Who does not want competent workforce or competent health care providers? Health sciences and clinical degree programs are among many professions continue to embrace competency-based education. So, if the goal is to assure that we as educators graduate competent students into the profession, what kind of competencies should guide our curriculum development and allow us to evaluate the relevance of our curriculum to the needs of the profession or practice? It is possible to identify certain competency models provided by certain associations, recommended or required by accreditation agencies. After a quick glance at these models, the comprehensive coverage of competencies in a variety of areas is impressive and overwhelming at the same time. The first impression becomes they cover everything, great! Later, the same greatness becomes a problem. The answer to the question in the title of this blog is “somewhat.” Here are the reasons:
- Too comprehensive therefore less beneficial and requires extensive valuable time for stakeholders to adapt
A great example can be the National Center for Healthcare Leadership (NCHL) Competency Model which is popular among Master of Health Care Administration programs. 3 domains, 26 competencies, and 123 competency levels. Perhaps, 26 competencies may sound manageable. However, the NCHL instructions recommend the programs to align the individual course objectives to the competency levels rather than competencies. In fact, the language of competencies in this model can be more considered competency domains or categories, and competency levels can be more considered more as competencies comparing to other competency models. The result is that the model provides a collective set of all possible competencies that a successful healthcare leader may possess regardless of their specialization. It becomes the individual degree program’s responsibility to identify what the target competencies could be. To be fair, the model is not developed to guide the curriculum development directly, and the healthcare administration field is very broad. However, that being said, many hours of conversations and decision-making would be required to benefit from this model to develop a competency-based curriculum.
- Either too basic or too advanced competencies
The Core Competencies for Public Health Professionals developed by the Council on Linkages between Academia and Public Health Practice can be a great example for too basic and too advanced competencies for the development of a competency-based curriculum. The 2014 version of the model has 8 domains, 3 tiers of competencies within each domain. The number of competencies varies based on the tier. In this model, the competencies within each domain move from more basic to more advanced. The difficulty is the basic competencies perhaps are written more as learning objectives than true competencies if competencies are described as capacities to be developed by an individual. For instance, the first competency within the Analytical / Assessment Skills is “Describes factors affecting the health of a community (e.g., equity, income, education, environment).” There is no doubt that this is important prerequisite cognitive ability to be able to be more competent in analytical / assessment skills domain. However, it is very difficult to consider this cognitive ability as a target competency in a curriculum due to the language being used. Developing a learning objective aligning with this competency while not sounding identical to this competency becomes quite challenging. In the meantime, the last competency in the same domain states “Advocates for the use of evidence in decision making that affects the health of a community (e.g., helping policy makers understand community health needs, demonstrating the impact of programs). This competency can perhaps be assessed by an employer during the tenure of the public health employee.
- Too general and obvious therefore not useful
Competencies for the Physician Assistant Profession can be a good example model to talk about too general and obvious competencies. The model includes six competencies and 48 sub levels. Here is the first expectation within the model under the competency called “Medical Knowledge.” Physician assistants are expected to understand, evaluate, and apply the following to clinical scenarios: (a) evidence-based medicine”. When you think about this competency and sub-level, no one can argue that it is not an important one for the profession. In fact, all medical practices should be based on evidence. However, developing a curriculum based on this competency becomes difficult since almost everything in the curriculum should relate to the evidence-based medicine. Therefore, the analysis of sufficient exposure and assessment of the students will be difficult since almost every course directly include or indirectly should expose and assess students on understanding, evaluating, and applying evidence-based medicine to clinical scenarios.
The examples in this article are some selected competencies to demonstrate the issues in competency models developed to lead the field for the professional standards. This does not mean that there are not any helpful competencies which allow the curriculum designers to develop a competency-based curriculum. This was the reason the answer to the question in the title of this article was somewhat. These issues making the models somewhat helpful arise when competency models are developed focusing on the expectations for a successful individual professional rather than the development of the competency-based curriculum. At least two questions are critical during the identification of competencies to develop a competency-based curriculum. First is if these expectations should be developed and assessed during the pursuit of a professional degree. Second is if the degree program curriculum can assist the students to develop these competencies or if they are to be developed by an individual as a personal attribute such as professionalism. These questions are yet to be addressed during the development of competency models to develop competency-based curriculum. As the accreditation agencies continue to demand competency-based curriculum particularly in health sciences, the programs will continue to seek more helpful models or will, in fact, their own ones. However, developing a competency model requires a lot of work such as environmental scanning. It is more ideal for the prominent professional associations or perhaps the accreditation agencies to guide the programs by developing and providing the competency models for the development of competency-based curriculum. Of course, I expect that the latter recommendation of accreditation agencies providing the competency models can be a sensitive topic for some programs and accreditation agencies. However, Accreditation Review Commission on Education for the Physician Assistant, Inc adopting a model with American Academy of Physician Assistants, Physician Assistant Education Association, and National Commission on Certification of Physician Assistants shows the signs that promoting one competency model is possible. Recent changes in the accreditation standards of Council on Education for Public Health and expecting the accredited programs to align their curriculum with one proposed foundational competencies model show the signs that it might soon to be a reality for the medical and health sciences programs. Based on my personal review, I believe that CEPH proposed model is developed with curriculum design in mind. Future will tell if the CEPH foundational competency model proves to be useful for the programs.