The Impact of Training Settings on Competence Development in the Area of Health Care

• In Event: 65.078 - "Context Matters!" Antecedences of Vocational Education and Training Competencies

Abstract

While professionalizing health-related occupations and developing corresponding competency profiles, there is still a definite lack of methods for assessing these competencies. This is somewhat surprising, given the general trend towards a ‘competency-based’-realignment of health-related training programs (e.g., American Association of Colleges of Nursing 2010; Sottas 2011). The question how different institutional contexts influence the individual competence development during the VET-programs still merits clarification. The aim of this paper is to shed light on the individual and institutional determinants governing this process.
In this study N=1.150 apprentices for medical assistance were surveyed at the end of their three-year-apprenticeship. Characteristic for the German “Dual System” is the combination of work-place and school-based learning. With regard to the institutional setting (hospital versus private medical practice) and as a function of diverging medical specialisations, substantial variations were encountered.
The measurement of occupational expertise presupposes substantial knowledge as to the (future) occupational domain and its practical requirements. Following the Evidence-Centered-Assessment-Design (Mislevy & Haertel 2006), the first step was to conduct an analysis of domain characteristics, based on typical activities of health-care assistants. A three-dimensional competency model resulted: (1) Advice and support for patients, before and after the actual medical treatment. In order to meet this goal, knowledge and abilities are required which take the psycho-social and somatic conditions of the patient into account. Also included are methods and techniques to motivate the patient and to resolve conflict situations. Beyond the primary socio-communicative skills, medical expertise stricto sensu can be assumed to also play a role here, e.g., the ability to arrive at a tentative, elementary diagnosis derived from reported symptoms. (2) Medical health-related activities which do not involve direct contacts with patients such as laboratory work or the implementation of rigorous hygienic standards. (3) Practice and maintenance of principles of management and administration, i.e., the ability to plan work sequences under due consideration of health and hygiene constraints, and follow the requirements for accounting and documentation of medical services.
Figure 1 shows the tentative competency model which distinguishes between the three sub-domains described above, each of which is characterized by specific cognitive challenges and action patterns. Moreover, Figure 1 takes the complex dispositional structure of the relevant knowledge, abilities, and skills as well as their background in terms of motivation, (health-related) epistemological beliefs and their occupation-sensitive self-efficacy beliefs, as well as the institutional and diverging medical specializations training settings.
The assessment consists of three modules. Firstly, there is a computer-based, adaptive module covering declarative knowledge, demographics and contextual data, secondly a video-based module simulating complex occupational situations and intended to measure procedural competencies, and, thirdly, a module intended to capture selected aspects of socio-communicative skills.
Expertise is here conceived as an individual latent variable measured on the basis of partial-credit IRT models, also generalized to multidimensional partial-credit models. The final presentation will include results of several structural equation single- and multi-level models which will be estimated by using MPlus 5.0, allowing to assess the influence of different individual and institutional factors: how context matters!

Author

• Susan Seeber, University of Goettingen