The percent of RN-to-baccalaureate graduates has increased nationally from 30.6% in 2010 to 47.4% in 2016 (Campaign for Action, 2017), supporting the goals of the Future of Nursing reports (Institute of Medicine, 2010; National Academy of Sciences, Engineering, and Medicine, 2016; U.S. Department of Health and Human Services, 2014; Tanner, Gubrud-Howe, & Shores, 2008). Concurrently, hospitals continue to demonstrate improved patient outcomes when staffed with higher numbers of baccalaureate- or graduate degree-prepared nurses (Bugajski et al., 2017; Kelly, McHugh, & Aiken, 2012; McHugh et al., 2013; Wilson et al., 2015).
The Oregon Consortium for Nursing Education (OCNE) curriculum was crafted with organizational and statewide inter-program consensus to address nursing shortages and increase the number of baccalaureate-prepared nurses (Gaines & Spencer, 2013). The resulting model of nursing education features a guiding set of competencies and benchmarks to meet the developmental needs of nursing students and offers transition from associate degree to baccalaureate (Gubrud-Howe et al., 2003; Tanner, 2006; Tanner & Herinckx, 2012). The OCNE program competencies and individual benchmarks are routinely assessed for application to current nursing practice. They are used as a framework for the OCNE nursing curriculum (Gubrud, Spencer, & Wagner, 2017; Ostrogorsky & Raber, 2014). Periodic review of the OCNE competency benchmarks support the Commission on Collegiate Nursing Education (2018) Accreditation Standard IV for program effectiveness.
The American Nurses Association (2014) defined competency as an expected level of performance integrating knowledge, skills, and behaviors. Competence relates to job or position performance, whereas competency implies a nontask-oriented behavior including knowledge, skill, and attitude to support this performance (Altmiller & Armstrong, 2017; Cowan, Norman, & Coopamah, 2005). A competency includes multiple benchmarks. A benchmark has one or more defined objectives (OCNE, 2015).
These competencies and benchmarks feature three levels supporting student progress through the curriculum. Levels 1 and 2 are reached in associate degree programs as assessed through didactic and clinical experiences (Northrup-Snyder, Menkens, & Dean, 2017). Level 3 targets the final year of a bachelor's degree program. Licensed RNs can return to school to finish their degree or final year through the Oregon Health & Sciences University (OHSU) School of Nursing's RN-to-Baccalaureate (RNBS) Completion Program, completing the Baccalaureate of Science (BS) degree with a major in nursing through online coursework. The program is designed to accept any licensed post-AD graduate from OCNE partner schools and those currently practicing.
Student understanding of competency/benchmark and how course work affects attainment is assessed through self-reflection. Student self-reflection has a long history in nursing education and different models can guide the reflective process, including competency assessments (Boyer, Tardif, & Lefebvre, 2015; Duffy, 2008; Lasater & Nielson, 2009; Levett-Jones, Gersbach, Arthur, & Roche, 2011; Poulton & McCammon, 2007; Wagenschutz, McKean, Zurales, & Santen, 2016). Self-reflection supports clinical learning and specific patient or population care concepts foundational to professional development and overall competency attainment (Wheeler, Butell, Epeneter, Langford, & Taylor, 2016). Reflecting on benchmark attainment demonstrates student perceptions in a guided format.
Student competency self-report is used at three points in the RNBS curriculum. RNBS students are introduced to their final year in a Transition course and finish with a Capstone course. Experienced nursing students are given the option to complete the competency self-report throughout or write papers exploring the competencies through their practice in the Capstone course. Levels 1 and 2 provide AD graduates with foundational nursing skills, and Level 3 encourages RNBS students' growth and deep reflection on their roles as nurse leaders. As students identify their own competency attainment at Level 3, they begin to see connections and use of these attributes, knowledge, and skills in their practice within organizations and care teams. A focus on leadership to improve patient care and engage team members in this effort is a critical expectation of the bachelor's graduate.
The three levels of benchmarks in the OCNE curriculum spiral and address Benner's pedagogical recommendations. Five stages of nursing practice growth have been outlined (Benner, 2004; Benner & Day, 2018): novice, advanced beginner, competent, proficient, and expert. Prelicensure (Level 1 and 2) assumes novice status, where tasks and skills are learned through reading, direct supervision, and educator-guided and -constructed situations. Newly licensed and working nurses are considered advanced beginners with multiple practice opportunities for situational learning. In both the novice and advanced beginner stages, the use of a narrative pedagogy is valuable yet must be clearly structured and include contextual examples (Benner, Tanner, & Chesla, 2009). Within the RNBS program, this includes self-reflective activities on nursing experiences. Because of the new contexts, application, and expectations, RNBS students are considered novices as they begin this final year at Level 3. Those students with more nursing experience may reflect on the benchmarks at a deeper and more applied level, although they may not have experience in population health, leadership, or deep use of evidence. The final three stages of Benner's (2004) model are beyond the scope of this article, but they are relevant to nursing education, transition into practice, and developing expertise.
The OCNE competencies are one method for focusing nursing students and nurse educators on the necessary skills and concepts learned prior to graduation. As bachelor's-prepared graduates, awareness of the underpinnings of professional practice through reflection on the OCNE competencies, along with application to their own practice, supports professional development from advanced beginner to expert nurse. An initial exploration of OCNE competency attainment uncovered strengths and gaps in the final year of an RNBS program (Northrup-Snyder et al., 2017). It was important to determine whether the OCNE framework used within the OHSU RNBS program was supportive of the student and the development of competencies for the professional nurse graduate.
The purpose of this research was to expand the literature on OCNE competencies by evaluating the final year of the curriculum to explore student perceptions of competency and benchmark proficiency at Level 3. Student assignments were explored longitudinally at three time points to determine the fit of prior study attainment strength definitions (Northrup-Snyder et al., 2017), add to data on the student's perception of benchmark attainment, and provide a longitudinal assessment of perceived attainment strength for benchmarks across the RNBS curriculum. Following the same students allowed for the assessment of student self-confidence through competency/benchmark growth by comparing the first Transition and final Capstone courses. This research provides a framework for analysis of competency attainment.
This study used a retrospective, longitudinal, mixed-methods approach to collect data. Data were collected in summer 2016 at the finish of all student coursework. Eligibility criteria included enrollment in the Transition course in either fall 2014 or winter 2015, completion of the Capstone course by spring 2016, and completion of the self-reflection assignment at all three time points. The two Transition course groups were tracked through their Capstone course. This Capstone course was taken in 2015 (spring, summer, or fall) or 2016 (summer, winter, or spring) dependent on student enrollment plan. Courses included practicing nurses with 3 months to several years of experience, but seasoned nurses were lost to the sample due to the optional Capstone assignment, removing the ability to compare experienced nurses to new-to-practice nurses in the final time point. This convenience sample provided an opportunity to assess individual changes over time in student language of proficiency in a benchmark self-assessment assignment. The first assessment assignment was done early in the Transition course, the second at week 3 of the Capstone course (C-3), and the third at week 10 (C-10) of the Capstone course. Data included demographics, collected during student enrollment, and the required student Level 3 benchmark self-assessments. Confidentiality was supported by eliminating any identifying information. Institutional review board approval was obtained. No consent was required due to the postgraduation retrospective nature of the study.
Method of Analysis
There were 71 students in the initial sample. Students missing one or more of the self-assessment assignments, including those with RN work experience who completed the optional practice paper at the final time point (n = 15), were removed from the sample. Students who did not complete their program during the study time frame (n = 7) were also removed, reducing the final sample to 49 participants. Missing data were found across all benchmarks and time points. Competencies 3, 4, 5, 6, and 8 had higher rates of missing benchmarks.
Demographic data (Table 1), collected in the prior study (Northrup-Snyder et al., 2017) from registration files, and individual answers from the student self-assessment documents were imported into Excel® for formatting, then into NVivo 10 software to analyze themes. Each student self-assessment required a written explanation of how each benchmark was met, providing data that could be thematically analyzed (Bazeley & Jackson, 2013). Missing data up to three answers within a document were considered acceptable.
Demographics of the Sample
Qualitative Data Analysis
This study used the methods described by Northrup-Snyder et al. (2017) for the analysis and assessment of student language into attainment themes. The first two authors completed the analysis, and although each had taught in one of the courses, blinded data and up to 2 years between teaching and analysis reduced bias. This prior thematic analysis determined the meaning and strength of proficiency words within the Level 3 benchmark statements providing a related set of six researcher defined levels of attainment not met, low, medium low, medium, medium high, and strong/met that were used to determine an attainment strength value of 0 to 5 (0 = not met to 5 = strong/met). Student proficiency language of “I've met this” was coded as strong attainment while “no experience” was coded in the not met category. Details on how these thematic categories were reached are described in the initial cross-sectional study (Northrup-Snyder et al., 2017). Self-assessed benchmarks left blank by students were coded with “n/a” and treated as missing information. Patterns were explored to determine whether missing data were specific to a benchmark or competency across student attainment responses.
After using NVivo 10 to code for the six attainment levels, the researchers collapsed the levels into four categories of strong (combining strong and medium high), medium, low (combining medium low and low), and not met for presentation of results and to strengthen interrater reliability. Independent analyses and meetings of researchers were held to maintain continuity of coding strategies toward interrater reliability (kappa coefficient of 91.7%) (McHugh, 2012). The original audit trail was expanded to explore attainment definitions and benchmark coding strategies, including longitudinal concepts. Triangulation of the data occurred comparing prior research results, current thematic analysis, and statistical values and significance.
Quantitative Data Analysis
There were two quantitative analyses. In the first, a summary of values was obtained by transferring NVivo reports to Excel to explore values of attainment related to each competency and benchmark. Data were sorted to explore meaning of attainment levels across the three self-assessments. Researchers calculated the percent of students in each of the four attainment categories for every benchmark at each time point. Benchmark attainment was established if at least 70% of the students' self-assessment statements were coded as strong attainment. Nonattainment of a benchmark occurred when at least 20% of students were coded as not attained.
In the second analysis, the numerical value for attainment responses were summarized as a mean benchmark score for each competency. This analysis explored changes over time for significance. Several competencies appeared skewed; however, no transformations to correct for skewness were performed to keep the interpretations as simple as possible. The longitudinal analyses were conducted using a linear mixed effects modeling approach implemented in the nlme package (Pinheiro, Bates, DebRoy, Sarkar, & R Core Team, n.d.) for the R statistical computing environment, with mean competency score as the dependent variable and time point as a categorical fixed effect. Models were run with the transitional course as the initial reference and then again with week 10 of the Capstone course to allow for pairwise comparisons between all three time points. Alpha was set at p = .001 for all analyses to decrease type I error due to multiple tests.
Students were predominantly White, female, and age < 39 years (Table 1) in the larger population (N = 71) and the sample (n = 49). Students represented OCNE community colleges.
At each of the three time points, researchers explored existing coding strategies and themes. A longitudinal look at written student assessment of perceived benchmark attainment themes reflected a range of language strength. Strength-based language subthemes indicated confidence through nursing experience or personally identified attributes (Northrup-Snyder et al., 2017). Moderate or ambivalent language was softer, less confident, or indicated partial proficiency in the benchmark. The language indicating less experience suggested either areas for growth or barriers to benchmark attainment. Student language increased in strength or detail of attainment in week 3 of the Capstone course, compared with the Transition course. In some cases, the language showed a shift in accomplishment, detail, or confidence between weeks 3 and 10. Student responses to competency 6 (patient safety benchmark) demonstrates this shift:
- Not applicable. (not attained; Transition course)
- I do this in the [intensive care unit], we have many initiatives in place to prevent patient error. Unusual Occurrence Report writing is part of this. (strong; C-3)
- I just prevented a medication error at work and provided feedback to multiple departments about how the event can be prevented in the future. (strong; C-10)
Students often repeated the language descriptors from week 3 benchmarks at week 10. This may reflect a personal sense of highest attainment in week 3 and the option to copy and paste the electronic data. Although inconsistent or specific to a single student, responses indicated some benchmark language was less clear. Although clinical assignments were determined prior to the term, faculty roles included using the week 3 assessment to prompt understanding of benchmarks (e.g., exploring nursing leadership in a unique community setting) and to explore how prior experiences supported attainment in current clinical settings.
Student responses at each time point, but especially in the C-3 and C-10 assessments, reflect the need to deal with emotions and find meaning to the personal or clinical situations across several competencies. This is noted especially in self-care (competency 2), where students shared both positive and negative experiences on maintaining their ability to connect to friends or family in their personal time apart from school and job requirements. Most students struggled with their insights early in the curriculum, and by C-10 many shared their learning in both clinical and practice situations throughout the 10 competencies, but principally in leadership (competency 4), broader health care systems (competency 6), and evidence-based practice (competency 10). Students shared ah-ha moments within C-3 and C-10 related to what they learned in clinical and how they applied to self, nursing practice, and each benchmark. Some comments were self-deprecating, whereas others showed planning and movement toward attainment of the benchmarks over time.
Comparisons of Level 3 Benchmark Attainment
To examine changes in patterns across the time points, the four coded content analysis levels of attainment were sorted and reviewed under the categories of benchmark, competency, and strength of attainment. Changes in proportions could be seen in the two sets of results for each competency (Table 2). The first quantitative analysis (Table 2) examined benchmarks within each competency, at each time point, to identify where at least 70% of students used language indicating a strong perception of meeting a benchmark. The number of Level 3 benchmarks obtained within each time point is provided for each competency. The overall number of benchmarks met over time improves for each competency. Relationship-centered care (competency 7) exceeded 90% of students reaching strong for all five benchmarks at each time point.
Perception of Competency Attainment by RN-to-Baccalaureate Students Across Three Time Points
The data on the right side of Table 2 demonstrate variability in the average percentages of student attainment—longitudinally and across attainment categories. At Capstone weeks 3 and 10, student perception language and the related numerical attainment scores for most benchmarks was stronger than in the Transition course. For example, in the competency reflection on self-care (competency 2), the Transition group attainment reached an average of 74.5% even while only six Level 3 Benchmarks reached the 70% threshold. However, in the Capstone course student scores met the threshold for all eight benchmarks with a slight increase in the overall strong attainment percentage from week 3 (92.5%) to week 10 (96.6%).
Within each time point, the average strong attainment score was achieved (≥ 70%) for competencies 1, 2, 5, 7, and 9. The competencies intentional learning (competency 3) and communication (competency 8) were achieved moderately in the Transition course with a shift toward strong attainment as a group in the Capstone course. Benchmarks for competencies 4, 6, and 10 suggest low overall attainment in the Transition course. In competencies with lower and moderate group attainment percentages, more of the student attainment scores are found in the low and no categories at each time point. All competencies demonstrated movement toward the strong attainment score, with group percentages rising above 90% by week 10 of the Capstone course, except for competencies 4 (82.1%) and 6 (85.9%). All benchmarks are met within each competency by week 10 above 70% except competency 4, which evaluates practice and use of change process in leadership. These areas of lower perceived attainment are further supported in Table 3 with the list of benchmarks meeting the nonattainment threshold.
Level 3 Benchmarks Scoring ≥ 20% in the Not Attained Category
Competency 6, broader health care systems, accounts for more than half the nonattained benchmarks (≥ 20% in the not attained category) in the Transition course. Grouping data demonstrates four knowledge gap patterns (leadership changes, understanding data, awareness of systematic outreach, and communication in populations) found across three competencies (Table 3).
The second quantitative analysis explored the mixed effects models. Table 4 displays the mean competency scores at baseline and changes over time. Mean competency scores in the Transition course ranged from 2.15 in competency 6 to 4.69 in competency 7 (scale = 0 to 5). All competencies showed mean increases between each pairwise comparison of the time points. Significant increases in attainment were seen in nine of the 10 competencies, with p values < .001 between Transition and C-3 and also between Transition and C-10. Students showed increases in mean attainment between C-3 and C-10, although not at significant levels. The largest increases in competency attainment were in leadership (competency 4), broader health care systems (competency 6), and evidence-based practice (competency 10), which were also the competencies with the lowest mean attainment during the Transition course. Relationship-centered care (competency 7) was the only competency to not see significant growth between the Transition and Capstone courses. This may be due to a ceiling effect, as students scored highest on this competency in the Transition course.
Results of Mixed Effects Models After Assigning Numerical Scale to Competency Attainment Coding
The RNBS curriculum includes student self-reflection of the Level 3 benchmark to extend clinical skills into areas of leadership, evidence-based practice, and systems thinking. Student perceptions of attainment ranged between not met and strong. Competencies have variable numbers of benchmarks; thus, drawing strong conclusions for overall attainment is difficult.
There were many similarities to our prior cross-sectional study (Northrup-Snyder et al., 2017). In both, there was mixed understanding of benchmark connection to nursing practice or to clinical experience, especially in population concepts, leadership, or use of evidence. Student language revealed levels of confidence and reflected awareness of opportunities, self-efficacy, sense of competence, and personal beliefs. Overall, increased strength or confidence in language in the Capstone course suggests a higher level of perceived attainment compared with the Transition course. However, the Capstone cohort in the cross-sectional study did not achieve strong attainment at or above 70% in all competencies, whereas this study did. Further, the current longitudinal study shows significant growth in nine of 10 competencies between the Transition and Capstone courses (p < .001). Although student language and subsequent coding continued to show improvement between weeks 3 and 10, this change was not significantly different, most likely due to the much shorter time span between the last two time points. In both studies, perceived nonattainment scores suggest patterns of difficulty in understanding key concepts across the leadership (4) and broader health care (6) competencies, even while these current qualitative findings indicate higher attainment scores for these areas.
Additional themes emerged from this study. The competencies of ethics (1), reflection and self-care (2), collaboration (5), and clinical judgment (9) demonstrated higher perceived attainment across time. This may be an indication of the strength of learning in the Associate's degree curriculum and the emphasis of these concepts throughout the RNBS curriculum. Of note, the leadership (4), broader health care systems (6), and evidence-based practice (10) competencies had 0 to 1 benchmarks met at the 70% strong attainment threshold in the Transition course. However, there was sustained but moderate growth over time (Table 2). Evidence-based practice (competency 10) showed strong attainment by the second assessment (C-3). Low perceived competence on the concepts of personal practice evaluation and medication error management were noted (Table 3). By week 3, no benchmarks had > 20% low attainment, and this continued through week 10. Although the longitudinal study demonstrates overall higher perceived attainment, there are still gaps in several competencies and 100% attainment is not reached.
Benchmarks and Understanding of Attainment
The Transition course Level 3 benchmark self-assessment is one measure of student achievement of the benchmarks from their Associate's degree program. Support from academic and practice educators and targeted learning activities can bolster individual student perceived attainment.
Although this guided reflection of the benchmarks is one component of professional development, competency or benchmark attainment should also include assessment and feedback from faculty and clinical preceptors, as students may have difficulty accurately assessing their own proficiency (Adair, Hughes, Davis, & Wolcott-Breci, 2014; Boahin & Hofman, 2014). Benner's model suggests that development comes from experience and frequent application is associated with higher self-assessed competency (Meretoja, Isoaho, & Leino-Kilpi, 2004). New-to-nursing practice students through clinical and focused course guidance link OCNE benchmarks with professional nursing experiences. Responsive reflection on these benchmarks may be a useful transition tool to recognize strengths and areas for growth.
Expected Competency Attainment for a Bachelor's-Prepared Nurse
As newly licensed students move into nursing practice with their baccalaureate degree, there is a question of how the attained or missing competencies are reflected in this transition. Bridging the OCNE competencies into the practice environment may better support nurses as advanced beginners within 3 to 5 years of licensure. Retention of newly hired nurses within 2 years is associated with 15 months of a nurse residency or intern program (Ackerson & Stiles, 2018). Application of any learning model requires organizational support, mentorship, and a strategic plan for novice-to-expert learning (Cadmus, Conners, Zavotsky, Young, & Pagani, 2014; Fisher, Cusack, Cox, Feigenbaum, & Wallen, 2016). Mentoring programs should include the competencies of communication, leadership, organization, critical thinking, simulation to practice situations, clinical judgment, and stress management targeting feelings of value and job satisfaction (Lusk Monagle, Lasater, Stoyles, & Diekmann, 2018; Theisen & Sandau, 2013).
The transition and growth in perceived competency and confidence over time seen in this study mirrors the novice and the advanced beginner of Benner's model. As graduates complete the OCNE curriculum, they have many skills, both technical and professional, but may lack experience. Lusk Monagle et al. (2018) explored the first year of employment, noting areas for growth in areas of complexity of patients, communication, and interprofessional support. New nurses with less than 3 years of nursing experience required more support to build confidence in their clinical judgment, and nurses with 3 to 6 years were excellent mentors, perhaps because they are balanced in their understanding between inexperience and the expert (Lasater, Nielson, Stock, & Ostrogorsky, 2015). Internship and residency programs developed through academic partnerships can support development of new nurse competencies. This additional reinforcement is crucial to the new graduate to promote safe and quality patient care, retention, and job satisfaction (Fisher et al., 2016; Theisen & Sandau, 2013). Further, acute care nurses with deeper population knowledge may more effectively transition patients to home (Northrup-Snyder, Van Son, & McDaniel, 2011).
Although most new graduates are considered advanced beginners, RNBS students may graduate at the proficiency stage of Benner's model given that many practice for up to 1 to 2 years while obtaining their baccalaureate degree. A competency-driven program, such as OCNE, might also shift the baccalaureate nurse graduate into proficiency. A residency program tailored to the correct stage of development may be cost effective and better support the new nurse. Most development foci in the new nurse are found in the OCNE competencies, and benchmarks suggesting this framework may have value within nurse residency programs using a new level of benchmarks. The Joint OHSU Hospitals and Clinics Leaders and School of Nursing Portland Undergraduate Faculty Collaborative Transition to Practice Project is exploring this idea (personal communication, S. Greeno, K. Lasater, A. Nielson, & P. Gubrud-Howe, August 15, 2018).
This is a relatively small cohort, so generalizations should not be made beyond the RNBS sample and the OCNE curriculum. The students were treated as a single blended cohort (fall 2014 and winter 2015 Transition course). No differentiation between Capstone course groups was allowed due to small enrollment. Several factors may have influenced student responses on the Level 3 self-assessment benchmark. Different faculty within the study time frame and faculty conversation stimulated by the prior research may have affected student responses and understanding of the benchmarks. Missing answers may be related to students having a poor understanding of some benchmarks, not addressing multiple objectives within some benchmarks, or choosing to complete the assignment as quickly as possible.
Analyzing the student self-assessment of benchmark Level 3 demonstrated a significant change of student perceived attainment over time. Results of these assessments may guide curriculum options, influence student and graduate professional development, and provide a foundation for revising competency/benchmark language and goals. This study supports one aspect of program effectiveness addressing ongoing program improvement in assessment of student competency attainment, which may support accreditation purposes. Study results were forwarded to the statewide OCNE Curriculum Committee for the 2019–2020 review. Future research might include testing benchmark Levels 1 to 3 in Associate degree, 3-year BS, and RNBS programs. It is important to explore student perception of attainment compared with faculty and preceptor evaluations to validate attainment levels found in this research. In addition, employers can support professional development by linking competency-based programs, such as OCNE, to residency and internship programs. Further integration and translation of benchmark concepts into residence programs may increase professional self-perception and efficacy within nursing practice, supporting the OCNE vision of meeting nursing, employer, and patient needs.
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Demographics of the Sample
|Variable||Initial Sample, N = 71||Final Sample, n = 49|
| White||53 (75%)||36 (73%)|
| Asian/Pacific Islander/Indian||8 (11%)||7 (14%)|
| Hispanic||4 (6%)||1 (2%)|
| African American||1 (1%)||1 (2%)|
| Unidentified||5 (7%)||4 (8%)|
| Female||55 (77%)||41 (84%)|
| Male||16 (23%)||8 (16%)|
| 20 to 29||32 (45%)||25 (51%)|
| 30 to 39||23 (32%)||11 (22%)|
| 40 to 49||12 (17%)||9 (18%)|
| ≥50||4 (6%)||4 (8%)|
Perception of Competency Attainment by RN-to-Baccalaureate Students Across Three Time Pointsa
|Competency||Coursec||Benchmarks Met at >70% Strong Attainmentd||Average Percentage of Student Attainment Level Over Timeb|
|1: Ethics||T||6 of 8||71.9||5.4||18.1||4.1|
|C-3||8 of 8||93.4||2.6||3.8||0|
|C-10||8 of 8||96.9||2||1||0|
|2: Reflection/self-care||T||4 of 6||74.5||4.4||18.7||1.7|
|C-3||6 of 6||92.5||2||4.4||0.3|
|C-10||6 of 6||96.6||1.4||1.4||0.3|
|3: Intentional learner||T||2 of 5||67.8||1.2||27.3||2.4|
|C-3||5 of 5||89||2.9||5.7||1.2|
|C-10||5 of 5||95.1||0.8||1.2||1.2|
|4: Leadership||T||1 of 12||45.1||1.7||36.6||15.3|
|C-3||8 of 12||76.9||7||12.2||1|
|C-10||10 of 12||82.1||8.2||5.6||1|
|5: Collaboration||T||5 of 10||72||1.4||18||5.5|
|C-3||10 of 10||89.2||1.2||5.3||1.2|
|C-10||10 of 10||92.4||0.6||2.4||1.4|
|6: Health care system||T||0 of 13||31.4||1.3||45.4||19.9|
|C-3||9 of 13||78.6||2.4||16.8||0.3|
|C-10||13 of 13||85.9||2.5||9.4||0.3|
|7: Relationship centered||T||5 of 5||90.6||1.2||6.1||1.2|
|C-3||5 of 5||97.6||0||0||2|
|C-10||5 of 5||97.6||0||0||2|
|8: Communication||T||6 of 10||62.2||1.4||25.7||7.8|
|C-3||8 of 10||90.4||2.7||6.3||0.2|
|C-10||9 of 10||93.7||2.4||3.3||0.2|
|9: Clinical judgment||T||9 of 12||78.2||1.7||17.5||1.4|
|C-3||12 of 12||91.7||0.2||7||0.7|
|C-10||12 of 12||96.4||0.2||2||0.9|
|10: Evidence-based practice||T||0 of 6||33.7||2.7||54.8||7.5|
|C-3||6 of 6||89.1||2||7.8||0.7|
|C-10||6 of 6||95.9||1.4||1.7||0.7|
Level 3 Benchmarks Scoring ≥ 20% in the Not Attained Categorya
|Competency: Level 3 Benchmarks||Transitional Course|
|Knowledge gap—Foundations of developing and measuring leadership changes|
| Competency 4: Measures change||22.45%|
| Competency 4: Frameworks for quality and safety||28.57%|
| Competency 4: Use of change process||30.61%|
|Knowledge gap—Practice specific areas of safety and growth|
| Competency 4: Evaluates practice||32.65%|
| Competency 6: Mitigates patient error||20.41%|
|Knowledge gap—Understanding data|
| Competency 6: Use of data in populations||20.41%|
| Competency 6: Data for analysis||30.61%|
|Knowledge gap—Awareness of systematic outreach across different populations and partnerships|
| Competency 6: Community partnership||22.45%|
| Competency 6: Maintain networks||26.53%|
| Competency 6: Improves health management||26.53%|
| Competency 6: Access to health care for populations||28.57%|
| Competency 6: Health care barriers||32.65%|
|Knowledge gap—Communication in populations|
| Competency 8: Population communication||20.41%|
| Competency 8: Population-based education||20.41%|
Results of Mixed Effects Models After Assigning Numerical Scale to Competency Attainment Coding
|Competency||Mean Competency Score in Ta||Mean Change: T to C-3||p*||Mean Change: T to C-10||p*||Mean Change: C-3 to C-10||p*|
|1: Ethics||3.846||0.834||< .001||0.947||< .001||0.113||.276|
|2: Reflection/self-care||3.959||0.682||< .001||0.825||< .001||0.143||.153|
|3: Intentional learner||3.740||0.756||< .001||0.956||< .001||0.200||.096|
|4: Leadership||2.677||1.420||< .001||1.656||< .001||0.236||.065|
|5: Collaboration||3.867||0.719||< .001||0.833||< .001||0.113||.239|
|6: Health care system||2.148||1.845||< .001||2.149||< .001||0.304||.018|
|7: Relationship centered||4.686||0.204||.036||0.212||.029||0.008||.933|
|8: Communication||3.541||1.026||< .001||1.165||< .001||0.139||.109|
|9: Clinical judgment||4.137||0.518||< .001||0.654||< .001||0.136||.130|
|10: Evidence-based practice||2.644||1.817||< .001||2.072||< .001||0.255||.022|