National Learning Competencies to Support Excellence in CEhp Executive Summary Background In 2011, the Alliance for Continuing Medical Education took steps to respond to the environmental changes in health care and demands for health care team-based education and processes. A strategic plan and name change positioned the Alliance for Continuing Education in the Health Professions (Alliance for CEhp) to align the organization, along with its services and programming, with the needs and expectations of the health care team to maintain competence and improve patient care. Following its strategic plan, the Alliance for CEhp began a process to revise its 2003 Competencies for CME Professionals. The 2003 Competencies described skills needed in the field of Continuing Medical Education (CME). The Alliance s plan to update its competencies was designed to ensure that they reflected abilities that would help educators in the health professions succeed today and in the future. Once outlined, the updated Competencies would help articulate the transformation that has occurred with the role of educators in the health professions where the focus is on learning and change along with performance and quality improvement. Process The Alliance s Professional Development Committee (PDC) convened an interprofessional volunteer workgroup to lead the process of reviewing and revising the Competencies. Subject matter experts from multiple disciplines and organizational types within the field of CEhp reviewed each Competency Area. Stakeholder groups such as the American Nurses Credentialing Center (ANCC) and Accreditation Council for Pharmacy Education (ACPE) reviewed the proposed revisions to ensure that interprofessional knowledge and skills were included in the Competencies. In early 2013, a questionnaire was distributed to CEhp practitioners to help validate the Alliance for CEhp Competencies and that revisions articulated the skills needed to support effective and quality CEhp programs. Results The Alliance for CEhp s National Learning Competencies are unique in the field of continuing education in the health professions as a comprehensive compendium of CEhp practitioner abilities. Drawing upon the Dreyfus Model of Skill Acquisition i, the Alliance s National Learning Competencies provide a staged approach to the development of proficiency and expertise in the field. The eight Competency Areas represent different yet interconnected components of CEhp that, taken together, form the foundation for excellence in the field.
The National Learning Competencies are designed to describe the abilities needed for success and to outline a professional development pathway for CEhp practitioners. Self-assessment and monitoring of performance in each area will support CEhp practitioners lifelong learning journeys. The Competencies also provide a framework for position descriptions, performance expectations, and career growth. CEhp practitioners can look to the Alliance for CEhp s National Learning Competencies to guide their own performance, professional development, and career aspirations. Summary of the National Learning Competencies Competency Area CEhp Practitioners should be able to Area 1 Using Adult & Organizational Learning Principles Use evidenced-based adult and organizational learning principles to improve the performance of health care professionals, the health care team, and the organizations in which they work, in order to improve patient outcomes. Area 2 Designing Educational Interventions Implement and improve independent, fair, balanced, and evidence-based educational interventions that produce expected results for learners and the organizations in which they work. Area 3 Area 4 Area 5 Measuring the Effectiveness of CEhp Activities and the Impact of Overall CEhp Program Collaborating and Partnering with Stakeholders Managing and Administering the CEhp Program Use data to evaluate the effectiveness of CEhp activities/interventions and the impact of the overall CEhp program. Collaborate and partner with stakeholders to help meet the CEhp mission. Manage and administer the CEhp office operations to meet personnel, financial, legal, logistical, accreditation, CE credit, and/or regulatory standards Area 6 Leading the CEhp Program Provide leadership for the CEhp program. Area 7 Engaging in self-assessment and lifelong learning Continually assess individual performance and CEhp program effectiveness and make improvements through relevant learning experiences. Area 8 Engaging in Systems Thinking in CEhp Approach the practice of CEhp from a system-thinking perspective, recognizing that a team of health care professionals that are part of a complex health care system delivers patient care. 2
Environmental Issues Driving the Evolution of CEhp Beginning over a decade ago, multiple reports were published that identified the need to improve the quality of health care in the United States. ii, iii, iv, v. Since that time, organizations throughout the health care and health care provider education systems have been working to develop strategies to improve provider competence, health care system performance and overall patient care vi, vii, viii, ix, x, xi. This work has resulted in what has become known as the triple aim of health care. These aims reflect the need for better health, better health care, and lower health care costs. Health care legislation and changes in health care reimbursement reinforce these aims. Today s practice environment one that demands both high quality and efficient health care looks far different than decades ago. In addition to technological innovation, patient care is now expected to be more team-based. Today s health care team can include physicians, pharmacists, nurse practitioners, physician assistants, nurses, social workers, dieticians, as well as other allied health professionals working with patients and their families. A health care team works to provide integrated care that is patient-centered, requiring the team to work together to deliver coordinated, deliberate and thoughtful patient care. Although these teams work together to deliver care, licensing and certification processes for health care professionals are at the individual practitioner level. At this level, the focus is on assessment of knowledge and skills by each of the health care professions standards for education and practice. Each profession has certifications and processes to identify when an individual health care practitioner meets specific standards for performance and has the requisite knowledge and skill sets needed for competent performance. Health care professionals ability to achieve specified Competencies is verified through licensing and certification. The use of competencies for health care professionals is evolving into the gold standard for ensuring public trust and expectations for quality care. In light of the national studies mentioned above, the need for performance improvement-based education to support professional competencies has become increasingly important to addressing health care s triple aims. Emergence of a Profession: CEhp As health care and health care delivery shifts to a focus on outcomes and quality, there is more pressure on providers to learn new practice skills that impact the outcomes for patients. These skills are being tied to professional credentials, reimbursement, and accreditation of health care institutions. Systems of continuing education accreditation have changed to reflect the new health care environment. New continuing education accreditation requirements, as illustrated by the ACCME Criteria, require CE providers to have a much more in-depth understanding of adult learning, quality improvement, and outcomes assessment than has ever been true in the past. Like health care providers, those professionals involved in continuing education for health care providers have, for many years, worked in their own professional silos. Practitioners working in Continuing Medical Education, Nurse Professional Development, and Continuing Pharmacy Education, for example, worked to meet requirements of different credit systems and accrediting bodies. Although the procedures used to develop education for each discipline were disconnected from one another, the educational principles behind the processes were the same. 3
All of the educators involved were working to address gaps in health care by facilitating opportunities for learning and addressing systems issues that can impede improvements. All of these educators were working to design educational interventions that would have an impact on health care professionals knowledge or ability to ultimately help them improve their performance using adult learning and change models that are applicable across professions xii, xiii, xiv, xv Assessment of learning and change were standard components of this design. The push for team-based care has created a demand for changes in corresponding education systems that need to modified to teach and support new skills for the development of interprofessional teams and changing models of care delivery. Interprofessional Education at all levels undergraduate, graduate, and post-graduate professional development is receiving more attention and recognition. Students and practitioners are learning principles of quality improvement, coordinated care, and outcomes-focused care. Individual practitioners, or individual professions, practicing in isolation, cannot accomplish these goals. Developing interprofessional continuing education presents a new set of challenges and the need for new skills for educators. As educators from different professions come together, they are noting their similarities, and well as their unique skills. As health care professionals understand the value of learning together, so too have the educators embraced the value of sharing resources, working together to address common problems, breaking down barriers, eliminating redundancies, and creating efficiencies in the system. When the aspiration is to help a health care professional learn and change to improve patient care, common goals can lead to complimentary and collective processes, cooperative procedures, shared strategies and interprofessional and systems-based interventions. Facilitating lifelong learning for physicians, nurses, pharmacists, nurse practitioners, and other allied health care workers has become a profession of its own. Continuing Education in the Health Professionals is a unique field critical to today s health care system and the expectations of the system. CEhp practitioners, who work everyday to help improve health care professionals performance, have a skill set of their own that enables them to facilitate learning, change, and improvement. CEhp practitioners competencies include creating, implementing and evaluating quality continuing education that is linked to performance improvement. These CEhp Practitioner Competencies complement those that groups like the IOM, ACGME, ABMS, and ANCC have outlined for health care professionals. When CEhp Practitioners successfully achieve their own competencies, they can more fully support lifelong learning and performance improvement the health care professionals. Competencies for CEhp Practitioners Background of Competencies In 2003, the Alliance for Continuing Medical Education (what was formerly the name of the Alliance for CEhp) adopted a set of competencies for CME professionals. Over time, the set of eight Competency areas came to include 48 specific competencies with numerous KSAs (knowledge, skills, and attitude) related to each competency. These competencies helped to define the profession along with the attributes of CME professionals. In 2011, the Alliance for Continuing Medical Education took steps to respond to the environmental changes in health care and demands for health care team-based education and processes. A strategic plan and name change positioned the Alliance for CEhp to align the 4
organization, along with its products and programming, with the needs and expectations of the health care team to maintain competence and improve patient care. Following its strategic plan, the Alliance began a process to revise its 2003 Competencies for CME Professionals. The 2003 Competencies described skills needed in the field of Continuing Medical Education (CME). The Alliance s plan to update its competencies was designed to ensure that the Competencies reflected abilities that would help educators in the health professions succeed today and in the future. Once outlined, the updated competencies will help articulate the transformation that has occurred with the role of educators in the health professions where the focus is on learning and change along with performance and quality improvement. Process to Modify and Update Competencies The Alliance utilized a modified Delphi method to revise its 2003 Competencies. The Alliance s Professional Development Committee (PDC) convened an interprofessional volunteer workgroup to lead the process, staffed by Mary Martin Lowe, PhD, Education Advisor to the Alliance. The Competency Workgroup members, chosen for their expertise and leadership in their disciplines, were: Billie Dalrymple (Chair) Pam Dickerson, PhD, RN-BC Pam McFadden Karen Overstreet, EdD, RPh, FACME, CCMEP Brooke Taylor, MPH, CCMEP Tim Welty, PharmD FCCP BCPS Subject matter experts (SMEs) from multiple disciplines and organizational types within the field of CEhp were then identified based on their expertise and assigned to a SME group for one Competency Area. Each of the eight SME groups reviewed its assigned Competency Area and corresponding Competencies. SMEs were asked to provide their feedback on the following areas: 1. The applicability of the Competency Area and each Competency to today s CEhp Professional. 2. The need to delete or add Competencies based on changes in the field or overall work environment. 3. The need to and appropriateness of modifying physicians and CME specific language in the Competencies to broader fields of health care professionals and CEhp SMEs completed online surveys, completed forms, and engaged in conference call discussions to review and discuss results as well as review proposed revised Competencies. As SME work was occurring, the Alliance partnered with the AXDEV Group to develop a Competency Model that could be used with the Alliance s Revised Competencies. The intent of the Competency Model was to allow for an articulation of the ACEhp s Competencies at levels that would correspond with skill development, from novice to mastery. The Dreyfus Model of Skill Acquisition served as a reference and guide for the Alliance Competency Model. The Competency Workgroup built on the work of the SMEs to assist in the development of the Competency Model. Revised Competencies, based on feedback was SMEs, were applied in the Competency Model and a set of Draft Revised Competencies for CEhp Practitioners emerged. Stakeholder groups, including the ANCC and ACPE, were engaged in reviewing the Draft Revised Competencies. Both ANCC and ACPE affirmed that the Draft Revised Competencies 5
were relevant and applicable to educators in the disciplines of nurse professional development and continuing pharmacy education. The Alliance Board of Directors endorsed the Revised Competencies as relevant to CEhp professionals. Feedback from CEhp practitioners regarding the relevance of the Competencies to their positions and workplace was sought via survey. Field Survey In early 2013, a questionnaire was developed to help validate the Competencies developed by the Alliance for CEhp articulated the skills needed to support effective and high-quality quality CEhp programs. The Competency Workgroup agreed that individuals in the best positions to provide feedback on these points were CEhp practitioners. Using the Alliance s database, individuals, stratified by their stated occupational function received the survey if they (1) had a function of Manager or higher or (2) had a function lower than a Manager but were the only individual in the database from their organization. Individuals who were the only organizational representative were selected because they were believed to most likely be operating in oneperson CEhp offices, and would have some oversight of their CEhp Program. All individuals working for the same organization who had a function of manager or higher received this survey. There were a total of 2638 individuals who met the criteria to be included in the survey. However, 301 individuals were removed from the group because there were no email addresses for them in the Alliance s database. 2337 were selected to receive the field questionnaire. A total of 181 responses were received. The number of responses to individual items in the survey varied. Respondents were given each Competency Statement and asked questions related to the Competency s perceived value of the Competency. The first survey item was: In thinking about the skills needed to support a successful CEhp program, how important is it for CEhp practitioners to have the ability to <Competency Statement>. Response options were: Very Important (5), Important (4), Moderately Important (3), Of Little Importance (2) and Not at all Important (1). The overall average for all Competencies was 4.5. The range was 4.12 to 4.84. The Competencies Workgroup believed that, based on these results, it was fair to conclude that all of the revised Competencies were perceived as Important and that no Competency should be deleted. In contrast to the first question that called for reflection of success of a CEhp program, in general, the second set of questions in they survey prompted respondents to reflect on their own CEhp program and consider, for each Competency: 1) How important is it to the success of your CEhp program to have staff proficient in the Competency? (Mean rating = 4.24) 2) Considering the collective work of all CEhp staff, with what frequency is the Competency applied in the implementation of your CEhp activities and the overall CEhp program? (Mean rating = 4.14) 3) How important is it that you and other CEhp staff have opportunities for professional development related to the Competency? (Mean rating = 4.06) 6
The results did not identify any of the competencies as being irrelevant, but several were noted to be used less frequently. Some Competencies would, but their nature, be applied more often than others. The value of proficient staff would be lower for some Competencies compared to others, because of the difference in how often such skills are applied. Affirmation and Adoption The workgroup concluded that the Revised Competencies were relevant to CEhp practitioners. They then reviewed feedback from stakeholders and respondents regarding specific edits or additions to better clarify the Competencies. The Alliance s Professional Development Committee affirmed the Workgroup s conclusions and recommended that the Alliance Board of Directors adopt the Competencies for CEhp Practitioners. In July 2013, the Alliance for Continuing Education in the Health Professions adopted the Competencies for Continuing Education Professionals. Next Steps There are several next steps for the Alliance s Revised Competencies for CEhp Practitioners. Uses of the competencies range from self-assessments and professional development pathways to job descriptions and performance reviews. CEhp practitioners in various organization types and practice settings can use the Competencies so that they can be even further tailored to specifics of the CEhp environment. Adoption of the Revised Competencies was an important milestone. It marks the beginning of how the Competencies can further transform and support the exciting and important field of Continuing Education in the Health Professions. i Dreyfus S, Dreyfus H. (1980). A five stage model of the mental activities involved in directed skill acquisition, Research Paper, California University Berkeley Operations Research Center, A155480 ii IOM (Institute of Medicine). 1999. To err is human: Building a safer health system. Washington, DC: National Academy Press. iii IOM (Institute of Medicine). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. iv McGlynn, E. A., S. M. Asch, J. Adams, J. Keesey, J. Hicks, A. DeCristofaro, and E. A. Kerr. 2003. The quality of health care delivered to adults in the United States. New England Journal of Medicine. 348(26): 2635-2645. v IOM (Institute of Medicine). (2003). Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academy Press. vi American Board of Medical Specialties Maintenance of Certification Program vii Accreditation Council for Continuing Medical Education 2006 Updated Criteria viii American Medical Association s PI-CME Activity Format, approved in 2005 ix National Research Council. (2013). Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models Across the Continuum of Education to Practice: Workshop Summary. Washington, DC: The National Academies Press. x National Research Council. (2010). Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. xi Federation of State Medical Board s Maintenance of Licensure (MOL) Program xii Knowles, M.S. (1970). The Modern Practice of Adult Education: Androgogy Versus Pedagogy. New York: Cambridge Books. xiii Prochaska, J.O, & DiClemente, C.C. (1983) Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395. xiv Schon, D.A. (1983). The Reflective Practitioner: How professionals think in action. New York: Basic Books. xv Kolb, D. A. (1984). Experiential Learning: experience as the source of learning and development. New Jersey: Prentice-Hall. 7