Program directors commonly refer to the "61" competencies required in a CAAHEP accredited medical assisting program. In actuality, programs must document that more than 61 competencies are taught and evaluated. When a program director sees "and" in a competency she/he should be aware that careful documentation is required to demonstrate that all components of the competency are taught and evaluated.

The Administrative competency "Schedule AND manage appointments" is an example of a competency with two components. The program must show that students schedule appointments. For instance, students might use a software scheduling program. In order to demonstrate students can manage appointments they could apply office policy and protocol to late patients or no shows or change appointments, noting the change and reason for change. Additional two-part competencies follow:

Some competencies have four components. As an example, the Administrative competency "Schedule inpatient AND outpatient admissions AND procedures" has four parts: 1) schedule inpatient admissions, 2) schedule outpatient admissions, 3) schedule inpatient procedures and 4) schedule outpatient procedures. It is important to make sure the tools used to evaluate students are clearly linked to each of the competency's components. The following competencies also contain four components:

"Prepare patient for AND assist with procedures, treatments and minor office surgeries" is a clinical competency with six components: 1) prepare patient for procedures, 2) prepare patient for treatments, 3) prepare patient for minor office surgeries, 4) assist with procedures, 5) assist with treatments and 6) assist with minor office surgeries. This competency might be evaluated with one or more check-sheets. If one check sheet is used to evaluate more than one component of the competency it is important to label which components of the competency are evaluated in specific sections of the check sheet.

The AND in a competency statement is a signal that complete documentation is needed. The Educational Competencies for Medical Assistants (ECMA) can provide further guidance in this area.

What Is Competency Based Education?

Competency-based education is many things to many educators. If you asked them to define it you would probably get many different answers, but they probably would all agree on the following two points:

1. Designed around specific competencies a student must demonstrate.
   
   
2. Based on competency statements that describe skill to be performed, conditions for performing the task, and standards for the performance.

What are the competencies a medical assisting student must demonstrate?

The competencies are defined in the 2003 CAAHEP Standards for an Accredited Medical Assisting Program. Each accredited program uses these competencies along with the required content areas as the foundation for their educational offering. The 61 competencies listed in the 2003 Standards are the minimum required entry-level skills and were derived from an occupational analysis conducted by the AAMA.

Can a program select which of the 61 competencies they would like to offer their students?

No, a program must teach all 61 competencies in order to meet the 2003 Standards.

Can a program have additional competencies?

Yes, a program may add to the required competencies. The community of interest for your program may suggest additional competencies to meet the needs of the local medical community so the graduate may obtain a job in the area.

Are there other requirements the Curriculum Review Board (CRB) has besides stating the competency?

Yes, there are other requirements. You must state the task (competency), the conditions (equipment/supplies) and the standards (time and accuracy) for each of the 61 competencies. Students must know all of the requirements for competency, or how the student will be graded, so when they check off there are no surprises.

1. To begin, you need to state the skill the students will demonstrate at the end of the instruction. For example, file medical records and perform hand washing are two of the competencies stated in the Standards.
   
   
2. Next you need to state the conditions under which the students are expected to perform the skill. What supplies/equipment are necessary for the student to perform the skill. For example, you might state given the medical record forms, a folder, color coding materials, and a group of charts as the conditions for filing medical records.
   
   
3. Last you need to state the standards that students must achieve to pass the competency. Two items that are critical to the standard is the time and the accuracy. Time can be stated in minutes, hours, etc. or it may be stated as not critical. Accuracy is usually stated as satisfactory completion in a percentage such as 85 percent or better in a given number of attempts, such as two or three. The time and accuracy are the prerogatives of the program, but they must be stated in writing. The important thing to note is students need to know what is required to pass the competency before the students practice the competency.

Reality Check

Here are three examples of competency-based performance. Which of the three meet the criteria mentioned in this article?

If you selected #2 as the right answer, pat yourself on the back.

#1 is not correct because it does not state the conditions, the minimum time required to pass the competency and the standards. Stating 10 minutes is desirable is just that; the student does not know how long he/she gets to pass the competency. The student knows there are 200 points possible but how many points does it take to pass. All 200 points may be required to pass or maybe just 180. Your guess is as good as ours. Because the check sheet has a place for 3 attempts we can assume the student has 3 chances but it is not stated.

#3 is not accurate unless the time and accuracy are filled in prior to the student checking off. It could become competency-based very easily by filling in the blanks prior to the student practicing the skill. It is the philosophy of competency-based education that the student gets an opportunity to repeat until he/she passes. Because faculty do not have unlimited time to devote to competency check offs usually the number of attempts is mentioned on the check sheet. If this is done, usually the first attempt becomes the student's best attempt especially if a penalty is applied for each repeated attempt. It is important to note the student passed before the penalty was applied.

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