Overview: Competency-Based Education & Evaluation

Dr. Deborah M. FournierAssistant Provost for Institutional Research & EvaluationBoston University Medical

December 7, 2009

Competency-based Education

An approach to curriculum that emphasizes the attainment of specific knowledge, skill and attitudes associated with carefully defined performance behaviors expected of entry-level independent practitioners.

Competency-based Education

Performance evolves along a continuum from novice beginner competent proficient mastery

Competency-based Education

Focus on integration and synthesis of information and experiences to create “working knowledge” that can be used in a real world setting

Competency-based Education

Focus on how students organize and structure knowledge (how students learn versus how and what to teach)

Competency-Based Education

Grounded in Mastery LearningA Mastery Learning approach can

produce significant gains in student achievement

Research

One-on-One Coaching and Apprenticeship: 90% of students perform at the level primarily

reached by the top 16% of students in a traditional curriculum

Mastery Learning Strategies: Given enough time on task and under optimal

conditions 70% of students achieve the level primarily reached by the top 16% of students in a traditional program

Longer lasting effect weeks after the course ended (recall was enduring)

Aptitude

Achievement

Mastery Learning

Major Assumptions

The higher the quality of instruction, the less relevant student aptitude becomes

Most students can learn well and achieve high performance if:1) given enough time on task2) instruction is designed and delivered for

“optimal effect”

Major Assumptions

Traditional

Time = ConstantLearning = Variable

Competency-based

Time = VariableLearning = Constant

General Characteristics

Competency-based Cognitive Outcomes-based Demonstrating independent practice Successive stages

toward mastery Each student gets the amount and kind of instruction needed Instruction varies and learning is constant Achievement is skewed

to the right

Traditional Behavioral Content-based Meeting clinical

requirements Accumulation of facts, concepts, skill All students receive

same identicalinstruction

Instruction is constant and learning varies Achievement is normally distributed

Basic Features

Competencies Prerequisite Testing Instructional Activities Formative Evaluation Summative Evaluation Criterion-based Evaluation Remediation or Corrective Activities Enrichment Activities Milestones (Progress Monitoring Mechanisms)

Competency-based Evaluation

Involves the evaluation of complex, higher-level skills in a real world setting that provides open-ended tasks that require a high degree of choice and judgment.

Competency-based Evaluation

Multiple methodsMultiple measuresMultiple perspectivesMeasurement over timePattern of evidenceLevels of evidenceValid and reliable measurement

Formative Evaluation

To direct and pace student learning and tailor faculty teaching

It gives evidence on how students are changing in their progress toward competency

It gives evidence about learning while instruction is in progress

Encourages students to take intellectual risks without being penalized

Summative Evaluation

It gives evidence on how students have changed (as opposed to formative which shows how they are changing)

The student is put in a testing mode where they are performing independently, that is, there is “no instruction/teaching in progress” as with formative

Evaluation Tools

Standardized Patients Objective Structured Clinical Examination Simulations Oral Structured Examination Triple Jump Examination Chart-stimulated Recall Skill Test Competency Examination Portfolio Review Case Presentation Mock Board Written Tests (combined w/ performance tests)

Standardized Patients

Individuals (actors) who are scripted to behave in a certain way so as to solicit certain kinds of responses from students

Uses a checklist type instrument called an Interaction Analysis tool where a faculty observer records and scores how the student behaves/performs in a particular scenario

Useful for assessing communication and interpersonal skills, diagnosis, treatment planning, and patient presentations

Objective Structured Clinical Exam

A series of timed stations that examine a variety of higher-order thinking situations

Write a tx plan, assessment and diagnosis, interview a patient

Useful for assessing diagnosis, treatment planning, clinical reasoning

Simulations

Contains some of the most salient features of the situation to be experienced by students once in practice

Computer sims, manikins, actors, models

Useful for assessing subsets of clinical skills, clinical judgment

Oral Structured Exam

A series of standardized questions that require the student to use higher-order thinking skills to respond

Questions focus on patient management, treatment planning, cultural awareness, outcomes of treatment

Useful for assessing judgment, professionalism, evidenced-based critique

Triple Jump Exam

A specific type of Oral Structured Exam that involves three steps:1) Problem Definition (1/2 hour)2) Information Search (2 hours)3) Synthesis (1/2 hour)

Useful for assessing critical thinking, problem solving, research skills, ethical decision-making, self-directed learning

Chart-stimulated Recall

A review of several patient charts that belong to a student

Faculty evaluator asks a series of standardized questions on patient mgt, risk assessment, clinical judgment

Useful for assessing patient management, ethical decision-making, cultural awareness

Skill Test

Examines an extracted set of skills from a more complex situation and ignores other skills

Emphasis is often on evaluating the product at the end of each step

Useful for assessing a variety of skill sets in the novice and beginner stages

Competency Exam

Integration of multiple skill sets while the student is rendering patient care

Focused on observing and scoring the integration of a broad range of skills during the entire student-patient interaction

Uses open-ended tasks that require a high degree of choice and judgment

Useful for assessing integrated knowledge and skill – putting it all together in varied and complex situations

Portfolios

A “purposeful” collection of student work that documents evidence of progress and achievement over time

Not a collection of most assignments completed during school

Requires careful development of guidelines for what to include, standards, timelines, etc.

Useful for assessing many skills evidenced in other tools