Johns Hopkins University's Path to Competency-Based Education

Speaker: Keilah Jacques, Adjunct Instructor, Johns Hopkins University

Keilah Jacques: So overall, we're trying to talk about competency-based education whenever and wherever we can. Faculty now readily recognize the term, but we're still learning what it will actually mean in practice. Fortunately, we're learning that a lot of our assessments are competency-based to some extent. So, that's reassuring, and there's a lot of momentum amongst leadership and faculty for the shift. Specifically, we're trying to develop competency-based education champions, and we're doing this by engaging course leaders. We just completed course evaluations, and that was an opportunity for faculty to reflect and share the extent to which they're already assessing the AACN competencies. So this gave people confidence that that shift wouldn't be too difficult.

Keilah Jacques: Though we haven't begun implementation yet, we're already learning a lot. First, we learned that ideas are great, but we need to involve the frontline folks as early as possible. For example, we plan to rely on sims for some of our pilot competency-based education formative and summative experiences. But there's much demand for sim, and we had trouble making it work. So now, we're planning to adapt existing sims versus trying to create new ones. And the second thing that we learned is not to forget about our clinical faculty. So, if the competency-based education team is changing or adding concepts to assessments, and the faculty team is not on board, it won't work. For example, we added a screener for the social determinants of health to our competency-based health form, but the faculty were hesitant to use it because they were not sure how to respond to a positive screen. We learned that we need to get faculty comfortable first, and then we can add this to the clinical instructor orientation, which is what we've now done. Another simple, but important lesson has been the importance of technology as we gather data. So we use Power BI instead of Excel. And it's given us tremendous flexibility to see our gaps and redundancies in our competency work. We also learned that there is no point in doing all the work and gathering all the data if you can't make it work for you.

Keilah Jacques: In addition to population health, we selected patient-centered care or domain two. We selected this because it focuses on the competencies that nurses need to practice safely. And we know it would engage the medical surgical faculty. We also saw that this domain includes competencies that are needed to not just provide safe care, but equitable care. And we love the idea of engaging a variety of faculty members, and being able to demonstrate how tightly safety and equity are tied.

Keilah Jacques: We have two partners: Johns Hopkins Care at Home Group, and Source, the University's community engagement and service learning center. We sought out these two partners because our school wants to prioritize, normalize, and operationalize community-based perspectives. Our team includes home health experts, and they are providing the guidance. we need to help ensure students are ready to provide care, not just in the hospital, but in community-based settings including homes. While some students may not go on to work in home settings, we know they will benefit from these competency-based experiences. Julie Ellis, who is the lead educator for the care at home group, helped us deconstruct competencies relevant for new nurses. This will guide our development of assessments, and in turn, the learning activities. For example, in the community and home setting, the need to collaborate and really center care around the client is paramount. These lessons on patient-centered care will benefit students no matter where they practice. And our partner from Source, Tyler Derreth, really understands how to assess student experiences in community settings. And we need that insight given that that's where care delivery is moving. So, we're learning as we go.

Keilah Jacques: Competency-based education will build student confidence, and rethink employer confidence that these new grads are ready for practice. Competency-based education means that students will demonstrate, not just know about the AACN competencies. And if they struggle, we'll use remediation to help them get there. Competency-based education provides more active, learner-centered activities and assessments that are perfect fit for adult learners who need to move at a different pace. For example, we have been working on an idea for a home-based assessment related to diabetes care. The students will have to both recognize abnormal findings and negotiate with the client to complete their physical assessment. We all know this takes trust and rapport. The home setting allows us to also highlight the need for shared decision-making and empowering self-care. So we're confident our move.

Keilah Jacques: This grant has given us the space and resources to demonstrate how connected nursing is to health equity. Nursing competencies represent a skill set, a skill set that can be used to advance health equity. It's been exciting for faculty to reflect on their existing teaching and learning strategies and recognize that they are already moving in a competency-based direction. This work gives us new tools and resources to support them to continue that development.