Competency based education in Public Health

Competency-Based Education in Public Health

A provisional non-tested model

Tarek Tawfik Amin

Professor

Public Health and Community Medicine

Faculty of Medicine, Cairo University.

[email protected]

3/20/2014 Competency-based learning 1Public Health

mailto:[email protected]

3/20/2014 Public Health Competency-based learning 2

Objective:

To provide a provisional problem-based educational

model aiming at enhancing the core Public Health

competencies of undergraduate medical students.

The objective of this presentation is:


Introduction:

oPublic health response to new threats,

oGlobalization of complex health-related challenges *, oRadical new professional approaches empowering individuals and

communities to promote health and prevent disease, oPublic health professionals prepared to react quickly and

competently **.

* - Sharma K, Zodpey S; Gaidhane A; Syed ZQ; Kumar R; Morgan A. Designing the Framework for Competency-Based Master of Public Health Programs in India. J P u b l i c H e a l t h M a n a g e

m e n t P r a c t i c e , 2013, 19(1), 30–39

-** Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424 DOI 10.1007/s10389-009-

0256-7.

***- An Environmental Scan of Best Practices in Public Health Undergraduate Medical Education REPORT 1: Peer-Reviewed Literature Scan MARCH 2009. Prepared by the Nevis Consulting

Group for the Association of Faculties of Medicine of Canada (AFMC) Public Health Task Group.

Public Health Competencies: ***

Competency: capacity to act effectively in a specific situation, mobilize

knowledge

and put knowledge into action.

Not only knowledge („know-how‟), includes the skills and attitudes

(„show-how‟).


The process [development of competency-based

curriculum] * Identification of public health competencies

Specifications:

-Competencies to be covered

-Competencies to be enhanced

-Methods

-Evaluation and assessment

Mapping of competencies and

learning objectives

Gap analysis for the current status

Future planning and review

* - Building the Public Health Workforce for the 21 Century. A Pan-Canadian Framework for Public Health Human Resources Planning. 2005.

Cancer screening in undergraduate medical curriculum

as a model to enhance core Public Health

Competencies.


The topic:

Proposed Core competencies and competencies statements*


* CDC, WHO, CanMED and others. ,

Competencies

statements

Core Public Health competency domains

Principles

of

Epidemio

logy

Basic

Biostatisti

cs

Social

and

behavior

al

sciences

Health

care

system,

policy, and

planning

Environ

mental

health

Crosscu

tting

domains

3- Demonstrate critical appraisal of different screening modalities

√ √ √

4-Identify principles and limitations of screening tests

√ √ √

5-Identify risk factors for non-communicable diseases, implications for their prevention and control.

√ √


Proposed Core competencies and competencies statements (cont.)

Competencies

statements


Principle

s of

Epidemi

ology

Basic

Biostatisti

cs

Social and

behavioral

sciences

Health

care

system,

policy, and

planning

Environ

mental

health

Crosscut

ting

domains

8-Demonstrate competence in identifying, obtaining, and critically reviewing literature form different sources

√ √

9-Identify the behavioral determinants for health behavior change

√


Proposed Core competencies and competencies statements

Competencies

statements


Principle

s of

Epidemi

ology

Basic

Biostatisti

cs

Social and

behavioral

sciences

Health care

system,

policy, and

planning

Environ

mental

health

Crosscut

ting

domains

13-Produce/deliver oral/written health education message of his/her own choice

√ √

14-Demonstrate ability to think critically

√ √

Proposed Educational

methods


Method/strategy

Hybrid.

Medical students: Undergraduate, 2nd-3rd year.

Pre-requites: basic science, cancer biology.

Duration: 2 weeks

Weeks:1st lecture, problem case, discussion sessions, self

learning,

2nd week: discussions, presentation, self reflection,

self learning.

Field contact: primary health care facility

Facilitators: Public Health faculty.

3/20/2014 Public Health 10

The PBL case: Breast cancer screening

Problem

Scenario

Identify Facts

Formulate and analyze problem

GenerateHypotheses

ID KnowledgeDeficiencies

Apply new

knowledge

Self-Direc ted

Learning

Evaluation

Abstraction

Identify main ideas/keywords

Identify key questions

Writing of learning

objectives

The figure from - COMPETENCY-TO-CURRICULUM TOOLKIT: Developing Curricula For Public Health Workers, Center for Health

Policy Columbia University School of Nursing and Association of Teachers of Preventive Medicine (2004). - Caitlin Ryan Problem Based

Learning Medical Science II (2009).


The process: The three Cs of PBL process *.

Contextual 1. Students are presented with a problem

2. PBL discussion, clarify the facts, define

problem, brainstorm, identify learning needs .

3. Independent study (library, databases, experts )

Collaborative

4. Sharing information, peer teaching and collaborative

working

Constructive 5. Present solution to the problem

6. Review what learned , engage in self, peer and

tutor review of process and reflections on contribution

1- Retention;

2- Integrated knowledge;

3- lifelong learning;

4- Early exposure;

5- Student-staff liaison;

6- Overall motivation.

Advantages

**

* Hartling L, Spooner C, Tjosvold L, and Oswald A: Problem-based learning in pre-clinical medical education: 22 years of outcome research. Med.Teacher 2010, 32:28-35. ** Miller SK. Comparison of student outcomes following problem-based learning instruction versus traditional lecture learning in a graduate pharmacology course. J Am Acad Nurse Pract 2003;15:550-6.

- Mrs. C is a rural Egyptian housewife aged 52 years, with technical

diploma education, and has 4 children. She showed up to the

primary care physician complaining of lump in her left breast.

Examination revealed a mass measuring 2 cm at the upper right

quadrant of her left breast and the axilla was free. Mrs. C is diabetic

with previous history of lumpectomy of a benign lesion from her

right breast at the age of 39. She loss her period three years back,

and mentioned the intake of hormonal contraception for 10 years.

Mrs. C was so anxious about her condition as she mentioned the

death of her mother with breast cancer at the age of 49 years plus

she heard from a T.V show that breast cancer is a familial condition.


The problem case: Relevancy to public health, Interest of the

involved students, and Accessibility to search. *

* - Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424


Relevant learning questions: Examples

1. What are the common risk factors for breast

cancer?

2. Does breast cancer can be prevented?

3. What are the available screening tests?

4. How effective are these tests?

5. Do these tests of value in reducing mortality?

6. Are women in rural areas receiving equal

services as urban?


Relevant sources and documents

Textbook:

- Breast Cancer Epidemiology Li, Christopher (Ed.) 2010, XIII, 417p. 19

illus. Springer.

- Cancer Epidemiology: Principles and Methods IARC Nonserial Publication.

Edited by I. Dos Santos Silva. 999; 425 pages. ISBN 92 832 0405

Open resources:

-http://www.cdc.gov/cancer/breast/index.htm

- http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/

- http://www.who.int/cancer/detection/variouscancer/en/

-http://www.who.int/cancer/nccp/en/

Documents:

- National breast cancer screening guidelines / Egyptian cancer registry

- Facilitator‟s case-book/guidelines

- Student‟s guidelines notes and case portfolio.

Availability of subject‟s experts: Epidemiologist, Oncologist, Primary physician, Health education

consultant.

http://www.cdc.gov/cancer/breast/index.htm

http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/



http://www.who.int/cancer/detection/variouscancer/en/



http://www.who.int/cancer/nccp/en/


Learning Objectives: examples

1) Identify the different genetic/behavioral/environmental risk

and protective factor for breast cancer

2) Recognize and communicate the recommended case-wise

guidelines for breast cancer screening

3) Criticize the efficiency of different breast cancer screening

methods.

4) Apply and interpret the basic epidemiological terms in

describing the risk (Odds, relative risk).

5) Define the potential factors influence health disparity in

Egypt especially the socio-economic and geography.

An:

Analysis

K: Knowledge Ap:

Application

C: Comprehension

Cognitive domains

Bloom’s *

Taxonomy

Ev:

Evaluation

A

p

C

A

n

K

E

v

* Bloom BS, Englehart MD, Furst EJ, Hill WH, Krathwohl DR. Tax- onomy of educational objectives: handbook I: cognitive domain. New York: David McKay; 1956.


Competency-based education [Methods and

assessment plan]: Skill stage

(Dreyfus)*

Objectives Bloom’s

Taxonomy

Teaching

methods

Assessment

method

New learner

(awareness

stage)

- Identify the different risk and

protective factors

- Assess barriers and promoters

for screening

- Define potential factors

influence health disparity

Knowledge

and

comprehensi

on

Orientatio

n lecture

self

learning

Case study

Written test

(pre-post)

Discussion

sessions

participation

Advanced

learner

(proficiency

stage)

- Recognize and communicate the

recommended case wise-

guidelines for screening

Application

Analysis

Case

scenario

Discussion

Field

Observation

Self

reflection

Presentation

s

Experienced

learner

(mastery

stage)

- Value the risk for cancer based

on patient’s risk factors

background.

Synthesis

Evaluation

Case study

Self

learning

Field

Observation

checklist

Written test * Dreyfus HL, Dreyfus SE. Mind over machine: the power of human intuition and experience in the era of the computer. Oxford: Basil Blackwell; 1986.


Competency mapping: Examples

Learning Objectives

Competencies

3 4 5 8 9 13 14

-Identify the different risk and protective

factor for breast cancer

K

C

C K

- Define the potential factors influence

health disparity.

K A

p

- Recognize and communicate the

recommended case wise-guidelines for

screening

Ap A

n

- Criticize the different methods used in

screening.

Ev A

p

- Apply and interpret the basic

epidemiological terms in describing the

risk (Odds, relative risk).

An A

p

K= Knowledge, C=Comprehension, An=Application,

An=Analysis, Ev= Evaluation

Current status

More competencies

Modifications

Future plan


Gap Analysis of the model:


Thank you

- Czabanowska , Moust JHC, Peter Schröder-Bäck P, Roebertsen H. Problem-based

Learning Revisited, introduction of Active and Self-directed Learning to reduce fatigue

among students. Journal of University Teaching & Learning Practice. 9(1), 2012.

Available at:http://ro.uow.edu.au/jutlp/vol9/iss1/6.

- Czabanowska K, Smith T, Ko KD , Sumskas L, Otok R, Bjegovic-Mikanovic V,

Brand H. In search for a public health leadership competency framework to support

leadership curriculum–a consensus study. European Journal of Public Health, 2013, 1–

6. doi:10.1093/eurpub/ckt158.

- Sharma K, Zodpey S; Gaidhane A; Syed ZQ; Kumar R; Morgan A. Designing the

Framework for Competency-Based Master of Public Health Programs in India. J P u b l

i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(1), 30–39

- Brownie S, Thomas J, Bahnisch M . Exploring the Literature: Competency-based

Education and Training & Competency-Based Career Frameworks. Report by the

National Health Workforce Planning & Research Collaboration. Faculty of Health

Sciences and University of Queensland Centre for Clinical Research, University of

Queensland, Australia October 2011.

- Loureiro I, Sherriff N, John Davies JK. Developing public health competencies

through building a problem-based learning project. J Public Health (2009) 17:417–424

DOI 10.1007/s10389-009-0256-7.

- An Environmental Scan of Best Practices in Public Health Undergraduate Medical

Education REPORT 1: Peer-Reviewed Literature Scan MARCH 2009. Prepared by

the Nevis Consulting Group for the Association of Faculties of Medicine of Canada

(AFMC) Public Health Task Group.3/20/2014 Public Health Competency-based learning 20

References

- Kristine M. Gebbie, KM; Weist EM; McElligott JE; Biesiadecki LA; Gotsch AR; Keck W

et al. Implications of Preparedness and Response Core Competencies for Public Health. J P u

b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(3), 224–230.

- Mainor A; Leeman J, MDiv; Sommers J, Heiser C; Gonzales C; Farris RP et al . A

Systematic Approach to Evaluating Public Health Training: The Obesity Prevention in

Public Health Course. J P u b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 00(00),

1–7

- Building the Public Health Workforce for the 21 Century. A Pan-Canadian Framework for

Public Health Human Resources Planning. 2005.

- Competencies and Learning Objectives. a technical assistance document. Accreditation

Criteria for Schools of Public Health, June 2011, and Accreditation Criteria for Public

Health Programs, June 2011, for the accreditation criteria.

- Cultural Competence Education for Students in Medicine and Public Health Report of an

Expert Panel. Joint Expert Panel Convened by the Association of American Medical

Colleges and the Association of Schools of Public Health. July 2012.

- Public Health Education and Training in the Context of an Enlarging Europe. A guide

towards a more effective, comparable and mobile work force across Europe. 2009.

- Hai-chao LI and Chen W. Reform direction of medical education in China: implementing

“competency-based” medical education. Chinese Medical Journal 2013;126 (17).

- Hou SI. Integrating Problem-based Learning with Community-engaged Learning in

Teaching Program Development and Implementation. Universal Journal of Educational

Research 2(1): 1-9, 2014 http://www.hrpub.org DOI: 10.13189/ujer.2014.020101.

- Hoover CR, Wong CC, Azzam A. From primary care to public health: using problem-based

learning and the ecological model to teach public health to first year medical students. J

Community Medicine, 2011, DOI 10.1007/s10900-011-9495-y. 3/20/2014 Public Health Competency-based learning 21

References

- Jabbari H, Bakhshian F,Alizadeh M, Alikhah H, Behzad MN. Lecture-based Versus

Problem-Based Learning Methods in Public Health Course for Medical Students. Res

Dev Med Educ, 2012, 1(2), 31-35.

- Calhoun JG, Rowney R, Eng E, Yael Hoffman Y. Competency Mapping and Analysis

for Public Health Preparedness Training Initiatives. Public Health Reports, 2005 Suppl

1 (120), 91-99.

- COMPETENCY-TO-CURRICULUM TOOLKIT: Developing Curricula For Public

Health Workers, Center for Health Policy Columbia University School of Nursing and

Association of Teachers of Preventive Medicine (2004).

- Caitlin Ryan Problem Based Learning Medical Science II (2009).

- Miller SK. Comparison of student outcomes following problem-based learning

instruction versus traditional lecture learning in a graduate pharmacology course. J Am

Acad Nurse Pract 2003;15:550-6.

Public Health Association of Canada (2007) Core competencies for public health in

Canada. PHAC, Ottawa. (www.phac-aspc.gc.ca/core_competencies).

- Hartling L, Spooner C, Tjosvold L, and Oswald A: Problem-based learning in pre-

clinical medical education: 22 years of outcome research. Med.Teacher 2010, 32:28-35.

Bloom BS, Englehart MD, Furst EJ, Hill WH, Krathwohl DR. Tax- onomy of

educational objectives: handbook I: cognitive domain. New York: David McKay; 1956.


References

Details of the learning Questions,

Objectives, Competencies and

Mapping.


Proposed Core competencies and core public

health domains


CDC, WHO, CanMED and others. ,

Competencies statements


Principles of Epidemiology

Basic Biostatistics

Social and behavioral sciences

Health care system, policy, and planning

Environmental health

Crosscuttingdomains

1-Apply the basic terminology and definitions of epidemiology

√

2-Describe a public health problem in person, time and place.

√ √

3-Critical appraisal of different screening modalities

√ √ √

4-Identify principles and limitations of screening programs

√ √ √

5-Identify risk factors for non-communicable diseases,implications for their prevention and control.

√ √ √

6-Define health issues form social perspectives

√ √

7-Describe health care disparities in relation to geographical, social and economical factors

√ √


health domains


Competencies statements



Basic Biostatistics




Crosscutt

ing

domains

8-Demonstrate competence in identifying, obtaining, and critically reviewing literature form different sources

√ √

9-Identify the behavioral determinants for health behavior change

√

10-Describe the interaction of physical and social environment and health

√


health domains


Competencies statements Core Public Health competency domains


Basic Biostatistics




Crosscuttingdomains

11-Demonstrate leadership skills , and team building skills

√

12-Demonstrate interpersonal communication skills (problem solving, listening, conflict resolution and decision)

√

13-Produce/deliver oral/written health education message of his/her own choice

√ √

14-Demonstrate ability to think critically

√ √ √


Relevant learning questions

1. What are the common risk factors for breast cancer?

2. Does breast cancer can be prevented?

3. What are the available screening tests for breast

cancer?

4. How effective are these tests?

5. Do these tests of value in reducing mortality from

Breast cancer?

6. What are the barriers to women getting these

recommended screening tests?

7. What factors promote the uptake of screening?

8. How we are going to increase women’s awareness

about breast cancer screening?

9. Are women in rural areas receiving equal health care

services as urban?

10. Are the current policies-programs for breast cancer

screening are efficient?

By the end of this case, undergraduate medical students should be

able to:


Intended learning outcomes (ILO)

1) Recall the epidemiological features and risk factors responsible for the

development of non-communicable disease with especial reference to cancer.

2) Identify the different genetic/behavioral/environmental risk and protective

factor for breast cancer

3) Define the basic pillars for screening tests namely

sensitivity/specificity/predictive values

4) Recognize and communicate the recommended case wise-guidelines for breast

cancer screening

5) Criticize the different methods used in screening in terms of false

positive/negative, labeling, lead time effect ect.,

6) Apply and interpret the basic epidemiological terms in describing the risk (Odds,

relative risk).

7) Value the risk for breast cancer on individual case based on patient‟s risk factors

background.

8) Assess the potential barriers and promoters for breast cancer screening in Egypt

especially in rural areas

9) Define the potential factors influence the health disparity among Egyptian

population especially the socio-economic and geography.

K

An: Analysis

K:Knowledge Ap: ApplicationC: Comprehension

Cognitive

domains

Bloom’s

Taxonomy

Ev: Evaluation

Ap

C

C

An

K

Ev

Ev

C

C


Competency-based learning and assessment planSkill stage

(Dreyfus)*

Objectives Bloom

Taxonomy

Teaching

methods

Assessment

methodNew learner

(awareness stage)

1. Recall the epidemiological features and risk factors responsible for the development of non-communicable disease with especial reference to cancer.

2. Identify the different genetic/behavioral/environmental risk and protective factor for breast cancer

3. Define the basic pillars for screening tests namely sensitivity/specificity/predictive values

8. Assess the potential barriers and promoters for breast cancer screening in Egypt especially in rural areas

9. Define the potential factors influence the health disparity among Egyptian population especially the socio-economic and geography.

10. Define the responsibility of primary care in assessing, guiding and educating individuals with risk factors.

Knowledge and comprehension

Orientation lecture

Readings/self learning

Case studies

Written test (pre-post)

Discussion sessions

Advancer learner

(proficiency stage)

4- Recognize and communicate the recommended case wise-guidelines for breast cancer screening

5- Criticize the different methods used in screening in terms of false positive/negative, labeling, lead time effect ect.

Application

Analysis

Simulated case scenario

Role play

Searching /synopsis

Observation

Self reflection

Presentations

Experienced learner (mastery stage)

6- Apply and interpret the basic epidemiological terms in describing the risk (Odds, relative risk).

7- Value the risk for breast cancer on individual case based on patient’s risk factors background.

Synthesis

Evaluation

Case study Observation checklist

Simulated case


Competency mapping :K= Knowledge, C=Comprehension, An=Application, An=Analysis, Ev= Evaluation

Learning Objectives Competencies

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1-Recall the epidemiological features and risk

factors responsible for the development of non-

communicable disease with especial reference to

cancer.

K

C

K K

C

K K

2-Identify the different

genetic/behavioral/environmental risk and

protective factor for breast cancer

K

C

A

p

3-Define the basic pillars for screening tests namely

sensitivity/specificity/predictive values

A

p

An Ap

8-Assess the potential barriers and promoters for

breast cancer screening in Egypt especially in rural

areas

K KC Ev Ap K

9-Define the potential factors influence the health

disparity among Egyptian population especially

the socio-economic and geography.

K

C

K

C

10-Define the responsibility of primary care in

assessing, guiding and educating individuals

with risk factors.

K C Ap

4-Recognize and communicate the recommended

case wise-guidelines for breast cancer screening

Ap An

5-Criticize the different methods used in screening

in terms of false positive/negative, labeling, lead

time effect ect.

K

C

C

6-Apply and interpret the basic epidemiological

terms in describing the risk (Odds, relative risk).

Ap