the development of competency frameworks in healthcare...

Author Accepted Manuscript. Note: This is a post-peer-review, pre-copyedit version of an article published in Advances in Health Sciences Education. The final authenticated version is available online at: https://doi.org/10.1007/s10459-019-09946-w

- 1 -

The development of competency frameworks in healthcare professions: a scoping review.

Authors

Alan M. Batt MSc 1,2 [email protected]

Walter Tavares PhD 3,4

Brett Williams PhD 1

1. Department of Paramedicine, Monash University, Frankston, Australia

2. Fanshawe College, London, Ontario, Canada.

3. The Wilson Centre, Department of Medicine. University of Toronto/University Health

Network, Toronto, Canada

4. Post-MD Education (Post-Graduate Medical Education/Continued Professional

Development)University of Toronto, Toronto, Canada

Abstract

Competency frameworks serve various roles including outlining characteristics of a competent

workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their

relevance in the health professions, we sought to understand the methods and strategies used in

the development of existing competency frameworks. We applied the Arksey and O’Malley

framework to undertake this scoping review. We searched six electronic databases (MEDLINE,

CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources

(greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We

screened studies for inclusion by title and abstract, and we included studies of any type that

described the development of a competency framework in a healthcare profession. Two

reviewers independently extracted data including study characteristics. Data synthesis was both

quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of

studies were conducted in medicine and nursing professions. Literature reviews and group

techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of

stakeholder deliberation. We observed a significant degree of diversity in methodological

strategies, inconsistent adherence to existing guidance on the selection of methods, who was

involved, and based on the variation we observed in timeframes, combination, function,

application and reporting of methods and strategies, there is no apparent gold standard or

standardised approach to competency framework development. We observed significant

variation within the conduct and reporting of the competency framework development process.

While some variation can be expected given the differences across and within professions, our

results suggest there is some difficulty in determining whether methods were fit-for-purpose, and

therefore in making determinations regarding the appropriateness of the development process.

This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is

a need for improved guidance in the process for developing and reporting competency

frameworks.

https://doi.org/10.1007/s10459-019-09946-w

mailto:[email protected]


- 2 -

Introduction

As individual health professions evolve, identification of competencies describing the required

knowledge, skills, attitudes and other characteristics (KSAOs) for effective professional practice

are needed by professionals, educators, and regulators (Campion et al. 2011; Gonczi et al. 1990;

Palermo et al. 2017). Identifying these competencies ensures that healthcare professions are well

defined, promotes competent workforces, facilitates assessment, facilitates professional mobility,

and helps to analyze and evaluate the expertise of the profession and the professional (Baer

1986; Campion et al. 2011; Eraut 1994; Gonczi et al. 1990; Heywood et al. 1992; ten Cate 2005;

Whiddett and Hollyforde 1999; Winter and Maisch 2005; World Health Organization 2005). The

CanMEDS framework, the ACGME Outcomes project, and the entry-level registered nurse

practice competencies are examples of frameworks that have been used in these ways (Black et

al. 2008; J. Frank et al. 2015; Swing 2007). Given the stakes that such frameworks hold for

educators, learners, regulators, health professions and healthcare broadly, development

guidelines have been created (See Table 1).

Table 1. Summary of existing framework development guidance Author/Year Summary of guidance

Heywood 1992 1. Examine the existing information (government reports, studies undertaken by

the profession, curriculum documents etc.)

2. Choose a combination of techniques (professions will need to choose a

combination of techniques that address a range of practical and theoretical issues

appropriate to the profession concerned)

a. The chosen methods should analyse the functions/activities/roles of the

profession and the attributes of individuals

b. Methods should be practical and cost-effective

c. Methods should be acceptable to the profession

d. The more important the purpose of the framework, the more that

validity needs to be assured using a combination of methods

3. Apply the methods

a. professions need to have developed a nationally representative steering

group prior to commencing a project

4. Continuing consultation (widespread discussion of the project within the

profession as a whole, both while it is being undertaken and after the

development)

Roe 2002 1. Conduct occupational or job analysis

2. Perform competence analysis (including KSAOs)

3. Undertake competence modelling

4. Test the competence model

Marelli 2005 1. Define the Objectives

a. Why is there a need to develop a competency model?

b. What is the unit of analysis?

c. What is the relevant timeframe?

d. How will the competency model be applied?

e. Obtain the Support of a Sponsor

2. Develop and Implement a Communication and Education Plan

3. Plan the Methodology

a. Select the sample – use multiple groups, focus on high performers,

identify desirable characteristics, select a representative sample

b. Select data collection methods – Use at least two methods that are

complementary. Suggests literature review as a preliminary approach.

https://doi.org/10.1007/s10459-019-09946-w


- 3 -

Suggests consideration of focus groups, interviews, surveys,

observation, work logs, and competency menus.

4. Plan the Data Recording and Analysis

a. Identify the Competencies and Create the Competency Model

b. Define the job

c. Identify the competencies

5. Assemble the competency model

a. Review by subject matter experts

b. Develop behavioural examples

6. Apply the Competency Model

7. Evaluate and Update the Competency Model

Kwan 2016 1. Select the EPA topic

2. Develop the EPA content by collecting data from participants using focus group

and individual interviews

3. Draft the EPAs based on analysis of collected data

4. Seek feedback on the draft EPAs from the participants and other stakeholders

5. Refine and finalise the EPAs based on feedback

Moerkamp and

Onstenk 1991 in

Klink and Boon 2002

1. Identify developments in the profession

2. Identify tasks of professionals

3. Identify competencies

4. Draft curriculum

5. Design or revise curriculum

Whiddett and

Hollyforde, 1999;

Whiddett and

Hollyforde, 2003

Framework must be relevant to all those who may benefit from its use

It must meet the needs of a wide range of possible applications

Involve the people who will be affected by the framework in its development

Keep people informed about what is happening and why during the development

process

Create competencies that are relevant

Maintain a quality standard

Sequence of general stages:

Get buy in from key people

Clarify the purpose

Plan the project

Put together data gathering and analysis team

Choose analysis techniques

Gather data – the type of data collected will be influenced by the intended

purpose of the competency framework

Prepare for analysis

Analyze data

Draft competency framework

Validate the competencies

Revise and finalize the competencies

Launch the framework

Lucia and Lepsinger

1999

1. Lay the groundwork

a. Determine objectives and scope

b. Clarify implementation goals and standards

c. Develop an action plan

d. Identify individuals at various performance levels

2. Develop the model

a. Determine data collection methodology

b. Collect data

c. Direct observation of incumbents

https://doi.org/10.1007/s10459-019-09946-w


- 4 -

d. Develop an interim competency model

3. Finalize and validate

a. Test the competency model

b. Analyze the new data and refine the model

c. Validate the competency model

d. Finalize the model

Ten Cate 2005 Competencies should be specific, comprehensive, durable, trainable, measurable,

related to professional activities and connected to other competencies

Child and Shaw 2019 Developers should consider three arguments when developing a competency

framework in order to align the process with the intended use:

1. Binary vs continuum – is the framework going to be used to make a

competent versus not-competent argument? Or is it to be used in a

developmental manner (learning) manner?

2. Atomistic vs holistic – atomistic, checklist type competency frameworks

can result in reductionist approaches to complex tasks. Holistic frameworks

can face challenges when attempts are made to operationalize them due to

lack of detail.

3. Context-specific vs Context-general – the intended generalisability and

adaptability of a framework beyond particular contextual boundaries should

help to determine the degree of contextual specificity incorporated into the

development process.

Mansfield 2000 1. What HR application should we include in the initial model building project?

2. What will the key users of the model need from it?

3. How should key stakeholders be involved?

4. How extensive should the data collection be?

5. How should we balance research with intuitive approaches?

6. What format of behavioural descriptors will best suit the application?

7. How do we plan to accommodate additional, future competency models?

Campion et al 2011 1. Consider organizational context competency

2. Link competency models to organizational goals and objectives

3. Start at the top

4. Use rigorous job analysis methods to develop competencies

5. Consider future-oriented job requirements

6. Use additional unique methods

7. Define the anatomy of a competency

8. Define levels of proficiency on competencies

9. Use organizational language

10. Include both fundamental (cross-job) and technical (job-specific) competencies

11. Use competency libraries

12. Achieve the proper level of granularity (number of competencies and amount of

detail)

13. Use diagrams, pictures, and heuristics to communicate competency models to

employees

14. Use organizational development techniques to ensure competency modeling

acceptance and use

15. Maintain the currency of competencies over time

The development of competency frameworks requires strategies to capture and represent the

complexity associated with healthcare practice. This complexity can emerge in a number of

ways. For example, regional or contextual variability, unique practice patterns, the role and

attributes of individuals and individuals within teams, and other interacting competencies make

practice in multiple contexts possible (Bordage and Harris 2011; Garavan and McGuire 2001;

https://doi.org/10.1007/s10459-019-09946-w


- 5 -

Heywood et al. 1992; Hodges and Lingard 2012; Knapp and Knapp 1995; Lingard 2012;

Makulova et al. 2015; Roe 2002). The nature of clinical practice can also be difficult to define or

understand fully (Garavan and McGuire 2001; Mendoza 1994). The role of tacit knowledge in

professional practice for example, can be difficult to represent - that is, there can be a disconnect

between the personal knowledge of professionals which becomes embedded in their practice, and

the publicly accessible knowledge base of the profession (Collin 1989; Eraut 1994). Competence

and its component parts are often inconsistently understood or defined and attributed multiple

meanings depending on context (Hay-McBer 1996; Spencer and Spencer 1993; ten Cate and

Scheele 2007). Other difficulties may include shifts in patient demographics or societal

expectations, the role of technology, and changes in organizational structures (Duong et al. 2017;

Jacox 1997; Whiddett and Hollyforde 1999). As such, any attempt to represent professional

practice must contend with these challenges, which leaves developers with decisions on how best

to make those choices (Garavan and McGuire 2001; Shilton et al. 2001).

Given this inherent complexity in capturing and accurately representing the features of a health

profession, a variety of approaches may be employed. Influencing issues such as practicality,

efficiency, and what might be deemed acceptable to the profession may have a role (see Table 1).

While there is no guidance on what specific methods to use, when to use them, or how to use

them, there is consensus that in order to increase the validity and utility of competency

frameworks a combination of approaches may be necessary, akin to a process of triangulation

(Heywood et al. 1992; Klink and Boon 2002; Kwan et al. 2016; Marrelli et al. 2005). However,

feasibility, the complexity of practice, and access to appropriate stakeholders may prompt

developers to prioritise aspects of the developmental and validation process (Marrelli et al. 2005;

Whiddett and Hollyforde 1999).

These challenges may result in variable or uncertain outcomes that may be of limited validity

and utility (Lester 2014; Shilton et al. 2001). This in turn may inaccurately represent the

profession, or represent it in unintended ways, and inappropriately impact downstream

dependent systems such as policy/standards development, accreditation and curriculum. Given

the activity related to the development of competency frameworks in many health professions,

little attention has been paid to the development process. Despite existing guidelines, the

complexity associated with different professional practices may lead some to enact development

activities differently. This emphasis on actual developmental processes, in the context of existing

but perhaps incomplete or inadequate guidelines, is the focus of our study. Understanding these

activities may provide insights into how these processes shape eventual outcomes and their

validity and/or utility, and provide insights into what may hold value for the refinement of

existing guidelines. As such, the primary objective of our study is to understand the way in

which health professions develop competency frameworks and then to consider these activities

against existing guidance.

Methods

Design

We conducted a scoping review, which enabled us to identify, map and present an overview of a

heterogeneous body of literature (Arksey and O’Malley 2005; Munn et al. 2018). We deemed a

scoping review to be appropriate given our interest in identifying key characteristics of

https://doi.org/10.1007/s10459-019-09946-w


- 6 -

competency framework development as well as potential knowledge or practice gaps (Munn et

al. 2018). We employed Arksey and O’Malley’s (2005) five-stage framework which included (1)

identifying the research question, (2) identifying relevant studies, (3) refining the study selection

criteria, (4) collecting relevant data from each article, and (5) collating, summarizing, reporting,

and interpreting the results. We reported our process according to the PRISMA Extension for

Scoping Reviews (Tricco et al. 2018).

Research questions

1. How are competency frameworks developed in healthcare professions?

2. How do competency framework development processes align with previous guidance?

3. What insights can be gleaned from the activities of health professions in their

developmental activities and their alignment or not with previous guidance?

Identify relevant studies

Systematic search

We structured searches using terms that addressed the development of competency frameworks

in healthcare professions. In addition, we considered other related concepts, and combinations of

keywords and subject headings that were used are outlined in Appendix I. We selected six

databases to ensure a broad range of disciplines were included: MEDLINE, CINAHL,

PsycINFO, EMBASE, Scopus, and Education Resources Information Center (ERIC). We also

searched grey literature sites greylit.org and Trove, and we reviewed the first 1,000 records from

Google Scholar. We title screened citations within articles if they appeared relevant to the review

(Greenhalgh and Peacock 2005). Our search was restricted to articles published in English. No

limits were set on publication date, study design or country of origin. We conducted pilot

searches in May and June 2018 with the help of two information specialists to refine and finalize

the search strategy, and we conducted the final searches in August 2018.

Citations were imported into EndNote X8 (Clarivate Analytics, Philadelphia, PA) and we

manually removed duplicate citations. The remaining articles were uploaded to the online

systematic-review software Covidence (Veritas Health Innovation, Melbourne, Australia) for

title and abstract screening, and data characterisation.

Select the studies

Eligibility criteria

Studies were eligible for inclusion if they involved a healthcare profession, produced a

competency framework, and explicitly described the development process. Where the same data

were reported in more than one publication (e.g., a journal article and a thesis), we only included

the version that reported the most complete data. Studies of all types were included.

Title and abstract screening

Initial screening comprised of a review of title and abstracts by two reviewers (AB and BW).

Disagreements were resolved through discussion until consensus was achieved. Where

disagreement remained or there was insufficient evidence to make a decision, the citation was

included for full article review.

https://doi.org/10.1007/s10459-019-09946-w


- 7 -

Critical appraisal

In line with the scoping review framework, we did not conduct a critical appraisal (Arksey and

O’Malley 2005).

Chart the data

To support the full-text review, we developed a standardised data extraction form to organize

information, confirm relevance, and to extract study characteristics (See Appendix II) (Ritchie

and Spencer 2002). The information we collected included study characteristics, objectives of

studies, and citations. Relevance was confirmed by sampling population and objectives.

Characteristics collected via this form included: Author (year), country; Sampling population;

Objective/Aim; Methods used; Count of methods; Outcomes. Additional coding was performed

in September 2019 based on peer-review, and included: Rationale; Rationale for methods;

Triangulation; Funding. We compiled all data into a single spreadsheet in Microsoft Excel 2013

(Microsoft, Redmond, WA) for coding and analysis.

Data summary

Due to variations in terminology, methods and strategies used it was necessary to merge some of

these in order to facilitate synthesis. This was an iterative process whereby we reduced variation

to produce a discrete list of codes, while retaining the pertinent information in each study. For

example, we considered ‘steering groups’, ‘working groups’, ‘committees’, and ‘expert panels’

sufficiently similar to be coded as a form of 'group technique’, while we coded Delphi process

and nominal group technique (NGT) as forms of ‘consensus methods’. Stakeholder deliberation

included conferences or workshops (but these may also have been used for other purposes), and

alternative strategies including input from professional associations. Codes and their definitions

are outlined in Table 2.

Table 2. Codes and definitions Code Definition/description of approach Example from included studies

1. Literature review A method that seeks to identify current

knowledge of a topic, allow for

consolidation, and facilitate researchers

to build on previous work, to avoid

duplication and to identify any

omissions or gaps in the knowledge of a

topic (Grant and Booth 2009). A review

of related research literature was

conducted prior to or during the

development of the competency

framework. These included systematic,

scoping, integrative and focused

reviews, and other variations such as

environmental scans.

“A literature search was carried out in

order to identify existing competency

frameworks for dementia care” (Smythe

et al. 2014)

https://doi.org/10.1007/s10459-019-09946-w


- 8 -

2. Group techniques Various methods of group processes

were used to draft initial frameworks,

edit drafts created by expert panels, or

provide expert review and input into

framework development. These

included steering/working groups,

expert groups, and conferences or

workshops.

“An Expert Working Group, comprising

an SBN [specialist breast nurse] and

researchers and academics in the field of

breast cancer nursing, was convened to

synthesise the data that emerged from

stakeholder consultation with the

published literature.” (Yates et al. 2007)

2.1 Conference or

workshop

A method whereby events are hosted to

bring together small and large groups,

of the same or multiple disciplines, in

order to gain input, and depending on

the format of the event, consensus and

feedback to refine and revise the

competency framework

“A one-day conference was held with

two leaders from each of 31 medical

schools” (Z. Liu et al. 2016)

3. Stakeholder

deliberation

A strategy whereby stakeholders

(practitioners, external organisations,

experts in the field or other relevant

parties) were solicited for feedback

“The professional association,

occupational health nurses who were not

members of ACORN, and other

stakeholders in the workplace were

invited to provide feedback.” (Davey

1995)

3.1 Stakeholder

deliberation

(patient/carer)

A strategy whereby patients and/or their

carers were directly engaged in the

framework development process as a

stakeholder

“A meeting convened in 2010 involved

stakeholders in UK nursing education,

practice and management, including

patient representatives” (Kirk et al. 2014)

4. Mapping exercise The competency framework was

mapped against existing national or

international standards for the

profession, or for the health service of

the country or region to ensure

alignment with existing standards and

policies.

“Using the results of the literature review

and environmental scan, the Working

Group adapted the Irish Palliative Care

Competence Framework” (McCallum et

al. 2018)

5. Consensus

methods

Methods that involved the input of

individuals in order to gain consensus or

agreement on items, framework

construct or validate a draft framework.

Methods included Delphi process, NGT,

and group priority sort.

https://doi.org/10.1007/s10459-019-09946-w


- 9 -

5.1 Delphi process A facilitated group consensus method

conducted over several iterations, in

order to elicit opinion and response

from a panel of experts, with an

emphasis on informed judgement

(Brown 1968) in order to inform

framework development.

“We convened an inter-professional

panel of experts to validate our

competency framework by way of a

modified Delphi technique” (Moaveni et

al. 2010)

5.2 Nominal group

technique

A method involving a highly structured

meeting during which a group of

diverse, but representative participants

individually respond to questions,

present their responses one at a time,

and subsequently prioritize responses in

an anonymous fashion (Delbecq and

Van de Ven 1971) in order to inform

framework development

“We employed three methods in this

study: (1) nominal group technique

(NGT), (2) expert committee, and (3)

text analysis” (Ho et al. 2011)

5.3 Group priority sort A method whereby a group of diverse

stakeholders identify priorities, define a

complex concept and contribute to

informed decision making in topics

where evidence is lacking or

inappropriate (Jacobson et al. 2013)

“The group priority sort method, which

involves engaging groups of stakeholders

in sorting and ranking activities, was

used as a validation method” (Ling et al.

2017)

6. Survey A method whereby an online or offline

questionnaire was sent to stakeholders

(practitioners, external organisations,

experts in the field or other relevant

parties)

“…validate the resulting framework by

conducting a complex survey of two

cohorts of Fellows” (J. R. Frank 2005)

7. Focus groups A method that involves in-depth group

interviews on a particular topic in which

participants are selected because they

are a purposive sampling of a specific

population (Lederman 1990, p117).

Competency frameworks were

discussed in focus groups with

stakeholders or practitioners.

“Preliminary input was obtained through

a series of focus groups” (Myers et al.

2015)

8. Interviews A method whereby competency

frameworks were discussed in

interviews (structured, semi-structured ,

in-depth, group* etc.) with stakeholders

or practitioners

“A purposive sample of 25 nurse leaders

provided information during structured

interviews” (Amendola 2008)

9. Practice analysis A strategy whereby authors sought to

directly or indirectly observe the

conduct of practice in the context of the

practice environment, operationalized

through several different methods

“Over 800 hours of specialist critical

care nursing practice were observed and

grouped into `domains' or major themes

of specialist practice” (Dunn et al. 2000)

https://doi.org/10.1007/s10459-019-09946-w


- 10 -

Data synthesis

We further explored the outlined codes in order to provide insight into their purpose and how

they were operationalized. After synthesizing the results, we then organized them by frequency

of use from most to least common. We outlined variations that existed within each code

including form, function, application, and intended outcomes. This qualitative approach to

analysis was performed inductively and iteratively, allowing the data to be representative of

itself. The synthesis and subsequent discussion are influenced by our perspective that context is

important both in the original studies, and in our own interpretation of the literature.

Additionally, study authors may have held underlying positions that are distinct from ours, which

may result in differing interpretations of their studies.

Results

Search results and study selection

The search yielded 5,669 citations. We identified an additional 110 citations through searches of

grey literature, and hand searching. After elimination of duplicates, we screened 5,710 citations

at the title and abstract level. This led to the exclusion of 5,331 citations. After full-text review of

379 citations, we included 190 full-texts for data extraction and analysis. See Figure 1 for an

illustration of these findings using PRISMA Diagram, and Appendix III for a full list of included

studies.

Figure 1. PRISMA Diagram

https://doi.org/10.1007/s10459-019-09946-w


- 11 -

Characteristics of included studies

Included studies were published between 1978 and 2018. The majority were published as peer-

reviewed articles (n=172), with the remaining literature comprised of reports (n=13) and theses

(n=5). The majority of studies were from the USA (n=65, 34%), followed by the United

Kingdom, Canada, and Australia (n=27 each, 14% each). Nursing and medicine competency

frameworks accounted for the majority (n=65, 34% each), followed by multidisciplinary

frameworks (n=36, 19%). See Table 3 for further characteristics of included studies.

Table 3. Study locations and professions. Country n %

USA 65 35%

UK 27 14%

Canada 27 14%

Australia 27 14%

Brazil 6 3%

Europe 6 3%

China 5 3%

Netherlands 3 2%

Global 3 2%

South Africa 2 1%

Germany 2 1%

Lebanon 2 1%

India 2 1%

Sweden 1 1%

Italy 1 1%

Thailand 1 1%

Korea 1 1%

Finland 1 1%

Cyprus 1 1%

Taiwan 1 1%

Mexico 1 1%

Western Pacific 1 1%

Belgium 1 1%

Saudi Arabia 1 1%

Africa 1 1%

Ireland 1 1%

Profession n %

Nursing 65 34%

Medicine 65 34%

Multidisciplinary 36 19%

Allied health 10 5%

Pharmacy 7 4%

EMS 5 3%

https://doi.org/10.1007/s10459-019-09946-w


- 12 -

CAM 1 1%

Psychology 1 1%

Literature reviews and group techniques were utilised in 116 studies each (61%). Strategies of

stakeholder involvement were utilised in 85 studies (45%), and mapping exercises were

conducted in 73 (38%). See Table 4 and Figure 2 for frequency of the methods used, and

Appendix IV for full details.

Table 4. Frequency of reported methods and strategies Method/strategy n %

1. Literature review 116 61%

2. Group techniques 116 61%

2.1 Conference / workshop 40 21%

3. Stakeholder deliberation 85 45%

3.1 Stakeholder deliberation (patient/carer) 21 11%

4. Mapping exercise 73 38%

5. Consensus methods 54 28%

5.1 Delphi process 49 26%

5.2 NGT 5 3%

5.3 Group priority sort 1 0.5%

6. Survey 49 26%

7. Focus Groups 36 19%

8. Interviews 31 16%

9. Practice analysis 22 12%

Figure 2. Frequency of reported methods and strategies

https://doi.org/10.1007/s10459-019-09946-w


- 13 -

Studies varied in the number of approaches used from one (n=20, 11%) to seven (n=3, 2%) (See

Table 5). The median number used was three, and a total of 132 studies (69%) utilised three or

more methods or strategies. Combinations of methods varied, and no distinct pattern of use

emerged when analysed by profession, location or year. Triangulation of methods was mentioned

in 18 (9%) studies. Study periods were not outlined in the majority of studies, but of those that

did (n=81, 43%), the timeframe for development ranged from two days to six years, with 41 of

these (51%) completed in 12 months or less.

Table 5. Number of methods and strategies used by studies Number of methods/strategies n %

1 20 11%

2 39 21%

3 56 29%

4 43 23%

5 26 14%

6 3 2%

7 3 2%

All included studies provided a rationale for the development of the framework. Improvement in

education was the most commonly reported rationale (medicine), followed by lack of a

competency framework (see Table 6 and Appendix V for more detail). A total of 79 studies

(42%) provided a clearly outlined rationale for their choice of methods, and a further 27 (14%)

provided a partial rationale. While a detailed analysis of evaluation was outside of the scope of

our review, evaluation of the final framework was reported in seven studies (4%), while a further

66 (35%) recommended or planned evaluation. Funding sources were outlined for 110 studies

(58%).

Table 6. Rationale for development

Rationale Description n %

Education improvement The framework was developed in order to improve the education of the

profession, including curriculum development, assessment processes etc.

44 23

Lack of competency

framework

The framework was developed in order to address an identified lack of

existing or adequate competency frameworks in the profession.

36 19

Care improvement The framework was developed in order to clarify clinical profile or

improve care processes for patients.

35 18

Improve understanding The framework was developed to gain insight into the professional role, or

to improve understanding of the competencies required in a specific area.

32 17

Standardize The framework was developed in order to standardize the abilities or

competency profile of one or multiple professions, or used to facilitate

freedom of movement across jurisdictions.

23 12

Healthcare changes The framework was developed in response to actual or perceived changes

in the healthcare system, or in order to prepare the profession for future

predicted changes in practice

20 11

Variation in application of approaches

While diversity existed in the methods and strategies used in the development of competency

frameworks, we also observed variability within these approaches in form, function, application

https://doi.org/10.1007/s10459-019-09946-w


- 14 -

and intended outcomes (e.g., to achieve consensus, to facilitate dissemination, to review drafts

etc.). The variation evident within these approaches suggests that authors made choices (that

were not always explicit) in what they valued as meaningful when using such techniques. As

such, the functional alignment of these choices remains unclear, and poses a challenge when we

attempt to infer alignment with framework objectives. Next we elaborate on these findings, with

the exception of Develop a curriculum (DACUM) due to its low popularity. Examples are

referenced to illustrate variance, but are not intended to be exhaustive lists. See Appendix III for

full details.

Literature reviews

Different types of literature reviews included (a) systematic reviews (Galbraith et al. 2017; Klick

et al. 2014), (b) scoping reviews (AlShammari et al. 2018; Redwood-Campbell et al. 2011), (c)

integrative reviews (Camelo 2012), (d) focused reviews (Tavares et al. 2016; Yates et al. 2007),

and (e) environmental scans (McCallum et al. 2018; National Physiotherapy Advisory Group

2017). Many authors did not explicitly outline the type of review they conducted, and instead

described it using generic terms such as ‘broad’, ‘extensive’, and ‘comprehensive’. Some authors

performed a review to identify existing competencies (Chen et al. 2013; Hemalatha and

Shakuntala 2018), while others performed it to inform subsequent methodology (Davey 1995;

Sherbino et al. 2014). It appears that authors made decisions regarding the type, role and

relevance of reviews, and integrated them (or not) for a variety of reasons which are often

unclear and remain implicit.

Group techniques

Group techniques included working/steering, or expert groups (Aylward et al. 2014; D. Davis et

al. 2005), and various group data collection strategies (e.g., conferences and workshops) (Klick

et al. 2014; Skirton et al. 2010). Aylward et al. (2014) used a group technique to draft the initial

framework, while Davis et al. (2005) used it to edit a draft created by an expert group. Authors

including Klick et al. (2014) used a large conference to facilitate input and dissemination.

Conversely, others such as Skirton et al. (2010) elected for a smaller group workshop to review

drafts and gain input. While there is variation within this category, the same holds true for other

sources of evidence for competency framework development.

Stakeholder deliberation

We also noted variations in the role and relevance of stakeholder deliberation strategies, which

included involving (a) healthcare professionals (J. R. Frank 2005; Yates et al. 2007), (b)

professional associations (Davey 1995; Gillan et al. 2013), (c) academics (du Toit et al. 2010;

Tangayi et al. 2011), (d) charities and non-profit organisations (Tsaroucha et al. 2013), (e)

regulatory bodies (du Toit et al. 2010), (f) trade unions and employers (Reetoo et al. 2005), and

(g) patients and their families (R. Davis et al. 2008; Dewing and Traynor 2005). Authors elected

to use focus groups (Hamburger et al. 2015), interviews (Tsaroucha et al. 2013), surveys

(Tangayi et al. 2011), action research (Dewing and Traynor 2005), conferences and workshops

(D. Davis et al. 2005), online wikis (Ambuel et al. 2011), and/or patient advocacy organisations

(Yates et al. 2007). Stakeholder input served different purposes, and was used to draft the initial

framework (Kirk et al. 2014; Macmillan Cancer Support 2017), to refine and revise draft

frameworks (Aylward et al. 2014; Davey 1995), and to gain consensus for the adoption of

frameworks (Brewer and Jones 2013; Santy et al. 2005). Despite the focus on ‘patient-centred’

https://doi.org/10.1007/s10459-019-09946-w


- 15 -

care described in many frameworks, only 21 studies (11%) reported engaging patients or their

caregivers. In other instances, it was difficult to understand the role of stakeholders. Who to

engage as stakeholders, how to engage them, and for what purpose was, similar to other

approaches, also idiosyncratic and thus difficult to infer alignment with framework goals.

Mapping exercises

The documents used for mapping exercises included (a) specialty board certification exams or

reporting milestones (Cicutto et al. 2017; Klein et al. 2014), (b) national policies and health

service agendas (Glanville Geake and Ryder 2009; Mills and Pritchard 2004), (c) relevant

frameworks from other countries (L. Liu et al. 2014; McCallum et al. 2018), and (d) international

or regional frameworks (Barry 2011; Wölfel et al. 2016). These mapping exercises were used as

a foundation for framework development (Boyce et al. 2011; McCallum et al. 2018), to identify a

pool of items to use in consensus methods (M. Liu et al. 2007), to generate behavioural items for

identified competencies (Aylward et al. 2014) and to organise and tabulate responses from

stakeholders (Loke and Fung 2014). There appears to be inconsistent adherence with previous

development guidance within this approach in relation to the importance of regional context.

Consensus methods

Consensus methods included (a) Delphi method (Cappiello et al. 2016; Sousa and Alves 2015),

(b) group priority sort (Ling et al. 2017) and, (c) nominal group technique (Kirk et al. 2014;

Landzaat et al. 2017). Cappiello et al. (2016) used a Delphi method to gain agreement on

competencies early in the development of the framework, while Sousa and Alves (2015) used it

as a final step to gain consensus. Kirk et al. (2014) utilised NGT as traditionally described

(Delbecq and Van de Ven 1971), while Landzaat et al. (2017) utilised a hybrid of modified

Delphi and NGT components. Ling et al. (2017) was the only study to utilise group priority sort

method. While consensus is a worthwhile strategy that aligns with previous guidance, the

rationale for a given approach over another, the sequence, or application was often unclear, and

this poses a challenge when we attempt to examine alignment.

Surveys

Surveys also varied by method, purpose, and characteristics of survey population. From a

methodological perspective, some were conducted online or via e-mail (Barnes et al. 2010; Klick

et al. 2014), via post (Bluestein 1993; R. Davis et al. 2008), or using a combination of

approaches (Baldwin et al. 2007). In terms of function, surveys were utilised to identify initial

competencies (Parkinson’s UK 2016), to elicit feedback during the development process

(Smythe et al. 2014), and in the subsequent validation of the framework (Sherbino et al. 2014).

Sample sizes varied from 33 (Ketterer et al. 2017) to 18,000 (National Physiotherapy Advisory

Group 2017), while response rates varied from 3% (NPAG 2017) to 89% (Z. Liu et al. 2016).

Actual number of responses ranged from 20 (Ketterer et al. 2017) to 6,247 (Z. Liu et al. 2016).

As evidenced within other methods employed, here too we observed variation in the application

and function of surveys.

Focus groups

Focus groups varied in composition, the size and number of groups, and purpose. For example,

the composition for some comprised of members of the same discipline (Halcomb et al. 2017;

Palermo et al. 2016), while others saw value in using members from different disciplines (Booth

https://doi.org/10.1007/s10459-019-09946-w


- 16 -

and Courtnell 2012; Gillan et al. 2013) - in direct contrast to the sine qua non of focus groups

(Lederman 1990). In terms of how this method was used, some used it in the initial identification

and drafting of competencies (Booth and Courtnell 2012; Patterson et al. 2000), while others

used it to engage stakeholders during the development process (Banfield and Lackie 2009;

Smythe et al. 2014). Authors including Myers et al. (2015) used focus groups to validate draft

frameworks. The reasons for choices made by developers, and the methodological variation

evident in this approach remain unclear and inconsistently reported.

Interviews

The forms of interviews included (a) semi-structured (Akbar et al. 2005; Daouk-Öyry et al.

2017), (b) structured (Amendola 2008), (c) in-depth (Blanchette 2015; Tavares et al. 2016), (d)

group interviews (not focus groups) (Loke and Fung 2014), (e) critical incident (Lewis et al.

2010; McCarthy and Fitzpatrick 2009), and (f) behavioural event interviews (Calhoun et al.

2008; Chen et al. 2013). Participants in interviews included patients and family members

(Dijkman et al. 2017; Patterson et al. 2000), academics (Chen et al. 2013; Gardner et al. 2006),

and healthcare professionals (Calhoun et al. 2008; Chen et al. 2013). Interviews were conducted

to gain expert input (Smythe et al. 2014; Tavares et al. 2016), to gain insight into practice (Dunn

et al. 2000; McCarthy and Fitzpatrick 2009), to confirm findings from other methods (i.e.

triangulation) (Dunn et al. 2000; Palermo et al. 2017), and to solicit contributions from diverse

stakeholders (Kwan et al. 2016). The number of interviews conducted was often not reported,

however, several authors provided details on population, technique, and analysis for interviews

in their studies (Palermo et al. 2017; Tavares et al. 2016). As with other approaches, who to

interview, how, and for what purpose was often not adequately reported, and this presents a

challenge when we attempt to evaluate the outcomes.

Practice analysis

Practice analysis involved methods such as (a) functional analysis (Bench et al. 2003; Palermo et

al. 2016), (b) analysis of administrative data (Dressler et al. 2006; Stucky et al. 2010), (c) direct

observation of practice (Dewing and Traynor 2005; Underwood et al. 1996), (d) critical incident

technique (CIT) (Dunn et al. 2000; Lewis et al. 2010), (e) review of position descriptions (Akbar

et al. 2005; Fidler 1997), and (f) task or role analysis (Cattini 1999; Chang et al. 2013). Dressler

et al. (2006) identified commonly encountered conditions in billing data, while Stucky et al.

(2010) and Shaughnessy et al. (2013) identified commonly recorded diagnostic codes to inform

the development of competency frameworks. Dunn et al. (2000), Underwood et al. (1996), and

Dewing and Traynor (2005) observed practice in-person, while Patterson et al. (2000) observed

video recorded interactions to develop an understanding of practice. Practice analyses were used

to inform the initial list of competencies (Dressler et al. 2006; Fidler 1997), as a means of

capturing the complexity of practice in context (Dunn et al. 2000; Underwood et al. 1996), to

triangulate data from other methods (Lewis et al. 2010; McCarthy and Fitzpatrick 2009), and as a

means of validating frameworks (Carrington et al. 2011). Timeframes of data collection also

varied significantly, and were not always reported. The variation with this approach was perhaps

to be expected given the differences in practice between professions. Despite existing guidance

related to the importance of job/practice analysis (Lucia and Lepsinger 1999; Roe 2002), this

method was rarely utilised, which obligates us to question why given its ability to explore the

complexities of practice.

https://doi.org/10.1007/s10459-019-09946-w


- 17 -

Discussion

Competency frameworks serve various roles including outlining characteristics of a competent

workforce, facilitating mobility, and analysing or assessing expertise. Given how existing

development guidelines may be limited, combined with the known complexities of practice and

practical challenges faced by framework developers, we sought to understand the choices made

when developing competency frameworks. After we examined frameworks across multiple

contexts, we suggest that: variability exists in what methods or combinations of methods

developers use as well as within methods; there is inconsistent adherence to existing guidance

(e.g., most neglect practice analyses, but include multiple methods); limited connections are

made between intended use and methodological choices; and, outcomes are inconsistently

reported.

Given how competency frameworks are developed, we identified a lack of guidance on how to

identify the most appropriate methods. While existing guidance permits and/or encourages a

certain flexibility (Table 1), we did not identify any guidance regarding making those choices or

examining their suitability for the intended purpose or claims authors intend to make about their

outcomes (i.e., competency framework). In other words, existing guidance acknowledges that

what we consider fit for one setting or profession and intended use may not be for another, hence

the flexibility and variability (Whiddett and Hollyforde 1999). While this seems necessary,

existing guidelines also seem to lack organizing conceptual frameworks. As an example, social

sciences and humanities research often include conceptual or theoretical frameworks as means to

impose, organize, prioritize or align methodological choices. These validity ideals appear

challenged by practicalities when developing frameworks. That is, we assume by the

heterogeneity in our findings that methodological choices may have been influenced by

practicalities such as available resources, timeframes, and the experience and expertise of

developers. Other factors may include the maturity of the profession, the perspectives and

mandate of the developer (i.e. who is creating the framework), the consistency of roles within the

profession, and the complexity of practice which is enacted within broader social contexts. These

influencing factors remained largely implicit. Lacking sufficient guidance on these conceptual

and practical issues, the utility and validity associated with the framework becomes less clear, or

difficult to examine.

Limitations in guidelines related to methodological choices ultimately leave producers and users

struggling to make interpretations regarding suitability, utility and validity of competency

frameworks. In developing competency frameworks limited in conceptual, theoretical or “use”

alignment, we risk the perpetuation of frameworks that adopt a form of unintended or

unwarranted legitimacy. This may subsequently result in the creation of what we could term a

‘false-god’ framework, which refers to an object of afforded high value that is illegitimate or

inaccurate in its professed authority or capability (Toussaint 2009). That is, despite these

limitations when developing competency frameworks, the outcomes are ‘worshipped’, or treated

as legitimate or accurate representations of practice without sufficient conceptual or empirical

arguments, derived by the methods used, or in alignment with intended purpose. It has been

argued for example that social contexts and the complexities of clinical practice remain largely

ignored in current competency frameworks (Bradley et al. 2015). Outcomes (i.e. final products)

could perhaps (unknowingly) be prioritised over accurate representations of practice, thus

https://doi.org/10.1007/s10459-019-09946-w


- 18 -

limiting their suitability and utility, and threatening validity arguments. Existing guidance

cautions that the more important the intended use of the framework, the more that its validity

needs to be assured (Heywood et al. 1992; Knapp and Knapp 1995). If validity is compromised,

this ‘false-god’ could exert substantial downstream effects including poor definitions of

competence as well as threats to curriculum and assessment frameworks. These implications

warrant consideration of improved guidance related to development and evaluation processes.

As a way forward, we may need to revisit and refine guidance surrounding competency

framework development to include ways of capturing and/or representing the complexity of

practice, borrowing from philosophical guidance included in mixed methods research in order to

improve suitability, utility and validity, while also establishing reporting and evaluation

principles (see Figure 3 for conceptual framework). First, we may need to leverage if not

obligate affordances of conceptual frameworks that have been associated with systems theory,

social contexts, and mixed-methods approaches to research in development guidelines. Doing so

may provide developers with kinds of organizing frameworks, including the role of underlying

philosophical positions, assumptions, commitments and what counts as evidence of rigour and

validity. Second, those developing frameworks should consider three core issues when

developing a framework in order to align purpose with process: “binary/continuum;

atomistic/holistic; and, context-specific/context-general” (Child and Shaw 2019) – see Table 1.

These arguments require developers to explicitly consider the scope or intended use of the

framework (which will inform their validity arguments); the level of granularity (which will

inform their methods and alignment); and, the contexts in which the framework may be enacted

(which will inform the degree of contextual specificity required in the development process). If

we integrate organizing frameworks of these kinds and associated arguments into guidelines, it

may lead to better alignment between intended uses, methods and sequences such that they are

deemed “fit for purpose”. This shifts the emphasis from what or how many methods were used –

since any one method can be aligned with more than one purpose – to the theoretical and

functional alignment of methods with the rationale for development and intended uses (Child and

Shaw 2019). Until implementation of these types of guidelines, we suggest that interpretation of

the utility and validity of outcomes (i.e., competency frameworks) may be more variable or less

certain (Arundel et al. 2019; Child and Shaw 2019; Simera et al. 2008).

Figure 3. Conceptual framework

https://doi.org/10.1007/s10459-019-09946-w


- 19 -

In addition to improved developmental guidelines, we may also support developers and users of

competency frameworks through the creation of reporting guidelines that provide structure and

clarity (Moher 2007; Moher et al. 2011; Simera et al. 2010). This may include reference to our

recommendations above but also incorporate a format that borrows from recently described

layered analyses for educational interventions (Cianciolo and Regehr 2019; Horsley and Regehr

2018; Varpio et al. 2012). Applied to competency framework development, techniques may be

regarded as surface functions or selected methodologies that are highly context dependent, with

underlying principles and philosophy that are context independent. This may help to account for

the flexibility required when we attempt to provide guidance to multiple professions across

varying contexts. We submit that the suitability, utility and validity of outcomes may leave too

much room for interpretation without explicit consideration of the proposals outlined above.

However, we acknowledge that the inconsistent adherence to existing guidance we observed in

this review suggests that future guidance may also face challenges to implementation.

Limitations

Our study needs to be considered in the context of its limitations. We may not have identified all

relevant studies despite attempts to be comprehensive. While our search strategy included terms

previously used to describe the development of competency frameworks in various professions,

others may exist. The keywords used to index papers lack consistency and a wide variety of

descriptive terms are used in abstracts. Our search and review was restricted to articles published

in English, but this does not inherently bias a review (Morrison et al. 2012). The Google Scholar

search was limited to the first 1000 results; however, the first 200–300 results from Google

Scholar are considered adequate for grey literature searches (Haddaway et al. 2015). No new

codes were generated after approximately 50 articles were coded, which suggests that the

inclusion of additional literature would likely not have influenced the overall findings of our

review. Due to the lack of detail provided by many authors regarding their underlying

assumptions, rationale, selection, and conduct of methods, our review cannot provide a concrete

overview of all aspects of each included study. Finally, the dynamic nature of research into

competency frameworks, EPAs, and the general discourse on competency based education may

be considered a limitation. However, our review offers a comprehensive overview of the

development of competency frameworks to date along with suggestions for future directions and

research.

Conclusion

Our review identified and explored the research pertaining to competency framework

development. Research to date has focused predominantly on the framework outcomes, with

considerably less attention devoted to the process of development. Our findings demonstrated

that the development process varied substantially, across and within professions, in the choice of

methods and in the reporting of the process. There is evidence of inconsistent adherence to

existing guidance and a suggestion that existing guidelines may be insufficient. This may result

in uncertainty regarding the utility and validity of the outcomes, which may lead to unintended or

unwarranted legitimacy. In light of our findings, the development process for competency

framework development may benefit from improved guidance. This guidance should obligate a

focus on organizing conceptual frameworks that promote the functional alignment of methods

and strategies with intended uses and contexts. In addition, such guidance should assist

https://doi.org/10.1007/s10459-019-09946-w


- 20 -

developers to determine approaches that may be better positioned to overcome many of the

challenges associated with competency framework development, including sufficiently capturing

the complexities of practice. Extending existing guidelines in these ways may be complemented

with further research on the implementation, reporting, and evaluation of competency

frameworks outcomes.

Acknowledgments

The authors wish to thank Ms. Paula Todd and Ms. Megan Anderson for their valuable insights

into the search strategy.

References

Akbar, H., Hill, P. S., Rotem, A., Riley, I. D., Zwi, A. B., Marks, G. C., et al. (2005). Identifying

competencies for Australian health professionals working in international health. Asia-Pacific

Journal of Public Health,17(2), 99–103. https://doi.org/10.1177/101053950501700207.Google

Scholar

AlShammari, T., Jennings, P. A., & Williams, B. (2018). Emergency medical services core

competencies: A scoping review. Health Professions

Education. https://doi.org/10.1016/j.hpe.2018.03.009.Google Scholar

Ambuel, B., Trent, K., Lenahan, P., Cronholm, P., Downing, D., Jelley, M., et al.

(2011). Competencies Needed by Health Professionals for Addressing Exposure to Violence and

Abuse in Patient Care. MN: Eden Prairie.Google Scholar

Amendola, M. L. (2008). An examination of the leadership competency requirements of nurse

leaders in healthcare information technology. ProQuest Information & Learning US, US.

Retrieved

from http://media.proquest.com/media/pq/classic/doc/1674957421/fmt/ai/rep/NPDF?hl=informat

ion,information,for,for,nurses,nurse,nurses,nurse&cit:auth=Amendola,+Mark+Lawrence.

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological

framework. International Journal of Social Research Methodology,8(1), 19–

32. https://doi.org/10.1080/1364557032000119616.Google Scholar

Arundel, C., James, S., Northgraves, M., & Booth, A. (2019). Study reporting guidelines : How

valid are they ?, 14(March), 2018–2020. https://doi.org/10.1016/j.conctc.2019.100343.Google

Scholar

Aylward, M., Nixon, J., & Gladding, S. (2014). An entrustable professional activity (epa) for

handoffs as a model for epa assessment development. Academic Medicine,89(10), 1335–

1340. https://doi.org/10.1097/ACM.0000000000000317.Google Scholar

Baer, W. (1986). Expertise and Professional Standards. Work and Occupations,13(4), 532–


Baldwin, K. M., Lyon, B. L., Clark, A. P., Fulton, J., Davidson, S., Dayhoff, N., et al. (2007).

Developing clinical nurse specialist practice competencies. Clinical Nurse Specialist,21(6), 297–

303. https://doi.org/10.1097/01.NUR.0000299619.28851.69.Google Scholar

Banfield, V., & Lackie, K. (2009). Performance-based competencies for culturally responsive

interprofessional collaborative practice. Journal of Interprofessional Care,23(6), 611–


https://doi.org/10.1007/s10459-019-09946-w

https://doi.org/10.1177/101053950501700207

http://scholar.google.com/scholar_lookup?title=Identifying%20competencies%20for%20Australian%20health%20professionals%20working%20in%20international%20health&author=H.%20Akbar&author=PS.%20Hill&author=A.%20Rotem&author=ID.%20Riley&author=AB.%20Zwi&author=GC.%20Marks&author=T.%20Mark&journal=Asia-Pacific%20Journal%20of%20Public%20Health&volume=17&issue=2&pages=99-103&publication_year=2005&doi=10.1177%2F101053950501700207

http://scholar.google.com/scholar_lookup?title=Identifying%20competencies%20for%20Australian%20health%20professionals%20working%20in%20international%20health&author=H.%20Akbar&author=PS.%20Hill&author=A.%20Rotem&author=ID.%20Riley&author=AB.%20Zwi&author=GC.%20Marks&author=T.%20Mark&journal=Asia-Pacific%20Journal%20of%20Public%20Health&volume=17&issue=2&pages=99-103&publication_year=2005&doi=10.1177%2F101053950501700207

https://doi.org/10.1016/j.hpe.2018.03.009

http://scholar.google.com/scholar_lookup?title=Emergency%20medical%20services%20core%20competencies%3A%20A%20scoping%20review&author=T.%20AlShammari&author=PA.%20Jennings&author=B.%20Williams&journal=Health%20Professions%20Education&publication_year=2018&doi=10.1016%2Fj.hpe.2018.03.009

http://scholar.google.com/scholar_lookup?title=Competencies%20Needed%20by%20Health%20Professionals%20for%20Addressing%20Exposure%20to%20Violence%20and%20Abuse%20in%20Patient%20Care&author=B.%20Ambuel&author=K.%20Trent&author=P.%20Lenahan&author=P.%20Cronholm&author=D.%20Downing&author=M.%20Jelley&publication_year=2011

http://media.proquest.com/media/pq/classic/doc/1674957421/fmt/ai/rep/NPDF%3fhl%3dinformation%2cinformation%2cfor%2cfor%2cnurses%2cnurse%2cnurses%2cnurse%26cit:auth%3dAmendola%2c%2bMark%2bLawrence

http://media.proquest.com/media/pq/classic/doc/1674957421/fmt/ai/rep/NPDF%3fhl%3dinformation%2cinformation%2cfor%2cfor%2cnurses%2cnurse%2cnurses%2cnurse%26cit:auth%3dAmendola%2c%2bMark%2bLawrence

https://doi.org/10.1080/1364557032000119616

http://scholar.google.com/scholar_lookup?title=Scoping%20studies%3A%20Towards%20a%20methodological%20framework&author=H.%20Arksey&author=L.%20O%E2%80%99Malley&journal=International%20Journal%20of%20Social%20Research%20Methodology&volume=8&issue=1&pages=19-32&publication_year=2005&doi=10.1080%2F1364557032000119616

https://doi.org/10.1016/j.conctc.2019.100343

http://scholar.google.com/scholar_lookup?title=Study%20reporting%20guidelines%3A%20How%20valid%20are%20they%3F&author=Catherine.%20Arundel&author=Sophie.%20James&author=Matthew.%20Northgraves&author=Alison.%20Booth&journal=Contemporary%20Clinical%20Trials%20Communications&volume=14&pages=100343&publication_year=2019

http://scholar.google.com/scholar_lookup?title=Study%20reporting%20guidelines%3A%20How%20valid%20are%20they%3F&author=Catherine.%20Arundel&author=Sophie.%20James&author=Matthew.%20Northgraves&author=Alison.%20Booth&journal=Contemporary%20Clinical%20Trials%20Communications&volume=14&pages=100343&publication_year=2019

https://doi.org/10.1097/ACM.0000000000000317

http://scholar.google.com/scholar_lookup?title=An%20entrustable%20professional%20activity%20%28epa%29%20for%20handoffs%20as%20a%20model%20for%20epa%20assessment%20development&author=M.%20Aylward&author=J.%20Nixon&author=S.%20Gladding&journal=Academic%20Medicine&volume=89&issue=10&pages=1335-1340&publication_year=2014&doi=10.1097%2FACM.0000000000000317

https://doi.org/10.1177/0730888486013004005

http://scholar.google.com/scholar_lookup?title=Expertise%20and%20Professional%20Standards&author=W.%20Baer&journal=Work%20and%20Occupations&volume=13&issue=4&pages=532-552&publication_year=1986&doi=10.1177%2F0730888486013004005

https://doi.org/10.1097/01.NUR.0000299619.28851.69

http://scholar.google.com/scholar_lookup?title=Developing%20clinical%20nurse%20specialist%20practice%20competencies&author=KM.%20Baldwin&author=BL.%20Lyon&author=AP.%20Clark&author=J.%20Fulton&author=S.%20Davidson&author=N.%20Dayhoff&journal=Clinical%20Nurse%20Specialist&volume=21&issue=6&pages=297-303&publication_year=2007&doi=10.1097%2F01.NUR.0000299619.28851.69

https://doi.org/10.3109/13561820902921654

http://scholar.google.com/scholar_lookup?title=Performance-based%20competencies%20for%20culturally%20responsive%20interprofessional%20collaborative%20practice&author=V.%20Banfield&author=K.%20Lackie&journal=Journal%20of%20Interprofessional%20Care&volume=23&issue=6&pages=611-620&publication_year=2009&doi=10.3109%2F13561820902921654


- 21 -

Barnes, T. A., Gale, D. D., Kacmarek, R. M., & Kageler, W. V. (2010). Competencies needed by

graduate respiratory therapists in 2015 and beyond. Respiratory Care,55(5), 601–616.Google

Scholar

Barry, M. M. (2011). The CompHP core competencies framework for health promotion short

version. Health Education & Behavior: The Official Publication of the Society for Public Health

Education,39(20081209), 648–662. https://doi.org/10.1177/1090198112465620.Google Scholar

Bench, S., Crowe, D., Day, T., Jones, M., & Wilebore, S. (2003). Developing a competency

framework for critical care to match patient need. Intensive & Critical Care Nursing,19(3), 136–

142. https://doi.org/10.1016/S0964-3397(03)00030-2.Google Scholar

Black, J., Allen, D., Redfern, L., Muzio, L., Rushowick, B., Balaski, B., et al. (2008).

Competencies in the context of entry-level registered nurse practice: A collaborative project in

Canada. International Nursing Review,55(2), 171–178. https://doi.org/10.1111/j.1466-

7657.2007.00626.x.Google Scholar

Blanchette, L. (2015). An exploratory study of the role of the organization and the. ProQuest

Information & Learning US, US. Retrieved

from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc13a&NEWS=N&A

N=2016-17339-289.

Bluestein, P. (1993). A model for developing standards of care of the chiropractic

paraprofessional by task analysis. Journal of Manipulative and Physiological

Therapeutics,16(4), 228–237.Google Scholar

Booth, M., & Courtnell, T. (2012). Developing competencies and training to enable senior nurses

to take on full responsibility for DNACPR processes. International Journal of Palliative

Nursing,18(4), 189–195. https://doi.org/10.12968/ijpn.2012.18.4.189.Google Scholar

Bordage, G., & Harris, I. (2011). Making a difference in curriculum reform and decision-making

processes. Medical Education,45(1), 87–94. https://doi.org/10.1111/j.1365-


Boyce, P., Spratt, C., Davies, M., & McEvoy, P. (2011). Using entrustable professional activities

to guide curriculum development in psychiatry training. BMC Medical Education,11(1),

96. https://doi.org/10.1186/1472-6920-11-96.Google Scholar

Bradley, J. M., Unal, R., Pinto, C. A., & Cavin, E. S. (2015). Competencies for governance of

complex systems of systems. International Journal of System of Systems Engineering,6(1/2),

71. https://doi.org/10.1504/ijsse.2015.068804.Google Scholar

Brewer, M., & Jones, S. (2013). An interprofessional practice capability framework focusing on

safe, high-quality, client-centred health service. Journal of Allied Health,42(2), e45–49.Google

Scholar

Brown, B. (1968). Delphi process: A methodology used for the elicitation of opinions of experts.

Santa Monica, CA: RAND Corporation.Google Scholar

Calhoun, J. G., Ramiah, K., Weist, E. M., Shortell, S. M., Dollett, L., Sinioris, M. E., et al.

(2008). Development of an interprofessional competency model for healthcare

leadership. Journal of healthcare management/American College of Healthcare

Executives,53(6), 375–391. https://doi.org/10.1097/00115514-200811000-00006.Google

https://doi.org/10.1007/s10459-019-09946-w

http://scholar.google.com/scholar_lookup?title=Competencies%20needed%20by%20graduate%20respiratory%20therapists%20in%202015%20and%20beyond&author=TA.%20Barnes&author=DD.%20Gale&author=RM.%20Kacmarek&author=WV.%20Kageler&journal=Respiratory%20Care&volume=55&issue=5&pages=601-616&publication_year=2010

http://scholar.google.com/scholar_lookup?title=Competencies%20needed%20by%20graduate%20respiratory%20therapists%20in%202015%20and%20beyond&author=TA.%20Barnes&author=DD.%20Gale&author=RM.%20Kacmarek&author=WV.%20Kageler&journal=Respiratory%20Care&volume=55&issue=5&pages=601-616&publication_year=2010

https://doi.org/10.1177/1090198112465620

http://scholar.google.com/scholar_lookup?title=The%20CompHP%20core%20competencies%20framework%20for%20health%20promotion%20short%20version&author=MM.%20Barry&journal=Health%20Education%20%26%20Behavior%3A%20The%20Official%20Publication%20of%20the%20Society%20for%20Public%20Health%20Education&volume=39&issue=20081209&pages=648-662&publication_year=2011&doi=10.1177%2F1090198112465620

https://doi.org/10.1016/S0964-3397(03)00030-2

http://scholar.google.com/scholar_lookup?title=Developing%20a%20competency%20framework%20for%20critical%20care%20to%20match%20patient%20need&author=S.%20Bench&author=D.%20Crowe&author=T.%20Day&author=M.%20Jones&author=S.%20Wilebore&journal=Intensive%20%26%20Critical%20Care%20Nursing&volume=19&issue=3&pages=136-142&publication_year=2003&doi=10.1016%2FS0964-3397%2803%2900030-2

https://doi.org/10.1111/j.1466-7657.2007.00626.x

https://doi.org/10.1111/j.1466-7657.2007.00626.x

http://scholar.google.com/scholar_lookup?title=Competencies%20in%20the%20context%20of%20entry-level%20registered%20nurse%20practice%3A%20A%20collaborative%20project%20in%20Canada&author=J.%20Black&author=D.%20Allen&author=L.%20Redfern&author=L.%20Muzio&author=B.%20Rushowick&author=B.%20Balaski&journal=International%20Nursing%20Review&volume=55&issue=2&pages=171-178&publication_year=2008&doi=10.1111%2Fj.1466-7657.2007.00626.x

http://ovidsp.ovid.com/ovidweb.cgi%3fT%3dJS%26PAGE%3dreference%26D%3dpsyc13a%26NEWS%3dN%26AN%3d2016-17339-289

http://ovidsp.ovid.com/ovidweb.cgi%3fT%3dJS%26PAGE%3dreference%26D%3dpsyc13a%26NEWS%3dN%26AN%3d2016-17339-289

http://scholar.google.com/scholar_lookup?title=A%20model%20for%20developing%20standards%20of%20care%20of%20the%20chiropractic%20paraprofessional%20by%20task%20analysis&author=P.%20Bluestein&journal=Journal%20of%20Manipulative%20and%20Physiological%20Therapeutics&volume=16&issue=4&pages=228-237&publication_year=1993

https://doi.org/10.12968/ijpn.2012.18.4.189

http://scholar.google.com/scholar_lookup?title=Developing%20competencies%20and%20training%20to%20enable%20senior%20nurses%20to%20take%20on%20full%20responsibility%20for%20DNACPR%20processes&author=M.%20Booth&author=T.%20Courtnell&journal=International%20Journal%20of%20Palliative%20Nursing&volume=18&issue=4&pages=189-195&publication_year=2012&doi=10.12968%2Fijpn.2012.18.4.189

https://doi.org/10.1111/j.1365-2923.2010.03727.x

https://doi.org/10.1111/j.1365-2923.2010.03727.x

http://scholar.google.com/scholar_lookup?title=Making%20a%20difference%20in%20curriculum%20reform%20and%20decision-making%20processes&author=G.%20Bordage&author=I.%20Harris&journal=Medical%20Education&volume=45&issue=1&pages=87-94&publication_year=2011&doi=10.1111%2Fj.1365-2923.2010.03727.x

https://doi.org/10.1186/1472-6920-11-96

http://scholar.google.com/scholar_lookup?title=Using%20entrustable%20professional%20activities%20to%20guide%20curriculum%20development%20in%20psychiatry%20training&author=P.%20Boyce&author=C.%20Spratt&author=M.%20Davies&author=P.%20McEvoy&journal=BMC%20Medical%20Education&volume=11&issue=1&pages=96&publication_year=2011&doi=10.1186%2F1472-6920-11-96

https://doi.org/10.1504/ijsse.2015.068804

http://scholar.google.com/scholar_lookup?title=Competencies%20for%20governance%20of%20complex%20systems%20of%20systems&author=JM.%20Bradley&author=R.%20Unal&author=CA.%20Pinto&author=ES.%20Cavin&journal=International%20Journal%20of%20System%20of%20Systems%20Engineering&volume=6&issue=1%2F2&pages=71&publication_year=2015&doi=10.1504%2Fijsse.2015.068804

http://scholar.google.com/scholar_lookup?title=An%20interprofessional%20practice%20capability%20framework%20focusing%20on%20safe%2C%20high-quality%2C%20client-centred%20health%20service&author=M.%20Brewer&author=S.%20Jones&journal=Journal%20of%20Allied%20Health&volume=42&issue=2&pages=e45-49&publication_year=2013

http://scholar.google.com/scholar_lookup?title=An%20interprofessional%20practice%20capability%20framework%20focusing%20on%20safe%2C%20high-quality%2C%20client-centred%20health%20service&author=M.%20Brewer&author=S.%20Jones&journal=Journal%20of%20Allied%20Health&volume=42&issue=2&pages=e45-49&publication_year=2013

http://scholar.google.com/scholar_lookup?title=Delphi%20process%3A%20A%20methodology%20used%20for%20the%20elicitation%20of%20opinions%20of%20experts&author=B.%20Brown&publication_year=1968

https://doi.org/10.1097/00115514-200811000-00006

http://scholar.google.com/scholar_lookup?title=Development%20of%20an%20interprofessional%20competency%20model%20for%20healthcare%20leadership&author=JG.%20Calhoun&author=K.%20Ramiah&author=EM.%20Weist&author=SM.%20Shortell&author=L.%20Dollett&author=ME.%20Sinioris&journal=Journal%20of%20healthcare%20management%2FAmerican%20College%20of%20Healthcare%20Executives&volume=53&issue=6&pages=375-391&publication_year=2008&doi=10.1097%2F00115514-200811000-00006


- 22 -

Scholar

Camelo, S. H. H. (2012). Professional competences of nurse to work in intensive care units: An

integrative review. Revista Latino-Americana de Enfermagem,20(1), 192–

200. https://doi.org/10.1590/S0104-11692012000100025.Google Scholar

Campion, M. A., Fink, A. A., Ruggeberg, B. J., Carr, L., Phillips, G. M., & Odman, R. B.

(2011). Doing competencies well: Best practices in competency modeling. Personnel

Psychology,64, 225–262. https://doi.org/10.1111/j.1744-6570.2010.01207.x.Google Scholar

Cappiello, J., Levi, A., & Nothnagle, M. (2016). Core competencies in sexual and reproductive

health for the interprofessional primary care team. Contraception,93(5), 438–

445. https://doi.org/10.1016/j.contraception.2015.12.013.Google Scholar

Carrington, C., Weir, J., & Smith, P. (2011). The development of a competency framework for

pharmacists providing cancer services. Journal of Oncology Pharmacy Practice,17(3), 168–


Cattini, P. (1999). Core competencies for clinical nurse specialists: A usable framework. Journal

of Clinical Nursing,8(5), 505–511. https://doi.org/10.1046/j.1365-2702.1999.00285.x.Google

Scholar

Chang, A., Bowen, J. L., Buranosky, R. A., Frankel, R. M., Ghosh, N., Rosenblum, M. J., et al.

(2013). Transforming primary care training—Patient-centered medical home entrustable

professional activities for internal medicine residents. Journal of General Internal

Medicine,28(6), 801–809. https://doi.org/10.1007/s11606-012-2193-3.Google Scholar

Chen, S. P., Krupa, T., Lysaght, R., McCay, E., & Piat, M. (2013). The development of recovery

competencies for in-patient mental health providers working with people with serious mental

Illness. Administration and Policy in Mental Health and Mental Health Services Research,40(2),

96–116. https://doi.org/10.1007/s10488-011-0380-x.Google Scholar

Child, S. F. J., & Shaw, S. D. (2019). A purpose-led approach towards the development of

competency frameworks. Journal of Further and Higher Education,00(00), 1–

14. https://doi.org/10.1080/0309877X.2019.1669773.Google Scholar

Cianciolo, A. T., & Regehr, G. (2019). Learning theory and educational intervention: Producing

meaningful evidence of impact through layered analysis. Academic Medicine: Journal of the

Association of American Medical Colleges,94(6), 789–

794. https://doi.org/10.1097/ACM.0000000000002591.Google Scholar

Cicutto, L., Gleason, M., Haas-Howard, C., Jenkins-Nygren, L., Labonde, S., & Patrick, K.

(2017). Competency-based framework and continuing education for preparing a skilled school

health workforce for asthma care: The Colorado experience. Journal of School Nursing,33(4),

277–284. https://doi.org/10.1177/1059840516675931.Google Scholar

Collin, A. (1989). Managers’ competence: Rhetoric, reality and research. Personnel

Review,18(6), 20–25. https://doi.org/10.1108/00483488910133459.Google Scholar

Daouk-Öyry, L., Zaatari, G., Sahakian, T., Rahal Alameh, B., & Mansour, N. (2017).

Developing a competency framework for academic physicians. Medical Teacher,39(3), 269–

277. https://doi.org/10.1080/0142159X.2017.1270429.Google Scholar

Davey, G. D. (1995). Developing competency standards for occupational health nurses in

https://doi.org/10.1007/s10459-019-09946-w

http://scholar.google.com/scholar_lookup?title=Development%20of%20an%20interprofessional%20competency%20model%20for%20healthcare%20leadership&author=JG.%20Calhoun&author=K.%20Ramiah&author=EM.%20Weist&author=SM.%20Shortell&author=L.%20Dollett&author=ME.%20Sinioris&journal=Journal%20of%20healthcare%20management%2FAmerican%20College%20of%20Healthcare%20Executives&volume=53&issue=6&pages=375-391&publication_year=2008&doi=10.1097%2F00115514-200811000-00006

https://doi.org/10.1590/S0104-11692012000100025

http://scholar.google.com/scholar_lookup?title=Professional%20competences%20of%20nurse%20to%20work%20in%20intensive%20care%20units%3A%20An%20integrative%20review&author=SHH.%20Camelo&journal=Revista%20Latino-Americana%20de%20Enfermagem&volume=20&issue=1&pages=192-200&publication_year=2012&doi=10.1590%2FS0104-11692012000100025

https://doi.org/10.1111/j.1744-6570.2010.01207.x

http://scholar.google.com/scholar_lookup?title=Doing%20competencies%20well%3A%20Best%20practices%20in%20competency%20modeling&author=MA.%20Campion&author=AA.%20Fink&author=BJ.%20Ruggeberg&author=L.%20Carr&author=GM.%20Phillips&author=RB.%20Odman&journal=Personnel%20Psychology&volume=64&pages=225-262&publication_year=2011&doi=10.1111%2Fj.1744-6570.2010.01207.x

https://doi.org/10.1016/j.contraception.2015.12.013

http://scholar.google.com/scholar_lookup?title=Core%20competencies%20in%20sexual%20and%20reproductive%20health%20for%20the%20interprofessional%20primary%20care%20team&author=J.%20Cappiello&author=A.%20Levi&author=M.%20Nothnagle&journal=Contraception&volume=93&issue=5&pages=438-445&publication_year=2016&doi=10.1016%2Fj.contraception.2015.12.013

https://doi.org/10.1177/1078155210365582

http://scholar.google.com/scholar_lookup?title=The%20development%20of%20a%20competency%20framework%20for%20pharmacists%20providing%20cancer%20services&author=C.%20Carrington&author=J.%20Weir&author=P.%20Smith&journal=Journal%20of%20Oncology%20Pharmacy%20Practice&volume=17&issue=3&pages=168-178&publication_year=2011&doi=10.1177%2F1078155210365582

https://doi.org/10.1046/j.1365-2702.1999.00285.x

http://scholar.google.com/scholar_lookup?title=Core%20competencies%20for%20clinical%20nurse%20specialists%3A%20A%20usable%20framework&author=P.%20Cattini&journal=Journal%20of%20Clinical%20Nursing&volume=8&issue=5&pages=505-511&publication_year=1999&doi=10.1046%2Fj.1365-2702.1999.00285.x

http://scholar.google.com/scholar_lookup?title=Core%20competencies%20for%20clinical%20nurse%20specialists%3A%20A%20usable%20framework&author=P.%20Cattini&journal=Journal%20of%20Clinical%20Nursing&volume=8&issue=5&pages=505-511&publication_year=1999&doi=10.1046%2Fj.1365-2702.1999.00285.x

https://doi.org/10.1007/s11606-012-2193-3

http://scholar.google.com/scholar_lookup?title=Transforming%20primary%20care%20training%E2%80%94Patient-centered%20medical%20home%20entrustable%20professional%20activities%20for%20internal%20medicine%20residents&author=A.%20Chang&author=JL.%20Bowen&author=RA.%20Buranosky&author=RM.%20Frankel&author=N.%20Ghosh&author=MJ.%20Rosenblum&journal=Journal%20of%20General%20Internal%20Medicine&volume=28&issue=6&pages=801-809&publication_year=2013&doi=10.1007%2Fs11606-012-2193-3

https://doi.org/10.1007/s10488-011-0380-x

http://scholar.google.com/scholar_lookup?title=The%20development%20of%20recovery%20competencies%20for%20in-patient%20mental%20health%20providers%20working%20with%20people%20with%20serious%20mental%20Illness&author=SP.%20Chen&author=T.%20Krupa&author=R.%20Lysaght&author=E.%20McCay&author=M.%20Piat&journal=Administration%20and%20Policy%20in%20Mental%20Health%20and%20Mental%20Health%20Services%20Research&volume=40&issue=2&pages=96-116&publication_year=2013&doi=10.1007%2Fs10488-011-0380-x

https://doi.org/10.1080/0309877X.2019.1669773

http://scholar.google.com/scholar_lookup?title=A%20purpose-led%20approach%20towards%20the%20development%20of%20competency%20frameworks&author=SFJ.%20Child&author=SD.%20Shaw&journal=Journal%20of%20Further%20and%20Higher%20Education&volume=00&issue=00&pages=1-14&publication_year=2019&doi=10.1080%2F0309877X.2019.1669773

https://doi.org/10.1097/ACM.0000000000002591

http://scholar.google.com/scholar_lookup?title=Learning%20theory%20and%20educational%20intervention%3A%20Producing%20meaningful%20evidence%20of%20impact%20through%20layered%20analysis&author=AT.%20Cianciolo&author=G.%20Regehr&journal=Academic%20Medicine%3A%20Journal%20of%20the%20Association%20of%20American%20Medical%20Colleges&volume=94&issue=6&pages=789-794&publication_year=2019&doi=10.1097%2FACM.0000000000002591

https://doi.org/10.1177/1059840516675931

http://scholar.google.com/scholar_lookup?title=Competency-based%20framework%20and%20continuing%20education%20for%20preparing%20a%20skilled%20school%20health%20workforce%20for%20asthma%20care%3A%20The%20Colorado%20experience&author=L.%20Cicutto&author=M.%20Gleason&author=C.%20Haas-Howard&author=L.%20Jenkins-Nygren&author=S.%20Labonde&author=K.%20Patrick&journal=Journal%20of%20School%20Nursing&volume=33&issue=4&pages=277-284&publication_year=2017&doi=10.1177%2F1059840516675931

https://doi.org/10.1108/00483488910133459

http://scholar.google.com/scholar_lookup?title=Managers%E2%80%99%20competence%3A%20Rhetoric%2C%20reality%20and%20research&author=A.%20Collin&journal=Personnel%20Review&volume=18&issue=6&pages=20-25&publication_year=1989&doi=10.1108%2F00483488910133459

https://doi.org/10.1080/0142159X.2017.1270429

http://scholar.google.com/scholar_lookup?title=Developing%20a%20competency%20framework%20for%20academic%20physicians&author=L.%20Daouk-%C3%96yry&author=G.%20Zaatari&author=T.%20Sahakian&author=B.%20Rahal%20Alameh&author=N.%20Mansour&journal=Medical%20Teacher&volume=39&issue=3&pages=269-277&publication_year=2017&doi=10.1080%2F0142159X.2017.1270429


- 23 -

Australia. AAOHN Journal,43(3), 138–143.Google Scholar

Davis, D., Stullenbarger, E., Dearman, C., & Kelley, J. A. (2005). Proposed nurse educator

competencies: Development and validation of a model. Nursing Outlook,53(4), 206–

211. https://doi.org/10.1016/j.outlook.2005.01.006.Google Scholar

Davis, R., Turner, E., Hicks, D., & Tipson, M. (2008). Developing an integrated career and

competency framework for diabetes nursing. Journal of Clinical Nursing,17(2), 168–

174. https://doi.org/10.1111/j.1365-2702.2006.01866.x.Google Scholar

Delbecq, A. L., & Van de Ven, A. H. (1971). A group process model for problem identification

and program planning. The Journal of Applied Behavioral Science,7(4), 466–


Dewing, J., & Traynor, V. (2005). Admiral nursing competency project: Practice development

and action research. Journal of Clinical Nursing,14(6), 695–703. https://doi.org/10.1111/j.1365-


Dijkman, B., Reehuis, L., & Roodbol, P. (2017). Competences for working with older people:

The development and verification of the European core competence framework for health and

social care professionals working with older people. Educational Gerontology,43(10), 483–

497. https://doi.org/10.1080/03601277.2017.1348877.Google Scholar

Dressler, D. D., Pistoria, M. J., Budnitz, T. L., McKean, S. C. W., & Amin, A. N. (2006). Core

competencies in hospital medicine: Development and methodology. Journal of hospital medicine

(Online),1(1), 48–56. https://doi.org/10.1002/jhm.6.Google Scholar

du Toit, R., Cook, C., Minnies, D., & Brian, G. (2010). Developing a competency-based

curriculum for eye care managers in Sub-Saharan Africa. Rural and Remote Health,10(2),

1278.Google Scholar

Dunn, S. V., Lawson, D., Robertson, S., Underwood, M., Clark, R., Valentine, T., et al. (2000).

The development of competency standards for specialist critical care nurses. Journal of

Advanced Nursing,31(2), 339–346. https://doi.org/10.1046/j.1365-2648.2000.01292.x.Google

Scholar

Duong, H. V., Herrera, L. N., Moore, J. X., Donnelly, J., Jacobson, K. E., Carlson, J. N., et al.

(2017). National characteristics of emergency medical services responses for older adults in the

United States. Prehospital Emergency

Care. https://doi.org/10.1080/10903127.2017.1347223.Google Scholar

Eraut, M. (1994). Developing professional knowledge and competence. London:

Routledge. https://doi.org/10.4324/9780203486016.Google Scholar

Fidler, J. R. (1997). The role of the phlebotomy technician: Skills and knowledge required for

successful clinical performance. Evaluation and the Health Professions,20(3), 286–


Frank, J. R. (2005). The CanMEDS 2005 physician competency framework. Better standsards.

Better physicians. Better care. (Jason Frank, Ed.)The Royal College of Physicians and Surgeons

of Canada. The Royal College of Physicians and Surgeons of Canada.Google Scholar

Frank, J, Snell, L., & Sherbino, J. (2015). CanMEDS 2015 Physician Competency Framework.

Ottawa: Royal College of Physicians and Surgeons of Canada. CanMEDS 2015 Physician

https://doi.org/10.1007/s10459-019-09946-w

http://scholar.google.com/scholar_lookup?title=Developing%20competency%20standards%20for%20occupational%20health%20nurses%20in%20Australia&author=GD.%20Davey&journal=AAOHN%20Journal&volume=43&issue=3&pages=138-143&publication_year=1995

https://doi.org/10.1016/j.outlook.2005.01.006

http://scholar.google.com/scholar_lookup?title=Proposed%20nurse%20educator%20competencies%3A%20Development%20and%20validation%20of%20a%20model&author=D.%20Davis&author=E.%20Stullenbarger&author=C.%20Dearman&author=JA.%20Kelley&journal=Nursing%20Outlook&volume=53&issue=4&pages=206-211&publication_year=2005&doi=10.1016%2Fj.outlook.2005.01.006

https://doi.org/10.1111/j.1365-2702.2006.01866.x

http://scholar.google.com/scholar_lookup?title=Developing%20an%20integrated%20career%20and%20competency%20framework%20for%20diabetes%20nursing&author=R.%20Davis&author=E.%20Turner&author=D.%20Hicks&author=M.%20Tipson&journal=Journal%20of%20Clinical%20Nursing&volume=17&issue=2&pages=168-174&publication_year=2008&doi=10.1111%2Fj.1365-2702.2006.01866.x

https://doi.org/10.1177/002188637100700404

http://scholar.google.com/scholar_lookup?title=A%20group%20process%20model%20for%20problem%20identification%20and%20program%20planning&author=AL.%20Delbecq&author=AH.%20Ven&journal=The%20Journal%20of%20Applied%20Behavioral%20Science&volume=7&issue=4&pages=466-492&publication_year=1971&doi=10.1177%2F002188637100700404

https://doi.org/10.1111/j.1365-2702.2005.01158.x

https://doi.org/10.1111/j.1365-2702.2005.01158.x

http://scholar.google.com/scholar_lookup?title=Admiral%20nursing%20competency%20project%3A%20Practice%20development%20and%20action%20research&author=J.%20Dewing&author=V.%20Traynor&journal=Journal%20of%20Clinical%20Nursing&volume=14&issue=6&pages=695-703&publication_year=2005&doi=10.1111%2Fj.1365-2702.2005.01158.x

https://doi.org/10.1080/03601277.2017.1348877

http://scholar.google.com/scholar_lookup?title=Competences%20for%20working%20with%20older%20people%3A%20The%20development%20and%20verification%20of%20the%20European%20core%20competence%20framework%20for%20health%20and%20social%20care%20professionals%20working%20with%20older%20people&author=B.%20Dijkman&author=L.%20Reehuis&author=P.%20Roodbol&journal=Educational%20Gerontology&volume=43&issue=10&pages=483-497&publication_year=2017&doi=10.1080%2F03601277.2017.1348877

https://doi.org/10.1002/jhm.6

http://scholar.google.com/scholar_lookup?title=Core%20competencies%20in%20hospital%20medicine%3A%20Development%20and%20methodology&author=DD.%20Dressler&author=MJ.%20Pistoria&author=TL.%20Budnitz&author=SCW.%20McKean&author=AN.%20Amin&journal=Journal%20of%20hospital%20medicine%20%28Online%29&volume=1&issue=1&pages=48-56&publication_year=2006&doi=10.1002%2Fjhm.6

http://scholar.google.com/scholar_lookup?title=Developing%20a%20competency-based%20curriculum%20for%20eye%20care%20managers%20in%20Sub-Saharan%20Africa&author=R.%20Toit&author=C.%20Cook&author=D.%20Minnies&author=G.%20Brian&journal=Rural%20and%20Remote%20Health&volume=10&issue=2&pages=1278&publication_year=2010

https://doi.org/10.1046/j.1365-2648.2000.01292.x

http://scholar.google.com/scholar_lookup?title=The%20development%20of%20competency%20standards%20for%20specialist%20critical%20care%20nurses&author=SV.%20Dunn&author=D.%20Lawson&author=S.%20Robertson&author=M.%20Underwood&author=R.%20Clark&author=T.%20Valentine&journal=Journal%20of%20Advanced%20Nursing&volume=31&issue=2&pages=339-346&publication_year=2000&doi=10.1046%2Fj.1365-2648.2000.01292.x

http://scholar.google.com/scholar_lookup?title=The%20development%20of%20competency%20standards%20for%20specialist%20critical%20care%20nurses&author=SV.%20Dunn&author=D.%20Lawson&author=S.%20Robertson&author=M.%20Underwood&author=R.%20Clark&author=T.%20Valentine&journal=Journal%20of%20Advanced%20Nursing&volume=31&issue=2&pages=339-346&publication_year=2000&doi=10.1046%2Fj.1365-2648.2000.01292.x

https://doi.org/10.1080/10903127.2017.1347223

http://scholar.google.com/scholar_lookup?title=National%20characteristics%20of%20emergency%20medical%20services%20responses%20for%20older%20adults%20in%20the%20United%20States&author=HV.%20Duong&author=LN.%20Herrera&author=JX.%20Moore&author=J.%20Donnelly&author=KE.%20Jacobson&author=JN.%20Carlson&journal=Prehospital%20Emergency%20Care&publication_year=2017&doi=10.1080%2F10903127.2017.1347223

https://doi.org/10.4324/9780203486016

http://scholar.google.com/scholar_lookup?title=Developing%20professional%20knowledge%20and%20competence&author=M.%20Eraut&publication_year=1994

https://doi.org/10.1177/016327879702000303

http://scholar.google.com/scholar_lookup?title=The%20role%20of%20the%20phlebotomy%20technician%3A%20Skills%20and%20knowledge%20required%20for%20successful%20clinical%20performance&author=JR.%20Fidler&journal=Evaluation%20and%20the%20Health%20Professions&volume=20&issue=3&pages=286-301&publication_year=1997&doi=10.1177%2F016327879702000303

https://scholar.google.com/scholar?q=Frank%2C%20J.%20R.%20%282005%29.%20The%20CanMEDS%202005%20physician%20competency%20framework.%20Better%20standsards.%20Better%20physicians.%20Better%20care.%20%28Jason%20Frank%2C%20Ed.%29The%20Royal%20College%20of%20Physicians%20and%20Surgeons%20of%20Canada.%20The%20Royal%20College%20of%20Physicians%20and%20Surgeons%20of%20Canada.


- 24 -

Competency Framework. Ottawa: Royal College of Physicians and Surgeons of

Canada. http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications.

Galbraith, K., Ward, A., & Heneghan, C. (2017). A real-world approach to evidence-based

medicine in general practice: A competency framework derived from a systematic review and

Delphi process. BMC Medical Education,17(1), 1–15. https://doi.org/10.1186/s12909-017-0916-

1.Google Scholar

Garavan, T., & McGuire, D. (2001). Competencies & workplace learning: The rhetoric & the

reality. Journal of Workplace Learning,13(4), 144–164.Google Scholar

Gardner, G., Carryer, J., Gardner, A., & Dunn, S. (2006). Nurse practitioner competency

standards: Findings from collaborative Australian and New Zealand research. International

Journal of Nursing Studies,43(5), 601–

610. https://doi.org/10.1016/j.ijnurstu.2005.09.002.Google Scholar

Gillan, C., Uchino, M., Giuliani, M., Millar, B.-A. A., & Catton, P. (2013). Defining imaging

literacy in radiation oncology interprofessionally: Toward a competency profile for Canadian

residency programs. Journal of Medical Imaging and Radiation Sciences,44(3), 150–

156. https://doi.org/10.1016/j.jmir.2013.03.002.Google Scholar

GlanvilleGeake, B., & Ryder, R. (2009). A community nurse clinical competency

framework. British journal of community nursing,14(12), 525–

528. https://doi.org/10.12968/bjcn.2009.14.12.45527.Google Scholar

Gonczi, A., Hager, P., Oliver, L., & Oliver, M. L. (1990). Establishing competency…:Based

standards in the professions, (1).Google Scholar

Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and

associated methodologies. Health Information & Libraries Journal., 26(2), 91–

108. https://doi.org/10.1111/j.1471-1842.2009.00848.x.Google Scholar

Greenhalgh, T., & Peacock, R. (2005). Effectiveness and efficiency of search methods in

systematic reviews of complex evidence: Audit of primary sources. British Medical

Journal,331(7524), 1064–1065. https://doi.org/10.1136/bmj.38636.593461.68.Google Scholar

Haddaway, N. R., Collins, A. M., Coughlin, D., & Kirk, S. (2015). The role of google scholar in

evidence reviews and its applicability to grey literature searching. PLoS ONE,10(9), 1–

17. https://doi.org/10.1371/journal.pone.0138237.Google Scholar

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of

professional practice standards for Australian general practice nurses. Journal of Advanced

Nursing,73(8), 1958–1969. https://doi.org/10.1111/jan.13274.Google Scholar

Hamburger, E. K., Lane, J. L., Agrawal, D., Boogaard, C., Hanson, J. L., Weisz, J., et al. (2015).

The referral and consultation entrustable professional activity: Defining the components in order

to develop a curriculum for pediatric residents. Academic Pediatrics,15(1), 5–

8. https://doi.org/10.1016/j.acap.2014.10.012.Google Scholar

Hay-McBer. (1996). Scaled competency dictionary. Boston, MA: Hay-McBer.Google Scholar

Hemalatha, R., & Shakuntala, B. (2018). A Delphi approach to developing a core competency

framework for registered nurses in Karnataka, India. Nitte University Journal of Health

Science,8(2), 3–7. https://doi.org/10.12927/cjnl.2011.22142.Google Scholar

https://doi.org/10.1007/s10459-019-09946-w

http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications

https://doi.org/10.1186/s12909-017-0916-1

https://doi.org/10.1186/s12909-017-0916-1

http://scholar.google.com/scholar_lookup?title=A%20real-world%20approach%20to%20evidence-based%20medicine%20in%20general%20practice%3A%20A%20competency%20framework%20derived%20from%20a%20systematic%20review%20and%20Delphi%20process&author=K.%20Galbraith&author=A.%20Ward&author=C.%20Heneghan&journal=BMC%20Medical%20Education&volume=17&issue=1&pages=1-15&publication_year=2017&doi=10.1186%2Fs12909-017-0916-1

http://scholar.google.com/scholar_lookup?title=Competencies%20%26%20workplace%20learning%3A%20The%20rhetoric%20%26%20the%20reality&author=T.%20Garavan&author=D.%20McGuire&journal=Journal%20of%20Workplace%20Learning&volume=13&issue=4&pages=144-164&publication_year=2001

https://doi.org/10.1016/j.ijnurstu.2005.09.002

http://scholar.google.com/scholar_lookup?title=Nurse%20practitioner%20competency%20standards%3A%20Findings%20from%20collaborative%20Australian%20and%20New%20Zealand%20research&author=G.%20Gardner&author=J.%20Carryer&author=A.%20Gardner&author=S.%20Dunn&journal=International%20Journal%20of%20Nursing%20Studies&volume=43&issue=5&pages=601-610&publication_year=2006&doi=10.1016%2Fj.ijnurstu.2005.09.002

https://doi.org/10.1016/j.jmir.2013.03.002

http://scholar.google.com/scholar_lookup?title=Defining%20imaging%20literacy%20in%20radiation%20oncology%20interprofessionally%3A%20Toward%20a%20competency%20profile%20for%20Canadian%20residency%20programs&author=C.%20Gillan&author=M.%20Uchino&author=M.%20Giuliani&author=B-AA.%20Millar&author=P.%20Catton&journal=Journal%20of%20Medical%20Imaging%20and%20Radiation%20Sciences&volume=44&issue=3&pages=150-156&publication_year=2013&doi=10.1016%2Fj.jmir.2013.03.002

https://doi.org/10.12968/bjcn.2009.14.12.45527

http://scholar.google.com/scholar_lookup?title=A%20community%20nurse%20clinical%20competency%20framework&author=B.%20GlanvilleGeake&author=R.%20Ryder&journal=British%20journal%20of%20community%20nursing&volume=14&issue=12&pages=525-528&publication_year=2009&doi=10.12968%2Fbjcn.2009.14.12.45527

https://scholar.google.com/scholar?q=Gonczi%2C%20A.%2C%20Hager%2C%20P.%2C%20Oliver%2C%20L.%2C%20%26%20Oliver%2C%20M.%20L.%20%281990%29.%20Establishing%20competency%E2%80%A6%3ABased%20standards%20in%20the%20professions%2C%20%281%29.

https://doi.org/10.1111/j.1471-1842.2009.00848.x

http://scholar.google.com/scholar_lookup?title=A%20typology%20of%20reviews%3A%20an%20analysis%20of%2014%20review%20types%20and%20associated%20methodologies&author=MJ.%20Grant&author=A.%20Booth&journal=Health%20Information%20%26%20Libraries%20Journal.&volume=26&issue=2&pages=91-108&publication_year=2009&doi=10.1111%2Fj.1471-1842.2009.00848.x

https://doi.org/10.1136/bmj.38636.593461.68

http://scholar.google.com/scholar_lookup?title=Effectiveness%20and%20efficiency%20of%20search%20methods%20in%20systematic%20reviews%20of%20complex%20evidence%3A%20Audit%20of%20primary%20sources&author=T.%20Greenhalgh&author=R.%20Peacock&journal=British%20Medical%20Journal&volume=331&issue=7524&pages=1064-1065&publication_year=2005&doi=10.1136%2Fbmj.38636.593461.68

https://doi.org/10.1371/journal.pone.0138237

http://scholar.google.com/scholar_lookup?title=The%20role%20of%20google%20scholar%20in%20evidence%20reviews%20and%20its%20applicability%20to%20grey%20literature%20searching&author=NR.%20Haddaway&author=AM.%20Collins&author=D.%20Coughlin&author=S.%20Kirk&journal=PLoS%20ONE&volume=10&issue=9&pages=1-17&publication_year=2015&doi=10.1371%2Fjournal.pone.0138237

https://doi.org/10.1111/jan.13274

http://scholar.google.com/scholar_lookup?title=The%20development%20of%20professional%20practice%20standards%20for%20Australian%20general%20practice%20nurses&author=E.%20Halcomb&author=M.%20Stephens&author=J.%20Bryce&author=E.%20Foley&author=C.%20Ashley&journal=Journal%20of%20Advanced%20Nursing&volume=73&issue=8&pages=1958-1969&publication_year=2017&doi=10.1111%2Fjan.13274

https://doi.org/10.1016/j.acap.2014.10.012

http://scholar.google.com/scholar_lookup?title=The%20referral%20and%20consultation%20entrustable%20professional%20activity%3A%20Defining%20the%20components%20in%20order%20to%20develop%20a%20curriculum%20for%20pediatric%20residents&author=EK.%20Hamburger&author=JL.%20Lane&author=D.%20Agrawal&author=C.%20Boogaard&author=JL.%20Hanson&author=J.%20Weisz&author=M.%20Ottolini&journal=Academic%20Pediatrics&volume=15&issue=1&pages=5-8&publication_year=2015&doi=10.1016%2Fj.acap.2014.10.012

http://scholar.google.com/scholar_lookup?title=Scaled%20competency%20dictionary&publication_year=1996

https://doi.org/10.12927/cjnl.2011.22142

http://scholar.google.com/scholar_lookup?title=A%20Delphi%20approach%20to%20developing%20a%20core%20competency%20framework%20for%20registered%20nurses%20in%20Karnataka%2C%20India&author=R.%20Hemalatha&author=B.%20Shakuntala&journal=Nitte%20University%20Journal%20of%20Health%20Science&volume=8&issue=2&pages=3-7&publication_year=2018&doi=10.12927%2Fcjnl.2011.22142


- 25 -

Heywood, L., Gonczi, A., & Hager, P. (1992). A guide to development of competency standards

for professions. Canberra.Google Scholar

Ho, M. J., Yu, K. H., Hirsh, D., Huang, T. S., & Yang, P. C. (2011). Does one size fit all?

Building a framework for medical professionalism. Academic Medicine, 86(11), 1407–

14.Google Scholar

Hodges, B. D., & Lingard, L. (2012). The question of competence the question of competence.

New York: Cornell University Press. https://doi.org/10.7591/9780801465802.Google Scholar

Horsley, T., & Regehr, G. (2018). When are two interventions the same? Implications for

reporting guidelines in education. Medical Education,52(2), 141–

143. https://doi.org/10.1111/medu.13496.Google Scholar

Jacobson, A., McGuire, M., Zorzi, R., Lowe, M., Oandasan, I., & Parker, K. (2013). The group

priority sort: A participatory decision-making tool for healthcare leaders. Healthcare

Quality., 14(4), 47–53.Google Scholar

Jacox, A. (1997). Determinants of who does what in health care. Online Journal of Issues in

Nursing, 2(4), Manuscript

1. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/

TableofContents/Vol21997/No4Dec97/DeterminantsofWhoDoesWhatinHealthCare.aspx.

Ketterer, A., Salzman, D., Branzetti, J., & Gisondi, M. (2017). Supplemental milestones for

emergency medicine residency programs: A validation study. Western Journal of Emergency

Medicine,18(1), 69–75. https://doi.org/10.5811/westjem.2016.10.31499.Google Scholar

Kirk, M., Tonkin, E., & Skirton, H. (2014). An iterative consensus-building approach to revising

a genetics/genomics competency framework for nurse education in the UK. Journal of Advanced

Nursing,70(2), 405–420. https://doi.org/10.1111/jan.12207.Google Scholar

Klein, M. D., Schumacher, D. J., & Sandel, M. (2014). Assessing and managing the social

determinants of health: Defining an entrustable professional activity to assess residents’ ability to

meet societal needs. Academic Pediatrics,14(1), 10–

13. https://doi.org/10.1016/j.acap.2013.11.001.Google Scholar

Klick, J. C., Friebert, S., Hutton, N., Osenga, K., Pituch, K. J., Vesel, T., et al. (2014).

Developing competencies for pediatric hospice and palliative medicine. Pediatrics,134(6),

e1670–e1677. https://doi.org/10.1542/peds.2014-0748.Google Scholar

Knapp, J. E., & Knapp, L. G. (1995). Practice analysis: Building the foundation for validity. In J.

Impara (Ed.), Licensure testing: Purposes, procedures, and practices (pp. 93–116). Buros Center

for Testing.Google Scholar

Kwan, J., Crampton, R., Mogensen, L. L., Weaver, R., Van Der Vleuten, C. P. M., & Hu, W. C.

Y. (2016). Bridging the gap: A five stage approach for developing specialty-specific entrustable

professional activities. BMC Medical Education,16(1), 1–13. https://doi.org/10.1186/s12909-

016-0637-x.Google Scholar

Landzaat, L. H., Barnett, M. D., Buckholz, G. T., Gustin, J. L., Hwang, J. M., Levine, S. K., et

al. (2017). Development of entrustable professional activities for hospice and palliative medicine

fellowship training in the United States. Journal of Pain and Symptom Management,54(4), 609–

616.e1. https://doi.org/10.1016/j.jpainsymman.2017.07.003.Google Scholar

https://doi.org/10.1007/s10459-019-09946-w

https://scholar.google.com/scholar?q=Heywood%2C%20L.%2C%20Gonczi%2C%20A.%2C%20%26%20Hager%2C%20P.%20%281992%29.%20A%20guide%20to%20development%20of%20competency%20standards%20for%20professions.%20Canberra.

http://scholar.google.com/scholar_lookup?title=Does%20one%20size%20fit%20all%3F%20Building%20a%20framework%20for%20medical%20professionalism&author=MJ.%20Ho&author=KH.%20Yu&author=D.%20Hirsh&author=TS.%20Huang&author=PC.%20Yang&journal=Academic%20Medicine&volume=86&issue=11&pages=1407-14&publication_year=2011

https://doi.org/10.7591/9780801465802

http://scholar.google.com/scholar_lookup?title=The%20question%20of%20competence%20the%20question%20of%20competence&author=BD.%20Hodges&author=L.%20Lingard&publication_year=2012

https://doi.org/10.1111/medu.13496

http://scholar.google.com/scholar_lookup?title=When%20are%20two%20interventions%20the%20same%3F%20Implications%20for%20reporting%20guidelines%20in%20education&author=T.%20Horsley&author=G.%20Regehr&journal=Medical%20Education&volume=52&issue=2&pages=141-143&publication_year=2018&doi=10.1111%2Fmedu.13496

http://scholar.google.com/scholar_lookup?title=The%20group%20priority%20sort%3A%20A%20participatory%20decision-making%20tool%20for%20healthcare%20leaders&author=A.%20Jacobson&author=M.%20McGuire&author=R.%20Zorzi&author=M.%20Lowe&author=I.%20Oandasan&author=K.%20Parker&journal=Healthcare%20Quality.&volume=14&issue=4&pages=47-53&publication_year=2013

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol21997/No4Dec97/DeterminantsofWhoDoesWhatinHealthCare.aspx

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol21997/No4Dec97/DeterminantsofWhoDoesWhatinHealthCare.aspx

https://doi.org/10.5811/westjem.2016.10.31499

http://scholar.google.com/scholar_lookup?title=Supplemental%20milestones%20for%20emergency%20medicine%20residency%20programs%3A%20A%20validation%20study&author=A.%20Ketterer&author=D.%20Salzman&author=J.%20Branzetti&author=M.%20Gisondi&journal=Western%20Journal%20of%20Emergency%20Medicine&volume=18&issue=1&pages=69-75&publication_year=2017&doi=10.5811%2Fwestjem.2016.10.31499

https://doi.org/10.1111/jan.12207

http://scholar.google.com/scholar_lookup?title=An%20iterative%20consensus-building%20approach%20to%20revising%20a%20genetics%2Fgenomics%20competency%20framework%20for%20nurse%20education%20in%20the%20UK&author=M.%20Kirk&author=E.%20Tonkin&author=H.%20Skirton&journal=Journal%20of%20Advanced%20Nursing&volume=70&issue=2&pages=405-420&publication_year=2014&doi=10.1111%2Fjan.12207

https://doi.org/10.1016/j.acap.2013.11.001

http://scholar.google.com/scholar_lookup?title=Assessing%20and%20managing%20the%20social%20determinants%20of%20health%3A%20Defining%20an%20entrustable%20professional%20activity%20to%20assess%20residents%E2%80%99%20ability%20to%20meet%20societal%20needs&author=MD.%20Klein&author=DJ.%20Schumacher&author=M.%20Sandel&journal=Academic%20Pediatrics&volume=14&issue=1&pages=10-13&publication_year=2014&doi=10.1016%2Fj.acap.2013.11.001

https://doi.org/10.1542/peds.2014-0748

http://scholar.google.com/scholar_lookup?title=Developing%20competencies%20for%20pediatric%20hospice%20and%20palliative%20medicine&author=JC.%20Klick&author=S.%20Friebert&author=N.%20Hutton&author=K.%20Osenga&author=KJ.%20Pituch&author=T.%20Vesel&journal=Pediatrics&volume=134&issue=6&pages=e1670-e1677&publication_year=2014&doi=10.1542%2Fpeds.2014-0748

https://scholar.google.com/scholar?q=Knapp%2C%20J.%20E.%2C%20%26%20Knapp%2C%20L.%20G.%20%281995%29.%20Practice%20analysis%3A%20Building%20the%20foundation%20for%20validity.%20In%20J.%20Impara%20%28Ed.%29%2C%20Licensure%20testing%3A%20Purposes%2C%20procedures%2C%20and%20practices%20%28pp.%2093%E2%80%93116%29.%20Buros%20Center%20for%20Testing.

https://doi.org/10.1186/s12909-016-0637-x

https://doi.org/10.1186/s12909-016-0637-x

http://scholar.google.com/scholar_lookup?title=Bridging%20the%20gap%3A%20A%20five%20stage%20approach%20for%20developing%20specialty-specific%20entrustable%20professional%20activities&author=J.%20Kwan&author=R.%20Crampton&author=LL.%20Mogensen&author=R.%20Weaver&author=CPM.%20Vleuten&author=WCY.%20Hu&journal=BMC%20Medical%20Education&volume=16&issue=1&pages=1-13&publication_year=2016&doi=10.1186%2Fs12909-016-0637-x

https://doi.org/10.1016/j.jpainsymman.2017.07.003

http://scholar.google.com/scholar_lookup?title=Development%20of%20entrustable%20professional%20activities%20for%20hospice%20and%20palliative%20medicine%20fellowship%20training%20in%20the%20United%20States&author=LH.%20Landzaat&author=MD.%20Barnett&author=GT.%20Buckholz&author=JL.%20Gustin&author=JM.%20Hwang&author=SK.%20Levine&journal=Journal%20of%20Pain%20and%20Symptom%20Management&volume=54&issue=4&pages=609-616.e1&publication_year=2017&doi=10.1016%2Fj.jpainsymman.2017.07.003


- 26 -

Lederman, L. C. (1990). Assessing educational effectiveness: The focus group interview as a

technique for data collection. Communication Education,39(2), 117–


Lester, S. (2014). Assessment & evaluation in higher education professional competence

standards and frameworks in the United Kingdom Kingdom. Assessment & Evaluation in Higher

Education,39(1), 38–52. https://doi.org/10.1080/02602938.2013.792106.Google Scholar

Lewis, R., Yarker, J., Donaldson-Feilder, E., Flaxman, P., & Munir, F. (2010). Using a

competency-based approach to identify the management behaviours required to manage

workplace stress in nursing: A critical incident study. International Journal of Nursing

Studies,47(3), 307–313. https://doi.org/10.1016/j.ijnurstu.2009.07.004.Google Scholar

Ling, S., Watson, A., & Gehrs, M. (2017). Developing an addictions nursing competency

framework within a Canadian context. Journal of Addictions Nursing,28(3), 110–

116. https://doi.org/10.1097/JAN.0000000000000173.Google Scholar

Lingard, L. (2012). Rethinking competence in the context of teamwork. In B. D. Hodges & L.

Lingard (Eds.), The Question of Competence (pp. 42–70). New York: Cornell University

Press.Google Scholar

Liu, L., Curtis, J., & Crookes, P. (2014). Identifying essential infection control competencies for

newly graduated nurses: A three-phase study in Australia and Taiwan. Journal of Hospital

Infection,86(2), 100–109. https://doi.org/10.1016/j.jhin.2013.08.009.Google Scholar

Liu, M., Kunaiktikul, W., Senaratana, W., Tonmukayakul, O., & Eriksen, L. (2007).

Development of competency inventory for registered nurses in the People’s Republic of China:

Scale development. International Journal of Nursing Studies,44(5), 805–

813. https://doi.org/10.1016/j.ijnurstu.2006.01.010.Google Scholar

Liu, Z., Tian, L., Chang, Q., Sun, B., & Zhao, Y. (2016). A competency model for clinical

physicians in China: A cross-sectional survey. PLoS ONE,11(12), e0166252–

e0166252. https://doi.org/10.1371/journal.pone.0166252.Google Scholar

Loke, A. Y., & Fung, O. W. M. (2014). Nurses’ competencies in disaster nursing: Implications

for curriculum development and public health. International journal of environmental research

and public health,11(3), 3289–3303. https://doi.org/10.3390/ijerph110303289.Google Scholar

Lucia, A. D., & Lepsinger, R. (1999). The art and science of competency models : Pinpointing

critical success factors in organizations. Jossey-Bass/Pfeiffer. Retrieved October 3, 2019

from https://www.wiley.com/en-

ca/The+Art+and+Science+of+Competency+Models%3A+Pinpointing+Critical+Success+Factors

+in+Organizations-p-9780787946029.

Lucia, A. D., & Lepsinger, R. (1999b). The art and science of competency models: Pinpointing

critical success factors in organizations. San Francisco: Jossey-Bass/Pfeiffer.Google Scholar

Macmillan Cancer Support. (2017). The Macmillan allied health professions competence

framework for those working with people affected by cancer. London: Macmillan Cancer

Support.Google Scholar

Makulova, A. T., Alimzhanova, G. M., Bekturganova, Z. M., Umirzakova, Z. A., Makulova, L.

T., & Karymbayeva, K. M. (2015). Theory and practice of competency-based approach in

https://doi.org/10.1007/s10459-019-09946-w

https://doi.org/10.1080/03634529009378794

http://scholar.google.com/scholar_lookup?title=Assessing%20educational%20effectiveness%3A%20The%20focus%20group%20interview%20as%20a%20technique%20for%20data%20collection&author=LC.%20Lederman&journal=Communication%20Education&volume=39&issue=2&pages=117-127&publication_year=1990&doi=10.1080%2F03634529009378794

https://doi.org/10.1080/02602938.2013.792106

http://scholar.google.com/scholar_lookup?title=Assessment%20%26%20evaluation%20in%20higher%20education%20professional%20competence%20standards%20and%20frameworks%20in%20the%20United%20Kingdom%20Kingdom&author=S.%20Lester&journal=Assessment%20%26%20Evaluation%20in%20Higher%20Education&volume=39&issue=1&pages=38-52&publication_year=2014&doi=10.1080%2F02602938.2013.792106


http://scholar.google.com/scholar_lookup?title=Using%20a%20competency-based%20approach%20to%20identify%20the%20management%20behaviours%20required%20to%20manage%20workplace%20stress%20in%20nursing%3A%20A%20critical%20incident%20study&author=R.%20Lewis&author=J.%20Yarker&author=E.%20Donaldson-Feilder&author=P.%20Flaxman&author=F.%20Munir&journal=International%20Journal%20of%20Nursing%20Studies&volume=47&issue=3&pages=307-313&publication_year=2010&doi=10.1016%2Fj.ijnurstu.2009.07.004

https://doi.org/10.1097/JAN.0000000000000173

http://scholar.google.com/scholar_lookup?title=Developing%20an%20addictions%20nursing%20competency%20framework%20within%20a%20Canadian%20context&author=S.%20Ling&author=A.%20Watson&author=M.%20Gehrs&journal=Journal%20of%20Addictions%20Nursing&volume=28&issue=3&pages=110-116&publication_year=2017&doi=10.1097%2FJAN.0000000000000173

http://scholar.google.com/scholar_lookup?title=Rethinking%20competence%20in%20the%20context%20of%20teamwork&author=L.%20Lingard&pages=42-70&publication_year=2012

https://doi.org/10.1016/j.jhin.2013.08.009

http://scholar.google.com/scholar_lookup?title=Identifying%20essential%20infection%20control%20competencies%20for%20newly%20graduated%20nurses%3A%20A%20three-phase%20study%20in%20Australia%20and%20Taiwan&author=L.%20Liu&author=J.%20Curtis&author=P.%20Crookes&journal=Journal%20of%20Hospital%20Infection&volume=86&issue=2&pages=100-109&publication_year=2014&doi=10.1016%2Fj.jhin.2013.08.009


http://scholar.google.com/scholar_lookup?title=Development%20of%20competency%20inventory%20for%20registered%20nurses%20in%20the%20People%E2%80%99s%20Republic%20of%20China%3A%20Scale%20development&author=M.%20Liu&author=W.%20Kunaiktikul&author=W.%20Senaratana&author=O.%20Tonmukayakul&author=L.%20Eriksen&journal=International%20Journal%20of%20Nursing%20Studies&volume=44&issue=5&pages=805-813&publication_year=2007&doi=10.1016%2Fj.ijnurstu.2006.01.010

https://doi.org/10.1371/journal.pone.0166252

http://scholar.google.com/scholar_lookup?title=A%20competency%20model%20for%20clinical%20physicians%20in%20China%3A%20A%20cross-sectional%20survey&author=Z.%20Liu&author=L.%20Tian&author=Q.%20Chang&author=B.%20Sun&author=Y.%20Zhao&journal=PLoS%20ONE&volume=11&issue=12&pages=e0166252-e0166252&publication_year=2016&doi=10.1371%2Fjournal.pone.0166252

https://doi.org/10.3390/ijerph110303289

http://scholar.google.com/scholar_lookup?title=Nurses%E2%80%99%20competencies%20in%20disaster%20nursing%3A%20Implications%20for%20curriculum%20development%20and%20public%20health&author=AY.%20Loke&author=OWM.%20Fung&journal=International%20journal%20of%20environmental%20research%20and%20public%20health&volume=11&issue=3&pages=3289-3303&publication_year=2014&doi=10.3390%2Fijerph110303289

https://www.wiley.com/en-ca/The%2bArt%2band%2bScience%2bof%2bCompetency%2bModels%253A%2bPinpointing%2bCritical%2bSuccess%2bFactors%2bin%2bOrganizations-p-9780787946029



http://scholar.google.com/scholar_lookup?title=The%20art%20and%20science%20of%20competency%20models%3A%20Pinpointing%20critical%20success%20factors%20in%20organizations&author=AD.%20Lucia&author=R.%20Lepsinger&publication_year=1999

http://scholar.google.com/scholar_lookup?title=The%20Macmillan%20allied%20health%20professions%20competence%20framework%20for%20those%20working%20with%20people%20affected%20by%20cancer&publication_year=2017


- 27 -

education. International Education Studies,8(8),

183. https://doi.org/10.5539/ies.v8n8p183.Google Scholar

Mansfield, R. S. (2000). Practical questions for building competency models. Communications,

1–34. Retrieved from http://workitect.performatechnologies.com/pdf/PracticalQuestions.pdf.

Marrelli, A. F., Tondora, J., & Hoge, M. A. (2005). Strategies for developing competency

models. Administration and Policy In Mental Health,32(5–6), 533–

561. https://doi.org/10.1007/s10488-005-3264-0.Google Scholar

McCallum, M., Carver, J., Dupere, D., Ganong, S., Henderson, J. D., McKim, A., et al. (2018).

Developing a palliative care competency framework for health professionals and volunteers: The

nova scotian experience. Journal of Palliative Medicine,21(7), 947–

955. https://doi.org/10.1089/jpm.2017.0655.Google Scholar

McCarthy, G., & Fitzpatrick, J. J. (2009). Development of a competency framework for nurse

managers in Ireland. The Journal of Continuing Education in Nursing,40(8), 346–

350. https://doi.org/10.3928/00220124-20090723-01.Google Scholar

Mendoza, J. (1994). If the suit doesn’t fit why wear it?’Competency-based training and health

promotion. Health Promotion Journal of Australia,4(2), 9.Google Scholar

Moaveni, A., Gallinaro, A., Conn, L., Callahan, S., Hammond, M., & Oandasan, I. (2010). A

delphi approach to developing a core competency framework for family practice registered

nurses in Ontario. Nursing Leadership, 23(4), 45–60.Google Scholar

Moher, D., Liberati, A., Tetzlaff, J., Altman, DG., & The PRISMA Group. (2009). Preferred

reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS

Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed1000097.Google Scholar

Mills, C., & Pritchard, T. (2004). A competency framework for nurses in specialist

roles. Nursing Times,26(43), 28–29.Google Scholar

Moerkamp, T., & Onstenk, J. (1991). From profession to training: An inventory of procedures

for the development of competency profiles. Referenced in van der Klink and Boon, 2002

(original in Dutch).Google Scholar

Moher, D., Schulz, K. F., Simera, I., & Altman, D. G. (2010). Guidance for developers of health

research reporting guidelines. PLoS Medicine, 7(2), e1000217.Google Scholar

Morrison, A., Polisena, J., Husereau, D., Moulton, K., Clark, M., Fiander, M., et al. (2012). The

effect of English-language restriction on systematic review-based meta-analyses: A systematic

review of empirical studies. International Journal of Technology Assessment in Health

Care,28(2), 138–144. https://doi.org/10.1017/S0266462312000086.Google Scholar

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., Mcarthur, A., & Aromataris, E. (2018).

Systematic review or scoping review ? Guidance for authors when choosing between a

systematic or scoping review approach, 1–7.Google Scholar

Myers, J., Krueger, P., Webster, F., Downar, J., Herx, L., Jeney, C., et al. (2015). Development

and validation of a set of palliative medicine entrustable professional activities: Findings from a

mixed methods study. Journal of Palliative Medicine,18(8), 682–

690. https://doi.org/10.1089/jpm.2014.0392.Google Scholar

https://doi.org/10.1007/s10459-019-09946-w

https://doi.org/10.5539/ies.v8n8p183

http://scholar.google.com/scholar_lookup?title=Theory%20and%20practice%20of%20competency-based%20approach%20in%20education&author=AT.%20Makulova&author=GM.%20Alimzhanova&author=ZM.%20Bekturganova&author=ZA.%20Umirzakova&author=LT.%20Makulova&author=KM.%20Karymbayeva&journal=International%20Education%20Studies&volume=8&issue=8&pages=183&publication_year=2015&doi=10.5539%2Fies.v8n8p183

http://workitect.performatechnologies.com/pdf/PracticalQuestions.pdf

https://doi.org/10.1007/s10488-005-3264-0

http://scholar.google.com/scholar_lookup?title=Strategies%20for%20developing%20competency%20models&author=AF.%20Marrelli&author=J.%20Tondora&author=MA.%20Hoge&journal=Administration%20and%20Policy%20In%20Mental%20Health&volume=32&issue=5%E2%80%936&pages=533-561&publication_year=2005&doi=10.1007%2Fs10488-005-3264-0

https://doi.org/10.1089/jpm.2017.0655

http://scholar.google.com/scholar_lookup?title=Developing%20a%20palliative%20care%20competency%20framework%20for%20health%20professionals%20and%20volunteers%3A%20The%20nova%20scotian%20experience&author=M.%20McCallum&author=J.%20Carver&author=D.%20Dupere&author=S.%20Ganong&author=JD.%20Henderson&author=A.%20McKim&journal=Journal%20of%20Palliative%20Medicine&volume=21&issue=7&pages=947-955&publication_year=2018&doi=10.1089%2Fjpm.2017.0655

https://doi.org/10.3928/00220124-20090723-01

http://scholar.google.com/scholar_lookup?title=Development%20of%20a%20competency%20framework%20for%20nurse%20managers%20in%20Ireland&author=G.%20McCarthy&author=JJ.%20Fitzpatrick&journal=The%20Journal%20of%20Continuing%20Education%20in%20Nursing&volume=40&issue=8&pages=346-350&publication_year=2009&doi=10.3928%2F00220124-20090723-01

http://scholar.google.com/scholar_lookup?title=If%20the%20suit%20doesn%E2%80%99t%20fit%20why%20wear%20it%3F%E2%80%99Competency-based%20training%20and%20health%20promotion&author=J.%20Mendoza&journal=Health%20Promotion%20Journal%20of%20Australia&volume=4&issue=2&pages=9&publication_year=1994

http://scholar.google.com/scholar_lookup?title=A%20delphi%20approach%20to%20developing%20a%20core%20competency%20framework%20for%20family%20practice%20registered%20nurses%20in%20Ontario&author=A.%20Moaveni&author=A.%20Gallinaro&author=L.%20Conn&author=S.%20Callahan&author=M.%20Hammond&author=I.%20Oandasan&journal=Nursing%20Leadership&volume=23&issue=4&pages=45-60&publication_year=2010

https://doi.org/10.1371/journal.pmed1000097

http://scholar.google.com/scholar_lookup?title=Preferred%20Reporting%20Items%20for%20Systematic%20Reviews%20and%20Meta-Analyses%3A%20The%20PRISMA%20Statement&author=D.%20Moher&author=A.%20Liberati&author=J.%20Tetzlaff&author=DG.%20Altman&journal=PLoS%20Medicine&volume=6&issue=7&pages=e1000097&publication_year=2009&doi=10.1371%2Fjournal.pmed1000097

http://scholar.google.com/scholar_lookup?title=A%20competency%20framework%20for%20nurses%20in%20specialist%20roles&author=C.%20Mills&author=T.%20Pritchard&journal=Nursing%20Times&volume=26&issue=43&pages=28-29&publication_year=2004

https://scholar.google.com/scholar?q=Moerkamp%2C%20T.%2C%20%26%20Onstenk%2C%20J.%20%281991%29.%20From%20profession%20to%20training%3A%20An%20inventory%20of%20procedures%20for%20the%20development%20of%20competency%20profiles.%20Referenced%20in%20van%20der%20Klink%20and%20Boon%2C%202002%20%28original%20in%20Dutch%29.

http://scholar.google.com/scholar_lookup?title=Guidance%20for%20developers%20of%20health%20research%20reporting%20guidelines&author=D.%20Moher&author=KF.%20Schulz&author=I.%20Simera&author=DG.%20Altman&journal=PLoS%20Medicine&volume=7&issue=2&pages=e1000217&publication_year=2010

https://doi.org/10.1017/S0266462312000086

http://scholar.google.com/scholar_lookup?title=The%20effect%20of%20English-language%20restriction%20on%20systematic%20review-based%20meta-analyses%3A%20A%20systematic%20review%20of%20empirical%20studies&author=A.%20Morrison&author=J.%20Polisena&author=D.%20Husereau&author=K.%20Moulton&author=M.%20Clark&author=M.%20Fiander&journal=International%20Journal%20of%20Technology%20Assessment%20in%20Health%20Care&volume=28&issue=2&pages=138-144&publication_year=2012&doi=10.1017%2FS0266462312000086

https://scholar.google.com/scholar?q=Munn%2C%20Z.%2C%20Peters%2C%20M.%20D.%20J.%2C%20Stern%2C%20C.%2C%20Tufanaru%2C%20C.%2C%20Mcarthur%2C%20A.%2C%20%26%20Aromataris%2C%20E.%20%282018%29.%20Systematic%20review%20or%20scoping%20review%E2%80%AF%3F%20Guidance%20for%20authors%20when%20choosing%20between%20a%20systematic%20or%20scoping%20review%20approach%2C%201%E2%80%937.

https://doi.org/10.1089/jpm.2014.0392

http://scholar.google.com/scholar_lookup?title=Development%20and%20validation%20of%20a%20set%20of%20palliative%20medicine%20entrustable%20professional%20activities%3A%20Findings%20from%20a%20mixed%20methods%20study&author=J.%20Myers&author=P.%20Krueger&author=F.%20Webster&author=J.%20Downar&author=L.%20Herx&author=C.%20Jeney&journal=Journal%20of%20Palliative%20Medicine&volume=18&issue=8&pages=682-690&publication_year=2015&doi=10.1089%2Fjpm.2014.0392


- 28 -

National Physiotherapy Advisory Group. (2017). Competency Profile for Physiotherapists in

Canada. National Physiotherapy Advisory Group.Google Scholar

Palermo, C., Capra, S., Beck, E. J., Dart, J., Conway, J., & Ash, S. (2017). Development of

advanced practice competency standards for dietetics in Australia. Nutrition and Dietetics,74(4),

327–333. https://doi.org/10.1111/1747-0080.12338.Google Scholar

Palermo, C., Conway, J., Beck, E. J., Dart, J., Capra, S., & Ash, S. (2016). Methodology for

developing competency standards for dietitians in Australia. Nursing and Health Sciences,18(1),

130–137. https://doi.org/10.1111/nhs.12247.Google Scholar

Parkinson’s UK. (2016). Competencies: A competency framework for nurses working in

Parkinson’s disease management 3rd edition. Royal College of Nursing, PDNSA. London:

Parkinson’s UK. https://doi.org/10.4137/nmi.s29530.Google Scholar

Patterson, F., Ferguson, E., Lane, P., Farrell, K., Martlew, J., & Wells, A. (2000). A competency

model for general practice: Implications for selection, training, and development. British Journal

of General Practice,50(452), 188–193. https://doi.org/10.3399/bjgp13X667196.Google Scholar

Redwood-Campbell, L., Pakes, B., Rouleau, K., MacDonald, C. J., Arya, N., Purkey, E., et al.

(2011). Developing a curriculum framework for global health in family medicine: Emerging

principles, competencies, and educational approaches. BMC Medical

Education, 11(1). https://doi.org/10.1186/1472-6920-11-46.

Reetoo, K. N., Harrington, J. M., & Macdonald, E. B. (2005). Required competencies of

occupational physicians: A Delphi survey of UK customers. Occupational and Environmental

Medicine,62(6), 406–413. https://doi.org/10.1136/oem.2004.017061.Google Scholar

Ritchie, J., & Spencer, L. (2002). Qualitative data analysis for applied policy research. In A.

Huberman & M. Miles (Eds.), The Qualitative Researcher’s Companion (pp. 305–329).

Thousand Oaks: SAGE Publications Inc.Google Scholar

Roe, R. (2002). What makes a competent psychologist? European Psychologist,7(3), 192–

202. https://doi.org/10.1027//1016-9040.7.3.192.Google Scholar

Santy, J., Rogers, J., Davis, P., Jester, R., Kneale, J., Knight, C., et al. (2005). A competency

framework for orthopaedic and trauma nursing. Journal of Orthopaedic Nursing,9(2), 81–

86. https://doi.org/10.1016/j.joon.2005.02.003.Google Scholar

Shaughnessy, A. F., Sparks, J., Cohen-Osher, M., Goodell, K. H., Sawin, G. L., & Gravel, J.

(2013). Entrustable professional activities in family medicine. Journal of Graduate Medical

Education,5(1), 112–118. https://doi.org/10.4300/JGME-D-12-00034.1.Google Scholar

Sherbino, J., Frank, J. R., & Snell, L. (2014). Defining the key roles and competencies of the

clinician-educator of the 21st century: A national mixed-methods study. Academic

Medicine,89(5), 783–789. https://doi.org/10.1097/ACM.0000000000000217.Google Scholar

Shilton, T., Howat, P., James, R., & Lower, T. (2001). Health promotion workforce development

and health promotion workforce competency in Australia. Health Promotion Journal of

Australia,12(2), 117–123.Google Scholar

Simera, I., Altman, D. G., Moher, D., Schulz, K. F., & Hoey, J. (2008). Guidelines for reporting

health research: The EQUATOR network’s survey of guideline authors. PLoS Medicine, 5(6),

869–874. https://doi.org/10.1371/journal.pmed.0050139.Google Scholar

https://doi.org/10.1007/s10459-019-09946-w

https://scholar.google.com/scholar?q=National%20Physiotherapy%20Advisory%20Group.%20%282017%29.%20Competency%20Profile%20for%20Physiotherapists%20in%20Canada.%20National%20Physiotherapy%20Advisory%20Group.

https://doi.org/10.1111/1747-0080.12338

http://scholar.google.com/scholar_lookup?title=Development%20of%20advanced%20practice%20competency%20standards%20for%20dietetics%20in%20Australia&author=C.%20Palermo&author=S.%20Capra&author=EJ.%20Beck&author=J.%20Dart&author=J.%20Conway&author=S.%20Ash&journal=Nutrition%20and%20Dietetics&volume=74&issue=4&pages=327-333&publication_year=2017&doi=10.1111%2F1747-0080.12338

https://doi.org/10.1111/nhs.12247

http://scholar.google.com/scholar_lookup?title=Methodology%20for%20developing%20competency%20standards%20for%20dietitians%20in%20Australia&author=C.%20Palermo&author=J.%20Conway&author=EJ.%20Beck&author=J.%20Dart&author=S.%20Capra&author=S.%20Ash&journal=Nursing%20and%20Health%20Sciences&volume=18&issue=1&pages=130-137&publication_year=2016&doi=10.1111%2Fnhs.12247

https://doi.org/10.4137/nmi.s29530

http://scholar.google.com/scholar_lookup?title=Article%20Commentary%3A%20The%20Influence%20of%20Early%20Infant-Feeding%20Practices%20on%20the%20Intestinal%20Microbiome%20and%20Body%20Composition%20in%20Infants&author=Aifric.%20O%27Sullivan&author=Marie.%20Farver&author=Jennifer%20T..%20Smilowitz&journal=Nutrition%20and%20Metabolic%20Insights&volume=8s1&pages=NMI.S29530&publication_year=2015

https://doi.org/10.3399/bjgp13X667196

http://scholar.google.com/scholar_lookup?title=A%20competency%20model%20for%20general%20practice%3A%20Implications%20for%20selection%2C%20training%2C%20and%20development&author=F.%20Patterson&author=E.%20Ferguson&author=P.%20Lane&author=K.%20Farrell&author=J.%20Martlew&author=A.%20Wells&journal=British%20Journal%20of%20General%20Practice&volume=50&issue=452&pages=188-193&publication_year=2000&doi=10.3399%2Fbjgp13X667196

https://doi.org/10.1186/1472-6920-11-46

https://doi.org/10.1136/oem.2004.017061

http://scholar.google.com/scholar_lookup?title=Required%20competencies%20of%20occupational%20physicians%3A%20A%20Delphi%20survey%20of%20UK%20customers&author=KN.%20Reetoo&author=JM.%20Harrington&author=EB.%20Macdonald&journal=Occupational%20and%20Environmental%20Medicine&volume=62&issue=6&pages=406-413&publication_year=2005&doi=10.1136%2Foem.2004.017061

http://scholar.google.com/scholar_lookup?title=Qualitative%20data%20analysis%20for%20applied%20policy%20research&author=J.%20Ritchie&author=L.%20Spencer&pages=305-329&publication_year=2002

https://doi.org/10.1027/1016-9040.7.3.192

http://scholar.google.com/scholar_lookup?title=What%20makes%20a%20competent%20psychologist%3F&author=R.%20Roe&journal=European%20Psychologist&volume=7&issue=3&pages=192-202&publication_year=2002&doi=10.1027%2F%2F1016-9040.7.3.192

https://doi.org/10.1016/j.joon.2005.02.003

http://scholar.google.com/scholar_lookup?title=A%20competency%20framework%20for%20orthopaedic%20and%20trauma%20nursing&author=J.%20Santy&author=J.%20Rogers&author=P.%20Davis&author=R.%20Jester&author=J.%20Kneale&author=C.%20Knight&journal=Journal%20of%20Orthopaedic%20Nursing&volume=9&issue=2&pages=81-86&publication_year=2005&doi=10.1016%2Fj.joon.2005.02.003

https://doi.org/10.4300/JGME-D-12-00034.1

http://scholar.google.com/scholar_lookup?title=Entrustable%20professional%20activities%20in%20family%20medicine&author=AF.%20Shaughnessy&author=J.%20Sparks&author=M.%20Cohen-Osher&author=KH.%20Goodell&author=GL.%20Sawin&author=J.%20Gravel&journal=Journal%20of%20Graduate%20Medical%20Education&volume=5&issue=1&pages=112-118&publication_year=2013&doi=10.4300%2FJGME-D-12-00034.1

https://doi.org/10.1097/ACM.0000000000000217

http://scholar.google.com/scholar_lookup?title=Defining%20the%20key%20roles%20and%20competencies%20of%20the%20clinician-educator%20of%20the%2021st%20century%3A%20A%20national%20mixed-methods%20study&author=J.%20Sherbino&author=JR.%20Frank&author=L.%20Snell&journal=Academic%20Medicine&volume=89&issue=5&pages=783-789&publication_year=2014&doi=10.1097%2FACM.0000000000000217

http://scholar.google.com/scholar_lookup?title=Health%20promotion%20workforce%20development%20and%20health%20promotion%20workforce%20competency%20in%20Australia&author=T.%20Shilton&author=P.%20Howat&author=R.%20James&author=T.%20Lower&journal=Health%20Promotion%20Journal%20of%20Australia&volume=12&issue=2&pages=117-123&publication_year=2001

https://doi.org/10.1371/journal.pmed.0050139

http://scholar.google.com/scholar_lookup?title=Guidelines%20for%20reporting%20health%20research%3A%20The%20EQUATOR%20network%E2%80%99s%20survey%20of%20guideline%20authors&author=I.%20Simera&author=DG.%20Altman&author=D.%20Moher&author=KF.%20Schulz&author=J.%20Hoey&journal=PLoS%20Medicine&volume=5&issue=6&pages=869-874&publication_year=2008&doi=10.1371%2Fjournal.pmed.0050139


- 29 -

Simera, I., Moher, D., Hirst, A., Hoey, J., Schulz, K. F., & Altman, D. G. (2010). Transparent

and accurate reporting increases reliability, utility, and impact of your research: reporting

guidelines and the EQUATOR Network. BMC Medicine, 8(1), 24. https://doi.org/10.1186/1741-

7015-8-24.Google Scholar

Skirton, H., Lewis, C., Kent, A., & Coviello, D. A. (2010). Genetic education and the challenge

of genomic medicine: Development of core competences to support preparation of health

professionals in Europe. European Journal of Human Genetics,18(9), 972–

977. https://doi.org/10.1038/ejhg.2010.64.Google Scholar

Smythe, A., Jenkins, C., Bentham, P., & Oyebode, J. (2014). Development of a competency

framework for a specialist dementia service. Journal of Mental Health Training, Education and

Practice,9(1), 59–68. https://doi.org/10.1108/JMHTEP-08-2012-0024.Google Scholar

Sousa, J. M., & Alves, E. D. (2015). Nursing competencies for palliative care in home

care. ACTA Paulista de Enfermagem,28(3), 264–269. https://doi.org/10.1590/1982-

0194201500044.Google Scholar

Spencer, L., & Spencer, S. (1993). Competence at work. New York: Wiley.Google Scholar

Stucky, E. R., Ottolini, M. C., & Maniscalco, J. (2010). Pediatric hospital medicine core

competencies: Development and methodology. Journal of Hospital Medicine,5(6), 339–

343. https://doi.org/10.1002/jhm.774.Google Scholar

Swing, S. R. (2007). The ACGME outcome project: Retrospective and prospective. Medical

Teacher,29(7), 648–654. https://doi.org/10.1080/01421590701392903.Google Scholar

Tangayi, S., Anionwu, E., Westerdale, N., & Johnson, K. (2011). A skills framework for sickle

cell disease and thalassaemia. Nurs Times, 107(41), 12–13.Google Scholar

Tavares, W., Bowles, R., & Donelon, B. (2016). Informing a Canadian paramedic profile:

Framing concepts, roles and crosscutting themes. BMC Health Services Research,16(1), 1–

16. https://doi.org/10.1186/s12913-016-1739-1.Google Scholar

ten Cate, O. (2005). Entrustability of professional activities and competency-based

training. Medical Education,39(12), 1176–1177. https://doi.org/10.1111/j.1365-


ten Cate, O., & Scheele, F. (2007). Competency-based postgraduate training: Can we bridge the

gap between theory and clinical practice? Academic Medicine: Journal of the Association of

American Medical Colleges,82(6), 542–

547. https://doi.org/10.1097/ACM.0b013e31805559c7.Google Scholar

Toussaint. (2009). False god (Wikipedia page). Retrieved May 30, 2019

from https://en.wikipedia.org/wiki/False_god.

Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., et al. (2018).

PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of

Internal Medicine. https://doi.org/10.7326/M18-0850.Google Scholar

Tsaroucha, A., Benbow, S. M., Kingston, P., & Le Mesurier, N. (2013). Dementia skills for all:

A core competency framework for the workforce in the United Kingdom. Dementia,12(1), 29–


https://doi.org/10.1007/s10459-019-09946-w

https://doi.org/10.1186/1741-7015-8-24

https://doi.org/10.1186/1741-7015-8-24

http://scholar.google.com/scholar_lookup?title=Transparent%20and%20accurate%20reporting%20increases%20reliability%2C%20utility%2C%20and%20impact%20of%20your%20research%3A%20reporting%20guidelines%20and%20the%20EQUATOR%20Network&author=I.%20Simera&author=D.%20Moher&author=A.%20Hirst&author=J.%20Hoey&author=KF.%20Schulz&author=DG.%20Altman&journal=BMC%20Medicine&volume=8&issue=1&pages=24&publication_year=2010&doi=10.1186%2F1741-7015-8-24

https://doi.org/10.1038/ejhg.2010.64

http://scholar.google.com/scholar_lookup?title=Genetic%20education%20and%20the%20challenge%20of%20genomic%20medicine%3A%20Development%20of%20core%20competences%20to%20support%20preparation%20of%20health%20professionals%20in%20Europe&author=H.%20Skirton&author=C.%20Lewis&author=A.%20Kent&author=DA.%20Coviello&journal=European%20Journal%20of%20Human%20Genetics&volume=18&issue=9&pages=972-977&publication_year=2010&doi=10.1038%2Fejhg.2010.64

https://doi.org/10.1108/JMHTEP-08-2012-0024

http://scholar.google.com/scholar_lookup?title=Development%20of%20a%20competency%20framework%20for%20a%20specialist%20dementia%20service&author=A.%20Smythe&author=C.%20Jenkins&author=P.%20Bentham&author=J.%20Oyebode&journal=Journal%20of%20Mental%20Health%20Training%2C%20Education%20and%20Practice&volume=9&issue=1&pages=59-68&publication_year=2014&doi=10.1108%2FJMHTEP-08-2012-0024

https://doi.org/10.1590/1982-0194201500044

https://doi.org/10.1590/1982-0194201500044

http://scholar.google.com/scholar_lookup?title=Nursing%20competencies%20for%20palliative%20care%20in%20home%20care&author=JM.%20Sousa&author=ED.%20Alves&journal=ACTA%20Paulista%20de%20Enfermagem&volume=28&issue=3&pages=264-269&publication_year=2015&doi=10.1590%2F1982-0194201500044

http://scholar.google.com/scholar_lookup?title=Competence%20at%20work&author=L.%20Spencer&author=S.%20Spencer&publication_year=1993

https://doi.org/10.1002/jhm.774

http://scholar.google.com/scholar_lookup?title=Pediatric%20hospital%20medicine%20core%20competencies%3A%20Development%20and%20methodology&author=ER.%20Stucky&author=MC.%20Ottolini&author=J.%20Maniscalco&journal=Journal%20of%20Hospital%20Medicine&volume=5&issue=6&pages=339-343&publication_year=2010&doi=10.1002%2Fjhm.774

https://doi.org/10.1080/01421590701392903

http://scholar.google.com/scholar_lookup?title=The%20ACGME%20outcome%20project%3A%20Retrospective%20and%20prospective&author=SR.%20Swing&journal=Medical%20Teacher&volume=29&issue=7&pages=648-654&publication_year=2007&doi=10.1080%2F01421590701392903

https://scholar.google.com/scholar?q=Tangayi%2C%20S.%2C%20Anionwu%2C%20E.%2C%20Westerdale%2C%20N.%2C%20%26%20Johnson%2C%20K.%20%282011%29.%20A%20skills%20framework%20for%20sickle%20cell%20disease%20and%20thalassaemia.%20Nurs%20Times%2C%20107%2841%29%2C%2012%E2%80%9313.

https://doi.org/10.1186/s12913-016-1739-1

http://scholar.google.com/scholar_lookup?title=Informing%20a%20Canadian%20paramedic%20profile%3A%20Framing%20concepts%2C%20roles%20and%20crosscutting%20themes&author=W.%20Tavares&author=R.%20Bowles&author=B.%20Donelon&journal=BMC%20Health%20Services%20Research&volume=16&issue=1&pages=1-16&publication_year=2016&doi=10.1186%2Fs12913-016-1739-1

https://doi.org/10.1111/j.1365-2929.2005.02341.x

https://doi.org/10.1111/j.1365-2929.2005.02341.x

http://scholar.google.com/scholar_lookup?title=Entrustability%20of%20professional%20activities%20and%20competency-based%20training&author=O.%20Cate&journal=Medical%20Education&volume=39&issue=12&pages=1176-1177&publication_year=2005&doi=10.1111%2Fj.1365-2929.2005.02341.x

https://doi.org/10.1097/ACM.0b013e31805559c7

http://scholar.google.com/scholar_lookup?title=Competency-based%20postgraduate%20training%3A%20Can%20we%20bridge%20the%20gap%20between%20theory%20and%20clinical%20practice%3F&author=O.%20Cate&author=F.%20Scheele&journal=Academic%20Medicine%3A%20Journal%20of%20the%20Association%20of%20American%20Medical%20Colleges&volume=82&issue=6&pages=542-547&publication_year=2007&doi=10.1097%2FACM.0b013e31805559c7

https://en.wikipedia.org/wiki/False_god

https://doi.org/10.7326/M18-0850

http://scholar.google.com/scholar_lookup?title=PRISMA%20extension%20for%20scoping%20reviews%20%28PRISMA-ScR%29%3A%20Checklist%20and%20explanation&author=AC.%20Tricco&author=E.%20Lillie&author=W.%20Zarin&author=KK.%20O%E2%80%99Brien&author=H.%20Colquhoun&author=D.%20Levac&journal=Annals%20of%20Internal%20Medicine&publication_year=2018&doi=10.7326%2FM18-0850

https://doi.org/10.1177/1471301211416302

http://scholar.google.com/scholar_lookup?title=Dementia%20skills%20for%20all%3A%20A%20core%20competency%20framework%20for%20the%20workforce%20in%20the%20United%20Kingdom&author=A.%20Tsaroucha&author=SM.%20Benbow&author=P.%20Kingston&author=N.%20Mesurier&journal=Dementia&volume=12&issue=1&pages=29-44&publication_year=2013&doi=10.1177%2F1471301211416302


- 30 -

Underwood, M., Robertson, S., Clark, R., Crowder, K., Dunn, S., Lawson, D., et al. (1996). The

emergence of competency standards for specialist critical care nurses. Australian Critical Care:

Official Journal of the Confederation of Australian Critical Care Nurses,9(2), 68–

71. https://doi.org/10.1016/S1036-7314(96)70355-7.Google Scholar

van der Klink, M., & Boon, J. (2002). The investigation of competencies within professional

domains. Human Resource Development International,5(4), 411–


Varpio, L., Bell, R., Hollingworth, G., Jalali, A., Haidet, P., Levine, R., et al. (2012). Is

transferring an educational innovation actually a process of transformation? Advances in Health

Sciences Education,17(3), 357–367. https://doi.org/10.1007/s10459-011-9313-4.Google Scholar

Whiddett, S., & Hollyforde, S. (1999). The competencies handbook. London: Institute of

Personnel and Development.Google Scholar

Whiddett, S., & Hollyforde, S. (2003). A practical guide to competencies: How to enhance

individual and organisational performance. London: Chartered Institute of Personnel and

Development.Google Scholar

Winter, R., & Maisch, M. (2005). Professional Competence And Higher Education: The ASSET

Programme. Routledge.Google Scholar

Wölfel, T., Beltermann, E., Lottspeich, C., Vietz, E., Fischer, M. R., & Schmidmaier, R. (2016).

Medical ward round competence in internal medicine - An interview study towards an

interprofessional development of an Entrustable Professional Activity (EPA). BMC Medical

Education,16(1), 1–10. https://doi.org/10.1186/s12909-016-0697-y.Google Scholar

World Health Organization. (2005). Preparing a health care workforce for the 21st century: The

challenge of chronic conditions. Geneva: Switzerland.Google Scholar

Yates, P., Evans, A., Moore, A., Heartfield, M., Gibson, T., & Luxford, K. (2007). Competency

standards and educational requirements for specialist breast nurses in Australia. Collegian (Royal

College of Nursing, Australia),14(1), 11–15. https://doi.org/10.1016/S1322-7696(08)60542-

9.Google Scholar

https://doi.org/10.1007/s10459-019-09946-w

https://doi.org/10.1016/S1036-7314(96)70355-7

http://scholar.google.com/scholar_lookup?title=The%20emergence%20of%20competency%20standards%20for%20specialist%20critical%20care%20nurses&author=M.%20Underwood&author=S.%20Robertson&author=R.%20Clark&author=K.%20Crowder&author=S.%20Dunn&author=D.%20Lawson&journal=Australian%20Critical%20Care%3A%20Official%20Journal%20of%20the%20Confederation%20of%20Australian%20Critical%20Care%20Nurses&volume=9&issue=2&pages=68-71&publication_year=1996&doi=10.1016%2FS1036-7314%2896%2970355-7

https://doi.org/10.1080/13678860110059384

http://scholar.google.com/scholar_lookup?title=The%20investigation%20of%20competencies%20within%20professional%20domains&author=M.%20Klink&author=J.%20Boon&journal=Human%20Resource%20Development%20International&volume=5&issue=4&pages=411-424&publication_year=2002&doi=10.1080%2F13678860110059384

https://doi.org/10.1007/s10459-011-9313-4

http://scholar.google.com/scholar_lookup?title=Is%20transferring%20an%20educational%20innovation%20actually%20a%20process%20of%20transformation%3F&author=L.%20Varpio&author=R.%20Bell&author=G.%20Hollingworth&author=A.%20Jalali&author=P.%20Haidet&author=R.%20Levine&author=G.%20Regehr&journal=Advances%20in%20Health%20Sciences%20Education&volume=17&issue=3&pages=357-367&publication_year=2012&doi=10.1007%2Fs10459-011-9313-4

http://scholar.google.com/scholar_lookup?title=The%20competencies%20handbook&author=S.%20Whiddett&author=S.%20Hollyforde&publication_year=1999

http://scholar.google.com/scholar_lookup?title=A%20practical%20guide%20to%20competencies%3A%20How%20to%20enhance%20individual%20and%20organisational%20performance&author=S.%20Whiddett&author=S.%20Hollyforde&publication_year=2003

https://scholar.google.com/scholar?q=Winter%2C%20R.%2C%20%26%20Maisch%2C%20M.%20%282005%29.%20Professional%20Competence%20And%20Higher%20Education%3A%20The%20ASSET%20Programme.%20Routledge.

https://doi.org/10.1186/s12909-016-0697-y

http://scholar.google.com/scholar_lookup?title=Medical%20ward%20round%20competence%20in%20internal%20medicine%20-%20An%20interview%20study%20towards%20an%20interprofessional%20development%20of%20an%20Entrustable%20Professional%20Activity%20%28EPA%29&author=T.%20W%C3%B6lfel&author=E.%20Beltermann&author=C.%20Lottspeich&author=E.%20Vietz&author=MR.%20Fischer&author=R.%20Schmidmaier&journal=BMC%20Medical%20Education&volume=16&issue=1&pages=1-10&publication_year=2016&doi=10.1186%2Fs12909-016-0697-y

http://scholar.google.com/scholar_lookup?title=Preparing%20a%20health%20care%20workforce%20for%20the%2021st%20century%3A%20The%20challenge%20of%20chronic%20conditions&publication_year=2005

https://doi.org/10.1016/S1322-7696(08)60542-9

https://doi.org/10.1016/S1322-7696(08)60542-9

http://scholar.google.com/scholar_lookup?title=Competency%20standards%20and%20educational%20requirements%20for%20specialist%20breast%20nurses%20in%20Australia&author=P.%20Yates&author=A.%20Evans&author=A.%20Moore&author=M.%20Heartfield&author=T.%20Gibson&author=K.%20Luxford&journal=Collegian%20%28Royal%20College%20of%20Nursing%2C%20Australia%29&volume=14&issue=1&pages=11-15&publication_year=2007&doi=10.1016%2FS1322-7696%2808%2960542-9

Appendix I

1

Table 1A. Search terms, dates, and number of results by database.

Database Medline CINAHL PSYCINFO EMBASE Scopus ERIC Search term

1. competenc*.ti,ab. 2 Clinical Competence/ or Competency-Based Education/ 3 Professional Competence/st [Standards] 4 capabilit*.ti,ab. 5 Education, Professional/st [Standards] 6 milestone*.ti,ab. 7 "entrustable professional activity".ti,ab. 8 framework.ti. 9 Models, Educational/ 10 profile.ti. 11 standard.ti. 12 Allied Health Personnel/ed, st [Education, Standards] 13 NURSES/ed, st [Education, Standards] 14 NURSING/ed, st [Education, Standards] 15 EDUCATION, NURSING/ed, st [Education, Standards]

S22 AND S23 AND S24 S19 OR S20 OR S21 S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 (MH "Physicians/ED/ST") (MH "Nurses/ED/ST") OR (MH "Health Personnel/ED") (MH "Allied Health Personnel/ED") OR (MH "Allied Health Professions/ED/ST") OR (MH "Specialties, Allied Health/ED/ST") AB standard TI standard AB profile TI profile (MH "Models, Educational/ED/ST") AB framework TI framework (MH "Conceptual Framework/ED/ST") AB "entrustable professional activity" TI "entrustable professional activity"

1 competenc*.ti,ab. 2 Clinical Competence.ti,ab. 3 Professional Competence.ti,ab. 4 capabilit*.ti,ab. 5 milestone*.ti,ab. 6 "entrustable professional activity".ti,ab. 7 framework.ti. 8 "model".ti. 9 profile.ti. 10 standard.ti. 11 "allied health personnel".ti,ab. 12 nurses.ti,ab. 13 nursing.ti,ab. 14 medicine.ti,ab. 15 "allied health occupations".ti,ab. 16 1 or 2 or 3 or 4 or 5 or 6 17 7 or 8 or 9 or 10 18 11 or 12 or 13 or 14 or 15 19 16 and 17 and 18

1 competenc*.ti,ab. 2 Clinical Competence.ti,ab. 3 Professional Competence.ti,ab. 4 capabilit*.ti,ab. 5 milestone*.ti,ab. 6 "entrustable professional activity".ti,ab. 7 framework.ti. 8 "model".ti. 9 profile.ti. 10 standard.ti. 11 "allied health personnel".ti,ab. 12 nurses.ti,ab. 13 nursing.ti,ab. 14 medicine.ti,ab. 15 "allied health occupations".ti,ab. 16 1 or 2 or 3 or 4 or 5 or 6 17 7 or 8 or 9 or 10 18 11 or 12 or 13 or 14 or 15 19 16 and 17 and 18

( TITLE-ABS ( competency OR competency OR capability OR capabilities OR milestones OR "entrustable professional activity" ) ) AND ( TITLE-ABS ( framework OR model OR profile OR standard ) ) AND ( TITLE-ABS ( nurse OR nursing OR physician OR "allied health" OR paramedic OR "emergency medical technician" OR "EMS" OR "EMT" ) ) AND ( LIMIT-TO ( SUBJAREA , "MEDI " ) OR LIMIT-TO ( SUBJAREA , "NURS " ) OR LIMIT-TO (

((noft(competenc*) OR noft(capabilit*) OR noft(milestone*) OR noft(abilit*) OR noft("entrustable professional activity")) AND (noft(framework) OR noft(model) OR noft(profile) OR noft(standard)) AND (noft(nurs*) OR noft(medicine) OR noft(physician) OR noft("allied health professional") OR noft("allied health personnel"))) AND (la.exact("ENG") AND yr(1970-2019))

Appendix I

2

16 exp MEDICINE/ed, st [Education, Standards] 17 Allied Health Occupations/ed, st [Education, Standards] 18 Health Personnel/ed, st [Education, Standards] 19 1 or 2 or 3 or 4 or 5 or 6 or 7 20 8 or 9 or 10 or 11 21 12 or 13 or 14 or 15 or 16 or 17 or 18 22 19 and 20 and 21

AB milestone* TI milestone* (MH "Education, Health Sciences/ED/ST") AB capabilit* TI capabilit* (MH "Education, Competency-Based/ED/ST") OR (MH "Professional Competence/ED/ST") OR (MH "Clinical Competence/ED/ST") AB competenc* TI competenc*

SUBJAREA , "HEAL " ) OR LIMIT-TO ( SUBJAREA , "DENT " ) ) AND ( LIMIT-TO ( DOCTYPE , "ar " ) OR LIMIT-TO ( DOCTYPE , "re " ) OR LIMIT-TO ( DOCTYPE , "ch " ) OR LIMIT-TO ( DOCTYPE , "bk " ) ) AND ( LIMIT-TO ( LANGUAGE , "English " ) )

Search Date

24/08/18 27/08/18 25/08/18 27/08/18 02/08/18 24/08/18

No of Results

1039 139 2012 1014 3579 1267

Appendix I

3

Table 2A. Search terms, dates, and number of results – grey literature resources

Resource Greylit.org Trove Google Scholar Search term Clinical competence

Competency-Based Education Professional Competence Education, Professional Models, Educational Allied Health Personnel Nurse, competency Nursing, competency Education, nursing Allied Health Occupations Health Personnel competency framework competency model

(competency, OR competencies, OR capability, OR capabilities, OR milestone, OR milestones, OR ability, OR abilities, OR entrustable) (framework, OR model, OR profile, OR standard, OR modelling) (paramedic, OR nurse, OR nursing, OR physician, OR allied OR health)

(competency OR competencies OR capabilities OR milestone OR "entrustable professional activity)(framework OR model OR profile OR standard)(nurse OR nursing OR physician OR paramedic OR "emergency medical technician" OR "allied health" OR "medical")

Search Date 01/08/18 02/08/18 02/08/18

No of Results 31 142 First 1000 reviewed (out of 25,900)

Appendix II

Table 3A. Coding template with example

NGT = nominal group technique; DACUM = ‘Develop a curriculum’

Lea

d au

thor

Yea

r

Loc

atio

n

Stud

y po

pula

tion

Spec

ialty

Stud

y ob

ject

ive

Lite

ratu

re r

evie

w

Map

ping

pro

cess

Surv

e y

Gro

u p te

chni

que

Del

phi

Del

phi r

ound

s

Con

fere

nce/

wor

ksho

p N

GT

D

AC

UM

St

akeh

olde

r de

liber

atio

n

Inte

rvie

ws

Prac

tice

anal

ysis

Fo

cus G

roup

s C

ount

of m

etho

ds

Out

com

es

Cicutto 2017 USA Nursing School nursing

The purpose of this article is to describe the development and application of a competency-based framework, which was subsequently used to develop and pilot a continuing education curriculum for school nurses

The lens of two conceptual frameworks, the National Asthma Educator Certification Board, Certified Asthma Educator competency framework and the healthy learner model were used to inform the development of our competency-based asthma care in school settings framework

A modified Delphi was used to inform the development of the Colorado competency framework.

3 The selection of panellist members... included school health leaders, regional school health nurse consultants, chronic disease school nurse specialists, school nurses, UAP, school secretaries, and asthma specialists; and nurse practitioner, physician assistant, medical assistants, and certified asthma educators with experience working in school settings

5 The end product of the modified Delphi, described above, was the development of the Colorado Competency Framework for Asthma Care in Schools. This framework was used to develop and pilot a curriculum to support the attainment of minimum competencies for school nurses.

Appendix III

1

Citations for included studies

Ablah, E., Biberman, D. A., Weist, E. M., Buekens, P., Bentley, M. E., Burke, D., et al. (2014). Improving global health education: Development of a global health competency model. American Journal of Tropical Medicine and Hygiene, 90(3), 560–565. doi:10.4269/ajtmh.13-0537

Akbar, H., Hill, P. S., Rotem, A., Riley, I. D., Zwi, A. B., Marks, G. C., & Mark, T. (2005). Identifying competencies for Australian health professionals working in international health. Asia-Pacific Journal of Public Health, 17(2), 99–103. doi:10.1177/101053950501700207

Alfieri, E., Alebbi, A., Bedini, M. G., Boni, L., & Foà, C. (2017). Mapping the nursing competences in neonatology: a qualitative research. Acta bio-medica : Atenei Parmensis, 88(3–S), 51–58. doi:10.23750/abm.v88i3-S.6614

Ali, A. M. (2012). Pharmacist prescribing in the Australian context: development and validation of competency standards and identification of pharmacists’ educational needs. Monash University. Retrieved from https://trove.nla.gov.au/work/186453738

AlShammari, T., Jennings, P. A., & Williams, B. (2018). Emergency medical services core competencies: A scoping review. Health Professions Education. doi:10.1016/j.hpe.2018.03.009

Ambuel, B., Trent, K., Lenahan, P., Cronholm, P., Downing, D., Jelley, M., et al. (2011). Competencies Needed by Health Professionals for Addressing Exposure to Violence and Abuse in Patient Care. Eden Prairie, MN.

Amendola, M. L. (2008). An examination of the leadership competency requirements of nurse leaders in healthcare information technology. ProQuest Information & Learning US, US. Retrieved from http://media.proquest.com/media/pq/classic/doc/1674957421/fmt/ai/rep/NPDF?hl=information,information,for,for,nurses,nurse,nurses,nurse&cit:auth=Amendola,+Mark+Lawrence

Anderson, R. O. (2016). Assessing Nurse Manager Competencies in a Military Hospital. ProQuest Dissertations and Theses. ProQuest Information & Learning US, US. Retrieved from http://primo-pmtna01.hosted.exlibrisgroup.com/openurl/01WMU/01WMU_SERVICES??url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&genr

Ash, S., Gonczi, A., & Hager, P. (1992). Combining Research Methodologies to Develop Competency-Based Standards for Dietitians: A Case Study for the Professions. Canberra.

Aylward, M., Nixon, J., & Gladding, S. (2014). An entrustable professional activity (epa) for handoffs as a model for epa assessment development. Academic Medicine, 89(10), 1335–1340. doi:10.1097/ACM.0000000000000317

Baldwin, K. M., Lyon, B. L., Clark, A. P., Fulton, J., Davidson, S., & Dayhoff, N. (2007). Developing Clinical Nurse Specialist Practice Competencies. Clinical Nurse Specialist, 21(6), 297–302. doi:10.1097/01.NUR.0000299619.28851.69

Appendix III

2

Banfield, V., & Lackie, K. (2009). Performance-based competencies for culturally responsive interprofessional collaborative practice. Journal of Interprofessional Care, 23(6), 611–620. doi:10.3109/13561820902921654

Barnes, T. A., Gale, D. D., Kacmarek, R. M., & Kageler, W. V. (2010). Competencies needed by graduate respiratory therapists in 2015 and beyond. Respiratory Care, 55(5), 601–616.

Barrett, H., & Bion, J. F. (2006). Development of core competencies for an international training programme in intensive care medicine. Intensive care medicine, 32(9), 1371–1383. doi:10.1007/s00134-006-0215-5

Barry, M. M. (2011). The CompHP Core Competencies Framework for Health Promotion Short Version. Health education & behavior : the official publication of the Society for Public Health Education, 39(20081209), 648–662. doi:https://dx.doi.org/10.1177/1090198112465620

Basile, J. L., & Stone, D. B. (1986). Profile of an effective hospice team member. Omega: Journal of Death and Dying, 17(4), 353–362. doi:10.2190/046W-WVD7-X7P4-154K

Bench, S., Crowe, D., Day, T., Jones, M., & Wilebore, S. (2003). Developing a competency framework for critical care to match patient need. Intensive & critical care nursing, 19(3), 136–142. doi:10.1016/S0964-3397(03)00030-2

Black, J., Allen, D., Redfern, L., Muzio, L., Rushowick, B., Balaski, B., et al. (2008). Competencies in the context of entry-level registered nurse practice: a collaborative project in Canada. International Nursing Review, 55(2), 171–178. doi:http://dx.doi.org/10.1111/j.1466-7657.2007.00626.x

Blanchette, L. (2015). An exploratory study of the role of the organization and the ... ProQuest Information & Learning US, US. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc13a&NEWS=N&AN=2016-17339-289

Bluestein, P. (1993). A model for developing standards of care of the chiropractic paraprofessional by task analysis. J Manipulative Physiol Ther, 16(4), 228–237.

Bobo, N., Adams, V. W., & Cooper, L. (2002). Excellence in school nursing practice: developing a national perspective on school nurse competencies. The Journal of school nursing : the official publication of the National Association of School Nurses, 18(5), 277–285.

Booth, M., & Courtnell, T. (2012). Developing competencies and training to enable senior nurses to take on full responsibility for DNACPR processes. International Journal of Palliative Nursing, 18(4), 189–195. doi:10.12968/ijpn.2012.18.4.189

Boyce, P., Spratt, C., Davies, M., & McEvoy, P. (2011). Using entrustable professional activities to guide curriculum development in psychiatry training. BMC Medical Education, 11(1), 96. doi:10.1186/1472-6920-11-96

Appendix III

3

Brewer, M., & Jones, S. (2013). An Interprofessional Practice Capability Framework Focusing on Safe, High-Quality, Client-Centred Health Service. Journal of Allied Health, 42(2), e45-49.

Brown, C. R. J., Criscione-Schreiber, L., O’Rourke, K. S., Fuchs, H. A., Putterman, C., Tan, I. J., et al. (2016). What Is a Rheumatologist and How Do We Make One? Arthritis Care & Research, 68(8), 1166–1172. doi:10.1002/acr.22817

Brown, S. J. (1998). A framework for advanced practice nursing. Journal of Professional Nursing, 14(3), 157–164. doi:10.1016/S8755-7223(98)80091-4

Cai, D., Kunaviktikul, W., Klunklin, A., Sripusanapan, A., & Avant, P. K. (2017). Developing a cultural competence inventory for nurses in China. International Nursing Review, 64(2), 205–214. doi:10.1111/inr.12350

Calhoun, J. G., Ramiah, K., Weist, E. M., Shortell, S. M., Dollett, L., Sinioris, M. E., et al. (2008). Development of an interprofessional competency model for healthcare leadership. Journal of healthcare management / American College of Healthcare Executives, 53(6), 375–391. doi:10.1097/00115514-200811000-00006

Camelo, S. H. H. (2012). Professional competences of nurse to work in Intensive Care Units: an integrative review. Revista Latino-Americana de Enfermagem, 20(1), 192–200. doi:10.1590/S0104-11692012000100025

Cappiello, J., Levi, A., & Nothnagle, M. (2016). Core competencies in sexual and reproductive health for the interprofessional primary care team. Contraception, 93(5), 438–445. doi:10.1016/j.contraception.2015.12.013

Carraccio, C., Englander, R., Gilhooly, J., Mink, R., Hofkosh, D., Barone, M. A., & Holmboe, E. S. (2017). Building a Framework of Entrustable Professional Activities, Supported by Competencies and Milestones, to Bridge the Educational Continuum. Academic medicine : journal of the Association of American Medical Colleges, 92(3), 324–330. doi:https://dx.doi.org/10.1097/ACM.0000000000001141

Carrico, R. M., Rebmann, T., English, J. F., Mackey, J., & Cronin, S. N. (2008). Infection prevention and control competencies for hospital-based health care personnel. American Journal of Infection Control, 36(10), 691–701. doi:10.1016/j.ajic.2008.05.017

Carrington, C., Weir, J., & Smith, P. (2011). The development of a competency framework for pharmacists providing cancer services. Journal of Oncology Pharmacy Practice, 17(3), 168–178. doi:10.1177/1078155210365582

Cattini, P. (1999). Core competencies for Clinical Nurse Specialists: A usable framework. Journal of Clinical Nursing, 8(5), 505–511. doi:10.1046/j.1365-2702.1999.00285.x

Caverzagie, K. J., Cooney, T. G., Hemmer, P. A., & Berkowitz, L. (2015). The development of entrustable professional activities for internal medicine residency training: A report from the Education Redesign Committee of the Alliance for Academic Internal Medicine. Academic Medicine, 90(4), 479–484. doi:10.1097/ACM.0000000000000564

Chan, B., Englander, H., Kent, K., Desai, S., Obley, A., Harmon, D., & Kansagara, D. (2014). Transitioning Toward Competency: A Resident-Faculty Collaborative Approach to

Appendix III

4

Developing a Transitions of Care EPA in an Internal Medicine Residency Program. Journal of Graduate Medical Education, 6(4), 760–764. doi:10.4300/JGME-D-13-00414.1

Chang, A., Bowen, J. L., Buranosky, R. A., Frankel, R. M., Ghosh, N., Rosenblum, M. J., et al. (2013). Transforming primary care training - Patient-centered medical home entrustable professional activities for internal medicine residents. Journal of General Internal Medicine, 28(6), 801–809. doi:10.1007/s11606-012-2193-3

Chen, S. P., Krupa, T., Lysaght, R., McCay, E., & Piat, M. (2013). The development of recovery competencies for in-patient mental health providers working with people with serious mental Illness. Administration and Policy in Mental Health and Mental Health Services Research, 40(2), 96–116. doi:10.1007/s10488-011-0380-x

Cicutto, L., Gleason, M., Haas-Howard, C., Jenkins-Nygren, L., Labonde, S., & Patrick, K. (2017). Competency-Based Framework and Continuing Education for Preparing a Skilled School Health Workforce for Asthma Care: The Colorado Experience. Journal of School Nursing, 33(4), 277–284. doi:10.1177/1059840516675931

Clay-Williams, R., & Braithwaite, J. (2009). Determination of health-care teamwork training competencies: A Delphi study. International Journal for Quality in Health Care, 21(6), 433–440. doi:10.1093/intqhc/mzp042

Collins, P. Y., Musisi, S., Frehywot, S., & Patel, V. (2015). The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa. Global Health Action, 8(1), 1–6. doi:10.3402/gha.v8.26682

Council of Ambulance Authoritie. (2013). Professional Competency Standards Paramedics. Melbourne, Australia. http://www.caa.net.au/images/documents/accreditation_resources/Paramedic_Professional_Competency_Standards_V2.2_February_2013_PEPAS.pdf

Cox, R. S., & Danford, T. (2014). The need for a systematic approach to disaster psychosocial response: A suggested competency framework. Prehospital and Disaster Medicine, 29(2), 183–189. doi:10.1017/S1049023X14000259

Crabtree, M. K., Stanley, J., Werner, K. E., & Schmid, E. (2002). Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric,and Women’s Health. Washington, D.C: Health Resources and Services Administration. https://search.proquest.com/docview/62194866?accountid=12528

Cutcliffe, J. R., & Sloan, G. (2014). Towards a Consensus of a Competency Framework for Clinical Supervision in Nursing: Knowledge, Attitudes, and Skills. Clinical Supervisor, 33(2), 182–203. doi:10.1080/07325223.2014.981494

Czabanowska, K., Klemenc-Ketis, Z., Potter, A., Rochfort, A., Tomasik, T., Csiszar, J., & Van den Bussche, P. (2012). Development of a competency framework for quality improvement in family medicine: A qualitative study. Journal of Continuing Education in the Health Professions, 32(3), 174–180. doi:10.1002/chp.21142

Daouk-Öyry, L., Mufarrij, A., Khalil, M., Sahakian, T., Saliba, M., Jabbour, R., & Hitti, E. (2017). Nurse-Led Competency Model for Emergency Physicians: A Qualitative Study.

Appendix III

5

Annals of Emergency Medicine, 70(3), 357–362.e5. doi:10.1016/j.annemergmed.2016.11.023

Daouk-Öyry, L., Zaatari, G., Sahakian, T., Rahal Alameh, B., & Mansour, N. (2017). Developing a competency framework for academic physicians. Medical Teacher, 39(3), 269–277. doi:10.1080/0142159X.2017.1270429

Davey, G. D. (1995). Developing competency standards for occupational health nurses in Australia. AAOHN Journal, 43(3), 138–143.

Davis, D., & Southern Regional Education Board. (2002). Nurse Educator Competencies 2002. Atlanta, GA.

Davis, R., Turner, E., Hicks, D., & Tipson, M. (2008). Developing an integrated career and competency framework for diabetes nursing. Journal of Clinical Nursing, 17(2), 168–174. doi:10.1111/j.1365-2702.2006.01866.x

De Clercq, G., Goelen, G., Danschutter, D., Vermeulen, J., & Huyghens, L. (2011). Development of a nursing practice based competency model for the Flemish master of nursing and obstetrics degree. Nurse Education Today, 31(1), 48–53. doi:10.1016/j.nedt.2010.03.013

De Holanda, F. L., Marra, C. C., & Olm Cunha, I. C. K. (2014). Construction of a Professional Competency Matrix of the nurse in emergency services. Acta Paulista de Enfermagem, 27(4), 373–379. doi:10.1590/1982-0194201400062

Deacon, K. S., Baldwin, A., Donnelly, K. A., Freeman, P., Himsworth, A. P., Kinoulty, S. M., et al. (2017). The National Competency Framework for Registered Nurses in Adult Critical Care: An overview. Journal of the Intensive Care Society, 18(2), 149–156. doi:10.1177/1751143717691985

Deitte, L. A., Gordon, L. L., Zimmerman, R. D., Stern, E. J., McLoud, T. C., Diaz-Marchan, P. J., & Mullins, M. E. (2016). Entrustable professional activities: Ten things radiologists do. Academic Radiology, 23(3), 374–381. doi:10.1016/j.acra.2015.11.010

Denninghoff, K. R., Knox, L., Cunningham, R., & Partain, S. (2002). Emergency medicine: Competencies for youth violence prevention and control. Academic Emergency Medicine, 9(9), 947–956. doi:10.1197/aemj.9.9.947

Dewing, J., & Traynor, V. (2005). Admiral nursing competency project: Practice development and action research. Journal of Clinical Nursing, 14(6), 695–703. doi:10.1111/j.1365-2702.2005.01158.x

Dijkman, B., Reehuis, L., & Roodbol, P. (2017). Competences for working with older people: The development and verification of the European core competence framework for health and social care professionals working with older people. Educational Gerontology, 43(10), 483–497. doi:10.1080/03601277.2017.1348877

Dressler, D. D., Pistoria, M. J., Budnitz, T. L., McKean, S. C. W., & Amin, A. N. (2006). Core competencies in hospital medicine: development and methodology. Journal of hospital medicine (Online), 1(1), 48–56. doi:10.1002/jhm.6

Appendix III

6

du Toit, R., Palagyi, A., Brian, G., & Brain, G. (2010). The development of competency-based education for mid-level eye care professionals. A process to foster an appropriate, widely acceptable and socially accountable initiative. Education for health, 23(2), 7.

Dunn, S. V, Lawson, D., Robertson, S., Underwood, M., Clark, R., Valentine, T., et al. (2000). The development of competency standards for specialist critical care nurses. Journal of Advanced Nursing, 31(2), 339–346. doi:10.1046/j.1365-2648.2000.01292.x

Edwards, T. (2017). Using a delphi study approach to develop competencies for allied health professionals working in acute medicine. Acute Medicine, 16(4), 177–184. https://acutemedjournal.co.uk/journal/volume-16/volume-16-issue-4-pages-153-212-2017/using-delphi-study-approach-develop-competencies-allied-health-professionals-working-acute-medicine/

El-Haddad, C., Damodaran, A., McNeil, H. P., & Hu, W. (2017). A Patient-Centered Approach to Developing Entrustable Professional Activities. Academic Medicine, 92(6), 800–808. doi:10.1097/ACM.0000000000001616

Eskes, A. M., Maaskant, J. M., Holloway, S., van Dijk, N., Alves, P., Legemate, D. A., et al. (2014). Competencies of specialised wound care nurses: A European Delphi study. International Wound Journal, 11(6), 665–674. doi:10.1111/iwj.12027

Fan, L., Gui, L., Xi, S., & Qiao, A. (2016). Core competence evaluation standards for emergency nurse specialist: Developing and testing psychometric properties. International Journal of Nursing Sciences, 3(3), 274–280. doi:10.1016/j.ijnss.2016.08.005

Fehr, F., Weiß-Becker, C., Becker, H., & Opladen, T. (2017). Entrustable professional activities in post-licensure training in primary care pediatrics: Necessity, development and implementation of a competency-based post-graduate curriculum. GMS journal for medical education, 34(5), Doc67-Doc67. doi:10.3205/zma001144

Fessler, H. E., Addrizzo-harris, D., Beck, J. M., & Buckley, J. D. (2014). Entrustable Professional Activities and Curricular Milestones for Fellowship Training in Pulmonary and Critical Care Medicine Report of a Multisociety Working Group. CHEST, 146(3), 813–834. doi:10.1378/chest.14-0710

Fidler, J. R. (1997). The role of the phlebotomy technician: Skills and knowledge required for successful clinical performance. Evaluation and the Health Professions, 20(3), 286–301. doi:10.1177/016327879702000303

Finnie, A., & Wilson, A. (2003). Development of a Tissue Viability Nursing Competency Frameword. British Journal of Nursing, 12(6), s38-44. doi:10.12968/bjon.2003.12.Sup1.11251

Fitzgerald, G. J., Aitken, P., Arbon, P., Archer, F., Cooper, D., Leggat, P., et al. (2010). A national framework for disaster health education in Australia. Prehospital and Disaster Medicine, 25(1), 4–11. doi:10.1017/S1049023X00007585

Frank, J. R. (2005). The CanMEDS 2005 physician competency framework. Better standsards. Better physicians. Better care. (J. Frank, Ed.)The Royal College of Physicians and Surgeons of Canada. The Royal College of Physicians and Surgeons of Canada.

Appendix III

7

Galbraith, K., Ward, A., & Heneghan, C. (2017). A real-world approach to Evidence-Based Medicine in general practice: A competency framework derived from a systematic review and Delphi process. BMC Medical Education, 17(1), 1–15. doi:10.1186/s12909-017-0916-1

Gardner, G., Carryer, J., Gardner, A., & Dunn, S. (2006). Nurse Practitioner competency standards: Findings from collaborative Australian and New Zealand research. International Journal of Nursing Studies, 43(5), 601–610. doi:10.1016/j.ijnurstu.2005.09.002

Gillan, C., Uchino, M., Giuliani, M., Millar, B.-A. A., & Catton, P. (2013). Defining Imaging Literacy in Radiation Oncology Interprofessionally: Toward a Competency Profile for Canadian Residency Programs. Journal of Medical Imaging and Radiation Sciences, 44(3), 150–156. doi:10.1016/j.jmir.2013.03.002

Gilmore, G. D., Olsen, L. K., Taub, A., & Connell, D. (2005). Overview of the National Health Educator Competencies Update Project, 1998-2004. American Journal of Health Education, 36(6), 363–372. doi:10.1080/19325037.2005.10608209

Gouveia, E. A. H., Braga, T. D., Heráclio, S. A., & Pessoa, B. H. S. (2016). Validating competencies for an undergraduate training program in rural medicine using the Delphi technique. Rural and Remote Health, 16(4).

Graafland, M., Ten Cate, O., van Seventer, J.-P., Schraagen, J. M. C., & Schijven, M. P. (2015). Mapping the Demand for Serious Games in Postgraduate Medical Education Using the Entrustable Professional Activities Framework. Games for Health Journal, 4(5), 381–386. doi:10.1089/g4h.2014.0129

Hadjibalassi, M., Papastavrou, E., Lambrinou, E., Tsangari, H., Athini, E., Georgiou, E., et al. (2012). Development of an instrument to determine competencies of postgraduate ICU nurses in Cyprus. Nursing in Critical Care, 17(5), 255–264. doi:10.1111/j.1478-5153.2012.00503.x

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal of Advanced Nursing, 73(8), 1958–1969. doi:10.1111/jan.13274

Hamburger, E. K., Lane, J. L., Agrawal, D., Boogaard, C., Hanson, J. L., Weisz, J., & Ottolini, M. (2015). The referral and consultation entrustable professional activity: Defining the components in order to develop a curriculum for pediatric residents. Academic Pediatrics, 15(1), 5–8. doi:10.1016/j.acap.2014.10.012

Hamui-Sutton, A., Monterrosas-Rojas, A. M., Ortiz-Montalvo, A., Flores-Morones, F., Torruco-García, U., Navarrete-Martínez, A., & Arrioja-Guerrero, A. (2017). Specific entrustable professional activities for undergraduate medical internships: A method compatible with the academic curriculum. BMC Medical Education, 17(1), 143. doi:10.1186/s12909-017-0980-6

Harris, R., Simons, M., & Bone, J. (1994). Residential Aged Care Workers In Rural Settings: A Study Of Their Roles And Training Needs. Australian Journal on Ageing, 13(2), 64–71. doi:10.1111/j.1741-6612.1994.tb00643.x

Hauer, K. E., Kohlwes, J., Cornett, P., Hollander, H., ten Cate, O., Ranji, S. R., et al. (2013). Identifying Entrustable Professional Activities in Internal Medicine Training. Journal of Graduate Medical Education, 5(1), 54–59. doi:10.4300/JGME-D-12-00060.1

Appendix III

8

Hemalatha, R., & Shakuntala, B. (2018). A Delphi Approach to Developing a Core Competency Framework for Registered Nurses in Karnataka, India. Nitte University Journal of Health Science, 8(2), 3–7. doi:10.12927/cjnl.2011.22142

Hewitt, C. M., Roye, C., & Gebbie, K. M. (2014). Core competency model for the family planning public health nurse. Public Health Nursing, 31(5), 472–479. doi:10.1111/phn.12133

Ho, M. J., Yu, K. H., Hirsh, D., Huang, T. S., & Yang, P. C. (2011). Does one size fit all? Building a framework for medical professionalism. Academic Medicine, 86(11), 1407–1414. doi:10.1097/ACM.0b013e31823059d1

Hsu, D., Nypaver, M., Fein, D. M., McAneney, C., Santen, S., Nagler, J., et al. (2016). Essentials of PEM Fellowship Part 2. Pediatric Emergency Care, 32(6), 410–418. doi:10.1097/PEC.0000000000000827

Interprofessional Education Collaborative. (2016). Core Competencies for Interprofessional Collaborative Practice : 2016 Update. Washington, D.C: Interprofessional Education Collaborative Expert Pane. doi:10.1097/ACM.0b013e3182308e39

Ketterer, A., Salzman, D., Branzetti, J., & Gisondi, M. (2017). Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study. Western Journal of Emergency Medicine, 18(1), 69–75. doi:10.5811/westjem.2016.10.31499

Kieffer, V., Davies, K., Gibson, C., Middleton, M., Munday, J., Shalet, S., et al. (2015). Society for Endocrinology Competency Framework for Adult Endocrine Nursing: 2nd edition. Endocrine Connections, 4(1), W1–W17. doi:10.1530/EC-14-0134

Kim, M. J., Lee, Y.-M., Han, J. J., Choi, S. J., Hwang, T.-Y., Kwon, M. J., et al. (2018). Developing the Korean Association of Medical Colleges graduate outcomes of basic medical education based on “the role of Korean doctor, 2014.” Korean Journal of Medical Education, 30(2), 79–89. doi:10.3946/kjme.2018.83

Kirk, M., Tonkin, E., & Skirton, H. (2014). An iterative consensus-building approach to revising a genetics/genomics competency framework for nurse education in the UK. Journal of Advanced Nursing, 70(2), 405–420. doi:10.1111/jan.12207

Klein, M. D., Schumacher, D. J., & Sandel, M. (2014). Assessing and Managing the Social Determinants of Health: Defining an Entrustable Professional Activity to Assess Residents’ Ability to Meet Societal Needs. Academic Pediatrics, 14(1), 10–13. doi:10.1016/j.acap.2013.11.001

Klick, J. C., Friebert, S., Hutton, N., Osenga, K., Pituch, K. J., Vesel, T., et al. (2014). Developing Competencies for Pediatric Hospice and Palliative Medicine. Pediatrics, 134(6), e1670–e1677. doi:10.1542/peds.2014-0748

Knox, L. M., & Spivak, H. (2005). What Health professionals should know: Core competencies for effective practice in youth violence prevention. American Journal of Preventive Medicine, 29(5 SUPPL. 2), 191–199. doi:10.1016/j.amepre.2005.08.030

Koehler, T. C., Bok, H., Westerman, M., & Jaarsma, D. (2018). Developing a competency framework for pharmacy technicians: Perspectives from the field. Research in Social and Administrative Pharmacy. doi:10.1016/j.sapharm.2018.06.017

Appendix III

9

Kwan, J., Crampton, R., Mogensen, L. L., Weaver, R., Van Der Vleuten, C. P. M., & Hu, W. C. Y. (2016). Bridging the gap: A five stage approach for developing specialty-specific entrustable professional activities. BMC Medical Education, 16(1), 1–13. doi:10.1186/s12909-016-0637-x

Landzaat, L. H., Barnett, M. D., Buckholz, G. T., Gustin, J. L., Hwang, J. M., Levine, S. K., et al. (2017). Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States. Journal of pain and symptom management, 54(4), 609–616.e1. doi:10.1016/j.jpainsymman.2017.07.003

Lane, D., & Ross, V. (1998). Defining Competencies and Performance Indicators for Physicians in Medical Management. Am J Prev Med, 14(3), 229–236. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=9569225

Lankshear, A., English National Board for Nursing, M. and H. V. L., & Others, A. (1996). Mapping the Nursing Competencies Required in Institutional and Community Settings in the Context of Multidisciplinary Health Care Provision (An Exploratory Study). English National Board for Nursing, Midwifery and Health Visiting. http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=ED398405&site=ehost-live

Leipzig, R. M., Sauvigné, K., Granville, L. J., Harper, G. M., Kirk, L. M., Levine, S. A., et al. (2014). What is a geriatrician? American geriatrics society and association of directors of geriatric academic programs end-of-training entrustable professional activities for geriatric medicine. Journal of the American Geriatrics Society, 62(5), 924–929. doi:10.1111/jgs.12825

Leonello, V. M., & Oliveira, M. A. de C. (2008). Competencies for educational activities in nursing. Revista Latino-Americana de Enfermagem, 16(2), 177–183. doi:10.1590/S0104-11692008000200002

Leung, K., Trevena, L., & Waters, D. (2016). Development of a competency framework for evidence-based practice in nursing. Nurse Education Today, 39, 189–196. doi:10.1016/j.nedt.2016.01.026

Lewis, R., Yarker, J., Donaldson-Feilder, E., Flaxman, P., & Munir, F. (2010). Using a competency-based approach to identify the management behaviours required to manage workplace stress in nursing: A critical incident study. International Journal of Nursing Studies, 47(3), 307–313. doi:10.1016/j.ijnurstu.2009.07.004

Lin, I. B., Beattie, N., Spitz, S., & Ellis, A. (2009). Developing competencies for remote and rural senior allied health professionals in Western Australia. Rural and remote health, 9(2), 1115. doi:1115 [pii]

Lindberg, M., Lundström-Landegren, K., Johansson, P., Lidén, S., & Holm, U. (2012). Competencies for practice in renal care: A national delphi study. Journal of Renal Care, 38(2), 69–75. doi:10.1111/j.1755-6686.2012.00260.x

Ling, S., Watson, A., & Gehrs, M. (2017). Developing an addictions nursing competency framework within a Canadian context. Journal of Addictions Nursing, 28(3), 110–116. doi:10.1097/JAN.0000000000000173

Appendix III

10

Liu, L., Curtis, J., & Crookes, P. (2014). Identifying essential infection control competencies for newly graduated nurses: A three-phase study in Australia and Taiwan. Journal of Hospital Infection, 86(2), 100–109. doi:10.1016/j.jhin.2013.08.009

Liu, M., Kunaiktikul, W., Senaratana, W., Tonmukayakul, O., & Eriksen, L. (2007). Development of competency inventory for registered nurses in the People’s Republic of China: Scale development. International Journal of Nursing Studies, 44(5), 805–813. doi:10.1016/j.ijnurstu.2006.01.010

Liu, Z., Tian, L., Chang, Q., Sun, B., & Zhao, Y. (2016). A competency model for clinical physicians in China: A cross-sectional survey. PLoS ONE, 11(12), e0166252–e0166252. doi:10.1371/journal.pone.0166252

Loke, A. Y., & Fung, O. W. M. (2014). Nurses’ Competencies in Disaster Nursing: Implications for Curriculum Development and Public Health. International journal of environmental research and public health, 11(3), 3289–3303. doi:https://dx.doi.org/10.3390/ijerph110303289

Macmillan Cancer Support. (2017). The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer. London: Macmillan Cancer Support.

Mallow, M., Baer, H., Moroz, A., & Nguyen, V. Q. C. (2017). Entrustable Professional Activities for Residency Training in Physical Medicine and Rehabilitation. American Journal of Physical Medicine and Rehabilitation, 96(10), 762–764. doi:10.1097/PHM.0000000000000741

Manenti, S. A., Ciampone, M. H. T., Mira, V. L., Minami, L. F., & Soares, J. M. S. (2012). The construction process of managerial profile competencies for nurse coordinators in the hospital field. Revista da Escola de Enfermagem, 46(3), 727–733. doi:10.1590/S0080_62342012000300027

Markenson, D., DiMaggio, C., & Redlener, I. (2005). Preparing health professions students for terrorism, disaster, and public health emergencies: Core competencies. Academic Medicine, 80(6), 517–526. doi:10.1097/00001888-200506000-00002

McCallum, M., Carver, J., Dupere, D., Ganong, S., Henderson, J. D., McKim, A., et al. (2018). Developing a Palliative Care Competency Framework for Health Professionals and Volunteers: The Nova Scotian Experience. Journal of Palliative Medicine, 21(7), 947–955. doi:10.1089/jpm.2017.0655

McCarthy, G., & Fitzpatrick, J. J. (2009). Development of a Competency Framework for Nurse Managers in Ireland. The Journal of Continuing Education in Nursing, 40(8), 346–350. doi:10.3928/00220124-20090723-01

McCloskey, C. B., Domen, R. E., Conran, R. M., Hoffman, R. D., Post, M. D., Brissette, M. D., et al. (2017). Entrustable Professional Activities for Pathology: Recommendations From the College of American Pathologists Graduate Medical Education Committee. Academic Pathology, 4, 1–9. doi:10.1177/2374289517714283

McLane, A. (1978). Core competencies of master’s prepared nurses. Nursing Research, 27(1), 48–53.

Appendix III

11

McMurray, L., Hall, A. K., Rich, J., Merchant, S., & Chaplin, T. (2017). The Nightmares Course: A Longitudinal, Multidisciplinary, Simulation-Based Curriculum to Train and Assess Resident Competence in Resuscitation. Journal of Graduate Medical Education, 9(4), 503–508. doi:10.4300/JGME-D-16-00462.1

Meade, L. B., Suddarth, K. H., Jones, R. R., Zaas, A. K., Albanese, T., Yamazaki, K., & O’Malley, C. W. (2016). Patients, nurses, and physicians working together to develop a discharge entrustable professional activity assessment tool. Academic Medicine, 91(10), 1388–1391. doi:10.1097/ACM.0000000000001189

Meadows, N., Webb, D., McRobbie, D., Antoniou, S., Bates, I., & Davies, G. (2004). Developing and validating a competency framework for advanced pharmacy practice. Pharmaceutical Journal, 273(7327), 789–792.

Mills, C., & Pritchard, T. (2004). A competency framework for nurses in specialist roles. Nursing Times, 26(43), 28–29.

Mills, E., Farmer, D., Bates, I., Davies, G., Webb, D., & McRobbie, D. (2005). Development of an evidence-led competency framework for primary care and community pharmacists. Pharmaceutical Journal, 275(7357), 48–52.

Moaveni, A., Gallinaro, A., Conn, L., Callahan, S., Hammond, M., & Oandasan, I. (2010). A Delphi Approach to Developing a Core Competency Framework for Family Practice Registered Nurses in Ontario. Nursing Leadership, 23(4), 45–60. doi:10.12927/cjnl.2011.22142

Moloughney, B., Moore, K., Dagnone, D., & Strong, D. (2017). The development of national entrustable professional activities to inform the training and assessment of public health and preventative medicine residents. Canadian medical education journal, 8(3), e71–e80.

Moore, D., Young, C. J., & Hong, J. (2017). Implementing entrustable professional activities: the yellow brick road towards competency-based training? ANZ Journal of Surgery, 87(12), 1001–1005. doi:10.1111/ans.14120

Morrison, L. J., Scott, J. O., & Block, S. D. (2007). Developing Initial Competency-Based Outcomes for the Hospice and Palliative Medicine Subspecialist: Phase I of the Hospice and Palliative Medicine Competencies Project. Journal of Palliative Medicine, 10(2), 313–330. doi:10.1089/jpm.2006.9980

Myers, J., Krueger, P., Webster, F., Downar, J., Herx, L., Jeney, C., et al. (2015). Development and Validation of a Set of Palliative Medicine Entrustable Professional Activities: Findings from a Mixed Methods Study. Journal of Palliative Medicine, 18(8), 682–690. doi:10.1089/jpm.2014.0392

National Association of Pharmacy Regulatory Authorities. (2007). Professional Competencies for Canadian Pharmacists at Entry to Practice 2nd Revision. Ottawa: National Association of Pharmacy Regulatory Authorities.

National Physiotherapy Advisory Group. (2017). Competency Profile for Physiotherapists in Canada. National Physiotherapy Advisory Group.

Appendix III

12

Nieminen, A. L., Mannevaara, B., & Fagerström, L. (2011). Advanced practice nurses’ scope of practice: A qualitative study of advanced clinical competencies. Scandinavian Journal of Caring Sciences, 25(4), 661–670. doi:10.1111/j.1471-6712.2011.00876.x

Niskala, H. (1986). Competencies and Skills Required by Nurses Working in Forensic Areas. Western Journal of Nursing Research, 8(4), 400–413. doi:10.1177/019394598600800402

O’Keeffe, M. (2014). Clinical competence in developmental-behavioural paediatrics: Raising the bar. Journal of Paediatrics and Child Health, 50(1), 3–10. doi:10.1111/jpc.12238

O’Leary, K. J., Afsar-Manesh, N., Budnitz, T., Dunn, A. S., & Myers, J. S. (2011). Hospital quality and patient safety competencies: Development, description, and recommendations for use. Journal of Hospital Medicine, 6(9), 530–536. doi:10.1002/jhm.937

Oandasan, I. F., Hammond, M., Gotlib Conn, L., Callahan, S., Gallinaro, A., & Moaveni, A. (2010). Family practice registered nurses: The time has come. Canadian Family Physician, 56(10), e375-82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954102/pdf/056e375.pdf

Palermo, C., Capra, S., Beck, E. J., Dart, J., Conway, J., & Ash, S. (2017). Development of advanced practice competency standards for dietetics in Australia. Nutrition and Dietetics, 74(4), 327–333. doi:10.1111/1747-0080.12338

Palermo, C., Conway, J., Beck, E. J., Dart, J., Capra, S., & Ash, S. (2016). Methodology for developing competency standards for dietitians in Australia. Nursing and Health Sciences, 18(1), 130–137. doi:10.1111/nhs.12247

Paramedic Association of Canada. (2011). National Occupational Competency Profile for Paramedics. Ottawa: Paramedic Association of Canada.

Parker, T. A., Guiton, G., & Jones, M. D. (2017). Choosing entrustable professional activities for neonatology: A Delphi study. Journal of Perinatology, 37(12), 1335–1340. doi:10.1038/jp.2017.144

Parkinson’s UK. (2016). Competencies: A competency framework for nurses working in Parkinson’s disease management 3rd edition. Royal College of Nursing, PDNSA. London: Parkinson’s UK. doi:10.4137/NMi.s29530

Partnership for Dietetic Education and Practice. (2012). The Integrated Competencies for Dietetic Education and Practice. Canada: Partnership for Dietetic Education and Practice.

Patterson, F., Ferguson, E., Lane, P., Farrell, K., Martlew, J., & Wells, A. (2000). A competency model for general practice: Implications for selection, training, and development. British Journal of General Practice, 50(452), 188–193. doi:10.3399/bjgp13X667196

Penciner, R., Langhan, T., Lee, R., McEwen, J., Woods, R. A., & Bandiera, G. (2011). Using a Delphi process to establish consensus on emergency medicine clerkship competencies. Medical Teacher, 33(6), 333–339. doi:10.3109/0142159X.2011.575903

Pillay, R. (2010). Towards a competency-based framework for nursing management education. International Journal of Nursing Practice, 16(6), 545–554. doi:10.1111/j.1440-172X.2010.01880.x

Appendix III

13

Pugh, D., Cavalcanti, R. B., Halman, S., Ma, I. W. Y., Mylopoulos, M., Shanks, D., & Stroud, L. (2017). Using the Entrustable Professional Activities Framework in the Assessment of Procedural Skills. Journal of Graduate Medical Education, 9(2), 209–214. doi:10.4300/JGME-D-16-00282.1

Redwood-Campbell, L., Pakes, B., Rouleau, K., MacDonald, C. J., Arya, N., Purkey, E., et al. (2011). Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches. BMC medical education, 11, 46. doi:https://dx.doi.org/10.1186/1472-6920-11-46

Reetoo, K. N., Harrington, J. M., & Macdonald, E. B. (2005). Required competencies of occupational physicians: A Delphi survey of UK customers. Occupational and Environmental Medicine, 62(6), 406–413. doi:10.1136/oem.2004.017061

Rose, S., Fix, O. K., Shah, B. J., Jones, T. N., & Szyjkowski, R. D. (2014). Entrustable professional activities for gastroenterology fellowship training. Gastroenterology, 147(1), 233–242. doi:10.1053/j.gastro.2014.04.038

Rydin, S. L. (2007). Community-based competencies for entry-level occupational therapy educational programs. Dissertation Abstracts International Section A: Humanities and Social Sciences. Denton, TX. Retrieved from http://search.proquest.com/docview/621712954?accountid=15115%0Ahttp://vr2pk9sx9w.search.serialssolution.com?ctx%7B_%7Dver=Z39.88-2004%7B&%7Dctx%7B_%7Denc=info:ofi/enc:UTF-8%7B&%7Drfr%7B_%7Did=info:sid/PsycIN

Santy, J., Rogers, J., Davis, P., Jester, R., Kneale, J., Knight, C., et al. (2005). A competency framework for orthopaedic and trauma nursing. Journal of Orthopaedic Nursing, 9(2), 81–86. doi:10.1016/j.joon.2005.02.003

Sburlati, E. S., Lyneham, H. J., Mufson, L. H., & Schniering, C. A. (2012). A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression. Clinical Child and Family Psychology Review, 15(2), 93–112. doi:10.1007/s10567-012-0111-1

Schultz, C. H., Koenig, K. L., Whiteside, M., & Murray, R. (2012). Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals. Annals of Emergency Medicine, 59(3), 196–208. doi:10.1016/j.annemergmed.2011.09.003

Schultz, K., Griffiths, J., & Lacasse, M. (2015). The Application of Entrustable Professional Activities to Inform Competency Decisions in a Family Medicine Residency Program. Academic Medicine, 90(7), 888–897. doi:10.1097/ACM.0000000000000671

Schwartz, R. B., McManus, J. G., Croushorn, J., Piazza, G., Coule, P. L., Gibbons, M., et al. (2010). Tactical medicine-competency-based guidelines. Prehospital Emergency Care, 15(1), 67–82. doi:10.3109/10903127.2010.514092

Sharma, P., Tanveer, N., & Goyal, A. (2018). A search for entrustable professional activities for the 1 st year pathology postgraduate trainees. Journal of Laboratory Physicians, 10(1), 26. doi:10.4103/JLP.JLP_51_17

Appendix III

14

Shaughnessy, A. F., Sparks, J., Cohen-Osher, M., Goodell, K. H., Sawin, G. L., & Gravel, J. (2013). Entrustable Professional Activities in Family Medicine. Journal of Graduate Medical Education, 5(1), 112–118. doi:10.4300/JGME-D-12-00034.1

Sherbino, J., Frank, J. R., & Snell, L. (2014). Defining the key roles and competencies of the clinician-educator of the 21st century: A national mixed-methods study. Academic Medicine, 89(5), 783–789. doi:10.1097/ACM.0000000000000217

Sherrill, W. W., & Keels-Williams, F. (2005). Mapping competencies for the multiskilled health care professional: An allied health curriculum reform project. Journal of Allied Health, 34(4), 185–191. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=16529180

Shumway, N. M., Dacus, J. J., Lathrop, K. I., Hernandez, E. P., Miller, M., & Karnad, A. B. (2015). Use of Milestones and Development of Entrustable Professional Activities in 2 Hematology/Oncology Training Programs. Journal of Graduate Medical Education, 7(1), 101–104. doi:10.4300/JGME-D-14-00283.1

Skirton, H., Lewis, C., Kent, A., & Coviello, D. A. (2010). Genetic education and the challenge of genomic medicine: Development of core competences to support preparation of health professionals in Europe. European Journal of Human Genetics, 18(9), 972–977. doi:10.1038/ejhg.2010.64

Smith, A. P., & Lichtveld, M. (2009). A Competency-Based Approach to Expanding the Cancer Care Workforce. Medical Surgical Nursing, 18(1), 38–49.

Smythe, A., Jenkins, C., Bentham, P., & Oyebode, J. (2014). Development of a competency framework for a specialist dementia service. Journal of Mental Health Training, Education and Practice, 9(1), 59–68. doi:10.1108/JMHTEP-08-2012-0024

Sousa, J. M., & Alves, E. D. (2015). Nursing competencies for palliative care in home care. ACTA Paulista de Enfermagem, 28(3), 264–269. doi:10.1590/1982-0194201500044

Stewart, G., & Bonner, A. (2000). Competency based standards for advanced practice in nephrology nursing. EDTNA-ERCA Journal, 26(3), 50–54. doi:10.1111/j.1755-6686.2000.tb00106.x

Strasser, S., London, L., & Kortenbout, E. (2005). Developing a competence framework and evaluation tool for primary care nursing in South Africa. Education for Health, 18(2), 133–144. doi:10.1080/13576280500145615

Stucky, E. R., Ottolini, M. C., & Maniscalco, J. (2010). Pediatric hospital medicine core competencies: development and methodology. Journal of hospital medicine, 5(6), 339–343. doi:https://dx.doi.org/10.1002/jhm.843

Subbarao, I., Lyznicki, J., Hsu, E. B., Gebbie, K. M., Markenson, D., Barzansky, B., et al. (2007). A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster Medicine and Public Health Preparedness, 2(1), 57–66. doi:https://dx.doi.org/10.1097/DMP.0b013e31816564af

Appendix III

15

Supamanee, T., Krairiksh, M., Singhakhumfu, L., & Turale, S. (2011). Preliminary clinical nursing leadership competency model: A qualitative study from Thailand. Nursing and Health Sciences, 13(4), 433–439. doi:10.1111/j.1442-2018.2011.00649.x

Tangayi, S., Anionwu, E., Westerdale, N., & Johnson, K. (2011). A skills framework for sickle cell disease and thalassaemia. Nurs Times, 107(41), 12–13. http://pesquisa.bvsalud.org/portal/resource/es/mdl-23251980

Tavares, W., Bowles, R., & Donelon, B. (2016). Informing a Canadian paramedic profile: Framing concepts, roles and crosscutting themes. BMC Health Services Research, 16(1), 1–16. doi:10.1186/s12913-016-1739-1

Taylor, D. R., Park, Y. S., Smith, C. A., Karpinski, J., Coke, W., & Tekian, A. (2018). Creating entrustable professional activities to assess internal medicine residents in training a mixed-Methods approach. Annals of Internal Medicine, 168(10), 724–729. doi:10.7326/M17-1680

Thoma, B., Poitras, J., Penciner, R., Sherbino, J., Holroyd, B. R., & Woods, R. A. (2015). Administration and leadership competencies: establishment of a national consensus for emergency medicine. Cjem, 17(02), 107–114. doi:10.2310/8000.2013.131270

Touger-Decker, R., & Thomson, C. A. (2003). Complementary and alternative medicine: Competencies for dietetics professionals. Journal of the American Dietetic Association, 103(11), 1465–1469. doi:10.1016/j.jada.2003.08.015

Training Research and Education for Nurses in Diabetes UK. (2013). An integrated career and competency framework for diabetes nursing. (D. Hicks, Ed.). London: TREND-UK. http://trend-uk.org/

Traynor, V., Inoue, K., & Crookes, P. A. (2011). Understanding Nursing Competencies in Dementia Care: A literature review. Journal of Clinical Nursing, 20(13–14), 1948–1960.

Tsaroucha, A., Benbow, S. M., Kingston, P., & Le Mesurier, N. (2013). Dementia skills for all: A core competency framework for the workforce in the United Kingdom. Dementia, 12(1), 29–44. doi:10.1177/1471301211416302

Turrill, S. (2014). The education of UK specialised neonatal nurses: Reviewing the rationale for creating a standard competency framework. Nurse Education in Practice, 14(5), 504–511. doi:10.1016/j.nepr.2014.07.001

Underwood, M., Robertson, S., Clark, R., Crowder, K., Dunn, S., Lawson, D., et al. (1996). The emergence of competency standards for specialist critical care nurses. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 9(2), 68–71. doi:10.1016/S1036-7314(96)70355-7

Vaughn, S., Mauk, K. L., Jacelon, C. S., Larsen, P. D., Rye, J., Wintersgill, W., et al. (2016). The Competency Model for Professional Rehabilitation Nursing. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 41(1), 33–44. doi:https://dx.doi.org/10.1002/rnj.225

Waeckerle, J., Seamans, S., Whiteside, M., Pons, P., White, S., & Burstein, J. (2001). Executive summary: Developing objectives, content, and competencies for the training of

Appendix III

16

emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical (NBC) incidents. Annals of Emergency Medicine, 37(6), 587–601.

Walter, S., Mulherin, K., & Cox, C. D. (2018). A Preceptor competency framework for pharmacists. Part 2 of a 3-part series. Currents in Pharmacy Teaching and Learning, 10(3), 402–410. doi:10.1016/j.cptl.2017.11.018

Weiss, A., Ozdoba, A., Carroll, V., & Dejesus, F. (2016). Entrustable Professional Activities: Enhancing Meaningful Use of Evaluations and Milestones in a Psychiatry Residency Program. Academic Psychiatry, 40(5), 850–854. doi:10.1007/s40596-016-0530-2

Wisman-Zwarter, N., Van Der Schaaf, M., Ten Cate, O., Jonker, G., Van Klei, W. A., & Hoff, R. G. (2016). Transforming the learning outcomes of anaesthesiology training into entrustable professional activities. European Journal of Anaesthesiology, 33(8), 559–567. doi:10.1097/EJA.0000000000000474

Wölfel, T., Beltermann, E., Lottspeich, C., Vietz, E., Fischer, M. R., & Schmidmaier, R. (2016). Medical ward round competence in internal medicine - An interview study towards an interprofessional development of an Entrustable Professional Activity (EPA). BMC Medical Education, 16(1), 1–10. doi:10.1186/s12909-016-0697-y

Wolff, M., Hamberger, L. K., Ambuel, B., Ahmed, S., Swain, G. R., Hunter, P., & Smith, D. (2007). The development and evaluation of community health competencies for family medicine. WMJ : official publication of the State Medical Society of Wisconsin, 106(7), 397–401. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=18030828

World Health Organization. (2005). Preparing a health care workforce for the 21st century: The challenge of chronic conditions. Geneva, Switzerland.

World Health Organization. (2015). Core competencies in adolescent health and development for primary care providers: including a tool to assess the adolescent health and development component in pre-service education of health-care providers. Geneva, Switzerland: World Health Organization.

Yates, P., Evans, A., Moore, A., Heartfield, M., Gibson, T., & Luxford, K. (2007). Competency standards and educational requirements for specialist breast nurses in Australia. Collegian (Royal College of Nursing, Australia), 14(1), 11–15. doi:10.1016/S1322-7696(08)60542-9

Young, J. Q., Hasser, C., Hung, E. K., Kusz, M., O’Sullivan, P. S., Stewart, C., et al. (2018). Developing End-of-Training Entrustable Professional Activities for Psychiatry. Academic Medicine, 93(7), 1048–1054. doi:10.1097/ACM.0000000000002058

Appendix IV Characteristics of included studies

1

Lead author Year Location

Study population

(health profession)

Sub-specialty Timeframe

(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Ablah 2014 USA Multidisciplinary Public Health 2 years X X X X X 3 X X X 6 X X* Akbar 2005 Australia Multidisciplinary Intl Health 2 years X X X 3 X X Alfieri 2017 Italy Nursing Neonatal X 1 AlShammari 2018 Saudi

Arabia EMS X 1 X

Ambuel 2011 USA Multidisciplinary Violence and abuse

X X X X 3 X

Amendola 2008 USA Nursing IT X X 2 X Anderson 2017 USA Nursing Management X X 2 X Ash 1992 Australia Allied health Dietetics X X X X X X 5 X X Aylward 2014 USA Medicine Internal medicine 1 year X X X X X 4 X X Baldwin 2009 USA Nursing Advanced

practice 2 years X X X 3 X X

Banfield 2009 Canada Multidisciplinary X X X X X 4 X Barnes 2010 USA Allied health Respiratory

therapy 2 years X X X X 3 X

Barrett and Bion 2006 Europe Medicine ICU 3 years X X 2 X X X X 5 X X Barry 2012 Europe Multidisciplinary Public Health 3 years X X X X 2 X X X X X 7 X X Basile 1986 USA Multidisciplinary Hospice care X X 2 X X 3 Bench 2003 UK Nursing ICU 2.5 years X X X X X X 5 Black 2008 Canada Nursing 2 years X X X X X X 5 Blanchette 2015 USA Nursing Town nurse X 1 X Bluestein 1993 USA CAM Chiropractic 6 days X X X X 4 Bobo 2002 USA Nursing School nursing X X 1 X Booth 2012 UK Nursing Palliative care 9 months X 1 X

2


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Boyce 2011 Australia Medicine Psychiatry X X X X X 4 X Brewer 2013 Australia Multidisciplinary X X 2 Brown 1998 USA Nursing Advanced

practice X 1

Brown 2016 USA Medicine Rheumatology X X X 2 X Cai 2017 China Nursing Cultural

competency 7 months X X X X 3 X X

Calhoun 2008 USA Multidisciplinary Leadership 2 years X X X X X X 5 X Camelo 2012 Brazil Nursing ICU 3 months X X X 3 X X Cappiello 2016 USA Multidisciplinary Sexual health 6 months X X 3 X 2 X X Caraccio 2017 USA Medicine Paediatrics X X X 3 X Carrico 2008 USA Multidisciplinary Infection control 9 months X X X X 3 X 3 X X Carrington 2011 Australia Pharmacy Cancer X X X X X 4 X Cattini 1999 UK Nursing Clinical Nurse

specialist 2 years X X 2

Caverzagie 2015 USA Medicine Internal medicine 18 months X X X X X 4 X Chan 2014 USA Medicine Internal medicine X X X X 3 X X Chang 2013 USA Medicine Residents 6 months X X X X X X 5 X Chen 2012 Canada Multidisciplinary Mental health

(inpatient) X X X 3 X

Cicutto 2017 USA Nursing School nursing X X 3 X X X 4 X X Clay-Williams 2009 Australia Multidisciplinary CRM X X 2 X X 3 X X Collins 2015 Africa Multidisciplinary Mental,

neurological, and substance use

X X X 2 X

3


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Council of Ambulance Authorities (CAA)

2013 Australia EMS X X X X X 4

Cox 2014 Canada Multidisciplinary Disaster X 1 Crabtree 2002 USA Nursing Advanced

practice 2 years X X X 2 X

Cutcliffe 2014 Global Nursing Clinical supervision

X 1 X

Czabanowska 2012 Europe Medicine Primary care X X 2 X 2 X X Daouk-Oyry 2016 Lebanon Medicine Emergency X X X 2 X Daouk-Oyry 2017 Lebanon Medicine Academic

Medicine X X 2

Davey 1995 Australia Nursing Occupational health

1 year X X X X X X X 5 X X

Davis 2002 USA Nursing Nurse educators 7 months X X X X X 4 X Davis 2007 UK Nursing Diabetes 3 years X X X X 2 X X 4 X X De Holanda 2014 Brazil Nursing Emergency 7 months X X X 2 X Deacon 2017 UK Nursing ICU X X X X 3 X De Clerq 2011 Belgium Nursing Advanced

practice 2 months X X 2 X 2 X

Deitte 2016 USA Medicine Radiology X X 1 Denninghoff 2002 USA Multidisciplinary Youth violence

prevention 6 months X X X X 3 X

Dewing 2005 UK Nursing Dementia 3 years X X X X X X 5 X X Dijkman 2017 Europe Multidisciplinary Gerontology X X X X 2 X X 4 X X Dressler 2006 USA Medicine Hospitalists 4 years X X X 3 X

4


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

du Toit 2010 Western Pacific

Multidisciplinary Opthamology X X X X 3 X

Dunn 2000 Australia Nursing ICU X X 2 X X X Edwards 2017 UK Multidisciplinary Allied health X X 4 1 X El-Haddad 2017 Australia Medicine Rheumatology 4 months X X X 3 X X Eskes 2014 Europe Nursing Wound care X X 3 X X 3 X* Fan 2016 China Nursing Emergency X X X X 2 X X X X X 7 Fehr 2017 Germany Medicine Paediatrics X X X X X X 4 Fessler 2014 USA Medicine ICU 1 year X X X X 3 Fidler 1997 USA Allied health Phlebotomy X X X X 3 Finnie 2003 UK Nursing Wound care 3 years X X X X ? X 3 Fitzgerald 2010 Australia Multidisciplinary Disaster X X X X X 3 Frank 2005 Canada Medicine 4 years X X X X X X X X 6 X X Galbraith 2017 UK Medicine Family medicine X X X X 2 X 3 X X X Gardner 2006 Australia Nursing Advanced

practice X X X 3 X X X

Gillan 2013 Canada Medicine Trainee X X 2 X Gilmore 2005 USA Multidisciplinary Health education 6 years X 1 X* X Gouveia 2016 Brazil Medicine Rural health 2 months X X X X 2 X 3 X Graafland 2015 Netherlands Medicine Multiple

specialties 7 months X X 2 1 X

Hadjibalassi 2012 Cyprus Nursing ICU X X X X X X 5 X* X Halcomb 2017 Australia Nursing Primary care 1 year X X X X X X 5 X X Hamburger 2015 USA Medicine Paediatrics X X X X X 4 X X

5


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Hamui-Sutton 2017 Mexico Medicine Trainee X X 3 X X 3 X X X Harris 1994 Australia Multidisciplinary Gerontology X 1 X* X Hauer 2013 USA Medicine Internal medicine X X X X X 2 X X 5 X* X Hemalatha 2018 India Nursing 3 months X X 3 X X 3 X Hewitt 2014 USA Nursing Family planning 4 months X X 3 X 2 X Ho 2011 Taiwan Medicine Professionalism X X X X 3 X X Hsu 2016 USA Medicine Paediatrics 5 years X X X X X 4 ? Interprofessional Education Collaborative Expert Panel (IECEP)

2011 USA Multidisciplinary Interprofessional practice

X X X X X 4 X

Ketterer 2017 USA Medicine Emergency 4 months X X X 2 X*

Kieffer 2015 UK Nursing Endocrine X X X X 3 X Kim 2018 Korea Medicine Trainee 20 months X X X X X 4 X* X Kirk 2014 UK Nursing Genetics X X X X X 3 X X Klein 2014 USA Medicine Paediatrics X X X 2 X* Klick 2014 USA Medicine Palliative care X X X X 4 X Knox 2005 USA Multidisciplinary Youth violence

prevention 2 days X X 1 X

Koehler 2018 Netherlands Pharmacy Pharmacy technicians

2 years X X X X 2 X X 4 X X

Kwan 2016 Australia Medicine Emergency X X X X 4 X X

6


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Landzaat 2017 USA Medicine Palliative care 18 months X X X X X 4 X Lane 1998 USA Medicine Management X X X X 3 X Lankshear 1996 UK Nursing X X X X X X 5 X X X Leipzig 2014 USA Medicine Gerontology 2 years X X X 2 ? Leonello 2008 Brazil Nursing Education X X X X 3 Leung 2016 Australia Nursing 5 months X X 2 X Lewis 2010 UK Nursing Stress X X X X X X 5 X X X Lin 2009 Australia Allied health Rural health X X X X 3 X X X X 6 X X Lindberg 2012 Sweden Nursing Renal 6 months X X X 4 X X 4 X X Ling 2017 Canada Nursing Addiction X X X X 3 X Liu 2014 Australia Nursing Infection control 16 months X X 3 X 2 X X Liu 2016 China Medicine X X X X X X 5 X* X Liu 2007 China Nursing X X X X X 4 X* X Loke 2014 China Nursing Disaster X X X 3 X X Macmillan Cancer Support (MCS)

2017 UK Multidisciplinary Cancer 9 months X X X X X X 5 ?

Mallow 2017 USA Medicine Rehabilitation X X X X 2 X X 4 X

Manenti 2012 Brazil Nursing Management 2 months X X X 2 X Markenson 2005 USA Multidisciplinary Disaster X X X 3 X McCallum 2018 Canada Multidisciplinary Palliative care 26 months X X X X X 4 ? McCarthy 2009 Ireland Nursing Management X X X X X 5 McCloskey 2017 USA Medicine Pathology 2 years X X 2 X

7


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

McLane 1978 USA Nursing Advanced practice

X X X X 3

McMurray 2017 Canada Medicine Multiple specialties

X X 1 X

Meade 2016 USA Medicine Internal medicine 2 months X X X X X 4 X* X Meadows 2004 UK Pharmacy X X X X X 4 X Mhd Ali 2012 Australia Pharmacy X X X X 3 X Mills 2005 UK Pharmacy Primary care X X X X X 4 Mills 2004 UK Nursing Advanced

practice X X X 2 X X

Moaveni 2010 Canada Nursing Primary care 3 months X X 3 1 X X X Moloughney 2017 Canada Medicine Public health X X X X X X 5 X Moore 2017 Australia Medicine Surgery X X 2 X* Morrison 2007 USA Medicine Palliative care 1 year X X X 3 X Myers 2015 Canada Medicine Palliative care 19 months X X X X X 5 X National Association of Pharmacy Regulatory Authorities (NAPRA)

2007 Canada Pharmacy X X X 2

National Physiotherapy Advisory Group (NPAG)

2017 Canada Allied health Physiotherapy 6 months X X X X X X X X 7

Nieminen 2011 Finland Nursing Advanced practice

5 months X 1 X X

8


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Niskala 1986 Canada Nursing Mental health (inpatient)

X X X X X 4 X X

Oandasan 2010 Canada Nursing none X X 2 X X X O'Keefe 2014 Australia Medicine Paediatrics X 1 O'Leary 2011 USA Medicine Hospitalists 15 months X X X X 3 Palermo 2017 Australia Allied health Dietetics X X X 3 X X X Palermo 2016 Australia Allied health Dietetics X X X X 2 X X X 5 X X X Paramedic Association of Canada (PAC)

2011 Canada EMS 4 years X X X X X X 5 X

Parker 2017 USA Medicine Neonatal X X X X 2 2 X* Parkinson's UK 2016 UK Nursing Parkinson's X X 2 X Partnership for Dietetic Education and Practice (PDEP)

2012 Canada Allied health Dietetics 4 years X X X X X 4 X

Patterson 2000 UK Medicine Primary care X X X 3 X X Penciner 2011 Canada Medicine Emergency X X X X 2 X X 4 X* Pillay 2010 South Africa Nursing Management 5 months X X 2 Pugh 2017 Canada Medicine Internal medicine X X 2 X X Redwood-Campbell

2011 Canada Medicine Primary care 6 months X X X X X 4 X* X

Reetoo 2005 UK Medicine Occupational health

X X 2 1 X X

Rose 2014 USA Medicine Gastroenterology 2 years X X X X 3 ?

9


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Rydin 2008 USA Allied health Occupational therapy

X X X 3 X

Santy 2005 UK Nursing Orthopaedics 3 years X X X X X X 5 X* Sburlati 2012 Australia Psychology Depression X X X X 3 X Schultz 2012 USA Multidisciplinary Disaster X X X X ? X X 4 X* X Schultz 2015 Canada Medicine Primary care 3 years X X X X 3 X* X Schwartz 2011 USA EMS Tactical X X X X X X 4 X* ? Sharma 2018 India Medicine Pathology X X 2 X* X Shaugnessy 2012 USA Medicine Primary care 3 years X X X X 2 X X X 5 X X X Sherbino 2014 Canada Medicine Education 7 months X X X 3 X X X Sherrill 2005 USA Multidisciplinary Multiskilled

technician X X X X X 4 X X X*

Shumway 2015 USA Medicine Haematology 6 months X X X X 3 X Skirton 2010 Europe Multidisciplinary Genetics 2 years X X X X X 4 X Smith 2009 USA Multidisciplinary Cancer X X X X 3 X Smythe 2014 UK Multidisciplinary Dementia X X X X X 5 X X Sousa 2015 Brazil Nursing Palliative care 4 months X X X X 1 X 3 Stewart 2000 Australia Nursing Nephrology X X X X 3 2 X ? Strasser 2005 South Africa Nursing Primary care X X X X 2 2 X X Stucky 2010 USA Medicine Pediatrics 6 years X X X X X X 5 X* ? Subbarao 2008 USA Multidisciplinary Disaster X X X X 3 X X 4 X Supamanee 2011 Thailand Nursing Management X X 2 X X X Tangayi 2011 UK Nursing Haematology 1 year X X X 2 X Tavares 2016 Canada EMS X X X 3 X X X

10


Study population

(health profession)


(if provided)

Gro

up te

chni

ques

Stee

ring/

wor

king

gro

up

Con

fere

nce/

wor

ksho

p

Con

sens

us m

etho

ds

Del

phi p

roce

ss

Del

phi r

ound

s

NG

T

Lite

ratu

re r

evie

w

Stak

ehol

der

inpu

t

Map

ping

pro

cess

Surv

ey

Focu

s gro

ups

Inte

rvie

ws

Prac

tice

anal

ysis

DA

CU

M

Cou

nt o

f met

hods

^

Rat

iona

le fo

r m

etho

ds

Fund

ing

decl

ared

Tri

angu

latio

n st

ated

Fram

ewor

k ev

alua

ted

Taylor 2018 Canada Medicine Internal medicine X X X X ? X X X 5 X X Thoma 2015 Canada Medicine Management 3 months X X 2 X X 3 X Touger-Decker 2003 USA Allied health Dietetics 6 months X X X 2 ? Traynor 2011 UK Nursing Dementia X 1 X X TREND-UK 2011 UK Nursing Diabetes X X X X 3 X Tsaroucha 2013 UK Multidisciplinary Dementia X X X X X 4 X Turrill 2014 UK Nursing Neonatal 9 months X X X X 3 ? Underwood 1996 Australia Nursing ICU 4 years X X X X X 4 X* X Vaughn 2016 USA Nursing Rehabilitation 1 year X X X X 3 ? Waeckerle 2001 USA Multidisciplinary Disaster X X X X 3 X X Walter 2018 Canada Pharmacy Preceptors X X X X X 4 X Weiss 2016 USA Medicine Psychiatry X X X X 3 X* Wisman-Zwarter 2016 Netherlands Medicine Anaesthesiology 10 months X X 3 X 2 X X Wolfel 2016 Germany Medicine Internal medicine X X X X X 4 X* X Wolff 2007 USA Medicine Primary care X X X X X X 4 X World Health Organisation (WHO)

2015 Global Multidisciplinary Adolescent health

3 years X X X X X 4 X* X

World Health Organisation (WHO)

2005 Global Multidisciplinary Chronic conditions

X X 2 X

Yates 2007 Australia Nursing Cancer X X X X X 4 X* X Young 2017 USA Medicine Psychiatry 21 months X X X X X 2 X X 5 X X

11

Abbreviations: CAM=Complementary and alternative medicine; CRM=crew resource management; DACUM=Develop a curriculum; EMS=Emergency Medical Services; IT=information technology; ICU=Intensive Care Unit. ^ = some studies may have used more than one form of a given method/strategy. * = partial/incomplete. ? = unclear language.

Appendix V. Rationale by profession

Rationale code Alli

ed h

ealth

CA

M

EM

S

Med

icin

e

Mul

tidis

cipl

inar

y

Nur

sing

Phar

mac

y

Psyc

holo

gy

Total Care improvement 1 5 10 16 2 1 35 Education improvement 1 26 7 9 1 44 Healthcare changes 6 2 4 4 3 1 20 Improve understanding 1 1 13 5 12 32 Lack of competency framework 1 1 1 10 6 14 3 36 Standardize 1 7 4 11 23

the development of competency frameworks in healthcare...

Documents