A Competency Based Osteopathic Internship

Bruce Dubin, DO

The Edward Via – Virginia College of Osteopathic Medicine

Interns

Study basic areas of: Internal Medicine Surgery Obstetrics Pediatrics Family Practice Emergency Medicine

Model Rotating Osteopathic Internship

No less than two months of exposure in general internal medicine

One month exposure in emergency medicine

One month in family practice

Progression has been time based

Interns

Do not progress at the Same Rate

The schedule expects/requires everyone to move at the same rate

Tends to be teacher centered

Performance

Restraints of time

Measures are frequently pre and then post-rotation

Individual assistance in problem areas is minimized

Time based education is an ineffective and inefficient system when the goal is to train individuals to perform specific, job related skills

Pilot Training

Competent Clinician

One who is able to perform clinical skills to a satisfactory standard

Competency Based Training

CBT

The unit of progression is mastery of specific knowledge and skills to a specific standard

Two Key Components of CBT

Skill

A task or group of tasks performed to a specific level of proficiency which use motor functions and typically require manipulation of instruments and equipment

1. Central Line, ABG

2. Counseling

Competency

A skill performed to a specific standard and under specific conditions

CBT

Competencies to be achieved are carefully:

1. Identified

2. Verified

3. Made public in advance

CBT

Assessment criteria are:

1. Explicitly stated

2. Made public in advance

CBT

Instructional program provides for individual development and evaluation of each of the competencies specified.

CBT

Actual performance of the competency as the primary source of evidence is required(take into account knowledge and attitude of participant)

CBT

Participants progress through the instructional program at their own rate by demonstrating the attainment of the specified competencies

Characteristics of a CBT Curriculum

Characteristics of a CBT Curriculum

1. Competencies are carefully selected

2. Essential knowledge is learned to support skill performance

3. Detailed training materials are keyed to the competencies to be achieved and are designed to support the acquisition of knowledge and skills

Characteristics of a CBT Curriculum

4. Premise that all participants can master the required knowledge or skill, provided sufficient time and appropriate training methods are used.

5. Knowledge and skills are assessed as interns enter a program and those with satisfactory knowledge and skills may bypass training or competencies already attained.

Characteristics of a CBT Curriculum

6. Learning should be self paced

7. Use flexible training methods1. Large and small group activities

2. Individual study components

8. Use a variety of support materials1. Print

2. Audiovisual

3. Simulations

Characteristics of a CBT Curriculum

9. Satisfactory completion of training is based on achievement of all specified competencies

Advantages of CBT

1. Achieve competencies required in clinical job performance

2. Build confidence as success is demonstrated and measured in mastering specific competencies

3. Interns receive a transcript or list of competencies achieved

Advantages of CBT

4. More efficient use of training time

5. Trainer is a facilitator of learning rather than a provider of information

6. More time devoted to interns individually or in small groups

7. More time devoted to evaluation and an individuals ability to perform essential job skills

Disadvantages of CBT

1. Need to train the trainers (tendency to “teach as we were taught).

2. CBT is only as effective as the process used to identify competencies

CBT

A course may be called CBT, but unless specific CBT materials and training approaches are designed and used, it is unlikely that the resulting course will be truly competency-based.

Use of Models and Simulations

The Cave at Virginia Tech

The Cave

Student Inside a DNA Molecule

Suturing inside the Cave

Laser Surgery

It’s All About Education