Breaking barriers: a competency-based framework for promoting the integration of the pediatrician's education

0021-7557/11/87-06/529 Jornal de Pediatria Original Article Copyright © 2011 by Sociedade Brasileira de Pediatria Breaking barriers: a competency-based framework for promoting the integration of the pediatrician’s education Alessandra V. Naghettini,1 Valdes R. Bollela,2 Nilce M. S. C. Costa,3 Luciana M. R. Salgado4 Abstract Objective: To describe the process of integration and revision of a pediatric program curriculum which resulted in the creation of a competency-based framework recommended in the Brazilian National Curricular Guidelines. Methods: Quali-quantitative analysis of an intervention evaluating the students and professors’ perception of the pediatric program curriculum (focus groups and semi-structured interviews). Results were discussed during teaching development workshops. A competency-based framework was suggested for the pediatric program from the 3rd to the 6th year. The new curriculum was approved, implemented, and reevaluated six months later. Results: Twelve students (12%) from the 3rd to the 6th year participated in the focus groups, and 11 professors (78.5%) answered the questionnaire. Most participants reported lack of integration among the courses, lack of knowledge about the learning goals of the internships, few opportunities of practice, and predominance of theoretical evaluation. In the training workshops, a competency-based curriculum was created after pediatrics and collective health professors reached an agreement. The new curriculum was focused on general competency, learning goals, opportunities available to learn these goals, and evaluation system. After six months, 93% (104/112) of students and 79% (11/14) of professors reported greater integration of the program and highlighted the inclusion of the clinical performance evaluation. Conclusion: The collective creation of a competency-based curriculum promoted higher satisfaction of students and professors. After being implemented, the new curriculum was considered to integrate the teaching practices and contents, improving the quality of the clinical performance evaluation. J Pediatr (Rio J). 2011;87(6):529-34: Curriculum, competency-based education. Introduction The challenge of medical education in the turn of the the United States, with consequences in all Latin America. 20th century was faced by the Flexnerian revolution. In In the beginning of the 21st century, the fundamental that moment, the crisis in the medical education received issues in medical education were related to the school’s attention from the public and authorities. This crisis social responsibility of training competent physicians precipitated a series of events leading to a drastic reform in for the professional practice.1 In the last decades, there 1. Doutora. Professora, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil. 2. Doutor. Professor, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP). Ribeirão Preto, SP, Brazil. 3. Doutora. Professora, Faculdade de Nutrição, UFG, Goiânia, GO, Brazil. 4. Acadêmica de Medicina, UFG, Goiânia, GO, Brazil. No conflicts of interest declared concerning the publication of this article. Financial support: Luciana M. R. Salgado received an undergraduate research scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Suggested citation: Naghettini AV, Bollela VR, Costa NM, Salgado LM. Breaking barriers: a competency-based framework for promoting the integration of the pediatrician’s education. J Pediatr (Rio J). 2011;87(6):529-34. Manuscript submitted Feb 10 2011, accepted for publication Jul 13 2011. http://dx.doi.org/10.2223/JPED.2132 529 530 Jornal de Pediatria - Vol. 87, No. 6, 2011 Curricular integration and competency-based framework – Naghettini AV et al. have been increasing worldwide efforts to determine the the child health care in a competent manner. Nevertheless, meaning of professional competency among the healthcare fragmented programs that are oriented towards early professions.2 specialization can still be found in the curricula of medical In Brazil, this movement has gained strength and undergraduate programs and residency.10 Within this visibility after the publication of the National Curricular context, revising the courses of a pediatrics program with Guidelines (Diretrizes Curriculares Nacionais, DCN) for a focus on a greater integration is both a challenge and a medical undergraduate programs. These guidelines were means of valuing the training in consonance with the DCN published by the Ministry of Education in November 2001. and society’s needs. A change in the curricular models of the medical programs The objective of the present study was to describe the was expected. The programs were organized in the format process of curricular revision of the pediatrics undergraduate of curriculum grids and were usually characterized by medical program at the Universidade Federal de Goiás excessive inflexibility and fragmentation at the expense of (UFG), Brazil. Such revision included the identification of the more integrated and flexible proposals as the ones suggested changes necessary for the creation of a competency-based in the DCN.3 Almeida4 reflects on the challenges faced by framework for the pediatrics and collective health courses schools that intend to make curricular changes based on from the 3rd to the 6th year of the program based on the the publication of the DCN. According to this author, the logics of an integrated curriculum. DCN describes in detail what should be done in relation to the path or direction of the development of the national medical education. However, how these changes could be put into practice has not been defined yet. Methods A longitudinal intervention and quali-quantitative study It would be reasonable to expect that the managers was conducted with the professors and students enrolled of medical schools should try to revise their curricula in in courses of the department of pediatrics during the study the light of the new proposals, considering the creation period. The study was divided into three phases: and implementation of a competency-based curriculum (CBC), since a CBC explains the competencies expected from medical school graduates. Practical experiences in this area are still relatively scarce in Brazil. Nevertheless, many international experiences have produced much knowledge on which a CBC could be built, such as the one suggested by Bollela in 2008,5 and by Bollela & Machado in 2010,6 for the 2 years of medical internship. Competency-based education (CBE) is centered on the physician’s training for medical practice according to the society’s and patient’s needs. Thus, CBE is aimed at reducing the focus on time- and content-based training, making room for a more flexible learning process, which is Phase one: evaluation of the needs of change The focus group technique (...truncated)