Becoming a competent clinician: basic competencies in intervention

This article summarizes the results from the Intervention Work Group of the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The generic charge presented to the Intervention Work Group was "to address issues related to interventions." The Intervention Work Group identified four competency components of knowledge, skills, and abilities: (a). foundational competencies; (b). intervention planning; (c). intervention implementation; and (d). intervention evaluation competencies. A fifth component that included "practice management" was labeled as "others." Each component is discussed, including competencies that were deemed an essential knowledge, skill, and/or value. A discussion of training for intervention competence and assessing that intervention competence is included. Future directions for the science and practice of psychology in the intervention arena are summarized. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

The scientifically-minded psychologist: science as a core competency

At the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, the Scientific Foundations and Research Competencies Work Group focused on identifying how psychologists practice scientifically. This article presents the subcomponents associated with the core competency of scientific practice. The subcomponents include: 1). access and apply current scientific knowledge habitually and appropriately; 2). contribute to knowledge; 3). critically evaluate interventions and their outcomes; 4). practice vigilance about how sociocultural variables influence scientific practice; and 5). routinely subject work to the scrutiny of colleagues, stakeholders, and the public. In addition, the article briefly discusses how the depth of training for and assessment of each subcomponent will vary by training model. Implications and future directions for individual psychologists, training programs, and the profession are discussed. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Competencies conference: future directions in education and credentialing in professional psychology

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was organized around eight competency-focused work groups, as well as work groups on specialties and the assessment of competence. A diverse group of psychologists participated in this multisponsored conference. After describing the background and structure of the conference, this article reviews the common themes that surfaced across work groups, with attention paid to the identification, training, and assessment of competencies and competence. Recommendations to advance competency-based education, training, and credentialing in professional psychology are discussed. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Consultation and interprofessional collaboration: modeling for the future

Consultation and interprofessional collaboration by psychologists occur with individuals, groups, programs, and organizations. The practice of consultation and interprofessional collaboration involves interdisciplinary relationships, preparation, and advanced skill development within specialty areas of psychology (e.g., clinical, counseling, industrial-organizational, and school). The Workgroup on Consultation and Interdisciplinary Relationships engaged in a planning process at the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology to address fundamental issues regarding consultation and interprofessional collaboration in professional psychology. The Workgroup articulated working definitions, consensus points about psychologists as consultants and interprofessional collaborators, a consulting and interprofessional competency blueprint for preparation and assessment strategies, and future directions. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

The Hierarchical Clustering of Clinical Psychology Practicum Competencies: A Multisite Study of Supervisor Ratings

Competency evaluation rating forms are widely used to assess a range of global and specific psychology practitioner competencies during and at the end of clinical placements. Surprisingly, there is little research examining the dimensional structure or the hierarchical clustering of items on these ratings. The current, multisite study examined supervisor ratings of clinical psychology trainees (N = 204) on the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS). Based on the proximity criterion chosen, hierarchical clustering yielded either nine clusters or four super clusters: Good Practitioner Attributes and Conduct, Scientist Practitioner and Professional Management, Assessment and Intervention, and Psychological Testing. The study also tracked the developmental trajectory of competency attainment. CΨPRS ratings differentiated groups between early but not between later stages of training. Measurement issues and implications for training and practice are discussed.     

Individual and cultural-diversity competency: focus on the therapist

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was held in Arizona in November 2002. One of the workshops, Individual and Cultural Differences (ICD), focused on racism, homophobia, and ageism. The consensus was that self-awareness and knowledge about the three "isms" are critical components in the education and training of psychologists. This article, authored by four of the workshop attendees, is a review of the current research and theoretical literature. Implications that address both content and context in graduate programs and training sites are presented. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

军校学员领导力胜任特征模型的建立

目的 建立军校学员领导力胜任胜任牲模型,为军校学员的选拔和培养提理论依据.方法 据文献回顾和专家评判,挑先出11项指标构成胜任牲模型.分别以32门功课的学业成绩和毕业后领导绩效评价为效标,对该模型进行效度验证.结果 胜任特征评价和领导绩效评价总成绩之间具有显著正相关,在胜任特征评价优秀与一般者之间,其领导绩效评价也有显著差异.结论 该胜任特征模型对军校赏领导力具有较好的预测效度,可用于军校学员的选拔和领导能力的培养.     

Competency in surgical residency training: defining and raising the bar.

Competency-based surgical residency training is rapidly becoming the norm across surgical specialties. Ensuring that graduating surgeons are competent to deliver the necessary services and skills to their patients remains a seminal objective of training programs. Defining surgical competence, the measures used to assess and quantify that competence, and the criteria used to judge whether it has been achieved are critical issues. The bar that surgical residency programs have established is, and must continue to be, set very high. Definitions of competency differ across disciplines. In education, two approaches are recognized. According to the behaviorist approach, competence is assessed by precise measures of performance, generally documented by checklists. The integrated (holistic) approach defines competence as a complex combination of personal attributes. Assessments of competence also fall under two categories: the traditional scientific paradigm, emphasizing objectivity and reproducibility, and the judgment paradigm, reflecting the need to assess clinical competence in the final stages of medical training. In surgery, competence is the ability to successfully apply professional knowledge, skills, and attitudes to new situations as well as to familiar tasks. A critical step in assessing surgical competency is developing methodology for competency evaluation and certification. Matching different aspects of surgical competency with the appropriate assessment instruments is the theme of the contemporary evaluation process, with emphasis on a whole-task approach and the assessment of professional judgment. An effective assessment program will incorporate several competency elements, using multiple sources of information to assess competencies on multiple occasions, at various levels, and in different settings.     

Evaluation Methods for the Assessment of Acute Care Nurse Practitioner Inserted Central Lines: Evidence-Based Strategies for Practice

BackgroundAssessing acute care nurse practitioners' (ACNPs) procedural competence for central line insertions encourages best patient outcomes and meets requirements of national credentialing bodies. Implementation of processes to effectively evaluate procedural competence is complicated by the lack of validated, evidenced-based metrics to evaluate ACNP practices.PurposeThis article identifies validated, evidenced-based metrics to effectively evaluate ACNP procedural competencies.Methodology: A two-part literature review was performed to 1) determine competency evaluation methods for ACNP skills and to 2) evaluate the use of templates/checklists as a means to encourage compliance with national, evidence-based guidelines. Due to the lack of literature on the use of evaluation tools to assess ACNP procedural competency, literature related to medical training programs and practices was reviewed.Review of Literature: Fifteen articles were identified that met review criteria related to procedural competency evaluation. Eleven methods for competency evaluation were commonly identified in the literature; however, conclusive evidence indentifying the most effective means of procedural competency evaluation was not found. Seven studies and one expert consensus were identified related to use of standardized forms and templates/checklists to improve national guideline compliance. All studies indicated the use of standardized documentation significantly increased compliance with national guidelines.     

Shifting paradigms: from Flexner to competencies.

Realizing medical education is on the brink of a major paradigm shift from structure- and process-based to competency-based education and measurement of outcomes, the authors reviewed the existing medical literature to provide practical insight into how to accomplish full implementation and evaluation of this new paradigm. They searched Medline and the Educational Resource Information Clearinghouse from the 1960s until the present, reviewed the titles and abstracts of the 469 articles the search produced, and chose 68 relevant articles for full review. The authors found that in the 1970s and 1980s much attention was given to the need for and the development of professional competencies for many medical disciplines. Little attention, however, was devoted to defining the benchmarks of specific competencies, how to attain them, or the evaluation of competence. Lack of evaluation strategies was likely one of the forces responsible for the three-decade lag between initiation of the movement and wide-spread adoption. Lessons learned from past experiences include the importance of strategic planning and faculty and learner buy-in for defining competencies. In addition, the benchmarks for defining competency and the thresholds for attaining competence must be clearly delineated. The development of appropriate assessment tools to measure competence remains the challenge of this decade, and educators must be responsible for studying the impact of this paradigm shift to determine whether its ultimate effect is the production of more competent physicians.     

Building foundational knowledge competencies in professional geropsychology: Council of Professional Geropsychology Training Programs (CoPGTP) recommendations

By 2050, the US older adult population will have doubled to 83.7 million people from earlier in this century, and the workforce is woefully underprepared to meet the mental health needs of this population. Professional geropsychology has developed comprehensive geropsychology competencies for specialists. Generalists are unlikely to attain full specialty geropsychology competency, however, and there has been little guidance on what core knowledge is key for those who treat a small number of older adults, or how much training is needed. Based on a survey of geropsychology experts, this article presents recommendations for foundational knowledge competencies at the basic “Exposure” level of training for any psychologist who serves older adults along with recommendations for continuing education training time allocation.     

Graduates' perceptions of their clinical competencies in allergy and immunology: results of a survey.

PURPOSE: The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) have identified six areas of general competency. This study surveyed graduates of allergy and immunology training programs about their perceived clinical competency and the adequacy of their subspecialty training. METHOD: In August 2000 and May 2001, a questionnaire was mailed to 373 physicians who had completed a fellowship in allergy and immunology in the United States between 1995 and 2001. Physicians were asked to rate the perceived importance and adequacy of their training in, and their level of competency for, 57 general competencies and subspecialty-specific competencies and procedures. RESULTS: A total of 253 physicians responded (68%). All items in the six ACGME/ABMS general competencies had high ratings (>/= 90%) for perceived importance. One item in the practice-based learning area had low ratings for adequacy of training (57%) and intermediate for competency (75%). Two items in the system-based practice area had low ratings for training (65% and 67%) and intermediate for competency (86% and 88%). Generally, core specialty-specific items (allergic rhinitis, asthma, and urticaria) had high ratings (>/= 90%) for importance, training, and competency. Without exception, items with ratings of less than 70% for adequacy of training also had ratings of less than 90% for competency. CONCLUSION: The general competencies were considered important, but training in system-based practice and practice-based learning may be deficient. Although self-perceived competency in core areas of allergy and immunology was high, weaknesses in training and self-perceived competency in selected areas were identified.     

Taking apart the art: the risk of anatomizing clinical competence.

The Accreditation Council for Graduate Medical Education (ACGME) is encouraging medical residency programs to objectively assess their trainees for possession of six general clinical competencies by the completion of residency training. This is the thrust of the ACGME Outcome Project, now in its seventh year. As residency programs seek to integrate the general competencies into clinical training, educators have begun to suggest that objective assessment of clinical competence may be able to guide decisions about length of training and timing of subspecialization. The authors contend that higher-level competence is not amenable to assessment by the objective comparison of resident performance with learning objectives, even if such objectives are derived from general competencies. Present-day attempts at such assessment echo the uses to which medical schools hoped to put curricular learning objectives in the 1970s. Objective assessment may capture knowledge and skills that amount to the "building blocks" of competence, but it cannot elucidate or scrutinize higher-level clinical competence. Higher-level competence involves sensitivity to clinical context and can be validly appraised only in such a context by fully competent clinical appraisers. Such assessment is necessarily subjective, but it need not be unreproducible if raters are trained and if sampling of trainee performance is sufficiently extensive. If the ACGME approach to clinical competency is indeed brought to bear on decisions about training length and subspecialization timing, the present apprenticeship model for clinical training in the United States, a model both remarkably successful and directly descendant from Osler's innovations, will be under threat.     

Implantación del Examen Clínico Objetivo y Estructurado en la Facultad de Medicina de la Universidad Autónoma de Madrid

The Objective Structured Clinical Examination (OSCE) evaluates clinical skills of medical students at the end of medical school training. Professional competence is the set of knowledge and clinical skills that helps to solve professional problems with the correct attitude. The Conference of Deans from all 40 Schools of Medicine in Spain agreed that all students completing their medical training in the 2015/16 academic year should take an exam to assess 8 competency areas: medical history, physical examination, communication skills, clinical judgment, diagnosis, management and treatment, prevention and health promotion, inter-professional relationships, and ethical and legal aspects. The Madrid Autonomous University Medical School took part in this national project, and conducted its first OSCE, with 25 tests, for the 197 students that concluded their training in 2016. This paper describes the 7 stages, or essential processes followed in order to establish the OSCE. This experience may be useful for the understanding and implementation of this complex competence evaluation process.     

Unified professional psychology: implications for the Combined-Integrated model of doctoral training

The authors outline a new identity for the professional psychologist termed Unified Professional Psychology (UPP). UPP combines recent movements toward a unified psychological science, an independent professional psychology, and Combined-Integrated (C-I) doctoral training programs in psychology. The value in the synthesis of these ideas is that they (a) provide a comprehensive system of thought that defines the science and practice of psychology in a commensurable manner, (b) offer a clear identity for the professional psychologist, and (c) set the stage for a training model that develops competencies that will prepare graduates to serve as leaders and advocates in a wide array of health settings. Issues pertaining to why a new view is needed and how UPP specifies the science-practice relationship are addressed in detail.     

Society of pediatric psychology task force report: recommendations for the training of pediatric psychologists

OBJECTIVE: To provide an overview of the types of training experiences considered most important to the development of competency in pediatric psychology. METHODS: This is the work of a task force commissioned by the Society of Pediatric Psychology, Division 54 of the American Psychological Association. RESULTS: Twelve topic areas, adapted from Roberts et al. (1998), deemed important for obtaining knowledge and expertise in pediatric psychology, were identified. These topics include life span developmental psychology; life span developmental psychopathology; child, adolescent, and family assessment; intervention strategies; research methods and systems evaluation; professional, ethical, and legal issues pertaining to children, adolescents, and families; issues of diversity; the role of multiple disciplines in service-delivering systems; prevention, family support, and health promotion; social issues affecting children, adolescents, and families; consultant and liaison roles; and disease process and medical management. Each area is briefly described and recommendations for obtaining training in these areas are offered. CONCLUSIONS: The Society of Pediatric Psychology offers this document as a comprehensive review of the ideal types of training experiences most important to developing competencies in pediatric psychology. These recommendations can be used by graduate students and graduate programs in shaping a training plan for students interested in pediatric psychology training.     

Preparing neuropsychologists for the future: The need for additional training guidelines.

New guidelines for training in neuropsychology are needed for several reasons: increased diagnostic accuracy of neuroradiologic techniques: an increasing need for functional neuropsychological evaluations; emergence of other psychological specialties; and managed care/economic factors. Current INS-Division 40 guidelines emphasize neurological and diagnostic areas with minimal suggestions for training in rehabilitation and functional issues. The recent publication of training guidelines for Rehabilitation Psychology (APA Division 22) illustrates weaknesses in Division 40 training. It is proposed that neuropsychological training guidelines (formal guidelines and informal training experiences) incorporate another content area for training and demonstration of competency, defined as Functional Outcomes. Specific training is suggested in: (a) issues in disability; (b) ecological validity of tests; (c) vocational evaluation/training; (d) academic programs for students with disabilities; (e) independent living resources; (f) specific cognitive-behavioral interventions; (g) resources for individuals with disabilities; and (h) government assistance programs for individuals with disabilities.     

Responding to Clinical Psychology Practicum Competencies: An APPIC Perspective

This article offers a commentary by representatives of the Association of Psychology Postdoctoral and Internship Centers (APPIC) on the 2015 article written by Gonsalvez et al. related to the assessment of clinical competencies in clinical psychology practicum students. The four competency “super clusters” derived by Gonsalvez et al. result from a unique empirical hierarchical clustering approach and are sure to add important knowledge to the field. This commentary generalizes from clinical psychology education and training in Australia to the United States, expands from practica to internship and postdoctoral training, and reflects on some relevant APPIC issues and initiatives. Future research is also suggested.     

乌市三甲医院产科护士核心能力影响因素的研究

目的 了解乌鲁木齐市三甲医院不同年龄、学历、职称的产科护士核心能力的现状及其影响因素,为产科护士的评价、培训、考核、准入等提供量化依据,为产科护理人力资源管理和政策的制定提供参考。方法 选取2018年3月~6月乌鲁木齐市10所三甲医院398名产科护士作为研究对象,采用一般资料调查表及产科护士核心能力评价指标量表对其进行调查。结果 乌鲁木齐市三甲医院不同年龄、学历、职称的产科护士核心能力总分以及各维度得分比较,差异均具有统计学意义（P＜0.05）。398名产科护士总体核心能力总分为（84.09±23.12）分,得分最高的维度为职业道德及服务意识（2.94±0.73）分,其次为沟通及合作能力（2.78±0.84）分。结论 乌鲁木齐市产科护士总体核心能力较好,护理管理者应重视低年资、低学历、低职称产科护士核心能力的培训,尤其是教育与咨询能力和个人专业发展和知识综合能力,以提高产科护理服务能力及水平。