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Health Services Research Doctoral Training Competencies

NRSA Trainees Research Conference Slide Presentation (Text Version)

By Christopher B. Forrest, M.D., Ph.D., Erin Holve, M.P.H., M.P.P., and Diane Martin, Ph.D.

On June 24, 2006, Christopher B. Forrest, Erin Holve, and Diane Martin made a slide presentation on health services research doctoral training competencies at the 12th Annual National Research Service Award (NRSA) Trainees Research Conference. This is the text version of the slide presentation. Select to access the PowerPoint® slides (82 KB).

Slide 1

Health Services Research [HSR] Doctoral Training Competencies

Christopher B. Forrest, M.D., Ph.D.,
Johns Hopkins Bloomberg School of Public Health

Erin Holve, M.P.H., M.P.P.
Johns Hopkins Bloomberg School of Public Health

Diane Martin, Ph.D.
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.

Slide 2

Content

Context & Statement of Problem.
Methods.
Core Competencies.
Discussion and Next Steps.

Slide 3

Context

HSR is a scientific field with an emerging professional identify. But,
- No common approach to educating HSR professionals.
- No common set of skills and knowledge bases.
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.).

Slide 4

Goal of the Competency Project

To develop HSR core competencies:

A minimum set.
Common to all HSR professionals.
That most programs could implement.

Slide 5

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.

Slide 6

Example of Competency Levels: Health Disparities

Awareness:
Describe health disparities and their origins.
Critique and Explain:
Critique alternative explanations for the origins of disparities.
Integrate and Innovate:
Propose health system solutions to health disparities.

Slide 7

Methods Used to Develop Core Competencies

Slide 8

Initial Workplan and Timeline

A series of boxes shows the workplan and timeline.

A box at the left is labeled "Literature Review." To its right are six boxes, from top to bottom. The top one is labeled "Council on Education for Public Health (CEPH) Self-Studies (n=27 schools)." The next one below is "Job Postings (n=320)." Below that is "T32 Training Grants (n=14)." These three boxes are followed by a bracket to the right and then there are four more boxes. The first is "Sample of Universities with HSR PhD Programs. Review for major categories, themes." This is followed by an arrow pointing to "Plan for Structured Analysis of Skills/Behaviors/Knowledge Bases/Competencies." This is followed by an arrow pointing to "Summarize documents." This is followed by an arrow to and from "Review and revise occupational categories and classification of skills."

Below this first group are three more boxes. At the top is "Degree and Title Review from AH Membership File (n=3,623)." This is followed by an arrow pointing to "Professional identities according to AH members. Distribution of degrees held within major categories: HSR, policy analyst, physician, etc." The second box is "Continuing Ed. Options for HSR Professionals." This is followed by an arrow pointing to "Summary of course offerings and objectives with emphasis on highly requested skills and topics." The third box is "Summary of Academy Health Member Survey (n=1,793)." This is followed by an arrow pointing to "Review of member survey conducted by Academy Health with attention to professional development needs."

At the bottom are four more boxes depicting a timeline. The first is "July 2004," followed by "August 2004," "October/November/December 2004," and "January 2005."

Slide 9

Literature Review

Followed Cochrane Collaborative protocol, reviewing peer and non-peer reviewed literature.
- Major keywords "competencies" "health services," "health policy" and "health systems administration."
Most material focused on objectives for management training rather than research.
No specific literature on health services or health policy competencies.

Slide 10

T32 Training Programs

Reviewed 14 AHRQ-Sponsored Institutional Training Grant Programs in HSR (T32).
Learning objectives for doctoral training are not a requirement of NIH or AHRQ-funded training programs.
- No grant applications contained learning objectives for doctoral training or sufficient information to infer learning objectives or training competencies.

Slide 11

Competency Review: Taxonomy of Learning Objectives

A box at the left is labeled "CEPH-Accreditation Self-studies section V.C. "Learning Objectives (n=21 HSR Ph.D. Programs)." From this box there are two arrows. The first goes to a box labeled "Observer 1: Learning Objectives entered into MS Excel." The second goes to "Observer 2: Learning Objectives entered into MS Excel." Below this second box are "Interobserver Agreement = 93%" and "Disagreement arbitrated by PI." Arrows from Observer 1 and Observer 2 lead to a box labeled "Learning Objectives transferred to Atlas ti 5.0 (text analysis software) (n=650)." This is followed by an arrow pointing to "PI Reviews full set of competencies and summarizes into domains and core competencies: Develop Initial Taxonomy." This is followed by an arrow pointing to "JHU and U Wash Faculty Review and Comment on Taxonomy (v2)." This is followed by an arrow pointing to "Revised Taxonomy Based on Work Group Comments (Current v.3)." Under this is an arrow pointing to "Final Taxonomy Based on Meeting."

Slide 12

Health Services Research Doctoral Training Competencies Conference

Objectives:

To provide a forum for exploring the possibility of developing core competencies for the field.
To produce a consensus-derived set of knowledge-based and skills-based HSR doctoral training competencies and their content areas.

Slide 13

Organizations Attending the HSR Competency Conference

AcademyHealth.
Centre d'Etude du Polymorphisme Humain (CEPH).
Agency for Healthcare Research and Quality (AHRQ).
Blue Cross/Blue Shield National Association.
Boston University.
Centers for Medicare & Medicaid Services (CMS).
Harvard University.
Johns Hopkins University.
Urban Health Institute.
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.

Slide 14

Core Competencies

Slide 15

HSR Core Competencies: Summary

Breadth of HSR theoretical and conceptual knowledge.
In-depth disciplinary knowledge and skills.
Application of HSR foundational knowledge to health policy problems.
Pose innovative HSR questions.
Interventional and Observational Study Designs.
Primary data collection methods.
Secondary data acquisition methods.
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.

Slide 16

(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

All health services researchers should be versed in a wide range of theoretical and conceptual frameworks.
The work group felt that programs could define the range of disciplines and fields. As a field, we have not yet defined these.

Slide 17

(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 discipline or interdisciplinary area, and should be able to apply this expertise in an independent research project.
The work group left unresolved the question of whether HSR itself is a field or discipline.

Slide 18

(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.
HSR professionals should be able to synthesize this knowledge to create novel solutions to vexing health policy problems.

Slide 19

(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.
Knowing how to include stakeholders into research question development is a critically important skill.

Slide 20

(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.
Quasi-experimental designs distinguish HSR from other quantitative fields in public health, such as epidemiology.

Slide 21

(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 of discussion 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 "knowing about" primary data collection may be adequate for some HSRers (e.g., health economists who conduct secondary data analysis exclusively).

Slide 22

(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-sets that HSRers have expertise in is a distinguishing characteristic of the field.
There was less contention on the importance of secondary data acquisition than there was for primary data collection.

Slide 23

(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 of social science research.

Slide 24

(9) Implementation of research protocols

Implement research protocols with standardized procedures that ensure reproducibility of the science.

Comments

Learning how to create "electronic research records" was seen as an important new competency for future HSR professionals.

Slide 25

(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 created data sources.

Slide 26

(11) Multi-disciplinary teamwork

Work collaboratively in multi-disciplinary teams.

Comments

Although HSR is characterized by multi-disciplinary teams and most thought that this competency was important, there was a sense that the roadmap for how to teach it was unclear.

Slide 27

(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 of analysis. The competency intentionally does not specify which set.

Slide 28

(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.

Slide 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 this TRIP competency.

Slide 30

Essential HSR Educational Domains for the Core Competencies

Health.
Financing of health care.
Organization of health care.
Health policy.
Health care seeking, access and use.
Quality of care.
Data acquisition and quality control.
Research ethics.
Teamwork.
Proposal development.
Dissemination.
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.

Slide 31

Optional HSR Educational Domains for the Core Competencies

Health policy analysis.
Health care law.
Ethics and health care.
Quality improvement applications.
Health care decision-making.
Project management.
Professional development.
Pedagogy.

Slide 32

HSR Doctoral Education Next Steps

Diane Martin, Ph.D.
University of Washington

Slide 33

Continuing the Dialog

Presentations.
- NRSA Trainees Conference, June 24.
- Academy Health, June 26.
- American Public Health Association (APHA), November 6.
Journal article submission to HSR.

Slide 34

Program Discussions

Discuss among faculty.
Discuss with students.
Draft competencies or modify existing competencies.
Map competencies to courses or experiential learning.

Slide 35

Program Considerations

Program faculty interests and expertise.
Admissions: bachelor vs master.
Work independently & in multidisciplinary teams.
Traditional dissertation vs journal articles.
Average time to completion; # yrs coursework.

Slide 36

HSR Doctoral Education

A box on the top is labeled "Past Experience & Training." Under this is an arrow pointing to a box labeled "Doctoral Courses & Seminars." Inside this box are "General requirements," "Specific Concentration," and "Electives."

Under this is an arrow pointing to a box labeled "Required Exams & Other Benchmarks." Pointing to it is a box labeled "Teaching Experience." Under the box "Required Exams & Other Benchmarks" is an arrow pointing to a box labeled "Research & Policy Experience." Inside this box are "RA, independent study—multi-disciplinary team" and "Dissertation—independent leadership." Pointing to "Research & Policy Experience" from the left is "Professional Development & Socialization into HSR." Pointing to "Research & Policy Experience" from the right is "Mentorship." Inside "Mentorship" are "Faculty," "Research & Policy Partners," and "Peers." An arrow from "Research & Policy Experience" points to "Successful HSR Graduate."

Slide 37

Delivery of Competencies

Deliver competencies via didactic courses, seminars, indep. study, field work, dissertation project.
Competencies delivered in short courses by experts.
Doctoral e-learning?

Slide 38

Assessment

Course grades, field work assessments.
Program exams: qualifying exams; comprehensive exams; defense of dissertation proposal; dissertation defense.
Faculty and university review.
Alumni jobs, grants, publications.
Employer feedback about alumni.

Slide 39

Promising Practices

Innovative financial support.
Shared curriculum across universities.
Student experiences: mentoring, prof. development, teamwork, field exp.
Partnerships: industry, gov't., HSR orgs., other academic institutions, community groups.

Current as of August 2006

Internet Citation:

Health Services Research Doctoral Training Competencies. Text Version of a Slide Presentation. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/fund/training/martintxt.htm