Reﬂection: Health Delivery System Competencies
Health care systems around the world are transforming to align with the needs of 21st-century patients and populations. Transformation must also occur in the educational systems that prepare the health professionals who deliver care, advance discovery, and educate the next generation of physicians in these evolving systems.
Competency-based, time-variable education, a comprehensive educational strategy guided by the roles and responsibilities that health professionals must assume to meet the needs of contemporary patients and communities, has the potential to catalyze optimization of educational and health care delivery systems.
By designing educational and assessment programs that require learners to meet speciﬁc competencies before transitioning between the stages of formal education and into practice, this framework assures the public that every physician is capable of providing high-quality care. By engaging learners as partners in assessment, competency-based, time-variable education prepares graduates for careers as lifelong learners.
While the medical education community has embraced the notion of competencies as a guiding framework for educational institutions, the structure and conduct of formal educational programs remain more aligned with a time-based, competency-variable paradigm. The authors outline the rationale behind this recommended shift to a competency-based, time-variable education system. They then introduce the other articles included in this supplement to Academic Medicine, which summarize the history of, theories behind, examples demonstrating, and challenges associated with competency-based, time-variable education in the health professions.
Week 8: Reﬂection Reﬂect Back Over The Past Eight Weeks And Describe How The Achievement Of The Course Outcomes In This Course Have Prepared You To Meet The MSN Program Outcome #4, The MSN Essential IV, And The Nurse Practitioner Core Competencies # 7.MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.
Nurse Practitioner Core Competencies # 7#
Health Delivery System Competencies
● Applies knowledge of organizational practices and complex systems to improve health care delivery.
● Effects health care change using broad based skills including negotiating, consensus-building, and partnering.
● Minimizes risk to patients and providers at the individual and systems level.
● Facilitates the development of health care systems that address the needs of culturally diverse
● populations, providers, and other stakeholders. Reﬂection: Health Delivery
System Competencies. Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment.
● Analyzes organizational structure, functions and resources to improve the delivery of care.
● Collaborates in planning for transitions across the continuum of care.
In the past seven weeks, this course has taught me important concepts that enhance my understanding in the health promotion of numerous conditions affecting the primary care setting. We learned to optimize one’s health through disease prevention and treatment implementation for neurological issues, pulmonary conditions, cardiovascular and hematological problems, mental health, and inﬂammatory disorders.
This course has helped me achieve the master’s program outcome number four, the Master’s Essential IV, and the Nurse Practitioner Core Competency number seven competency.
Master’s Program Outcome #4: Integrating professional values via scholarship and the provision of service in healthcare
In this course, we achieved the program’s outcome of professional identity by analyzing how primary care practice is organized and inﬂuenced by ethical, legal, economic, and political factors (Chamberlain University, 2019). Through evaluation of clinical cases and research, I was able to integrate professional values and thus, develop professional identity as a family nurse practitioner (FNP).
The professional core values of a nurse practitioner was not only learned in theory, but implemented in practice as well. Integrating the professional core values of compassion, trustworthiness, and accountability in clinical practice helped further my development of professionalism and my identity as a FNP.
One instance in which I had exposure to this outcome was during my clinical rotation when I addressed a young female with bulimia nervosa disorder. It was evident that she was extremely anxious and expressed concern about her body image and eating habits. It was important to allow her to openly communicate about her emotions. While it was diﬃcult to address all of her concerns in a time-constraint environment, I did the best I could to provide compassion and give her ample time to talk and ask questions about her treatment plan
. Developing the trust and respect between myself and the patient was critical in optimizing her health outcome. Another instance that helped achieve this particular outcome was in the implementation of treatment plans for patients who struggled to obtain proper services in healthcare.
During my clinical rotations, I had a patient who had multiple comorbidities and came in with a chief complaint of constipation. Through imaging, she was found to have bile duct cancer and had issues getting an initial evaluation appointment with an oncologist. Instead of placing another referral that would take a signiﬁcant amount of time to address the patient’s issue, we placed a call to an oncologist colleague to expedite the care and accommodate the patient. Furthermore, she was also counseled and supported with ﬁnancial resources.
Master’s Essential IV: Transforming and incorporating scholarship into practice
The Master’s Essential IV of transforming and incorporating scholarship into practice was also met during this course through interdisciplinary team participation, application of research outcomes within the primary care setting, dissemination of research results, and utilization of practice guidelines to improve health outcomes (American Association of Colleges of Nursing [AACN], 2011).
This particular master’s essential was heavily emphasized throughout this course by using reliable sources of information, applying national guidelines, and integrating clinical judgment and perspectives of other professionals for treatment plans of various illnesses (AACN, 2011). For example, we applied different evidence-based clinical guidelines to help formulate treatment plans for patients in the weekly discussion posts. Case studies of different illnesses, such as pulmonary, cardiovascular, and mental health disorders, during week 2 and 3 were heavily discussed and supported with the latest recommendations of scholarly research, as well as national treatment guidelines from healthcare associations and governmental agencies, including the American Heart Association, the Centers for Disease Control and Prevention, and the American Psychological Association.
Applying these practice guidelines to improve practice fully incorporating scholarship into the primary care practice. This master’s essential was also fulﬁlled in a second example during week 6 where we were assigned mental health disorder case studies to present. Various mental health disorders were discussed and supported by reliable sources and each peer took on a leadership position to facilitate the discussion throughout the week.
As leader of an assigned topic, I responded to peers and demonstrated my knowledge of the mental health disorder through discussion of hallmark symptoms, diagnostic tools, and treatment plans while acknowledging results and conclusions of others. This example fulﬁlled knowledge and research dissemination to enhance health outcomes for each case study patient and incorporate scholarship into clinical practice.
Nurse Practitioner Core Competency #7:
Lastly, the nurse practitioner core competency #7, which was established by the National Organization of Nurse Practitioner Faculties (NONPF), focuses on the competencies related to health delivery systems. This competency involves the application of knowledge generated from organizational practices, the support of healthcare needs of culturally diverse populations, the impact of healthcare change, the organizational structure of the healthcare system, and the collaboration in the continuity of care (NONPF, 2017).
This competency was achieved in the clinical rotation by supporting continuity of care and incorporating cultural competence in the primary care oﬃce. For example, I saw an elderly male patient in the clinical rotation with complaints of hematuria intermittently for the past three weeks. The patient had not established care with a primary care provider in many years. We obtained a urine sample, which showed frank blood. The patient required a higher level of care and was subsequently referred to the nearest ER.
We were able to call the facility and give a report to the receiving physician. The patient was then evaluated emergently. This example demonstrated the process of collaborating and planning for transitions across the healthcare continuum.
The second example of achieving this competency deals with cultural competence in healthcare. In the clinical rotation, I saw a young Hispanic female patient who had depression and an eating disorder. Her mother had brought her into the oﬃce, but they both primarily spoke Spanish.
The oﬃce generally does not have a high Hispanic population, but we had interpreter services to help facilitate the visitation. We were able to utilize the interpreter services to help formulate a treatment plan for the patient, as well as discuss her emotions with her mother.
The goal of culturally competent healthcare care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, and English proﬁciency. Both the patient and her mother were very appreciative for taking the time to address their concerns. This example demonstrated support of healthcare needs of culturally diverse populations. Therefore, the accomplishment of outcomes in this course helped me prepare to meet the program’s outcome number four, the master’s Essential IV, and the NONPF competency number seven. Reﬂection:
American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Retrieved from http://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf
Chamberlain University. (2019). Academic catalog 2019-2020. Retrieved from https://www.chamberlain.edu/docs/default-source/academics-admissions/catalog.pdf National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies content. Retrieved from Sample essays https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_ NPCoreComps_with_Curric.pdf
After reﬂecting over the course of Advanced Clinical Diagnosis and Practice Across the Lifespan, the student identiﬁed achievements of the course outcomes. This course had a few speciﬁc areas that the student reﬂected on that assisted her in preparing for the Master of Science program outcome #4, the Master of Science in Nursing (MSN) Essential IV, and the Nurse Practitioner Core Competency #7.
The professional outcome #4 is to “Integrate professional values through scholarship and service in health care.” This outcome was achieved by taking the week 4 APEA predictor exam. As the student studied for the exam, she identiﬁed several areas of improvement.
By reviewing a wide knowledge base of concepts seen in the primary care setting the student was to identify her areas of strengths and weaknesses. The test was broken down into categories and assisted the student to ﬁnd her professional identity. Another way the student found her professional identity was through clinicals. The preceptor pushed autonomy and let the student formulate the treatment plan while she would offer suggestions and advice. The student realized that in a few short months that she would be in practice with varying levels of guidance depending on job location. The student identiﬁed her professional identity in the clinic which will aid her in her next rotation and future practice.
The MSN Essential IV is “Translating and integrating scholarship into practice recognizes that the master’s prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.” Health Delivery System Competencies Refllection Sample essays.
Over the course, the student achieved the MSN Essential IV by discussion in week 6 mental health presentation and in the clinical setting. The student is accustomed to seeing a lot of mental health patients but sometimes has diﬃculty categorizing the present illness. The week 6 presentation allowed each student to formulate a patient scenario with a diagnosis provided by the instructor.
The student saw how mental illness was related, but also how it differed from patient to patient. This assignment assisted the student in identifying the patient’s chief complaints, differentiate from different ailments, educate and act as a change agent, and evaluate results over time. In the clinical setting, the student was able to educate teens about IUDs. The NP she followed at the FQHC would insert IUDs that lasted for 5 years for $20.
Many teenage girls would come to the clinic and admit to being sexually active without the use of protection or teenagers that already had a few kids would come in asking for birth control options. The student felt as if she was able to minimize teenage pregnancy or unwanted pregnancies by providing patients with the appropriate knowledge and offering an affordable pregnancy prevention method. The Nurse
Practitioner Core Competency #7 is geared towards Health Delivery System Competencies. In the course, the students were exposed to case studies, expected to formulate case studies, and created diagnoses based upon case studies other students provided. The different levels and dynamics of the case studies opened up opportunities for the student to review articles, clinical practice guidelines, and the most up-to-date information for each disease process.
Real-life scenarios allowed the student to apply practice knowledge to complex systems and improve healthcare outcomes. In the clinic setting, the student had many Hispanic patients who were Spanish speaking only. This opened up a concept of culturally diverse patients and populations. The student learned that diabetes is common amongst the Hispanic race related to their culturally diverse diet and heritage.
The student incorporated a sliding scale pay plan to make it affordable for the patients, utilized an on-site translator, and reviewed costs of medications to ensure the patient would pick up the prescription and adhere to the treatment plan. The FQHC clinic allowed for the student to identify the organizational structure, function, and resources available for these types of low socioeconomic patient classes.
Thank you, doi: 10.1097/ACM.0000000000002080
Challenges With Today’s Approach To Medical Education
In today’s medical education environment, time is our nemesis. Educational structures are time bound. Learners dwell in discrete phases of education for a predetermined amount of time (in the United States, that is no less than 130 weeks of medical school or 3 years of an internal medicine residency), and they transition to the next phase of training after passing time-bound courses (6 weeks in pediatrics, 8 weeks in surgery) and demonstrating satisfactory performance on exams that focus primarily on their mastery of factual knowledge (e.g., licensing exams, certifying exams). All learners commence education labeled with their year of graduation (“Class of 2022”) and must be prepared to enter the National Resident Matching Program as a cohort or risk the stigma and the economic consequences of delayed entry into a residency or fellowship.
Learners and faculty are time challenged. Faculty supervisory assignments on clerkships or residency rotations are brief and insuﬃcient to develop the trusting relationships needed for effective, critical assessment.15 Within those short rotations, faculty have little time to engage in the direct observation that competency-based education demands.16 Faculty ﬁnd themselves asked to make assessment judgments (e.g., meets, exceeds, does not meet competency) with limited information.
They lack both skills and time to engage in coaching dialogues with their learners and instead communicate these assessment judgments through electronic forms.17,18 Students, realizing the short time they have to impress a faculty member and earn the grades they need to pursue their desired residency, view assessment as a threat to be avoided rather than as an opportunity to be embraced.
18–21 They use time to study to earn higher scores on episodic high-stakes examinations rather than to optimize patient care competencies in the workplace. Learners identiﬁed as needing or desiring additional time to meet competencies are viewed as failures. Consequently, these students spend time arguing about the veracity of the assessment rather than strengthening the part of their performance that is weak.
Learners who are capable of accelerating their progress through formal education are unable to do so in the current system and thus must add time to the total length of their education if they wish to engage in enrichment activities such as research, service, or family building.
Many question the quality of learning and the reliability of assessments made under these time constraints and challenges.
Program directors raise concerns that the graduating medical students or residents they receive into their programs are not prepared for the roles they need to assume as interns or fellows.22–26 Nonphysician health care providers readily identify students, residents, and practicing physicians who have not mastered competencies in teamwork, communication skills, and professionalism.
27 Employers decry the need to retrain newly employed physicians in systems-based practice.28 Certiﬁed physicians struggle to accept the need for oversight of their practice-based learning. Persistent problems with health care safety, quality, and equity are at least partly attributable to individual physician competence.