Methods and Principles
Competency-based education
Competencies are “a cluster of related knowledge, skills, and attitudes that affect a major part of one's job (a role or responsibility), that correlates with performance on the job, that can be measured against some accepted standards, and that can be improved via training and development."1 For purposes of this cooperative agreement, the competency sets that will provide foundational guidance include competencies for all clinicians,2 competencies for all hospital workers,3 public health bioterrorism competencies,4 and competencies for emergency medical technicians, emergency physicians and emergency nurses.5
Types of responders
In considering the population of health professionals who may be involved in an emergency response within a community, this consortium has found it helpful to consider response as involving the following range of individuals:
- First detectors. Particularly important in the case of biological or infectious disease emergencies, this group includes any clinician who might be approached for diagnosis and treatment by a member of the community. While this term has been primarily associated to date with response in the agricultural area,6 it aptly describes the function of the alert clinician who is prepared to identify and report to public health authorities clinical information indicative of a potential emergency. Training for this role is generally combined with secondary responders or surge responders training.
- First responders. This familiar term includes all emergency medical services personnel and their colleagues from the emergency response community, called to the scene of any emergency. To the extent that a community has an ‘all citizens emergency preparedness’ training approach, any member of the community might be a first responder.
- First receivers. While considered part of the first responders, this group generally does not travel to an emergency scene, but receives them into facilities for more definitive care. It includes all personnel at emergency departments, whether or not the regular staff or additional staff has been added because of surge needs.
- Secondary receivers and responders. This term has been developed by participants in emergency preparedness planning and development of the existing Columbia BT courses to identify all members of the hospital staff called upon to work throughout a hospital to support or back up the emergency department in any large scale emergency event.
- Surge responders. This group includes members of local Medical Reserve Corps and NDMS units, who are individuals who are prepared to move out of their usual institutions and practices to support surge needs in personal care or public health response elsewhere in the community.
This project has components particularly directed to First detectors, First responders, Secondary receivers and responders and Surge responders, as well as training relevant to and supplementing that already developed (or under development) for First receivers.
Progression of competency
The continuing education offered through this cooperative agreement recognizes that competency can be achieved at a range of levels from beginning awareness to advanced proficiency.7 Outside of emergency management agencies, hospital emergency departments, emergency medical services and the limited number of clinicians already participating in national disaster medical systems or local Medical Reserve Corps, the majority of emergency preparedness education for health professionals has been awareness level. Those who have completed awareness level training can list or describe a range of activities but may not have been required to demonstrate or analyze those activities and are not yet ready to combine or evaluate them. The NYCEPCE will develop materials that require at least demonstration of beginning proficiency in competencies most essential to the roles expected of clinicians within institutional and community plans.
Iterative course development
In order to assure that course materials are meaningful to the target audience, and consistent with the desired competency outcomes, all courses are developed following a well-established developmental framework8 that requires collaborative planning with decision-makers to identify target audiences and dialogue with members of the target audience to tailor approaches. In addition, each module or experience will be pilot tested with at least one audience before wider distribution. Materials for distance-based distribution methods will be tested in face-to-face settings to assure accuracy and relevance before movement to distance format and assessment of quality and outcomes. Principles of adult learning become very important in this process, and full attention will be paid to lessons learned elsewhere, including ongoing support for instructors, participatory learning techniques, and the use of simulation techniques such as interactive computer-based learning.9 10 11 12
Progression of activities
The development of institutional-wide and community-wide response to emergencies or threatened emergencies requires development of capacity in a stepwise fashion, moving from discussion and written documents through small-scale proficiency drills and culminating in large-scale exercises such as TOPOFF. The figure below illustrates this progression. Courses and materials developed by consortium members will contribute to this building process at least through the functional exercises level. This work will be done in concert with the bioterrorism coordinators of the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) emergency preparedness programs in New York City, New York State, and individual New York Counties.
Approaches
The primary methodological approach used for this project will continue as begun under the current project and will develop and deliver adult education to dispersed audiences that share many educational needs but have variations depending on specific profession, institution, role or level of prior involvement in emergency preparedness. Key features of this approach will continue to be:
- Planning to target audiences in highest need, with guidance from:
- Overall project advisory board
- State and city emergency preparedness offices
- State, city and other local public health agencies, including hospital and public health BT coordinators
- Dialogue with representatives of identified target audiences to identify specifics of competency demonstration in that audience.
- Focus groups, pilot groups and pre- and post-tests to tailor offerings.
- Distribution via a range of methods including face-to-face, web, satellite broadcast or CD-ROM, depending upon access, learner time and distance, and need for hands-on demonstration of competency.
- Ongoing evaluation by outside evaluation team familiar with emergency preparedness training to assure that appropriate questions are asked with the expectation that improvements will be made as information is received from the evaluators.
The complete details of methodology, activities and involved staff are spelled out in the work plan section.
1 Parry, S.R. (1996). The Quest for Competencies. Training, 33(7), p. 50.
2 Association for Prevention Teaching and Research (2007). Clinician Competencies During Initial Assessment and Management of Emergency Event. Available at: http://www.cumc.columbia.edu/dept/nursing/chphsr/pdf/ClinicianCompetenciesBroch070625.pdf.
3 Center for Public Health Preparedness Columbia University Mailman School of Public Health, Center for Health Policy Columbia University School of Nursing. (2003). Emergency Preparedness and Response Competencies for Hospital Workers. July 2003. Available at: http://www.gnyha.org/266/Default.aspx.
4 Columbia University School of Nursing Center for Health Policy, Centers for Disease Control and Prevention, Association for Prevention Teaching and Research. (2002). Bioterrorism and Emergency Readiness, Competencies for all Public Health Workers. Available at: http://cumc.columbia.edu/dept/nursing/chphsr/pdf/EmerPrepTrgCompetency.doc.
5 US Department of Labor, Occupational Safety & Health Administration. Emergency Preparedness and Response: Responders. Available at: http://www.osha.gov/SLTC/emergencypreparedness/responder.html .
6 New Mexico State University. (2004). Agroterrorism conference. Available at: http://cahe.nmsu.edu/terrorism/biosecurity_conference/biosecurity.html.
7 Gronlund NE. University of Mississippi. (2004).Bloom’s Taxonomy Cognitive Domains.
Available at: http://www.olemiss.edu/depts/educ_school2/pdfs/C&I_Undergraduate_Field_Experience_Clinical_Practice_Handbook.pdf.
8 Center for Health Policy Columbia University School of Nursing, Association for Prevention Teaching and Research (2008). Competency to curriculum toolkit. Available at: http://www.cumc.columbia.edu/dept/nursing/chphsr/pdf/Toolkit05_08.pdf.
9 Kirkpatrick, D. (1994). Evaluating Training Programs: The Four Levels. San Francisco: Berret-Koehler.
10 National Institute of Environmental Health Sciences. (1997). National Clearinghouse for Worker Safety and Health, Training Resource Guide For Evaluating Worker Training: A Focus on Safety and Health. Available at: http://www.wetp.org/Wetp/public/dwloads/HASL_132dnlfile.HTM.
11 National Clearinghouse for Worker Safety and Health. (2002). Learning from Disaster: Weapons of Mass Destruction Preparedness Through Worker Training: Report of a National Technical Workshop.
12 Johns Hopkins University Bloomberg School of Public Health. (2002).Worker Training in a New Era: Responding to New Threats- Report of A conference. Sponsored by CDC and NIOSH. Grant # CCT310419-03 Baltimore MD.