Competency-Based Education in Medicine and Pharmacy: Learning from Others
Purpose: Health professions education are in a current state of evolution, and some would argue there is a need for “radical transformation” where educators work together with health care practitioners to determine the competencies needed to continue to deliver high quality care that meets societal needs. Educational approaches in medicine and pharmacy are developing evolving competency-based education (CBE) frameworks that include competencies, milestones, and entrustable professional activities (EPAs), designed to meet these societal needs. A critical component of these current competency discussions is a deeper understanding of competencies that goes beyond skills assessed through checklists, but as identification of entrustable professional activities (EPAs)-- “performance acts in professional practice that really matter.” The benefits of a competency-based approach are well described in education literature; however, many challenges continue to exist with full-scale implementation of learning, performance, and assessment. As the profession of physical therapy begins to consider the opportunities offered by competency-based education, we should embrace the chance to learn from those professions that started down this path before us. The purpose of this session is to present challenges and opportunities physical therapist education faces in its current approach to education across the learner continuum, and describe the paths taken by medical and pharmaceutical education in their ongoing implementation of CBE. Educators from medicine and pharmacy will share their profession’s rationale for pursuing CBE; early challenges; lessons learned; current state of use; future opportunities, and recommendations for physical therapy. Audience exchange with the panel will follow and provide a forum for discussion of future challenges and opportunities for physical therapist education.Methods and/or Description of Project: In 2016, the physical therapy educational community came together through the formation of the Education Leadership Partnership (ELP) which comprises representation from the American Council of Academic Physical Therapy (ACAPT), the American Physical Therapy Association (APTA), and the Academy of Physical Therapy Education (APTE), and to address issues which would help reduce unwarranted variation in practice by focusing on best practices in education. In January 2017, a group of 24 stakeholders representing the ELP, education researchers, the Foundation for Physical Therapy staff and APTA staff engaged in a two day Education Research Strategy Meeting (ERSM). The group used the paper developed by an ACAPT Task Force, Education Research in Physical Therapy: Visions of the Possible, as a framework for discussions and identification of workgroup initiatives across four areas: conceptual framing/competencies, building a community of education researchers/professional development, data analytics and funding and infrastructure. The ERSM subgroup working on the conceptual framework/competencies has a schedule of activities designed to engage physical therapy faculty in educational sessions and collegial dialogue about performance outcomes across the learner continuum. An initial step was the recent Point of View article published in Physical Therapy which posed questions about considering the possible value of entrustable professional activities (EPAs) for the profession. A second activity in April of 2018, is a webinar, led by two leaders from medical education, on their current process and progress of transforming medical education with the development of EPAs and outcome-based medical education.Results/Outcomes: This educational session on current progress and trends in competency-based education from two health profession represents a third proposed activity from the ERSM sub-group on conceptual framework/competencies. Key concepts of competency- based education will be provided with updates to the ongoing development of CBE in medicine and pharmacy, and discussion regarding current needs and potential application in physical therapy. These discussions that include perspectives from other health professions are important as they inform future activities for the profession.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: A recent Josiah Macy report on competency-based health professions education argued that now is the time for leaders of health profession education systems to partner closely with stakeholders to revolutionize our educational approach towards one of continuous learning guided by principles of competency-based education. Now is the time for physical therapy to engage in serious dialogue about transformation of physical therapist education that considers an assessment framework that includes an EPA model, achieved through collaborative work across stakeholders and identifies essential expectations for physical therapist development across the learner continuum. The educational theories supporting the use of competency-based education have existed for decades. There is ongoing development and implementation of this innovative model by other health professions, including medicine and pharmacy, and it is vital for the physical therapy profession to collaborate to discuss the challenges they incurred and to learn from them. This session will provide opportunities to discuss and identify research questions and needed infrastructure that should be considered by our profession prior to the possibility of implementing such a model in physical therapy.References: 1-American Association of Medical Colleges. Education in Pediatrics Across the Continuum. Available at: https://www.aamc.org/initiatives/epac/. Accessed on January 27, 2018. 2-American Association of Colleges of Pharmacy. Entrustable Professional Activities. Available at: https://www.aacp.org/resource/entrustable-professional-activities-epas. Accessed on January 27, 2018. 3-Brown D, Green M, Lupi C, Obeso V, Hyderi A, Cutrer B, Warren H, Carney P, Phillipi C, on behalf of the Core EPA Pilot Group. Association of American Medical Colleges (AAMC) Core Entrustable Professional Activity (EPA) Supervisory Language Task Force Executive Summary. Available at https://www.aamc.org/initiatives/coreepas/publicationsandpresentations/. 4-Brown D, Warren JB, Hyderi A, Drusin RE, Moeller J, Rosenfeld M, Orlander PR, Yingling S, Call S, Terhune K, Bull J, Englander R, Wagner DP. Finding a Path to Entrustment in Undergraduate Medical Education. A Progress Report from the Entrustment Concept Group of the AAMC Core Entrustable Professional Activities (EPAs) for Entering Residency Pilot. Academic Medicine. 2017 Jun;92(6):774-779. doi: 10.1097/ACM.0000000000001544. 5-Brown D, Gillespie, CC, Warren, JB. EPA 9—Collaborate as a Member of an Interprofessional Team: a Short Communication from the AAMC Core EPAs for Entering Residency Pilot Schools. Medical Science Educator. 2016;26(3):457-461. doi: 10.1007/s40670-016-0273-4 6-Carraccio, C., Englander, R., Van Melle, E., ten Cate, O., Lockyer, J., & Chan, M. et al. (2016). Advancing Competency-Based Medical Education. Academic Medicine, 91(5), 645-649. 7-Chesbro SB, Jensen GM, Boissonnault WG. Entrustable professional activities as a framework for continued professional competence: is now the time? Phys Ther. 2018;98:3–7. 8-Chen HC, McNamara M, Teherani A, ten Cate O, O’Sullivan P. Developing entrustable professional activities for entry into clerkship. Acad Med. 2016;91(2):247-255. 9-El-Haddad C, Damodaran A, McNeil HP, Hu W. The ABCs of entrustable professional activities: an overview of ‘entrustable professional activities’ in medical education. J Int Med. 2016;46(9):1006-1010. 10-Englander, R., Flynn, T., Call, S., Carraccio, C., Cleary, L., & Fulton, T. et al. (2016). Toward Defining the Foundation of the MD Degree. Academic Medicine, 91(10), 1352-1358. 11-Englander R, Frank JR, Carracio C, Sherbino J, Ross S, Snell L. Toward a shared language for competency-based medical education. Med Teach. 2017;39(6):582-587. 12-Haines S, Pittenger A, Plaza C. Describing entrustable professional activities is merely the first step. A J Phar Edu. 2017;81(1):1-4. 13-Holmboe ES, Sherbino J, Englander R, Snell L, Frank JR. A call to action: The controversy of and rationale for competency-based medical education. Med Teacher. 2017;39:574-581. 14-Jensen GM, Nordstrom T, Mostrom E, Hack LM, Gwyer J. National study of excellence and innovation in physical therapist education: Part 1—Design, method, and results. Phys Ther. 2017;97:857-874. 15-Jensen GM, Hack LM, Nordstrom T, Gwyer J, Mostrom E. National study of excellence and innovation in physical therapist education: Part 2—A call to reform. Phys Ther. 2017;97:875-888. 16-Jensen GM, Nordstrom T, Segal RL, McCallum C, Graham C, Greenfield B. Education research in physical therapy: Visions of the possible. Phys Ther. 2016;96:1874-1884. 17-Jensen GM, Mostrom E, Hack L, Nordstrom T, Gwyer J. Educating Physical Therapists: Moving into the Future. Thorofare, NJ; Slack Inc. in press 18-Lucey CR, Thibault GE, ten Cate O. Competency-based, time-variable education in the health professions: crossroads. Acad Med. 2018;93(3):S1-S5. 19-Macy Foundation. Achieving Competency-Based, Time-Variable Health Professions Education. New York, New York. Pittenger AL, Chapman SA, Frail CK, Moon JY, Undeberg MR, Orzoff JH. Entrustable professional activities for pharmacy practice. A J Phar Edu. 2016;80(4):1-4. 20-Pittenger AL, Copeland DA, Lacroix MM, et al. Report of the 2016-17 Academic Affairs Standing Committee: Entrustable Professional Activities Implementation Roadmap. A J Phar Edu. 2017;81(5):S4. 21-Teherani A, Chen HC. The next steps in competency-based medical education: Milestones, entrustable professional activities and observable practice activities. J Gen Intern Med. 2014:29(8): 1090-1092. 22-ten Cate O, Gruppen LD, Kogan JR, Lingard LA, Teunissen. Time-variable training in medicine: Theoretical Considerations. Acad Med. 2018;93:S6-S1. 23-ten Cate O, Billett S. Competency-based medical education: origins, perspectives and potentialities. Med Educ. 2014; 48:325-332.Course Objectives: Upon completion of this session, participants will: 1-Describe the key learning concepts that foundational to the current work in CBE across health professions. 2-Identify the challenges and opportunities for physical therapist education faces in its current approach to education across the learner continuum; 3-Examine the paths taken by medical and pharmaceutical education in their implementation of competency-based medical/pharmaceutical education; and 4-Discuss possible next steps for physical therapist education in considering the need for a model of learning and assessment across the educational continuum.Instructional Methods: This session will include lecture presentations from educational researchers in the fields of medicine and pharmacy, followed by an update on where physical therapy currently stands and the work in progress. The session will culminate with a question and answer panel discussion among the presenters to give the audience the opportunity to ask questions and have an exchange of thought.Tentative Outline/Schedule: 1- Setting the stage: Introductions/session aims (5min) 2- Current state of educational approaches and consideration of key learning concepts in physical therapist education. (5 minutes) 3- Medicine’s experience with use of competency-based education (15 minutes) 4- Pharmacy’s experience with use of competency-based education (15 minutes) 5- An Association’s role in facilitating adoption of CBE for a profession (15 minutes) 6- Physical Therapy’s Roadmap: Present and future (update on current work) (10 minutes) 7- Audience engagement with the panelists (25 min)