Competency Statements Research Articles

Applications of Trauma Informed Approaches in Vocational Education and Training

This paper utilises a qualitative literature review to highlight the shift to learner-centred methodologies in vocational education and training and profile the applications of trauma informed approaches to address learner needs and increase learner inclusion and chances of success. The discussion begins by identifying the need for trauma informed approaches in delivery related to technical and further education and workplace settings. The characteristics of trauma informed training environments are then considered such that the professional development needs of trainers can be established. The paper presents a model competency statement that can be used to develop training programs for trainers working in vocational education and training. The model competency statement, entitled “Utilise trauma informed training practices”, can be used as a basis for development of accredited programs, nationally recognised units of competence, professional development programs or any other program related to implementation of trauma informed approaches in an adult training setting.

Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition

BackgroundEliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.MethodsA literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa – Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.ResultsHealth practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming ‘competent’ in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.ConclusionsA move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.

Inter-sectoral work practice in Zimbabwe: Professional competencies required by occupational therapists to facilitate work participation of persons with disabilities

Background Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor’s degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe. Aims To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities. Material and Methods This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner’s Council of Zimbabwe gave ethical clearance and permissions to conduct the study. Results Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services. Conclusions Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.

A core competency framework for prostate cancer peer navigation.

Trained peer navigators can offer valuable peer support and mentorship to cancer patients and caregivers due to their highly relevant and unique perspective about the disease experience. In order to define the role of prostate cancer (PC) peer navigators within the cancer care system, it is important to establish the essential competencies of a PC peer navigator. We systematically identified and verified a set of core competencies for PC peer navigators and present a competency framework for PC peer navigators. In phase 1, we conducted formative research consisting of a literature review and environmental scan as well as a secondary analysis of qualitative interviews. In phase 2, we drafted and mapped competencies. Finally in phase 3, expert stakeholders completed an anonymous survey to indicate whether they endorsed the competencies and to rank the importance of each competency to the peer navigator role. Open-ended feedback was also provided for each competency. Six core competency domains emerged: (1) self as navigator, (2) communication, (3) knowledge/information, (4) facilitate patient-centred care, (5) eHealth/technology, and (6) caregiver needs. Forty-seven core competency statements were mapped to these domains. Expert stakeholders (n = 27) included cancer survivors, caregivers, and healthcare providers. Most (89%) of core competency statements were endorsed by stakeholders and received high priority ratings, whereas only five of the competencies were less uniformly endorsed. This is the first attempt to list core competencies for PC peer navigators and may offer guidance for standardizing the PC peer navigator role and training.

2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography): A Report of the ACC Competency Management Committee.

James A. Arrighi, MD, FACC, Chair Lisa A. Mendes, MD, FACC, Co-Chair Jesse E. Adams III, MD, FACC John E. Brush Jr, MD, FACC[#][1] G. William Dec Jr, MD, FACC Ali Denktas, MD, FACC Susan Fernandes, LPD, PA-C Rosario Freeman, MD, MS, FACC[#][1] Rebecca T. Hahn, MD, FACC Jonathan L.

Emergency medical services core competencies: a Delphi study

IntroductionThe emergency medical services (EMS) education in Saudi Arabia has evolved considerably during the past decade and this rapid improvement has seen a disparity of educational approaches. Therefore, a core competency framework which aligns with the requirements of Saudi EMS education should be identified and accommodated. The aim of this study was to obtain professional group consensus on the desirable core competencies for EMS Bachelor degree graduates in Saudi Arabia in order to develop a core competency framework for Saudi Arabian EMS.MethodsA two-round Delphi method using a quantitative survey with a purposeful sampling technique of expert information-rich participants was used. The instrument comprised 40 core competency statements (rated on a 1-10 Likert scale, with 1 being ‘not important at all’ and 10 being ‘extremely important’) and an open-ended question. An international systematic scoping review and local national review informed the items in this study.ResultsAt the end of the second round, the response rate was 70%, and the sample demonstrated diversity in terms of qualifications, expertise and discipline. All core competencies achieved a majority and stability in the first and second rounds. Core competency items achieved the 75% consensus requirement.ConclusionThis study provided consensus on 41 core competencies specific to Saudi EMS industry requirements. However, the findings do not represent a definitive blueprint model for alignment into EMS curricula. Further research and statistical modelling for the core competencies are highly recommended.

2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee

James A. Arrighi, MD, FACC, Chair Lisa A. Mendes, MD, FACC, Co-Chair Jesse E. Adams III, MD, FACC John E. Brush Jr, MD, FACC[#][1] G. William Dec Jr, MD, FACC Ali Denktas, MD, FACC Susan Fernandes, LPD, PA-C Rosario Freeman, MD, MS, FACC[#][1] Rebecca T. Hahn, MD, FACC Jonathan L.

Adapting and validating informatics competencies for senior nurse leaders in the Canadian context: Results of a Delphi study

BackgroundNurse leaders in senior leadership positions in various parts of the world can play an important role in the acquisition, implementation and use of health information technologies. To date, international research related to nurse leader informatics competencies has been carried out in specific healthcare delivery contexts with very specific health information technology environments. In this body of literature, the definition of a ‘nurse leader’ has not been clearly defined. As a result, it is challenging for senior nurse leaders in leadership and management positions in other countries to apply this research to their unique contexts. PurposeThe objective of this study was to obtain consensus on the informatics competencies of priority to senior Canadian nurse leaders. The goal of completing this work was to adapt and validate a set of nurse leader informatics competencies to be endorsed and supported nationally. MethodsThis study used a modified Delphi technique with a panel of nurse leaders with significant informatics knowledge from across Canada. Three rounds of information gathering were completed electronically. In Round 1, participants were provided a series of 26 potential competency statements obtained from a review of the literature; they were asked to comment on the clarity and wording of each statement. Two statements were eliminated after Round 1 due to redundancy. In Rounds 2 and 3, participants rated the remaining competency statements on a 7-point Likert scale for relative priority to nurse leaders. ResultsA total of 25, 24 and 23 participants completed the survey in Rounds 1, 2 and 3 respectively. Consensus was achieved at the end of Round 3 with the inclusion of 24 competency statements. All of the statements had a mean of 5 or greater on a 7-point Likert scale (1=low priority and 7=high priority). ConclusionsThe study participants agreed upon 24 informatics competency statements of priority to Canadian nurse leaders. These competencies will be presented to senior national nursing leaders and nursing informatics organizations for endorsement. Inspired by work completed in the United States, the authors plan to develop a self-assessment instrument for use by Canadian nurse leaders using the identified competency statements. Future anticipated work includes identifying and creating resources for nurse leaders to develop these important informatics competencies.

Quality culinary workforce competencies for sustainable career development among culinary professionals

Competencies are vital factors that provide an incredible impact on individuals' career sustainability. However, the lack of guidelines has made it difficult to define and measure these competencies. This study attempted to identify important competencies that are deemed essential for culinary professionals in the hospitality industry. The qualitative research design composed of document analysis and interviews with culinary experts in Malaysia. The qualitative data were used to form the framework of the Star-Chef Competency Model, which consists of six identified competency constructs. The compilation of the identified competency statements was fully utilised in the development of the competency model and is believed to be a very helpful guidance for culinary professionals in Malaysian hospitality industry. Findings provide culinary educators and trainers with useful insights on important competencies that need to be emphasized in the training and education of professional chefs.

Patient-Specific, Risk-Based Prevention, Maintenance, and Supportive Care: A Need for Action and Innovation in Education.

To develop a competency-based curriculum framework for prevention, supportive care, and maintenance for use in educational and patient care programs and to seek consensus on an overarching competency statement that embraces these critical learning and patient care concepts. A preliminary survey of current preventive and maintenance practices in U.S. dental and prosthodontic programs was completed and summarized with quantitative analysis. The American College of Prosthodontists organized a one-day consensus workshop with 14 participants from various U.S. dental schools with diverse backgrounds to develop a curriculum framework. The curriculum framework was used in the development of a joint competency statement using an iterative, online consensus process of debate and feedback. The preliminary survey helped frame the initiative and identify potential educational needs and gaps. Consensus was achieved for a recommended competency statement: "Graduates must be competent in promoting oral health through risk assessment, diagnosis, prevention, and management of the hard tissue, soft tissue, and prostheses, and as part of professional recall and home maintenance."This competency statement complements the proposed curriculum framework designed around 3 domains-caries prevention, periodontal supportive care, and prosthesis supportive care-with a set of recommended learning objectives. Commission on Dental Accreditation (CODA) learning standards do not outline patient-customized, evidence-based recall and home maintenance programs that highlight prevention of dental caries, periodontal supportive care, prosthesis maintenance, and patient education.The proposed competency-based curricular framework serves as an initial step in addressing student learning and patient care within the context of a recall system and home maintenance program while offering schools the needed flexibility for implementation within their curriculum.

Association of Canadian Faculties of Dentistry Educational Framework for the Development of Competency in Dental Programs.

The Association of Canadian Faculties of Dentistry (ACFD) recently developed a proposal that reflects its evolving understanding of competency-based dental education. The ACFD proposal was developed into an Educational Framework for the Development of Competency in Dental Programs and has been adopted by all ten Canadian dental schools as the basis for their ongoing curriculum development and assessment. This framework identifies five global competencies that provide a big picture of the complex skills, knowledge, and behaviors that dental graduates must demonstrate. Detail for clarification and illustration is provided by more comprehensive "components" of each area that elaborate on the global statement and by a new dimension that assists with assessment: "indicators" of the specific knowledge, skills, and behaviors that can be measured as steps towards developing competence. In the information supporting understanding and assessment of the five key areas are both the existing national competency statements to facilitate the use of the framework by other stakeholders and a parallel set of knowledge, skills, and abilities statements developed by the National Dental Examining Board of Canada (NDEB) as the starting point for updating its examination blueprints. This article outlines the development, structure, and contents of the ACFD Educational Framework in the hope that it can serve as the foundation for a new Canadian national competencies document serving all national stakeholders.

Development of nutrition science competencies for undergraduate degrees in Australia.

The need for updated competencies for nutrition scientists in Australia was identified. The aim of this paper is to describe the process of revising of these competencies for undergraduate nutrition science degrees in Australia. An iterative multiple methods approach comprising three stages was undertaken: 1. Scoping study of existing competencies; 2. Exploratory survey; and, 3. Modified Delphi process (2 rounds) involving 128 nutrition experts from industry, community, government and academia. A ≥70% consensus rule was applied to Rounds 1 and 2 of the Delphi process in order to arrive at a final list of competencies. Stage 1: Scoping study resulted in an initial list of 71 competency statements, categorised under six core areas. Stage 2: Exploratory survey-completed by 74 Nutrition Society of Australia (NSA) members; 76% agreed there was a need to update the current competencies. Standards were refined to six core areas and 36 statements. Stage 3: Modified Delphi process-revised competencies comprise five core competency areas, underpinned by fundamental knowledge, skills, attitudes and values: Nutrition Science; Food and the Food System; Nutrition Governance, Sociocultural and Behavioural Factors; Nutrition Research and Critical Analysis; and Communication and Professional Conduct; and three specialist competency areas: Food Science; Public Health Nutrition; and Animal Nutrition. The revised competencies provide an updated framework of nutrition science knowledge for graduates to effectively practice in Australia. They may be used to benchmark current and future nutrition science degrees and lead to improved employability skills of nutrition science graduates.

IPEC’s core competency 2 roles and responsibilities: What more do we need to implement these?

The Interprofessional Education Collaborative (IPEC) has published guidelines to promote interprofessional collaboration. These guidelines are encompassed in four core competency sets. The core competencies are: Core 1: Value/Ethics, Core 2: Roles and Responsibilities, Core 3: Interprofessional Communication and Core 4: Teams and Teamwork. IPEC has outlined sub-competencies for each, which can be interpreted as a compilation of principles, behaviors, precepts and competencies. Together they serve to promote direction for interprofessional collaboration amongst health care professionals. However, the compilation may need more explanation to guide education and practice. Though the sub-competencies described in each core overlap in their application, specifically, Core 2: Roles and Responsibilities is explored for its underpinnings. The literature to date reflects educational delivery modes, but specific content is sparse, and not in the totality of the representative sub-competencies. Much of the literature omits the background that creates the context, and the content for, our deeper understanding of the principles. Therefore, important information is missing that underpins the competency statement set to teach and to learn these sub-competencies. The aim was to identify principles and applicable content to both support learning and to address barriers to learning, which may be essential to implement the sub-competency statements. The sub-competencies independent of further elucidation are unlikely to yield the comprehension needed for implementation and discernible actions that prompt interprofessional collaborative success.

Expanding Pharmacist and Student Pharmacist Access to Genetics/Genomics/Pharmacogenomics Competency Education.

Background:As pharmacogenomics (PGx), a component of genetics/genomics and precision medicine, gains traction in the clinical setting, education of health care providers and health professions students must be made broadly available to improve accessibility of such services to patients. As medication experts with education in pharmacology, pharmacokinetics, and pharmacodynamics, pharmacists must further their education to include pharmacogenomics. Currently, few opportunities exist to gain this type of education, and therefore, these services are not yet broadly available to the public.Objective:The specific goal of this study was to evaluate pharmacists’ and student pharmacists’ self-assessed perception of competence related to genetics, genomics, and pharmacogenomics as presented via an online “pharmacogenomics certification program” (PGx program).Design:The PGx program was delivered online with the content consisting of 3 background lessons and 8 specific drug-gene lessons presented in the context of pharmacist competency statements. In addition, 11 “video modules” with competency-related PGx content were included to provide a comprehensive program. A pre- and post-course survey instrument was used to evaluate the participants’ self-assessed perception of competence related to each of 16 statements.Results:One hundred thirty-seven (137) individuals enrolled in and completed the pharmacogenomics certification program. Overall, participants reported self-perceived improved competency as evidenced by the pre-course survey as compared with the post-course survey for each of the 16 competency statements related to genetics/genomics, including pharmacogenomics. Similar results were observed for the subgroups of student pharmacists (n = 63) and pharmacists (n = 74).Future direction:This study showed that dissemination of genetics/genomics/pharmacogenomics competency statements education can be accomplished via online delivery. This delivery approach can expand genetics/genomics/pharmacogenomics content dissemination. The intent is to reach a broader population of pharmacy students, pharmacists, and other health care providers and health professions students to potentially advance the availability of such services, which can improve the safety and efficacy of medication use for patients.

End-tidal carbon dioxide on emergency department arrival predicts trauma patient need for transfusion, vasopressors, and operative hemorrhage control in the first 24 hours

Introduction: Predicting early need for trauma resuscitation is an important goal of trauma systems. Aim/Hypothesis: We sought to compare the predictive value of end-tidal carbon dioxide (EtCO2) compared to hemoglobin, shock index, systolic blood pressure, heart rate, and respiratory rate in determining transfusion requirement, need for operative hemorrhage control, or pressor use in the first 24 h after trauma alert activation. Materials and Methods: A convenience sample of trauma patients at a Level 1 community trauma center were enrolled. EtCO2 was measured via nasal cannula upon arrival, in addition to initial hemoglobin levels and vital signs. Once stable and competent, patients or families were consented. EtCO2 average over three measurements 3 min apart was used as the EtCO2 value. The electronic medical record was reviewed by a trained research associate who was not involved in the care of the patient to determine the need for transfusion, pressor use, or operative hemorrhage control within the first 24 h of hospitalization. Results: Fifty patients were enrolled, with a median age of 52 years. Seven patients required transfusion, pressor use, and/or surgical hemorrhage control. Vital signs between groups were statistically no different. The mean EtCO2 in patients requiring transfusion was 26.8 (19.5–34.1) versus 34.1 (31.8–36.3) in those who did not (P = 0.027). A cutoff value of EtCO2 ≤33 mmHg was 100% sensitive and 62.8% specific, with an area under the curve of 0.889. Conclusion: EtCO2 has a high sensitivity in predicting the need for intervention in trauma patients. Additional research is needed to determine further utility of this value in the triage and treatment of trauma patients. The following core competency statement: Patient care and Systems-based practice.

Interprofessional communication: How do we do it?

Interprofessional education in preparation for the skills to execute teams and teamwork through interprofessional collaboration has been publicized and mandated by several professional associations through accreditation standards. The prerequisite is emphasized by the National Academy of Medicine (formerly the Institute of Medicine) as a mantra for successful healthcare outcomes. In response, the Interprofessional Education Collaborative (known as IPEC) published core competencies in 2011 with an update in 2016. While these statements are not each independently expressed in measurable terms, they stand as a compendium to guide interprofessional collaboration. To date, the literature does not reflect a comprehensive approach to explicating or interpreting these to be embraced more readily. Further, the literature to enlighten student education outstrips the literature to illuminate faculty education, though we acknowledge the work of the National Center for Interprofessional Practice and Education to inspire faculty education through a variety of platforms. Though the IPEC publications represent seminal work in the US, built on earlier work from the UK and others, its translation for faculty education applying a straight-forward, orderly, and methodical approach has not been done. Our attempt was to take one of the four (“4”) IPEC core competencies, Core Competency 3: Interprofessional Communication, and describe its underpinnings in a systematic way as another tool for faculty education. It may open the door to further expound on each competency statement to employ IPEC competencies within a healthcare community that includes students, faculty and post graduate professionals.

Development of a public health emergency preparedness competency model for European Union countries.

In 2017, the European Centre for Disease Prevention and Control (ECDC) developed a competency model for individuals who work in public health emergency preparedness (PHEP) in European Union (EU) countries. The model serves as the basis for developing competency-based training programmes to support professionals in PHEP efforts at the country level. The competency model describes the knowledge and skills professionals need when working in national-level PHEP, such as preparedness committee members or their equivalents. In order to develop the model, existing competency statements were reviewed, as well as case studies and reports. Fifty-three professionals from the EU and other countries provided feedback to the model by participating in a three-stage consultation process. The model includes 102 competency, 100 knowledge and 158 skill statements. In addition to specifying the appropriate content for training programmes, the proposed common competency model can help to standardise terminology and approaches to PHEP training.

Evaluating an Initiative to Promote Entry-Level Competence in Palliative and End-of-Life Care for Registered Nurses in Canada

Numerous competency statements have been developed for the purpose of guiding nurse educators and clinicians. Rarely, though, are there evaluations of the use of these competency statements in practice. In this cross-sectional descriptive study, nurse educators were surveyed to determine how the Canadian Association of Schools of Nursing (CASN) Palliative and End-of-Life Care Entry-to-Practice Competencies and Indicators are used in schools of nursing in Canada. Twenty-four respondents consented to participating in this study. Findings supported that some version of palliative and end-of-life care (PEOLC) education was offered at each school of nursing in Canada, and it was most commonly threaded throughout existing undergraduate courses. Data also suggested that if nurse educators were interested in PEOLC and had existing knowledge or expertise in PEOLC, the CASN Palliative and End-of-Life Care competency document was used to integrate content into curricula. This study provides some initial insights into the use of the CASN Palliative and End-of-Life Care competency document in Canadian schools of nursing. Implications for additional research, policy, education, and practice are discussed.

Getting underneath IPEC competencies: Core Competency 4: Teams and teamwork

The Interprofessional Education Collaborative (IPEC) formed in 2009 provided significant guidance to advance interprofessional collaboration in its publication of the IPEC competencies in 2011, which described Four Domains and associated competencies to address interprofessional education and practice. Its updated publication in 2016 included public health and the care of populations and clarified its intent that interprofessional collaboration is the overarching theme of the now renamed 4 Core Domains to 4 Core Competencies. The article examines the literature that correlates with the sub competency statements represented within Core Competency 4: Teams and Teamwork (TT) to identify the underpinnings that support their fulfillment. The TT core statement is broad: “Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles…”. There is also considerable overlap between the sub-competency statements. Though the existing literature describes structural characteristics and behavioral elements of good functioning teams, the repertoire is not collectively accessible and assimilated into a whole, but is fragmented, embedded in multiple sources. The article integrates and assembles the qualities of teams and team-members likely to be successful while getting underneath the competency statements to identify the mechanisms and dispositions that drive those competencies. The exploration begins with the structural components of teams and then proceeds to key attributes of teams and team members. The article provides a nexus to correlate IPEC’s TT’s sub-competencies to yield favorable team functioning from which academic institutions, and health care professionals might enrich their knowledge about what works.

Development of a Professional Practice Model for Neuro-oncology Advanced Practitioners at an Academic Medical Center: A Quality Improvement Project

In medicine, neuro-oncology practice falls outside the scope of established practice requirements for the specialties of neurology, medical oncology, and neurosurgery, justifying the prerequisite of specialized training to practice neuro-oncology. Neuro-oncology advanced practitioners (AP) also require specialization beyond the scope of population-based generalist training and education. This quality improvement project's primary purpose was to develop a professional practice model (PPM) for APs employed at an academic medical center (AMC) ambulatory neuro-oncology practice. Using the focus, analyze, develop, execute, and evaluate (FADE) quality improvement methodology, the authors (1) reviewed literature and relevant professional organizations to identify possible professional competencies for neuro-oncology APs; (2) analyzed data to develop evidence-based practice domains; (3) used purposive sampling to recruit an interprofessional team of neuro-oncology experts; and (4) conducted a Delphi study with an interprofessional team of experts to gain consensus on practice domains and professional competencies. Twenty-three participants (n = 23) were recruited for the Delphi study, which was executed via electronic transmission using the Web-based software Qualtrics. After two rounds of the Delphi survey, the expert team reached consensus on six domains of practice, with 50 corresponding competency statements. Through interprofessional collaboration and consensus, this quality improvement project successfully created a PPM for an AMC neuro-oncology AP team. The PPM supports neuro-oncology APs by validating the unique set of skills that combines several specialties. The PPM provided the framework to standardize orientation and training, evaluate performance, and support the professional development of an AMC neuro-oncology AP team.