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Competency Workshop
MedbiquitousMay 2011
Susan Albright
Workshop Objectives
By the end of this workshop, participants will be able to:
Describe a process for developing competency frameworks
Identify challenges and potential barriers to developing and implementing competency frameworks
Identify opportunities available with the implementation of competency frameworks in an electronic system
Agenda
Introductions Part 1 – Background on the Tufts
Experience Activity
Part 2 Assessment Discussion
Break Part 3 – Developing the system Discussion Summary
Why Competencies?
“Competency-based education is characterized by the development of clearly defined and explicitly published competencies, mapping the curriculum to achieve competencies, and assessment process matched to competencies.”
(Ron Harden, Medical Teacher 2002 #24 Vol 2
What is Competency Based Education CBE is an institutional process that moves education
from focusing on what academics believe graduates need to know (teacher-focused) to what students need to know and be able to do
CBE is focused on outcomes (competencies) that are linked to workforce needs as defined by the profession.
CBE necessitates complex assessment through portfolios or experiential learning assessement in field experience
Large skill sets are broken down into competencies which sequestial levels of mastery
CBE
Competencies may reinforce one another from basic to advanced as learning progresses
Continual refinement of competencies is essential as this a process not a product
Consistency in expectations across the curriculum
Consistency in gradinghttp://www.ceph.org/pdf/Competencies_TA.pdf
Council on Education for Public Health
Competency Frameworks
ACGME Scottish Doctors Tomorrow’s Doctors The Tuning Project CanMeds MSOP AAMC
ACGME Competency Domains
Patient care Medical knowledge Practice-based learning and
improvement Interpersonal and communication
skills Professionalism Systems-based practice
AAMC Learning objectives
The first of the four attributes is that physicians must be altruistic. There are seven learning objectives, including the objective that before graduation, the student can demonstrate compassionate treatment of patients and respect for their privacy and dignity.
The second attribute is that physicians must be knowledgeable; one of the six learning objectives is that the student can demonstrate knowledge of the normal structure and function of the body and of each of its major organ systems.
The third attribute is that physicians must be skillful; one of the eleven learning objectives is that the student have knowledge about relieving pain and ameliorating the suffering of patients.
The last attribute is that physicians must be dutiful; one of the six learning objectives is that the student have knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies.
Planning Process at the Tufts Cummings Veterinary School
One year + planning process involving:•Educational Dean•Chair of Rotation Directors •All Rotation Directors•Support Workshops provided by the Tufts Center for Teaching and Learning
Part 1 The Tufts Cummings Veterinary School Experience Start with Competency Statements of
accrediting body – AVMA Localize to School Wide graduating
competencies for clinical rotations Workshops on CBE and competency
writing Build rotation/clerkship Competencies Produce Grading Rubrics
Vet School Experience Match each rotation back to the school
wide competencies All competencies come back to
curriculum committee for approval Informatics had not been identified by
any rotation – curriculum committee added these competencies
Curriculum committee added the preclinical competencies
Helpful Tips Provide a good model Provide support – workshops Do not insist on uniformity Make sure grading rubrics match
back to competencies Identify it as a work in progress Hard part was getting the attention
of the rotation directors
Helpful Tips
One person brings it all together Work with external bodies –
curriculum committee to provide overview
How to write Competencies
Understand the level (school-wide, course, content)
Action Words Verbs followed by nouns Measureable and/or observable Performance based
How to write….
Consider relationships up and down the framework
Do not use evaluative words in the competency (this will come later)
Who owns the competency? Who can create? Who can modify?
Feel free to use terms like ‘outcomes’, learning objectives
Part 2
Assessment and grading rubrics
How rubrics help: For Courses:
Rubrics enable faculty to clearly communicate expectations for student performance to students. They support more consistent and objective assessment of student work. They also facilitate detailed feedback to students. When areas of strength and weakness in performance are noted, students more easily comprehend the reasoning behind their professor’s assessment of their work.
A rubric is a scoring guide that seeks to evaluate a student's performance based on the sum of a full range of criteria rather than a single numerical
score. For Student Outcomes Assessment:
Rubrics facilitate quality conversations among faculty about student learning, shorten the time it takes to do SOA, and contribute to the validity and reliability of the assessment process.
- Stevens and Levi, Ch. 2www.uni.edu/chfasoa/IntroductiontoRubrics.ppt
Developing a Rubric cont. Scale
How well or poorly has the student done on the task?
Sophisticated, competent, partly competent, not yet competent. Exemplary, proficient, marginal, unacceptable. Advanced, Intermediate, Novice. Distinguished, proficient, intermediate, novice. Accomplished, developing, beginning. (Huba and Freed, 2000)
Note: Consider whether a scale needs more than three levels. Some research indicates that information about student learning obtained from a three-level scale is comparable to that obtained from a five-level scale. More levels typically means more time spent on assessment.
Developing a Rubric cont.
Dimensions
Dimensions break down a task into components and identify the importance of these components.
Dimensions are descriptive, not evaluative (e.g., “organization” not “good organization”).
Dimensions help students see that the work they are doing is multidimensional and draws on multiple abilities.
Developing a Rubric cont.
Description of the Dimensions
Rubrics should contain at least a description of the highest level of performance.
With experience and in response to the complexity of the performance, descriptions of all levels can be written.
Students need not fit cleanly into a single category. On oral presentation skills, a student might speak in a clear voice but lack eye contact.
Descriptions for each level help students see that the work they are doing does have varying levels of achievement. There is a difference between poor and excellent work.
Examples of Grading Rubrics
handout
Competency Assessment- TUSK mock-ups
Planning Process
After the competencies and grading rubrics TUSK had a series of meetings with :•Educational Dean•Chair of Rotation Directors •All Rotation Directors
•Iterative process of moving current process to Online version integrated with TUSK• Create Powerpoint ”story board” which developer used as functional spec
Process to get to competency assessment in TUSK
TUSK meetings with vet school leaders Understand business processes Translate these to the online world Develop powerpoint story board to achieve
agreement of functional spec Iterate over 7 months Check in with all rotation directors
Test and train Pilot test in two clerkships Release to all clerkships
View the Process through Every Lens Course Administrators
Create form Link to competencies Link Faculty to students
Faculty Assessors Able to select/deselect students See picture of student Easy access to form
Course Director See each assessor’s view as well as summary Able to add comments Able to override scores
Student View the results Compilation of all clerkship results
Registrar Access final grade (allow resubmit)
Competency AssessmentFeatures
Prepare TUSK to accept competencies Link to School-wide/course competencies Configurable form for each course Multiple assessors Access to Registrar Show scores or only feedback Multiple rubrics per form Override score/grade Student retains access to scores over time
Overview
I. Admin Viewa) Populate Competency Datab) Populate Competency
Assessment Form & Datac) Other Assessment Form Data
II. Faculty Viewa) Access to the Assessmentb) Selecting Additional Studentsc) Assessment Form
III. Director Viewa) Assessment Results for All
Studentsb) Completion Report
III. Director View (con’t)c) Individual Student Resultsd) Completed Faculty/Staff
Forme) Summary Form
IV. Student Viewa) Accessing Assessment
Results
V. Registrar ViewIV. View final grades
I. Administrator View
Creating and Populating
Competency Assessment Data
POPULATE COMPETENCY DATA
Done at the School Administrator level
Step 1: Create Competency Category
Modify Competency Category
Add Sub-Competency Levels (if applicable)
Sort Competencies
Sort Child Competencies
POPULATE COMPETENCY ASSESSMENT FORM DATA
Done at the Course Admin level
Step 2: Create Assessment Form(s)
Note: The “View Reports” button is only visible to the course director “Balance Weights” still needs to be further discussed/clarified
Populate Assessment Form Metadata
Grading is numeric. There will be an option in the grade book to give an equivalent letter or pass/fail grade
Scoring Range defaults to ‘No’
Score Display:• Score & Feedback• Feedback Only
Scoring Value:• Max value = 25
Frequency:• Max No. = 10
Step 3: Populate Fields and Data
Question type: Scaling Scaling w/Sub-question Single Select Single Select w/Sub-question
Multi-level questions (options with sub-questions)
Link competencies to questions Free-text feedback option
Add Field: Scaling
Make text boxes bigger
Linking Competencies
Scaling w/ Sub-Questions
Add Field: Single Select
Single Select w/ Sub-level Questions
OTHER COMPETENCY ASSESSMENT FORM DATA
Done at the Course Admin level
Considerations
Display student images? Display elective information? Display summary comments Multiple assessors? Who selects assessors?
Considerations?
Use Numeric scores? Display scores to students or just
comments? Display scores to assessors? 360 degress review? What else?
Link Faculty/Student
II. Faculty View
Getting to the form
Accessing the Assessment(s)
Accessing the FormEvaluator: J. Berg
Assessment Form – Scaling
Assessment Form – Single Select
III. Director View
Viewing assessment results
Assessment Results – All Students
Assessment Results – Individual Student
Note: To view a form completed by a faculty/staff click their name
Note: When ready, click here to fill out a final assessment form for the student
Completed Form by Faculty/Staff
Summary Form
Hover over score to see actual individual
scores
This is at the bottom of the form
Click to view student’s patent logs in a pop-up window
Student’s Patient Log Summary
This opens up as a pop-up window
Completion Report
Send Email Reminders
IV. Student View
Access via the Grade Book
Accessing Assessment Form
Note: Link to view final assessment form completed by the course director
Accessing Assessment Form
J. Berg happens to also be the course director
V. Registrar View
View Final Grades
Grades by Course
Step 1: Select the course
Grades by Course
Step 2: Select the time period
Part 3
Building the Framework
First steps
A set of clear definitions Use cases A survey of Canadian, US and UK
health professional education organizations (24 respondents)
See definitions_and_usecases.pdf for details (medbiquitous.org)
Comparison of published frameworks
Accreditation Council on Graduate Medical Education (ACGME) Competencies8
Acute Care Nurse Practitioner Competencies American Association of Critical-Care Nurses (AACN) General
Patient Care Competencies American Society of Health-System Pharmacists CanMEDS 20059
CanMEDS Specialty Competencies Good Medical Practice (UK) Good Medical Practice (USA) The Scottish Doctor7 Tomorrow's Doctors Tuning (MEDINE) Women’s Healthcare Competencies
DEVELOPMENT OF A CONCEPTUAL MODEL
Outcomes for Clinical Skills
A competency object . . .
Relates to other competency objects . . .
Which can relate to external resources . . . Learning
ObjectAssess-ment
Performance data
Outcomes for Clinical Skills
A competency object . . .
Relates to other competency objects . . .
Which can relate to external resources . . . Learning
ObjectAssess-ment
Performance data
Current Specifications
Specs and Schemas Available At:
http://www.medbiq.org/working_groups/competencies/index.html
Open license, membership not required
Competencies – individual competency definition
A standard format for a single competency definition, including an identifier, categories and references.
Competency Object
Working draftBeing implemented by TuftsMay be implemented by VA
Essential for tying curricula to competencies and enabling competency based education.
Competencies – an interrelated set of competencies
A framework for establishing the relationships among competencies in a single framework
Competency Framework
Working draftBeing implemented by TuftsMay be implemented by VA
Essential for integrating existing competency sets into curriculum management systems.
Competencies – evidence of achievement
A format for documenting achievement of a milestone or competency.
Educational Achievement
Work to begin in July 2010
This will be important for schools tracking competence in a portfolio and for residency programs tracking competence.
Competencies – cross-mapping
A format for mapping competencies from one framework to competencies from another framework.
Informal proposal from competency working group (planned work)
Should we arrive at the point of having a national competency framework, this would be important for schools that want to see how local competencies fit into the national picture.
Competencies – mapping to external resources
A way of mapping competencies to learning activities and resources, curricula, and potentially performance data.
Informal proposal from competency working group (planned work)
Could be important for the curriculum inventory portal should it be competency based.
Spec needs Analysis of the Problem from all perspectives Student View
How am I doing? What do I have to do? How can I show my learning
Faculty view How is student doing Grade/Rate/Comment on student View proof of learning See full range of expected learning outcomes
Registrar Track grades
Admin View What are the competencies Where are competencies taught -
content/courses/themes/rotations/clinics Where are the gaps
Need tools to Enter, Store, view, Grade
Medbiquitous Competency Object Standard
Copyright Medbiquitous consortium 2010 All rights reserved May 20 2010 p.11
What Info Needs to be brought Together
School wide competencies Course level competencies/learning
objectives Content addressing competencies
and learning objectives Element of time – when and how
much How are competencies assessed
Where does TUSK get the Data
Schedule Content linked to schedule (upon
upload) Curriculum hours pulled from
schedule Keywords linked to content
School WideCompetencies:Competency Framework
School WideCompetencies:Competency Framework
Course competenci
es
Course competenci
esCourse competenci
es
Course competenci
es
Content repository
w/metadata
Content repository
w/metadata
Contentcompetenc
ies
Contentcompetenc
ies
Competency
Assessment
Competency
Assessment
skillsskills knowledge
knowledge attitudesattitudes
Where are they taught ?
How are they taught?
Where are they assessed?
ExternalCompetency Framework
ExternalCompetency Framework
lectures
lectures
PBLPBL
rotations
rotations
When?(Links to schedule)
Competencies
Schedule – Curriculum View
First year courses
Course Summary view
Methods to Display Complex Datacomplex data displays
References Medical Teacher: Outcomes-Based Education Themed Issue
Vol 29 Number 7 September 2007 Lessons Learned from the Competency-Based Curriculum
Initiative at Baylor College of Dentistry. McCann, Ann L.; Babler, William J.; Cohen, Peter A., Journal of Dental Education, v62 n2 p197-207 Feb 1998
The new formal competency based curriculum at Indiana University School of Medicine, Litzleman and Cottingham, Academic Medicine Vol 82, No. 4 April 2007
An educational blueprint for the Brown Medical School, Smith MD
Learning objectives for medical student education--guidelines for medical schools: report I of the Medical School Objectives Project. AAMC Acad Med. 1999 Jan;74(1):13-8.