Competency-based training in the Netherlands

EH10.05.2006

Professor Gerrit Glas MD PhDLiesbeth Vleugel MD

g.glas@zwolsepoort.nllvleugel@xs4all.nl

Het opleidingsplan: de theorieCompetency-based training in the Netherlands

EH10.05.2006

Overview

• Introduction: why competency-basedlearning ?

• What is competency-based learning?

• ‘Building’ a training programma.

Competency-based learning: competence as a conceptCompetency-based training in the Netherlands: why ?

• Government initiatives– Rearrangement of the landscape of professions– Emphasis on demand-side instead of supply side– Shortening length of medical specialist training

• Science of teaching– Approaches of the initial professional education (MD)

applied to medical specialist training (problem orientedteaching; homework assignments; discussion; reflection on learning process)

• Transfer of responsibility– Trainee is responsible for his/her own learning process– Preparation for ‘life-long learning’ (education

permanente)

“Competence is 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.”

R.M. Epstein & E.M. Hundert, JAMA, Vol 287 (2002), 226-235.

Competency-based learning: competence as a concept

‘Mindful practice’R.M. Epstein, JAMA, Vol. 282 (1999), 833-839

Het opleidingsplan: de theorie

EH10.05.2006

Competency-based learning: the CanMEDS Roles Framework

Het opleidingsplan: de theorie

• Knowledge and skills of the profession• Patient, family and professionals• Evidence-based medicine; teaching; informing the

public; participation in research• Colleagues and health providers within and outside

the hospital/clinic• Appropriate working with others; optimization of

health logistics• Prevention; knowledge / application of legislation;

risk management; dealing with adverse events• Ethics; reflection; knowledge of own limitations

Competencies of the medical specialist

Based on CanMEDS: 7 competency areas, each with 4 specified competencies

• Medical• Communication• Scholarly attributes

• Collaboration

• Organisational knowledge

• Health advocacy

• Professional behaviour

Competency area relates to:

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Competency-based learning: competence as a concept

Het opleidingsplan: de theorie

Some examples of general competenciesMedical the specialist has state of the art knowledge and

skills

Communication the specialist creates effective diagnostic and treatment relations with patients

Collaboration the specialist refers/transfers adequately

Organisation the specialist works effectively and efficientlywithin a health care organisation

Health advocate the specialist works according to the relevant legislation

Scholarly attributes the specialist contemplates medical informationcritically, encourages expertise development of students, colleagues, etc.

Professional the specialist shows awareness of his/her owncompetencies and limitations

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Competency-based learning: competence as a concept

Het opleidingsplan: de praktijkHet opleidingsplan: de theorieThe Training Programme: in Practice

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Het opleidingsplan: de theorieThe Training Programme: Legislation

Legislation

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Competencies of the specialistProfile of the specialism

Het opleidingsplan: de theorieThe Training Programme: Profile of the Specialism and Competencies

Legislation

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Profile of the specialism

Het opleidingsplan: de theorieThe Training Programme: the Foundation

The competencies of the specialist

The capacity to perform, in an adequate way, a professional activity in a specific, authentic context through integration of knowledge, skills and attitude

Global picture of the profession and itsposition in health care, now and in the years to come

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Het opleidingsplan: de theorieThe Training Programme: Themes, Operationalised competencies, Assessment

Themes AssessmentOperationalisedcompetencies

Competencies of the specialistProfile of the specialism

Legislation

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Themes: • Activities which belong together/ recognizable partsof the training

• Arrangement of the training programme on the basis of the work of the medical specialist

Het opleidingsplan: de theorieThe Training Programme: the Work as Point of Departure

Operationalisedcompetencies

Assessment

• Competencies made explicit within the context of the training programme

• Knowledge, skills and attitudes which the trainee attains in the course of the training

• Description of a vision and the starting points of a programme of assessment

• Assessment methods

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Het opleidingsplan: de theorieThe Training Programme: Themes: general view versus details

Themes show a general view, no detailled plan

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Vision of the training programme on assessment

• Why do you want to assess?

• What do you want to assess?

• How much do you want to assess?

• When do you want to assess?

• Who does the assessment?

• Which instruments do you want to use?

Het opleidingsplan: de theorieThe Training Programme: Assessment

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Developmental focus: formative

Selection focus: summative

Why assessment?

Het opleidingsplan: de theorieThe Training Programme: Assessment Philosophy

Wat toetsen? Knowledge, skills, attitude, competencies

When assessment? Dependent on objectives and content:

before, during, after completed training, before, during, after practical work

Who does the assessment

Dependent on objectives and content;

trainee, fellow trainee, director of training, supervisor, nurse, patiënt…..

What has to beassessed?

Which instruments? Not everything can be formally assessed;

A mix of instruments is important EH10.05.2006

Het opleidingsplan: de theorieThe Training Programme: Training Method, Activities and Material

Training method

Trainingactivities

Trainingmaterial

Themes AssessmentOperationalisedcompetencies

Competencies of the specialistProfile of the specialism

Legislation

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Training method Philosophy about training: how do we want to train?

Principles of training of professionals and of competency-based training

Het opleidingsplan: de theorieThe Training Programme: Training Method, Activities and Material

Training activities

Training material

Learning clinical medicine in workplaces/courses/self

What material do we need for training activities to beeffective?

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• Stimulating work and learning climate

• Experience-based learning: competency development on the basis of previousexperiences

• Rolmodelling and coaching (feedback)

• Reflection on and insight in own competencies

• Increasing responsibility and independence

• Individual adaptation of the training scheme on the basis of portfolio

• Opportunities to study and train with e.g. modern media (e-learning,

virtual reality, skillslab, training courses)

According to the principles of learning by professionals

Het opleidingsplan: de theorieThe Training Programme: the Training Method

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Training activities:

patient reporting

journal clubs

teaching round

out patient clinic

patient round

consultations

mortality/morbidity review

multidisplinary conferences

structured series of conferences

OR

teaching ……………….

Het opleidingsplan: de theorieThe Training Programme: the Training Activities

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Het opleidingsplan: de theorieThe Training Programme: Quality control

Training method

Trainingactivities

Trainingmaterial

Themes AssessmentOperationalisedcompetencies

Competencies of the specialistProfile of the specialism

Legislation

Quality control:• Training process• Check on legislation• Professionalizing trainers and trainees• Research of education

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• visitation

• internal audit

• professionalizing trainers and trainees

• (participation) in research of education

• …………………

Quality control

Het opleidingsplan: de theorieThe Training Programme: Quality control

EH10.05.2006

Profile of the specialism

The competencies of the specialist

Themes

Operationalised competencies

Assessment

� philosophy

� methods

� programme

Educational method

Educational activities

Educational material

Quality control

� educational process

� legislation check

� professionalizing trainees and trainers

� research of educational process

Support by peers

Checklist training programme:

Het opleidingsplan: de theorieThe Training Programme: checklist

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The Training Programme: in Practice

Training method

Trainingactivities

Trainingmaterial

Themes AssessmentOperationalisedcompetencies

Competencies of the specialistProfile of the specialism

Legislation

Quality control:• Training process• Check on legislation• Professionalizing trainers and trainees• Research of education

Support by peersEH

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In a nutshell…

• Logbook; collection

• Reflection

Portfolio