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The Omnibus Budget Reconciliation Act of 1987. A policy analysis.

The Omnibus Reconciliation Act of 1987 set forth new provisions for Medicare and Medicaid sections related to new standards for care in the nursing home setting. One major provision was for nurse aide training. Within that provision there are four specified requirements: (1) nurse aide training for 75 hours, (2) competency evaluation of newly trained nurse aides, (3) competency evaluation of nurse aides already providing care, and (4) a registry for nurse aides. The primary implications of the these requirements center on the responsibility of the individual nurse or nurse community in ensuring appropriate implementation of the new requirement. Without appropriate implementation, some of the provisions increase the liability of the nurse and the risk to the public. The reality of OBRA 1987 and its intent of bringing a measure of quality assurance to the nursing home industry should only serve as an impetus for the nursing community to better translate the nurse role and its contribution in the nursing home setting to policy makers at local, state, and federal levels.

Competency-Based Education↗

Multicompetency education in radiologic technology.

A primary method of cost control in health care facilities is the utilization of one employee in more than one capacity. The need for multicompetency education is readily apparent in radiologic technology, a field that consists of a wide variety of closely related specialty areas. The curriculum in the Division of Radiological Health Sciences at the University of Texas School of Allied Health Sciences at Galveston, has been specifically structured to accommodate this need. The division offers associate degree programs in radiography, nuclear medicine technology, and radiation therapy technology, and makes use of a core curriculum. The division also offers advanced skills training in subspecialty areas at the postassociate level in computed tomography, magnetic resonance imaging, angiography, and dosimetry. An evaluation of this system of multicompetent education is provided, based on a survey of graduates from the program. Multicompetent graduates were found to receive significantly higher salaries, enjoy an expanded job market, and have consistently better outlooks toward their future careers than single-skilled graduates.

Career Choice↗

Appropriate dental training.

Primary dental health care has emerged as an important concept, particularly in the poor countries of the world, where dentistry as currently practised has not proved capable of controlling oral disease. Training for primary dental health care provision must be shaped to meet the specific needs of countries and communities. It demands a reorientation of those objectives which are conventional in dental teaching and the development of new attitudes on the part of teachers. Training must aim at self-development in which the ability to achieve simple goals is to the fore. The formulation of plans, the activities which result from them and the evaluation of their effects must be central to the teaching philosophy. Training must aim to develop competency in individual workers. This can best be generated by the use of field exercises. Teachers must not just deliver packages of information but they should develop a climate favourable to self-learning and use resources in a manner which allow students to recognise their own growth and development. Appropriate methods for achieving these goals are reviewed.

Community Dentistry↗

Performance-based pharmacy internship program.

A structured training program based on behavioral objectives was developed for interns in a hospital pharmacy department. In an 831-bed hospital that employs eight pharmacy interns, each for an average of less than or equal to 20 hours per week, a program was developed to ensure (1) that interns have experience working in all service areas and (2) that staff pharmacists are consistent in the tasks they assign to interns. Interns worked with area supervisors and the internship coordinator to develop 23 learning objectives that covered 10 pharmaceutical service areas. A manual listing the objectives is used by interns to document their progress and by pharmacists to ensure uniform experience for all interns. All staff pharmacists work with interns and participate in their evaluations. This program using behavioral objectives provides interns with basic experience in all areas of hospital pharmacy operations.

Competency-Based Education↗

Pediatric training in family practice: a core curriculum.

Official residency guidelines for pediatric training of family practice residents focus on the number of months of block time on pediatric rotations and the percentage of pediatric patients in the resident's model practice. These guidelines do not ensure competence in pediatrics. Family practice residencies need a competency-based curriculum derived from actual pediatric experience in family practice. Such a curriculum should define specific knowledge, skills, and attitudes required, define the family physician's role in handling each issue or condition, be used on a daily basis, and form a basis for evaluation of residents and curriculum. This paper describes the development and implementation of such a pediatric core curriculum at the University of Colorado Family Practice Residency.

Clinical Competence↗

Competency-based advancement program for pharmacists.

A competency-based advancement program for practicing pharmacists is presented. The criteria for selecting this method of providing incentives for pharmacists are outlined. Procedures for developing and implementing this competency-based program are described. Five competency levels for pharmacists were developed based on the pharmacist's educational background, training, and experience. Differentiated position titles and competency expectations for each level are summarized. Criteria for pharmacist placement and promotion from one completely level to another are outlined. The administration of the program is described, including budget considerations and methods for evaluating its effectiveness. This system recognizes and rewards accomplishments of staff pharmacists without removing them from patient care roles.

Budgets↗

Code 50: an orientation matrix to track orientation cost.

Estimates of staff orientation costs can range from $20,000-50,000 per person. The Director of Finance and the Director of Nursing Education and Research developed a system to track the orientation process to determine the actual costs. Head nurses and educators approached the orientation process differently; therefore, there was no consistency as to the time allotted for orientation. Although competency-based orientation tools were used for all new orientees, the average amount of time for new orientees to become productive ranged from 3-9 months. By creating the orientation matrix, a unique pay class (code 50) was assigned for all new orientees, and a computer program was developed to track costs. The overtime hours for orientees dropped to 159 from 941, resulting in an 83% reduction in overtime hours. The matrix ensured a more cost effective approach to orientation.

Clinical Competence↗

Performance indicators for assessing competencies of preventive medicine residents.

Heightened national interest in population-based medicine, clinical preventive services, and health care management underscores the current need for definition and assessment of physician competency in these areas. This article describes a project sponsored by the Health Resources and Services Administration (HRSA) to develop competencies for each of the three specialty areas in preventive medicine and appropriate measures for the achievement of those competencies. We discuss fundamental issues surrounding assessment that helped guide the process, types of measurement strategies, and criteria for effective competencies and performance indicators. The article also explains the Work Group process used to reach consensus and identifies concerns and challenges raised during this process. We include the list of specialty competencies and performance indicators developed by the project. The project, entitled "Improving Training of Preventive Medicine Residents through the Development and Evaluation of Competencies," served as a model for interorganizational collaboration between the federal government (HRSA); a specialty society, the American College of Preventive Medicine (ACPM); and a preventive medicine residency program, State University of New York (SUNY) at Stony Brook. The commonality of competencies expected of residents in all three specialty areas of preventive medicine--occupational medicine, general preventive medicine and public health, and aerospace medicine--reaffirmed the rationale for including all of these areas within the single specialty of preventive medicine.

Aerospace Medicine↗

Establishing clinical competence in postanesthesia care nursing.

Today the manager in postanesthesia care is faced with the reality that basic nursing education and general nursing practice do not provide the specific body of knowledge required to prepare nurses to deliver competent nursing care for patients in the PACU phase I. This, in addition to the growing shortage of critical care nurses, the diminishing dollars available for education, and the massive amounts of knowledge being added almost daily to the basic knowledge base specific to the postanesthesia care area, requires the successful PACU manager to develop methods to select personnel with the highest success potential and to establish a competency-based, unit-specific education program to ensure individual success.

Accreditation↗

Educational trends in the radiologic sciences. Results of a validation research survey.

This special report examines the results of a validation research survey conducted to assess ASRT members' opinions regarding future educational requirements for radiologic technologists as well as satisfaction with their own educational training. Results of the survey were compared to recommendations made by participants of the profession's first Educational Consensus Conference to measure the level of agreement. Comparison showed a strong degree of agreement in most areas.

Attitude of Health Personnel↗

Making science clinically relevant.

Clinical practice requires a sound foundation in the basic and clinical sciences. However, the traditional dental curriculum often separates the two in a variety of ways that reduce their integration. The basic sciences are commonly taught in the first two years by a basic science faculty with inconsistent integration with clinical dental practice. The clinical sciences are often taught by faculty who may not be actively involved in research-related activities. The curriculum is dense and is difficult to modify to adapt to evolving scientific discovery and application. The 1995 IOM report focuses much of its attention on these issues. The Harvard School of Dental Medicine has dramatically modified its curriculum twice in the recent past to more closely integrate the basic and clinical sciences and to promote the clinical relevance of the basic sciences. The class entering in 1980 began a five-year D.M.D. program that was designed to decompress the curriculum and increase experiences that enhance scientific and clinical integration. The class entering in 1994 initiated a four-year program that uses a problem-based learning design throughout the entire curriculum. Strategies for integrating the clinical and the basic sciences along with research training and experience were developed and implemented in both programs.

Clinical Competence↗