Seeing Competency-Based Assessment in a Different Light

Ivy F. Oandasan MD CCFP MHSc Associate Professor, Department of Family & Community Medicine

University of Toronto

Director of Education College of Family Physicians of Canada

Academic Family Physician, Toronto Western Hospital

A Change in Mindset is Needed

Assessment is a curriculum tool

Competency & Capability

“Self-assessment should not imply an isolated or

individualistic activity; it should commonly involve

peers, teachers, and other sources of information.”

Competence is multi-dimensional and dynamic

– it changes with time, experience and setting

Frank JR, Snell L, ten Cate O, Holmboe ES, Carraccio C, Swing SR, et al.

Competency-based medical education: theory to practice. Med Teacher. 2010;32:638-45.

Metacognition: the ability of learning how to learn

and transferring learning to new contexts.

Doctors require self-understanding and insight to

the nature and limitations of their knowledge and

their capacity to apply it are crucial.

Helping both learner and preceptor/assessor understand

how much has been learned & what yet needs to be learned

A Competency based Curriculum that is: Comprehensive, focused on Continuity of Care & Centred in learning

specific for Family Physicians

Launched in 2011

FUNDAMENTAL TEACHING ACTIVITIES FRAMEWORK

College of Family Physicians of Canada

Framework Taxonomy

DOMAIN Clinical Preceptor

TASKS Clinical Coach- a supervisor in day-to day practice Competency Coach – an educational advisor along the course of a learner’s training

ACTIVITIES

Explicitly embodies the roles attitudes and competencies of a family physician in clinical work

Helps learners design and update their individual learning plans

Promotes and stimulates clinical reasoning and problem solving

Guides a comprehensive periodic progress review informed by the learners’ self-analysis

Gives learner-centred feedback at the appropriate time Assists learners in their professional development

Uses program assessment tools to document observed learners’ performance according to their level of training.

Adjusts interventions to support learners facing progression challenges

Employs reflective practices to refine clinical supervision

Competent in assessing what they yet need to improve

An instructor with andragogical philosophy aims to create an

informal, collaborative and respectful climate. He involves the

learner in the process of designing and evaluation of the

learning activities which are based on the learner’s problem

areas.

Davenport, J., & Davenport, J. H. (1985). Knowles or Lindeman: Would the real father of

American andragogy pleas stand up? Lifelong Learning, 9(3), 4-5.

Competent AND Capable

Competency can be understood as a proven

ability in acquiring knowledge and skills based

against a standard

www.cihc.ca

Values/ethics for IP Practice

Roles/Responsibilities

Interprofessional

Communication

Teams and teamwork

American Interprofessional Education Collaborative Expert

Panel, 2011

2011

Task Design

Task Type

Management

Project

Care delivery

patient/disease type

(e.g., geriatric/stroke)

care delivery setting

(e.g., acute)

Task Features

Interdependence

Autonomy

Specialized knowledge/expertise

Clarity of rules and procedures

Work cycle

Use of quality framework/guidelines

Team Composition

Size, age, gender, tenure

Discipline

Diversity

Team Processes Communication

Collaboration

Coordination

Conflict

Leadership

Decision-making

Participation

Team Effectiveness

Objective Outcomes

Patient (e.g., functional

status, satisfaction)

Team (e.g., clinical quality of

care)

Organization (e.g., cost-

effectiveness)

Subjective Outcomes

Perceived team effectiveness

by team members (e.g.,

perceived task outcomes, well

being, and willingness to work

together in the future)

Team Psycho-

Social Traits

Cohesion

Norms

Efficacy

Problem-solving

effectiveness

Organizational Context

Goals/Standards

Structure/Characteristics

Rewards/Supervision

Resources (human, technological)

Training environment

Information system

Social and

Policy Context

Competent? Incompetent? Capable but….

What is the best outcome expected?

Capable people exhibit the following traits:

self-efficacy, in knowing how to learn and continuously reflect on the learning process;

communication and teamwork skills, working well with others and being openly communicative;

creativity, particularly in applying competencies to new and unfamiliar situations

being adaptable and flexible in approach;

Having positive values

(Hase & Kenyon, 2000; Kenyon & Hase, 2010; Gardner et al., 2007).

heutagogy

An approach that supports development of an ability

of a learner to reflect upon his/her problem solving

process, the outcome chosen, considering what was

learned through the process.

Self-determined

Hase & Kenyon, 2000: http://www.psy.gla.ac.uk/~steve/pr/Heutagogy.html

Heutagogy is the study of self-determined learning enabling a

learner to reflect upon his/her problem solving process, the

outcome chosen and considering what was learned through

the process

From: Lisa Marie Blaschke: http://www.slideshare.net/lisamarieblaschke/sustaining-lifelong-learning-a-review-of-

heutagogical-practice?related=2

From: Lisa Marie Blaschke: http://www.slideshare.net/lisamarieblaschke/sustaining-

lifelong-learning-a-review-of-heutagogical-practice?related=2

Is self-reflection a skill

that is teachable?

Can we help learners self-

assess in order to act for

improvement?

self-awareness,

self-regulation,

self-motivation,

social awareness,

and social skills

40

Emotional Intelligence

Intrapersonal and Interpersonal

skills in the areas of…

What assumptions am I making?

Where did I learn these values?

What values orient me?

How might someone whose role is different than mine look at this?

Why do I feel threatened when I am challenged on this issue?

McKee, 2003

General professional competencies including the ability to

work in a team, metacognitive skills, professional behaviour,

the ability to reflect and to carry out self-appraisal are

highlighted as future trends

The advancement of more qualitative approaches 360

degrees, peer assessment, reflective portfolios - OSCE’s

that can be used to demonstrate capability and ongoing

daily workplace assessments by clinical preceptors …

A change in mindset in how we think about assessment is

needed by learners and assessors

An assessment process including formative assessments is

a curricular opportunities

We need Competent and Capable graduates – let us look

at theoretical models like heutagogy to help guide us

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