Guidelines, Learning Objects, & Competency Definitions
Over the last 15 months, I’ve been working as part of the Massage Therapy Foundation’s Best Practices Committee on defining a protocol for creating evidence-based guidelines for massage therapy. Fairly early on in the process I did a draft literature review of existing criteria for guideline creation. Recently, I’ve been thinking of how to define outcomes from training. These are what the trainee should be able to do/demonstrate after the training, not the process of the training. It gets away from the pervasive idea in the massage world that the results of training are defined by hours. Several weeks ago, I put together a few notes and an example of some very rough XML.
With a bit more searching around, I’ve come up with some more pieces of what the informatics people are doing in similar directions. The first addition is the work on Learning Object Metadata (LOM). The second piece is with Reusable Competency Definitions (RCDs). In particular, look at Claude Ostyn’s white paper on Distilling Competency Information.
The interaction between these information elements would be useful, for example, to a rural health care facility willing to hire practitioners not fully meeting desired knowledge and skills, and then bring them up to speed. Thus identifying and remedying skill gaps would be important. The flexibility to do this, provides the rural facility more leverage in recruiting — i.e. lets them be more competitive in recruiting practitioners for what might be seen as less desirable locations. The facility could use guidelines to help determine what prior knowledge is essential and what can be added “in place”. The interaction of context specific guidelines [Guideline Element Model (GEM)], learning object metadata (LOM), and reusable competence descriptions (RCDs) facilitate this.
The guidelines can include fields both for suggested protocols and considerations for suggested competencies. The suggested competencies can point directly to a database of RCDs. The RCDs can in turn point to the collection of learning objects for the competencies. The comparison of the individual’s knowledge, skills, and abilities (based on multiple streams of input) with the LOMs in the RCDs results in the training plan. In searching around, I found sample use cases for implementation of these concepts in recruiting and filling team learning gaps. I also came across a paper and presentation specific to health care.
Back in December 2003, I attended a lecture by William A. Wulf, president of the National Academy of Engineering. One of his comments that struck me was on the difference between small improvements in technology that make something already being done easier and on the continuing and often unexpected social changes stemming from huge quantitative changes in technology. He noted that he had a computer in his briefcase 100 times faster than the ENIAC (circa 1946) which weighed 100 tons and was the size of a squash court. The computer in his briefcase? A greeting card with a general 4-bit microprocessor to generate music. Wulf quoted a statement by Danny Hillis.
“I went to my first computer conference at the New York Hilton about 20 years ago. When somebody there predicted the market for microprocessors would eventually be in the millions, someone else said, ‘Where are they all going to go? It’s not like you need a computer in every doorknob!'”
“Years later, I went back to the same hotel. I noticed the room keys had been replaced by electronic cards you slide into slots in the doors.”
“There was a computer in every doorknob.”
I expect the changes in the informatics of guidelines, learning objects, and competence descriptions to create a similar impact. We can expect the health care system (and other systems) to adopt both the mechanisms and the benefits of more specific granularity in managing knowledge, skills, and abilities (KSAs) that technology is making possible. It’s more efficient use of people. One way or the other, legislation will evolve to accommodate such practices. We might as well look to the future and start defining competence in terms of KSAs and training outcomes.
All of this combines well with the studies of how people transition to new careers (e.g. Herminia Ibarra, Working Identity). Technology will change how we view learning and careers. It allows us to be more precise on what needs to be learned and when, and to allow the “try it on” approach that Ibarra discusses without the costs of “front-loading” education in the “linear model” of learning.
It also ties in with a quote in a presentation by David Leach, executive director of the Accreditation Council for Graduate Medical Education. “You Improve what you measure”.
Won’t industrywide standardization and regulation create the same culture within the massage field that causes people inside other professions to seek out a massage in the first place?
You improve what you measure–but who benefits when you do? While companies can milk incremental improvements out of their employees, at what costs to basic humanity? Look at this holistically. Complex performance benchmarks imposed on personnel have a way of resulting in a measurable decrease in happiness and increase in turnover, two huge cost considerations in their own right.
Whenever you explore the subject of competency and productivity you run the risk of reducing people to the level of machines. We are not. And this is why I’m saddened by the FDA making yet another power grab, this time in the massage profession. All this regulation and standardization f*cks over the end consumer too — consumers whose own professions are under threat of homogenization.
Whether you or I like it or not, the majority of states are now regulating massage, with some groups continually pushing for more hours of training for entry. I was at a meeting in March during which someone remarked that AZ had invoked a clause in their law that let the massage board raise the entry hours to 720. The person behind the podium clapped in approval, no questions asked about basis of need, no questions about what would get taught, no questions about effects on who would be able to take the training, just blind approval. There’s this pervasive myth that hours equate with competence, but that’s almost never true unless you have measurable training goals.
So going the other direction, setting required outcomes that actually are needed for the work, figuring out how to get students to the goals they can’t already do, and implementing that teaching and practice can both greatly reduce the amount of training specified and improve the performance. Think of it as along the lines a sports coach or band leader would use to get their team ready to play.
Likewise, there is some merit to product regulation, particularly in a global economy. It is rather nice to have some knowledge that what’s supposed to be in the bottle is what’s actually there, and not replaced with something cheaper. Accurate labeling also helps those who might have an allergic response to certain additives. Some types of regulation improve choice rather than limit it. The recent pet food poisonings were a case in which regulation wasn’t vigilant enough, as are the cases of adulterated medicine in today’s NY Times.
[…] Keith also explains it a little further : “These are what the trainee should be able to do/demonstrate after the training, not the process of the training. It gets away from the pervasive idea in the massage world that the results of training are defined by hours. Several weeks ago, I put together a few notes and an example of some very rough XML. “ […]