Research
Curry, L., & Docherty, M.A. (2017). Implementing competency-based education. In S. Beaulieu, N. Haave, R. Harde, M. MacKinnon, J.L. Plews, J. Wesselius (Eds). CELT Collected Essays on Learning and Teaching, 10. 75-88.
The rapid and widespread adoption of competency-based education (CBE) has brought into sharp focus long-standing tensions built into education systems, particularly for graduate and professional schools. We all share the desire to produce graduates equipped to respond capably in a rapidly changing world. However, many of us struggle with the knowledge, skills, and attitudes required to identify, articulate, deliver, document, assess, assure, and adjust those necessary competencies across learning engagements, work-study experiences, and into work careers. CBE forces us to alter familiar pedagogical beliefs, attitudes, and behaviours. The purpose of this essay is to assist faculty, students, administrators, regulators, and employers in considering the strengths and limitations of competencebased education (CBE). We also introduce a range of mitigating strategies to address CBE shortcomings.
Docherty, M.A. (2020). Sociocultural learning in emergency medicine: a holistic examination of competence. Diagnosis, 7(3), 325-332.
Background: In the medical community of practice, the resident is situated in systems of professional and cultural activities. How diagnostic competence manifests in this sociocultural context is examined through situativity and systems theories. A holistic model is proposed that could examine diagnostic competence across micro (individual), meso (activity), and macro (cultural) systems.
Methods: Two short scenarios are presented resulting from observations of emergency medicine residents and their supervising physicians. These scenarios are analyzed using the holistic model to understand how diagnostic competence manifests in practice (activity system).
Results: Assessment of diagnostic competency in a sociocultural context may wish to include how much of the context of the activity system a resident can competently manage and synthesize. This information may signal that the resident also has the skills to identify appropriate information channels within an activity system and can accurately collect and prioritize clinical information within those channels. Therefore, the formal assessment of competent clinical reasoning performance, as a situated practice, may benefit from delineating how much of the context of an activity system is required to be competently managed and synthesized across the competency milestones.
Conclusion: The examination of diagnostic competence as a sociocultural practice can provide a unique and holistic examination of clinical reasoning performance and assessment.
Keywords: Situativity theory, systems theory, competence, communities of practice, emergency medicine
Docherty, M. A., & Richard, M. P. (2022). Achieving person-centred care through a team-based care ecosystem approach. Healthcare Management Forum.
The implementation of Person-Centred Care (PCC) by primary care teams is complex. Framed through the Quadruple Aim, successful healthcare system redesigns result in improved health outcomes of individuals and populations, reduce costs, and ensure an engaged and productive workforce. However, how can primary care teams achieve the Quadruple Aim? This article provides a learning and performance framework to support PCC through a Team-Based Care (TBC) ecosystem approach. We developed our approach using action research to improve TBC orientations, workshops, and consultations for teams and their leaders in Urgent Primary Care Centres and Primary Care Networks in Canada. This paper provides a synthesis of our experience in the context of the relevant evidence. We aim to share our efforts and acknowledge that our experience is still ongoing and complemented by ongoing improvement activities by others in the TBC ecosystem.
Docherty, M.A., Foran, K.E., Burnett-Roy, S., & May, S. (2017). Pair scanning: Integrating the student sonographer without impacting patient care. Journal of Ultrasound in Medicine, 36, 1841-1849.
Objective: Ultrasound departments in Canada frequently reduce patient bookings to support student training which impacts not only patient care but also revenue generation. Therefore physicians and employers are reluctant to host student sonographers and educational programs struggle to find sufficient clinical placements for their students. Two research questions were investigated: 1) Can a pair scanning technique effectively integrate the student sonographer into the workplace without impacting patient volumes, and 2) Does the pair scanning technique prepare the student sonographer for entry-level practice faster than traditional practice?
Methods: This research project was divided into two phases. The first phase used action research to develop the pair scanning protocol at a single site with a single preceptor and student. The second phase used a mixed methods approach to test the transferability of the pair scanning protocol across multiple sites, preceptors and students.
Results: In phase 1, the student sonographer performed a greater number of total examinations than the rest of her cohort (who were at different placement sites) and the higher performance of independent exams by the student sonographer under the pair scanning technique was statistically significant (H=36.297, p < 0.01). In phase 2, the pair scanning group and the control group performed equally with no statistically significant differences
Conclusion: The pair scanning protocol is effective at integrating the student sonographer into the workflow without impacting patient care. It prepares the student sonographer for entry-level practice equally with traditional practice and may be most effective with the weak to average student.
Docherty, M.A. (2017). Action research as a process for developing professional capacity within a community of practice. International Journal of Knowledge Management Studies, 8, 74-82.
Learning within a community of practice is a common approach for competency development in the healthcare field. Despite the strengths of situated learning, hegemony can inhibit learning. This case study illustrates how action research was used to examine and challenge an entrenched training practice within the ultrasound community of practice. The action research process also resulted in an unintentional shift in the professional identities of two co-researchers. This case study examines action research as an existential process and concludes that action research can increase organisational capacity through the development of individual professional identity.