#KeyLIMEPodcast 190: Competencies in the Eye of the Beholder

Reference:

Paradis E, Zhao R, Kellar J, Thompson A. How are competency frameworks perceived and taught? : An exploratory study in the context of pharmacy education. Perspect Med Educ. 2018 Jun;7(3):200-206

Reviewer: Jason Frank (@drjfrank)

Background

Regular KeyLIMErs know that we often talk about CBME (competency-based medical education), but what do we really know about those scaffolds of our professions, the deified competency frameworks?

Almost every profession in the 21^st century has borrowed, stolen, adapted, shoe-horned, or invented one. Ellaway says they are tools of consensus, coordination, or control. Others more critically have said that they are merely tools to prop up privilege. Love them or hate them, they are often essential ingredients of contemporary curriculum, and 1/5 of van Melle’s Core Components of CBME.

Caveat on this one: Linda, Jon & I have co-edited multiple editions of competency frameworks. We’ll check our reflexivity at the door.

Purpose

The authors, from the Faculty of Pharmacy at the University of Toronto, set out explore how core curriculum leaders in their school perceived the new pharmacy competency framework.

Key Points on Method

This was a qualitative study using interviews of 10 curriculum leaders at one school, asking about the participants’ understanding of the new competencies, their significance for stakeholders and how they will be taught and assessed. Interviews were transcribed and coded using content analysis. They undertook this work as the profession of pharmacy was evolving in Canada to provide more patient care.

Key Outcomes

In general, the participants endorsed the new roles and competencies as having value for their profession. Some key themes included that the competencies:

• …were key to student professional development as a well-rounded clinician
• …were essential for quality patient care
• …legitimize the profession’s expertise
• …articulate the value of the profession to health care
• …were articulations of scholarly knowledge
• …were articulations of behaviours

With respect to teaching and curriculum, participants indicated that they would, use the competencies to:

• …start a teaching session
• …guide their role modeling
• …provide a scaffold for learning
• …guide learning in the workplace

They noted that faculty struggled to elaborate on how to use the competencies further in curriculum.

Key Conclusions

The authors conclude that faculty were “not unified in their views”, could be using the competencies to mimic and borrow legitimacy from medicine, and that plans to teach and assess the competencies were limited.

Spare Keys – other take home points for clinician educators

1. We should all be careful to point to critical editorials as evidence of a problem to be addressed.
2. Competency frameworks, like all complex innovations, inevitably diffuse through communities who adopt, adapt, change, and make them their own. This is a reality in change management and sometimes a threat to fidelity of implementation.
3. Any educational innovation evolves over time, and implementation needs support to ensure true alignment of teaching, learning, and assessment on the front lines.
4. Competency frameworks are useful tools to articulate the abilities of graduates and the value proposition for those served by them. However, having a framework alone does not mean a curriculum is CBME.

ShoutOut: Thanks to Elise Paradis for this novel take on CanMEDS.

Hola to Jesus Moran-Barrios, who shared his heartfelt story of adapting and implementing CanMEDS in Spain over the last 2 decades. Bravo.

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