Through the Looking Glass: Competencies and the Self-Preservation of Basic Science Education

1. Through the Looking Glass: Competencies and the Self-Preservation of Basic Science Education N. Kevin Krane, MD; David S. Franklin, PhD; Kerstin Honer zu Bentrup, PhD; Jennifer W. Gibson, PhD; Deborah Larimer, EdD IAMSE June 10, 2014 - Nashville

2. INTRODUCTIONKevin Krane, MDProfessor of Medicine, Vice Dean for Academic Affairs kkrane@tulane.edu Case Presentation A third-year medical student received a failing grade for his surgery clerkship. While he had passed the shelf exam, the attending documented that he missed rounds several times; and despite meeting with the student to address concerns, the student still missed participating in a patient’s splenectomy. In addition, he was not well prepared on rounds, and avoided helping his intern.

3. The student had no previous academic difficulty in medical school. His case was presented at the Academic Review Committee and the 2 students on this committee were not at all surprised to hear about his behavior. The Student Affairs Dean asked why he hadn’t heard about this student earlier. • Why was this a surprise to the faculty but not the students? • Could the basic science faculty have played a role in identifying this student who was not progressing satisfactorily? • How can our medical education program address these types of issues?

4. Setting the Stage: • What are competencies? • Why are they important? • Where do they fit in basic science?

5. A competency can be defined as . . . • “The ability to perform a specific task in a • manner that yields desirable outcomes.” • Kak N, Burkhalter B, Cooper M. Measuring the competence of healthcare providers: QA • assurance project. U.S. Agency for International Development. 2001 July;2(1):1-28. • “An observable ability . . . integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition.” • Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: Theory to practice. • Med Teach.2010;32:638-645.

6. The AAMC Competencies • Patient Care • Knowledge for Practice • Practice-Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-Based Practice • Interprofessional Collaboration • Personal and Professional Development

7. Competencies in Action Personal & Professional Development - Demonstrate healthy coping mechanisms. - Manage conflict between personal & professional responsibilities. Knowledge for Practice Systems-Based Practice - Describe/Differentiate between forms of CVD. - Describe effective therapies based on basic science. - Learn how to coordinate patient care within the health care system. - Integrate awareness of cost considerations . Patient Care - Role play in teams for history taking. - Practice making informed decisions based on patient information, up-to-date evidence & clinical judgment. Interprofessional Collaboration - Participate in different team roles to provide effective patient care. - Communicate responsibly with other health professionals. Cardiovascular Disease Professionalism Practice-Based Learning & Improvement Communication Skills - Practice responsiveness and sensitivitytodiversity. - Demonstrate integrity, respect & compassion. -Communicate with patients and their families effectively. - Demonstrate understanding & insight about emotions to manage interpersonal interactions effectively. - Peer Instruction to address student gaps in knowledge, skills, and/or attitudes. - Use information technology to optimize learning.

8. Breakout Session 1: Locating Competencies in Basic Science Instruction David S. Franklin, PhD Associate Professor of Biochemistry and Molecular Biology Course Director, Biochemistry Tulane University SOM franklin@tulane.edu

9. Learning Objectives • Locate and/or utilize the AAMC competencies in basic science. • At the completion of this session, attendees will be able to describe methods to address non-knowledge competency-based learning in the basic science curriculum.

10. Let’s Get Organized What’s your level of comfort with identifying the AAMC Competencies in your course? 1. Those with a good comfort level, please line up on the right, towards the front. 2. Clinicians? Please line up behind group one. 3. Those with low comfort level, please line up behind group two. 4. Newbies? Please line up behind group three.

11. Small Teams Case-Based w/ Peer Instruction Personal & Professional Development - Demonstrate healthy coping mechanisms. - Manage conflict between personal & professional responsibilities. Knowledge for Practice Systems-Based Practice - Describe/Differentiate between forms of CVD. - Describe effective therapies based on basic science. - Learn how to coordinate patient care within the health care system. - Integrate awareness of cost considerations . Patient Care - Role play in teams for history taking. - Practice making informed decisions based on patient information, up-to-date evidence & clinical judgment. Interprofessional Collaboration - Participate in different team roles to provide effective patient care. - Communicate responsibly with other health professionals. Cardiovascular Disease Professionalism Practice-Based Learning & Improvement Communication Skills - Practice responsiveness and sensitivitytodiversity. - Demonstrate integrity, respect & compassion. -Communicate with patients and their families effectively. - Demonstrate understanding & insight about emotions to manage interpersonal interactions effectively. - Peer Instruction to address student gaps in knowledge, skills, and/or attitudes. - Use information technology to optimize learning.

12. Competency Example 1 • Based on Biochemistry Topic: Heme Breakdown and Jaundice • Competency: Knowledge for Practice • Describe the underlying difference between hemolytic, obstructive and hepatocellular jaundice. • Based upon lab results, use the increase/decrease of compounds involved in heme breakdown to distinguish each type of jaundice.

13. Competency Example 2 • Based on Biochemistry Topic: Cardiovascular Disease • Competency: Practice-Based Learning and Improvement • After analyzing a full lipoprotein profile, have students work in teams to assess ATP-III guidelines (supply URL) and clinical CHD equivalents. • After viewing data from initial and 3-month follow-up visits, have students refer to the Framingham 10-Year CHD risk score (supply URL) and discuss change in patient’s CHD risk. Make sure to use the risk calculator for the appropriate gender.

14. Let’s Get Going:Competency Exercise (~20 minutes) Use Diabetes to create competency-based activities. • Discuss what each of you is already doing to address your assigned competency as it pertains to diabetes. • Based upon your assigned competency, design activities involving diabetes instruction. • Identify formats or modalities that will work well. • Write results on a flip chart sheet and post on wall. • Note any cross-over with other AAMC competencies. What you will develop:Educational activities that reflect your assigned competency.

15. (10 min) Team Summary for Breakout Session 1

16. Breakout session 2: Assessment of Competencies in Basic Science Courses Kerstin Honer zuBentrup, PhD Assistant Professor of Microbiology Course Director, Introduction to Infectious Diseases Tulane University SOM khonerzu@tulane.edu

17. Learning Objectives • Identify methods to assess the AAMC competencies that are/can be incorporated into basic science topics. For this exercise, limit your discussion to your assigned competency and the information your group generated in the previous exercise. • At the completion of this session, attendees will be able to describe methods to assess non-knowledge competency-based learning in the basic science curriculum.

18. Group Exercise 2 (~20 min) • Based on your results in the previous session: • What are you already doing or what can you envision to assess the competencies you identified in the previous breakout session? • Bear in mind that you don’t always have to be able to assess every single student with the same activity or the same competency. • Write your results on a flip chart sheet and post on wall.

19. Team Summary for Breakout Session 2 (10 min)

20. Wrap-UpJennifer Gibson, PhD; Deborah Larimer, EdDOffice of Medical Education Tulane University SOMjwgibson@tulane.edudlarimer@tulane.edu • Where is Tulane in this process? • Take-Aways • References • Session Eval

21. Selected References • Albanese MA, Mejicano G, Anderson WM, Gruppen L. Building a competency-based curriculum: the agony and the ecstasy. Adv Health SciEduc Theory Pract. 2010 Aug; 15(3):439-54. • Bowe CM, Voss J, Thomas Aretz H. Case method teaching: an effective approach to integrate the basic and clinical sciences in the preclinical medical curriculum. Med Teach. 2009 Sep; 31(9): 834-41. • Fincher RE, Wallach PM, Richardson WS. Basic science right, not basic science lite: medical education at a crossroad. J Gen Intern Med. 2009; 24(11):1255-8. • PangaroL. The role and value of the basic sciences in medical education: the perspective of clinical education – students’ progress from understanding to action. Med Sci Ed. 2010; 20(3):307-13. • Englander R, Cameron T, Ballard A, Dodge J, Bull J, Aschenbrener C. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013 Aug; 88(8):1088-94.