Teaching through competencies Heiko Spallek, DMD, PhD Center for Dental Informatics University of Pittsburgh, School of

1. Teaching through competencies Heiko Spallek, DMD, PhD Center for Dental Informatics University of Pittsburgh, School of Dental Medicine, Pittsburgh, PA BioInf 2202, January 12th, 2005

2. Why competency-based education? 1995: IOM report “Dental Education at the Crossroads: Challenges and Change - a closer integration with medicine and the overall health care system - significant curricular reforms relative to content and presentation 1998: CODA (ADA) - adopted predoctoral dental program accreditation standards requiring competency-based assessment We don’t have a choice!

3. Components of the dental education reform agenda 1. Redesign the curriculum to incorporate competency-based learning principles and evaluation methods as required by CODA standards. … … … 10. Utilize computer-based and web-based information technology to enrich student learning. (Hendricson, Cohen 2001)

4. CODA 2-7 “The dental school must define competencies needed for graduation, which must be focused on educational outcomes.” CODA 2-8 “The dental school must employ student evaluation methods that measure the defined competencies.” CODA 2-10 “The dental school has a curriculum management plan that ensures …. evaluation of all courses with respect to the defined competencies of the school to include student evaluation of instruction ….”

5. Educational Outcomes Statements that identify the biomedical knowledge, technical/procedural skills, patient management skills, communication skills and professional behaviors that students must perform to demonstrate competency.

6. Foundational Knowledge The product of didactic and laboratory instruction which provides the information and experience that are prerequisite for satisfactory attainment of competency. The basic sciences, behavioral sciences and clinical sciences all provide instruction at the foundational level.

7. What is a competency? general: … capacity to identify a problem and act skillfully in its solution (Beltran-Neira, Beltran-Aguilar, 2004) specific: Behavior expected of beginning practitioners, that includes the psychomotor skills, knowledge of when and how to use it, demonstration of the values of the profession and the ability to communicate knowledge and value. Being able to function in context. (Chambers, 1994)

8. What is a competency? In competency-based dental education, what students learn is based on clearly articulated competencies, comprising the biomedical knowledge, cognitive and psychomotor skills, and ethical values that are essential for successful, independent and unsupervised performance as an entry-level general dental practitioner. (UTHSCSA Competency Document)

9. Ethical dilemma? Can an instructor ethically justify letting students inflate the treatment for the sake of the student's education to match an actual care delivery situation after graduation? 1. In-class assignment Please read scenario and discuss the ethical ramifications. (Scenario is about resident training, but situation could easily be applied to pre-doctoral teaching as well.)

10. What is a competency? To be certified for entry into professional practice, dental students must demonstrate that they can perform these competencies without assistance in realistic patient care settings. (UTHSCSA Competency Document)

11. What Competency Assessment is NOT? Completion of clinical requirements does not indicate competence! Successful daily grades do not necessarily indicate competence! Communicate expectations to the students, e.g. course objectives listed in the syllabi!

12. How to write a competency: A graduate of the SDM will be competent to… 1. Verb: restore, assess, refer 2. Direct object: diagnostic radiographs, malocclusions (specific procedure or patient condition) 3. Qualifying conditions: special circumstances, limitations, explicit outcomes

13. 2. In-class assignment: Write a competency statement First review the current SDM competency document, then add one competency under “Practice Administration” which relates somehow to dental informatics.

14. Different Types of Education Novice Learning: explicit directions, extrinsic feedback, constant norming, no choices Beginner Learning: applying of what has been learned, adjustment of rules, little initiative Learning Competencies: ready to begin independent practice, repertoire of procedures, rudiments of self-sustaining professional values (Chambers, 1997)

15. Different Types of Evaluation Novice Learning: Tests (facts) Beginner Learning: Simulations (controlled amount of realism) Learning Competencies: Authentic Evaluation (Portfolio) (Chambers, 1997)

16. Authentic Evaluation - situation that resembles the environment after graduation - student can accurately assess his or her own competence - professionalism & values - more weight judgment on evaluators than on objectivity - dichotomous judgment, no scores: able or not able (Chambers, 1997)

17. Types of Authentic Evaluation - Ratings: summary judgments about student regarding ability - Exemplary Products: documented cases or research abstracts - Test Cases: independent, unaided performances of tasks - Portfolio Evaluation: synthesis of various approaches (Chambers, 1997)

18. Educational Qualification Paths (in competency-based education) Qualified: done, ready to move on Becoming qualified: progressing satisfactorily, needs more Not becoming qualified: is not on right path, but likely to succeed with reasonable accommodation Unqualified: is not on right path, but unlikely to succeed (Chambers, 1997)

19. Desirable characteristics of evaluation - face validity - low cost - interprability - non-reactivity - generalizability - reliability - validity

20. Evolution of dental competency-based education phase 1: defining various educational experiences phase 2: addressing evaluation of individual students & competencies as part of outcomes assessment phase 3: combination of written competency statements and evaluation methods into an integrated system

21. General Competency Theory (Chambers 2001) - CODA 2.7 & 2.8 requires that all competencies must be assessed - discipline-specific approach to competency is based on lists of behaviors  Conclusion: - maximum subject matters desired - block approach instead of comprehensive care - licensure exam based on average score - graduation decision based on point system rather than on judgment of faculty of students’ capability to practice independently

22. However … “This is like saying a forest is defined as so many trees of various types. On the general competency hypothesis, a forest is a dynamic ecosystem that evolves over time in a specific pattern to the point of being self-sustaining.” (Chambers, 2001)

23. 3. In-class assignment: Design an evaluation for the competency statement you developed during the last assignment!

24. Future - used for postdoctoral dental programs (Glassman & Chambers, 1998) - periodic recertification of competence - expansion of knowledge within the profession - CDE: little evidence that it alters practice - dentists: reluctance to participate in structured quality assessment programs, especially those that include peer evaluation (Saporito, Feldman, Stewart, Buchanan, 1994) - public demands accountability: increasingly resort to litigation - 95% of all medical specialists with certification after 1993 will find that their certification will expire in 7-10 years (Langsley, 1991)

25. Basic Predoctoral Information Technology Courseaddresses the growing importance of information technology in dental education, practice and research. “Introduction to Computing“ information technology skills applicable throughout education and professional life SDM’s competency #6, The graduate of the University of Pittsburgh School of Dental Medicine must be able to: ... evaluate the scientific literature including information technology resources to make evidence-based decisions about oral health. ...* *Competency Document, University of Pittsburgh School of Dental Medicine, Revised December 17, 2002