The effectiveness and impact on performance of pharmacy-related competency development frameworks: A systematic review and meta-analysis

Abstract

Background

Competency frameworks for education, training and development are widely used in the health professions, including pharmacy. Published studies suggest that competency frameworks have an impact on professional performance. Professional performance that is consistent with up-to-date knowledge and skills influences health care quality and patient safety. This review assessed the effectiveness of competency frameworks in facilitating improvement in pharmacists’ performance.

Method

PubMed/Medline, CINAHL, Embase, ERIC, PsycINFO and Scopus electronic databases were searched to identify relevant literature. The findings of the included studies were synthesised qualitatively, and via a meta-analysis. The meta-analysis evaluated the odds of improved competency behaviour as a proxy measure of impact on pharmacists’ performance. Study quality was assessed using 12 criteria adapted from the EPPI-Centre guidelines v0.9.7. The protocol for this review is registered on PROSPERO with reference number CRD42018096580.

Results

In total, nine interventional studies were identified for review. The review findings showed observable and significant improvement in pharmacists’ performance when competency frameworks are used to appraise performance, identify knowledge gaps, and tailor learning activities. A meta-analysis that involved a total of 348 pharmacists undergoing repeat peer assessment showed pooled odds for improved competency behaviour of 4.41 (95% CI: 1.89–10.29, I² = 83%). Subgroup analyses showed pooled odds with corresponding 95% CI of 6.50 (1.77–23.97, I² = 77%) vs 2.95 (0.59–14.72, I² = 93%) for the studies that were conducted in countries within or outside Europe, respectively; 10.51 (3.73–29.62, I² = 24%) vs 2.39 (0.96–5.95, I² = 87%) for studies with reassessment conducted at ≤6 months from baseline, or more, respectively; 6.68 (1.63–27.45, I² = 88%) vs 2.80 (0.86–9.07, I² = 74%) for studies involving hospital or community pharmacists, respectively; and 2.80 (1.22–6.45, I² = 77%) for studies with low risk of bias.

Conclusion

These findings suggest competency frameworks facilitate improvement in pharmacists’ performance; however, further evaluative studies are needed.

Introduction

Global reforms in health professional education involving the implementation of outcome and competency-based education and training (CBET) have occurred in recent decades.1, 2, 3 Key drivers for the implementation of CBET within the health professions include the dissatisfaction with the outcomes of traditional theory-based education models and the imperative for a flexible workforce that is adaptable to changing population health needs.¹ A crucial element of the CBET model is the identification of the competencies required for safe, effective, and consistent performance within the limits of professional practice.^4,5 Competencies refer to the knowledge, skills, and attributes that are essential for effective professional performance.^6,7 A compilation of these competencies and their corresponding behaviours produces a framework that is used to design education and training curricular, define expectation of practice, regulate career entry, and support expertise development.⁸ With the implementation of CBET in the training of health workers, competency frameworks that provide a shared understanding of the requirements for professional practice are now commonplace within the health professions.⁹

Competency frameworks in the health professions provide a blueprint of the required standards of practice, benchmarks of work accountability, and career progression pathways.⁸ In Pharmacy, these frameworks include those containing generic competencies for a defined level of practice (for example, foundation10, 11, 12 and advanced practice13, 14, 15), and others that are sector/role-related16, 17, 18, 19 or specialty-specific.20, 21, 22 These frameworks are typically defined and developed by professional leadership bodies, regulatory or accreditation agencies. For example, the International Pharmaceutical Federation (FIP) has developed two global frameworks that describe the generic competencies for foundation and advance pharmacy practice respectively.^10,15 Other organisations have also developed regional, national, and institutional frameworks that map the expectations for pharmacy practice in the specified region or country.23, 24, 25, 26, 27 A 2015 survey of 48 countries across the six World Health Organization (WHO) regions, showed that competency frameworks in pharmacy were either already in use or being developed in approximately 60% of the countries surveyed.²⁸

Pharmacy-related competency frameworks generally comprise competencies grouped into clusters (or domains), and sub-divided into respective behavioural indicators (or behaviours).^4,10 The competency behaviours in the frameworks are the discrete measurable metrics of professional performance that are assessed to determine competence and identify knowledge/skills gaps or deficiencies. Professional performance refers to the way a practitioner carries out a given job function, role or task and describes what an individual actually does in practice.²⁹ There is evidence that suggest that the acquisition of knowledge about a subject matter does not guarantee or imply successful on-the-job performance in daily practice.^1,30 Rather, professional performance is underpinned by the application of acquired knowledge, skills, and experience to solve problems and influence practice.^31,32 Professional performance that is consistent with up-to-date knowledge and skills influence health care quality and patient safety.²⁹ Existing evidence in pharmacy suggest that the use of competency frameworks to benchmark standards of practice, appraise performance and tailor learning activities aids the attainment of competence and improvement in professional performance.33, 34, 35 However, the level of impact on performance of pharmacy-related competency frameworks remains unclear in the literature. This review aims to evaluate the evidence and determine the effectiveness of competency frameworks in facilitating performance improvement in pharmacy.