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

INTRODUCTIONKevin Krane, MD

Professor of Medicine, Vice Dean for Academic Affairs kkrane@tulane.edu

Case PresentationA 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.

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?

Setting the Stage:

What are competencies?

Why are they important?

Where do they fit in basic science?

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.

The AAMC Competencies

1. Patient Care2. Knowledge for Practice3. Practice-Based Learning and Improvement4. Interpersonal and Communication Skills5. Professionalism6. Systems-Based Practice7. Interprofessional Collaboration8. Personal and Professional Development

Competencies in Action

Cardiovascular Disease

Knowledge for Practice

Practice-Based Learning & Improvement

Professionalism

Systems-Based Practice Personal & Professional Development - Demonstrate healthy coping mechanisms. - Manage conflict between personal & professional responsibilities.

- Describe/Differentiate between forms of CVD.- Describe effective therapies based on basic science.

- Peer Instruction to address student gaps in knowledge, skills, and/or attitudes.- Use information technology to optimize learning.

Communication Skills

- Communicate with patients and their families effectively.- Demonstrate understanding & insight about emotions to manage interpersonal interactions effectively.

- Practice responsiveness and sensitivity to diversity.- Demonstrate integrity, respect & compassion.

- Learn how to coordinate patient care within the health care system. - Integrate awareness of cost considerations .

Interprofessional Collaboration

- Participate in different team roles to provide effective patient care.- Communicate responsibly with other health professionals.

Patient Care

- Role play in teams for history taking.- Practice making informed decisions based on patient information, up-to-date evidence & clinical judgment.

Breakout Session 1: Locating Competencies in Basic Science Instruction

David S. Franklin, PhDAssociate Professor of Biochemistry and Molecular BiologyCourse Director, BiochemistryTulane University SOM

franklin@tulane.edu

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.

Let’s Get OrganizedWhat’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.

Small Teams Case-Based w/ Peer Instruction

Cardiovascular Disease

Knowledge for Practice

Practice-Based Learning & Improvement

Professionalism

Systems-Based Practice Personal & Professional Development - Demonstrate healthy coping mechanisms. - Manage conflict between personal & professional responsibilities.

- Describe/Differentiate between forms of CVD.- Describe effective therapies based on basic science.

- Peer Instruction to address student gaps in knowledge, skills, and/or attitudes.- Use information technology to optimize learning.

Communication Skills

- Communicate with patients and their families effectively.- Demonstrate understanding & insight about emotions to manage interpersonal interactions effectively.

- Practice responsiveness and sensitivity to diversity.- Demonstrate integrity, respect & compassion.

- Learn how to coordinate patient care within the health care system. - Integrate awareness of cost considerations .

Interprofessional Collaboration

- Participate in different team roles to provide effective patient care.- Communicate responsibly with other health professionals.

Patient Care

- Role play in teams for history taking.- Practice making informed decisions based on patient information, up-to-date evidence & clinical judgment.

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.

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.

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.

TEAM SUMMARY FOR BREAKOUT SESSION 1

(10 min)

Breakout session 2: Assessment of Competencies in Basic Science Courses

Kerstin Honer zu Bentrup, PhDAssistant Professor of MicrobiologyCourse Director, Introduction to Infectious DiseasesTulane University SOM

khonerzu@tulane.edu

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.

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.

TEAM SUMMARY FOR BREAKOUT SESSION 2

(10 MIN)

Wrap-Up

Jennifer Gibson, PhD; Deborah Larimer, EdDOffice of Medical Education Tulane University SOM

jwgibson@tulane.edu dlarimer@tulane.edu

Where is Tulane in this process?

Take-Aways

References

Session Eval

Selected References

Albanese MA, Mejicano G, Anderson WM, Gruppen L. Building a competency-based curriculum: the agony and the ecstasy. Adv Health Sci Educ 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.

Pangaro L. 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.