Health Professions Education A Bridge to Quality (2003) / Chapter Skim
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6. Recommendations for Reform
6. Recommendations for Reform
Pages 121-144
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From page 121... ...
A recent article synthesizing nine major reports on physician competencies appears to support this approach, concluding that "without data about medical-education quality, accreditation is the most potent lever for curricula reform in our decentralized medical education system." (Halpern, 2001) The committee also recommends pursing other leverage points to reform health professions education such as the use of report cards that incorporate education-related measures and innovations in financial incentives.
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From page 122... ...
Defining a core set of competencies across educational oversight processes holds the potential for reducing costs as a result of better communication and coordination across oversight bodies, with processes being streamlined and redundancies reduced. Integrating core competencies into oversight processes would likely provide the impetus for faculty development, curricular reform, and leadership activities.
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From page 123... ...
, without the linkages required in an interdisciplinary academic or practice environment (Evers, 2001; Lang, 1999; Prentice and Bentley, 1999~. Finally, the lack of common terms may make assessing the evidence base on any given topic difficult (Jordan, 2000~.
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From page 124... ...
. Recommendation 1: DHHS and leading foundations should support an interdisciplinary effort focused on developing a common language, with the ultimate aim of achieving consensus across the health professions on a core set of competencies that includes patientcentered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics.
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From page 125... ...
, and the associated desire on the part of public payers and consumers for increased accountability (Leach, 2002; Lenburg et al., 19994. In Europe, there also appears to be a sense that increased globalization will afford greater interaction among clinicians of different countries, generating the need for a set of core competencies that define clinicians regardless of where they are trained, and a related need for enhanced accountability (Harden, 20024.
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From page 126... ...
In nursing, the two accrediting organizations also have defined competencies which do not fully overlap with the core competencies defined here but they differ in whether they require demonstration of such competencies (Commission on Collegiate Nursing Education, 2002; National League for Nursing Accrediting Commission, 19994. Finally, the curricula for the selected allied health professions examined in this report vary in the extent to which they incorporate the five competencies outlined herein (Collier, 20024.
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From page 127... ...
As noted in Chapter 5, with the exception of patient-centered care, which is consistently included in examinations across the professions, licensing exams for health professionals vary considerably in whether they test for competency in the five core areas highlighted in this report (National Association of Boards of Pharmacy, 2002; National Council of State Boards of Nursing, 2001; United States Medical Licensing Exam, 2002~. This situation also needs to be addressed and could be the focus of a subset of the oversight organizations described in recommendation 2.
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From page 128... ...
Moreover, in response to the paucity of evidence that taking continuing education courses improves practice outcomes, some certifying organizations are beginning to emphasize alternative measures that are more evidence based (American Board of Medical Specialties, 2000; American Nurses Association/NursingWorId.Org, 2001; Bashook et al., 2000; Board of Pharmaceutical Specialties, 2002; Federation of State Medical Boards, 2002; Finocchio et al., 1998; National Council of State Boards of Nursing, 1997-2000; Swankin, 2002a)
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From page 129... ...
Recommendation 5: Certification bodies should require their certificate holders to maintain their competence throughout the course of their careers by periodically demonstrating their ability to deliver patient care that reflects the five competencies, among other requirements. Training Environments Education does not occur in a vacuum; indeed, much of what is taught during the educational experience and much of what is learned lies outside formal academic coursework.
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From page 130... ...
The committee believes that initial support should be given to existing exemplary practice organizations including innovative academic health centers, that are already providing the interdisciplinary education and training necessary for staff to consistently deliver care that incorporates the core competencies. Further, the committee believes that these leading organizations should be identified as training models for other organizations, and should be given the resources necessary to test alternative approaches to providing curricula that integrate the core competencies.
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From page 131... ...
Recommendation 6: Foundations, with support from education and practice organizations, should take the lead in developing and funding regional demonstration learning centers, representing partnerships between practice and education. These centers should leverage existing innovative organizations and be state-of-the art training settings focused on teaching and assessing the five core competencies.
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From page 132... ...
should take the lead in funding experiments that will enable and create incentives for health professionals to integrate interdisciplinary approaches into educational or practice settings, with the goal of providing a training ground for students and clinicians that incorporates the five core competencies. O sugar levels and blood pressure, as well as to transmit pictures of their hands and feet, as is currently the case for 1,500 patients in a Medicare demonstration in New York (IDEATel, 20024.
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From page 133... ...
The committee believes that a more developed evidence base, particularly one linked to patient outcomes, would help make the case to educational institutions, regulators, professional societies, and others that dictate and shape health professions education that the acquisition and application of these competencies is essential to the provision of patient-centered care in a 21 St-century health system. Summit participants agreed, and proposed a strategy focused on evidence-based education and the core competencies (see Appendix C)
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From page 134... ...
One outcome of these initiatives is best-evidence medical education, which operates on two levels: · What is taught: Development of an evidence base related to key competencies required in the practice environment, focusing on their relationship to quality. · How it is taught: Reform of educational methods and practices based on available evidence about what works, and further development of the evidence base on the effectiveness of educational interventions.
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From page 135... ...
Providing Leadership Significant reform in health professions education is a challenge to say the least. The oversight framework is a morass of different organizations with differing requirements and philosophies, now under considerable pressure to demonstrate greater accountability (Batalden et al., 2002; O'Neil and the Pew Health Professions Commission, 1998~.
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From page 136... ...
Given this environment, the committee believes that reform of health professions education will be possible only through the skill and dedication of a broad set of health care leaders from the professions, educational institutions, and oversight bodies, among others. A review of the literature underscores the importance of leadership.
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From page 137... ...
The committee believes that the development of common language and definition of core competencies should happen as rapidly as possible and by no later than 2004, given that the integration of core competencies into oversight processes will take considerable time, perhaps a decade or more if the efforts of ACGME and ACPE are any guide. As the work of integrating core competencies into oversight processes proceeds, the efforts of leading practice and education organizations to provide a training environment that integrates the core competencies into care delivery should be fostered through regional demonstration learning centers and Medicare demonstration projects.
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From page 138... ...
2002. ""Crossing the Quality Chasm: Next Steps for Health Professions Education"; Panel Discussion." Online.
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From page 139... ...
1999. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
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From page 140... ...
2002. ""Crossing the Quality Chasm: Next Steps for Health Professions Education"; Panel Discussion." Online.
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From page 141... ...
2001. Role models and the learning environment: Essential elements in effective medical education.
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From page 142... ...
2000. Credentialing physicians: Challenges for continuing medical education.
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From page 143... ...
2002. "Crossing the Quality Chasm: Next Steps for Health Professions Education; Panel Discussion." Online.
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