Articulating and Measuring Competencies Across the Continuum of Osteopathic Medical Education

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

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

How? Competency Based Education 101 Assessment Mapping OMM & Institutional Assessment Questions Discussion

INSTITUTE OF MEDICINE A Bridge to Quality

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

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

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

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

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”

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

Why Should We Move to Competency Based Education??

How do you design a competency based curriculum?

BACKWARDS

Designing a Competency Based Curriculum Start with the finishing resident/student Identify Knowledge Skills Attitudes/behaviors WHAT to learn

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

BACKWARDS

Designing a Competency Based Curriculum Start with the finishing resident/student Identify Knowledge Skills Attitudes/behaviors What HOW

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

Linking Learning Objectives to Assessment: Millers Triangle Does Shows How Knows How Knows

Learning Objective Millers Triangle Perform a pap smear Does Outline management for an abnormal pap smear Shows How Assess the need for cervical screening Knows How Describe the pathogenesis of cervical neoplasia Knows

The ACGME Toolbox http://www.acgme.org

Learning Objective Millers Triangle Evaluation Tool Perform a pap smear Does Checklist, Record review Outline management for an abnormal pap smear Shows How OSCE, Standardized patient Assess the need for cervical screening Knows How Multiple choice exam, oral exam, OSCE Describe the pathogenesis of cervical neoplasia Knows Multiple choice exam, oral exam

Designing a Competency Based Curriculum Explicit Assessed BACKWARDS

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

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

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

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.

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%

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/OPPIntegDoc93.pdf)

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%

“Classroom/lab exposure to osteopathic philosophy was provided by: CLINICAL SCIENCES” faculty

“Classroom instruction/assistance in integration of OMT into practice was provided by: CLINICAL SCIENCES” faculty

“Classroom/lab exposure to osteopathic philosophy was provided by: BASIC SCIENCES” faculty

“Classroom instruction/assistance in integration of OMT into practice was provided by: BASIC SCIENCES” faculty

“At the end of your sophomore year, how well prepared were you to diagnose and treat a patient regarding OMT/OPP?”

“For rotations with DOs, instruction/assistance in integration of OMT into practice was provided by:

“To what extent did your clinical rotations enhance your preparation regarding OMT/OPP?”

“OVERALL, by graduation, did you feel that you were adequately prepared to diagnose and treat a patient regarding OMT/OPP?”

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%

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

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

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?