Competency-Based Approach to Community Pediatrics:
Service Learning Methodology
Community Pediatrics Program, Columbia University
Dodi Meyer; Patricia Hametz; Vicki LeBlanc;
Milagros Batista; Neil Goldberg
Workshop outline
 Designing a competency based curriculum
 Choosing a methodology: Service learning as an
example
 Designing an appropriate evaluation
 Open discussion
Frustrations with a lack of defined curriculum
 Little preparation / knowledge of role
 Unclear, one-sided objectives
 Evaluation limited to knowledge acquired
 Learning is often passive
What is a curriculum?
Key components of a curriculum
 Enrollment process: Who are we teaching?
 Competencies: What are we teaching?
 Methodology and Resources: How are we teaching?
 Outcomes Evaluation: Did they learn it?
 Process Evaluation: Did we teach as we said we
would?
Competency-based vs. Traditional
curriculum
 Traditional:
*Discipline-based
*Teacher-centered
*Historical
*Academically neutral
*Not multidisciplinary
 Competency-Based:
*Resident-centered
*Future-oriented
*Set Priorities
*Multidisciplinary
What is a competency statement?
What is a competency statement?
What do we mean by “competent”?
Beginner
Novice
Competent
Proficient
Expert
What is a Competency?
A competency statement describes precisely an essential skill,
combined with appropriate knowledge and attitude, that the
resident will be able to perform reliably upon completion of
training, in real settings and without assistance, in order to be
ready for beginning independent practice.
Example of a competency statement
Prescribe medications to treat a patient’s respiratory
distress appropriately
*skill component
*knowledge component
*attitude component
How do we develop a competency-based
curriculum?
1) Write competencies
2) Consider appropriate methodology
3) Determine evaluation tools
How to write a competency statement
 Statement of specific behavior or task
 Requires both understanding and application
of the materials to real work settings
 Behavior or task should be something that can
be evaluated
Examples
1. Understand how culture applies to the health of
children.
Examples
1. Understand how culture applies to the health of
children.
2. Explain how beliefs, culture and ethnic practices can
influence health status and health care for
children of the community.
Examples
1. Understand how culture applies to the health of
children.
2. Explain how beliefs, culture and ethnic practices can
influence health status and health care for
children of the community.
3. Explain how a health care belief system can
influence where and what type of health care is
sought, and how that decision affects the health
status of a child.
Examples of Verbs for Competencies
Objectives
Levels
Knowledge
Comprehension
Application
Analysis
Synthesis
Evaluation
Verbs
define, list, record recall, name, relate, underline
restate, discuss, describe, explain, express,
identify, locate, report, review, tell
translate, interpret, apply, employ, use,
demonstrate, dramatize, practice, illustrate, sketch
distinguish, analyze, differentiate, appraise,
calculate, test, compare, contrast, criticize,
diagram, inspect, debate, inventory, question,
relate, solve, examine
compose, plan, propose, design, formulate,
arrange, assemble, prepare, construct, create,
make, set up, organize, arrange
estimate, measure, assess, rate, compare, revise,
select
Community Pediatrics
“Community Pediatrics takes responsibility for all
children in a community, providing preventative
and curative services, and understanding the
determinants and consequences of child health
and illness, as well as the effectiveness of services
provided….The unique feature of Community
Pediatrics is its concern for all of the population.”
 Robert Haggerty, MD
Examples
1. Understand how culture applies to the health of
children.
2. Explain how beliefs, culture and ethnic practices can
influence health status and health care for
children of the community.
3. Explain how a health care belief system can
influence where and what type of health care is
sought, and how that decision affects the health
status of a child.
Theoretical framework: Service Learning
 Established educational methodology
 Integrates community service with explicit
learning objectives
 Responds to community needs, building on its
own perceived assets
Service Learning
 Involves community as active partner in program
design and implementation
 Emphasis on critical reflection: What? So What?
Now What?
Service Learning: Steps for
implementation
 Identify partners: negotiate different agendas,
expectations, roles and responsibilities
 Learning competencies for residents and
community members
 Service objectives for residents and community
members
 Structured reflection
Service Learning at Columbia:
Best Beginnings
 Home visitation program/Primary prevention
 Partnership: Alianza Dominicana/ Columbia
University/ School of Public Health/ NY Society
for Prevention of Cruelty to Children
 Medical home: community based primary care
site
Service Learning at Columbia:
Learning Competencies
Residents
Identify the cultural barriers that exist
between patient and and health care providers
Family case workers
Describe the institutional culture of the
medical center
Service Learning at Columbia:
Service Objectives
Residents
Teach family case workers topics in general
pediatrics
Perform home visitations / delivery of primary
care
Family case workers
Teach residents local health beliefs
Discuss community perception of the medical
center
Service Learning at Columbia:
Structured Reflection
Performed jointly by community and
academic preceptors
Targeted to both residents and family case
workers
What? So what? Now what?
Service Learning Potential Outcomes:
Academic Perspective
 Builds community-oriented competencies
Service Learning Potential Outcomes:
Academic Perspective
 Builds community-oriented competencies
 Enhances attitudes/ behaviors in health
professionals
Service Learning Potential Outcomes:
Academic Perspective
 Builds community-oriented competencies
 Enhances attitudes/ behaviors in health
professionals
 Enhances service delivery/access to vulnerable
populations
Service Learning Potential Outcomes:
Academic Perspective
 Builds community-oriented competencies
 Enhances attitudes/ behaviors in health
professionals
 Enhances service delivery/access to vulnerable
populations
 Improves community/academic relations
Service Learning Potential Pitfalls:
Academic Perspective
 Effective partnerships are labor intensive
 Needs to be realistic in service and learning
outcomes: change doesn’t follow a semester plan
Service Learning Implementation
Challenges: Academic Perspective
 Trust between academic center –community
History of town/gown relationships
 Buy in at a departmental/institutional level
 Buy in at a resident level
 Curriculum already overloaded
Service Learning Potential Outcomes:
Community Perspective
 Improves practice / Potential community
practitioners
 Enhances use of health practice
Family feeling back at home, “back to the good old days”
Friendly, people-centered, individualized care
Service Learning Potential Outcomes:
Community Perspective
 Improves scope of knowledge in the health field
 Orients, teaches, and empowers staff to teach
residents
 Opportunity to grow and develop
 Values the relevance of popular knowledge and
culture
Service Learning Potential Pitfalls:
Community Perspective
 Not only one way of learning
Teaching and learning can happen at the same time
 Time intensive / Labor intensive
 Financial incentives need to be balanced
Service Learning Implementation
Challenges: Community Perspective
 Buy in from leaders and grass root workers at the
community-based organization level
 Build trust between families and institution
Create a mediator
 Maintain the work flow
Service Learning: Steps for
implementation
 Identify partners: negotiate different agendas,
expectations, roles and responsibilities
 Learning competencies for residents and
community members
 Service objectives for residents and community
members
 Structured reflection
Evaluation
When determining the competencies and methodology,
we need to keep in mind the evaluation of the
curriculum
Two components to evaluation
Process evaluation: Are we doing what we set out to
do?
-focus groups
-satisfaction surveys
-documenting activities
Outcome evaluation: Are the residents learning what
we want them to learn?
Outcomes Evaluation
How do you measure a competency?
Three components:
-Knowledge
-Skills
-Attitudes
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Knowledge: Residents should be able to describe the
medications that can be used to treat respiratory
distress.
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Knowledge: Residents should be able to describe the
medications that can be used to treat respiratory
distress.
Evaluation: Describe the medications that can be used to treat
respiratory distress, and discuss their side effects.
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Skill: Residents should be able to assess the degree of
respiratory distress.
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Skill: Residents should be able to assess the degree of
respiratory distress.
Evaluation: Describe the steps required to assess the
respiratory distress of a 7-year old child.
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Skill: Residents should be able to assess the degree of
respiratory distress.
Evaluation: Describe the steps required to assess the
respiratory distress of a 7-year old child.
Performance evaluation of a resident conducting
a physical examination on a child with respiratory
distress.
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Attitude: Residents should recognize the importance of eliciting
the patient’s understanding of asthma in order to
identify barriers to implementing the treatment plan.
Examples of Evaluation
“Prescribe medications to treat a patient’s respiratory distress”
Attitude: Residents should recognize the importance of eliciting
the patient’s understanding of asthma in order to
identify barriers to implementing the treatment plan.
Evaluation: Video-taped interview of a resident discharging
a 7-year old with respiratory distress from the
emergency room.
Examples of Appropriate Evaluation
Methods
 Knowledge
-tests (Multiple choice, true or false, essay)
-literature review
 Skills
-simulations
-rating scales of clinical encounters
 Attitudes
-journals
-videotaped encounters
Example of Evaluation at Columbia:
Knowledge component
Competency:
 Explain how beliefs, cultures, and ethnic practices
can influence health status and care for children in
the community.
 Method:
 Service Learning
 Evaluation:
 Short answer test
Examples of Appropriate Evaluation
Methods
 Knowledge
-tests (Multiple choice, true or false, essay)
-literature review
 Skills
-simulations
-rating scales of clinical encounters
 Attitudes
-journals
-videotaped encounters