1 / 60

Building and Assessing Competence

Building and Assessing Competence. David C. Leach, M.D. Executive Director ACGME September 12, 2002. Objectives. To clarify what you have known all of your professional life about competence To explore how residents learn to make good clinical judgments

ilya
Download Presentation

Building and Assessing Competence

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Building and Assessing Competence David C. Leach, M.D. Executive Director ACGME September 12, 2002

  2. Objectives • To clarify what you have known all of your professional life about competence • To explore how residents learn to make good clinical judgments • To define specific steps that can be taken to respond to the ACGME Outcome Initiative

  3. Reasons this is hard Yet can also be immensely satisfying.

  4. Reason Number OneCompetence is a Habit

  5. Competence“…the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.”Epstein and Hundert JAMA, Jan. 9, 2001

  6. Why worry about it? • Public concerns with safety • Variability in patterns of care that are not based on science • Poor customer service

  7. ACGME Outcome Project • The Project A long term initiative • The Vision to enhance residency education • The Process through educational outcome assessment

  8. Reason Number TwoACGME/RRCs judge competence of Programs Boards judge individuals

  9. A slight problem … • We accredit programs • Programs don’t exist • The only things that are real are the humans and the relationships between humans in so-called programs • These relationships can either inhibit or facilitate learning

  10. So what do we accredit? • Humans? • Sets of relationships? • Educational outcomes?

  11. Reason Number ThreeHumans: the important things are hard to measure

  12. Dee Hock’s Criteria for Hiring People • Integrity • Motivation • Capacity • Understanding • Knowledge • Experience

  13. Reason Number FourKnowing the rules is not enough Residents need to prepare for the unknown

  14. Stacey, 1996 - Chaos Zone Of Complexity Agreement Control + + Certainty -

  15. “Needed are a few organizing principles to have conversations about our work.” Marvin Dunn, M. D. Paul Batalden, M.D.

  16. Organizing Principles • General competencies • Continuum • Measurements • Improvement models

  17. The General Competencies • Patient care • Medical Knowledge • Practice-based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-based Practice

  18. Accreditation Aside “You must call your mother every Sunday.” Prescription or invitation?

  19. The Continuum Life after competent

  20. Dreyfus Model of Skill Acquisition • Novice • Advanced Beginner • Competent • Proficient • Expert • Master

  21. Dreyfus Model

  22. “To become competent you must feel bad” Hubert Dreyfus

  23. Between Advanced Beginner and Competent • The number of potentially relevant details becomes overwhelming • Exhausting to manage with rules • Choose a perspective • Result depends on the perspective adopted by the learner/risk taking • Fright replaces exhaustion

  24. Two Paths • Go back to rules • Cycle between advanced beginner and competent • Burn out • Become fully involved • Feel bad when wrong and good when right

  25. Next • Proficient - intuition replaces reasoned responses. - immediately sees the problem - recognizes patterns • Expert - immediately sees how to solve problem • Master – styles, continuous learning

  26. Conceptual Model

  27. Reason Number Five Residents seek practical wisdom

  28. Aristotle • Episteme • Cognitive knowledge, science • Techne • Craft/Art of medicine • Phronesis • Practical wisdom

  29. Accreditation Aside Minimal threshold Do your graduates know the rules? Can they apply them in complex contexts without supervision?

  30. Accreditation Aside Improvement Model Do your graduates have the habit of accountability? Have they acquired practical wisdom?

  31. Reason Number Six The quality of the program is dependent on the quality of the relationships.

  32. Medicine, education and management are cooperative arts rather than productive arts. Therefore the quality of the activity is dependent on the quality of the relationships.

  33. Cooperative Arts • Medicine cooperates with the body’s natural tendency to heal • Teaching cooperates with the mind’s natural tendency to ascend to the truth • Management cooperates with people’s natural tendency to form communities

  34. Microsystems: another unit of learning

  35. Real learning (intelligent adaptation) occurs in microsystems And sometimes in macrosystems.

  36. Health care systems consist of macrosystems and microsystems Paul Batalden, M.D.

  37. Substance is enduring; form is ephemeral. Preserve substance; modify form; know the difference. Dee Hock

  38. Substance attracts resources; form attracts expenses. Dee Hock

  39. Microsystems have a high substance to form ratio; macrosystems have the reverse.

  40. Characteristics of High Performing Microsystems • Integration of information • Measurement • Interdependence • Supportiveness of the larger organization • Constancy of purpose • Investment in improvement • Alignment of roles and training • Connection with community Julie Mohr, Ph.D.

  41. Reason Number Seven Introducing learners can enhance or inhibit the function of a microsystem. This is a big opportunity for improvement.

  42. Rehearsals are good for relationships and outcomes. A restaurant in Chicago Simulation offers a huge opportunity for improvement.

  43. Whatever we measure we tend to improve.

  44. Useful Concepts about Measurement • Life is not condensable • We use models to understand life • All models are limited, some are useful • Measurements are applied to models • Both measurements and models must be constantly reassessed • We need structured dialogue about measurement

  45. Useful Concepts • Rules and context • Science is universal; art is always unique • Objective and subjective

  46. Characteristics of good assessment • Measures actual performance • Identifies areas for improvement • Satisfies reasonable request for accountability • Is practical • Is done over time to discern growth

  47. www.acgme.org/Outcome/ • Assessment toolbox • References • Table of “best methods” • Key considerations in selecting and implementing assessment approaches • Assessment approaches

  48. RRC Think Tank • Chair Gail McGuiness, M.D. • Clarify expectations for programs • Clarify operational issues for RRCs • Identify PIF questions relevant to assessment for relational database

  49. What to Do Right Away

More Related