I.C.C.P

Institutional Core Competency Plan

A compliance manual for the integration of the “Core Competencies” into osteopathic graduate medical education at

_________________________________________________ Hospital.

                                   (your hospital name here)

TABLE OF CONTENTS

Page

  3        Timeline for the Implementation and Assessment Process 

  4        Part I:  American Osteopathic Association (AOA) Guidelines for Structuring the ICCP

  7        Part II: ICCP and GME Committee Responsibilities

  9        APPENDIX A: AOA Core Competencies and Requisite Elements

10        APPENDIX B: Resident evaluations sheets for AOA Core Competencies and requisite elements

22        APPENDIX C: Core Competency Teaching Planning Forms

31        APPENDIX D: Core Competency Matrix

32         APPENDIX E: Year End Report: Program “Complete” Summary – Final Resident Assessment for ________________________ (specialty field)

33         APPENDIX F: Template for Annual Report

34        APPENDIX G: Core Competency Program Review

37        APPENDIX H: GME Committee at __________________________ (your hospital name here)

TIMELINE FOR THE IMPLEMENTATION

AND ASSESSMENT PROCESS

The American Osteopathic Association requires DME’s and Program Directors to implement training and Program Evaluators to assess, the AOA Core Competencies in all AOA training programs.  Below is the timeline for the implementation and assessment process:

By  July 2004, Program Directors must implement training in the first two competencies in a speciality specific manner:

-          Osteopathic Philosophy & Osteopathic Manipulative Medicine and

-          Medical Knowledge

By January 2005, Program Evaluators must begin assessment through site review process of the first two competencies:

-          Osteopathic Philosophy & Osteopathic Manipulative Medicine and

-          Medical Knowledge

By July 2005, Program directors must implement training in the next three competencies:

-          Patient Care

-          Interpersonal and Communication Skills and

-          Professionalism

By January 2006, Program Evaluators must begin assessment through site review process of the next three competencies:

-          Patient Care

-          Interpersonal and Communication Skills and

-          Professionalism

By July 2006, Program Directors must implement training in the last two competencies:

-          Practice-based Learning Improvements and

-          Systems-based Practice Competencies

By January 2007, Program Evaluators must begin assessment through site review process of the last two competencies:

-          Practice-based Learning Improvements and

-          Systems-based Practice Competencies

Part I

American Osteopathic Association (AOA) Guidelines for Structuring the ICCP

Purpose:  This document will serve as the road map for the implementation of competency- based education at _____________________________________ Hospital in response to the AOA’s commitment to integrate competency-based education in all osteopathic GME programs and the mission of the Centers for Osteopathic Research and Education (CORE).

Institutional commitment to the success of the integration and monitoring of competency-based education is evident by the appointment of the DME (DME, sometimes referred to as the Chief Academic Officer (CAO)) or his/her designee as the Compliance Officer and by providing the appropriate support staff.

The role of the DME will include but not be limited to formulation of this ICCP, and monitoring the implementation and continued utilization of competency-based Graduate Medical Education (GME)  at the institution.

The GME Committee will provide the institutional oversight for the monitoring and approval of the ICCP.  The committee will be assisted in this role by periodic reporting of the DME about the overall institutional compliance and by the program directors about the program specific compliance. 

The program directors will serve in the designated role as the monitors for the implementation and continued adherence to the ICCP by the faculty of their residency programs.

The CORE faculty, the program directors, the DME and the GME Committee will be assisted by the institution’s designated support staff.  The support staff will provide administrative and technical expertise in implementing and supporting any and all programs of the ICCP.

On behalf of the institution and CORE, the GME Committee will ensure that each AOA accredited postdoctoral program of the institution will comply with the ICCP.

The magnitude of institutional resources, both personnel and financial, provided by the hospital to successfully implement the ICCP will be determined by the hospital's CEO/COO based on information provided by the GME Committee, the DME and the individual program directors.  This will be reflected in the hospital annual budget.

The ICCP recognizes the role of CORE in facilitating the implementation of the plan.  The CASC (Core Academic Steering Committee) and the CORE board have committed to support the individual institutions with collaborative initiatives and programs for the implementation of this plan.

The DME shall report to the Graduate Medical Education Committee the status of compliance with the Institutional Core Competency Plan.  The written report (APPENDIX F), submitted annually by the DME and approved by the Graduate Medical Education Committee, shall be forwarded to the CORE Academic Steering Committee (CASC) of CORE annually.  The annual report shall include the following:

¨      Summary of progress made in implementation of the Institutional Core Competency Plan (until fully implemented).

¨      Effectiveness of methods chosen by the institution to achieve compliance and evaluate core competencies.

¨      Report on each trainee’s progress in learning and development in each core competency reported on their respective annual report.

¨      Summary report for each trainee who is completing his/her respective program with an attestation that a minimal level of performance has been achieved in all competencies.

¨      Outcome measures and report of success in achieving institutional goals.

Each program will integrate the teaching of all seven core competencies in their core curriculum. Each intern and resident will be evaluated for the demonstrated mastery of each core competency.  Each program director identify appropriate teaching modalities and at least two evaluation tools to be used for each core competency.

The Program Director, DME and GME Committee roles in the implementation and continued adherence to the ICCP are summarized as follows:

Individually tailored remediation plans will be afforded to all trainees who fail to meet the performance expectations of the ICCP.  The remediation plan will be formulated from input by the program director, DME and individual instructors specific to the rotation.  The DME will present the plan to the Graduate Medical Education Committee fro approval.

The year-end summary report on the progress of each trainee will be reviewed annually and will form the documents from which the continual quality improvement process will select targeted goals and objectives for the following academic cycle.

An annual written evaluation summary of the overall effectiveness of the Core Competency Plan will be prepared by the medical education department and presented to the Graduate Medical Education Committee for review.

Part II:

ICCP and GME Committee Responsibilities

At ____________________________ (your hospital name here)

1.      The GME Committee will consist of the following members:

List DME, all residency program directors, and any other medical educators/staff (SEE APPENDIX H for Committee Member Form).

2.      The GME Committee must meet on a regular basis to accomplish this task.  Use the following lines to plan meetings.

    Date: _______, Time: ________, Place: _______, Activity: ________ (suggest: education and assignments)

    Date: _______, Time: ________, Place: _______, Activity: ________ (suggest: review matrix determine deficiencies, plan teaching events and assessment for deficiencies)

    Date: _______, Time: ________, Place: _______, Activity: ________ (suggest: set remediation and documentation standards)

    Date: _______, Time: ________, Place: _______, Activity: ________ (suggest: prepare and review end of year reports on students and program)

3.      In preparation for each academic year, the DME, Program Directors, and GME Committee will develop their  ICCP and continuous quality improvement plan by:

a.       Each residency director and DME (as the program director for the internship program) will:

                                                1.      Identify the teaching methods and evaluation tools currently used to teach and measure each required core competency.

                                                2.      Identify the areas of need in teaching each core competency.

a. For items 1 & 2 use the Core Competency Matrix at Appendix D.

b. For each mark on the Matrix note the specifics of who, what, when, where, and how (see Appendix C).

                                                3.      Identify remediation plan for any deficiencies.

b.      The GME Committee will meet to:

                                                1.      Identify common teaching methods and evaluation tools for required core competency.

                                                2.      Identify remaining areas of need in teaching and evaluating each required core competency.

                                                3.      Determine which teaching methods and evaluation tools will be used across programs and within programs.

                                                4.      Determine which anticipated outcomes will be used across programs and within programs.

                                                5.      If necessary, develop additional teaching methods and/or evaluation tools to comply with each required core competencies.

                                                6.      Set standards for successfully meeting the evaluation measures (e.g. the score for acceptable pass rates on rotation evaluations, OSCEs, etc.)

                                                7.      Approve remediation activities for those who fail to meet the standards.

                                                8.      Determine methods for monitoring the progress of each intern and resident so that program directors have data summaries that can be aggregated across programs.

                                                9.      Review the traditional internship curriculum to verify that the goal of traditional interns receiving adequate exposure to the core competencies is being met.

NOTE:

In identifying the evaluation tools, be sure to address the core competency map, the program directors evaluation of residents, and all other AOA tools.

c.       During the academic year, the GME Committee will:

                                                1.      Review the data from each program and in aggregate (how often).

                                                2.      Discuss what teaching methods and evaluation tools are working or need revisions.

                                                3.      Make modifications as needed throughout the year.

                                                4.      Summarize the status of the review (how often) and submit to the CORE/OPTI as requested.

d.      During the fourth quarter of the academic year, the GME Committee will review the current year and plan for the next year by:

                                                1.      Summarizing the progress made in implementation of the Institutional Core Competency Plan (until fully implemented).

                                                2.      Evaluating the effectiveness of methods chosen by the institution to achieve compliance and evaluate core competencies.

                                                3.      Develop a report on each trainee’s progress in learning and development in each core competency reported on their respective annual report.

                                                4.      Develop a summary report for each trainee who is completing his/her respective program with an attestation that a minimal level of performance has been achieved in all competencies.

                                                5.      Develop report of outcome measures and report success in achieving institutional goals.

                                                6.      Determine the best methods for institutional growth and which teaching methods and evaluation tools will continue to be used during the next academic year.

                                                7.      Identify any CORE/OPTI mandates that need to be worked into the ICCP for the next academic year.

                                                8.      If necessary, identify and develop new teaching methods and evaluation tools.

                                                9.      Until all core competencies are in compliance, repeat steps #3a and #3b above with the new required core competencies for the year.

APPENDIX A: AOA Core Competencies and Requisite Elements

Competency 1:  Osteopathic Philosophy and Osteopathic Manipulative Medicine:  Residents are expected to demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative Treatment (OMT) appropriate to their specialty.  The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to life-long learning and to practice habits in osteopathic philosophy and manipulative medicine.

Required Element #1:  This resident demonstrated competency in his/her understanding and application of OMT in                                                (specialty field)

Required Element #2:  This resident integrated Osteopathic Concepts and OMT into the medical care he/she provided to patients as appropriate.

Required Element #3: This resident understood and integrated Osteopathic Principles and Philosophy into all clinical and patient care activities.

Competency 2:  Medical Knowledge: Residents are expected to demonstrate and apply knowledge of accepted standards of clinical medicine in their respective specialty area, remain current with new developments in medicine, and participate in life-long learning activities, including research.

Required Element #1: This resident demonstrated competency in the understanding and application of clinical medicine to patient care.

Required Element #2:  This resident knows and applies the foundations of clinical and behavioral medicine appropriate to his/her discipline.

Competency 3:  Patient Care: Residents must demonstrate the ability to effectively treat patients, provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine, and health promotion.

Required Element #1:  Gathered accurate, essential information from all sources, including medical interviews, physical examinations, medical records, diagnostic/therapeutic plans, and treatments.

Required Element #2:   This resident validated competency in the performance of diagnosis, treatment and procedures appropriate to his/her medical specialty.

Required Element #3:  This resident provided health care services consistent with osteopathic philosophy, including preventative medicine and health promotion based on current scientific evidence.

Competency 4:  Interpersonal and Communication Skills: Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams.

Required Element #1:  This resident demonstrated effectiveness in developing appropriate doctor-patient relationships.

Required Element #2:  This resident exhibited effective listening, written and oral communication skills in professional interactions with patients, families and other health professionals.

Competency 5: Professionalism:  Residents are expected to uphold the Osteopathic Oath in the conduct of their professional activities that promote advocacy of patient welfare, adherence to ethical principles, collaboration with health professionals, life-long learning, and sensitivity to a diverse patient population.  Residents should be cognizant of their own physical and mental health in order to care effectively for patients.

Required Element #1:  This resident demonstrated respect for his/her patients and families and advocated for the primacy of his/her patient’s welfare and autonomy.

Required Element #2: This resident adhered to ethical principles in the practice of medicine.

Required Element #3: This resident demonstrated awareness and proper attention to issues of culture, religion, age, gender, sexual orientation, and mental and physical disabilities.

Competency 6:  Practice-Based Learning and Improvement:  Residents must demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based medicine into patient care, show an understanding of research methods, and improve patient care practices.

Required Element #1:  This resident treated patients in a manner consistent with the most up-to-date information on diagnostic and therapeutic effectiveness.

Required Element #2: This resident performed self-evaluations of clinical practice patterns and practice-based improvement activities using a systematic methodology.

Required Element #3: This resident understood research methods, medical informatics, and the application of technology as applied to medicine.

Competency 7: System-Based Practice:  Residents are expected to demonstrate an understanding of health care delivery systems, provide effective and qualitative patient care within the system, and practice cost-effective medicine.

Required Element #1: This resident understands national and local health care delivery systems and how they affect patient care and professional practice.

Required Element #2: This resident advocated for quality health care on behalf of his/her patients and assisted them in their interactions with the complexities of the medical system.

APPENDIX B

Resident evaluations sheets for AOA Core Competencies and requisite elements

Competency 1:  Osteopathic Philosophy and Osteopathic Manipulative Medicine

Residents are expected to demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative Treatment (OMT) appropriate to their specialty.  The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to life-long learning and to practice habits in osteopathic philosophy and manipulative medicine.

Required Element #1:  The resident demonstrated competency in his/her understanding and application of OMT in _______________________________ (specialty field).

Required Element #2:  The resident integrated Osteopathic Concepts and OMT into the medical care he/she provided to patients as appropriate.

Required Element #3:  The resident understood and integrated Osteopathic Principles and Philosophy into all clinical and patient care activities.

Competency 2:  MEDICAL KNOWLEDGE

Residents are expected to demonstrate and apply knowledge of accepted standards of clinical medicine in their respective specialty area, remain current with new developments in medicine, and participate in life-long learning activities, including research.

Required Element #1: The resident demonstrated competency in the application of clinical medicine to patient care.

Required Element #2:  This resident knows and applies the foundations of clinical and behavioral medicine appropriate to his/her discipline.

Competency 3:  PATIENT CARE

Residents must demonstrate the ability to effectively treat patients, provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine and health promotion.

Required Element #1:  Gathered accurate, essential information from all sources, including medical interviews, physical examinations, medical records, diagnostic/therapeutic plans and treatments.

Required Element #2:  This resident validated competency in the performance of diagnosis, treatment and procedures appropriate to his/her medical specialty.

Required Element #3:  This resident provided health care services consistent with osteopathic philosophy including preventive medicine and health promotion based on current scientific evidence.