Competency-Based Curriculum in Palliative Medicine. Tomasz R. Okon M.D. Director, Marshfield Clinic Palliative Medicine Fellowship. Objectives. Present the process of developing a competency-based curriculum in the Marshfield Clinic PM Fellowship in an ACGME template format
Tomasz R. Okon M.D.
Palliative Medicine Fellowship
definitions and components
All the coursesof study (e.g. medical rotations) offered by an educational institution
A document outlining such courses/rotations and specifying outcomes of the learningCurriculum Old vs. New Paradigms
Competency Based Curriculum (ACGME):
development steps and components
3.Diversified Learning Strategies
One could conduct a comprehensive needs assessment
Or, as we have done it, one may decide that the face validity of a set of minimal competencies is compelling enough to use them as a firm starting point
INPATIENT PALLIATIVE MEDICINE ROTATION
The Palliative Care Service rotation is the core of the Marshfield Clinic PM Fellowship program
The primary goal of this rotation is for the Fellow to learn the independent practice of Palliative Medicine, in both principal and consultative roles.
To that end, the trainee will be able to:
If the identified competencies are unsuitable for the best locally existing…
…then the curriculum – aimed at producing the desired output – is likely to fail.
Example Output: The trainee will demonstrate empathy
If a program is able to muster the teaching, assessment and improvement methods suitable for producing the desired output – ‘demonstration of empathy’ –
Otherwise, one may identify a broader competency that includes, and relies on frequent (even though variable) demonstration of empathy to:
Core Competency 4: The resident will be able to apply interpersonal and communication skills that result in effective relationship-building, information exchange, emotional support, shared decision-making and teaming with patients, their patients’ families, and professional associates
For summative purpose, the brief, general descriptions of the competencies #17 and #18 are sufficient, BECAUSE:
All parties to the curricular process have full understanding
For instance, unfolding of the 17th competency reveals that it contains several specific elements:
What are the skills necessary for attaining this competency?
Specifically, the trainee:
What level of skill is deemed inadequate, but remediable?
Again, Please refer to the evaluation form #17 and the comprehensive competencies table for full list of SPIKES-R items
Lastly, what are the attitudes necessary for attaining 17th competency?
Case based teaching
M & M
Simulation (see case scenario following evaluation form 17)
Self directed learning modules(ONCOTALK, Textbooks and JAMA series)
Individual or group projects
Step 5: Determine Teaching MethodsACGME resource site lists a rich inventory of teaching methods Underlinedare methods that we use for the 17th competency
For our purposes, the ACGME inventory remains inadequate; we needed additional, learning approaches and hence evaluation methods:
Reflective Journal is based on a complete patient log that fellow maintains – the log provides the minimum clinical data and CMR reference C:\Documents and Settings\okont\Desktop\palliative fellowship\Evaluation forms\Portfolio guidelines MC PMF.doc
Fellow enters cases selected for the RJ, in a three column table:
Please refer to Marshfield Clinic Palliative Medicine Fellowship cross-reference table:
Evaluation content is largely determined in step 4
Specific methods of evaluation can be broadened, however
For the specific format of 17th competency evaluation please refer to:
To review the evaluation process that we utilize, please refer to the handoutpalliative fellowship\Accreditation\#3 Cross-Table Comp vs Eval Method MARCH -07.doc
Paste the data into:
Make sure that – following the integrative principle of curricular development - implementation occurs as planned
Apply systematic curricular program evaluation for self-assessment and corrections
Identify and state mandatory and secondary educational resources (textbooks, CBP, Web-based resources, seminars, development modules etc)