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

2. 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

3. 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

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

6. INSTITUTE OF MEDICINE
A Bridge to Quality

7. 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

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

9. 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

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

11. 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”

12. 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

13. Why Should We Move to Competency Based Education??

16. How do you design a competency based curriculum?

17. BACKWARDS

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

19. 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

20. BACKWARDS

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

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

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

24. 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

25. The ACGME Toolbox

26. 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

27. Designing a Competency Based Curriculum
Explicit
Assessed
BACKWARDS

29. 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

31. 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

32. 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

33. 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.

34. 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%

35. OPP Integration Project
Task force named
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 *(

36. 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%

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

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

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

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

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

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

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

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

45. 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%

46. 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

47. 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

49. 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?