Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Establishing the Contents of Core Competencies for EPs
2.1.1. The Aspect of Professional Knowledge (PK)
2.1.2. The Aspect of Professional Skills (PS)
2.1.3. The Aspect of Professional Literacy (PL)
2.1.4. The Aspect of Care Services (CS)
2.2. DEMATEL
2.3. PCA (Principal Component Analysis)
2.4. Analytic Network Procedure (ANP)
2.5. VIKOR
3. Results
3.1. The Demographic Profile of the Valid Samples
3.2. The Network Relation Map (NRM)
3.3. The Comparative Analysis of Competency Development for Emergency Physicians
3.3.1. The Overall Views of Competency Development for Emergency Physicians
3.3.2. The PK (Professional Knowledge) Aspect of Competency Development for Emergency Physicians
3.3.3. The PS (Professional Skills) Aspect of Competency Development for Emergency Physicians
3.3.4. The PL (professional literacy) Aspect of Competency Development for Emergency Physicians
3.3.5. The CS (Care Services) Aspect of Competency Development for Emergency Physicians
3.4. PCA (Principal Component Analysis)
3.5. Analytic Network Procedure (ANP)
3.6. The Ranking of Professional Competency for Emergency Physicians under the VIKOR Approach
3.7. The Improving Paths Analysis for Different Stakeholders of Emergency Physicians
4. Discussion
4.1. Identifying the Gap in the Competency Development of EPs
4.2. Identifying Strategy Adoption Paths of the PGYs (Staff A)
4.3. Identifying Strategy Adoption Paths of the Residents (Staff B)
4.4. Identifying Strategy Adoption Paths of the Visiting Staff (Staff C)
4.5. Identifying Common Strategy Adoption Paths for the Three Stakeholders of EPs
4.6. Ranking of Professional Competency for Emergency Physicians Based on the VIKOR Approach
4.7. Comparing our Study with Previous Studies
5. Conclusions and Recommendations
5.1. Conclusions
5.2. Academic Contributions
5.3. Study Limitations
5.4. Future Studies
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CBME | competency-based medical education |
CPD | continuing professional development |
DEMATEL | decision-making trial and evaluation laboratory |
PCA | principal component analysis |
ANP | analytic network process |
VIKOR | Vlse kriterijumska Optimizacija I Kompromisno Resenje |
EPs | emergency physicians |
PL | professional literacy |
PS | professional skills |
PK | personal knowledge |
CS | care services |
ACGME | Accreditation Council for Graduate Medical Education |
ABMS | American Board of Medical Specialties |
PCRS | The Physician Competency Reference Set |
GME | graduate medical education |
ABEM | The American Board of Emergency Medicine |
KSABs | knowledge, skills, attitudes, and behaviors |
PGYs | doctors in post-graduate years |
NRM | network relation map |
MCDM | multiple criteria decision making |
PC | professional competency |
ED | emergency department |
POCUS | point-of-care ultrasound |
IPC | inter-professional communication |
SBP | systems-based practice |
AI | artificial intelligence |
CDI | competency development indicators |
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Aspects/Criteria | Descriptions | References |
---|---|---|
Professional knowledge (PK) | ||
Diagnostic studies (PK1) | Knowledge of diagnostic studies selection can help EPs improve their ability to diagnose and provide patient care. | [23,24] |
Pharmacotherapy (PK2) | The development of pharmacotherapy knowledge can help EPs select appropriate agents for therapeutic intervention. | [19,25,26] |
Differential diagnosis (PK3) | The development of differential diagnosis knowledge can help EPs prioritize the potential diagnosis based on the initial assessment. | [24,26] |
Observational reassessment (PK4) | Developing knowledge of disposition decisions and patient education plans can improve patient safety and maximize resources. | [19,25,26] |
Professional skills (PS) | ||
Emergency stabilization (PS1) | The development of emergency stabilization can help EPs to identify unstable patients and perform immediate interventions to stabilize patients before deterioration. | [27,28] |
Clinical assessment (PS2) | Performing a focused history and physical exam can help EPs to effectively guide the diagnosis and management of the patient’s urgent issues and minimize the need for further diagnostic testing. | [29,30] |
Procedure management (PS3) | Performing and interpreting procedures (e.g., endotracheal intubation, suturing, splinting, and vascular access) can help EPs to optimize aggregate patient outcomes within the system. | [27,28] |
Ultrasound use (PS4) | Performing goal-directed focused ultrasound exams can help EPs to manage patient assessment and invasive procedures promptly. | [31,32] |
Professional literacy (PL) | ||
Task transition (PL1) | The development of task transition can help EPs to manage available ED team members and resources efficiently under high volume or surge situations in the ED. | [33] |
Professional ethics (PL2) | The development of professional ethics can ensure that EPs respect workplace ethical principles, demonstrate professional responsibilities, and optimize their personal and professional well-being. | [34,35,36,37] |
Interpersonal communication (PL3) | Developing interpersonal communication strategies helps EPs mitigate stress, conflict, and miscommunication. | [28,29,30] |
Performance improvement (PL4) | EPs apply evidence-based care to complex patients and commit to personal growth to facilitate individual and institutional improvement. | [33] |
Care services (CS) | ||
Teamwork (CS1) | The development of teamwork management can facilitate EPs to resolve specific ED challenges through effective communication and mutual respect among team members. | [38,39,40] |
Patient safety (CS2) | EPs engage the emergency department and hospital system to offer error-prevention strategies and prevent patient safety events. | [38,41,42] |
System management (CS3) | EPs should develop and apply strategies to evaluate and improve healthcare supply to provide optimal healthcare in the system. | [43,44,45,46,47] |
Technology applications (CS4) | EPs use electronic devices to provide efficient and effective medical practice, the transition of care, computerized processes, and learning. | [48,49,50,51] |
Characteristics | Number (%) | |
---|---|---|
Gender | Male | 85 (72.6) |
Female | 32 (27.4) | |
Age | 20~25 | 12 (10.3) |
26~30 | 59 (50.4) | |
31~35 | 10 (8.5) | |
36~40 | 9 (7.7) | |
41~45 | 9 (7.7) | |
46~50 | 13 (11.1) | |
>51 | 5 (4.3) | |
Workplace institution | Medical center | 90 (76.9) |
Regional hospital | 27 (23.1) | |
Stakeholders | PGYs | 44 (37.6) |
Residents | 36 (30.8) | |
Visiting staff | 37 (31.6) |
Aspects | PGYs | Residents | Visiting Staff |
---|---|---|---|
(Staff A) | (Staff B) | (Staff C) | |
Horizontal analysis | |||
Professional knowledge (PK) | 8.426 [2] | 8.215 [3] | 8.568 [1] |
Professional skills (PS) | 8.051 [3] | 8.299 [1] | 8.257 [2] |
Professional literacy (PL) | 8.000 [2] | 7.750 [3] | 8.297 [1] |
Care services (CS) | 7.955 [2] | 7.535 [3] | 8.014 [1] |
Vertical analysis | |||
Professional knowledge (PK) | 8.426 [1] | 8.215 [2] | 8.568 [1] |
Professional skills (PS) | 8.051 [2] | 8.299 [1] | 8.257 [3] |
Professional literacy (PL) | 8.000 [3] | 7.750 [3] | 8.297 [2] |
Care services (CS) | 7.955 [4] | 7.535 [4] | 8.014 [4] |
Staffs Criteria | PGYs | Residents | Visiting Staff |
---|---|---|---|
(Staff A) | (Staff B) | (Staff C) | |
Horizontal analysis | |||
Diagnostic studies (PK1) | 8.705 [1] | 8.333 [3] | 8.622 [2] |
Pharmacotherapy (PK2) | 8.409 [1] | 8.222 [3] | 8.270 [2] |
Differential diagnosis (PK3) | 8.545 [2] | 8.278 [3] | 8.757 [1] |
Observational reassessment (PK4) | 8.045 [2] | 8.028 [3] | 8.622 [1] |
Vertical analysis | |||
Diagnostic studies (PK1) | 8.705 [1] | 8.333 [1] | 8.622 [2] |
Pharmacotherapy (PK2) | 8.409 [3] | 8.222 [3] | 8.270 [4] |
Differential diagnosis (PK3) | 8.545 [2] | 8.278 [2] | 8.757 [1] |
Observational reassessment (PK4) | 8.045 [4] | 8.028 [4] | 8.622 [2] |
Staffs Criteria | PGYs | Residents | Visiting Staff |
---|---|---|---|
(Staff A) | (Staff B) | (Staff C) | |
Horizontal analysis | |||
Emergency stabilization (PS1) | 8.136 [3] | 8.528 [2] | 8.838 [1] |
Clinical assessment (PS2) | 8.750 [1] | 8.139 [3] | 8.622 [2] |
Procedure management (PS3) | 7.818 [3] | 8.500 [1] | 8.297 [2] |
Ultrasound use (PS4) | 7.500 [2] | 8.028 [1] | 7.270 [3] |
Vertical analysis | |||
Emergency stabilization (PS1) | 8.136 [2] | 8.528 [1] | 8.838 [1] |
Clinical assessment (PS2) | 8.750 [1] | 8.139 [3] | 8.622 [2] |
Procedure management (PS3) | 7.818 [3] | 8.500 [2] | 8.297 [3] |
Ultrasound use (PS4) | 7.500 [4] | 8.028 [4] | 7.270 [4] |
Staffs Criteria | PGYs | Residents | Visiting Staff |
---|---|---|---|
(Staff A) | (Staff B) | (Staff C) | |
Horizontal analysis | |||
Task transition (PL1) | 7.477 [3] | 7.583 [2] | 8.162 [1] |
Professional ethics (PL2) | 8.250 [2] | 7.722 [3] | 8.405 [1] |
Interpersonal communication (PL3) | 8.182 [2] | 7.833 [3] | 8.459 [1] |
Performance improvement (PL4) | 8.091 [2] | 7.861 [3] | 8.162 [1] |
Vertical analysis | |||
Task transition (PL1) | 7.477 [4] | 7.583 [4] | 8.162 [3] |
Professional ethics (PL2) | 8.250 [1] | 7.722 [3] | 8.405 [2] |
Interpersonal communication (PL3) | 8.182 [2] | 7.833 [2] | 8.459 [1] |
Performance improvement (PL4) | 8.091 [3] | 7.861 [1] | 8.162 [3] |
Staffs Criteria | PGYs | Resident | Visiting Staff |
---|---|---|---|
(Staff A) | (Staff B) | (Staff C) | |
Horizontal analysis | |||
Teamwork (CS1) | 8.045 [2] | 7.722 [3] | 8.324 [1] |
Patient safety (CS2) | 8.455 [1] | 7.889 [3] | 8.351 [2] |
System management (CS3) | 7.932 [1] | 7.361 [3] | 7.784 [2] |
Technology applications (CS4) | 7.386 [2] | 7.167 [3] | 7.595 [1] |
Vertical analysis | |||
Teamwork (CS1) | 8.045 [2] | 7.722 [2] | 8.324 [2] |
Patient safety (CS2) | 8.455 [1] | 7.889 [1] | 8.351 [1] |
System management (CS3) | 7.932 [3] | 7.361 [3] | 7.784 [3] |
Technology applications (CS4) | 7.386 [4] | 7.167 [4] | 7.595 [4] |
Components | ||||
---|---|---|---|---|
Aspects | Components | Criteria | 1 | Community |
Professional knowledge (PK) | Diagnostic and therapeutic knowledge (PKP1) | Diagnostic studies (PK1) | 0.915 | 0.838 |
Pharmacotherapy (PK2) | 0.911 | 0.830 | ||
Differential diagnosis (PK3) | 0.897 | 0.805 | ||
Observational reassessment (PK4) | 0.852 | 0.726 | ||
Eigenvalue λ | 3.200 | |||
% of Variance | 79.993 | |||
Cumulative (%) | 79.993 | |||
Cronbach’s α | 0.916 | |||
Professional skills (PS) | Stabilization and procedural skills (PSP1) | Emergency stabilization (PS1) | 0.874 | 0.764 |
Procedure management (PS3) | 0.847 | 0.717 | ||
Ultrasound use (PS4) | 0.820 | 0.673 | ||
Clinic assessment (PS2) | 0.739 | 0.547 | ||
Eigenvalue λ | 2.700 | |||
% of Variance | 67.506 | |||
Cumulative (%) | 67.506 | |||
Cronbach’s α | 0.838 | |||
Professional literacy (PL) | Professionalism and interpersonal communication (PLP1) | Professional ethics (PL2) | 0.909 | 0.826 |
Interpersonal communication (PL3) | 0.897 | 0.805 | ||
Task transition (PL1) | 0.888 | 0.788 | ||
Performance improvement (PL4) | 0.875 | 0.765 | ||
Eigenvalue λ | 3.184 | |||
% of Variance | 79.599 | |||
Cumulative (%) | 79.599 | |||
Cronbach’s α | 0.914 | |||
Care services (CS) | System management & teamwork (CSP1) | System management (CS3) | 0.939 | 0.881 |
Teamwork (CS1) | 0.927 | 0.859 | ||
Patient safety (CS2) | 0.846 | 0.716 | ||
Technology applications (CS4) | 0.840 | 0.706 | ||
Eigenvalue λ | 3.162 | |||
% of Variance | 79.038 | |||
Cumulative (%) | 79.038 | |||
Cronbach’s α | 0.911 |
Aspects | Components | Component Weights |
---|---|---|
Professional knowledge (PK) | Diagnostic studies & Pharmacotherapy (PKP1) | 0.257 |
Professional skills (PS) | Emergency stabilization & Management (PSP1) | 0.259 |
Professional literacy (PL) | Professional ethics & communication (PLP1) | 0.238 |
Care services (CS) | Care management & Teamwork (CSP1) | 0.246 |
Total | 1.000 |
PGYs | Residents | Visiting Staff | ||
---|---|---|---|---|
(Staff A) | (Staff B) | (Staff C) | ||
v = 0.0 | Rvk | 0.205 | 0.247 | 0.199 |
CDI | 0.795 | 0.753 | 0.801 | |
Rank | 2 | 3 | 1 | |
v = 0.5 | Rvk | 0.197 | 0.225 | 0.185 |
CDI | 0.803 | 0.775 | 0.815 | |
Rank | 2 | 3 | 1 | |
v = 1.0 | Rvk | 0.189 | 0.204 | 0.171 |
CDI | 0.811 | 0.796 | 0.829 | |
Rank | 2 | 3 | 1 |
Advantage and Disadvantageous Aspects/Components | Strategy Adoption Paths (SAPs) | |
---|---|---|
PGYs (Staff A) | Professional knowledge (PK) > Professional skills (PS) > Professional literacy (PL) > Care services (CS) | 1. PL(3)→PS(2) {N} 2. PL(3)→PK(1)→PS(2) {Y} 3. PL(3)→CS(4)→PS(2) {Y} 4. PL(3)→CS(4)→PK(1)→PS(2) {Y} |
Residents (Staff B) | Professional skills (PS) > Professional knowledge (PK) > Professional literacy (PL) > Care services (CS) | 1. PL(3)→PS(1) {N} 2. PL(3)→PK(2)→PS(1) {N} 3. PL(3)→CS(4)→PS(1) {Y} 4. PL(3)→CS(4)→PK(2)→PS(1) {Y} |
Visiting staff (Staff C) | Professional knowledge (PK) > Professional literacy (PL) > Professional skills (PS) > Care services (CS) | 1. PL(2)→PS(3) {Y} 2. PL(2)→PK(1)→PS(3) {Y} 3. PL(2)→CS(4)→PS(3) {Y} 4. PL(2)→CS(4)→PK(1)→PS(3) {Y} |
Common strategy adoption paths (Common SAPs) | 3. PL→CS→PS 4. PL→CS→PK→PS |
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Chang, M.-W.; Kung, C.-T.; Yu, S.-F.; Wang, H.-T.; Lin, C.-L. Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach. Healthcare 2023, 11, 471. https://doi.org/10.3390/healthcare11040471
Chang M-W, Kung C-T, Yu S-F, Wang H-T, Lin C-L. Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach. Healthcare. 2023; 11(4):471. https://doi.org/10.3390/healthcare11040471
Chicago/Turabian StyleChang, Meng-Wei, Chia-Te Kung, Shan-Fu Yu, Hui-Ting Wang, and Chia-Li Lin. 2023. "Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach" Healthcare 11, no. 4: 471. https://doi.org/10.3390/healthcare11040471