Background: Work-integrated learning constitutes a large part of current healthcare education. During the last decades, a competency-based educational (CBE) approach has been introduced to reduce the theory-practice gap and to promote continuous competency development. Different frameworks and models have been developed to support CBE implementation in practice. Although CBE is now well-established, implementation at healthcare workplaces remains complex and controversial. This study aims to explore how students, mentors, and educators from different healthcare disciplines perceive the implementation of CBE at the workplace. The six-step model of Embo et al. (2015) was used as a base: (1) competency selection, (2) formulating learning goals, (3) self-monitoring performance, (4) self-assessing competency development, (5) summative assessment of individual competencies, and (6) summative assessment of global professional competence.Methods: Three semi-structured focus group interviews were conducted with (1) five students, (2) five mentors, and (3) five educators. We recruited participants from six different educational programs: audiology, midwifery, nursing (associate degree and bachelor), occupational therapy, or speech therapy. We used thematic analysis combining an inductive and deductive approach.Results: An overview of the predefined competencies was hard to find which complicated CBE implementation and resulted in a lack of consistency between the steps; e.g., the link between the selection of relevant competencies (step 1) and the formulation of learning goals based on these selected competencies (step 2) was absent. Furthermore, the analysis of the data helped identifying seven barriers for CBE implementation: (1) a gap between the educational program and the workplace, (2) a lacking overview of predefined competencies, (3) a major focus on technical competencies at the expense of generic competencies, (4) weak formulation of the learning goals, (5) obstacles related to reflection, (6) low feedback quality, and (7) perceived subjectivity of the assessment approach.Conclusion: The present barriers to CBE implementation lead to a fragmentation of current work-integrated learning. In this way, theory beats practice when it comes to CBE implementation as the theory of CBE is not effectively implemented. However, the identification of these barriers might help to find solutions to optimize CBE implementation. Future research seems critical to optimize CBE so that theory can meet practice and the opportunities of CBE optimize healthcare education.

This scoping review aims at providing a summary of available knowledge about the role of ePortfolios in scaffolding learning in eight healthcare disciplines to identify main concepts, best practices, and knowledge gaps. ePortfolios are well established in scaffolding learning in many healthcare disciplines. Yet, an overview of the ePortfolio literature in the context of healthcare education doesn't exist. A scoping review of ePortfolio use in the following healthcare disciplines was conducted: audiology, dental hygiene, midwifery, nursing (associate degree and bachelor), occupational therapy, podiatry, and speech therapy. Eight databases were systematically searched. By structuring the data, five themes were identified: (1) contexts, (2) research populations and samples, (3) ePortfolio platforms used and objectives, (4) benefits and challenges in the use of ePortfolios, and (5) recommendations derived from literature in the use of ePortfolios. The themes were further specified with sub-themes. The themes help meeting the aim of the scoping review to develop a structured overview of ePortfolio use and research. Thirty-seven articles were included. Samples predominantly involved students and fewer mentors, educators, and graduates. ePortfolios were used to support learning in the context of healthcare workplaces (n = 17), educational institutions (n = 14), or both (n = 6). Different objectives of ePortfolio use were derived from literature and categorized into eight themes: (1) to document and evidence competency, (2) reflection, (3) feedback and assessment, (4) (inter)professional collaboration, (5) support Continuous Professional Development, (6) bridging the gap between theory and practice, (7) employment, and (8) certification. These objectives were in turn coupled to two identified types of ePortfolio platforms: "store and communicate" and "work and learn" ePortfolios. The description of benefits and challenges formed a substantial part of the literature and data were mapped into five themes to structure the data: (1) technology, (2) collaboration, (3) competency development (before and after graduation), (4) employment, and (5) quality of patient care. Although the benefits outweighed the challenges, important challenges were identified, e.g., the high time investment required when working with an ePortfolio, low digital literacy, lack of internet access. Studies mainly focused on perceptions (n = 32). Only a few studies explored measurable outcomes (i.e., competencies or behavioral indicators). Because ePortfolios are used by different ePortfolio users, in different contexts, and with different objectives, new research directions are needed to investigate how specific features, such as collaboration tools, feedback tools, or assessment tools can improve the role of ePortfolios in supporting healthcare education. This scoping review presents an overview of the knowledge about the role of ePortfolios in scaffolding learning in eight healthcare disciplines.

Background: Several competency frameworks are being developed to support competency-based education (CBE). In medical education, extensive literature exists about validated competency frameworks for example, the CanMEDS competency framework. In contrast, comparable literature is limited in nursing, midwifery, and allied health disciplines. Therefore, this study aims to investigate (1) the completeness of the CanMEDS Roles, and (2) the relevance, formulation, and measurability of the CanMEDS key competencies in nursing, midwifery, and allied health disciplines. If the competency framework is validated in different educational programs, opportunities to support CBE and interprofessional education/collaboration can be created.Methods: A three-round online Delphi study was conducted with respectively 42, 37, and 35 experts rating the Roles (n = 7) and key competencies (n= 27). These experts came from non-university healthcare disciplines in Flanders (Belgium): audiology, dental hygiene, midwifery, nursing, occupational therapy, podiatry, and speech therapy. Experts answered with yes/no (Roles) or on a Likert-type scale (key competencies). Agreement percentages were analyzed quantitatively whereby consensus was attained when 70% or more of the experts scored positively. In round one, experts could also add remarks which were qualitatively analyzed using inductive content analysis.Results: After round one, there was consensus about the completeness of all the Roles, the relevance of 25, the formulation of 24, and the measurability of eight key competencies. Afterwards, key competencies were clarified or modified based on experts’ remarks by adding context-specific information and acknowledging the developmental aspect of key competencies. After round two, no additional key competencies were validated for the relevance criterion, two additional key competencies were validated for the formulation criterion, and 16 additional key competencies were validated for the measurability criterion. After adding enabling competencies in round three, consensus was reached about the measurability of one additional key competency resulting in the validation of the complete CanMEDS competency framework except for the measurability of two key competencies.Conclusions: The CanMEDS competency framework can be seen as a grounding for competency-based healthcare education. Future research could build on the findings and focus on validating the enabling competencies in nursing, midwifery, and allied health disciplines possibly improving the measurability of key competencies.

Background: Work-integrated learning (WIL) is widely accepted and necessary to attain the essential competencies healthcare students need at their future workplaces. Yet, competency-based education (CBE) remains complex. There often is a focus on daily practice during WIL. Hereby, continuous competency development is at stake. Moreover, the fact that competencies need to continuously develop is often neglected. Objectives: To ultimately contribute to the optimization of CBE in healthcare education, this study aimed at examining how competency development during WIL in healthcare education could be optimized, before and after graduation. Methods: Fourteen semi-structured interviews with 16 experts in competency development and WIL were carried out. Eight healthcare disciplines were included namely associate degree nursing, audiology, family medicine, nursing (bachelor), occupational therapy, podiatry, pediatrics, and speech therapy. Moreover, two independent experts outside the healthcare domain were included to broaden the perspectives on competency development. A qualitative research approach was used based on an inductive thematic analysis using Nvivo12© where ‘in vivo’ codes were clustered as sub-themes and themes. Results: The analysis revealed eight types of requirements for effective and continuous competency development, namely requirements in the context of (1) competency frameworks, (2) reflection and feedback, (3) assessment, (4) the continuity of competency development, (5) mentor involvement, (6) ePortfolios, (7) competency development visualizations, and (8) competency development after graduation. It was noteworthy that certain requirements were fulfilled in one educational program whereas they were absent in another. This emphasizes the large differences in how competence-based education is taking shape in different educational programs and internship contexts. Nevertheless, all educational programs seemed to recognize the importance of ongoing competency development. Conclusion: The results of this study indicate that identifying and meeting the requirements for effective and continuous competency development is essential to optimize competency development during practice in healthcare education.

Interprofessional communication is crucial for patient care, yet there is a dearth of comprehensive assessment tools essential to train and assess healthcare students. While the Interprofessional Educational Collaborative framework (IPEC) outlines eight sub-competencies, it lacks detailed behavioral indicators. This study aimed to create a repository of interprofessional communication behaviors to complement the IPEC sub-competencies. From 12,448 articles, 55 were selected and thematically analyzed with NVivo18 (R). We identified 230 interprofessional communication behaviors, organized into 10 themes and 61 sub-themes, aligning with the IPEC sub-competencies. This comprehensive repository could be foundational for developing interprofessional communication assessment tools in healthcare education and aiding healthcare institutions in improving interprofessional communication practices.

Background: Electronic portfolios (e-portfolios) are valuable tools to scaffold workplace learning. Feedback is an essential element of the learning process, but it often lacks quality when incorporated in ePortfolios, while research on how to incorporate feedback into an ePortfolio design is scarce. Objectives: To compare the ease of use, usefulness and attitude among three feedback formats integrated in an ePortfolio: open-text feedback, structured-text feedback and speech-to-text feedback. Methods: In a mixed method designed experiment, we tested with 85 participants from different healthcare disciplines, three feedback formats in an ePortfolio prototype. Participants provided feedback on students’ behaviour after observing video-recorded simulation scenarios. After this, participants completed a questionnaire derived from the Technology Acceptance Model (TAM). The experiment ended with a semi-structured interview. Results: Structured-text feedback received highest scores on perceived ease of use, usefulness, and attitude. This type of feedback was preferred above open-text feedback (currently the standard), and speech-to-text feedback. However, qualitative research results indicated that speech-to-text feedback is potentially valuable for feedback input on-premise. Respondents would use it to record short feedback immediately after an incident as a reminder for more expanded written feedback later or to record oral feedback to a student. Implications: Structured-text feedback was recommended over open-text feedback. The quality of the speech-to-text technology used in this experiment, was insufficient to use in a professional ePortfolio but holds the potential to improve the feedback process and should be considered when designing new versions of ePortfolios for healthcare education.