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Disclosures

Competency-based Medical Education (CBME) and Transformation Future Directions of Credentialing Research in Nursing: A Workshop. Disclosures. Eric Holmboe Employed by ACGME Formerly employed by ABIM Receives royalties for textbook from Mosby-Elsevier. Why CBME: System Needs.

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Disclosures

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  1. Competency-based Medical Education (CBME)and TransformationFuture Directions of Credentialing Research in Nursing: A Workshop

  2. Disclosures • Eric Holmboe • Employed by ACGME • Formerly employed by ABIM • Receives royalties for textbook from Mosby-Elsevier

  3. Why CBME: System Needs Frenk J. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010 3

  4. What Are The Outcomes? A competent (at a minimum) practitioner aligned with: CMS Triple Aim

  5. The Assessment “System” Unit of Analysis: Program Residents FB • Assessments within Program: • Direct observations • Audit and performance data • Multi-source FB • Simulation • ITExam J U D G E M E N T Accreditation Qual/Quant “Data” Synthesis: Committee P U B L I C D FB D D Certification and Credentialing FB Faculty, PDs and others Unit of Analysis: Individual Milestones and EPAs as Guiding Framework and Blueprint

  6. Milestones • By definition a milestone is a significant point in development. • Milestones should enable residents, fellows and the training program to better determine an individual’s trajectory of competency acquisition.

  7. Developmental Progression or Set of Milestones Competency Sub-competency Specific Milestone

  8. Entrustable Professional Activities • EPAs represent the routine professional-life activities of physicians based on their specialty and subspecialty • The concept of “entrustable” means: • ‘‘a practitioner has demonstrated the necessary knowledge, skills and attitudes to be trusted to perform this activity [unsupervised].’’1 1Ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007; 82(6):542–547.

  9. Competencies, Milestones and EPAs COMPETENCY COMPETENCY COMPETENCY COMPETENCY MILESTONES MILESTONES MILESTONES MILESTONES Entrustable Professional Activity

  10. Milestones and EPAs as Roadmap • Observations: • Journey not a straight line • More than one path (but not infinite) • “If you don’t know where you are going, any road will get you there”

  11. Dreyfus & DreyfusDevelopment Model Expert/ Master Proficient Competent Advanced Beginner Novice Time, Practice, Experience Dreyfus SE and Dreyfus HL. 1980 Carraccio CL et al. Acad Med 2008;83:761-7

  12. Dreyfus & DreyfusDevelopment Model MILESTONES Curriculum Assessment Curriculum Assessment Curriculum Assessment Curriculum Assessment Curriculum Assessment Expert/ Master Proficient Competent Advanced Beginner Novice Time, Practice, Experience Dreyfus SE and Dreyfus HL. 1980 Carraccio CL et al. Acad Med 2008;83:761-7

  13. Effective Assessment System Processes • Most important component of curriculum is the clinical care clnicians provide and experience • Clarity on right outcomes linked to curriculum • Integration of the educational and clinical systems • Right combination and synthesis of assessment methods • Critical importance of shared understanding & mental models of competence • Competencies, milestones, entrustable professional activities (EPAs)

  14. Improvements We Can Implement Now • Observe, observe, observe • There is currently no substitute for ongoing observation and feedback from an expert clinician. • Stop seeking the grail of assessment forms. • Assessment forms are only as good as the individual using them. • Align assessment forms with purpose & construct. • Invest in assessor development. • Refine use of work-based assessment methods. • Treat local assessment practices as a continuous quality improvement activity.

  15. Next Steps for Assessment • Need to advance development of work-based assessment (WBA) methods • Interprofessional team care • Effective use of clinical decision support • Quality, systems-based practice, safety • Sophisticated communication skills • Embed WBA into routine clinical work • EMRs will need to evolve • Robust and longitudinal feedback loops

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