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Development of an integrated competency framework for postgraduate paediatric training: a Delphi study.

ABSTRACT: Competency-based education (CBE) has transformed medical training during the last decades. In Flanders (Belgium), multiple competency frameworks are being used concurrently guiding paediatric postgraduate CBE. This study aimed to merge these frameworks into an integrated competency framework for postgraduate paediatric training. In a first phase, these frameworks were scrutinized and merged into one using the Canadian Medical Education Directives for Specialists (CanMEDS) framework as a comprehensive basis. Thereafter, the resulting unified competency framework was validated using a Delphi study with three consecutive rounds. All competencies (n = 95) were scored as relevant in the first round, and twelve competencies were adjusted in the second round. After the third round, all competencies were validated for inclusion. Nevertheless, differences in the setting in which a paediatrician may work make it difficult to apply a general framework, as not all competencies are equally relevant, applicable, or suitable for evaluation in every clinical setting. These challenges call for a clear description of the competencies to guide curriculum planning, and to provide a fitting workplace context and learning opportunities.Conclusion: A competency framework for paediatric post-graduate training was developed by combining three existing frameworks, and was validated through a Delphi study. This competency framework can be used in setting the goals for workplace learning during paediatric training. What is Known: •Benefits of competency-based education and its underlying competency frameworks have been described in the literature. •A single and comprehensive competency framework can facilitate training, assessment, and certification. What is New: •Three existing frameworks were merged into one integrated framework for paediatric postgraduate education, which was then adjusted and approved by an expert panel. •Differences in the working environment might explain how relevant a competency is perceived.

SUBMITTER: Robbrecht M

PROVIDER: S-EPMC8425852 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundWithin the 52 health districts in South Africa, the family physician is seen as the clinical leader within a multi-professional district health team. Family physicians must be competent to meet 90% of the health needs of the communities in their districts. The eight university departments of Family Medicine have identified five unit standards, broken down into 85 training outcomes, for postgraduate training. The family medicine registrar must prove at the end of training that all the required training outcomes have been attained. District health managers must be assured that the family physician is competent to deliver the expected service. The Colleges of Medicine of South Africa (CMSA) require a portfolio to be submitted as part of the uniform assessment of all registrars applying to write the national fellowship examinations. This study aimed to achieve a consensus on the contents and principles of the first national portfolio for use in family medicine training in South Africa.MethodsA workshop held at the WONCA Africa Regional Conference in 2009 explored the purpose and broad contents of the portfolio. The 85 training outcomes, ideas from the WONCA workshop, the literature, and existing portfolios in the various universities were used to develop a questionnaire that was tested for content validity by a panel of 31 experts in family medicine in South Africa, via the Delphi technique in four rounds. Eighty five content items (national learning outcomes) and 27 principles were tested. Consensus was defined as 70% agreement. For those items that the panel thought should be included, they were also asked how to provide evidence for the specific item in the portfolio, and how to assess that evidence.ResultsConsensus was reached on 61 of the 85 national learning outcomes. The panel recommended that 50 be assessed by the portfolio and 11 should not be. No consensus could be reached on the remaining 24 outcomes and these were also omitted from the portfolio. The panel recommended that various types of evidence be included in the portfolio. The panel supported 26 of the 27 principles, but could not reach consensus on whether the portfolio should reflect on the relationship between the supervisor and registrar.ConclusionA portfolio was developed and distributed to the eight departments of Family Medicine in South Africa, and the CMSA, to be further tested in implementation.

Project description:BACKGROUND:In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations. Therefore, this article focuses on these underlying normative aspects of integrated health services. This study investigates the values that underpin integrated health services delivery as a concept, by examining the extent to which an initial literature based set of underlying values underpins integrated care and the relevance of these values on the different levels of integration. METHODS:An international Delphi study with 33 experts from 13 different countries was carried out to examine the initial set of underlying values of integrated health services. In addition, the relevance of the values was assessed on the different levels of integration: personal level, professional level, management level and system level. RESULTS:The study resulted in a refined set of 18 values of integrated health services developed in three Delphi study rounds. In addition, the results provided insight into the relevance of these values on the personal level (e.g. 'trustful'), professional level (e.g. 'collaborative'), management level (e.g. 'efficient') and system level (e.g. 'comprehensive') of integration. Some of the values score consistent across the different levels of integration while other values score inconsistent across these levels. CONCLUSIONS:The Delphi study resulted in an international normative basis for integrated health services delivery as a concept. The values can be used as ingredients for a values framework and provide a better understanding of the normative aspects of integrated health services delivery. Future research could focus on associated behaviors in practice, the relationship between normative integration and governance, and differences between the value priorities of stakeholder groups.

Project description:Aging is an inevitable part of life. One can maintain well-being and wellness even after discharge and/or transition if his or her functional decline is minimized, sudden decline is prevented, and functioning is promoted during hospitalization. Caring appropriately for elderly patients requires the systematic application of Senior-Friendly Hospital principles to all operating systems, including medical centres' organization and environment, as well as patient treatment processes. The Senior-Friendly Hospital framework is valid and important for patient safety and quality improvement. This study aimed to make recommendations regarding the development of the Korean Framework for Senior-Friendly Hospitals for older patients' care management, patient safety interventions, and health promotion, via a Delphi survey.Two rounds of Delphi surveying were conducted with 15 participants who had at least 3 years' experience in accreditation surveying and medical accreditation standards, survey methods, and accreditation investigator education. In each round, we calculated statistics describing each standard's validity and feasibility.The Korean Framework for Senior-Friendly Hospitals included 4 Chapters, 11 categories, and 67 standards through consensus of the Senior-Friendly Hospitals task force and experts' peer review. After the two rounds of Delphi surveying, validity evaluation led to no changes in standards of the Senior-Friendly Hospitals; however, the number of standards showing adequate validity decreased from 67 to 58. Regarding feasibility, no changes were necessary in the standards; however, the number of categories showing adequate feasibility decreased from 11 to 8 and from 67 to 30, respectively. The excluded categories were 3.2, 4.2, and 4.3 (service, transportation, and signage and identification). The highest feasibility values were given to standards 2.1.1, 4.1.4, and 4.1.6. The highest feasibility score was given to standard 2.4.2.The Korean Framework for Senior-Friendly Hospitals needs to include 4 Chapters, 8 categories, and 30 standards. The Accreditation Program for Healthcare Organizations should include Senior-Friendly Hospitals -relevant standards considering Korea's medical environment.

Project description:BackgroundWorkplace-based assessments (WBAs) are part of a competency-based curriculum where training progression is dependent on the achievement of defined competencies in a real-world clinical environment. There is a significant literature gap on the impact of WBAs implemented in resource constrained countries and their contextual challenges. This study aimed to examine the use, impact, and educational context of WBAs in South African medical specialist training programs drawing on perspectives from both trainees and trainers to identify educational challenges and propose effective solutions.MethodsA mixed methods national electronic survey was conducted with specialist medical trainees and supervising trainers from all eight specialist training institutions in South Africa involving 16 specialities. The survey responses were voluntary and anonymous. The survey was closed after seven months when data saturation was achieved. Descriptive statistical analysis was performed using SPSS Version 27 (SPSS Inc, 2012, Chicago, IL) for the quantitative analysis. The thematic coding framework for the qualitative analysis was facilitated by NVivo Version 12 software.ResultsThere were 108 ethnically diverse supervising trainers and 248 specialist trainees' survey respondents. Across the 16 medical specialities, 45% of the respondents were using WBAs. Despite contextual resource and staff challenges, this study found that WBAs had a positive impact to Kirkpatrick level 2 in providing actionable feedback to improve competency. WBA users had a significantly higher rating for trainee supervision (p < 0.01), general quality of feedback on trainee competence (< 0.01) and the specialist training program (p = 0.03) compared to WBA non-users. They also had a higher rating for the assessment of the trainee as a professional (p < 0.01); scholar (p < 0.01); communicator (p < 0.01); collaborator (p = 0.001) and leader/manager (p < 0.001) based on the AfriMEDS competency framework. Racism, sexism and favouritism were challenges that negatively affected the training programs.ConclusionOverall, this study reports that the use of WBAs had a substantially favourable impact on teaching, learning, feedback and supports a competency-based approach to specialist training programs. Addressing the contextual concerns that negatively impact training; training the trainees and trainers about their relationship, roles and responsibilities; and focusing on a trainee-centred, inclusive and empowering teaching approach will help further enhance its effectiveness.

Project description:Background: Postgraduate training curricula should not be based on time-spans or predefined numbers of performed procedures. One approach to link competencies to clinical tasks is the concept of Entrustable Professional Activities (EPA). The goal of this study was the definition, ranking and validation of EPAs for anaesthesiology postgraduate training and the creation of an anaesthesiologic core curriculum. Methods: Anaesthesiologists of different levels of training participated in the study (single-center, cross-sectional) . First, an expert group defined a preliminary list of EPAs. Then a first Delphi round (n= 47 participants) was applied to identify daily anaesthesiology tasks with the goal to define EPAs. From the first Delphi round a new set of EPAs was defined, using the template and mapping method. Through an alignment process, conducted by the expert group, the preliminary EPAs and the new set of EPAs from the first Delphi round were summarised into a new list of EPAs. This list was presented to the study participants in a second Delphi round (n=80 participants), with the goal to validate and rank each EPA and to define the year of entrustment. For this purpose, participants were asked in the second Delphi round if each EPA should be included into an anaesthesiology core curriculum and in which year of training entrustment should take place. Furthermore, they were asked to rank each EPA on a numeric scale, defining its importance. From this numeric scale, the content validity index (CVI) for each EPA was calculated. Consensus of the results from the second Delphi round was calculated, using the one-way random effects model to calculate Intra-Class-Correlations (ICC). Percentages of agreement among the whole set of EPAs of this study and a previously published set of EPAs were computed. Results: A core-curriculum comprising of 39 EPAs was developed. The EPAs were subdivided into superior/high and inferior/low scoring EPAs, reflecting their importance and were mapped to the year of entrustment. The results reached high consensus among the different participating anaesthesiologist groups (overall agreement was 0.96 for the CVI of each EPA and 0.83 for the year in which the EPAs should be entrusted). Agreement with the previously defined set of EPAs was 73.3%. Conclusion: This study provides a further step in transforming postgraduate anaesthesiology training into a more contemporary approach. Other studies are necessary to complete and amend the presented core curriculum of EPA based postgraduate anaesthesiology training.

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Development of an integrated competency framework for postgraduate paediatric training: a Delphi study.

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