune time to lead global health issues due to the increase in international recognition and demand for K-quarantine in response to the COVID-19 pandemic. Meanwhile, Southeast Asian countries are experiencing growing demand for COVID-19 response and improving the quality of life for their citizens. Although ASEAN countries have made progress in achieving universal health coverage by improving healthcare accessibility and expanding the scope of health insurance, there is a need for cooperation in strengthening healthcare systems and building healthcare human resources. Against this background, there is a need for a strategic health cooperation project to establish universal health coverage in ASEAN and to improve the specialized skills of local health and medical personnel through education programs. However, research on systematic models of international health education training programs using curriculum models is inadequate, and studies proposing ASEAN-customized international health education training program models are also insufficient. Methodology: Therefore, this study utilized content analysis to conduct a literature review of the current status of universal health coverage in ASEAN countries and surveyed the needs of participants in international training programs to develop an ASEAN-customized training program using the ASSURE model. Result: The study secured an education and training module based on bidirectional communication and designed an education process focused on the needs of the training participants. Finally, an ASEAN-customized competency-based education international training program was designed and proposed. Conclusion and Implication: The systematically developed education and training program can be utilized not only as an ASEAN-customized curriculum but also as basic data for developing a systematic model of international health education based on competency-centered education. It can also be applied as a guideline for developing educational curricula using curriculum models. Moreover, it can contribute to sustainable health cooperation between Korea and ASEAN countries.

Procedure-based assessment implementation in colorectal surgery: a scoping review.

Competency-based training (CBT) programs use procedure-based assessments (PBAs) to evaluate trainees' abilities to perform specific procedures in clinical settings, similar to Entrustable Professional Activities (EPAs). PBAs help determine trainees' readiness for advanced training levels. However, there is limited evidence on implementing colorectal-specific PBAs in surgical training schemes. This review aims to identify observed and perceived challenges to implementing PBAs in workplace settings. A scoping review following the Joanna Briggs Institute Protocol for Scoping Reviews (JBI-ScR) was conducted. Eligible studies provided evidence on the implementation, feasibility, and challenges of PBAs in colorectal surgery, including various study designs from retrospective to prospective. Of the 80 screened studies, 75 were excluded based on exclusion criteria. Most of the included studies were conducted in national training institutions in the United Kingdom, assessing 778 colorectal procedures with specific PBAs. The main facilitators of implementing PBAs were structured assessments, focused assessors' training, and electronic forms usage. This review offers insight into the practicality and feasibility of implementing PBAs in colorectal surgery. Identified challenges include the need for adequate assessor training and the time-consuming nature of the assessment. These findings could improve PBA implementation in colorectal surgery and enhance surgical education quality. However, the limited number of studies and existing literature heterogeneity call for more research to identify other gaps.

An Artificial Intelligence Training Workshop for Diagnostic Radiology Residents.

To develop, implement, and evaluate feedback for an artificial intelligence (AI) workshop for radiology residents that has been designed as a condensed introduction of AI fundamentals suitable for integration into an existing residency curriculum. A 3-week AI workshop was designed by radiology faculty, residents, and AI engineers. The workshop was integrated into curricular academic half-days of a competency-based medical education radiology training program. The workshop consisted of live didactic lectures, literature case studies, and programming examples for consolidation. Learning objectives and content were developed for foundational literacy rather than technical proficiency. Identical prospective surveys were conducted before and after the workshop to gauge the participants' confidence in understanding AI concepts on a five-point Likert scale. Results were analyzed with descriptive statistics and Wilcoxon rank sum tests to evaluate differences. Twelve residents participated in the workshop, with 11 completing the survey. An average score of 4.0 ± 0.7 (SD), indicating agreement, was observed when asking residents if the workshop improved AI knowledge. Confidence in understanding AI concepts increased following the workshop for 16 of 18 (89%) comprehension questions (P value range: .001 to .04 for questions with increased confidence). An introductory AI workshop was developed and delivered to radiology residents. The workshop provided a condensed introduction to foundational AI concepts, developed positive perception, and improved confidence in AI topics.Keywords: Medical Education, Machine Learning, Postgraduate Training, Competency-based Medical Education, Medical Informatics Supplemental material is available for this article. © RSNA, 2023.

The Brain Medicine Fellowship: A Competency-Based Training Program to Treat Complex Brain Disorders.

Complex brain disorders involve symptoms in the domains of affect, behavior, and cognition. It is increasingly recognized that there is a need for a novel type of physician who can treat individuals with these conditions in an interdisciplinary fashion to best address their complexity. Few training programs have focused on the education of such practitioners. The authors outline the development and practices of the Brain Medicine Fellowship, an innovative, competency-based fellowship program at the University of Toronto Temerty Faculty of Medicine that accepts trainees from multiple brain medicine-related specialty training programs to develop expertise in integrative assessment and treatment of complex brain disorders. The authors describe how brain medicine competencies were generated, the current assessment process, and the seminal clinical experience associated with the fellowship-the Brain Medicine Clinic-and explain how it exemplifies brain medicine in action. The first fellow was registered from July 2019 to December 2020. As of December 2022, 3 fellows have entered the program, with 3 more anticipated to begin in July 2023. More than 26 supervisors are associated with the fellowship, who offer a diversity of experiences for fellows to choose from in developing their individualized learning plans. The Brain Medicine Fellowship not only fosters the development of a novel type of clinician (a brain medicine specialist) but also is innovative in its educational design as one of the first nonsurgical fellowships to implement competency-based medical education and has resulted in original clinical programming in the form of the Brain Medicine Clinic, which benefits patients and their caregivers. The development of the Brain Medicine Fellowship continues with competency refinement and translation into entrustable professional activities and constituent milestones. A comprehensive program evaluation will be completed by 2025.

Residents as supervisors: How senior residents make ad hoc entrustment decisions.

As residency programmes transition to competency-based medical education, there has been substantial inquiry into understanding how ad hoc entrustment decisions are made by attending supervisors in the clinical context. However, although attendings are ultimately responsible for the decisions and actions of resident trainees, senior residents are often the ones directly supervising junior residents enrolled in competency-based training programmes. This clinical dynamic has been largely overlooked in the ad hoc entrustment literature. The purpose of this study was to explore the considerations senior residents entertain when making ad hoc entrustment decisions for their junior resident colleagues. In semi-structured interviews, 11 senior resident supervisors (third, fourth and fifth year) in obstetrics and gynaecology described how they entrust junior residents with clinical activities in the moment. Following constructivist grounded theory methodology, data were iteratively collected and coded with constant comparison until theoretical sufficiency was determined. Senior residents described many similar considerations as attendings regarding ad hoc entrustment of junior residents, including patient safety, desire to optimise the learning environment, junior resident qualities (such as discernment and communication skills), learner handover from colleagues, and situational factors. Uniquely, senior residents discussed how their role as a middle manager and their desire to protect the junior resident (from burnout, becoming a second victim and from attendings) impacts their decisions. Although senior residents make ad hoc entrustment decisions with some similar considerations to attendings, they also seem to think about additional factors. It may be that these different considerations need to be accommodated in documentation of ad hoc entrustment decisions if these documents are to be used for high-stakes summative entrustment decisions made by competency committees.

A mixed methods evaluation of a World Health Organization competency-based training package for foundational helping skills among pre-service and in-service health workers in Nepal, Peru and Uganda.

Health systems globally demand more competent workers but lack competency-based training programs to reach their goals. This study evaluates the effectiveness of a competency-based curriculum (EQUIP-FHS) for trainers and supervisors to teach foundational helping knowledge, attitudes and skills, guided by the WHO/UNICEF EQUIP platform, to improve the competency of in-service and pre-service workers from various health and other service sectors. A mixed-methods, uncontrolled before-and-after trial was conducted in Nepal, Peru, and Uganda from 2020 to 2021. Trainees' (N = 150) competency data were collected during 13 FHS trainings. Paired t-tests assessed pre- to post-change in ENACT competency measures (e.g., harmful, helpful). Qualitative data was analyzed using thematic analysis. EQUIP-FHS trainings, on average, were 20 h in duration. Harmful behaviors significantly decreased, and helpful behaviors significantly increased, across and within sites from pre-to post-training. Qualitatively, trainees and trainers promoted the training and highlighted difficult competencies and areas for scaling the training. A brief competency-based curriculum on foundational helping delivered through pre-service or in-service training can reduce the risk that healthcare workers and other service providers display harmful behaviors. We recommend governmental and nongovernmental organizations implement competency-based approaches to enhance the quality of their existing workforce programming and be one step closer to achieving the goal of quality healthcare around the globe.