HPM Competency Work Group members also contributing to this project include: Bob Arnold, MD, University of Pittsburgh Medical School; Andy Billings, MD, Massachusetts General Hospital; Nathan Goldstein, MD, Mount Sinai School of Medicine; Tomasz Okon, MD, Marshfield Clinic; Sandra Sanchez-Reilly, MD, South Texas Veterans Health Care System; Rodney Tucker, MD, University of Alabama at Birmingham Center for Palliative Care; James Tulsky, MD, Duke University Medical Center; Charles von Gunten, MD, PhD, San Diego Hospice & Palliative Care; David Weissman, MD, Medical College of Wisconsin.

Phase 2 of the project to develop specific, measurable core competencies for a Hospice and Palliative Medicine (HPM) sub-specialist was recently completed. In Phase 1, a work group developed a final draft of the competencies (Phase 1 RSVP). These competencies will be modified as the subspecialty continues its rapid evolution.

In Phase 2, the Work Group identified measurable outcomes for each sub-competency within the six ACGME domains. The Dreyfus model of skill acquisition helped clarify what competence means for a resident versus a novice or expert physician. Bloom’s taxonomy provided an intellectual framework with relevant verbs for developing behavioral outcomes. For each sub-competency, a specific, measurable behavior was identified to define a minimum level of sub-specialist competency. Then, using a table format, one of Bloom’s intellectual behavior levels and an appropriate verb were selected to describe the behavior. An assessment method for the behavior was also indicated. Domain assignments and teams remained intact. Consensus on the measurable outcomes evolved through conference calls, emails, and one in-person meeting.

Lessons learned and challenges identified:

1. Redundancy – Multiple areas of overlap were identified between measurable outcomes in medical knowledge and other domains. Some cases were remedied by distinguishing between knowledge and skill-based outcomes while others needed the repetition.
2. Level of specificity – Although we know competence when we see it, achieving descriptive clarity while avoiding overwhelming detail was challenging. For example, the initial approach of specifying the number of times a behavior should be exhibited was eventually dismissed as too cumbersome. The Work Group decided to incorporate the level of attainment into the assessment tool instead.
3. Practicality – We hope that the measurable outcomes document will be useful to HPM fellowship directors for curricular improvement. However, the level of detail makes it an otherwise impractical document. Instead, a concise list of 10 – 15 sentinel competencies could represent what is unique to HPM and provide a practical focus for a 12 month fellowship. Each sentinel competency would be aligned with the appropriate competencies and measurable outcomes that we developed within each ACGME domain in the larger document. This idea will be explored
   in Phase 4.

Phase 3 will produce a toolkit of assessment methods to measure HPM behavioral outcomes.,

Contact Information:

Laura J. Morrison, MD Assistant Professor, Department of Medicine, Section of Geriatrics 1709 Dryden, Suite 850 Houston, TX 77030 lmorriso@bcm.tmc.edu