Competency framework vs framework of Entrustable

Prof Rhena Delport, Dept. Family Medicine, University of Pretoria

Competency framework vs framework of Entrustable Professional Activities

(EPAs)

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Outline

• Discussion points− Introduction

• Scope of practice: pharmacists / pharmacists intern / pharmacy student −Competency-based conceptual framework−Conceptual framework of EPAs− Application of EPA approach in Pharmacy Education−What is the difference?

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3. Acts specially pertaining to the profession of a pharmacist.—Except as provided for in section 29 (3) of the Act, and sections 23 (2) (a) (i) and 34 of the Veterinary and Para-Veterinary Professions Act, 1982 (Act 19 of 1982), the following acts shall be regarded to be acts specially pertaining to the profession of a pharmacist—• (1) the provision of pharmaceutical care by taking responsibility for the patient’s medicine related needs and

being accountable for meeting these needs, which shall include but not be limited to the following functions: − (a) evaluation of a patient’s medicine related needs by determining the indication, safety and effectiveness

of the therapy; − (b) dispensing of any medicine or scheduled substance on the prescription of a person authorised to

prescribe medicine; − (c) furnishing of information and advice to any person with regard to the use of medicine; − (d) determining patient compliance with the therapy and follow up to ensure that the patient’s medicine

related needs are being met; and − (e) the provision of pharmacist initiated therapy;

Scope of practiceGNR.1158 of 20 November 2000: Regulation relating to the practice of pharmacy

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3. Acts specially pertaining to the profession of a pharmacist.—Except as provided for in section 29 (3) of the Act, and sections 23 (2) (a) (i) and 34 of the Veterinary and Para-Veterinary Professions Act, 1982 (Act 19 of 1982), the following acts shall be regarded to be acts specially pertaining to the profession of a pharmacist— (Cont.)• (2) the compounding, manipulation, preparation or packaging of any medicine or scheduled substance or the

supervision thereof;

• (3) the manufacturing of any medicine or scheduled substance or the supervision thereof;

• (4) the purchasing, acquiring, importing, keeping, possessing, using, releasing, storage, packaging, repackaging, supplying or selling of any medicine or scheduled substance or the supervision thereof; and

• (5) the application for the registration of a medicine in accordance with the Medicines Act.


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4. Scope of practice of a pharmacist.—The following services or acts shall for purposes of the Act be regarded to be services or acts pertaining to the scope of practice of a pharmacist: • (1) the Acts specially pertaining to the profession of a pharmacist as prescribed in regulation 3;

• (2) the formulation of any medicine for the purposes of registration as a medicine;

• (3) the distribution of any medicine or scheduled substance;

• (4) the repackaging of medicines;

• (5) the initiation and conducting of pharmaceutical research and development; and

• (6) the promotion of public health.


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5. Scope of practice of a pharmacist intern.—A pharmacist intern may provide or perform all of the services or acts pertaining to the scope of practice of a pharmacist’s assistant registered in the category pharmacist’s assistant (post-basic) under the direct personal supervision of a pharmacist in a pharmacy. 6. A pharmacist intern may, for the purposes of education and training, provide or perform all of the services or acts pertaining to the scope of practice of a pharmacist under the direct personal supervision of a pharmacist in a pharmacy.


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7. Scope of practice of a pharmacy student.—(1) A pharmacy student may provide or perform all of the services or acts pertaining to the scope of practice of a pharmacist’s assistant registered in the category pharmacist’s assistant (basic) under the direct personal supervision of a pharmacist in a pharmacy; or (2) A pharmacy student who has successfully completed his or her second year of study may provide or perform all of the services or acts pertaining to the scope of practice of a pharmacist’s assistant registered in the category pharmacist’s assistant (post-basic) under the direct personal supervision of a pharmacist in a pharmacy. 8. (1) A pharmacy student may, for purposes of education and training, and under the auspices of a provider approved to offer education and training for a qualification in pharmacy and with whom such student is enrolled, provide or perform all of the services or acts pertaining to the scope of practice of a pharmacist under the direct personal supervision of a pharmacist; and (2) The services or acts referred to in subregulation 8 (1) must be provided or performed in accordance with a programmedeveloped by the provider and approved by the council.


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From…• Rote learning• Syllabus is content driven (subjects)• Textbook/worksheet/• Teacher centered• Syllabus is rigid/non-negotiable• Emphasis on what teacher hopes to achieve• Curriculum dev. process not open to public

Competency-based conceptual frameworkTo…• Critical thinking, reasoning• Learning is a process and outcome driven,

connected to real life situations• Learner and outcome centered• Teacher is facilitator• Learning programmes are guides• Emphasis on outcomes (what learner

achieves)• Wider community involvement encouraged

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Course design: Defining outcomes• Learning outcomes may be knowledge, skills,

abilities or attitudes acquired during the programme, which are required for competent and applied performance at the particular level of qualification

Competency-based conceptual frameworkDefining outcomes within domains• Knowledge

− Subject matter knowledge and mental skills.

• Attitudes − Deals with feelings, attitudes and values.

• Skills / abilities− Physical skills, manipulative ability and

neuromuscular co-ordination− Problem solving skills.

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Competency-based conceptual frameworkExit Level Outcomes: B Pharmacy

1. Integrate and apply foundational scientific knowledge and principles to pharmaceutical sciences.2. Apply integrated knowledge of product development and formulation in the compounding, manufacturing, distribution and dispensing of

pharmaceutical products.3. Compound, manipulate and prepare medication in compliance with Good Pharmacy Practice (GPP) rules, Good Manufacturing Practice

(GMP) and/or Good Clinical Practice (GCP) guidelines where applicable.4. Manage and control the development, manufacture, packaging and registration of pharmaceutical products in compliance with GMP and

GCP.5. Manage the logistics of the selection, procurement, storage, distribution and disposal of pharmaceutical products.6. Dispense medication and ensure optimal pharmaceutical care for a patient in compliance with Good Pharmacy Practice rules (GPP) and,

where applicable, GCP.7. Apply a pharmaceutical care management approach to ensure rational medicine use.8. Initiate and/or modify therapy, where appropriate, within the scope of practice of a pharmacist and in accordance with GPP and GCP,

where applicable.9. Promote public health.10. Integrate and apply management principles in the practice of pharmacy.11. Participate in research.

SAQA Qual ID: 65130 (SGB Pharmacy)http://regqs.saqa.org.za/viewQualification.php?id=65130

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http://regqs.saqa.org.za/viewQualification.php?id=65130


• Identify, analyse and solve problems related to the provision of pharmaceutical care using creative approaches.• Work effectively with others as a member of a team of health care professionals in applying pharmaceutical care

management principles.• Organise and manage activities responsibly and effectively in contributing to the institution and broader community.• Collect, analyse, organise and critically evaluate information in using evidence-based approaches in provision of services

and information to develop a pharmaceutical product or enhance pharmaceutical care programmes and services.• Communicate effectively using visual, mathematical and/or language skills in the modes of oral, written and/or practical

presentation in a sustained discourse.• Use science and technology, including informatics, in pharmacy effectively and critically, showing responsibility towards

the environment and health of others by promoting ethical conduct in all contexts.• Demonstrate an understanding of the world as a set of related systems by recognising that problem-solving contexts do

not exist in isolation. SAQA Qual ID: 65130 (SGB Pharmacy)http://regqs.saqa.org.za/viewQualification.php?id=65130

Competency-based conceptual frameworkCritical cross-field outcomes: B Pharmacy

Competencies may appear remote from clinical practice!

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On completion of the prescribed practical training programme the candidate shall be competent to act as custodian of medicines and to control medicines from concept to therapeutic reality by:

1. Individually or as part of a team, control and organise the development, testing, compounding and packaging of pharmaceutical products.

2. Managing the logistics of medicines by organising, managing and controlling the acquisition, storage and distribution of pharmaceutical material and products.

3. Becoming an indispensable and accepted link in the health care system as a member of the health care team by acting as a provider of cost-effective and efficient pharmaceutical services in satisfying the needs of society by:

3.1. Acting as a provider of pharmaceutical care by accepting co-responsibility for therapeutic outcomes and by being actively involved in the design, implementation and monitoring of pharmaceutical health care planning.

SAQA Qual ID: 72784 (NWU Pharmacy)http://regqs.saqa.org.za/viewQualification.php?id=72784

Competency-based conceptual frameworkExit Level Outcomes: B Pharmacy

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3.2. Applying pharmaco-economic knowledge, factors, models, theories and principles in the provision of cost-effective therapy and pharmaceutical services.3.3. Dispensing prescribed medicines and ensuring its optimal use by means of supervision, control and providing advice to the patient and the health care professions.3.4. Providing pharmacist-initiated care to the patient and ensuring the optimal use of medicines.3.5. Providing essential clinical services, including screening tests and referral to other members of the health care team.3.6. Providing education and information on health care and medicines by scientifically conveying information verbally, non-verbally and electronically.3.7. Promoting community health and providing related information and advice.

4. Serving one's fellow man with an attitude of altruism and a sense of responsibility and empathy by efficiently and effectively employing science and technology with a responsibility towards the environment, one's own health as well as that of others.


Competency-based conceptual frameworkExit Level Outcomes: B Pharmacy (Cont.)

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5. Independently identifying, evaluating, formulating and innovatively and creatively solving problems in the practice settingby using applicable literature, ready knowledge and laboratory techniques.

6. Having, apart from subject knowledge, insight into the encyclopedia and continuity of science and the fact that problem solving does not exist in isolation.

7. Starting to act entrepreneurially.

8. Having the ability and motivation to continuously develop one's scientific and professional knowledge, skills and abilities and to be a life-long learner in order to continue practicing one's profession on a high level of competency.


Competency-based conceptual frameworkExit Level Outcomes: B Pharmacy (Cont.)

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• Use of complex and confusing terminology

• Over-exhaustive, including very detailed descriptions of competencies – granular nature –

abstract nature

• Difficulty relating to the number of competencies to be taught, managed, tracked and assessed for

each trainee

• Difficulty in quantifying and qualifying competence

• Integration of competencies often required

Competency-based conceptual frameworkCritique

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Conceptual framework of EPA (Medicine)

Entrusted Professional Activities:“… identify the critical activities that constitute a specialty … the activities of which we would all agree should be only carried out by a trained specialist.”“Patients’ and instructors’ … entrustment of responsibility to a trainee is an essential concept in this approach…”

“Entrustment implies a level of competence.”

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Entrusted Professional Activities are:1. Professional activities that can be performed by a student/resident

without supervision2. They rely on the intuitive concept of “trust”

3. They allow to infer the global level of competence

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An Entrustable Professional Activity is …

• Part of essential work for a qualified professional• Requires specific knowledge, skill, attitude• Acquired through training• Leads to recognized output• Observable and measureable, leading to a conclusion• Reflects the competencies expected• EPA’s together constitute the core of the profession

ten Cate et al. Acad Med 2007; 82: 542-47 18

Conceptual framework of EPAs (Medicine)

DOI: (10.1177/2374289517714283)

Reference:Table 1. ten Cate, O . Entrustability of professional activities and competency-based training. Med Educ. 2005;39:1176–1177.

Table 2. ten Cate, O . Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013;5:157–158.


DOI: (10.1177/2374289517714283)

Conceptual framework of EPA (Medicine)Core competencies and milestones

A milestone is a behavioral descriptor that marks a level of performance for a given competency

DOI: (10.1177/2374289517714283)

Conceptual framework of EPA (Pharmacy)Core competencies and milestones

CANMEDS SEVEN FIRST LEVEL “ROLES”

1. MEDICAL EXPERT

2. COMMUNICATOR

3. COLLABORATOR

4. LEADER

5. HEALTH ADVOCATE

6. SCHOLAR

7. PROFESSIONAL


Adopted for Pharmacy

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Defining core entrustable activities

DOI: 10.1002/jac5.1083

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How Do EPAs Differ From Competencies?

American Journal of Pharmaceutical Education 2018; 82 (5) Article 6256

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• EPAs are not an alternative for competencies, but a means to translate competencies into clinical practice.

• Competencies are descriptors of physicians (professionals), EPAs are descriptors of work.

• EPAs usually require multiple competencies in an integrative, holistic nature.

• One can possess competencies; one cannot possess EPAs

How Do EPAs Differ From Competencies?

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QUESTIONS

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Documents

Competency framework vs framework of Entrustable