Developing a Competency Based Curriculum

Cathryn Frere
Associate Professor, Dental Hygiene
School of Dentistry

Part 1

Objectives

  1. Describe the difference between structure and competency process-based educational programs.
  2. Be able to write a competency statement for your students.
  3. Discuss the four steps outlined by Carraccio, et at. for developing a competency-based curriculum.

Required Readings

  1. Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: From Flexner to competencies. Acad Med. 2002;77(5):361-7.
  2. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-35.

Introduction

The author of this section, a faculty member of the WVU School of Dentistry’s Division of Dental Hygiene, was involved in the process of converting their Division’s processed-based curriculum to a competency-based curriculum in preparation for accreditation in Spring 2002. A brief summary of the two-year-long process taken by the Division of Dental Hygiene (the Division) will be presented here. Although there are many approaches for developing a competency-based educational program, as evidenced in the required readings, the basic principles are the same. The format used for documentation of a competency-based curriculum will be influenced by that program’s accreditation guidelines. However, the formative process taken, the chosen competency statements, and the methods used to determine student competency and assess program success will be unique to each program.

What are competencies?

Competencies are statements of the characteristics that graduating students should demonstrate which indicate they are prepared to perform and function independently in professional practice. Competencies should include more than just facts. They represent the integration and application of learned facts, skills and affective qualities needed to serve the patient, community and profession. Competencies developed for a program are not taught as a whole, i.e. in a single course, but rather their components are presented throughout the curriculum. Several courses usually assist in the attainment of each competency. The early phase of the curriculum consists primarily of mastering foundation facts and basic skills, but by program completion the parts culminate in the higher level application of these concepts in real-practice situations.

Phase One: Identifying Program Competencies

When the Division embarked on the task of converting their process-based curriculum to a competency-based curriculum, all Division faculty members met to identify the minimum characteristics the ideal graduate should reasonably possess to be able to practice their profession competently in their chosen setting. The dental hygiene faculty at the Baylor College of Dentistry suggests that the number of student competencies be kept to 20 or fewer (DeWald and McCann). Fewer competencies make the curriculum designing, student evaluation and program evaluation processes more easily managed. The faculty then reviewed the WVU Mission Statement and Division Program Goals to make sure the competencies were within these parameters. Table 1 lists the Division Program Goals.

Table 1

Program Goals Include:
Provide a high quality program of instruction that prepares dental hygienists to:

  1. Possess an heightened awareness of social and cultural diversity, ethics and professionalism.
  2. Apply critical thinking to integrate current scientific principles/technology with the provision of evidenced-based, comprehensive health care.
  3. Perform to the level of clinical competency those legally approved oral health services as defined by the West Virginia State Board of Dental Examiners and the WVU School of Dentistry.
  4. Perform to the level of laboratory competency those legally approved oral health services (beyond the scope of the West Virginia practice act) stipulated in the practice acts of other states, districts, or territories of the United States.
  5. Coordinate and administer oral health services for a variety of populations in diverse settings (public health agencies, hospitals, school systems, etc.).
  6. Function collaboratively with the community leaders, health care professionals and lay persons to manage the oral health needs of rural West Virginia.
  7. Provide didactic and clinical instruction in allied dental education programs.
  8. Pursue professional development through self-study, continuing education, research and advanced studies at the masters and doctoral levels.

In this first step, the Division faculty identified an omission in their Program Goals. Although the primary mission of the University is dedicated to the development of West Virginia, the Division felt the need to prepare their graduates to provide patient care services which presently may not be legally performed in this state, but which may be allowed in another state to which they may relocate. Goal “d” was then added to the Division’s Program Goals.

The faculty then assured that each program goal was reflected in at least one competency. This was easily determined by matching each competency statement with the program goal(s) it satisfied. Table 2 lists the 14 competencies for the Division of Dental Hygiene and the program goal(s) matched to each competency.

Table 2
Matching Program Goals by Competencies - Division of Dental Hygiene

Program Instructional Goals The Graduating Dental Hygienist Must be Competent to:
a,c,d 1. Apply the concepts of professionalism ethics, law, and regulation to the provision and/or support of oral health care services.
a 2. Demonstrate an awareness of social/cultural justice issues.
b 3. Apply basic, dental hygiene, and dental science concepts to the provision and/or support of oral health care services.
  4. Provide the dental hygiene process of care which includes assessment, planning, implementation, and evaluation components that are both evidence-based and patient-centered.
  5. Provide dental hygiene care to children, adolescents, adults, geriatrics, special needs patients, and persons with medically compromising conditions.
  6. Provide dental hygiene care for all types of classifications of periodontal disease, including patients who exhibit moderate to severe periodontal disease.
c,d 7. Provide dental hygiene/dental supportive treatment that is both evidence- based and patient-centered.
c,d 8. Provide appropriate life support measures for any medical emergencies that may be encountered in dental hygiene practice.
e,f 9. Assess, plan, implement, and evaluate community-based oral health programs to promote health and prevent disease among a variety of population groups in diverse settings.
a-h 10. Demonstrate interpersonal and group communication skills to effectively interact with diverse population groups.
g,h 11. Apply biostatistical principles in the analysis of scientific literature and the design and interpretation of a student research project.
c 12. Design courses, provide didactic and clinical instruction, and implement evaluation strategies in allied dental education programs.
h 13. Identify career options within the dental hygiene profession.
h 14. Participate in activities that promote life-long learning and professional growth.

Phase Two: Determining Competency Objectives And Means Of Assessment

Next, each faculty member was given a grid for each of the fourteen program competencies. Each faculty member was instructed to list on each labeled competency grid the courses they taught and the course objectives which contributed knowledge, skills, attitudes or values to the attainment of that competency. Table 3 is an example of the grid for the Division’s Competency 2 with sample objectives included. Course goals are general statements of what students should achieve following completion of the course. Objectives are more specific than goals and incorporate knowledge, skills, and attitudes/values. The term objectives has also been used interchangeably with student learning outcomes or competencies in some of the assessment literature. Course objectives is used by the Division to indicate the desired knowledge, skills, and attitudes/values expected of students following completion of a course. The courses’ syllabi should include course goals and their specific course objectives written in measurable terms. Successful attainment of all course objectives enumerated in the grid should lead the student to achieve mastery of that program competency.

Table 3 Competency #2 Demonstrate an awareness of social/cultural justice issues.

Course Name and Number Objective(s) That Assist in Meeting the Competency Teaching Methods Evaluation Methods to Assess Objectives Remediation if Performance is Unsatisfactory Evaluation Methods to Assess Competency Remediation if Competency is Not Reached
DH 101 Describe the key components of the 2000 Surgeon General’s Oral Health Report and how it applies to access to care and disparity issues in West Virginia, the nation and the world. Lecture
Handout		 Class Discussion
Quiz/Test		 Verbal/written feedback Case presentation at end of course using all course content Repeat case
DH 301 Demonstrate knowledge of socio-cultural issues in public health. Lecture Written Exam Verbal/written feedback    
  Demonstrate an understanding of the various methods of financing dental care. Lecture
Handout		 Written Exam Verbal/Written Feedback    
DH 302 Demonstrate an awareness of social justice and cultural issues encountered by the dental health educator. Lecture
Discussion		 Written Exam Verbal/written feedback Evaluation of classroom presentation
Self-assessment		 Discussion with student
Extra reading
Teach extra unit
DH 378 Display professionalism and respect for students and colleagues in all aspects of this course. Lecture
Discussion		 Observation
Professionalism
Presentation Evaluation		      
  Identify various learner conditions and styles. Lecture
Discussion
Handouts		 Exam
Presentation Evaluation		 Verbal Feedback    
  Describe learner characteristics. Lecture
Discussion
Handouts		 Exam
Presentation Evaluation		 Verbal Feedback    
DH 380 Practice dental hygiene with sensitivity to Appalachian and rural cultural values. CBL Seminar
Role-Play		 Case Participation
Written Exam		 Verbal/Written Exam Rural health rotation evaluation by rural faculty, site coordinator and self-assessment Repeat rotation
DH 490,493 (All sections) Display professionalism and respect for students and colleagues in all aspects of this course. Discussion
Mentoring of Faculty		 Faculty Observation Verbal Feedback    
DH 493D Display professionalism and respect for students and colleagues in all aspects of this course. Lecture
Discussion		 Observation
Professionalism
Evaluation		 Verbal Feedback    
  Summerize the role student/teacher contact plays in clinical education. Lecture
Discussion		 Observation Verbal Feedback    

Once the grids were completed, all faculty members met to review the grids. The first discussion topic involved course objectives that faculty felt were important but that did not relate to any of the competency statements. After scrutinizing these objectives, it was decided that more program competencies needed to be added, and the list grew from an initial eleven competencies to the final fourteen included in Table 2.

The Division members also checked for redundancies and omissions in the curriculum as well as areas which need to be expanded upon. The faculty reviewed the courses’ objectives under each competency to assess the sequencing of courses and to assure that each competency included performance assessment methods geared to the novice, beginner and competent stages. Other questions considered included: Were there tasks presented throughout the course of the curriculum to evaluate the student’s progression in development? What forms of documentation were used during task assessment?

Time was given to allow the course instructors to revise their courses with regard to goals, objectives, teaching methods and evaluation methods, and the syllabi were rewritten to include the competency statements to which the course contributed. The competency grids were then revised and completed.

This phase was time consuming, but the task led to much needed review of the curriculum content by the faculty as a whole and self-evaluation of teaching and evaluation methods by the course instructors. How can information be presented in a meaningful, effective way? What exercises can the student perform to demonstrate competency? What level of performance is considered “successful”? Do the methods of assessment distinguish those students who are competent from those who are not? Is there a plan for remediation when the student does not demonstrate competency? As educators, we have all experienced the situation in which a student has been allowed to progress beyond their capabilities before their weaknesses are recognized. Remediation at this late stage can be difficult, and descriptive documentation needed to support holding the student back for remediation is often lacking.

Phase Three: Program Assessment

At this stage, the faculty was feeling good about their curriculum development accomplishments! But how would the Division be able to document that the design for developing a competent practitioner was successful? The faculty met to identify the benchmarks (criteria) of success for each program competency and the sources of that information. Benchmarks were established at the beginner as well as the competent level. Sources of this information included class records and final grade reports, the program director’s files, student file logs, a patient satisfaction survey, rural health rotation faculty and coordinators’ surveys, and senior student surveys and exit interviews. External sources included alumni surveys conducted at one, five and 10 years after graduation, standardized board exams’ scores, and the West Virginia Board of Dental Examiners. Significant faculty tasks at this phase were again the determination of the performance or survey response levels that indicate success, and the analysis and revision of the alumni surveys to more accurately assess the program goals. See Table 4 for an example of an outcomes assessment data table which includes benchmarks for the Division’s Instructional Goal “h”.

Table 4

Goal: Provide a high quality program of instruction that prepares dental hygienists to:

h. Pursue professional development through self-study, continuing education, research, and advanced studies at the masters and doctoral levels.

Red Flag Resolution Code Red Flag OR
Check Mark		 Benchmark This Year's Goal Level Data Results Year: 1996 Data Results Year: 2000 Data Results Year: 2001

3

*

Monitor percent of alumni with active dental hygiene licenses that:

·Have completed at least 12 hours of professional CE in the past 2 years.

·Maintain membership in professional organizations.

·Attend professional meetings.

Monitor

100%

100%

50%

52%

  

87.5%

100%

67%
   

Monitor percent of alumni surveyed that have completed a higher degree within ten years of graduating from the program.

Monitor

(*10%)

18.2%

  

17%

3

*

90% of graduating seniors ranked the curriculum as “good” in preparing them to pursue professional development activities.

90%

  

64.7%

83.3%
   

50% of graduating seniors ranked the curriculum as “good” in preparing a foundation for graduate education.

50%

  

64.7%

61%
   

90% of graduating seniors and alumni ranked the curriculum as “good” in preparing them to conduct research. (Begin with 2002 senior and alumni surveys)

        

Red Flag Resolution Codes

1 = Failure to meet benchmark this year is because of unusual and unique circumstances.

2 = Failure to meet benchmark this year is because it was unrealistic; it is being revised to a more realistic level for next year.

3 = Failure to meet benchmark this year is a problem; steps are being taken to insure that it will be met next year.

* Alumni survey sent annually in June to graduates who completed their studies 1, 5, and 10 years prior

Conclusion

Faculty must dedicate time to work together to convert the haphazard curriculum of the past to the now-accepted organized, competency-based curriculum. This process of conversion includes examination of course content for gaps, redundancies, and proper sequencing, and the consideration of teaching methods which integrate scientific principles with clinical practice. Formative and summative assessment of student performance need to be criterion based; the integral parts of clinical practice must be evaluated in addition to the end product. Furthermore, the means of evaluating program effectiveness must give direction to the ongoing process of revision as technology and consumer demands change. The use of competencies in curriculum design provides direction for program course goals whose achievement produces a competent graduate.

Supplemental Readings

  1. Smith SR, Fuller B. MD2000: A competency-based curriculum for the Brown University School of Medicine. Med Health R.I. 1996;79(8):292-8.
  2. DeWald JP, McCann AL. Developing a competency-based curriculum for a dental hygiene program. JDE. 1999;63(11):793-804.

Part 2

Developing Student Learning Outcomes/Competencies and a Competency-Based Curriculum

Excersize

  1. Define the terms “competence” and “competency”.
  2. Discuss the differences between “Structure- and Process-based” and “Competency-based” educational programs according to Carraccio et al.
  3. List the four (4) steps as outlined by Carraccio et al, for developing a competency-based curriculum.
  4. How, and by whom, should the competencies be identified for your discipline?
    1. Write a competency statement for students in your discipline.
    2. For that competency, prepare one cognitive (knowledge), one psychomotor (skill), and one affective (values and attitudes) component for each of three desired student performance levels: novice, beginner, and competent (i.e., there should be different desired cognitive, psychomotor, and affective components for the novice level competency, the beginner competency, and the ‘competent’ competency).
    3. Describe teaching methods that could be used to facilitate learning for the beginner and ‘competent’ level students.
    4. Describe evaluation methods (e.g., activities, types of exercises or tests, etc.) that could be used to determine student mastery at the beginner competency and the ‘competent’ student performance levels
      1. For the evaluation methods described in d. above, what criteria (e.g., minimum standard) should be used to determine if a student has successfully achieved the learning outcomes or desired performance level?
      2. What criteria (e.g., minimum standard or threshold) should be used by the program to determine if its students have successfully achieved the outcomes or desired level of performance?