CURRICULUM DEVELOPMENT: FROM COMPETENCIES TO SKILLS AND BACK TO COMPETENCIES

CURRICULUM DEVELOPMENT: FROM COMPETENCIES TO SKILLS AND BACK TO COMPETENCIES Abstract Background: Skills play a central role in the competency- based undergraduate curriculum of the Faculty of Medicine, “Iuliu Hatieganu” University, Cluj-Napoca, Romania. Summary of work: The start point for curricular development was the CanMEDS 2005 Physician Competency Framework: Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. The competencies were translated and described in an notebook with 198 “generic skills”, organized in eleven chapters: Clinical examination, Clinical procedures, Laboratory and diagnostic tests, Effective communication, Clinical reasoning and decision-making, First aid and resuscitation in medical emergencies, Therapeutic prescriptions, Management skills, Health promotion and maintenance, Critical appraisal and Law & Ethics. The selection of skills was based on the requirements of modern practices, the curricular recommendations made by the Association for Medical Education in Europe (MEDINE 2) and the educational opportunities we can offer to our graduates. Summary of results: The teachers translated / applied these “generic skills” on the 228 Clinical presentations of the Faculty of Medicine, developing specific activities, learning outcomes and competencies. Conclusions: The learning outcomes of our competency- based curriculum were developed by applying the “generic skills” on specific learning objectives, i.e. clinical presentations. Take-home messages: The competency-based curriculum is the result of a continuous process of active student involvement in specific activities.

1. Introduction Medicine, regardless of the specialty, is basically a practical profession. The physician works in a complex environment which requires communication, patients’ physical examination, techniques, prescription, making decisions, social, professional or business networking. Practical skills are a core component of the medical education. Most faculties do not provide staff with training in teaching methodology or evidence-based teaching methods like competency-based curriculum, including regular skills, the use of portfolios, simulation lab practice, clinical assessment exercises. Also, professionalism, learning goals and outcomes and curricula planning should be kept in mind [14]. Medical education aim is to prepare undergraduate students to develop into clinically competent physicians. Studies have shown that it can take up to ten years of hard practice to achieve expert level in a particular field [2,4]. Both undergraduate and postgraduate medical training should take place in university medical centers but almost two-thirds of the clinical training for both students and residents takes place in connected non-academic hospitals [1]. However, most learning prospects depend on the available patients at a certain moment due to the fact that the clinical training programs are not structured. While clinical training represents a keystone part in professional development for undergraduate students, a theory-practice gap has been identified across multiple health care disciplines [3]. The question which stays is what skills and competencies are provided to the undergraduate students during clinical training and whether alternative tools may give support with the theory-practice gap paradigm. These tools, which can assess reliably the acquired competencies and skills and the efficiency and efficacy of these clinical internships are still under development.

In a traditional approach to medical education, problems about the coverage of skills areas do not arise seriously in any theoretical way. Implementation of a non-linear curriculum for training in advanced clinical skills represents an unmet need in most Romanian medical faculties. The project described below started due to our university aim to have trained and skilled graduates able to perform in the complex modern medicine environment.

2. Research Methodology The start point for curricular development was the CanMEDS 2005 Physician Competency Framework: Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional [8]. The competencies were translated and described in an notebook with 198 “generic skills”, organized in eleven chapters: Clinical examination, Clinical procedures, Laboratory and diagnostic tests, Effective communication, Clinical reasoning and decision-making, First aid and resuscitation in medical emergencies, Therapeutic prescriptions, Management skills, Health promotion and maintenance, Critical appraisal and Law & Ethics (Fig 1).

Figure 1: Workbook of clinical skills- content

The practical skills workbook was intended to represents a guide for the hospital and lab activity of the students, including recommendations regarding the mandatory activities to be performed by the students in order to achieve a solid professional training (Table 1). Table 1: Generic skills A. Interact with the patient: • Takes a patient history and obtains informed consent • Makes recommendations, gives advice and provides patient education • Communicates with the patient during examination/diagnostic/treatment • Explains to patients the effects of and possible adverse reactions to the medication and the importance of timing and compliance with treatment • Gives bad news • Communicates by telephone and through an interpreter B. Communicate with the patient’s family: • Gives recommendations and advice and provides

medical education • Negotiates and mediates family decision making C. Communicate with the medical and administrative staff: • Demonstrates effective group participation and input • Makes oral case presentations • Gives opinions and recommendations and provides telephone consultations

First step was an initial skills list send to the heads of disciplines (Fig 2). The feedback was integrated into a new list which was send to the whole academic community. The above procedure was renewed three times. Eventually, a final, generally accepted formula was achieved.

Figure 2: First list of generic skills to be achieved

The 7th International Conference Quality Management in Higher Education – QMHE 2012

The activities were selected according to the requirements of modern medicine and the recommendations of the Association for Medical Education in Europe (MEDINE 2) [12], GMC (Tomorrow’s DoctorsMedicine. 2009) [10], Royal College of Physicians and Surgeons of Canada recommendations regarding the Skill The training receives a great deal of 2005) [8]attention and Brown University (MD2000) o be performed(CanMEDS by the students in throughout the six-yearUSA medical curriculum.[15], as well as the educational d professional facilities training (Table 1). available in our Faculty of Medicine. Skill training receives a great deal of attention throughout the six-year medical curriculum. RESULTS AND DISCUSSION

Table 1: Generic skills

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