Competency Statements Research Articles

Genetics-genomics competencies and nursing regulation.

The aim of this article is to explore the interaction between the integration of genetics-genomics competencies into nursing curricula and regulatory standards. By taking a global perspective of activity in this field, we aim to develop a framework that can inform strategic planning in relation to international genetics-genomics and nursing education. We focus our exploration around a small-scale international survey on the progress, achievements, and critical success factors of 10 countries in relation to the integration of genetics-genomics into nursing education, with exemplars from three of those countries. Analysis of the data generated 10 themes, each with several subthemes that play a critical role in the development of genetics-genomics in nursing education and practice. The themes were organized into three overarching themes: nursing in genetics, genetics in nursing, and recognition and support. Genetics-genomics competence is not fully integrated into nursing education at an appropriate level in any country, nor was it reflected robustly in current standards for registration and licensure. Strong leadership from the specialist genetics community plays a critical role in defining genetics-genomics competence but the engagement of nursing professionals at senior levels in both government and regulatory institutions is essential if nurses are to be active participants in the innovations offered by genomic healthcare. Safe and effective nursing practice must incorporate the needs of those with, at risk for, or susceptible to genetic-genomic conditions, as well as those who might benefit from the application of genomic technologies in the diagnosis and management of common conditions such as cancer and heart disease. The scope of such practice can be articulated though competence statements. Professional regulation defines the standard of competence that practicing nurses should demonstrate at initial registration and licensure.

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

Developing Clinical Competencies to Assess Learning Needs and Outcomes: The Experience of the CS2day Initiative

An outcomes-based education (OBE) approach was desired for the CS2day initiative, and the size and scope of the initiative compelled a consistent and cohesive framework in order to apply such an approach. A series of competency statements were developed to provide that framework. The competency statements were based on current clinical guidelines, and further refined through stakeholder interviews and expert feedback. These competency statements were utilized throughout the CS2day initiative as the foundation for needs assessments, activity planning and development, and outcomes measurement. The CS2day partners found these competencies useful in developing over 150 educational activities in the initiative. The competencies became the firm linkages between the needs and outcomes measures used for all CS2day activities, and enabled a summative evaluation to be developed for the entire initiative. This article describes the rationale for developing the competencies, the methods used to deploy them, and the tools that incorporated these competencies.

Psychosomatic Medicine and Consultation-Liaison Psychiatry: Scope of Practice, Processes, and Competencies for Psychiatrists or Psychosomatic Medicine Specialists: A Consensus Statement of the European Association of Consultation-Liaison Psychiatry and the Academy of Psychosomatic Medicine

In 2008, the Board of the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) [corrected] and the Academy of Psychosomatic Medicine (APM) Council commissioned the creation of a task force to study consensus-based summaries of core roles, scope of clinical practice, and basic competencies for psychiatrists working in the field of Psychosomatic Medicine (PM) and/or Consultation-Liaison Psychiatry (CLP).The task force used existing statements of competencies and feedback from EACLPP and APM symposia and workshops to develop a draft document. After review by the EACLPP and APM committees, and the EACLPP Board and APM Council, a period of comment from the field preceded a final draft resubmitted for consideration of the EACLPP Board and APM Council in February 2010.The two organizations completed approval of final publication of the consensus statement on June 11, 2010. This consensus statement is a summary of clinical competencies, scope of clinical effort, and roles considered by the sponsoring organizations to be fundamental to the practice of this subspecialty or special area of expertise, anywhere, of PM or CLP.This consensus statement delineates a set of basic competencies and roles of a PM/CLP psychiatrist to serve as an internationally recognized base that may be used by national societies and institutions to formulate their own competencies, scope of practice, and roles or help with guideline formulation.

A Delphi Approach to Developing a Core Competency Framework for Family Practice Registered Nurses in Ontario

This paper describes the results of a Delphi panel process to gain consensus on a role description and competency framework for family practice registered nurses (FP-RNs) in Ontario. Based on the findings from interviews and focus groups with family practice registered nurses and their inter-professional colleagues throughout Ontario, a core competency framework for FP-RNs emerged consisting of six distinct roles - Professional, Expert, Communicator, Synergist, Health Educator and Lifelong Learner - with accompanying enabling competency statements. This framework was refined and validated by a panel of experts from various nursing and family medicine associations and organizations through a Delphi consensus process. This core competency framework for FP-RNs was developed as a stepping stone for clarifying this very important and poorly understood role in family practice. As a result of this research, we expect a greater acknowledgement of the contributions and expertise of the FP-RN as well as the need to celebrate and profile this role. This work has already led to the establishment of a network of stakeholders from nursing organizations in Ontario who are considering opportunities to move the development and use of the competency framework forward.

Reframing the Australian nurse teacher competencies: Do they reflect the ‘REAL’ world of nurse teacher practice?

The Australian nurse teacher competencies were introduced in 1996; however, the researchers perceived that changes to the health care system and a nursing workforce shortage may have affected nurse teacher roles over the past decade. This study aimed to explore perceptions of nurse teachers on the applicability of the current Australian nurse teacher competencies to practice, and modify the nurse teacher competencies to better reflect current practice. Methodology utilized mixed methods, and data collection was via focus groups, telephone interviews, and survey data. Results revealed that participants were mostly positive about the original competency statements, although there were some variations between items. Themes that emerged from the qualitative data were: changing trends in health care; preparation for teaching; understanding of the competencies, contextual influences on education role; nurse teachers as change agents, and resource management. Conclusions were that the Australian nurse teacher competencies (1996) were reflective of the current generic roles of nurse teachers however some of the competencies needed reframing to meet the current needs of nurse teachers. However, changes needed to be made in areas such as reducing complex language, inclusion of technology, and cultural competencies. Nurse teachers were supportive of the research because they valued the teacher competencies for reflection on their practice and the development of portfolios, job descriptions and performance appraisals.

129 Tecnical, Interpersonal and Critical Thinking Competency Assessment: A Systemic Approach

Competence is more than possessing the knowledge or psychomotor skills necessary to perform a specific task. For nurses, competence means the caregiver integrates knowledge, skills and personal attributes consistently in daily practice to meet established standards of performance. Goal: Presents our current Institution standards to assess nursing competencies needed to measure critical thinking and clinical decision-making abilities and necessary as a result of findings from quality-improvement data. To assess nursing competency a methodological plan had to be established. Competencies have two major components: first is a competency statement describing the general performance standard; second is a list of criteria describing the tasks required to ensure that the general performance standard is met. Before beginning four important aspects had to be considered: outcome, category, learning domain and audience. Expected outcomes were clearly defined based on pre-established goals with the aim of assessing acquisition of a new skill or of validating existing knowledge and skills. Competencies were selected for evaluating the skills and knowledge needed to execute complexes nursing interventions and intermediate or advanced in order to evaluate need for complex interventions. Identifying a particular learning domain to address competencies. Novice nurses needed a high percentage of psychomotor competencies, whereas competent nurses needed validation of higher level competencies. Competency assessment has been proved as a valid tool for building long-term continuous improvement of high quality nursing care.

Car Keys, House Keys, Easter Eggs, and Curricula

The hidden curriculum has become a topic of high concern within our colleges of pharmacy. Despite our efforts to map the curriculum to competency statements and our painstaking development of lectures and syllabi, students probably learn more about becoming a pharmacist from the unplanned, hidden curriculum than from our carefully designed formal presentations. It has been said that “The hidden curriculum is not simply found, one must go looking for it.”1 My efforts to go “looking for it,” lead me to conclude that our hidden curriculum is found in ways similar to how we find everyday things. Portions of the hidden curriculum might be compared to a misplaced set of car keys. Undoubtedly we have all spent time searching for car keys. In our hurry through our daily routine, we unconsciously drop our keys in unlikely places. In our curricula the “car keys” are passing conversations and nonverbal cues. Often our interactions with each other and our nonverbal communication are inconsistent with our more formal messages. Students receive didactic lectures espousing the importance of interprofessional teamwork. When they hear pharmacists belittle the efforts of other team members, they are unlikely to retain the right “take away” message. White coat ceremonies focused on the importance of core values, including respect for others and empathy, are unlikely to have the lasting impact we desire, if followed by an introductory pharmacy practice experience (IPPE) during which students hear health care professionals make derogatory remarks about a patient. Role modeling plays a critical part in developing future practitioners. Students learn by example. They not only learn specific skills, but also “cultural norms.” Faculty members who support each other, show empathy for patients, and create an inviting learning environment are likely to foster the development of future colleagues who are supportive, empathetic, and lifelong learners. On a different note, the hidden curriculum might be compared to house keys hidden under the doormat. The house keys are purposefully hidden, but their location may be more obvious than intended. The house keys in our curriculum are the powerful messages sent by our institutional policies and the allocation of our resources. Policies that allow students to attend professional meetings and funds that support their travel send messages that the institution values their participation in professional organizations. Promotion and tenure guidelines that reward excellence in teaching imply that the organization values teaching. Flexible work schedules for faculty and staff members may send the message that the organization is family friendly. These “keys” may not be in plain view, but their effect is evident. Finally, the hidden curriculum might be compared to an Easter egg hunt. Some messages we send in our curricula are expertly hidden, disguised in ways that one might never find without continually hunting. These are messages about our own shortcomings that we hide from our students, hoping that they will not be discovered. Perhaps we do not want students to realize that we do not have all the answers or that we make mistakes. We may worry that our students will recognize that transformation from resident or postdoctoral fellow one day to faculty member the next does not make us expert teachers overnight. We may avoid discussions that make us uncomfortable. After all, how do we teach a student how to deal with the death of a patient for whom he/she cared? How do we explain that the profession can evolve in the setting of health care reform legislation that we do not completely understand? Indeed, these Easter eggs in our curricula may pose the greatest challenges. It would be a productive exercise for faculty members within all of our colleges to examine their own personal curricula for hidden messages. Are we effective role models? What messages do our institutional policies convey? Does our allocation of resources reflect our values? And finally, what messages lurk in our silences?

ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

Capturing the Essence of Developing Endovascular Expertise for the Construction of a Global Assessment Instrument

Objectives To explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument. Design Literature review and an experimental study. Materials and methods The literature was searched for information regarding available global rating scales (GRSs); scientific societies’ official statements on endovascular competence; and task analyses of endovascular procedures. In the experimental study, clinicians performed a video-recorded simulated iliac-artery stenting procedure. Subsequently, by using the method of retrospective verbalisation, the clinicians were interviewed while watching their performance on video commenting on key issues of the construct. Data from all sources were analysed, categorised and synthesised into a novel rating scale. Results Available GRSs primarily included technical aspects of performance, whereas the competence statements, task analyses and clinicians’ perceptions added a range of non-technical aspects. The novel rating scale SAVE (Structured Assessment of endoVascular Expertise) differs from prior scales by including issues of pre-planning; prediction of challenges; preparation of tools; management of imaging presentation; distinction of technical skills into external and internal control according to operator focus of visual attention; adaptation of strategy; clinical decision making; use of assistant; complications; inter-personal skills; and post-procedural planning. Conclusions The essence of developing endovascular expertise goes far beyond mere technical aspects.

Web-based Portfolios for Pharmaceutical Care Plans During Advanced Pharmacy Practice Experiences

To implement and assess a Web-based patient care portfolio system for development of pharmaceutical care plans by students completing advanced pharmacy practice experiences (APPEs) throughout a statewide preceptor network. Using a Web database, students in APPEs documented 6 patient cases within 5 disease state categories. Through discussion of the disease states and inclusion of patient information such as problems, desired outcomes, and interventions, a complete pharmaceutical care plan was developed for each patient. Student interventions were compared by geographical regions to assess continuity of patient care activities by students. Additionally, students completed an evaluation of the portfolio course to provide feedback on the portfolio process. Students documented an average of 1.8 therapeutic interventions per patient case and documented interventions in all geographical regions. The majority of students indicated that the portfolio process improved their ability to develop a pharmaceutical care plan. The Web-based patient care portfolio process assisted with documentation of compliance with Accreditation Council of Pharmacy Education (ACPE) standards and College of Pharmacy Competency Statements. Students indicated the portfolio process was beneficial in developing skills needed for creating pharmaceutical care plans.

Leadership Message

Leadership Message

Core Competencies in Natural Health Products for Canadian Pharmacy Students

To reach consensus on core competency statements for natural health products (NHPs) for Canadian pharmacy students. Four rounds of a modified Delphi method were used to achieve consensus on core competency statements for NHPs. Pharmacy educators from Canada and the United States, and representatives from Canadian pharmacy organizations ranked their agreement using a 5-point Likert scale. Consensus was achieved on 3 NHP-related core competency statements: (1) to incorporate NHP knowledge when providing pharmaceutical care; (2) to access and critically appraise NHP-related information sources; and (3) to provide appropriate education to patients and other health care providers on the effectiveness, potential adverse effects, and drug interactions of NHPs. Consensus was reached among leaders in NHP education on 3 NHP-related core competency statements. Implementation of these competencies would ensure that graduating Canadian pharmacists would be able to fulfill their professional responsibilities related to NHPs.

A Competency‐Based Framework for Training in Advanced Dental Education: Experience in a Community‐Based Dental Partnership Program

While goals and objectives are useful to assess programmatic outcomes, they are not able to evaluate individual trainees' performance and/or corrective actions needed to improve performance. As a result, competency-based evaluation is increasingly being used to assess trainee performance at both the doctoral and postdoctoral levels. However, the translation of broadly stated competency statements into evaluable action statements continues to pose a challenge, especially in nontechnical domains such as the assessment and integration of cultural and sociodemographic variables in the development and execution of treatment plans. This article describes a process used to develop a competency-based framework that includes specific evaluable action statements to assess the performance of Advanced Education in General Dentistry (AEGD) residents providing dental care services to medically compromised patients in a community-based partnership program. Although the resultant framework may not itself be generalizable across training programs, the process described to develop the framework can be used by those individuals involved in evaluating students and/or residents in training programs.

Competencies for Interprofessional Collaboration

Background and Purpose. Interprofessional collaboration in health care is now considered a high priority, as concerns about patient safety, health and human resources shortages, and effective and efficient care have reached epic proportions. Although there are many models for interprofessional education for collaborative, patient-centered care, there is little in the literature to describe competencies for an interprofessional collaborative practitioner. This article will describe an emerging Canadian competency framework for interprofessional collaboration that (1) considers previous descriptions of collaborative practice and (2) uses existing literature to support a model for describing competencies for collaborative practice. Model Description and Evaluation. In this emerging competency framework, 6 competency domains are described using a competency statement and a set of associated descriptors. The collaborative leadership, dealing with interprofessional conflict, team functioning, and role clarification domains intersect with all of the others, yet are distinct and require focused descriptions. While patient-centered care and communication also are domains unto themselves, these competencies are integral elements of the other domains and are integrated throughout the framework. In the background supporting all of the domains are 3 key themes: context of practice, level of complexity, and quality improvement. The emerging framework was reviewed by a wide group of stakeholders, including an external review. Future use of the framework will assist in further shaping it to meet the needs of educators, researchers, practitioners, regulators, and accreditors. Discussion and Conclusion. The competency framework has been designed as a practical tool for a number of stakeholder groups. In particular, physical therapy educators can use it as a basis for interprofessional education programs and activities that prepare collaborative practitioners for the future. The framework is flexible and can be used in simple or complex situations, in a variety of practice settings, as a guide for learning outcomes and evaluation or assessment of performance, and as a tool for developing entry-level curricula and continuing professional development. The strength of the framework will emerge as it evolves over time.

Automated Versus Visual Segmental Scoring

Echocardiography is the most widely used noninvasive test for assessing the structure and function of the heart, accounting for 14% of overall Medicare expenditures for imaging in 2007.1 Despite the availability of a variety of validated quantitative methods for assessing chamber size and cardiac function, many elements of echocardiographic interpretation remain qualitative rather than quantitative. This is particularly true of the assessment of regional wall motion. Notwithstanding progress in the field of myocardial perfusion echocardiography2 and earlier efforts to quantitate regional function with acoustic quantitation3 and Doppler tissue imaging-based methods,4 echocardiographic assessment of regional wall motion remains the principal method by which echocardiographers make the diagnosis of coronary disease. Moreover, the ability to visually identify stress-induced regional wall motion abnormalities is the foundation for stress echocardiography. Article see p 47 The ability to reproducibly and reliably detect regional wall motion abnormalities is an essential skill for any physician interpreting echocardiograms and conceded to be one of the most difficult skills to acquire.5 Consequently, an automated quantitative approach to assessing regional function would be invaluable as a tool for the interpretation of echocardiograms for teaching and research and could prove useful in training echocardiographers. The study of Liel Cohen6 in this issue of Circulation: Cardiovascular Imaging proposes just such a tool. In their article, the authors report their evaluation of a semiautomated method of measuring regional longitudinal strain to develop segmental scores, classifying segments as normal, hypokinetic, or akinetic/dyskinetic/aneurysmal. As the authors note, strain analysis based on speckle tracking as opposed to angle-dependent Doppler tissue imaging methods is appealing because it avoids translation artifact and angle dependence. Twelve expert echocardiographers of the Israeli Echocardiography Research Group at 9 major Israeli cardiology centers used this approach as well as qualitative visual segmental scoring in 15 patients …

Core Technology Competencies for Librarians and Library Staff: A LITA Guide

Core Technology Competencies for Librarians and Library Staff: A LITA Guide

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

A Quantitative Assessment of the Research Chefs Association Core Competencies for the Practicing Culinologist

ABSTRACT: Professional organizations have linked core competency to professional success and competitive strategy. The Research Chefs Assn. (RCA) recently released 43 core competencies for practicing culinologists. Culinology® is a profession that links skills of culinary arts and food science and technology in the development of food products. An online survey was created asking RCA members from all 6 membership categories (Associate, Affiliate, Chef, Culinology, Food Science and Technology (FS&T), and Student) to rate their knowledge level based on a 7‐point scale and agreement to importance in job performance based on a 5‐point Likert scale for each competency statement. RCA participant's (N = 192) survey results were analyzed using SPSS for Windows version 13.0 at a significance level of P < 0.05. Statistical survey validation grouped all 43 competency statements into 8 factors (groupings) according to level of competency proficiency (opposed to the 7 groups each competency was originally designated by the RC A) and into 9 factors according to job success. Results suggest that Chef Members know “Culinary Arts” best and FS&T members know “Food Science” best. A gap analysis determined what competency factors were low in knowledge level yet important to job success for each membership category. Chef members have a lower level of knowledge in “Product Development,”“Food Science,” and “Quality Assurance” factors; however, the factors are important to job success. FS&T members have a lower level of knowledge in “Nutrition” yet identified the factor important to job success. An opportunity exists to improve educational efforts for specific membership categories.

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease

The mission of many organizations is the optimal care to those with or at risk for developing CVD (primary and secondary prevention). Over the past two decades, there have been dramatic increases in knowledge concerning specific risk factors in atherosclerosis, hypertension, thrombosis, and other forms of vascular dysfunction. Clinical trials have proven that strategies aimed at the appropriate detection and modification of risk factors can slow progression of atherosclerosis, diabetes mellitus, and hypertension and reduce the occurrence of clinical cardiovascular events in both primary and secondary prevention settings. More recently, it has been shown that atherosclerosis can be stabilized or even modestly reversed. Finally, a new and growing knowledge base of molecular genetics applied to the study of the cardiovascular system has potential relevance to the clinical practice of preventive cardiovascular medicine. Despite the fact that clinical outcomes can be improved by promotion of favorable life habits and behaviors and by the proper use of drug treatment, the application of primary and secondary preventive interventions in clinical practice is not optimal. Prevention of CVD in both the primary and secondary prevention setting, while dominantly the responsibility of the primary care provider, is increasingly challenged given this ever expanding new knowledge as well as the ongoing problems related to adherence to recommendations. New knowledge in the area of pre-clinical disease detection has presented increasingly challenging scenarios to primary care healthcare providers relative to the decisions regarding the need for further risk stratification and aggressive medical regimens. Furthermore, increasingly complex patients are surviving with CVD, many of whom can benefit from advanced knowledge and expertise with regard to risk factor management and rehabilitation that is beyond traditional general primary and cardiology practitioner's scope of practice. The prevention of cardiovascular morbidity and mortality is a shared responsibility among all health professionals involved in the care of people at risk of developing cardiovascular disease. This document is directed at those individuals seeking expertise at a leadership level in this field, and includes opportunities for formal training and alternative routes to competence and maintenance of competence in prevention of cardiovascular disease (Table 2), and educational resources for acquisition and maintenance of competence in the prevention of cardiovascular disease (Table 3). To address the expanding fund of knowledge in the area and to ensure that an adequately trained force of preventive cardiovascular leaders will be available to primary care providers, as well as provide a pool of providers with expertise in running rehabilitation and other programs designed to address the ongoing issue of adherence, the formulation of clinical competency criteria for the cardiovascular preventive specialist is needed. These competency criteria are expected to address issues of expert clinical and scientific leadership, specialty patient care and consultation, and directorship of primary and secondary preventive cardiac programs. Of note and similar to other subspecialty areas of medicine, cardiovascular preventive specialists will have varying areas of expertise and will not necessarily achieve all the outlined areas of competencies. These clinical competency criteria in the area of specialty treatment and prevention of CVD are needed given the current setting of a rapidly growing field of knowledge ranging from molecular and cellular mechanisms to clinical outcomes in order to translate into improved patient care. Table 2 Opportunities for Formal Training and Alternative Routes to Competence and Maintenance of Competence in Prevention of Cardiovascular Disease Table 3 Educational Resources for Acquisition and Maintenance of Competence in the Prevention of Cardiovascular Disease C. Noel Bairey Merz, MD, FACC, FAHA Chair, ACCF/AHA/ACP Clinical Competence Statement on Prevention of CVD