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altphysio assessment curriculum physiotherapy

Towards a competency-based curriculum in physiotherapy

I’ve been thinking about the concept of competency based education (CBE) in relation to the altPhysio series that I’m busy with. I’m drawn to the idea of CBE but am aware that there are some criticisms against it, especially from a theoretical and pedagogical perspective. This post is a short note to clarify some of my thinking around CBE.

I started with Frank et al. (2010) Toward a definition of competency-based education in medicine: a systematic review of published definitions to get a bit of an idea about how others think about CBE and to have a working definition of the concept. From the article:

We identified 4 major themes (organizing framework, rationale, contrast with time, and implementing CBE) and 6 sub-themes (outcomes defined, curriculum of competencies, demonstrable, assessment, learner-centred and societal needs)….From this research we have developed a proposed 21st century definition of CBE for medical education, namely:

Competency-based education (CBE) is an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from an analysis of societal and patient needs. It de-emphasizes time-based training and promises greater accountability, flexibility, and learner-centredness.

I quite like this definition of CBE and think that it addresses some of the concerns that are commonly levelled against a CBE approach. This is far from a foregone conclusion and there are still many contrasting points of view. But for my purposes this was a good place to start, especially since I’m looking at a physiotherapy curriculum, which has a significant emphasis on clinical performance, as opposed to another programme that emphasises different outcomes.

I’m obviously also interested in the use of technology, and Tony Bates’ The strengths and weaknesses of competency-based learning in a digital age was useful in this regard. From the post:

Competency-based learning is a relatively new approach to learning design which is proving increasingly popular with employers and suits certain kinds of learners such as adult learners seeking to re-skill or searching for mid-level jobs requiring relatively easily identifiable skills. It does not suit though all kinds of learners and may be limited in developing the higher level, more abstract knowledge and skills requiring creativity, high-level problem-solving and decision-making and critical thinking.

I’m not sure that I agree with the last bit; it may be limited in developing higher level, more abstract knowledge and skills like problem solving, decision making and critical thinking. I think that CBE does not inherently preclude the possibility of developing these skills. The fact that it may not doesn’t mean that it can’t (IMO).

Then there’s the CanMEDS framework, which is another piece of work that I’m a big fan of. Without going into the detail CanMEDS is a way of thinking about the different roles that a physician must demonstrate proficiency in. Again, this framework seems to be a great place to start when looking at a CBE curriculum.

canmeds-2015-diagram-e

So that’s how far I’ve gotten with looking at CBE as a possible basis for a physiotherapy curriculum. If you know of any physiotherapy curricula that are currently competency-based, or are aware of any other resources that you think would be good to read, I’d really like to hear from you.

Note: The featured image of this post is a map of the London underground that I wasn’t familiar with. The point I was trying to make is that there are many different ways of getting to the same end point, and it might be useful to allow people to take the route that most suits them.

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Twitter Weekly Updates for 2011-07-04

  • U.N. Report Declares Internet Access a Human Right | Threat Level | Wired.com http://bit.ly/ivNke2 #
  • #saahe2011 officially over. It was a wonderful conference made possible by the participation of health educators from all over the country #
  • Papert http://bit.ly/mggi6R. Being a revolutionary means seeing far enough ahead to know that there is going to be a fundamental change #
  • Papert http://bit.ly/le70h7. The impact of paper in education has led to the exclusion of those who don’t think in certain ways #
  • @dkeats When people are “experts” in a domain they can be blinded to great ideas in other fields and so miss opportunities to drive change #
  • @dkeats Agreed. I’ve had to work really hard to convince people in my dept that I’m not the “computer guy”, I’m the “education guy” #
  • Innovation is about linking concepts from different fields to solve problems, its not about doing the same thing with more efficiency #
  • “How do you learn enough of the words to make sense of the discipline?” #saahe2011 #
  • Presentation by David Taylor on the use of adult learning theories #saahe2011 #
  • Jack Boulet speaking about the challenges and opportunities in simulation-based assessment #saahe2011 #
  • Mendeley Desktop 1.0 Development Preview Released http://ow.ly/1ueXSs #
  • Social media is inherently a system of peer evaluation and is changing the way scholars disseminate their research http://ow.ly/1ueXMA #
  • @dkeats Wonder if the problem has to do with the fact that much “ed tech” is designed by Comp Scientists, rather than Social Sci? #
  • @dkeats Also, people have the idea that LMSs have something to do with T&L, & then struggle when it can’t do what they need it to #
  • @dkeats To qualify, the problem isn’t resistance, its misunderstanding. The conversation always ends up being about technology #
  • There’s a huge difference between “learning” & “studying”, not in terms of the process but ito motivation & objectives #
  • @thesiswhisperer conf is for health educators, mostly clinicians, many of whom are amazing teachers but for whom tech is misunderstood #
  • In a workshop with David Taylor, looking at using adult learning theories #saahe2011 #
  • Blackboard is a course management system, it has little to do with learning. Use it for what its designed for #saahe2011 #
  • Trying to change perception that technology-mediated teaching & learning isn’t about technology. Not going well #saahe2011 #
  • Just gave my presentation on the use of social networks to facilitate clinical & ethical reasoning in practice contexts #saahe2011 #
  • Deborah Murdoch Eaton talks about the role of entrepreneurship to innovate in health education #saahe2011 #
  • Social accountability is relevant for all health professions (healthsocialaccountability.org) #saahe2011 #
  • Charles Boelen talks about social accountability at #saahe2011 keynote, discusses its role in meeting society’s health needs #
  • First day of #saahe2011 over. Lots of interesting discussion and some good research being done in health science education #
  • Concept mapping workshop turned out OK. Got a CD with loads of useful information…a first for any workshop I’ve attended #saahe2011 #
  • Many people still miss the point when it comes to technology-mediated teaching & learning. Your notes on an LMS is not teaching or learning #
  • At a workshop on concept mapping, lots of content being delivered to me, not much practical yet #saahe2011 #
  • Noticed a trend of decreasing satisfaction from 1-4 year, even though overall scores were +. Implications for teaching? #saahe2011 #
  • Banjamin van Nugteren: do medical students’ perceptions of their educational environment predict academic performance? #saahe2011 #
  • Selective assignment as an applied education & research tool -> gain research exp, improve knowledge & groupwork #saahe2011 #
  • Reflective journaling: “as we write conscious thoughts, useful associations & new ideas begin to emerge” #saahe2011 #
  • Change paradigm from “just-in-case” learning to “just-in-time” learning #saahe2011 #
  • Benefits of EBP are enhanced when principles are modelled by clinicians #saahe2011 #
  • EBP less effective when taught as a discrete module. Integration with clinical practice shows improvements across all components #saahe2011 #
  • Students have difficulty conducting appraisals of online sources <- an enormous challenge when much content is accessed online #saahe2011 #
  • Looking around venue at #saahe2011 10 open laptops, 2 visible iPads (lying on desk, not being used), about 350 participants…disappointing #
  • EBP isn’t a recipe (or a religion), although that is a common misconception #saahe2011 #
  • Prof. Robin Watts discusses EBP and facilitating student learning. EBP isn’t synonymous with research #saahe2011 #
  • “A lecture without a story is like an operation without an anaesthetic” Athol Kent, #saahe2001 #
  • Kent drawing heavily on Freni et al, 2010, Health professionals for a new century, Lancet. #
  • #saahe2001 has begun. Prof. Athol Kent: the future of health science education #
  • Portfolios and Competency http://bit.ly/jfFpfU. Really interesting comments section. Poorly implemented portfolios aren’t worth much #
  • @amcunningham I think that portfolios can demonstrate competence and be assessed but it needs a change in mindset to evaluate them #
  • @amcunningham will comment on the post when I’m off the road #
  • @amcunningham Can’t b objective as I haven’t used NHS eportfolio. Also, its hard 2 structure what should be personally meaningful experience #
  • @amcunningham Portfolios must include reflection, not just documentation. Reflection = relating past experience to future performance #
  • @amcunningham Your delusion question in the link: practitioners / students not shown how to develop a portfolio with objectives #
  • @amcunningham Also spoke a lot about competency-based education and strengths / limitations compared to apprentice-based model #
  • @amcunningham Very much. Just finished a 4 day workshop that included the use of portfolios as reflective tools in developing competence #
  • Final day of #safri 2011 finished. Busy with a few evaluations now. Spent some time developing the next phase of my project. Tired… #
  • Last day of #safri today, short session this morning, then leaving for #saahe2011 conference in Potchefstroom. It’s been an intense 5 days #
  • Papert: Calling yourself some1 who uses computers in education will be as ridiculous as calling yourself some1 who uses pencils in education #
  • Daily Papert http://bit.ly/jKlVmn. 10 years ago, Papert warned against the “computers in education” specialist. How have we responded? #
  • Daily Papert http://bit.ly/m7rfYY. Defining yourself as someone who uses computers in education, is to subordinate yourself #
  • YouTube – Augmented Reality Brain http://bit.ly/kcZWXy. When this is common in health education, things are going to get crazy #
  • @rochellesa Everyone needs some downtime, especially at 10 at night when you’re out with your wife 🙂 Seems like a nice guy, very quiet #
  • @rochellesa The large policeman he’s with isn’t keen tho. Mr Nzimande has asked 2 not b disturbed. Understandable when u want to chill out #
  • I’m sitting in a hotel in Jo’burg & Minister of Higher Education Blade Nzimande walks in and sits down next to me. Any1 have any questions? #