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Health
Services Research
Doctoral Training Competencies
Christopher B. Forrest, MD, PhD
Johns Hopkins Bloomberg
School of Public Health
Erin Holve, MPH, MPP
Johns Hopkins Bloomberg
School of Public Health
Diane Martin, PhD
University of Washington
School of Public Health
Funding: Health Services Research Doctoral Training Competencies Conference sponsored by AHRQ R13 HS016070-01, Baltimore, MD, Sept 8-9, 2005
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Content
Methods
Core Competencies
Discussion and Next Steps
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Context
We need to elucidate the knowledge base and skills needed to be a successful health services researcher.
Why? To aid in defining the field. To communicate to employers and students the unique expertise of health services researchers. To develop similar competence among graduates from various programs. Other reasons (curricula development, continuing education, etc.).
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Goal of
the Competency Project
To develop HSR core competencies:
Common to all HSR professionals
That most programs could implement
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HSR Core
Competency
A
knowledge-based or skill-based asset
that all doctoral trainees in Health
Services Research should acquire during
their training. Core competencies
are the common denominator across all
training programs. They are the skills
and knowledge sets that all graduates
of HSR training programs should have
when they finish their doctoral training.
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Example
of Competency Levels:
Health Disparities
Describe
health disparities and their origins.
(2) Critique and Explain
Critique
alternative explanations for the origins
of disparities.
(3) Integrate and Innovate
Propose health system solutions to health disparities.
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Methods
Used to Develop
Core Competencies
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Initial
Workplan and Timeline
Council on Education
for Public Health (CEPH) Self-Studies (n=27 schools)
Job Postings
(n=320)
T32 Training Grants
(n=14)
Degree and Title Review
from AH Membership File (n=3,623)
Continuing Ed. Options
for HSR Professionals
Sample of Universities
with HSR PhD Programs. Review for major categories, themes
Professional identities
according to AH members. Distribution of degrees held within major categories:
HSR, policy analyst, physician, etc.
Summary of course
offerings and objectives with emphasis on highly requested skills and
topics
Review of member survey conducted
by Academy Health with attention to professional development needs
Summary of Academy
Health Member Survey (n= 1,793)
Literature Review
August 2004
October/November/December
2004
January 2005
July 2004
Plan for Structured Analysis of Skills/
Behaviors/ Knowledge
Bases / Competencies
Review and revise
occupational categories and classification of skills.
Summarize
documents
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Literature
Review
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T32 Training
Programs
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Competency
Review:
Taxonomy of Learning Objectives
Interobserver Agreement = 93%
Disagreement arbitrated
by PI
CEPH-Accreditation Self-studies section V.C. 00earning Objectives
(n=21 HSR PhD Programs)
Observer 1:
Learning Objectives entered
into MS Excel
Learning Objectives transferred to Atlas ti 5.0 (text analysis software)
(n=650)
Observer 2:
Learning Objectives entered
into MS Excel
PI Reviews full set of competencies and summarizes into domains and core competencies: Develop
Initial Taxonomy
Revised Taxonomy Based on Work Group Comments (Current v.3)
JHU and U Wash Faculty Review and Comment on Taxonomy
(v2)
Final Taxonomy Based on Meeting
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Health
Services Research Doctoral Training Competencies Conference
To produce a consensus-derived set of knowledge-based and skills-based HSR doctoral training competencies and their content areas.
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Organizations
Attending the HSR Competency Conference
Mathematica Texas A&M University of Alabama University of CA-Berkley University of Michigan University of Minnesota University of NC-Chapel Hill University of Washington Students from 4 programs
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Core Competencies
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HSR Core
Competencies: Summary
Conceptual models and operational measures Implementation of research protocols Responsible conduct of research Multi-disciplinary teamwork Data analysis Scientific communication Stakeholder collaboration and knowledge translation
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(1)
Breadth of HSR theoretical and conceptual
knowledge
Know how to apply alternative theoretical
and conceptual models from a range of relevant disciplines to HSR.
Comments
1. All health services researchers should be versed in a wide range of
theoretical and conceptual frameworks.
and fields. As a field, we have not yet defined these.
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(2)
In-depth disciplinary knowledge and
skills
Apply in-depth disciplinary knowledge
and skills relevant to health services research.
Comments
Each HSR professional should have expertise in at least one disciplineor interdisciplinary area, and should be able to apply this expertise in an
independent research project.
field or discipline.
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(3)
Application of HSR foundational
knowledge to health policy problems
Use knowledge of the structures,
performance, quality, policy, and environmental context of health and
health care to formulate solutions for health policy problems.
Comments
HSR has a common foundational knowledge.2. HSR professionals should be able to synthesize this knowledge to
create novel solutions to vexing health policy problems.
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(4) Pose
Innovative HSR Questions
Pose innovative and important research
questions, informed by systematic reviews of the literature, stakeholder
needs, and relevant theoretical and conceptual models.
Comments
Literature review techniques are a competency.2. Knowing how to include stakeholders into research question development
is a critically important skill.
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(5)
Interventional and Observational Study
Designs
Select appropriate interventional
(experimental and quasi-experimental) or observational (qualitative,
quantitative, or mixed methods) study designs to address specific health
services research questions.
Comments
Knowledge of qualitative and mixed methods research is an important skill.2. Quasi-experimental designs distinguish HSR from other quantitative fields
in public health, such as epidemiology.
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(6)
Primary data collection methods
Know how to collect primary health
and health care data obtained by survey, qualitative, or mixed methods.
Comments
The level of competence in primary data collection was a large point ofdiscussion during the competency conference. We agreed on an intermediate
level for both primary and secondary data analysis; however, there was a
minority opinion that simply 00nowing about00primary data collection may be
adequate for some HSRers (e.g., health economists who conduct secondary
data analysis exclusively).
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(7)
Secondary data acquisition methods
Know how to assemble secondary data
from existing public and private sources.
Comments
Manipulation of existing data is a strength of HSR. The types of data-setsthat HSRers have expertise in is a
distinguishing characteristic of the field.
acquistion than there was for primary data collection.
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(8)
Conceptual models and operational measures
Use a conceptual model to specify
study constructs for a health services research question and develop
variables that reliably and validly measure these constructs.
Comments
This competency was not contentious and is relevant for many fields ofsocial science research.
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(9)
Implementation of research protocols
Implement research protocols with
standardized procedures that ensure reproducibility of the science.
Comments
Learning how to create 00lectronic research records00was seen as animportant new competency for future HSR professionals.
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(10)
Responsible conduct of research
Ensure the ethical and responsible
conduct of research in the design, implementation, and dissemination
of health services research.
Comments
The competency should address both existing and newly createddata sources.
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(11)
Multi-disciplinary teamwork
Work collaboratively in multi-disciplinary
teams.
Comments
Although HSR is characterized by multi-disciplinary teams and mostthought that this competency was important, there was a sense that the
roadmap for how to teach it was unclear.
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(12)
Data analysis
Use appropriate analytical methods
to clarify associations between variables and to delineate causal inferences.
Comments
The specific techniques could be statistical, economic, or other types ofanalysis. The competency intentionally does not specify which set.
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(13)
Scientific communication
Effectively communicate the findings
and implications of health services research through multiple modalities
to technical and lay audiences.
Comments
Communication refers to both written and oral formats.29
(14)
Stakeholder collaboration and knowledge
translation
Understand the importance of collaborating
with policymakers, organizations, and communities to plan, conduct,
and translate health services research into policy and practice.
Comments
The importance of including stakeholders is emphasized in thisTRIP competency.
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Essential
HSR Educational Domains for the Core Competencies
Health informatics Scientific method and theory Literature review Study design Survey research Qualitative research HSR data sources Measurement and variables Advanced HSR analytic techniques Economic evaluation and decision sciences
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Optional
HSR Educational Domains for the Core Competencies
Health care decision-making Project management Professional development Pedagogy
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HSR
Doctoral Education Next Steps
Diane Martin, PhD
University of Washington
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Continuing
the Dialog
Journal article submission to HSR
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Program
Discussions
Discuss with students
Draft competencies or modify existing competencies
Map competencies to courses or experiential learning
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Program
Considerations
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HSR Doctoral
Education
Past
Experience & Training
Doctoral Courses & Seminars
General requirements Specific Concentration ElectivesRequired
Exams & Other Benchmarks
Research & Policy Experience
RA, independent study 00 multi-disciplinary team Dissertation 00independent leadershipSuccessful
HSR Graduate
Mentorship
Faculty Research & Policy Partners PeersProfessional
Development & Socialization into
HSR
Teaching Experience
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Delivery
of Competencies
Competencies delivered in short courses by experts
Doctoral e-learning?
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Assessment
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Promising
Practices
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