Learning and Assessment of Competencies: Two Sides of the Same Coin

• In Event: Clarifying Assessment and Measurement Issues Across Disciplines and Professions

Abstract

Perspectives/Theoretical framework
Six core competencies in medicine (patient care, medical knowledge, practice-based learning and improvement, interpersonal communication skills, professionalism and systems-based practice) were implemented in 1999 and are now considered a fundamental part of professional training. The core competencies, as defined by the Accreditation Council for Graduate Medical Education (ACGME, 2007), offer a conceptual framework to address the knowledge and skills needed by students in training and doctors to perform competently (Yaszay, Erik, Agel, & Hanel, 2009). Core competencies and related learning objectives are considered educational outcomes and medical residents are required to demonstrate sufficient proficiency in all of these competencies independent of their residency (Frank et al., 2010; Taylor & Swing, 1999). This means that professional training is becoming primarily driven by output measures (objectives, competencies) rather than input measures (instruction, educational activities). An outcome is "what" you expect your residents to achieve. It is assumed that assessment based upon the core competencies provides evidence of the program’s effectiveness in preparing residents for practice. The question of interest for educators is "how" residents perceive they acquire proficiency in the core competencies; the means to that end.

Methods
Residents from year 1-3 (2007-2010) were surveyed (n=1378) about what educational activities have been most helpful in their learning of the 6 core competencies. The educational activities listed included: (1) patient care interactions, (2) resident didactic teaching sessions, (3) journal club, (4) quality improvement sessions, (5) observation of peers and attendings, (6) independent reading and study. These questions were scored on 5-point Likert scales (1=not helpful - 5=most helpful).

Results
Descriptive statistics show that all educational activities contribute to learning each individual competency. The degree of perceived helpfulness for each educational activity varied per competency. Although the 6 core competencies have been defined as separate entities, our results show significant overlap among the educational activities that foster the competencies. This makes it unpractical to learn or assess competencies as independent constructs.

Conclusions
Competencies are not perceived to be learned through any single learning activity. Specific educational activities nurture multiple competencies. Because competencies are multi-dimensional and interconnected it is unlikely that a single approach to learning or assessment will be adequate (Lurie, Mooney, & Lyness, 2009). Outcome-based (or competency-based) education can serve as a roof on a well-designed educational system but can never be a substitute of an ill-defined educational system that does not adequately address the means to achieving the outcomes. A pure focus on individual outcomes will deny the art in medicine and such an approach will only touch the surface of performance and not the depth and breathe of being a physician. Clinical competence takes place at the intersection of a lot of different learned abilities and skills. This ability of implementing and applying multiple core competences is what medicine is about. Learning and assessment are very closely related although they seem different.

Authors

• Paul F. Wimmers, University of California - Los Angeles

• Lourdes R. Guerrero, University of California - Los Angeles

• Susan Baillie, University of California - Los Angeles