Miller's Prism of Clinical Competence. #medicaleducation #education #1 #learn #teaching #learning
Channel: SPM & Research with Dr Rock Britto
Date: 2024-01-07

Miller's Prism of Clinical Competence. 
Miller's Pyramid of Clinical Competence is a framework developed by Dr. George Miller to conceptualize the stages of clinical competence and skills acquisition in medical education. The pyramid consists of four levels, each representing a different stage of competency:

Knows (Knowledge):

At the base of the pyramid is the foundation of knowledge. This level involves the acquisition of factual information, theories, and concepts that form the basis for clinical practice.
Knows How (Skills):

The second level represents the ability to apply knowledge and skills in a practical manner. It involves the development of clinical skills and procedural competence.
Shows How (Performance):

This level focuses on the demonstration of clinical competence in a real-world setting. It includes the application of knowledge and skills in clinical practice, as well as effective communication and interaction with patients.
Does (Action):

The highest level of the pyramid involves the ability to independently and effectively perform clinical tasks. It represents the integration of knowledge, skills, and performance into competent and autonomous clinical practice.
Miller's Pyramid is often used in medical education to guide the design of educational programs and assessments. It emphasizes the progression from foundational knowledge to practical application and independent clinical practice.
In 1990 psychologist George Miller proposed a framework for assessing clinical competence. At the lowest level of the pyramid is knowledge (knows), followed by competence (knows how), performance (shows how), and action (does). In this framework, Miller distinguished between “action” and the lower levels.
Miller’s pyramid of clinical competence was developed specifically for assessing students in health care settings. It is useful for aligning learning outcomes (or clinical competencies) with what learners should be able to do at any stage of the learning process.
Novice learners should be able to recall facts, but as their understanding increases, they should be able to interpret and apply, demonstrate, and perform required knowledge, skills, and attitudes in authentic practice settings. Assessments should also evolve from traditional tests to more authentic assessments.

Miller’s pyramid is frequently used with Bloom’s revised taxonomy, core competencies, and entrustable professional activities (EPAs).
Miller’s pyramid model divides the development of clinical competence into four, hierarchical processes. On the lowest level of the pyramid is ‘knowledge’, tested by written exams and traditional multiple-choice questions (MCQs). The next level stands for ‘application of knowledge’, assessed by essays, clinical problem-solving exercises and extended MCQs. The third tier of the pyramid represents ‘clinical skills competency’, assessed by standardized patient exercises, simulations and clinical exams. Finally, on top of the pyramid is ‘clinical performance’, assessed by direct observation in real clinical settings. The lower level processes account for the cognitive components of competence and involve classroom-based assessments, while the two higher tiers of the pyramid account for the behavioural components of clinical competence, which involve assessment in simulated and real clinical settings.  By placing the observable behaviour at the apex of the hierarchy, Miller’s pyramid implies a preference towards the behaviourist tradition, as opposed to cognitive perspectives. Miller’s model suggested that simulated practice could provide a good approximation to how students would behave in the real-world clinical setting, and therefore firmly argued for the introduction of performance-based assessments.

#medicaleducation 
#cbme 
#MedEd
#MedicalEducation
#MedStudent
#MedSchool
#MedTwitter
#MedicalStudents
#ClinicalSkills
#MedStudentLife
#HealthProfessionals
#Medicine
#MedEducators
#MedicineLectures
#ResidencyLife
#MedicalSchoolLife
#Anatomy
#MedicalStudentsLife
#SurgeryEducation
#LearningMedicine
#TeachingMedicine
#InternalMedicine
#MedicalResidency
#MedicalCurriculum
#Pedagogy
#TeachingStrategies
#EduChat
#HigherEd
#TeachBetter
#ActiveLearning
#StudentEngagement
#InnovativeTeaching
#ClassroomManagement
#EdTech
#OnlineTeaching
#FlippedClassroom
#BlendedLearning
#Teachology
#TeachingTips
#PedagogicalApproaches
#EducationalTechnology
#TeachInspire
#TeachingMethods
#PedagogicalInnovation
#EducationForAll
#TeacherTraining
#LifelongLearning
#HigherEducation


References:
ESSENTIAL SKILLS
FOR A MEDICAL
TEACHER
An Introduction to Teaching and Learning
in Medicine
Second Edition
Ronald M. Harden 
Various internet references.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125657/#:~:text=In%201990%20psychologist%20George%20Miller,action%E2%80%9D%20and%20the%20lower%20levels. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246123/

https://openpress.usask.ca/ideabook/chapter/millers-pyramid-of-clinical-competence/