# Presentation: 266961

## Dissecting Training: Building Toward Competence in Emergency Preparedness 

- Mary Hoeppner, EdD, RN
- University of Minnesota
- School of Public Health
- Centers for Public Health Education & Outreach

## Cutting Carefully:  Defining Our Terms

- What is “competency”?
- What are competency sets?
- Are competency models different from competency sets?

## Cutting Carefully:  Defining Our Terms

- What’s the difference between capacity and competency?
- What’s an “indicator” and what do they have to do with competencies?

## What is Competency?

- “A **simultaneous integration** of the knowledge, skills, attitudes required for performance in a **designated role and setting**”
- Dorothy del Bueno, 1978

## What is Competency?

- “A cluster of related knowledge, skills & attitudes that affect a major part of one’s job (a role or responsibility) that correlates with performance on the job, **can be measured against well-accepted standards**, **and that** **can be improved** via training and development”.
- 				 Lucia & Lepsinger, 1999

## Common Elements 

- Comprised of knowledge, skill and ability elements
- Simultaneous integration
- Linked to performance
- In a specific role and setting

## Competency Measurement/Evaluation

- True competency can only be measured in context
- Example:
- Test out on CPR vs perform CPR
- Successfully demonstrate learning in a classroom vs perform what the class was designed to teach in an actual emergency in a functional role

## What are Competency Sets?

- Developed by groups of professionals
- Clusters of knowledge, abilities, skills, and attitudes (KSAs) statements
- Describe what practitioners in that profession are able to do

## Foundational Competencies

- Core Public Health Practice
- Council on Linkages Between Academia and Practice (COL)
- What public health professionals should be able to know, do; the attitude they bring to their work
- Divided into 8 “domains”
- 64 competencies and 4 attitudes (68)

## Slide 10

## Core Competency Domains

- Analytic/Assessment Skills
- Policy Development & Program Planning Skills
- Communication Skills
- Cultural Competency Skills
- Community Dimensions of Practice
- Basic Public Health Skills
- Financial Planning & Management Skills
- Leadership & Systems Thinking Skills

## Slide 12

## “THE” Bioterrorism/Emergency Readiness Competencies

- CDC (aka Gebbie, Columbia)
- Developed for use by all Public Health professionals who are involved in planning, responding, and/or recovering from an emergency
- Cross-cutting competencies (1-9)
- Role specific competencies

## Public Health Laboratory Staff

- Detailed articulation of the cross-cutting competencies as they relate to Laboratory Staff
- Identify additional competencies needed to be performed by Laboratory Staff in Preparedness/Planning, Response/Mitigation and Recovery/Evaluation activities

## Other Competency Sets

- Well over 100 specialized competency sets and growing
- American Society for Clinical Laboratory Science: “Supports the concept of career mobility (ladder) from Level I to Levels II and III which includes utilization of validated competency-based credentialing examinations to determine competency of personnel at all levels of responsibility”.
- http://www.ascls.org

## What are Competency Models?

- A “meeting” of Human Resources and Education/Training theory and practices
- Groupings of competency sets
- Targeted to a specific role
- Linked to job design, job tasks and role requirements
- Linked to evaluation measures/performance appraisal

## Building Competency

- More specialty competency
-   sets
- Lab Science competency
- 	 sets
- BT/ER competency set
- Core Public Health
-   Competency set

## Example: Public Health Laboratory Staff Manager

- Core Public Health Competency Set
- Foundational Public Health
- BT/ER Competency Set: Cross-cutting competencies
- Bioterrorism/Emergency Readiness
- Laboratory Science Competency Set
- BT/ER and Professional Specific
- Core Competencies for Supervisors, Managers and Executives
- Fiscal Management, Human Resource Management

## What is Capacity?

- Ability of an organization to perform in a specific need
- Dimensions of capacity:
- Human capital
- Physical capital
- Economic capital
- Social capital
- Cultural capital
- Knowledge, skills and attitudes (KSAs)

## Capacity & Competency: Not the Same Thing

- Individual competence contributes to capacity but is not “capacity”
- Individual performance is developed through training that reflects competencies
- Competencies are comprised of KSAs

## <footer>

- <date/time>

- Reproduced with permission from Miner, K.; Childers, W.; Alpern, M., Cioffi, J., & Hunt, N.  (June, 2005).  The MACH model: From competencies to instruction and performance of the public health workforce.  Public Health Reports: (120), Supplement 1, 9 – 15.

## Pinning the Specimen: Instructional Objectives

- Provide focus
- Reflect learning needs assessment
- Convey instructional intent
- Target evaluation measures
- As a set, reflect what is accepted as evidence that the overall purpose or goal is achieved by the learner

## Level of Specificity

- General Learning Objectives versus Specific Instructional Objectives
- Purpose/Goal vs. Measurable Behavior

## Domains of Learning 

- Cognitive
- Affective
- Psychomotor
- Each domain contains different levels of learning, arranged from low to high
- Each higher level includes the levels that precede it

## Cognitive Domain: Cognitive Process

- Taxonomy Revised in 2001
- Remember: Recall, retain
- Understand: Comprehend, explain
- Apply: Use
- Analyze: Differentiate, organize
- Evaluate: Judge, critique
- Create: Generate, construct new idea, knowledge

## Examples: Cognitive Domain Learning Objectives

**List** the events that created the French Revolution. (Remember)
**State** the meaning of the word “concentration”. (Understand)
**Differentiate** pre and post causes of renal failure. (Analyze)
**Evaluate** the results of current research about the correlation between obesity and Type 2 diabetes. (Evaluate)

## Try it Out: Cognitive Domain Exercise

- Describe challenges facing public health professionals planning for 2020.
- Design a surveillance program for use in your agency.
- Critique research findings in terms of their usefulness to providing methods to maintain low stress.
- List three causes of diseases associated with the agricultural industry.
- Analyze the relational dynamics occurring in communities when there is a shooting in a high school.

## Affective Domain

- Receiving: Willing to listen
- Responding: Reacting to
- Valuing: Attaching a “worth”
- Organization: Resolving conflicts between competing values
- Characterization by Value or Value Complex: Part of a lifestyle

## Examples: Affective Domain Learning Objectives

- From a list of volunteer activities, **select** three that match personal interests and preferences. (Responding)
**Explain** the impact of belief systems on compliance with health directives.  (Valuing)
**Integrate** 3 activities that support personal emotional health in to a daily schedule. (Organization)

## Try it Out: Affective Domain Exercise

- Recognize accountability issues & ethical dilemmas in application of advanced life support technology.
- Select personal heroes from a list of famous public figures.
- Mentor a colleague new to the field of laboratory science.
- Select priorities for use of discretionary income.
- Describe issues of personal responsibility in promoting primary & secondary prevention in order to effect social change.

## Psychomotor Domain

- Perception: Obtain cues
- Set: Readiness to act
- Guided Response: Imitation, trial and error
- Mechanism: Some confidence in doing
- Complex Overt Response: Proficient
- Adaptation: Modify for the situation
- Origination: Create new patterns of movement

## Examples: Psychomotor Domain Learning Objectives

**Identify** the correct meter for a waltz. (Perception).
**Display** correct positioning of feet for addressing the tee.  (Guided Response)
**Modify** strength at which volleyball is hit based on location of opponents. (Adaptation)
**Compose** a sonata. (Origination)

## Try it Out: Psychomotor Domain Exercise

- Demonstrate the ability to make chocolate chip cookies without a recipe.
- Gather materials needed to weed a garden.
- Alter your responses to requests for information based on the assessed stress level of the client.
- Create an arrangement of common folk music for performance by a string quartet.
- Distinguish among the needs of cats based on their meow.
- Using a template provided by conference organizers, write a letter to the editor to inform the community of an upcoming event.
- Demonstrate the ability to perform a square dance as part of a group of performers.

## Examining the Specimen

- Identifying the level of skill development targeted by the training

## Council on Linkages: Aware

- Basic level of mastery
- Can identify the concept or skill
- Have limited ability to perform the skill

## Council on Linkages: Knowledgeable

- Intermediate level of mastery of the competency
- Can apply and describe the skill

## Council on Linkages: Proficient/Advanced

- Advanced level of mastery
- Able to synthesize, critique or teach
- 	the skill to others

## Skill Level & Competency

- CDC Competencies: Public health workers need to be competent
- Per del Bueno, Lucia and Lepsinger:
- 		Competency requires the ability to 	_**apply**_ KSAs

## Skill Level & Competency

- Knowledgeable: Intermediate level of mastery; can apply and describe
- Proficient: “Advanced level of mastery of the competency; individuals are able to synthesize, critique or teach the skill.”

## Classifying the Specimen

- Domains of Learning arranged from simple to complex
- i.e. It is a higher level of learning to be able to evaluate than remember
- COL skill levels arranged from less skilled to higher skilled
- i.e. Training at the Awareness Level is less skilled than Proficient/Advanced level training

## Univ. of Minnesota Midwest Center for Life-Long-Learning in Public Health						    Mary Hoeppner		  January, 2002

|  | Aware | Knowledgeable | Proficient/
Advanced |
| --- | --- | --- | --- |
| Cognitive | Remember
Understand | Apply
Analyze | Evaluate
Create |
| Affective | Receive | Respond
Valuing | Organization
Value Complex |
| Psychomotor | Perception
Set
Guided Response | Mechanism
Complex 
Overt Response | Adaptation
Origination |

- Univ. of Minnesota Midwest Center for Life-Long-Learning in Public Health						    Mary Hoeppner		  January, 2002
- May not be reproduced without written permission of the University of Minnesota Midwest Center for Life-Long-Learning in Public Health

## What We Know

- BT/ER competencies are built on the core Public Health competencies
- Cross-cutting BT/ER competencies (1-9) are for every person who is PH responder
- The language of learning objectives can be correlated to the level of skill we want to develop

## Evaluating Competency: Use of Indicators 

- Discrete items that reflect KSAs that are related to the desired competency
- Develop through research
- Write in behavioral terms
- Use to evaluate progress toward “competency”, we measure the indicators
- 	Example: How quickly aspirin is given to patients who are suspected of having a heart attack

## Cross-cutting BT/ER Indicators

- Identify the modes of transmission for all biological agents of concern
- Demonstrate the ability to correctly use PPE
- Communicate directions in a clear and concise manner.
- Recognize signs of post traumatic stress in the behavior of yourself and/or colleagues following an event.

## Laboratory Science/Pathology: Role Specific Indicators

- Describe how to arrange for transport of a specimen.
- Correlate type of specimen to appropriate level of laboratory required for specimen receipt and analysis.
- Describe procedures used to rapidly analyze suspected biological or chemical agents.
- Identify precautions to be taken for autopsy when bioterrorism is suspected.

## What the Future Looks Like

- Expect performance measurement requirements to link to capacity
- Consider how to develop and use behavioral indicators to measure progress toward competency
- Use sound educational design principles to create competency-based training for the public health workforce