Development of a competency-based approach to teaching preventive medicine

A collaborative project to develop a competency-based curriculum and associated instructional materials for teaching preventive medicine to medical students has been undertaken by the Association of Teachers of Preventive Medicine in cooperation with the Center for Educational Development in Health at Boston University. A general model of physician responsibilities in the preventive dimension of clinical practice was elaborated and specific performance objectives were delineated. Specifications of physician performance were verified through Delphi and questionnaire surveys among approximately 100 practicing physicians. Three facets of physician performance emerged as warranting special attention: planning a practice-based program of clinical prevention, adapting the program to the needs of individual patients, and assisting patients to modify behavior patterns. Competency-based educational objectives were derived from the physician performance objectives. An instructional system to facilitate attainment of these objectives is under development. It incorporates five modules based on the following themes: the epidemiologic basis of clinical prevention, methods of clinical prevention, management planning for preventive services, clinical health and risk appraisal, and intervention for behavior change. Each module consists of units of instruction which specify expected learning outcomes, provide guidelines for evaluation of student performance, and recommend appropriate learning activities and resources.     

Competency-based training for nurses: alternation between theory and practice, professionalization, and complex thought

This study aims at eliciting a reflection on a competency-based education for nurses by understanding alternation as a necessary condition for an articulation between theory and practice, as well as at discussing some issues related to competency-based education and professionalization. We have searched to widen up our understanding of what competencies are and of an articulation between theory and practice. We have discussed the notion of professionalization and some ways of working on competencies by following different approaches and distinctive objectives, and we have reached an understanding about competencies, how to act in some situations, what leads to educational commitment, and what calls for contextualized and complex thought. Finally, we suggest alternation as a device for professional nurse education.     

Educational objectives and requirements of an undergraduate clerkship in general practice. The outcome of a consensus procedure

OBJECTIVES: The main aim of this study was to reach consensus between students, faculty and general practice teachers on the educational objectives and requirements of the clerkship in general practice. METHOD: The consensus procedure consisted of four steps and all active general practice teachers (n = 116) were asked to participate in the study. RESULTS: We identified 189 educational objectives: 127 complaints (problems, symptoms, syndromes), 29 clinical skills and 37 objectives concerning the theoretical dimensions of general practice. Educational requirements crystallized to 16 essential preconditions of a teaching practice and 35 didactic activities to be performed by the general practice teachers. CONCLUSIONS: These consensus results will be used to structure the medical curriculum and as guidelines for the educational process during the clerkship.      

Competency-based training of health professions teachers in seven developing countries.

A critical issue in the planning of better health care delivery for developing countries is the training and education of health personnel. The Center for Educational Development in Health (CEDH) has field tested its text, Systematic Course Design for the Health Fields, a manual on the application of competency-based curriculum development techniques. A competency-based approach to curriculum design derives instructional objectives, content, and evaluation from the on-the-job responsibilities for the health worker being trained. A field test was conducted in order to determine whether the systematic course design method was applicable in developing countries. For the purpose of the field test, 10 national field directors from Cameroon, Colombia, Honduras, Lebanon, Malaysia, Nepal, and Vietnam trained by CEDH in Boston taught teacher training workshops based on the Systematic Course Design model of a range of health professionals in their own countries. Evaluation of the teacher training workshops was conducted during and immediately following instruction and 1 year later. 167 men and women representing a range of 29 health professions, participated in the workshops. Participants designed 132 courses based on the SCD model and taught 54 courses to about 2000 students. In Colombia, Honduras, Malayasia, and Lebanon, the national field directors applied the method to a range of activities. These field directors developed and taught 11 additional teacher training workshops on SCD to 140 health professionals, and they provided consultation to 12 other health professional schools and governmental agencies. Subject to the limitations imposed by the data, it does seem that a systematic course design method can be applied in the developing world to train health professions teachers. A range of health professionals used the method to design and teach a variety of courses for their own instructional purposes. Further research on the long-range effect of the competency-based training program is required.     

A teachers' guide to teaching medical interviewing

Success in teaching a course in medical interviewing requires competence on the part of instructors, who also need training, and have to provide a structured approach. Problems encountered by course coordinators at the Department of Family Medicine, University of Miami School of Medicine, Miami, Florida have been: (1) a shortage of skilled teachers; (2) inadequate motivation of instructors for teaching the course; (3) differences in content, teacher's style, and outcomes from small groups; and (4) ambiguities in structure or guidelines provided for teachers. The development of a teacher's guide, giving specific objectives and step-by-step methods for teaching significantly improved teacher satisfaction and commitment to the course, as well as student learning.     

Revisiting Bloom's taxonomy for ethics and other educational domains

In the process of developing competency-based health services administration education, the Ethics Faculty Forum Co-Chairs from the Association of University Programs in Health Administration (AUPHA) were asked not only to identify their domains and competencies, but also to review six other faculty fora research outcomes. This article was written by the Ethics Faculty Forum Co-Chairs in response to the AUPHA request. Reviewing the work of the original six faculty fora using Bloom's taxonomy, we found that the fora focused mainly on the cognitive objectives and generally did not consider the affective objectives. The intent of this paper is to help those who teach healthcare ethics refine their current courses to include both cognitive and affective objectives. The paper pursues five objectives: 1. review of Bloom's taxonomy as a framework for creating course objectives in both the cognitive and affective domains; 2. present fora research and their domain outcomes; 3. present an overview of healthcare ethics literature; 4. provide a demonstration of healthcare ethics competencies in both the cognitive and affective domains; and 5. present possible directions for healthcare ethics and other educational domain research.     

Facing the challenges of competency-based assessment of postgraduate dental training: Longitudinal Evaluation of Performance (LEP)

CONTEXT: The evaluation of competence in the health professions is of great importance to the public and professionals alike. Recent efforts to design dependable and accurate systems of assessment for demanding clinical roles are increasingly attempting to focus on all-round competence of practitioners. Many challenges are faced in this field as a balance between robust assessment methodology and feasibility in practice is crucial to implementation and adoption. OBJECTIVES: The authors discuss some of the challenges faced by educators and clinicians involved in the development of systems of assessment for the health professions, and describe a method which aims to address these issues in the assessment of postgraduate dental training in Scotland. DISCUSSION: Three of the major challenges facing educators and clinicians involved in the design of competency-based systems of assessment are considered: the requirement for evaluation in different areas of competence; the importance of association of assessment with the training objectives, and the types and focus of the assessment introduced. Issues around the use of formative and summative assessment, and the perception that these must always remain completely separate, are discussed in detail. SOLUTIONS: A proposal is made for the introduction of a method of assessment which has been designed keeping these challenges in mind. The rationale behind this assessment method is described.     

Developing a competency-based curriculum in HIV for nursing schools in Haiti

Background

Preparing health workers to confront the HIV/AIDS epidemic is an urgent challenge in Haiti, where the HIV prevalence rate is 2.2% and approximately 10 100 people are taking antiretroviral treatment. There is a critical shortage of doctors in Haiti, leaving nurses as the primary care providers for much of the population. Haiti's approximately 1000 nurses play a leading role in HIV/AIDS prevention, care and treatment. However, nurses do not receive sufficient training at the pre-service level to carry out this important work.

Methods

To address this issue, the Ministry of Health and Population collaborated with the International Training and Education Center on HIV over a period of 12 months to create a competency-based HIV/AIDS curriculum to be integrated into the 4-year baccalaureate programme of the four national schools of nursing.

Results

Using a review of the international health and education literature on HIV/AIDS competencies and various models of curriculum development, a Haiti-based curriculum committee developed expected HIV/AIDS competencies for graduating nurses and then drafted related learning objectives. The committee then mapped these learning objectives to current courses in the nursing curriculum and created an 'HIV/AIDS Teaching Guide' for faculty on how to integrate and achieve these objectives within their current courses. The curriculum committee also created an 'HIV/AIDS Reference Manual' that detailed the relevant HIV/AIDS content that should be taught for each course.

Conclusion

All nursing students will now need to demonstrate competency in HIV/AIDS-related knowledge, skills and attitudes during periodic assessment with direct observation of the student performing authentic tasks. Faculty will have the responsibility of developing exercises to address the required objectives and creating assessment tools to demonstrate that their graduates have met the objectives. This activity brought different administrators, nurse leaders and faculty from four geographically dispersed nursing schools to collaborate on a shared goal using a process that could be easily replicated to integrate any new topic in a resource-constrained pre-service institution. It is hoped that this experience provided stakeholders with the experience, skills and motivation to strengthen other domains of the pre-service nursing curriculum, improve the synchronization of didactic and practical training and develop standardized, competency-based examinations for nursing licensure in Haiti.

     

Chinese medical school exit objectives: a multiinstitutional survey of teacher opinion

This paper describes a collaborative survey of Chinese medical school teacher opinion concerning clinical behaviours and skills that Chinese students should be expected to demonstrate prior to graduation from medical school. Selected teachers from four Chinese medical schools indicated whether each of 77 objectives was: essential for every student to know or demonstrate prior to graduation; useful but not essential; or not applicable to their educational programmes. Results show teachers' expectations regarding some of the behaviours and skills Chinese medical school teachers consider to be important for students to learn. Forty-nine per cent of the exit objectives were regarded as essential by 75% or more of the teachers. The most essential objectives involved performing clinical procedures, collaborating and communicating with health care professionals, conducting organ system examinations, formulating hypotheses and defining problems. Other essential objectives were concerned with communicating with patients and their families, maintaining currency within the discipline, and recognition, evaluation and triage of patients with life-threatening or chronic conditions. Exit objectives related to health promotion and risk assessment were regarded as useful but not essential at the undergraduate level. Implications for Chinese medical education are discussed.