Core Competency Domains Research Articles

The Houseless Simulation Exercise: An innovative educational approach to addressing houselessness interprofessionally using a virtual platform

BackgroundHouselessness, characterized by a lack of fixed and adequate nighttime residence, presents humanitarian and public health challenges. Health and houselessness are intricately connected, with houselessness exacerbating health issues and reducing life expectancy. Interprofessional education (IPE) is crucial in preparing healthcare professionals to address the unique needs of this population. MethodsThe Houseless Simulation Exercise (HSE) was designed as an innovative IPE activity to cultivate awareness, empathy, and skills for caring for houseless individuals. Informed by game-based learning theory, it integrates elements such as visual design, narrative, and collaboration. It comprises a choose-your-adventure style simulation and an interprofessional discussion on care and policy innovation. ResultsThe HSE ran for two years and involved 359 students. Participants reported positive experiences, improvements in interprofessional core competency domains, and awareness of challenges. Qualitative feedback highlighted the impact on individuals. ConclusionThe HSE offers a dynamic approach to IPE, fostering awareness, empathy, and collaboration among healthcare professionals. The HSE exemplifies the potential of innovative educational strategies in addressing complex healthcare challenges related to houselessness.

Development of advanced practice nursing core competencies in Saudi Arabia: A modified Delphi study

BackgroundAdvanced practice nursing requires a diverse set of competencies that define what advanced practice nurses need to know and be able to do to deliver safe, effective, and high-quality healthcare. Given the lack of evidence regarding core competencies and the evolution of advanced practice nursing roles in Saudi Arabia, it is becoming increasingly important to develop core competencies to standardize educational and clinical training programs. ObjectiveTo define the core competencies of advanced practice nursing in Saudi Arabia. DesignUtilizing a modified Delphi design and snowball sampling technique, data were collected between April and July 2023 using an online questionnaire consisting of 28 core competencies that was developed based on an in-depth literature review and a critical analysis of advanced practice nursing core competencies published by leading professional organizations. Two rounds of Delphi surveys were conducted. SettingsThe study was set in clinical and academic settings in Saudi Arabia. ParticipantsNursing experts with graduate degrees as advanced practice nurses. ResultsIn Round 1, 34 advanced practice nursing experts reached full consensus on 24 of the 28 core competencies, and four core competencies reached partial consensus. Based on suggestions and feedback from the experts, the investigators revised ten core competencies to reflect the improvement suggestions and created three new core competencies. A total of 26 core competencies were used in Round 2, which achieved a full consensus among the 34 advanced practice nursing experts, under the following six core competency domains: knowledge of advanced practice nursing, person-centered care, professional improvement, professionalism, communication and interprofessional partnership, and leadership and system-based practice. ConclusionsGiven the need for a standardized competency framework, the 26 core competencies proposed in our study have the potential to guide education and training in academic programs and facilitate the implementation of advanced practice nursing in clinical settings.

Perceived Competencies and Training Needs of Public Health Nurses in the Philippines: Basis for the Development of NurseLEAD: A Leadership Course on Advanced Practice Nursing in Public Health.

Public health nurses (PHNs) perform more than the provision of direct care to clients. They are also expected to perform roles as leaders, managers, and collaborators in different settings, especially in areas where there are no physicians. Their continuous professional development must be facilitated to empower them to lead the delivery of health programs and services in pursuit of universal healthcare. This study aims to determine the perceived competencies of public health nurses and describe their training needs. A descriptive, cross-sectional study was utilized, where an online survey was administered to PHNs across the Philippines to determine their self-perceived competencies and training needs based on the eight domains of core competencies of public health professionals. Descriptive statistics was used to summarize the data. A total of 330 PHNs answered the survey. The results showed that at baseline, PHNs perceived themselves to be competent (from most to least) in the following: communication, analytical/assessment, community dimensions of practice, policy development/ program planning, leadership and systems thinking, cultural competency skills, public health science, and financial planning and management. In terms of training needs, the enablers mentioned include a supportive work environment that can provide a work schedule that is inclusive of time for professional development and work-life balance; a learning environment where colleagues and supervisors support the need for training and innovation; strong internet connection; and enough equipment to participate and submit deliverables for courses taken. Filipino public health nurses perceived themselves to be competent in the areas of communication and community practice, but less competent in public health science, and financial planning and management. Future capacity-building programs must be designed to meet this demand. Furthermore, to make training programs truly responsive to the needs of nurses, steps must be taken to promote capacity-building enablers.

Cardiac Critical Care Fellowship Training in the United States and Canada: Pediatric Cardiac Intensive Care Society-Endorsed Subcompetencies to the 2022 Entrustable Professional Activities.

We aimed to define and map subcompetencies required for pediatric cardiac critical care (PCCC) fellowship education and training under the auspices of the Pediatric Cardiac Intensive Care Society (PCICS). We used the 2022 frameworks for PCCC fellowship learning objectives by Tabbutt et al and for entrustable professional activities (EPAs) by Werho et al and integrated new subcompetencies to the EPAs. This complementary update serves to provide a foundation for standardized trainee assessment tools for PCCC. A volunteer panel of ten PCICS members who are fellowship education program directors in cardiac critical care used a modified Delphi method to develop the update and additions to the EPA-based curriculum. In this process, the experts rated information independently, and repetitively after feedback, before reaching consensus. The agreed new EPAs were later reviewed and unanimously accepted by all PCICS program directors in PCCC in the United States and Canada and were endorsed by the PCICS in 2023. The procedure for defining new subcompetencies to the established EPAs comprised six consecutive steps: 1) literature search; 2) selection of key subcompetencies and curricular components; 3) written questionnaire; 4) consensus meeting and critical evaluation; 5) approval by curriculum developers; and 6) PCICS presentation and endorsement. Overall, 110 subcompetencies from six core-competency domains were mapped to nine EPAs with defined levels of entrustment and examples of simple and complex cases. To facilitate clarity and develop a future assessment tool, three EPAs were subcategorized with subcompetencies mapped to the appropriate subcategory. The latter covering common procedures in the cardiac ICU. This represents the 2023 update to the PCCC fellowship education and training EPAs with the defining and mapping of 110 subcompetencies to the nine established 2022 EPAs. This goal of this update is to serve as the next step in the integration of EPAs into a standardized competency-based assessment framework for trainees in PCCC.

Developing and validating a tool for assessing the confidence in the competence of midwifery tutors in India on WHO core competency domains.

Negligible quantitative research evidence exists on standardisation and psychometric validation of questionnaires that measure midwifery educators' confidence in their competence. This study developed a self-assessment of confidence in competence questionnaire in India based on the WHO Midwifery Educator Core Competencies (2014) with an aim to develop and validate a self-assessment tool measuring midwifery tutors' confidence in competence in imparting quality midwifery education. The questionnaire was developed as part of a multi-centre study to identify confident midwifery tutors for further training as educators, supporting India's rollout of professional midwives. The questionnaire underwent rigorous psychometric testing among 2016 midwifery tutors in India. Following exploratory Principal Component Analyses (PCA), the nine core competencies outlined in the WHO document were analysed separately. The results indicate that the questionnaire is psychometrically valid, with an internal consistency range of 0.81-0.93 for the nine domains. This robust testing process ensures the reliability and validity of the questionnaire. The self-assessment questionnaire can potentially be a valuable tool in India and other high-, middle-, and low-income countries. From a programmatic perspective, it can help identify key gaps and prioritise training needs, particularly in low-resource settings, so that limited resources are best utilised to fill the most prominent gaps. Furthermore, it can provide a universal platform for comparing data from different settings, facilitating global collaboration and learning in midwifery education.

PENILAIAN KINERJA MANAJER KEPERAWATAN BERDASARKAN BALANCED SCORE CARD DAN FUNGSI MANAJEMEN: LITERATUR REVIEW

One reason for the need for standardized assessment of nurse managers is to ensure their performance evaluations are consistent and objective. This research aimed to be used as a reference in conducting performance assessments at the nurse manager level. This research uses the Literature review method using the PRISMA flow diagram. An article search using 3 journal databases including Scopus, Google Scholar, and Pubmed, obtained 20 final articles published between 2018 and 2023. The results of the research show that the performance assessment of nurse managers includes 4 BSC perspectives and is oriented towards management functions and the five core competency domains of nursing. The performance assessment of nurse managers includes competency knowledge, skills and attitudes which are then linked to the implementation of management roles and functions (planning, organizing, driving and controlling) both from the dimensions of human resources, environment and business or cost control. The performance assessment of nurse managers can be adjusted to the level or career path of nurse managers from level I to level V which is divided into top, middle and low managers. Assessment instruments related to assessing the performance of nurse managers have not been standardized and are still diverse. Several regulations in Indonesia do not yet include competency and assessment standards for nurse managers. The BSC can be used as basis for preparing nurse manager performance assessment instrument which includes 4 perspectives, oriented towards management functions, and 5 core nursing competency domains.

Intersectional Disparities in Emergency Medicine Residents’ Performance Assessments by Race, Ethnicity, and Sex

Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments. To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments. This retrospective cohort study used data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education Milestones (Milestones) assessments to evaluate ratings for EM residents at 128 EM training programs in the US. Statistical analyses were conducted in June 2020 to January 2023. Training and assessment environments in EM residency programs across comparison groups defined by ethnoracial identity (Asian, White, or groups underrepresented in medicine [URM], ie, African American/Black, American Indian/Alaska Native, Hispanic/Latine, and Native Hawaiian/Other Pacific Islander) and sex (female/male). Mean Milestone scores (scale, 0-9) across 6 core competency domains: interpersonal and communications skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and system-based practice. Overall assessment scores were calculated as the mean of the 6 competency scores. The study sample comprised 128 ACGME-accredited programs and 16 634 assessments for 2708 EM residents of which 1913 (70.6%) were in 3-year and 795 (29.4%) in 4-year programs. Most of the residents were White (n = 2012; 74.3%), followed by Asian (n = 477; 17.6%), Hispanic or Latine (n = 213; 7.9%), African American or Black (n = 160; 5.9%), American Indian or Alaska Native (n = 24; 0.9%), and Native Hawaiian or Other Pacific Islander (n = 4; 0.1%). Approximately 14.3% (n = 386) and 34.6% (n = 936) were of URM groups and female, respectively. Compared with White male residents, URM female residents in 3-year programs were rated increasingly lower in the medical knowledge (URM female score, -0.47; 95% CI, -0.77 to -0.17), patient care (-0.18; 95% CI, -0.35 to -0.01), and practice-based learning and improvement (-0.37; 95% CI, -0.65 to -0.09) domains by postgraduate year 3 year-end assessment; URM female residents in 4-year programs were also rated lower in all 6 competencies over the assessment period. This retrospective cohort study found that URM female residents were consistently rated lower than White male residents on Milestone assessments, findings that may reflect intersectional discrimination in physician competency evaluation. Eliminating sex-specific ethnoracial disparities in resident assessments may contribute to equitable health care by removing barriers to retention and promotion of underrepresented and minoritized trainees and facilitating diversity and representation among the emergency physician workforce.

Objective structured clinical examination as a competency assessment tool of students’ readiness for advanced pharmacy practice experiences in South Korea: a pilot study

BackgroundThe assessment of pharmacy students’ readiness to begin the education of an advanced pharmacy practice experience (APPE) in clinical pharmacy settings continues to gain increasing attention. This study aimed to develop an objective structured clinical examination (OSCE) in the core domains acquired through an introductory pharmacy practice experience (IPPE), for evaluating its appropriateness as a tool of assessing clinical pharmacist competency for APPEs in Korean pharmacy students throughout a pilot study.MethodsOSCE’s core competency domains and case scenarios were developed through a literature review, ideation by researchers, and external experts’ consensus by a Delphi method. A prospective single-arm pilot test was conducted to implement the OSCE for Korean pharmacy students who completed a 60-h course of in-class simulation IPPE. Their competencies were assessed by four assessors in each OSCE station with a pass-fail grading system accompanied by a scoring rubric.ResultsOSCE competency areas including patient counseling, provision of drug information, over-the-counter (OTC) counseling, and pharmaceutical care services were developed with four interactive and one non-interactive cases. Twenty pharmacy students participated in the OSCE pilot test, and their competencies were evaluated by 20 assessors. The performance rate was the lowest in the area of patient counseling for a respiratory inhaler (32.1%) and the highest (79.7%) in OTC counseling for constipation. The students had an average performance rate of 60.4% in their communication skills. Most participants agreed on the appropriateness, necessity, and effectiveness of the OSCE in evaluating pharmacy students’ clinical performance and communication skills.ConclusionsThe OSCE model can be used to assess pharmacy students’ readiness for off-campus clinical pharmacy practice experience. Our pilot study suggests the necessity of conducting an OSCE domain-based adjustment of difficulty levels, and strengthening simulation-based IPPE education.

Impact of an Observation Medicine Educational Intervention on Residents' Confidence, Knowledge, and Attitudes: A Quasi-Experimental Study.

Driven by innovations in healthcare, observation medicine (OM) is expanding as a medical specialty. Despite exponential growth, education on OM remains underemphasized in the internal medicine (IM) residency programs. We assessed the impact of an educational intervention pairing didactic and experiential learning with an interdepartmental approach on IM residents' confidence, knowledge, and attitudes when providing observation care to patients with neuro-cardiovascular diseases in the hospital setting. Our multifaceted intervention incorporated OM's principles and practice in a flipped classroom with the team-, case-, lecture- and evidence-based learning model. Kirkpatrick's evaluation model was used to assess the educational intervention's effectiveness according to the first three levels, ie, reaction, learning, and behavior, using quantitative surveys. The surveys were completed pre-intervention, and immediately upon completion of the educational intervention. Of 55 eligible residents, 55 (100%) participated in this intervention. Fifty (90%) completed the pre-intervention survey, and 21 (38%) completed the immediate post-intervention survey. Kirkpatrick's evaluation framework showed that the intervention had a positive impact on residents' motivational reaction (attention, relevance, confidence, and satisfaction [ARCS], M = 3.8, SD = 0.87), their knowledge of common observation diagnoses (pre = 49%, post = 63%), particularly on cardiac diagnostic workup and approach to patients with transient neurological symptoms (P < .05), and their behavior and self-assessment of core competency domains (pre-mean = 2.69, post-mean = 3.18, P < .001). Our multimodal intervention provides a framework for a structured OM educational experience that can be incorporated into residency training, even without a formal observation unit rotation. The analysis also offers literary data on the current state of OM education in an IM residency program and supports the need to expand OM's educational resources to counteract the growth in hospital observation services. Future research should include an analysis of residents' knowledge and skills from a longitudinal OM experience and advancing the results to residency programs where observation care is as applicable as ours.

Using a Modified Delphi Methodology to Identify Essential Telemedicine Skills for Pediatric Residents.

ObjectiveTelemedicine use in pediatrics increased during the coronavirus disease-2019 (COVID-19) pandemic. Despite rapid uptake by pediatric residency programs, consensus on essential telemedicine skills for pediatric residents is lacking. We used a modified Delphi methodology to identify essential telemedicine skills and behaviors for pediatric residents.MethodsA focused literature search was performed to identify items for review by pediatric telemedicine experts. A modified Delphi methodology consisting of iterative rounds of anonymous surveys was conducted until consensus for each item was reached. Consensus was defined as >80% of experts identifying a topic as “very important.” All items were mapped to one of the Accreditation Council for Graduate Medical Education (ACGME) core competencies.ResultsSeventeen pediatric telemedicine skills and behaviors achieved a consensus of “very important.” Most items mapped to the ACGME core competency domains of interpersonal and communication skills and professionalism.ConclusionsThere was a high degree of agreement among pediatric telemedicine experts on the importance of 17 telemedicine skills and behaviors for pediatric trainees. These skills can inform pediatric telemedicine curricula and provide validity evidence for pediatric telemedicine assessment tools.

Embedding experiential learning in undergraduate health promotion curriculum.

The experiential teaching method draws on research-based principles of adult education. The integration of academic learning and practice provides students opportunities to increase their knowledge while developing capabilities to meet the International Union for Health Promotion and Education (IUHPE) Core Competencies and Professional Standards. Community Health Promotion is a second-year subject offered in the Bachelor of Health Sciences at La Trobe University. The project-based curriculum, delivered over 12 weeks, consists of theoretical material which students apply through hands-on project planning, implementation and evaluation; projects are carried out on campus. To bridge academic content and project practicalities the Victorian government's Integrated Health Promotion Resource Kit is used as a foundational teaching resource. Students are supported by teaching staff and a project sponsor throughout the project cycle. Assessment tasks comprised of problem definition and priority setting, project planning and critical reflection on project implementation. The experiential learning approach enables students, in a self-directed yet collaborative manner, to develop skills aligned with health promotion competencies. Students were able to safely "experiment" and apply health promotion theory while actively developing project management and partnerships skills, reflecting on their practice and communicating project findings. Students consistently provide feedback articulating the value they place on the purposeful and scaffolded transition of classroom learning to real-life environments which they recognised as building their competencies and enhancing their employability skills. Experiential learning through small-group projects prepares students for the health promotion workforce in a low-risk, high-impact educational setting while contributing to promoting the ethos of a health-promoting university. SO WHAT?: The authentic assessments provide students with the opportunity to develop competency within several domains of the IUHPE Core Competencies and Professional Standards.

Using a Milestone Framework for Assessing Resident, Fellow, and Faculty Competence in Diversity, Equity, and Inclusion.

Graduating residents and fellows who can competently provide equitable and inclusive care to a diverse patient population requires data to monitor progress and outcomes. This data must be continuously gathered and used to guide improvements at the individual program level and at the sponsoring institution level for trainee and faculty growth and development. Recognizing the need for data, the Accreditation Council for Graduate Medical Education (ACGME) updated its 2021 annual Resident/Fellow and Faculty Surveys to include items related to equity and inclusion. Yet, accessible data on the structural competency level of our residents and faculty specific to the areas of health equity, social responsibility, diversity, inclusion, and social determinants of health is limited.1Our aim was to develop and implement a quick, evidence-based, structural competency tool to monitor trainee and faculty proficiency over time. A literature review was completed to identify key competency elements. To facilitate implementation, we framed our assessment to parallel the structure and format of the ACGME's core competency milestone model. Literature-identified elements were plotted in each of the core competency domains with progression delineated across 5 levels resulting in a comprehensive 8-page milestone document. The milestone was then iteratively revised by multiple stakeholders (experts in diversity, equity, and inclusion, ethics, and medical education; faculty; learners; program directors) to create an annotated and referenced 2-page master milestone and an abbreviated milestone with domain threads across levels (eg, Medical Knowledge) for inclusion within each graduate medical education (GME) program's required milestone assessment form and for faculty self-assessment. For example, an element in the domain of Patient Care level 3 (Identifies and incorporates mitigation strategies to address structural risks in patient care) progresses to level 4 (Develops and collaborates with patient on plan of care cognizant of patient's intersectionalites and its influences on their health care values, decisions…). In the Professionalism domain, level 3 (Reconciles personal beliefs and identities with professional role; develops strategies to mitigate own implicit biases; recognizes the contribution of bias to iatrogenic risk and health disparities) progresses to level 4 (Speaks up in the moment [allyship]; utilizes incident reporting mechanism to address microaggressions and/or lateral workplace violence).The milestone was approved by the Graduate Medical Education Committee (GMEC) for inclusion as a required formative trainee assessment in every program beginning in January 2021 and as a request for faculty to complete as a needs assessment. Data are not used for trainee progress (Clinical Competency Committee reviews) or annual faculty performance reviews. Trainee milestone data across programs revealed a consistent progression in the institutional average competence by year of training from 3.1 (postgraduate year [PGY]-1) to 4.4 (PGY-6). The same progression held within each residency and fellowship program. Faculty self-assessment (N&gt;100) revealed that, on average, greater than 50% of the faculty perceived themselves to be at level 4 or higher: range between domains of 53%–79% at or above level 3 by competency domain with SD 1.1 to 1.7. Programs utilize the data as part of their annual program evaluations outlining measurable action steps. At the GMEC level, the data guide GME-wide diversity, equity, and inclusion educational sessions for trainees and faculty.This structural milestone innovation meets our need for data to monitor our trainees' and faculty's competence to guide ongoing program improvements. Formatted like existing ACGME Milestones, implementation within existing trainee competency assessment systems and/or as a faculty self-assessment is seamless, enhancing its utility, feasibility, and transferability. That said, we recognize that milestones are not static; the specific domain inclusions will need to evolve as we do on our equity journey.

Minimum Case Numbers: The New Pandemic in a Changing Clinical Environment.

Minimum Case Numbers: The New Pandemic in a Changing Clinical Environment.

Lay Health Workers in Community-Based Care and Management of Dementia: A Qualitative 'Pre' and 'Post' Intervention Study in Southwestern Uganda.

Background The global need for efficient and cost-effective use of healthcare resources in low-income countries has led to the introduction of lay health workers (LHWs) as a link of the community to healthcare services. As such, the LHWs perform a variety of tasks such as education, support for care delivery, and social support across all disease types. However, little is known about their ability to support dementia care and management in the community. Purpose The goal of the pilot intervention was to evaluate the 5-day training intervention for LHWs in rural southwestern Uganda in community-based care and management of people with dementia, and implementation of the knowledge and skills gained. Methods This was a “pre” and “post” pilot intervention study which involved a qualitative assessment of LHWs' knowledge on community-based management and care for people with dementia. We focused on four core competency domains in the WHO dementia toolkit. The intervention included a five-day training of the LHWs on dementia care, eight weeks of implementation, and an evaluation of the experiences. Analysis focused on the needs assessment, early detection and management, community engagement, support for people with dementia; and evaluation of the eight weeks implementation. Results Before the training, the LHWs did not know much about what dementia-related support to provide in the community. Activities were limited to general support, including nutrition, and health education. After the training, LHWs had a basic understanding of dementia and began sensitizing the communities. They felt more comfortable working with people with dementia and reported a notable change in the attitude of family members. However, they reported challenges in differentiating the signs of early dementia from superstitious beliefs. Conclusion With enhanced capacity, LHWs may be able to support community-based management for people with dementia. A larger study is needed to explore potential roles for LHWs and further assess effectiveness of the LHWs' skills.

Developing nurse preceptor competency domain guide tool: A Delphi study

Background and objective: One of the strategies used to prepare novice nurses for their professional journeys in clinical practice is by implementing the preceptorship teaching and learning model. Competencies such as knowledge, experience, abilities, and attributes need to be measured to ensure the desired outcomes of the preceptorship are achieved and consistent. This study aimed to develop a nurse preceptor competency domain guide tool at a tertiary hospital in Oman.Methods: Three-round Delphi iterative design with experts was used to develop the nurse preceptor competency domain guide tool. Following standard measures, eight expert opinions were combined until a group consensus was achieved. The level of consensus within the expert panel was defined as ≥ 75% scoring of items were selected as an essential required competency/item.Results: Eight experts from a main tertiary hospital were included in the panel. Five core competency domains and five subdomains were identified and considered to be relevant for nurse preceptors at the hospital with consensus levels varying from 75% to 100%. A total of 83 descriptive items were identified for the competency guide tool.Conclusions: This study found that the main core competency domains of the tool that nurse preceptors should acquire to be competent preceptors are inter-professional communication skills, appropriate teaching strategies, time management skills, building a learning atmosphere, and coaching critical thinking. This tool would improve nurse preceptors’ performance and equip them with the required prerequisite competencies to professionally start their journey in clinical practices. Follow-up research on tool implementation is highly recommended to evaluate its effectiveness.

A Behavior-Analytic Perspective on Interprofessional Collaboration

Collaborative service delivery models have gained considerable popularity in health care, education, and clinical settings. Despite the unique opportunity that this new popularity provides for the dissemination of applied behavior analysis, the majority of practicing behavior analysts have received little or no formal professional development on how to participate in teams with nonbehavioral colleagues. The purpose of this article is to elucidate the larger movement toward collaborative service delivery with an emphasis on interprofessionalism. The four core competency domains presented by the Interprofessional Education Collaborative (IPEC) Framework are interpreted through a behavior-analytic lens. This article is an initial attempt to operationalize constructs commonly associated with interprofessional educational and collaborative practices including (but not limited to) cultural sensitivity and responsiveness, cultural humility and reciprocity, empathy, and compassion.

The Effectiveness of Functional Exercises for Teaching Method Disaster Medicine to Medical Students.

IntroductionFunctional exercises are effective for testing disaster management training. Previously, we found that functional exercises promote student engagement and improve the perception of learning after exercise.ObjectiveThe study objective is to investigate whether functional exercise is effective for teaching disaster medicine.MethodsStudents who partook in a two-day course of disaster medicine were recruited. The course consisted of lectures and workshops followed by a half-day functional exercise and was designed based on four core competency domains which included major disaster medicine concepts. After the lectures and workshops, participants completed a test to assess their knowledge of the core competency domains and a questionnaire to evaluate their willingness to pursue further training and participate in a disaster medical assistance team (DMAT) and their interest in disaster exercises. The functional exercise involved the scenario of an earthquake and mass-casualty incident and participants acted as DMAT members in the exercise. A post-exercise debrief was conducted by the evaluators to discuss performance and evaluate the results of the exercise. Participants then completed the same tests and questionnaires as before the exercise.ResultsNinety-seven students were recruited, 72 of which were medical students. Pre- and post-exercise tests and questionnaires were completed by 48. We found disaster scene safety knowledge to be significantly improved after the functional exercise. Students’ willingness for further training and participation in a DMAT as well as their interest in disaster training was high before and after the exercise.ConclusionDisaster scene safety is a vital element of disaster medicine training but it is difficult to teach. Functional exercises represent a good tool for this purpose and can maintain enthusiasm for learning and participating in disaster medicine-related activities.

Development of undergraduate nursing entrustable professional activities through using a participatory design approach

Abstract Background Competencies represent sets of general abilities and attributes that graduating nurses must acquire. Most nursing programs adopt competency based assessment and training approaches to prepare their students to enter the clinical environment. However, some concern has been raised regarding their interpretation and implementation in everyday clinical training. To operationalize competencies for better use in clinical practice, the Entrustable Professional Activities framework (EPAs) was introduced in 2005 by ten Cate. Aim The aim of this study is to develop a framework of EPAs for an Undergraduate Nursing Program. Method Through using a participatory action design approach, the participants developed a set of EPAs linked with competencies for an Undergraduate Nursing Program. Thematic analysis was performed, and EPAs framework validity was constructed. Result A total of eight core EPAs were developed and each one was operationalized by a brief description and nested within the related core competency domains. Supervision levels and entrustment decisions were determined. Conclusion The development of EPAs specific to undergraduate nursing programs may offer the opportunity to have standardized language to evaluate students' progress toward competency in nursing. It is recommended to conduct further research to improve the developed EPAs.

Integrating Sleep Knowledge Into the Anesthesiology Curriculum.

There is common ground between the specialties of anesthesiology and sleep medicine. Traditional sleep medicine curriculum for anesthesiology trainees has revolved around the discussion of obstructive sleep apnea (OSA) and its perioperative management. However, it is time to include a broader scope of sleep medicine-related topics that overlap these specialties into the core anesthesia residency curriculum. Five main core competency domains are proposed, including SLeep physiology; Evaluation of sleep health; Evaluation for sleep disorders and clinical implications; Professional and academic roles; and WELLness (SLEEP WELL). The range of topics include not only the basics of the physiology of sleep and sleep-disordered breathing (eg, OSA and central sleep apnea) but also insomnia, sleep-related movement disorders (eg, restless legs syndrome), and disorders of daytime hypersomnolence (eg, narcolepsy) in the perioperative and chronic pain settings. Awareness of these topics is relevant to the scope of knowledge of anesthesiologists as perioperative physicians as well as to optimal sleep health and physician wellness and increase consideration among current anesthesiology trainees for the value of dual credentialing in both these specialties.

Use and Potential Misuse of Milestones.

By 2001, the Accreditation Council for Graduate Medical Education (ACGME) 6 core competencies were established, which introduced graduate medical education's (GME's) transition to competency-based medical education (CBME).1 Competencies are teachable attributes that residents and fellows must develop in order to carry out professional roles. Milestones describe the developmental pathway for achieving each competency in more than 150 GME specialtes and subspecialties. Yet confusion remains about their optimal use as well as misuse, which may produce adverse consequences for all stakeholders (eg, residents, faculty, programs, sponsoring institutions [SIs]).Milestones are narrative statements that describe skills, knowledge, and behaviors for performance in each of the 6 core competency domains and are arranged sequentially from attributes of novices to attributes that are aspirational.2 Milestone-based assessments enable faculty to provide GME learners specific formative feedback and improvement goals through the defined progression of levels toward expertise.3 Aggregated Milestone data from within and across programs can facilitate program, SI, and review committee (RC) learning and improvement.Milestones themselves are not assessments. They are constructs used by the GME community to build assessments. As constructs, Milestone assessments are open to interpretation and may be affected by context and other factors such as the skill and biases of assessors. These features can be mitigated during formative feedback sessions, but they make Milestone-based assessments inappropriate for high-stakes summative assessments of learning or competence. Thus, Milestone assessments should never be shared with certifying, credentialing or licensing boards or agencies, or potential employers, or provided as evidence of competence for legal purposes.4 When used for these unintended purposes, faculty may be reluctant to give honest assessments and clinical competency committees (CCCs) may be tempted to inflate Milestone judgements. Milestone security can facilitate the integrity of the assessment processes.