Samuel Merritt University's Path to Competency-Based Education

Speaker: Carmen Ward-Sullivan, PhD, RN, Program Director, Entry Level Master's in Nursing; Assistant Professor

Carmen Ward-Sullivan, PhD, RN: When I think about where we started at Samuel Merritt University in Oakland, California, we were just uncertain about where to start the process of our journey to competency-based education. And so we first started off with taking time to understand really what is competency-based education and how do the new Essentials play into this? And so we had a dedicated team that we called internally: Domain Champions. And we wanted to meet frequently so that we can understand what is competency-based and what's the best fit and model in terms of how do we educate the rest of the faculty at Samuel Merritt University and ourselves. And we began to have weekly meetings with the team beginning nearly a year ago actually. And so everyone was excited. However, we were just in the same place of really attempting to understand what is competency-based. And we held weekly meetings for up to a full year and a half. And then we decided to have um a workshop on campus which was really great, well-attended for those who had not attended any of our weekly meetings, they were able to come and participate in the workshop. And we had faculty with varying levels of understanding about competency-based, because some of the faculty were teaching or had other obligations and could not attend our weekly sessions. So, it was a chance to really exchange ideals, meet, talk about it, make changes in what they thought they wanted to include in terms of the mapping alignment. So it worked out really well. But again, it was a process and definitely a journey. But now we're into our second year, we still have a few challenges in how do we gain consensus in bringing everyone up to speed. But it's definitely moving forward and that's something that we're definitely so proud of.

Carmen Ward-Sullivan, PhD, RN: We had this big vision that we were going to complete all of our mapping within 3 to 6 months. That was not realistic, although we had high hopes. And so it just caused us to pause and think about, "What's another approach?" And so we changed our approach a few times just to make sure that we're accommodating all of our faculty needs and levels of understanding about competency- based because we, our small team, were well-informed. However, that was not true for all of the faculty and the lessons learned was just that we needed to slow down just a bit, because we thought we could move very fast with this work. We thought that we had a clear understanding based on looking at the Essentials, looking at the sub-competencies, creating key assignments. And then we realized, wait a minute, not everyone's on board. So, we can't change that unless we seek consensus. And so that was definitely a lesson learned. We also learned that we can move forward. However, we have to seek the approval of our UCC, which is our university curriculum committee before we make any changes and then we have to submit to the BRM. And so we didn't really allow that time factor into the changes that we wanted to implement. We were a little bit ahead early on because we were able to pilot a few courses hearing from our practice partners that our students, our graduates, were not quite practice-ready. Though some of the graduates were lacking confidence, resilience, and this is of course just coming out of the pandemic, so it's understandable. And then they were seeing a trend of students not completing the residency programs. And so we had to shift gears and we added a mindfulness-based stress reduction course and we thought it was perfect. But once you get feedback from the students, it's like, wait a minute. Oh, this is not great. So, we revised that course and the student feedback was really vital to ensuring that we make changes. We did include students on our planning so that we can have the student voice and understanding about what is that one semester like when we've added mindfulness-based stress reduction? We also changed a few courses and called those courses, "Role-based Professional Practice." We wanted to make sure that we were graduating graduates students from Samuel Merritt that really understood the role of professionalism because, again, we listened to our practice partners and we took what they said to heart. Those were hard lessons to hear about our students, right? But we appreciated learning about what was happening.

Carmen Ward-Sullivan, PhD, RN: In addition to using Domain 3, Population Health, we selected Domain 9, which is Professionalism. And we selected Domain 9, Professionalism, based on our practice partners' feedback, and also some of the concerns that we were noticing in our students and the level of engagement with faculty, staff, and their other colleagues, as well as the nurses in the hospital. And so we decided to create courses that focus on professional role development of the nurse—not just in one semester as we've previously had— but we wanted to make sure that we offered professionalism in every single semester of the pre-licensure course work. And I'd have to say we were successful in implementing this as a pilot. We have pulled that course for the meanwhile, just so that we can revise some of the assignments just based on student feedback again, that it was a little bit too heavy in terms of the course work and assignments. And so those courses have been revised and are in the process of being revised for one of those courses. We are looking at change in our community health course to call it "population health." There's so much of an interest in the community, as well as global health nursing. And so we have a dedicated community health faculty that are on board to change the title to "Population Health." It really helps stretch our students thinking beyond just what's happening in the community, but what's happening globally and how does this impact the health field, the health career of nursing, excuse me. And so we're excited; we're moving ahead. We haven't quite solidified our key assignments yet for that, but we are still working diligently on what does the new population course look like in terms of aligning to the Essentials and creating a new course, right? We can't just keep the old, you want to enhance what we have already, but also create new ideals, and new understandings, and new ways of helping our students grow and understanding population health. In terms of professionalism, again, we listen to our practice partners and we're still hearing concerns about some of the professionalism, not so much in a negative sense, but more so in terms of our students feeling confident enough to use their voice, ask questions, advocate for their patients. And so we want to make sure we help those students understand the value and importance and significance of their voice as a registered nurse in the field of nursing.

Carmen Ward-Sullivan, PhD, RN: In terms of engaging our practice partners, we have selected three because we have pre-licensure programs on three different campuses. And so we wanted to make sure that we captured the perspective and the needs of our practice partners in the three different regions. And each of the three shared, you know, similar concerns and we acted upon those and we asked for examples, concrete examples. We've asked for a few listed items so that we really can understand how do we best share this with the faculty and with the students and how do we make changes to meet their, the practice partners' needs? And so we realized again, as I mentioned earlier, that we weren't quite far enough along in terms of all faculty or the majority of faculty understanding what CBE is. And so we decided to hold off and inviting the practice partners to those sessions. We didn't to waste the practice partners time. We needed to shore up our understanding to make sure that we had a good sampling of faculty that knew what competency-based education is and had created examples in their class, key assignments, made their alignment, complete their alignment, excuse me, so that we can share what we're doing. And then I shared what the practice partners had shared with me previously with the faculty, so they can take that into consideration. Now, we're gonna be holding our second workshop and it's mandatory. And so we've already engaged our practice partners and let them know that we are now ready for them to join us in an all-faculty in-person meeting. Now, they may not be able to attend in-person, so we will definitely hold a Zoom capability so they can participate. We have had meetings which may have been just two or three of us faculty members, and meeting with our practice partners. And two of us, you know, faculty sit on an advisory committee with one of our practice partners. And so we get to hear those concerns directly and take that back to our team. So, it's been a smaller group meeting with our practice partners, but now we're ready if we can have each our three practice partners in the room at the same time with the faculty, I think we'll find that we can move pretty far ahead, because I'm imagining that what they've been telling us individually as we meet with our smaller groups with the practice partners will hear this. The faculty will be able to hear the same resounding, "Here's what we want in order to have a practice ready-graduate come and work for our institution." So it's a work in progress. So we're moving ahead though, of course, but it's definitely a work in progress.

Carmen Ward-Sullivan, PhD, RN: In terms of the move towards practice-ready graduates, we're excited about the change. We're excited about implementing competency- based education model and framework into our curriculum across all of the programs that we offer at Samuel Merritt University, and in particular, right now, for our pre-licensure students. We are listening to our practice partners, we are listening to faculty and students and we are excited about making the change. I believe our in person faculty workshop was set so that everyone realized they can work together and complete a new curriculum or just minor changes to their courses and really help graduate and prepare— prepare and graduate—our students to be ready to go out in the field and work. We keep hearing the term practice-ready. "We want practice-ready," from all of our clinical partners, our community-based partners and clinics. And so we're excited that we'll be able to contribute to meeting their needs of what they're seeking in graduates. Many of our faculty attended the UCLA session held by AACN, the workshop on competency-based education. I was able to get 18 faculty down at UCLA from the Bay area to Southern Cal. And the excitement and joy that we experienced was phenomenal. And there is a term that was used that as we had our private meetings and it's, "Let's just ride the high!" We're so excited and engaged. Let's ride the high. Let's share this excitement with our practice partners so they can understand we are working. We are very committed to graduating, practice-ready graduates and to meet their needs.

Carmen Ward-Sullivan, PhD, RN: When I think about what's most exciting for my faculty at Samuel Merritt it's the joy of working together. We decided to meet by Zoom for most of our weekly meetings throughout all of last year in 2023. But it was not until we decided to meet all in the same room and meet together and listen to just additional level of understanding and training that we provided internally, but also having the breakout sessions where they met with their content groups to work on what do they really want their student to know by the time they complete their course. And then the engagement of understanding: Well, what do you teach in the semester before my course? And what are you teaching in the semester after my course? That was exciting. I could just hear the, the laughter, the discussions. I took video shots and photos just to share with the faculty as a whole. But that working together in-person was the key. It seems like that added to the new level of understanding what CBE is, and what can be done, and that if we work together, we can complete this in, while I would like record time, but that's not realistic, but I'm very happy about the progress that we've made so far.