Overview: Competency-Based Education & Evaluation Dr. Deborah M. Fournier Assistant Provost for Institutional Research & Evaluation Boston 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 Learning A 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 task 2) instruction is designed and delivered for “optimal effect”

Major Assumptions Traditional Time = Constant Learning = Variable Competency-based Time = Variable Learning = 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 identical instruction 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 methods Multiple measures Multiple perspectives Measurement over time Pattern of evidence Levels of evidence Valid 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