Henry M. Sondheimer, MD Association of American Medical Colleges 7 August 2013 A Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians

1) Have a clear understanding of the concept of CBME 2) Have shared experiences of MEPI schools instituting CBME 3) Form future collaborative initiatives on Competency Based Medical Education Objectives for this session

What is a competency? A competency is an observable behavior that combines knowledge, skills, values, and attitudes related to a specific activity

What is a competency? Observable behavior that combines knowledge, skills, values, and attitudes related to a specific activity

The Paradigm Shift Structure/ProcessCompetency-based Driving Force for Curriculum Content & Knowledge Acquisition Outcomes & Knowledge Application Driving Force for Process TeacherLearner(s) Path of LearningHierarchyNo Hierarchy Responsibility for Learning TeacherStudent and Teacher partnership

Framework for Evaluation of Competence Structure/ProcessCompetency-based Typical Assessment Context Proxy / RemovedAuthentic / “In the trenches” Direct observation Typical Assessment Tool Single or few, often Multiple Choice Questionnaires (MCQs) Multiple, subjective as well as objective Portfolios

Framework for Evaluation of Competence Structure/ProcessCompetency-based Timing of AssessmentEmphasis on summativeEmphasis on formative Type of EvaluationNorm-referencedCriterion-referenced

Central Tenet of CBME

The Competent Physician

Patient Care Professionalism

The Competent Physician Patient Care Medical Knowledge Interprofessional Collaboration Personal & Professional Development Systems- based Practice Practice-based Learning & Improvement Professionalism Interpersonal and Communication Skills

Early on it became clear that the viewable and assessable competencies (“develop and carry out patient management plans”, “interpret lab data, imaging studies, and other tests required for one’s area of practice”) fell into higher domains (Patient Care) Each competency domain has multiple competencies (Patient Care has eleven) What are the Competency Domains?

Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice Inter-professional collaboration Personal and Professional Development The eight Competency Domains

The Competent Physician Patient Care Medical Knowledge Interprofessional Collaboration Personal & Professional Development Systems- based Practice Practice-based Learning & Improvement Professionalism Interpersonal and Communication Skills

Competencies for the Domain of Patient Care  Perform procedures of the specialty  Organize and prioritize responsibilities  Gather essential information  Interpret lab data, imaging studies and other tests  Make informed diagnostic/therapeutic decisions  Develop and carry out management plans

 Demonstrate an analytic approach to clinical situations  Apply principles of clinical sciences to diagnostic and therapeutic decision-making  Contribute to the creation, dissemination, application and translation of new healthcare knowledge Competencies for the Domain of Medical Knowledge

 Identify strengths, deficiencies and limits in one’s knowledge and expertise  Set personal learning and improvement goals  Identify and perform learning activities that match one’s needs  Systematically analyze one’s practice and make improvements  Incorporate formative feedback into practice Competencies for the Domain of Practice-based Learning and Improvement

 Communicate effectively with patients, families, and the public  Communicate effectively with other colleagues within one’s profession, other health care professionals, and health related agencies  Work effectively with others as a member or leader of a health care team or other professional group  Provide consultation to other health professionals  Maintain comprehensive, legible, and timely records  Demonstrate sensitivity, honesty, and compassion in difficult conversations  Demonstrate insight into emotions to allow management of interpersonal interactions Competencies for the Domain of Interpersonal and Communication Skills

 Demonstrate compassion, integrity and respect for others  Demonstrate responsiveness to patient needs that supersedes self-interest  Demonstrate respect for patient privacy and autonomy  Demonstrate accountability to patients, society, and the profession  Demonstrate sensitivity and responsiveness to a diverse patient population  Demonstrate a commitment to ethical principles (both patient care and business practices) Competencies for the Domain of Professionalism

 Work effectively in various health care delivery settings  Coordinate patient care within the health care system  Incorporate considerations of cost awareness and risk- benefit analysis in patient and/or population-based care  Advocate for quality patient care and optimal patient care systems  Participate in identifying systems errors and implementing potential systems solutions  Perform administrative and practice management responsibilities commensurate with one’s role Competencies for the Domain of Systems-based Practice

 Work with individuals of other professions to maintain a climate of mutual respect and shared values  Use knowledge of one’s own and others’ roles to assess and address health care needs of individuals and populations  Communicate with other health professionals to optimize health maintenance and treatment of disease in patients/populations  Participate in different team roles to establish, develop, and continuously enhance inter-professional teams to provide patient- and population-centered care that is timely, efficient, effective and equitable. Competencies for the Domain of Inter-professional Collaboration

 Know one’s limits and engage in help-seeking behaviors  Demonstrate a healthy response to stress  Manage conflict between personal and professional responsibilities  Practice flexibility and maturity in response to change  Demonstrate trustworthiness  Demonstrate leadership that ultimately improves patient care  Demonstrate confidence  Manage Uncertainty Competencies for the Domain of Personal and Professional Development

“A faculty member personally observed me performing a physical examination during this clerkship”: IM 73%78% FM72%82% Peds75%83% Surgery51%58% U.S. Graduation Questionnaire

“Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians” Englander et al., Academic Medicine, August 2013 thanks

Questions?