Articulating and Measuring Competencies Across the Continuum of Osteopathic Medical Education

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Articulating and Measuring Competencies Across
the Continuum of Osteopathic Medical Education
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Articulating and Measuring Competencies Across
the Continuum of Osteopathic Medical Education

• Peter B. Dane, D.O. FACEP
• Associate Dean for Pre-doctoral Education
• Ohio University College of Osteopathic Medicine
• Paul M. Krueger D.O. FACOOG
• Associate Dean for Education and Curriculum
• UMDNJ-School of Osteopathic Medicine
• Karen M. Steele, D.O. FAAO
• Associate Dean for Osteopathic Medical Education
• West Virginia School of Osteopathic Medicine

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Objectives

• At the end of the session attendees will
• Define the process of developing a competency
  based curriculum
• Link learning objectives to appropriate
  assessment tools
• Outline a method of competency assessment and
  documentation.
• Use institutional assessment to achieve the AOA
  Core Competency 1 Osteopathic Philosophy and
  Osteopathic Manipulative Medicine

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How?

• Competency Based Education 101
• Assessment Mapping
• OMM Institutional Assessment
• Questions
• Discussion

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INSTITUTE OF MEDICINE
A Bridge to Quality
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IOM Crossing the Quality Chasm

• Competencies are defined here as the habitual
  and judicious use of communication, knowledge,
  technical skills, clinical reasoning, emotions,
  values, and reflection in daily practice.
• Hundert et al. Acad Med 1996 71(6)624

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IOM Competencies

• Provide patient-centered care
• Work in interdisciplinary teams
• Employ evidence-based practice
• Apply quality improvement
• Utilize informatics

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Seven Core Competencies of the Osteopathic
Profession

• Osteopathic Philosophy and Osteopathic
  Manipulative Medicine
• Medical Knowledge
• Patient Care
• Interpersonal and Communication Skills
• Professionalism
• Practice-Based Learning and Improvement
• Systems-Based Practice

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Competency Based Education

• Who is it for?
• Not just residents!
• Not just medicine!
• What is the difference?
• Design
• Explicit
• Assessad

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Why Should We Move to Competency Based Education??

• Institute of Medicine
• All health professionals should be educated to
  deliver patient centered care as part of an
  interdisciplinary team, emphasizing
  evidence-based practice, quality improvement
  approaches and informatics

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Why Should We Move to Competency Based Education??

• IOM Levers
• Accreditation is the most potent lever for
  curricula reform
• CMS should take the lead in funding
• Report cards

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Why Should We Move to Competency Based Education??
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How do you design a competency based curriculum?
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BACKWARDS
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Designing a Competency Based Curriculum

• Start with the finishing resident/student
• Identify
• Knowledge
• Skills
• Attitudes/behaviors
• WHAT to learn

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Management of Cervical Neoplasia
Learning Objective
Perform a pap smear
Outline management for an abnormal pap smear
Assess the need for cervical screening
Describe the pathogenesis of cervical neoplasia
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BACKWARDS
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Designing a Competency Based Curriculum

• Start with the finishing resident/student
• Identify
• Knowledge
• Skills
• Attitudes/behaviors
• What
• HOW

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Teaching/Learning

• Lecture
• Discussion
• Student Directed Learning
• Case Based Learning
• Problem Based Learning
• Role Playing
• Simulated Patient Lab
• Electronic Computer Simulators
• Web Based

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Linking Learning Objectives to Assessment
Millers Triangle
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Millers Triangle
Learning Objective
Does
Perform a pap smear
Shows How
Outline management for an abnormal pap smear
Knows How
Assess the need for cervical screening
Knows
Describe the pathogenesis of cervical neoplasia
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The ACGME Toolbox
http//www.acgme.org
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Evaluation Tool
Millers Triangle
Learning Objective
Checklist, Record review
Does
Perform a pap smear
OSCE, Standardized patient
Shows How
Outline management for an abnormal pap smear
Multiple choice exam, oral exam, OSCE
Knows How
Assess the need for cervical screening
Multiple choice exam, oral exam
Knows
Describe the pathogenesis of cervical neoplasia
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Designing a Competency Based Curriculum

• Explicit
• Assessed

BACKWARDS
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Outline a method of competency assessment and
documentation

• Peter B. Dane, D.O. FACEP
• Associate Dean for Pre-doctoral Education
• Ohio University College of Osteopathic Medicine

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Articulating Measuring Competencies Across the
Continuum of Osteopathic Medical Education
Institutional Assessment

• Karen M. Steele, D.O., F.A.A.O.
• Associate Dean for Osteopathic
• Medical Education
• West Virginia School of Osteopathic Medicine

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Goal of OPP Integration Project

• to create a curriculum that will graduate
  physicians who utilize the osteopathic philosophy
  in their clinical practices and provide
  osteopathic manipulation to their patients.

James R. Stookey, D.O., 1992
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AOA Core Competency 1

• Residents are expected to demonstrate apply
  knowledge of accepted standard in Osteopathic
  Manipulative Treatment (OMT) appropriate to their
  specialty. The educational goal is to train a
  skilled competent osteopathic practitioner who
  remains dedicated to life-long learning and to
  practice habits in osteopathic philosophy
  manipulative medicine.

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Needs assessment, 1993

• Interviewed faculty, students, staff
• Reviewed senior exit data, national board
  performance in OPP, ECOP curriculum document, etc
• Surveyed classes of 1987 and 1988
• last classes to have finished residency and be in
  practice 2 or more years prior to OPP Integration
  project
• return rate 57

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OPP Integration Project

• 1992 Task force named
• 1993 Institutional self-assessment, creation of
  document, curriculum committee revision
  approval
• 1994 OPP Integration Discipline (now the Case
  Studies in Osteopathic Medicine Discipline)
• 1995 First OMM Student Clinic
• 1996 OPP Integration became standing faculty
  committee
• 1997 Faculty voted to change review
  criteria for retention, tenure and
  promotion to include OPP Integration
• 2003 Position of Associate Dean of Osteopathic
  Medical Education created, OPP Integrated into
  PBL
• (http//www.wvsom.edu/clinicalsciences/opp/OPPInt
  egDoc93.pdf)

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Assessment 2003

• Survey of class of 1998
• first class to have finished residency and be in
  practice 2 years and have had OPP Integration for
  4 years of osteopathic medical education
• return rate 38

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Classroom/lab exposure to osteopathic philosophy
was provided byCLINICAL SCIENCES faculty
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Classroom instruction/assistance in integration
of OMT into practice was provided by CLINICAL
SCIENCES faculty
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Classroom/lab exposure to osteopathic philosophy
was provided byBASIC SCIENCES faculty
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Classroom instruction/assistance in integration
of OMT into practice was provided by BASIC
SCIENCES faculty
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At the end of your sophomore year, how well
prepared were you to diagnose and treat a patient
regarding OMT/OPP?
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For rotations with DOs, instruction/assistance
in integration of OMT into practice was provided
by
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To what extent did your clinical rotations
enhance your preparation regarding OMT/OPP?
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OVERALL, by graduation, did you feel that you
were adequately prepared to diagnose and treat a
patient regarding OMT/OPP?
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Comparison end year two and four self evaluation
of preparation to diagnose and treat a patient
regarding OMT/OPP

• Class of 1988
• End of year 2 80 felt well or very well
  prepared
• End of year 4 60
• Class of 1998
• End of year 2 95 felt well or very well
  prepared
• End of year 4 75

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Future planned assessments

• Comparison of student rating of incorporation of
  osteopathic concepts
• between WVSOM on-campus and guest faculty
  teaching in 1st two years
• Between DO and non-DO teachers
• Between systems, courses and disciplines

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Conclusion

• Institutions can change in a pre-determined way,
  if guided by a vision and clearly defined goals
• Assessment is a powerful tool to reinforce and
  guide that change
• Create assessment tools that you can live with
  long term

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Questions for Discussion

• Competencies Important advance or the next fad?
• Are the AOA GME competencies right for
  predoctoral education?
• How do we assess professionalism?
• Can competencies be integrated into CME?
• How much Systems Based Practice is right for
  predoctoral education?