PhD overview: Do we preach what we practice? Capturing the complexities of clinical practice in health professions education.

My PhD research aims to explore competency frameworks in the health professions. This includes reviewing how they have been developed to date, outlining implications of these findings, identifying means by which the development process could be improved, and proposing updated reporting and evaluation processes. The project will include the development of a competency framework as a worked example. Outlined here is an overview of my PhD to date, with abstracts and links to published articles, pre-prints, copies of posters, and updates.

Publications

The development of competency frameworks in healthcare professions: a scoping review

Competency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. We applied the Arksey and O’Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. We observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.

Full text here: https://link.springer.com/article/10.1007/s10459-019-09946-w
Author accepted version here: http://alanbatt.net/wp-content/uploads/2014/10/191205-Scoping-review-competency-development-AAM.pdf

New ways of seeing: the role of systems thinking when developing competency frameworks in health professions education

Introduction

Competency frameworks provide a link between professional practice, education, training, and assessment. They support and inform downstream processes such as curriculum design, assessment, accreditation and professional accountability. However, a lack of organizing frameworks, and difficulties in representing complex professional practice result in uncertainty regarding the validity and utility of competency frameworks. This necessitates additional ways of “seeing” practice when developing competency frameworks. We highlight what a systems-thinking conceptual framework can offer when developing competency frameworks.

A Systems-Thinking Approach

Mirroring shifts towards systems thinking in program evaluation and quality improvement, we suggest that similar approaches that identify and make use of the role and influence of system features and contexts can provide value when developing competency frameworks. We framed a systems thinking approach first by adapting Ecological Systems Theory (EST). EST offers a realist perspective of the person and environment, and the evolving interaction between the two. Second, we utilized complexity thinking, which obligates attention to the relationships and influences, to explore the multiple complex, unique, and context-embedded problems that exist within the messy, real-world system.

Summary

The ability to represent clinical practice when developing competency frameworks may be improved when features that may be relevant, including their potential interactions, can be identified and understood. A systems thinking approach makes visible features of a practice in context that may otherwise be overlooked in the development of competency frameworks.

Pre-print here: http://alanbatt.net/wp-content/uploads/2020/07/200731-Systems-thinking-pre-print.pdf

Abstracts and commentaries

Batt, A.M., Williams, B., Brydges, M., Leyenaar, M., Tavares, W. A ‘systems thinking’ conceptual framework to explore clinical practice. DP 4-6. Canadian Medical Education Journal. 11(2):e170. Abstract.

Batt, A.M., Tavares, W., Williams, B. How do healthcare professions develop competency frameworks? DP 12-5. Canadian Medical Education Journal. 2020. 11(2):e201.

Batt, A.M., Tavares, W., Williams, B. A35. A scoping review of competency framework development in healthcare professions. PAC Paramedic Research Symposium Book of Abstracts. 2019. Abstract.

Batt, A.M. Explore and evolve. International Paramedic Practice. 2019;9(3):53 10.12968/ippr.2019.9.3.53. Full-text.

Presentations

Do we preach what we practice? The misalignment of paramedic practice and education. BSc in Paramedicine, University of Prince Edward Island, PEI, Canada, March 26, 2020.

Identifying training and education needs for community paramedics: a systems based approach. Ontario Community Paramedicine Secretariat Provincial Workshop, Toronto, ON, Canada, February 27, 2020.

Batt, A.M., Tavares, W., Williams, B. Towards a best practice model for developing competency frameworks. Monash Centre for Scholarship in Health Education HDR Symposium, Melbourne, VIC, Australia, October 31, 2019.

Batt, A.M., Tavares, W., Williams, B. The misalignment of paramedic practice and education. Ontario Paramedic Association Conference, Toronto, ON, Canada, October 26, 2019. Link: https://www.researchgate.net/publication/336779040_The_misalignment_of_paramedic_practice_and_education

Batt, A.M., Tavares, W., Williams, B. The development of competency frameworks in healthcare professions: a scoping review. Richard K. Reznick Wilson Centre Research Day, Toronto, ON, Canada, October 18, 2019. Link: https://www.researchgate.net/publication/336672273_The_development_of_competency_frameworks_in_healthcare_professions_a_scoping_review

Just what do paramedics do? Towards a definition of paramedic practice. Cape Breton Paramedic Conference, St. Ann’s, NS, Canada, September 27-29, 2019.

Preaching what we practice? Towards Practice Informed Education. BSc in Paramedicine, University of Prince Edward Island, PEI, Canada, March 7, 2019.

Batt, A.M., Tavares, W., Williams, B. Developing practice informed paramedic education. Monash Centre for Scholarship in Health Education HDR Symposium, Melbourne, VIC, Australia, November 8, 2018.

Batt, A.M., Tavares, W., Williams, B. The relationship between practice and education. County of Renfrew Paramedic Research Symposium, ON, Canada, June 12, 2018.

Poster presentations

Batt, A.M., Williams, B., Brydges, M., Leyenaar, M., Tavares, W. A ‘systems thinking’ conceptual framework to explore clinical practice. Canadian Conference on Medical Education, Vancouver, BC, Canada, April 19, 2020 (conference cancelled due to COVID-19). 10.13140/RG.2.2.13626.54720

Batt, A.M., Tavares, W., Williams, B. How do healthcare professions develop competency frameworks? Canadian Conference on Medical Education, Vancouver, BC, Canada, April 19, 2020 (conference cancelled due to COVID-19). 10.13140/RG.2.2.30403.76328

Batt, A.M., Tavares, W., Williams, B. A scoping review of competency framework development in healthcare professions. PAC Paramedic Research Symposium, Winnipeg, MB, Canada, September 19, 2019. 10.13140/RG.2.2.26401.35681

PhD Cartoon – “Worshipping False Gods”

I recently received my PhD cartoon from Ashleigh Neill of PhD Cartoons! In our scoping review of competency framework development processes (pre-print available on profile) we highlighted the risk that flawed development processes might lead to the creation of illegitimate or uncertain “false-god” competency frameworks. These frameworks appear legitimate, but contain artificial or uncertain outcomes, and are then inappropriately worshipped or admired in that they influence policy, assessment etc.Ashleigh took this rather abstract concept and created a cartoon which depicts tourists (who represent downstream processes such as policy and assessment) worshipping and admiring a cardboard cutout of Asclepius (who represents a competency framework), yet they do not realise it is a cutout, and is therefore illegitimate or artificial.It’s great to see a concept make it from my head to a visual interpretation on paper! Thank you Ashleigh, I’m very pleased with it and everyone who has seen it so far has been impressed!

CONFERD-HP Guideline

CONFERD-HP stands for the Guideline for Reporting COmpeteNcy FramEwoRk Development in Healthcare Professions. CONFERD-HP is a consensus-based reporting guideline that is being developed via the recommended EQUATOR Network methodology as a component of my PhD.

Our scoping review of competency framework development in healthcare professions highlighted a number of areas for improvement, including significant variability in the reporting of frameworks. As such, by developing this reporting guideline we aim to reduce this variability. The guideline aims to clarify and outline key reporting items for those who develop competency frameworks or competency profiles in healthcare professions.

CONFERD-HP is registered with the EQUATOR Network as a guideline under development. Updates will be posted on the CONFERD-HP website as they occur: conferd-guideline.org

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