Judith G. Calhoun

Development of an interprofessional competency model for healthcare leadership

During the past decade, there has been a growing interest in competency-based performance systems for enhancing both individual and organizational performance in health professions education and the varied healthcare industry sectors. In 2003, the Institute of Medicines report Health Professions Education: A Bridge to Quality called for a core set of competencies across the professions to ultimately improve the quality of healthcare in the United States. This article reviews the processes and outcomes associated with the development of the Health Leadership Competency Model (HLCM), an evidence-based and behaviorally focused approach for evaluating leadership skills across the professions, including health management, medicine, and nursing, and across career stages. The HLCM was developed from extensive academic research and widespread application outside healthcare. Early development included behavioral event interviewing, psychometric analysis, and cross-industry sector benchmarking. Application to healthcare was supported by additional literature review, practice analysis, expert panel inputs, and pilot-testing surveys. The model addresses three overarching domains subsuming 26 behavioral and technical competencies. Each competency is composed of prescriptive behavioral indicators, or levels, for development and assessment as individuals progress through their careers from entry-level to mid-level and advanced stages of lifelong development. The model supports identification of opportunities for leadership improvement in both academic and practice settings.

Validation of learning style measures: implications for medical education practice

Background  It is unclear which learners would most benefit from the more individualised, student‐structured, interactive approaches characteristic of problem‐based and computer‐assisted learning. The validity of learning style measures is uncertain, and there is no unifying learning style construct identified to predict such learners.

Harvey: the impact of a cardiovascular teaching simulator on student skill acquisition

Harvey, a life-sized cardiovascular patient simulator which depicts the auscultatory, tactile and visual findings for a broad range of cardiac problems was used as an adjunct to a standard sophomore physical skills course. Significant gains, as measured by a pre-posttest, were found in overall scores as well as in assessment and interpretation of carotid pulses and precordial auscultation. There were no significant changes in jugular venous pulse or precordial motion assessment. There were no significant correlations between student perceptions of skills gained and objective test measurements.This study underscores the need for cardiovascular examination skills training and confirms the utility of a simulator such as Harvey in developing these abilities. The lack of correlation between perceived improvements and actual changes highlights the need for objective evaluations of educational endeavours. Use of a simulator such as Harvey presents the student with the opportunity to compare and contrast cardiova...

Evaluating Medical Student Clinical Skill Performance Relationships among Self, Peer, and Expert Ratings

Second-year medical students (N = 187) evaluated their own videotaped performances of one of eight randomly assigned physical assessment examinations. The videotaped performance was one component of an introduction to clinical sciences course evaluation. Performance ratings were also obtained from two peers-one who served as the patient and the other who served as the camera person for the evaluation-and one expert. All rater groups used the same behaviorally anchored evaluation checklist of the key techniques and sequences identifiedfor each examination. High Pearsonproduct-moment correlations were obtained between (1) the two peer ratings for four of the examinations and (2) self andpeer ratings for the other four examinations. Repeated measures analysis of variance revealed significant differences among the four types of raters for all but one of the eight different examinations. Implications for future evaluation methodologies and curricular implementation of peer assessment are discussed.

Medical students’ development of self‐ and peer‐assessment skills: A longitudinal study

This study was undertaken to investigate the changes in medical students’ self‐and peer‐evaluative abilities as they progress through both the preclinical and clinical phases of their academic careers. Second‐year medical students were videotaped performing a randomly assigned physical examination. Based on behaviorally anchored checklists, students reviewed and rated their own performances as well as those of two of their peers; faculty also rated the students’ performances. These same students, as seniors, reviewed once again the videotapes of themselves and their peers and rated the performances. The students’ second‐year self‐ and peer‐evaluation ratings were significantly higher than those of the faculty ratings, whereas those same students’ ratings as seniors were not significantly different from the faculty ratings. Implications for integrating the use of self‐evaluation in undergraduate medical education programs are discussed.

A longitudinal investigation of changes in medical students’ attitudes toward the elderly

Medical students (N = 117) were surveyed and compared regarding their attitudes toward the elderly on four separate occasions in their medical school careers: (a) a baseline measure before an educational intervention interviewing the elderly in their 1st year, (b) after the intervention, (c) at the end of their 2nd year, and (d) at the end of their 4th year. Results indicated that (a) students whose educational intervention occurred in nursing homes (low independent‐living facilities) showed no significant attitude changes after the intervention, (b) students whose experiences occurred in residential facilities (high independent‐living facilities) did show significantly more positive increases in attitudes immediately after the course, (c) however, by the end of their fourth year, students’ attitudes dropped back to the baseline level. Implications for programs attempting to enhance long‐term attitudinal change in the medical school curriculum are addressed.

Competency Mapping and Analysis for Public Health Preparedness Training Initiatives

Competency-based education and assessment initiatives have been completed in a number of health care and health management professions during the past decade. In addition, several competency specification endeavors have been similarly undertaken in relation to the field of public health, including the development of the Council on Linkages between Academia and Public Health Practice competency model and the initial competency modeling Delphi survey completed by the Association of Schools of Public Health. All of these organizations have subsequently had to address the many challenges and barriers to the dissemination and integration of their models into specific educational and professional development practices. As previously addressed by many researchers in the field of competency modeling and deployment, understanding and acceptance of competency-based systems are formidable goals, often rife with controversy. This article describes the processes undertaken by The University of Michigan Center for Public Health Preparedness to integrate competency-based learning and assessment in educational and training initiatives with its many community partners.

Competencies for Global Heath Graduate Education

Competency specification and competency-based education (CBE) are increasingly being viewed as essential for optimizing educational outcomes for the next generation of global health workers. An overview is provided of this movement in graduate health professions education in the United States, the Association of Schools of Public Health (ASPH) contributions to advancing and researching related CBE processes and best practices, and the evolving ASPH competency model for graduate global health education.

House officer interviewing techniques - Impact on data elicitation and patient perceptions

The relationships among physicians’ interviewing techniques, the amount and type of data gathered, and patients’ perceptions of the interviewing process were studied. Thirty-one Internal Medicine house officers each interviewed one of three standardized patients. The house officers’ thoroughness of data collection was assessed by the patients and by a trained evaluator. A videotape of each interview was analyzed at the National Board of Medical Examiners using the interaction analysis system for interview evaluation, ISIE-81, to define house officers’ interviewing techniques. From the physicians’ problem-solving perspective, data elicitation was positively related to the length of the interview, asking psychosocial questions, the use of narrow questions, and the amount of time the patient talked. The patients’ assessments of house officers’ data-gathering thoroughness were also positively influenced by interview length, the use of narrow questions, and inquiries about their psychosocial histories. The use of broad questions by the house officer was positively related to the patient’s feelings about and reaction to the interaction. This study potentially explains some of the differences that appear to exist between patients’ and physicians’ judgments about and perceptions of the medical interviewing process.

On Academics Developing an Educated Citizenry: The Undergraduate Public Health Learning Outcomes Project:

In its seminal 1988 report, “The Future of Public Health,” the Institute of Medicine (IOM) called public health “what we do as a society collectively to assure the conditions in which people can be healthy.”1 Public health interventions may occur in myriad institutions, through a variety of direct and indirect mechanisms in communities across the country. Yet, despite the many proven benefits of health approaches based on prevention and the well-being of populations, public health does not enjoy popular support and is poorly understood by most Americans.2 The dominance of medical solutions to health challenges, even in the face of overwhelming evidence regarding the effectiveness of community-based preventive approaches, is illustrative of this broad lack of understanding. In 2003, the IOM suggested that the nation’s health would benefit from a greater understanding of the profession’s potential. To promote this enhanced awareness among the public, the IOM report called for every undergraduate to have access to education in public health.3 This call for broader public health education led to the formation of the Educated Citizen and Public Health initiative led by the Association for Prevention Teaching and Research, the Council of Colleges of Arts and Sciences, the Association of Schools and Programs of Public Health (ASPPH), and the Association of American Colleges and Universities (AAC&U). The initiative intended to respond to growing demand in the field and bring leadership to the suddenly explosive growth of courses and programs. The initiative further intended to introduce undergraduate study of integrative public health to all institutions of higher education and to take an interdisciplinary and inter-professional approach to collaboration.4 In recognition of the growth in undergraduate public health programs at colleges and universities, many without schools or programs of public health, ASPPH determined that it should actively engage in defining the learning outcomes and design of undergraduate public health programs. Many questions immediately surfaced: Should the traditional liberal arts be the recommended framework? Should programs prepare associate and baccalaureate graduates to enter the workforce? Should curricula include an internship or apprenticeship? Should programs focus on lifelong learning? How would an undergraduate public health degree articulate to existing master’s degrees in public health? And what faculty development opportunities would be needed to support the integration of public health theory and content into other areas of inquiry in an undergraduate setting? In September 2009, ASPPH convened an Undergraduate Task Force to consider these issues and to develop a strategy for integrating public health knowledge and principles in undergraduate education.