NCA PGR Session 5 March 07 2018

1. 1
Using Zoom
 Turn your webcam on!
 Please remember to
mute yourself during the
presentations.
 If you have a question,
you may un-mute
yourself and ask after
each presentation, OR
use the Q&A button

2. Agenda: March 7, 2018 3:00-4:30PM (EST)
• Welcome, Review Agenda
• Sharing resources (website and application) -10min
• Common Application and Interviewing Scenarios (FAQ) -15min
• Contracts, Agreements and On-Boarding -25min
• Part 2: Curriculum Development and Mapping -30min
• Questions/Wrap Up

3. Common Application and Interviewing Scenarios (FAQ)
• What is multiple candidates have the same score? How do you
rank post-interviews for offers?
• What do you do if a candidate drops out from the interview or
declines formal offer? Use backups or alter schedule
• How and when do you communicate the offers, declines and
back ups

4. • How much time do you give candidates to sign and return the
contract?
• How long do you keep someone as a backup?
• Will you provide relocation assistance? (housing
recommendations, advanced pay)
• Does your organization provide licensure reimbursement? If so,
for financial hardships will you provide advanced pay for
licensing fees? ( DEA, controlled substance etc.)
Common Application and Interviewing Scenarios (FAQ)

5. • What do you do if you do not have enough candidates?
• Understand your organization’s health benefits and link the
residents with HR for specific questions. It’s a good idea to
identify someone in HR who can work with the residents.
(Examples: what do the residents do for health insurance before
insurance starts? if PTO is accrued can they have a negative
balance? Will unused PTO be paid out at the end of the program
year?
• If you decided to take two but you have three stellar candidates,
what do you do?
• Other questions you’ve thought about we haven’t discussed?
Common Application and Interviewing Scenarios (FAQ)

6. Contracts and Agreements
• Immediately following the offer should be a formal employment contract.
• Determine method of delivery (electronic or direct mail) and length of time to
return signed contract
• The contract can be a modified version of your organization’s existing
employment contract. Items that may differ in the contract include:
• Term of the contract- 12 month residency program
• Practice location
• Salary
• PTO
• CME
• Employment requirement post residency year- determine length of
commitment and subsequent year salaries.

7. NEXT STEPS:
Onboarding,
tracking incoming
resident
credentialing,
licensure
certification
material
Sample Contract

8. Licensing and Credentialing
• Offers have been made and accepted – start immediately!
• The process is a domino effect and timelines are short
• Follow your organizations general policy – adjust as needed
• Be prepared for delays based on states candidates come from
• Guide your candidates through the process and keep track of
their status

9. Licensing and Credentialing
NP Residents
1. Sit for and pass boards
2. Apply for state RN license
3. Apply for state APRN license
4. Apply for state controlled
substance license
5. Apply for federal DEA license

10. Additional Onboarding
• In addition to licensing and credentialing process – Residents
must be on boarded as an employee
• Leverage your HR department to help apply the organizations
process for onboarding all new staff
• HR connects with Residents prior to start date and is also
invited to orientation
• We will cover orientation in more detail later!

11. Curriculum Development
Part 3
Domains, Competencies, Learner
Outcomes
11

12. Your outcome for this session
Describe knowledge, skills and attitudes in
curriculum development
Write and use curriculum objectives and
measurable learner outcomes so that you can
evaluate learner performance

13. NNPRFTC, 2015 Standard 2: Curriculum
5 Required Elements and 8 Competencies
Elements
1. clinical-based care and
patient care experiences;
2. regularly scheduled didactic
sessions;
3. systems based learning and
quality improvement;
4. population-based health
focus;
5. leadership and professional
development, especially in
inter-professional practice.
Competencies
1. patient-centered care;
2. knowledge for practice;
3. practice-based learning and
improvement;
4. interpersonal and
communication skills;
5. professionalism;
6. systems-based practice;
7. Inter-professional collaboration;
8. personal and professional
development.

14. DRIVERS LEADERSHIP/BOARD/FINANCES
MARKETING, RECRUITMENT
CURRICULUM
Domains/subdomains
Space/equipment Space/equipment
Policies
Patients DIDACTIC
Preceptors Faculty
EVALUATION OF LEARNER SCHEDULE EVALUATION OF LEARNER
REMEDIATION OF LEARNER REMEDIATION OF LEARNER
ACCCREDITATION GRADUATES WHO FULFILL YOUR MISSION
CLINICAL
TOPICS
/KSAs
MISSION
Program goals/objectives
Learner
outcomes/competencies

16. Some more definitions
• Competency Domains/subdomains: From accreditation standards;
these help to identify topics/content areas in clinical practice that will
be incorporated into didactic and clinical activities e.g.,
“Professionalism” in NP residency curriculum standards
• Topics: What do your residents need to know? What do they need to
know how to do? What values do they need to embrace and
demonstrate?
– KSA: Knowledge, Skills, Attitude
– Your standards of care
• Evaluation of the Learner: a formal process in which learners
evaluate their own learning and practice, and faculty/preceptors
evaluate the residents; this can include reflective journaling

17. Competency-based health professions
education and training
• Learner-centered, focused on outcomes and
ability of the learner to demonstrate a level of
mastery sufficient for practice in your setting to
your standards of care.
• Curriculum design for NP postgraduate training
begins with the end in mind: What should your
NP residents know and be able to do after one
year?
• Knowledge, skills and attitudes (KSAs):
characteristics of a competency-based education
framework (Bloom).

18. KSAs
• Knowledge: What does the NP need to know
to practice independently?
• Skills: What does the NP need to be able to do
to practice independently?
• Attitude: What attitudes and values should
the NP embody to practice independently?

19. Start with a competency domain:
Patient-centered care
1. Patient-centered care
2. Knowledge for practice
3. Practice Based
Learning and
Improvement
4. Interpersonal and
Communication Skills
5. Professionalism
6. Systems-based
Practice
7. Inter-professional
Collaboration
8. Personal and
Professional
Development

20. Competency/Domain: Patient Care
Patient Care Competency: Provide patient-centered care that is
compassionate, valued, appropriate and effective for the
treatment of health problems and the promotion of health.

21. Some sub-domains of Patient-Centered Care:
learner outcomes/competencies
1.1 Perform all screening, diagnostic assessments and procedures for
patients with _________.
1.2 Gather essential and accurate information about patients with
_________ through review of records, history-taking, physical exam
and assessment, and review of data derived from laboratory and
imaging testing.
1.3 Organize and prioritize responsibilities to provide care to patients
with _________ that is safe, effective and efficient.
1.4 Interpret laboratory data, imaging studies, other tests required for
the care of patients with _________.
1.5 Make informed decisions about diagnostic and therapeutic
interventions based on patient information and preferences, evidence
based information and clinical judgment
1.6 Develop and carry out management plans for patients with
_________.

22. Example
1.1 Perform all screening, diagnostic assessments and
procedures for patients with _________.
Ask yourself:
• What diagnoses are your NP residents most likely to
encounter?
• What are your standards of care for those diagnoses
re: screening, diagnostic assessments and procedures
for those diagnoses?

23. Another example using a subdomain of
Patient-centered Care
• 1.4 Interpret laboratory data, imaging studies, other
tests required for the care of patients with _________.
Ask yourself:
• What diagnoses are your NP residents most likely to
encounter?
• What are your standards of care for those diagnoses
re: laboratory data, imaging studies, other tests for
those diagnoses?

24. Start a list of topics
Knowledge
Describe, explain,
apply, develop…..
• Diagnostics (labs,
imaging, etc.):
which tests for
which conditions?
• Management plans
Skills
Demonstrate….
• History and
physical
• Procedures
Attitudes
Demonstrate…
• Compassion
• Respect for
patients
preferences

25. Bloom’s Taxonomy

26. Domains con’t.
• You can group the 8 domains into 3-4 general
domains to generate your goals (backward) and
objectives (forward)
• For example: combine Patient-Centered Care with
Knowledge for Practice; Professionalism with Inter-
professional Collaboration
• The guidelines are a standard for you to meet, not
necessarily a template to use as you develop your
own goals and objectives.

27. Example
• Domain: Patient-Centered Care and Knowledge for Practice
• Competency objective for domain: Provide appropriate and
effective care for adult patients with DIABETES that is
compassionate and consistent with patient preferences.
• Topics in subdomain: diagnostics, procedures, clinical
decision-making, history and physical, management of
treatment plan, etc…….
• Learner outcomes for domain: Using Bloom’s taxonomy

28. Measurable learner outcomes:
Patient-centered care Health problem DIABETES
Topic: History and physical
Knowledge
Explain components
of a patient history:
Review of systems
Family history
Screenings
Presenting problems
Etc.
Skills
Perform a head-to-
toe physical exam,
incl. cardiovascular,
pulmonary,
abdominal, mini-
mental status, etc.
Communicate
effectively with
patients…..
Attitudes
Commit to having
respect for patient
dignity, privacy,
confidentiality, and
autonomy

29. Diagnostics Procedures
Knowledge
Attitude Attitude
Clinical Decision-making History and Physical
Knowledge Management of treatment plan Knowledge
Attitude Knowledge Attitude
Attitude
Knowledge
SkillsSkills
Skills
Skills
Skills
HEALTH PROBLEM
DIABETES
KSAS: Provide appropriate and effective care
for adult patients with DIABETES……

30. A little sidebar before we continue….
• Have you done a needs assessment for your population?
• What is the standard of care for a history and physical in
your setting with your patients?
• For example: Do you always ask sexual history? Drug and
alcohol history? Do you always screen for depression?
Do a mini-mental status? Housing? Access to food?
• Do you have a standard of care for certain populations:
transgender, rural, homeless, HIV, diabetes?
• Use your standard of care when you develop your KSAs.

31. History and Physical
Knowledge
Attitude: Commit to respect….
Skills: Communicate effectively….
Skills: Communicate effectively: That’s from the Competency:
4. Interpersonal and Communication Skills: Communicate
effectively with patients….across a broad range of backgrounds
Attitude: Commit to respect: That’s from the Competency:
4. Professionalism: Demonstrate a commitment to compassion,
integrity, and respect for others
How your map unfolds…

32. Another way of doing it:
Start with the clinical rotations and map outcomes
to competencies
• Provide appropriate and effective care for adult primary care
patients that is compassionate and consistent with patient
preferences.
 Details of what that means and looks like: KSAs
• Communicate effectively with patients…..
 Details of what that means and looks like: KSAs
• Commit to having respect for patient dignity, privacy,
confidentiality, and autonomy
 Details
• Collaborate effectively with peers…..
• Demonstrate professional behavior and values…..
• Contribute to improvement of patient care….

33. One learner outcome has mapped to at least
three domains/competencies
1. Patient-centered care
2. Knowledge for practice
3. Practice Based
Learning and
Improvement
4. Interpersonal and
Communication Skills
5. Professionalism
6. Systems-based
Practice
7. Inter-professional
Collaboration
8. Personal and
Professional
Development

34. You will notice:
! There is a lot of overlap in topics, e.g., between
diagnostics and procedures
! There is a lot of overlap as you decide which
topics to put under which domain, e.g., Patient
care and Knowledge for practice
! You can use some of the same language again
and again-- Patient Care, e.g., change “patients
with _____” to “patients with HTN,” or “patients
with complex needs”
!This is how you start to organize your
curriculum!

35. Takeaways….
 Start with whatever piece of the curriculum seems easiest to start
with for you:
 Schedule
 List of the subdomains/topics
 What does the resident need to KNOW?
 What does the resident need to KNOW HOW TO DO?
 What behaviors do you want the resident to DEMONSTRATE?
 What belongs in didactic? In clinical? Other?
 There will be overlap—don’t worry for now
 JUST START
Patient
centered
care
Knowledge
for
practice

36. ASSIGNMENTS
• Continue your recruitment and marketing
efforts
• Meet with HR to establish an on-boarding
process
• Begin to map out curriculum

37. Questions?