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Health Services Research Core Competencies

Final Report

The purpose of this conference, held on January 10-11, 2008, was to refine competencies common to all doctoral trained health services research professionals.

Principal Investigator: Diane P. Martin, Ph.D.
Grantee Institution: University of Washington School of Public Health
Project Period: 5/1/2007 to 3/31/2008
Grant Project Officer: Brenda Harding, AHRQ
Grant Award: R13 HS016960-01

I. Abstract
II. Purpose of Conference
III. Scope
IV. Methods
V. Results: HSR Doctoral Level Core Competencies
VI. Literature Cited

I. Abstract

Purpose: The purpose of this conference, held on January 10-11, 2008, was to refine competencies common to all doctoral trained health services research professionals.

Scope: Health services research (HSR) applies methods from multiple disciplines to a wide variety of health issues. HSR doctoral competencies can offer a common framework for students, alumni, faculty, programs, and institutions that employ HSR doctoral graduates.

Methods: A Planning Meeting was held in June 2007 to ensure continuity from the previous conference grant (Forrest, Principal Investigator [PI]), gather Version 1 (V1) feedback, and plan next steps. A survey was conducted with HSR doctoral programs in 12/2007 to assess the extent to which programs used competencies. Survey results, comparisons to related field competencies, and a literature review were provided to conference invitees. During the conference, attendees drafted Version 2 (V2) competencies, delivery and assessment examples, and a policy statement. The Version 2 draft, along with a brief survey, was distributed to 38 HSR programs in March 2008 for review and revisions.

Results: Nineteen representatives from HSR programs, government agencies, and employers attended the Competencies Conference. Work during the conference and revisions made after the conference resulted in HSR doctoral competencies Version 2.

Key Words: health services research; doctoral education; core competencies.

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Purpose of Conference

The Health Services Research Competencies Conference goals were to refine competencies for health services research doctoral programs, and to discuss ways to deliver competencies in courses and experiential training and how to measure students' attainment of competencies.

Specifically, the conference goals were:

To develop and reach consensus on Version 2 competencies.
To provide delivery and assessment examples for each competency.
To compose a policy statement for Version 2.

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III. Scope

Health Services Research (HSR) can be loosely defined as scientific inquiry into the ways in which health services are delivered to various constituents (Forrest). HSR requires a multidisciplinary approach, drawing from traditional disciplines, including biological and social sciences, as well as contemporary fields like informatics.

As a relatively new field, there are multiple interpretations and applications of HSR, and therefore it is essential for HSR leaders to consider common competencies for HSR professionals. By establishing a common set of core HSR doctoral competencies, HSR leaders can achieve the following:

Offer a guiding framework for HSR doctoral programs.
Allow prospective HSR doctoral students to make informed decisions about their academic careers.
Provide common expectations for HSR doctoral graduates and their employers.
Aid employers and professional societies in planning continuing education activities.
Enable HSR alumni to self-assess their skills.
Aid in defining the field of HSR.

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IV. Methods

The University of Washington (Diane P. Martin, PI) received an AHRQ small conference grant in May 2007 to re-examine the HSR doctoral level competencies developed by Forrest et al. in 2005 (Version 1). Tom Ricketts of the University of North Carolina at Chapel Hill was designated as the conference co-chair. Drs. Martin and Ricketts worked closely with the team from Version 1 to ensure continuity in the project. Chris Forrest, Erin Holve, and Anne Millman were extremely helpful in providing information and answering questions from the Version 2 team.

Drs. Martin and Ricketts co-chaired a Planning Meeting at the AcademyHealth Annual Research Meeting in June 2007. Francis Chesley, Karen Rudzinski, and Brenda Harding from AHRQ collaborated via conference call with Drs. Martin and Ricketts to offer advice and guidance for the meeting. Input from the planning meeting committee also helped with meeting preparations. Representatives from HSR programs, AHRQ, AcademyHealth, and employers were invited to the Planning Meeting.

At the meeting, attendees agreed upon the importance of articulating competencies for HSR, discussed general omissions and commissions of Version 1, and agreed on next steps. Although the competencies for master's level training in the competencies was seen as important, it was decided that it would be best to focus on doctoral competencies first given the limited resources of the conference grant.

After the Planning Meeting, Drs. Martin and Ricketts developed a plan for the remainder of the grant. There were four major activities for the grant:

HSR Doctoral Program Survey.
Literature Review.
Competencies Review.
Version 2 Survey.

HSR Doctoral Program Survey

During fall 2007, Diane Martin and Gayle Garson attempted to capture information from as many HSR doctoral programs as possible. The starting point was the program list created for the 2005 HSR competencies conference held in 2005 and cross-referenced it with the AcademyHealth training program directory and AHRQ funded T32 programs. A few new programs were added to the list after a comprehensive Web search. The list was subsequently verified by reviewing program details online. Five institutions initially identified as HSR doctoral programs self-identified as ineligible (not having an HSR doctoral program): Columbia University, RAND, Stanford University, University of California—San Diego, and the University of Chicago (Stanford and the University of Chicago are T32 institutions that do not have a formal HSR doctoral degree granting program). The final list is comprised of 38 universities with HSR doctoral programs (Table 1).

In November 2007, a brief survey was sent to the 38 programs . The survey asked programs to indicate whether or not they used competencies, and whether or not they had any documentation for how competencies were delivered or assessed. Furthermore, respondents were asked to describe the extent to which the Version 1 competencies were addressed by their programs.

Literature Review

Using the information from Version 1 as a starting point, Gayle Garson conducted a literature review of competencies from medical and social science peer-reviewed journals in preparation for the planning meeting. Results from the review were incorporated into two white papers that provided guidance for discussion at the competency conference. Background Information for HSR Doctoral Core Competencies proposed a working definition of competencies and summarized competency work in related fields along with an analysis of the similarities and differences between other competencies and Version 1. Delivery and Assessment of HSR Doctoral Core Competencies presented findings from the HSR Doctoral Program Survey. Both papers posed questions for conference participants to consider during the conference.

Competencies Review

The competency conference was a collaborative among AcademyHealth, AHRQ, and the University of Washington. AcademyHealth hosted the conference at their Washington, DC headquarters on January 10-11, 2008.

Directors and students from AHRQ-sponsored NRSA T32 training programs and CEPH-accredited doctoral health services research programs were invited to the conference. In addition, representatives from AcademyHealth, AHRQ, and public and private sector HSR doctoral graduate employers were invited. A list of conference attendees is presented in Table 2.

An overview of the conference agenda is presented below:

Day 1
January 10th, 2008 1:30 PM-8:00 PM
AcademyHealth, Washington, DC

Introductory remarks.

Discussion of background information.

Presentation of the employer perspective on HSR competencies.

Small group discussions: Using V1 as a basis for developing.

Discussion of HSR competencies.

Day 2
January 11th, 2008 8:30 AM-3:00 PM

Large group discussion of competency delivery and assessment.

Policy development.

Closing remarks and next steps.

Conference participants were asked to complete a brief one page survey before leaving the conference.

After the conference, comments and suggestions from the conference were incorporated into a preliminary Version 2. The preliminary version was sent to conference participants to ensure that it reflected what occurred at the conference and to give participants a chance to offer further feedback after having time to reflect on the competencies.

Version 2 Survey

Version 2 of the competencies was distributed to all 38 doctoral programs for comment in March 2008. In addition, the following survey questions were asked of each program:

Do the competencies represent the essence of Health Services Research? If no, what would you change to capture HSR's essence?
How would your program use the competencies?
How can the competencies clarify HSR's identity and raise awareness outside of the field?
Where did your last 5 HSR doctoral graduates accept positions? Please provide the job title and institution name. For example: "Research Scientist, Research Triangle Institute" or "Assistant Professor, University of Illinois at Chicago"
From where did your 5 most recently hired faculty members graduate? Please list the degree, degree description, and university. For example: "Ph.D. in Health Economics from the University of Pennsylvania" or "D.Sc. in Health Services Research from Boston University"

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V. Results

HSR Doctoral Program Survey

Highlights from the HSR Program Survey are presented below.

A majority of the 38 HSR programs (87%) responded to the survey. Four programs did not respond, and one program refused to participate. Most respondents (67%) reported having a set of competencies, with an additional 19% noting that they were developing competencies. A Web review of the four non-responding programs revealed at least 3 additional programs with competencies published on their Web sites.

Programs with competencies were asked to assess the level to which their program addressed each competency from Version 1. All Version 1 competencies were addressed by a majority of responding programs (Table 3). Most programs addressed Version 1 competencies at a "high" level. Two notable exceptions were "primary data collection methods" and "stakeholder collaboration and knowledge translation," which were addressed to an intermediate or low degree by more than half of the programs.

We then asked programs about the various ways in which competencies were assessed. Incoming students were most frequently evaluated by "faculty assessment." Student performance in required and elective courses was most frequently assessed with numeric or letter grades. Research assistantships were evaluated with faculty informal assessment most often, and independent studies tended to be assessed with numeric or letter grades. Program benchmarks, including oral exams and dissertation defenses, were assessed with pass/fail or honors/pass/fail grades by a majority of the respondents.

Programs were asked about any challenges they faced with the creation, implementation, or assessment of competencies. Difficulty in finding faculty time to dedicate to competencies was mentioned by a few programs. In addition, the complexity in spanning multi-disciplinary resources, within and between departments, was cited by a number of respondents.

HSR Doctoral Core Competencies Version 2

Discussions at the conference and subsequent opportunities for comment after the conference resulted in the following 11 core competencies with domains (Table 4).

Competency Policy Statement

Conference participants emphasized the need to articulate a policy for the competencies. The policy statement is shown below:

Health Services Research (HSR) Doctoral Competencies Version 2 codifies the breadth of knowledge, skills and abilities that are essential for success as a health services researcher. The competencies are intended to provide a common framework for HSR doctoral education within academic programs for on the job training or continuing education. Delivery and assessment examples are provided to aid adoption of the competencies by the field.

HSR programs may use competencies for program assessment, to allocate resources, and to be competitive for training grants. Competencies can also be used by prospective HSR applicants to select programs, by HSR students and alumni to self-assess their skills, and by employers who hire HSR graduates. The competencies are an evolving document that warrants periodic review to account for changing HSR priorities and needs.

While this framework can help promote the field of HSR and define the knowledge and skills needed for HSR graduates, it is not intended for standardization or accreditation purposes. As a multi-disciplinary field, HSR thrives upon the diversity across programs and within each individual doctoral program. The depth and breadth of each competency is not proscribed in this list, although each program should have depth in at least one area. Individual programs can review their mission statements, faculty expertise, and available resources to determine the extent to which competencies may be implemented.

Competency Delivery and Assessment

During the conference, participants offered many suggestions for competency delivery and assessment. A summary of delivery and assessment examples are shown in Table 5 and Table 6.

Next Steps

Conference attendees discussed next steps for Version 2. Attendees agreed to review the preliminary Version 2 after the conference, and forward feedback from their colleagues. After Version 2 was revised, it would be sent to all HSR doctoral programs for comment, along with survey questions proposed by attendees.

Conference Evaluation

Fourteen participants (78%) completed the evaluation survey. Overall, feedback from conference participants was extremely positive. Participants were asked to evaluate conference objectives on a scale from 1 (poor) through 5 (excellent). As shown in Figure 1, participants rated the conference very highly. Furthermore, the average response to how useful the conference was to the HSR field on a scale from 1 (poor) through 5 (excellent) was 4.6.

Conference participants planned on using Version 2 in a number of ways, as shown in Table 7.

Table 7. How will you use Version 2?

Response	Percent
Generate discussion with faculty in your HSR program	71%
Generate discussion with students in your HSR program	64%
Aid in curriculum development	50%
Use as part of a grant application	29%
Generate discussion with hiring managers and/or other colleagues	21%
Aid in strategic planning	50%
Other	36%

Additional comments provided by participants are shown below:

Support ongoing efforts to keep the competencies alive
Include industry employees/alumni in future discussions
I look forward to "validating" my own institution
Excellent facilitation and management of the two days!
Thank you for leading us. More communication after meeting needed.

Version 2 Feedback from HSR Programs

In February 2008, Version 2 was sent to all 38 HSR doctoral programs along with the five survey questions presented on page 6. A majority of programs (66%) responded, approximately one-third of programs (31%) did not respond, and one program refused to participate.

A majority of respondents (61%) indicated that the competencies represented the essence of HSR. The remaining respondents felt that the competencies did not represent the essence of HSR (17%) or were not sure (22%). Comments from respondents who did not think the competencies captured HSR noted that the competencies were too vague or broad.

When asked about how their programs would use the competencies, most respondents (64%) indicated that they would use them to evaluate their curricula to identify any strengths or weaknesses in their programs. Some additional uses included student self-assessment tools and guides for recruiting new students or new faculty.

There was little consensus among respondents about how the competencies could clarify HSRs identity and raise awareness outside of the field. A few respondents noted that this would be beyond the scope of competencies, and that raising awareness should be done a different way. Respondents who felt that the competencies could contribute to HSR identity suggested using the competencies to educate potential employers about the skills an HSR graduate will have, and by incorporating the competencies into descriptive materials for potential students.

Sixteen programs provided information about the placement of their graduates (n=80 recent graduates), with a few programs noting that they were relatively new and did not have any graduates at the time of the survey. The most frequently identified job placement for graduates was at a University, either in a faculty (41%) or non-faculty (14%) capacity. A sizeable proportion of graduates accepted positions with private industry (24%). The remaining graduates went on to postdoctoral positions (14%) or employment within the public sector (8%).

Recent faculty hire information was completed by 19 programs (n=86 faculty). Exceptions included departments that did not have faculty hired recently, or new departments that drew established faculty from different departments. Table 8 displays the degree descriptions from responding companies.

Table 8. From where did your 5 most recently hired faculty members graduate?

Degree Description	Percent
Health Policy and Administration	19%
HSR	16%
Business	15%
Public Health	13%
Social Science	13%
Medicine	9%
Health Economics	8%
Other	7%
Total	100%

Version 2 Dissemination

Feedback from HSR programs was incorporated into a revised Version 2. Diane Martin presented preliminary findings at the AcademyHealth Annual Research Meeting in June, 2008 at a special session of the Methods Council. A manuscript is currently being drafted for submission to Health Services Research.

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VI. Literature Cited

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Current as of October 2008

Internet Citation:

Health Services Research Core Competencies. Final Report. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/fund/training/hsrcomp08.htm