A developmental trajectory supporting the evaluation and achievement of competencies: Articulating the Mastery Rubric for the nurse practitioner (MR-NP) program curriculum

English version

Autoři: Rochelle E. Tractenberg ^aff001; Melody R. Wilkinson ^aff002; Amy W. Bull ^aff002; Tiffany P. Pellathy ^aff002; Joan B. Riley ^aff003
Působiště autorů: Collaborative for Research on Outcomes and –Metrics, and Departments of Neurology, Biostatistics, Bioinformatics & Biomathematics, and Rehabilitation Medicine, Georgetown University, Washington, D.C., United States of America ^aff001; Department of Advanced Nursing Practice, School of Nursing & Health Studies, Georgetown University, Washington, D.C., United States of America ^aff002; Department of Nursing and Human Science, School of Nursing & Health Studies, and Center for New Designs in Learning and Scholarship, Georgetown University, Washington, D.C., United States of America ^aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224593

Souhrn

Background

Advanced practice registered nursing (APRN) competencies exist, but there is no structure supporting the operationalization of the competencies by APRN educators. The development of a Mastery Rubric (MR) for APRNs provides a developmental trajectory that supports educational institutions, educators, students, and APRNs. A MR describes the explicit knowledge, skills, and abilities as performed by the individual moving from novice (student) through graduation and into the APRN career.

Method

A curriculum development tool, the Mastery Rubric (MR), was created to structure the curriculum and career of the nurse practitioner (NP), the MR-NP. Cognitive task analysis (CTA) yielded the first of the three required elements for any MR: a list of knowledge, skills, and abilities (KSAs) to be established through the curriculum. The European guild structure and Bloom’s taxonomy of cognitive behaviors provided the second element of the MR, the specific developmental stages that are relevant for the curriculum. The Body of Work method of standard setting was used to create the third required element of the MR, performance level descriptors (PLDs) for each KSA at each of these stages. Although the CTA was informed by the competencies, it was still necessary to formally assess the alignment of competencies with the resulting KSAs; this was achieved via Degrees of Freedom Analysis (DoFA). Validity evidence was obtained from this Analysis and from the DoFA of the KSAs’ alignment with principles of andragogy, and with learning outcomes assessment criteria. These analyses are the first time the national competencies for the NP have been evaluated in this manner.

Results

CTA of the 43 NP Competencies led to seven KSAs that support a developmental trajectory for instruction and documenting achievement towards independent performance on the competencies. The Competencies were objectively evaluable for the first time since their publication due to the psychometric validity attributes of the PLD-derived developmental trajectory. Three qualitatively distinct performance levels for the independent practitioner make the previously implicit developmental requirements of the competencies explicit for the first time.

Discussion

The MR-NP provides the first articulated and observable developmental trajectory for the NP competencies, during and beyond the formal curriculum. A focus on psychometric validity was brought to bear on how learners would demonstrate their development, and ultimately their achievement, of the competencies. The MR-NP goes beyond the competencies with trajectories and PLDs that can engage both learner and instructor in this developmental process throughout the career.

Klíčová slova:

Learning – Human learning – Allied health care professionals – Nurses – Health care policy – Careers – Nursing science – Metacognition

Zdroje

1. Thomas, A., Crabtree, M. K., Delaney, K., Dumas, M. A., Kleinpell, R., Marfell, J, et al. Nurse practitioner core competencies content: A delineation of suggested content specific to NP core competencies. 2014. http://c.ymcdn.com/sites/nonpf.site-ym.com/resource/resmgr/Competencies/NPCoreCompsContentFinalNov20.pdf

2. Kulikowski CA, Shortliffe EH, Currie LM, Elkin PL, Hunter LE, Johnson TR, et al. AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. Journal of the American Medical Informatics Association, 2012. 19(6): p. 931–938. doi: 10.1136/amiajnl-2012-001053 22683918

3. Welch L, Lewitter F, Schwartz R, Brooksbank C, Radivojac P, Gaeta B, et al., Bioinformatics curriculum guidelines: toward a definition of core competencies. PLOS computational biology, 2014. 10(3): p. e1003496. doi: 10.1371/journal.pcbi.1003496 24603430

4. Holmboe ES, Edgar L, Hamstra S, The milestones guidebook. Chicago, IL: Accreditation Council for Graduate Medical Education, 2016.

5. Englander R, Frank JR, Carraccio C, Sherbino J, Ross S, Snell L, & on behalf of the ICBME Collaborators. Toward a shared language for competency-based medical education. Medical teacher, 2017. 39(6): p. 582–587. doi: 10.1080/0142159X.2017.1315066 28598739

6. Bresciani M.J., Outcomes-based academic and co-curricular program review: A compilation of institutional good practices. 2006. Sterling, VA: Stylus.

7. Tekian A, Hodges BD, Roberts TE, Schuwirth L, Norcini J., Assessing competencies using milestones along the way. Medical teacher, 2015. 37(4): p. 399–402. doi: 10.3109/0142159X.2014.993954 25523010

8. Wagner S.J. and Reeves S., Milestones and entrustable professional activities: the key to practically translating competencies for interprofessional education? Journal of interprofessional care, 2015. 29(5): p. 507–508. doi: 10.3109/13561820.2014.1003636 26062110

9. Scott Tilley DD, Allen P, Collins C, Bridges RA, Francis P, Green A., Promoting clinical competence: Using scaffolded instruction for practice-based learning. Journal of Professional Nursing, 2007. 23(5): p. 285–289. doi: 10.1016/j.profnurs.2007.01.013 17903787

10. Carter KF, Kaiser KL, O’Hare PA, Callister LC. Use of PHN competencies and ACHNE essentials to develop teaching–learning strategies for generalist C/PHN curricula. Public Health Nursing, 2006. 23(2): p. 146–160. doi: 10.1111/j.1525-1446.2006.230206.x 16684189

11. Ten Cate O, Billett S., Competency‐based medical education: origins, perspectives and potentialities. Medical Education, 2014. 48(3): p. 325–332. doi: 10.1111/medu.12355 24528467

12. American Physical Therapy Association, Competencies of the Transition DPT Graduate. 2015. http://www.apta.org/PostprofessionalDegree/GraduateCompetencies/

13. Burke JM, Miller WA, Spencer AP, Crank CW, Adkins L, Bertch KE, et al., Clinical pharmacist competencies: American College of Clinical Pharmacy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2008. 28(6): p. 806–815.

14. Fleming ML, Parker E, Gould T, Service M., Educating the public health workforce: issues and challenges. Australia and New Zealand Health Policy, 2009. 6:8. doi: 10.1186/1743-8462-6-8 19358714

15. Caverzagie KJ, Nousiainen MT, Ferguson PC, Ten Cate O, Ross S, Harris KA, et al., Overarching challenges to the implementation of competency-based medical education. Medical teacher, 2017. 39(6): p. 588–593. doi: 10.1080/0142159X.2017.1315075 28598747

16. Welch L, Brooksbank C, Schwartz R, Morgan SL, Gaeta B, Kilpatrick AM, et al., Applying, evaluating and refining bioinformatics core competencies (an update from the curriculum task force of ISCB’s Education Committee). PLoS computational biology, 2016. 12(5):e1004943. doi: 10.1371/journal.pcbi.1004943 27175996

17. American Association of Colleges of Nursing, Re-envisioning the clinical education of advanced practice registered nurses (White paper). 2015.

18. LeFlore J.L. and Thomas P.E., Educational changes to support advanced practice nursing education. The Journal of perinatal & neonatal nursing, 2016. 30(3): p. 187.

19. Giddens J.F., Lauzon-Clabo L, Morton PG, Jeffries P, McQuade-Jones B, Ryan S., Re-envisioning clinical education for nurse practitioner programs: themes from a national leaders’ dialogue. Journal of Professional Nursing, 2014. 30(3): p. 273–278. doi: 10.1016/j.profnurs.2014.03.002 24939338

20. Sroczynski M, Dunphy LM., Primary care nurse practitioner clinical education: Challenges and opportunities. Nursing Clinics, 2012. 47(4): p. 463–479. doi: 10.1016/j.cnur.2012.08.001 23137599

21. Holmboe ES, Sherbino J, Englander R, Snell L, Frank JR for the ICBME Collaborators A call to action: the controversy of and rationale for competency-based medical education. Medical Teacher, 2017. 39(6): p. 574–81. doi: 10.1080/0142159X.2017.1315067 28598742

22. Tractenberg RE, Umans J, McCarter RJ, A Mastery Rubric: Guiding curriculum design, admissions and development of course objectives. Assessment & Evaluation in Higher Education, 2010. 35(1): p. 15–32.

23. Tractenberg, RE. Developing a curriculum for research in pathology residency: A Pathology Research Mastery Rubric. Poster presented at the Northeast Group on Educational Affairs (NEGEA) Annual Meeting, Washington, DC, USA. 2011.

24. Tractenberg, RE., The Mastery Rubric: A tool for curriculum development and evaluation in higher, graduate/post-graduate, and professional education. Open Archive of the Social Sciences (SocArXiv), 2017.

25. Tractenberg RE, FitzGerald KT, and Collmann J, Evidence of sustainable learning from the Mastery Rubric for ethical reasoning. Education Sciences, 2017. 7(1):2.

26. Tractenberg RE, How the Mastery Rubric for Statistical Literacy can generate actionable evidence about statistical and quantitative learning outcomes. Education Sciences, 2017. 7(1):3.

27. National Institute for Learning Outcomes Assessment, Higher Education Quality: Why Documenting Learning Matters. 2016. Urbana, IL: University of Illinois and Indiana University

28. Kuh G. D., Ikenberry S. O., Jankowski N., Cain T. R., Ewell P. T., Hutchings P., & Kinzie J. Using evidence of student learning to improve higher education. 2015. San Francisco, CA: Jossey-Bass.

29. Hutchings, P., Kinzie J, and Kuh G.D., Evidence of student learning. In GD Kuh, SO Ikenberry, & NA Jankowski (Eds.). Using evidence of student learning to improve higher education, 2015: p. 17–50.

30. Hutchings P., Aligning Educational Outcomes and Practices. Occasional Paper# 26. Urbana, IL: University of Illinois and National Institute for Learning Outcomes Assessment, 2016.

31. Ambrose SA, DiPietro MW, Lovett MC, Norman MK, How learning works: Seven research-based principles for smart teaching. 2010. San Francisco, CA: John Wiley & Sons.

32. Tractenberg RE and FitzGerald KT, A Mastery Rubric for the design and evaluation of an institutional curriculum in the responsible conduct of research. Assessment & Evaluation in Higher Education 2012. 37(8): p. 1003–1021.

33. Tractenberg RE, Gushta MM, Weinfeld JM, The Mastery Rubric for evidence-based medicine: Institutional validation via multidimensional scaling. Teaching and learning in medicine. 2016. 28(2): p. 152–165 doi: 10.1080/10401334.2016.1146599 27064718

34. Lockyer J, Carraccio C, Chan MK, Hart D, Smee S, Touchie C, et al., Core principles of assessment in competency-based medical education. Medical teacher, 2017. 39(6): p. 609–616. doi: 10.1080/0142159X.2017.1315082 28598746

35. Campbell D.T., “Degrees of freedom” and the case study. Comparative political studies, 1975. 8(2): p. 178–193.

36. Tractenberg RE, Degrees of freedom analysis in educational research and decision-making: leveraging qualitative data to promote excellence in bioinformatics training and education. Briefings in Bioinformatics, 2019. 20(2): p. 416–425. doi: 10.1093/bib/bbx106 30908585

37. Knowles MS, Holton III, E F, Swanson RA, The adult learner 6th ed. 2005. Burlington MA: Elsevier.

38. Clark RE, Feldon DF, van Merriënboer J, Yates KA, Early S., Cognitive Task Analysis in Michael Spector J., David Merrill M., Elen Jan, Bishop M. J. Eds. Handbook of research on educational communications and technology, 3rd ed. 2008. Mahwah, NH: Lawrence Earlbaum Associates. 577–593.

39. Olgivie S., The economics of guilds. Journal of Economic Perspectives, 2014. 28(4): p. 169–92.

40. Kingston NM, Tiemann GC., Setting Performance Standards on Complex Assessments: The Body of Work Method, in Setting Performance Standards: Foundations, Methods, and Innovations, Cizek GJ, Editor. 2012. New York, NY: Routledge. Pp 201–223.

41. Messick S., The Interplay of Evidence and Consequences in the Validation of Performance Assessments. Educational Researcher, 1994. 23(2): p. 13–23.

42. Woodside A., Case study research: Theory, methods and practice. 2010. Bangles, UK: Emerald Group Publishing.

43. Plake BS, Cizek GJ. Variations on a Theme: The modified Angoff, Extended Angoff, and Yes/No standard setting methods., in Setting performance standards. Foundations, methods, and innovations, Cizek GJ, Editor. 2012. New York, NY: Routledge. Pp 181–199.

44. American Association of Colleges of Nursing, The Essentials of Baccalaureate Education for Professional Nursing Practice. 2008.

45. Cizek GJ, An introduction to contemporary standard setting: concepts, characteristics, and contexts, in Setting Performance Standards: Foundations, Methods, and Innovations, Cizek GJ, Ed. 2012. New York, NY: Routledge. pp. 3–14.

46. Bloom BS (Ed.), with Engelhart MD, Furst EJ, Hill WH & Krathwohl DR. Taxonomy of educational objectives: Handbook I: Cognitive domain. 1956. New York, NY: David McKay.

47. Diamond RM., Designing and assessing courses and curricula: A practical guide. 3rd ed. 2008. San Francisco, CA: Jossey Bass.

48. MacKay M, Glynn D, McVey C, Rissmiller P., Nurse practitioner residency programs and transition to practice. Nursing Forum, 2018. 53(2): p. 156–160. doi: 10.1111/nuf.12237 29076545

49. Egan KL, Schneider C, & Ferrara S, Performance level descriptors: History, practice, and a proposed framework., in Setting Performance Standards: Foundations, Methods, and Innovations, Cizek GJ, Editor. 2012. New York, NY: Routledge. pp. 79–106.