Using a contextualized competency framework to develop rehabilitation programmes and their curricula: a stepwise guide for programme and curriculum developers

Using a contextualized competency framework to develop rehabilitation programmes and their curricula A stepwise guide for programme and curriculum developers Version for field testing A d a p ting the Re ha b ilita tio n C o m p e te nc y Fra m e w o rk fo r a sp e c ifi c co nte xt

Using a contextualized competency framework to develop rehabilitation programmes and their curricula A stepwise guide for programme and curriculum developers Version for field testing Using a contextualized competency framework to develop rehabilitation programmes and their curricula: A stepwise guide for programme and curriculum developers. Version for field testing ISBN 978-92-4-001657-6 (electronic version) ISBN 978-92-4-001658-3 (print version) © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout by Inis Communication iii CONTENTS Acknowledgements iv Key terms v 1. Introduction 1 2. Good practices when developing a curriculum using a contextualized rehabilitation competency framework 5 3. Key considerations when developing a programme and curriculum using a contextualized rehabilitation competency framework 7 4. The process of developing a rehabilitation programme and its curriculum using a contextualized competency framework 9 References 25 Annex 1. Checklist for competency-based education 27 Annex 2. Template for competency-based rehabilitation programme and curriculum 28 Annex 3. Template for competency-based rehabilitation curriculum plan 29 iv ACKNOWLEDGEMENTS The World Health Organization (WHO) extends its gratitude to all those whose dedicated efforts and expertise contributed to this resource. This guide, Using a contextualized competency framework to develop rehabilitation programmes and their curricula, was developed with the oversight of Dr Alarcos Cieza, Unit Head, Sensory Functions, Disability and Rehabilitation, Department of Noncommunicable Diseases, WHO. Jody-Anne Mills, Rehabilitation Programme, WHO, was responsible for the coordination and development of the guide; Siobhan Fitzpatrick, Pauline Kleinitz and Elanie Marks provided valuable input to its development. Special thanks are given to Cheryl Burditt Footer, PT, PhD, independent consultant on rehabilitation programme and curriculum development, United States of America, and to the members of the Rehabilitation Competency Framework Technical Working Group who provided expert feedback on the drafts of the guide: Harvey Abrams, Courtesy Professor, Department of Communication Sciences and Disorders, University of South Florida, United States of America; Pamela Enderby, President, International Association of Communication Sciences and Disorders (IALP), United Kingdom of Great Britain and Northern Ireland (United Kingdom); Edward Lemaire, President, International Society for Prosthetics and Orthotics, Canada; Ashima Nehra, Professor, Neurosciences Centre, All India Institute of Medical Sciences, India; and Rhoda Olkin, Distinguished Professor, California School of Professional Psychology at Alliant International University, United States of America; and Stephanie Vaughn, Emeritus Professor, School of Nursing, California State University, United States of America. Biographies of each member are available online. The development of this guide was made possible through the support of the United States Agency for International Development (USAID). v KEY TERMS Activities An area of work that encompasses groups of related tasks. Activities are time-limited, trainable and, through the performance of tasks, measurable (1). Behaviours Observable conduct towards other people, or activities that express a competency. Behaviours are durable, trainable and measurable (1). Competencies The observable ability of a person, integrating knowledge, skills, values and beliefs in their performance of tasks. Competencies are durable, trainable and, through the expression of behaviours, measurable (1). Course The discrete units of study addressing specific subject areas. Courses generally increase in the depth of subject matter as learners move through the programme (2). They may be weighted, often using the metric of “units” to indicate the degree to which they contribute to programme completion. Curriculum The educational activities and environments that are designed to achieve specific learning objectives. A curriculum encompasses the content and objectives of learning; the learning experiences; teaching methods; and the formats of assessment. It also includes quality improvement and programme evaluation (3). Curriculum plan The organization of learning content within a curriculum. A curriculum plan demonstrates how curriculum content is structured and sequenced to enable the progressive attainment of competence, and offers a more detailed description of the learning experiences that students will be offered (2). Learning objectives Assessable units of learning which, in aggregate, reflect the attainment of a behaviour or task. This guide distinguishes between programme learning objectives, which capture the units of a behaviour or task, and course learning objectives, which capture the knowledge, skills and attitudes related to the subject matter of the course. Programme The totality of courses which provide a specific award or qualification to the learner on successful completion. Syllabus A description of the scope and depth of subject matter to be covered in a course, as well as the specific learning experiences, materials and assessments that the course will entail, typically in greater detail than the curriculum plan. A syllabus communicates to learners what they can expect from a course and what it will require of them. Tasks Observable units of work as part of an activity, which draw on knowledge, skills, attitudes and behaviours. Tasks are time-limited, trainable and measurable (1). * Description of terms is specific to this guidance. Interpretation and use of terms vary between contexts. * vi Using a contextualized competency framework to develop rehabilitation programmes and their curricula 1 1. INTRODUCTION This guide, Using a contextualized competency framework to develop rehabilitation programmes and their curricula complements both the Rehabilitation Competency Framework (RCF) and Adapting the WHO Rehabilitation Competency Framework to a specific context. It proposes a methodology for developing a rehabilitation education and training programme and curriculum that can be used to support competency- based education (see Figure 1). The phases and steps detailed (described in the box below) are relevant to those of any profession or specialization, either developing new rehabilitation programmes, or revising curricula within existing rehabilitation programmes. In addition to outlining the process of programme development, the methodology describes how competencies and activities modelled from the RCF can be used to generate learning objectives, and how these can be positioned in a comprehensive curriculum. It is important to note that whereas “competency-based education” is used in this guide because it is the normative term, the RCF differentiates between competencies and activities, and includes both (see Table 2). Many countries seek to expand their rehabilitation workforce through establishing education and training programmes for professions either not yet in existence in their health system, or only emerging. Establishing a new rehabilitation programme is an involved process, with political, legal, and regulatory facets that call for a systematic, collaborative and coordinated approach. Of utmost importance is ensuring that a programme produces graduates who are equipped to meet population needs, and who function effectively in the health system. While careful planning and cooperation ensure that programme graduates are legally recognized, well regulated, and absorbed into paid posts, the programme’s curriculum ensures graduates have the knowledge, skills and attitudes to address the specific needs of the population effectively. A curriculum is central to any rehabilitation programme, and encompasses the content, structure, learning experiences and assessment methods that will enable graduates to obtain the competence they require to perform their roles safely and effectively (3–5). While traditional curricula development looks retrospectively at the legacy of a profession’s knowledge and skills, curricula that support competency-based education are designed according to the required outcomes of the education and training; competency-based education looks ahead to determine what graduates will encounter in terms of population needs, and plans the curricula accordingly so that learners are equipped to meet what is required by the population, associated professionals, employers and regulating bodies (see Table 1) (6, 7). SCOPE OF THE GUIDE What workforce does this guide relate to? Rehabilitation programmes include those who provide education and training to health workers who deliver interventions that optimize functioning and reduce disability. The workforce using this guide will typically include those developing, or working in, rehabilitation programmes in the areas of audiology, occupational therapy, prosthetics and orthotics, physiotherapy, and speech and language therapy, as well as those in medical, nursing and psychology rehabilitation specialist programmes. In addition, the guide will be of relevance and use for programmes training rehabilitation assistants, technicians, and community- based rehabilitation workers, or any other health cadre delivering rehabilitation. What level and type of rehabilitation education and training does this guide relate to? The process described in this guide relates most directly to comprehensive rehabilitation programmes, such as undergraduate or post-graduate programmes, including those that award a diploma, bachelor’s or master’s degree. However, the methodology provided can be adapted and scaled for short courses, such as those used in continuous professional development, and to doctoral programmes that include course work. What stage of rehabilitation programme development does this guide relate to? This guide can be used in the context of establishing a new rehabilitation programme and its curriculum where one has not previously existed, or revising or renewing an existing programme and curriculum. 2 Using a contextualized competency framework to develop rehabilitation programmes and their curricula Figure 1. Progression from the RCF to its application in competency-based education and training Table 1. The contrasting focus of traditional versus competency-based education (3, 7) Traditional education Competency-based education Learning objectives focus on what the learner should know Learning objectives focus on what the learner should be able to do Focuses on the process of education Focuses on the objectives of education Curriculum largely shaped by what has been taught in the past Curriculum largely shaped by the competencies needed by the population Implicitly links the health needs of the population to the content of the curriculum Explicitly links the health needs of the population to the competencies required of learners This guide serves to assist those developing or revising rehabilitation programmes and their curricula to apply a competency lens to education and training; it can be applied in the context of pre- or post-service education and training, with outcomes and content scaled accordingly. While it provides a systematic approach for programme and curriculum development, the guide does not define content or specific educational approaches for either. These should be determined by the institution, reflect the learning objectives, and be suitable to the local context and specific needs of the learner. Furthermore, while an appropriately designed programme and curriculum are critical to competency-based education, these are only one aspect of its successful implementation. Implementing the programme and teaching the curriculum require adequate institutional capacity; this includes trained faculty, learning resources, opportunities and environments, and political and regulatory support (Figure 2) (3). Investment in competency-based education is supported by the available evidence and is a powerful mechanism to align education and training with health system priorities (6, 8, 9). Investment holds particular value for resource-limited countries, where the knowledge and skills of rehabilitation workers need to reflect, and accommodate for, not only the population’s health profile, but also the strengths and weaknesses (e.g. workforce gaps and maldistributions) of the health system (6). Context-specific competency framework Workforce planning Performance appraisal APPLY Curriculum guide This guide provides a systematic process for applying the contextualized RCF to develop a competency- based rehabilitation programme and its curriculum Competency- based education Regulation and accreditation ADAPT Adaption guide 1. Introduction 3 Figure 2. The competency-based education log frame Institutions developing programmes or designing curricula are encouraged to look beyond this guidance to the wealth of related evidence and resources, and to partner with experts. Those new to the process of programme development, curriculum design and competency-based education in rehabilitation can use this guide to become more informed and active participants in the development and design process. INPUTS OUTPUT OUTCOME IMPACT • Competency- based education • Competent rehabilitation workers • Population health • Curriculum • Faculty • Cohort • Learning materials • Learning environments • Learning experiences 4 Using a contextualized competency framework to develop rehabilitation programmes and their curricula 5 2. GOOD PRACTICES WHEN DEVELOPING A CURRICULUM USING A CONTEXTUALIZED REHABILITATION COMPETENCY FRAMEWORK The guide, Adapting the Rehabilitation Competency Framework to a specific context (the “RCF adaptation guide”) sets out good practices for developing a competency framework. The same practices apply when using the framework to develop or revise rehabilitation programmes and their curricula; the practices help ensure that a programme and curriculum is acceptable, implementable, and effective in supporting competency-based education, and include the following: ADOPTING AN INCLUSIVE APPROACH Including stakeholders in programme and curriculum development is essential to support competency- based education and to develop a workforce that will eventually be absorbed into, and be active and effective contributors to, the health sector. Representatives from government ministries (health, education and labour), service-users, professional associations, employers, and regulatory bodies, as well as key focal points from the institution, should be engaged to some extent in the process of curriculum development, particularly in the planning process (Step 1). Stakeholder input helps not only to shape curriculum content, but also to raise awareness and recognition of the field; it further fosters ownership and support of the programme. PLANNING IMPLEMENTATION FROM THE OUTSET Curriculum development is only one component of an effectively implemented competency-based rehabilitation programme. Adequate attention to the political and institutional environments in which the programme will be implemented, and to the institutional capacity and resources required, is essential; careful consideration of these factors from the outset can optimize the value of the programme and curriculum, ensuring that they are context compatible and are capable of equipping learners with knowledge and skills aligned with population needs. Of particular importance is the need to ensure that the qualification achieved will be appropriately recognized, that regulatory mechanisms are in place, and that sufficient paid posts exist for graduates to be absorbed into the health sector. MONITORING EFFECTIVENESS Monitoring the effectiveness of a programme and its curriculum can be challenging, since multiple internal and external factors can impact whether learners attain the expected level of competence. Nonetheless, regularly reviewing education and training objectives, and critically reviewing the underlying drivers of learners’ performances is an important aspect of programme and curriculum management. A programme and its curriculum should be reviewed periodically and refined according to feedback, assessment results, changing institutional capacity and shifting population needs (Step 12). 6 Using a contextualized competency framework to develop rehabilitation programmes and their curricula 7 3. KEY CONSIDERATIONS WHEN DEVELOPING A PROGRAMME AND CURRICULUM USING A CONTEXTUALIZED REHABILITATION COMPETENCY FRAMEWORK INSTITUTIONAL READINESS The state of institutional readiness is of particular importance when a new programme and curriculum are being developed, and remains significant even when the programme and curriculum are being revised, especially when the revision involves shifting from a traditional to a competency-based education approach. As outlined earlier, implementing competency-based education requires the commitment of appropriately-trained faculty; it is associated with a considerable assessment burden, and relies on learners having access to a range of real- world learning experiences. Programme and curriculum developers may need to advocate for competency-based education before securing the approval of the educational institution. Once buy-in is attained, there is a greater chance of the institution making the necessary investment. RESOURCE AVAILABILITY AND PARTNERSHIPS The availability of resources, whether human or material, can present a challenge in many countries. In particular, acquiring trained and qualified faculty and practice supervisors can pose a considerable barrier to implementing a curriculum. In situations or contexts where a programme is being introduced for the first time, or where there is scarcity of potential faculty, institutions may need to recruit internationally, and/or partner with institutions where faculty are more readily available. This may be implemented in a phased approach, in a medium- to long- term context towards the institution becoming self-sufficient (Step 11). Equipment, infrastructure, and learning materials are key to successful implementation of a rehabilitation curriculum. Depending on the programmes already run, some institutions will have much of the material resources required; however, in other situations this will need to be newly sourced. TARGET LEARNERS The group of learners that the programme and curriculum targets will determine the programme outcomes and curriculum content. For example, implementation as part of pre- or post-service education (e.g. undergraduate or post-graduate audience) will impact what knowledge and skills learners are expected to have when they enter the programme, and to what level the teaching and assessment should be tailored. It is worth considering whether the competencies and activities being developed through the curriculum have been represented by any other profession, and how potential future shifts in scopes of practice will be managed, both practically and legally. 8 Using a contextualized competency framework to develop rehabilitation programmes and their curricula 9 4. THE PROCESS OF DEVELOPING A REHABILITATION PROGRAMME AND ITS CURRICULUM USING A CONTEXTUALIZED COMPETENCY FRAMEWORK The process of developing a programme and its curriculum using a contextualized rehabilitation competency framework comprises five phases, each with a number of practical steps (Figure 3). Defining the competencies and activities (which constitute the learning outcomes of the programme) is a prerequisite to these phases. The process of using the RCF to identify and contextualize competencies and activities is described in the RCF adaptation guide and, as such, is not covered here. Programme and curriculum developers who do not yet have a competency framework, or have not yet identified the competencies and activities relevant to their programme, are encouraged to refer to the RCF adaptation guide, even if not intending to create a formalized competency framework. Figure 3. The phases and steps of developing a curriculum to support competency-based education for rehabilitation PHASE 1. PLANNING Planning is a pivotal phase of programme and curriculum development and, of all the phases, may require the greatest investment of time. It is not unusual for planning to occur over a period of months, or even years, depending on the situation. Planning lays the foundation for all future phases and steps of the development process and is essential for successful implementation. The planning process should occur through the coordinated efforts of key stakeholders, typically under the leadership of a designated focal point from the institution or setting within which the curriculum will be implemented, and possibly an external consultant or institutional partner (e.g. individual(s) from a university or college with an established equivalent programme). The stakeholders may operate as a core working group that could comprise the same members as the group responsible for contextualized competency framework development (see Step 4 in the RCF adaptation guide). Planning Step 1. Information gathering Step 2. Stakeholder dialogue and critical decision-making Step 3. Confirm availability of resources and learning experiences PHASE 1 Step 4. Clarify the competencies and activities, and the expected level of proficiency, to be achieved Step 5. Determine the learning objectives and associated knowledge and skills Step 6. Establish the learning experiences and material needed for learners to achieve the learning objectives Step 7. Structure the curriculum content Step 8. Allocate time and resources to courses Step 9. Assign assessment method(s) to each of the learning objectives in the curriculum Step 10. Determine the threshold for progression in or completion of a programme Step 11. Build institutional capacity to implement the programme Step 12. Evaluate and revise the curriculum Construction Sequencing Assessment Implementation PHASE PHASE PHASE PHASE 2 3 4 5 10 Using a contextualized competency framework to develop rehabilitation programmes and their curricula STEP 1. INFORMATION GATHERING Rehabilitation programmes and their curricula are not developed or implemented in a vacuum; they should recognize population needs; particular political and institutional environments; and national or international legal and regulatory frameworks, such as those imposed by professional associations and accreditation bodies (Figure 4). Figure 4. The ecological context of curriculum development REHABILITATION PROGRAMME INSTITUTIONAL ENVIRONMENT POLITICAL AND REGULATORY ENVIRONMENT POPULATION REHABILITATION NEEDS The first step of programme and curriculum development is a thorough process of information-gathering that informs key considerations, such as those described earlier in section III. Information-gathering may involve key stakeholder interviews, desk reviews, or both. Information should be sought on the following: • The health, demographic, and geographic profile of the population: While these will be reflected in the contextualized competency framework, they will also impact the extent to which specific competencies, behaviours, activities, and tasks are emphasized in the curriculum. For example, if the majority of the population exists in rural areas, the curriculum may devote proportionally more time to knowledge and skills related to working in primary health-care and community-based practice than a curriculum in an urban- dominated setting. • Legal and regulatory frameworks relevant to the programme and curriculum: Do they exist? What content or conditions do they specify? What are the implications of this programme and its curriculum? Are there minimum standards, such as number or qualification level, for faculty numbers? Is programme length stipulated? If necessary, will these be adjusted to meet the needs of the new or revised programme? • Institutional investment and capacity: The level of institutional commitment to the programme and its capacity to support the development and implementation of the curriculum must be investigated. • Vision and mission of the institution: What are the vision and mission, and how might they impact the programme and its curriculum? • Existing relevant programmes and curricula, such as from other institutions or rehabilitation professions: Do they exist? Are they current? Could they serve as valuable reference documents? 4. The process of developing a rehabilitation programme and its curriculum 11 STEP 2. STAKEHOLDER DIALOGUE AND CRITICAL DECISION-MAKING Development of a rehabilitation programme and curriculum sits in the nexus of the domains of ministries of education, labour, and health. As noted by UNESCO, programmes and their curricula are a “joint educational, political and social product cultivated by institutions and actors inside, as well as outside of the education system” (6). Engaging representatives from each of these government sectors, along with the educational institution and accreditation body (where applicable), in the early planning phase is critical in making key decisions. Stakeholder dialogues should consider: • The qualification to be awarded: Will the learners receive a certificate, diploma, bachelor’s degree, master’s degree, or doctorate on completion of the programme? • Accreditation and legal recognition: Will the programme be recognized by the local accreditation authority, and under health practitioner law? What requirements need to be met and what timelines need to be considered? • Recruitment of prospective learners: What are the programme entrance criteria? How competitive will entry be, compared with equivalent programmes at the institution? Will the learners’ fees be subsidized by the government or other organization? How will issues in showing diversity of the learner cohort be addressed? Will international students be accepted, and how will their fees differ from national students? Is the recruitment of international students necessary to help fund the programme, and if so, what impact will this have on how the programme is delivered and on curriculum content (e.g. will the programme be taught in English or another language to accommodate a greater range of students)? • Recruitment of prospective programme graduates: What is the estimated number of paid posts that will be opened to graduates with the qualification being awarded? How will these be distributed across the levels of the health system and between the public and private sector? These questions are important in determining the size of the learner cohort, and how recruitment might expand over time. • Modes of education: Will courses be taught face-to-face, or have online components? Will education be enhanced with technology in any way (Step 6)? What are the infrastructure and resource implications of these decisions? STEP 3. CONFIRM AVAILABILITY OF RESOURCES AND LEARNING EXPERIENCES While resource availability should be considered through the course of the planning process, more concrete estimates of resource requirements can be determined once critical decisions have been made. Resource requirements, and associated considerations, relate to, but are not limited to the following: • Human resources, including administration and teaching faculty: Consider what existing human resources are available and what additions may be required. For example, learners may be able to integrate into existing medical and social science courses, although the extra assessment burden additional learners bring should be accounted for, as well as any specific modifications to the courses that may be required. New courses specific to the programme may require new faculty, with specific qualifications and experience, who may not be available locally, and who may need to be trained and/or recruited internationally (see Table 6 for approaches to building the capacity of local/national faculty). Decisions regarding where and how to source faculty will generally be influenced by regulations stipulating the quota of national faculty required for a programme, and qualification requirements. • Material resources, including infrastructure and learning materials: Will implementation of the programme and its curriculum require specific infrastructure, such as a gym, anatomy laboratory, clinical practice space, acoustic laboratory, prosthetics workshop, etc.? Learning materials, such as texts relevant to the local context, and clinical and technical equipment for education and training should also be factored in, especially when they are not readily available. These need to be reviewed and refined as the curriculum develops. • Learning experiences: Practicing competencies and activities in real-world environments is a fundamental characteristic of competency-based education; therefore, opportunities for learners to practice in these settings are essential. Rehabilitation programme and curriculum developers should consider the range of environments and experiences that learners should be exposed to, as well as placement duration in these settings, and what supervisory requirements are needed. 12 Using a contextualized competency framework to develop rehabilitation programmes and their curricula PHASE 2. CONSTRUCTION Table 2. Differentiating between competencies and activities Competencies Activities Associated with a rehabilitation worker Associated with a role, its requirements and the scope of practice of the rehabilitation worker Durable (persist through different activities) Begin and end Expressed as behaviours Encompass tasks STEP 4. CLARIFY THE COMPETENCIES AND ACTIVITIES, AND THE EXPECTED LEVEL OF PROFICIENCY, TO BE ACHIEVED As noted earlier, identifying the competencies and activities to be achieved through the programme’s curriculum is a prerequisite to undertaking the phases and steps described in this guide. Competencies and activities (see Table 2 for the distinctions between the two), can be extracted and adapted from the RCF through the methodology detailed in the RCF adaptation guide. Even if a competency framework is not deemed necessary, many of the steps described will be useful in identifying and adapting the competencies and activities, which can be documented directly in the curriculum (Step 5). The level of proficiency at which each competency and activity is expected to be performed (i.e. the expected level of competence to be attained from the programme), should be clear and reflect the requirements of the institution, profession, or specialization (6, 8). Defining proficiency levels helps to determine the threshold for achieving competence, which should be predetermined within the curriculum (10). Proficiency levels may align with those described in the RCF proficiency profiles (levels 1–4) or be modified to suit specific learner expectations. STEP 5. DETERMINE THE LEARNING OBJECTIVES AND ASSOCIATED KNOWLEDGE AND SKILLS Translating competencies and activities into a curriculum to support competency-based education programmes involves transforming the behaviours associated with competencies, and the tasks associated with activities, into learning objectives. Learning objectives reflect what the learner will know or do after the learning activities (3, 5). Programme learning objectives allow behaviours or tasks to be broken down into units of learning that can be taught and assessed until the learner is competent in the behaviour or task. Table 3 provides an example of learning objectives for an RCF Practice domain competency (C4) and associated behaviours; and Table 4 for a Practice domain activity (A3) and associated tasks. Both examples are extracted directly from the RCF and expressed as Level 3 of the four proficiency levels. Together, Tables 3 and 4 show how learning objectives can support the development of behaviours (in this case, problem-solving and decision-making, but other behaviours could relate to communication or person-centredness, for example), and the ability to perform tasks (in this case, conducting a rehabilitation assessment, but other tasks could relate to implementing interventions, referring or discharging, for example). When defining learning objectives, the level of performance expected should be clearly described and reflect the time available for attaining the behaviour or task, as well as the demands that the learner will encounter and the level of autonomy they will have after completing the programme. 4. The process of developing a rehabilitation programme and its curriculum 13 Table 3. Example programme learning objectives for an RCF Practice domain competency (C4) and associated behaviours Competency Behaviours Programme learning objective* On completion of the programme, the learner: C4. Adopts a rigorous approach to problem-solving and decision-making C4.1 Considers personal, environmental, and health factors when conceptualizing problems and identifying solutions C4.1.1 Describes the International Classification of Functioning, Disability and Health (ICF) model C4.1.2 Describes the potential role of personal, environmental and health factors in impacting functioning C4.1.3 Compiles a problem list that captures personal, environ- mental and health factors specific to a person and their family C4.2 Integrates information from multiple sources when solving problems and making decisions with the person and their family C4.2.1 Identifies different sources of information C4.2.2 Demonstrates the ability to manage conflicting information from different sources C4.2.3 Presents a complete picture of a situation to a person and their family to facilitate their optimal engagement indecision making C4.3 Identifies innovative approaches to addressing challenges with a person and their family C4.3.1 Engages in a joint problem-solving discussion with a person and their family C4.3.2 Identifies a range of potential solutions to optimize functioning by addressing relevant personal, environmental and health factors C4.3.3 Identifies factors that contribute to selection of the most appropriate approach for a person and their family * Learning objectives are examples only; they are not applicable to all contexts, nor is the list exhaustive. 14 Using a contextualized competency framework to develop rehabilitation programmes and their curricula Table 4. Example programme learning objectives for an RCF Practice domain activity (A3) and selected associated tasks Activity Task Programme learning objectives* On completion of the programme, the learner: A3. Conducting rehabilitation assessments A3.1 Obtaining a comprehensive health, environmental and personal history, which reflects an in-depth understanding of the scope and complexity of determinants of health and well-being A3.1.1 Identifies the type and purpose of information to be collected A3.1.2 Conducts a chart review A3.1.3 Conducts a logical and organized interview with a person and their family A3.1.4 Identifies and uses alternative sources of information when indicated A3.1.5 Identifies the presenting problem(s) of a person and their family A3.1.6 Identifies significant factors impacting the person and their family’s rehabilitation management plan A3.2 Assessing whether a person is at a risk of harm to themselves and/or others and implement protection strategies where appropriate A3.2.1 Identifies indications a person is in need of protection measures A3.2.2 Describes the legal obligations and protocols for initiating protection mechanisms A3.2.3 Describes the potential barriers to identifying a person at risk of harm A3.3 Independently conducting assessments of body structures and functions, adjusting for specific factors, such as age, language, culture or impairment A3.3.1 Describes the potential assessment tools relevant to a person and their family A3.3.2 Manages the environment to provide optimum conditions for the assessment A3.3.3 Conducts a cognitive test using a standardized instrument A3.3.4 Scores, interprets and reports the results of the assessment * Learning objectives are examples only; they are not applicable to all contexts, nor is the list exhaustive. When defining learning objectives, the primary knowledge and skills related to each can be identified, while acknowledging that other more general knowledge and skills may also be required, acquired, or consolidated through the learning activities. Identifying what knowledge and skills underpin learning objectives is important in identifying the appropriate modes of education or learner experiences for knowledge and skill acquisition and assessment. The RCF includes both core and activity-specific knowledge and skills in each domain; these should be contextualized and expanded as needed before being included in the curriculum. STEP 6. ESTABLISH THE LEARNING EXPERIENCES AND MATERIAL NEEDED FOR LEARNERS TO ACHIEVE THE LEARNING OBJECTIVES Knowledge and skills are acquired through a range of different learning experiences; while knowledge is generally built on a theoretical foundation, skills tend to require application to be mastered. Building knowledge and skills, especially at an introductory level, may involve targeted learning experiences that isolate, or focus, on a specific subject matter or skill. As learners advance, they begin to integrate knowledge and skills in more practical, realistic scenarios. Figure 5 summarizes learning experiences as i) targeted and theoretical (i.e. experiences consider specific knowledge); ii) integrated and theoretical (experiences consider a range of knowledge); or iii) integrated and applied (experiences consider a range of knowledge which is contextualized in skills) (3, 5). Ultimately, competencies and activities can only be fully developed when integrated and applied, i.e. when the behaviours associated with different competencies are applied in the context of activities. This requires the learner to simultaneously utilize different behaviours while performing different tasks in a range of environments that place varying demands on the learner, honing their proficiency to the required level. For example, in conducting an assessment with a patient and their family, a learner needs to apply competencies associated 4. The process of developing a rehabilitation programme and its curriculum 15 with person-centredness, collaboration, communication, and decision-making (in the RCF Practice domain), as well as competencies from other domains, such as Professionalism and Research. Furthermore, a learner cannot be deemed competent in performing activities until they are applied in real-world contexts. These could include environments with limited access to resources; working with people with varying levels of needs, and in situations where there is limited awareness of their role. For this reason, competency-based education in rehabilitation relies on learners being exposed to a range of learning experiences, targeted, integrated, theoretical, and applied. Figure 5. Targeted and integrated learning experiences required to achieve learning objectives When selecting a learning experience, availability of resources and access to clinical experiences/placements should be considered and accounted for. For example, some learning experiences are reliant on infrastructure, such as anatomy laboratories with specimens; gait analysis laboratories; prosthetics and orthotics workshops; ready access to computers and internet connection; and facilities with policies and procedures for training and supervising learners. The provision of such training and supervising facilities can be especially challenging when the programme and curriculum concern an emerging profession that does not yet have a substantial presence in the country. In these instances, learners may need to complete placements abroad, and the costs associated with these need to be planned for and managed in a way that includes as many potential learners as possible. With the rapid evolution of technology, education institutions have a growing range of platforms from which to deliver learning experiences. While rehabilitation programmes have traditionally been delivered in-person, with learners physically attending the settings in which the learning experience is based, many institutions are increasingly making use of online learning platforms. While competency-based education is contingent on learners being exposed to authentic environments, certain courses, or components of courses, may be conducive to online learning, especially those that are theoretical. Indeed, a hybrid of in-person and online learning is increasingly becoming the norm, and offers the advantage of greater flexibility, reducing travel requirements, building digital literacy, and enabling access to a wider range of educators, such as international experts. The advances in education-related technology mean that digital platforms have functionality supporting highly interactive styles of learning. Use of online learning is conditional on learners having access to the necessary infrastructure, including reliable internet connection, which is not available in all contexts. Still another approach is “web-enhanced blended learning”, where learning occurs in-person, but is supported by technology to deliver content and enrich learning activities. This approach requires the educational institution to have a certain degree of digital infrastructure and web connectivity, but this is not required outside the classroom. LEARNING OUTCOMES COMPETENCIES BEHAVIOURS TARGETED, THEORETICAL INTEGRATED, APPLIED LEARNING OBJECTIVES LEARNING EXPERIENCES ACTIVITIES TASKS LEARNING OBJECTIVES INTEGRATED, THEORETICAL 16 Using a contextualized competency framework to develop rehabilitation programmes and their curricula PHASE 3. SEQUENCING Sequencing involves organizing the curriculum content, including the learning objectives and learning experiences, into meaningful components, or courses, within a curriculum plan. The plan documents the pathway that progresses learners towards attaining the required competencies and performing the relevant activities to the required standard (2); it further defines what time is allocated to various components of the curriculum, based on their weight or contribution to attainment of a competency or activity, the level of difficulty, or the time learners are expected to take to reach the anticipated level of mastery. Such decisions are highly context-specific and will inevitably reflect the institution’s values and preferences. For this reason, while the general curriculum content for equivalent programmes in different institutions or countries may be similar or based upon the same international standards, their curriculum plans may be diverse. STEP 7. STRUCTURE THE CURRICULUM CONTENT Programme organization, or how the curriculum content is structured across the duration of study, is generally presented in the curriculum plan. The plan lists and describes the courses included in the programme, and often indicates which courses are mandatory and which are elective (i.e. can be selected from a range of appropriate options). The plan is an important reference document for faculty, because it indicates where and how learning materials and experiences will be introduced, demonstrating the emphasis on different knowledge and skill areas. The plan is a “road map” documenting development from knowledge and skills to the attainment of learning objectives, and ultimately, to competence (8). Curriculum content can be structured in multiple ways, the best of which can be informed both by sound principles of pedagogy, and by the experiences of equivalent or similar programmes. Programme organization is also dynamic and should be informed by ongoing learner and faculty feedback (Step 12). The following questions can help determine how curriculum content is structured within a curriculum plan: • What learning should be theoretical, versus applied? There are different schools of thought relating to when a learner should be exposed to the settings in which they will eventually work. Early exposure enables the contextualization of knowledge and early development of skills; later exposure enables a strong theoretical foundation before applied learning. Practical considerations, such as adequate access to supervision in a clinical setting, are also determining factors (3). • What depth and scope of subject matter can feasibly be included within a course? The amount of curriculum content that can be included in a course, and the depth at which learners examine this content, should reflect existing or baseline knowledge and skills (i.e. the knowledge and skills the learner has when entering the course, based on entrance criteria and courses completed), and the time allocated to the course. • How do knowledge and skills intersect and consolidate in the context of different learning objectives? Programme composition and structure within a curriculum plan should reflect the accumulated knowledge and skills necessary to achieve the learning objectives. As discussed in Step 6, some courses may be targeted at specific areas of knowledge or skill (e.g. medical sciences), while others will require a range of knowledge and skills to be integrated and applied. The former may not aim at achieving a programme learning objective, but rather develop a course learning objective that serves as a foundational building block towards the achievement of programme learning objectives in later courses. Courses should include manageable components of curriculum content commensurate with learning expected, based on where the course is positioned within the programme (2). In addition to the curriculum plan, content can be organized and described to greater detail in a course syllabus. A syllabus specifies the course learning objectives, which should reflect, or align with, the learning objectives of the relevant programme, and should generally specify the specific knowledge, skills, or values and beliefs that are being targeted in the course. A course syllabus further describes how the learning content will be taught on a lesson-to-lesson, or week-by-week, basis. Course syllabi can be accessed by learners to inform them of what they can expect from the course, and what is required of them. Course syllabi will often have significant input from the educator(s) responsible for the course, although decisions concerning how a syllabus is designed will depend strongly on the educational approaches adopted by the institution. 4. The process of developing a rehabilitation programme and its curriculum 17 STEP 8. ALLOCATE TIME AND RESOURCES TO COURSES An important part of operationalizing a curriculum plan is determining the time and materials required for each course within the programme. The time allocated to courses should reflect the complexity of the subject matter and the weight of its contribution to the attainment of the programme’s learning outcomes. Some subject areas may need to be extended over several courses in order for the scope and depth to be adequately captured, while for others, learners may need only a superficial or introductory level of exposure. Prescribing set amounts of time to different areas of learning is somewhat at odds with the core principles of competency-based education, which advocates a highly flexible approach to learning, whereby a learner’s progression through a programme is dictated by their attainment of required behaviours or tasks, rather than completion of courses of study. However, it is important to acknowledge that competence is not static and will continue to develop within and beyond the programme. Reconciling a time-based curriculum with competency- based education is possible, provided that the milestones towards attaining competencies and activities of the curriculum are defined and signal progression between courses (3). A programme’s learning materials can considerably impact the quality of learning experiences and should be appropriate to learning context (i.e. relevant to the country and setting in which the curriculum will be taught and implemented). For example, some materials published in high-income or urbanized settings may need to be complemented with information relevant to low-income or rural settings. Learning materials should also be up-to-date and reflect evidence-based practice. Educational institutions can be important stakeholders in evidence-based guideline and protocol development. The process of identifying learning materials for a programme can highlight gaps and the resources needed to address these. PHASE 4. ASSESSMENT A key characteristic of competency-based education is the meaningful assessment of competence, which is also one of the greatest challenges to its implementation (11). Steps 9 and 10 propose a systematic approach to developing assessment strategies and ensuring that assessment aligns with an institution’s resource availability. STEP 9. ASSIGN ASSESSMENT METHOD(S) TO EACH OF THE LEARNING OBJECTIVES IN THE CURRICULUM Some of the functions of a curriculum are to delineate the types of assessment methods employed, and to demonstrate the robust assurance of competence, and a required level of proficiency (2). Determining attainment of competencies and mastery of activities should incorporate multiple assessment formats. Interaction of a learner’s performance with that of other people, as well as with environmental factors, requires the learner being observed performing activities in a wide range of contexts, and competencies being assessed in the context of multiple different activities (3, 6, 12). Assessment is thus both a complex and a resource-intensive aspect of competency-based education, and requires careful consideration and planning. Various factors influence the selection of the assessment method: • Suitability: Is the assessment conducive to the learning objective being tested? • Reliability: Does the assessment perform consistently, and is it trustworthy (3, 13, 14)? • Validity: Does the assessment measure what it is intended to measure (3, 13)? • Resource requirements: Are the required resources (human and material) available (3)? • Feasibility: Is implementation possible, when considering the size of the cohort, the time required, and/or the logistical factors (3)? “Miller’s Pyramid”, shown in the model below, posits that the learning process progresses from “Knows” to “Does” (Figure 6) (15). The model shows how assessment methods reflect this progression, and how progression corresponds with a shift in the objectivity and resource requirements of assessment, as the necessity for authentic assessment environments increases. 18 Using a contextualized competency framework to develop rehabilitation programmes and their curricula Figure 6. The implication for assessment of the progression through the stages of Miller’s Pyramid In te gr at io n an d a pp lic at io n of k no w le d ge a nd sk ills N ec es sit y of a ut he nt ic a ss es sm en t e nv iro nm en ts O bj ec tiv ity o f a ss es sm en t m et ho d s Re so ur ce re qu ire m en ts fo r a ss es sm en t Ex pl ici t a sse ssm en t o f k no wl ed ge Im pl ici t a sse ssm en t o f k no wl ed ge Ex pl ici t a sse ssm en t o f s kil ls DOES SHOWS HOW KNOWS HOW KNOWS Explicit assessment of competencies and activities Implicit assessment of competencies and activities Competency-based education involves carefully aligning assessment methods with learning objectives (14). Table 5 provides an example using the learning objectives of Tables 3 and 4. The assessment methods included in Table 5 should be interpreted as a demonstration of the diversity of assessment methods that may suit different objectives (acknowledging that they do not present an exhaustive list of potential methods), and how multiple methods can be used for one objective. Assignment of assessment methods as shown in Table 5 should not be construed as the most appropriate per se, since this will depend on how the factors listed earlier apply to a specific curriculum context (8). Multiple learning objectives may be assessed with the same method, and, where appropriate, simultaneously (6). 4. The process of developing a rehabilitation programme and its curriculum 19 Table 5. Example of programme learning objectives assigned to different assessment methods Programme learning objectives W rit te n es sa y W rit te n te st Or al q ue st io ni ng Ca se d isc us sio n Or al p re se nt at io n Se lf- as se ss m en t Pe er a ss es sm en t Ob se rv ed p er fo rm an ce Re po rt C4.1.1 Describes the International Classification of Functioning, Disability and Health (ICF) model X X C4.1.2 Describes the potential role of personal, environmental and health factors in impacting functioning X X X C4.1.3 Compiles a problem list that captures personal, environ- mental and health factors specific to a person and their family X X X C4.2.1 Identifies different sources of information X X X C4.2.2 Demonstrates the ability to manage conflicting information from different sources X X C4.2.3 Presents a complete picture of a situation to a person and their family to facilitate their optimal engagement in decision-making X X C4.3.1 Engages in a joint problem-solving discussion with a person and their family X X C4.3.2 Identifies a range of potential solutions to optimize functioning by addressing relevant personal, environmental and health factors X X X X X C4.3.3 Identifies factors that contribute to selection of the most appropriate approach for a person and their family X X X X X A3.1.1 Identifies the type and purpose of information to be collected X X A3.1.2 Conducts a chart review X X A3.1.3 Conducts a logical and organized interview with a person and their family X X A3.1.4 Identifies and uses alternative sources of information when indicated X A3.1.5 Identifies the chief complaint(s) of a person and their family X X A3.1.6 Identifies significant factors impacting the person and their family’s rehabilitation management plan X X A3.2.1 Identifies indications a person is in need of protection measures X X A3.2.2 Describes the legal obligations and protocols for initiating protection mechanisms X X A3.2.3 Describes the potential barriers to identifying a person at risk of harm X X A3.3.1 Describes the potential assessment tools relevant to a person and their family X X A3.3.2 Manages the environment to provide optimum conditions for the assessment X X A3.3.3 Conducts a cognitive test using a standardized instrument X X A3.3.4 Scores, interprets, and reports the results of the assessment X X X 20 Using a contextualized competency framework to develop rehabilitation programmes and their curricula When constructing a curriculum plan, additional assessments will target specific components of the subject matter relevant to each course. Depending on the educational approaches adopted by the institution, assessments in the earlier phases of a programme may target specific knowledge and skills, rather than behaviours or tasks, which begin to emerge once their informational base has been established. Selection of assessment methods requires consideration of the same factors as listed above. A further important consideration when selecting assessment methods is whether an assessment is formative or summative. When assessment is designed primarily to aid learning (formative), the priority is to provide a learning experience, and an indication of progress against learning objectives that signals learning needs (11). These typically occur more frequently throughout a course and, therefore, assessment methods that are less resource-intensive may be selected. Summative assessment evaluates the learner’s achievement of the learning objectives and, ultimately, their attainment of competence. Factors such as reliability and validity hold stronger weight in the context of summative assessment, which may also justify greater investment of resources, given that learner performance in summative assessment indicates their ability to progress through, or complete, the programme. STEP 10. DETERMINE THE THRESHOLD FOR PROGRESSION IN OR COMPLETION OF A PROGRAMME Decisions need to be predetermined regarding what a learner needs to achieve before progressing through the programme, or to achieve the programme’s award. Such decisions may be guided by a number of factors including: • the institution’s policies; • factors that indicate readiness to progress in the context of the subject area, or competencies or activities; • the implications of the decision for practice (i.e. does programme completion qualify the graduate to enter the workforce, or is an additional phase of assessment needed, such as a licencing exam?) (3, 11); • the conditions under which the learner will be working once they have completed the programme (e.g. the level of supervision and support they will receive) (3); and • the potential risks of a learner performing below the level of required competence (3, 11) In the context of competency-based education, decisions about progression through, or completion of, a programme should not rest on a single assessment method; rather they should draw on an array of information from multiple summative assessments that indicate the learner’s performance of the competencies and activities in a range of contexts (3, 11, 13). When adequate performance of competencies and activities, aligned with population rehabilitation needs, are established through comprehensive summative assessment, the quality and relevance of graduates can be assured (3). 4. The process of developing a rehabilitation programme and its curriculum 21 PHASE 5. IMPLEMENTATION STEP 11. BUILD INSTITUTIONAL CAPACITY TO IMPLEMENT THE PROGRAMME Ensuring successful implementation of competency-based education requires investment in institutional capacity; this includes strong administrative systems and staff, and equipping faculty to teach and assess the curriculum (8). Where competency-based education is newly implemented, offering faculty the opportunity to visit and learn from well-established institutions can be useful (Table 6 describes various approaches to building the capacity of faculty to deliver competency-based education). Ongoing professional development of faculty is also necessary for ensuring faculty retention and quality education. Institutions need to ensure an appropriate ratio of faculty and clinical educators to learners in order to support programme implementation, noting the heavier assessment burden associated with competency-based education. Research capacity should also be considered. Institutions should look to develop a strategy that allows expansion in this area over time, including identifying potential funding grants, ethics committees, and building partnerships with national and international research institutions. This is especially important for institutions offering post-graduate courses, but is also valuable in exposing undergraduate learners to research. Table 6. Approaches to building the capacity of faculty to deliver competency-based education Approach Considerations Learning tours Visits by faculty to educational institutions which have a strong reputation for delivering competency-based education. During these tours, faculty observe and study the approaches in order to better implement these in their own institution. Typically, lessons learned during a tour are shared with other faculty to maximize the benefits of the investment of time and resources. Sending multiple faculty on learning tours can be resource intensive, in terms of costs both for travel and time; local faculty are diverted from their teaching responsibilities for the duration of their tour, which can disrupt the delivery of the programme. Learning tours are valuable in that they offer an immersive experience which can be difficult to replicate through other approaches. They can also foster positive relationships between institutions, and provide wider and longer-term benefits for the programme. Faculty mentorship Faculty from educational institutions that have a strong reputation for delivering competency-based education, are brought in to teach and mentor local faculty for a specified time period. Bringing one or several competency-based education experts to the institution where the new programme or curriculum is being implemented can be more cost-effective than sending local faculty on a study tour, but does not provide the same immersive experience. A benefit of local faculty remaining at their institution is that delivery of the programme is not disrupted. This can be especially important when the number of faculty is very limited. Continuous professional development courses Faculty are supported to undertake courses in competency-based education, such as those offered by a university or teaching college. Supporting faculty to undertake professional development courses in competency-based education involves allowing them the required time to participate and meet the demands of the course, as well as potentially covering the cost of the course. 22 Using a contextualized competency framework to develop rehabilitation programmes and their curricula Approach Considerations Comprehensive teaching and learning courses Faculty, or potential faculty, can be supported to attend specific comprehensive courses on teaching and learning, either as an intensive block, or part-time. These courses may be offered by the educational institution in which the faculty will work, or externally. Typically, these courses may include the following topics: • Teaching and learning principles • Syllabus development • Course design • Course goals • Instructional methods • Teaching in the classroom • Assessment of teaching and learning • Development of assessment scoring criteria (rubric development) Comprehensive courses are likely to be more resource-intensive than incremental training, or ad-hoc professional development training; they are also likely to cover a wide range of content to greater depth. Comprehensive courses should be particularly considered for faculty with limited, to no teaching experience, acknowledging that delivering education and training effectively requires specific knowledge and skills, and that well-trained faculty are fundamental to providing quality education. Comprehensive higher education leadership courses As described above, faculty, or potential faculty, can be supported to attend specific comprehensive courses on leadership in higher education, either as an intensive block, or part-time. Typically, these courses might include the following topics: • Personal leadership development • Leading others • Leadership in the classroom • Leadership in the clinic/health system • Conflict resolution Faculty who will be supporting other staff, or holding a leadership or managerial role, can benefit from such courses, especially in a new programme where challenges associated with establishing courses call for clear direction and guidance. Integrate courses on teaching and learning into rehabilitation programmes Where a rehabilitation profession is still being established in a country, and the pool of faculty is very limited, courses on teaching and learning can be integrated into rehabilitation programmes so that graduates emerge with some capability to take on faculty roles. While faculty should ideally be highly experienced and hold post-graduate qualifications, this option may be suitable as a mechanism of progressive realization. STEP 12. EVALUATE AND REVISE THE CURRICULUM Regular evaluation and revision are good practices for all curricula. Evaluation should examine faculty performance, course and programme structure, and learner outcomes, in terms of results and employment. A curriculum evaluation team can comprise representatives from faculty, administration and learners. The team can oversee the evaluation processes, some of which may already be established by the institution, and ensure that the results are thoroughly reviewed and acted upon. Table 6 suggests curriculum evaluation information from a range of groups and in a number of formats. 4. The process of developing a rehabilitation programme and its curriculum 23 Table 7. Examples of a curriculum evaluation approach Evaluation topic Audience Format Example points of enquiry Course content Learners Course evaluation questionnaire • Content relevance • Educational approach • Learning materials • Learning experiences • Level of difficulty • Learner readiness • Methods and burden of assessment Educators Interview or survey • Learner readiness • Methods and burden of assessment • Learning materials • Learning experiences • Adequacy of teaching support Educator/supervisor performance Learners Educator/supervisor evaluation questionnaire • Knowledge of subject area/skills • Preparation • Organization • Teaching/supervisory style • Fairness • Communication • Availability • Approachability Learner performance Educators and supervisors Learner performance evaluation • Learner/graduate general readiness for practice • Learner/graduate performance in relevant domains (practice, professionalism, learning and development, and research) • Learner/graduate confidence • Learner/graduate values and attitudes Programme quality Learners and educators Programme evaluation questionnaire/focus group • Achievement of learning objectives • Quality of programme/course organization • Quality of learning materials • Quality of learning experience • Quality of infrastructure/facilities • Quality of faculty • Overall satisfaction Graduate experiences Learners Survey/interview • Number of students employed (disaggregated by sector and location) • Average time until employed • Readiness for job responsibilities • Alignment of knowledge and skills with population needs Service user satisfaction Service users Service-user survey • Quality of care • Communication and cultural competence Evaluation processes should be embedded within the curriculum and performed on an ongoing basis (e.g. course and teacher evaluations at the completion of each course; programme evaluation as each cohort graduates, etc.). Mechanisms should be in place to respond promptly to feedback, for example through modifying learning materials, and teaching styles, and by increasing learner access to educators. Curriculum revision, which encompasses a larger-scale amendment such as eliminating or replacing courses, reordering courses, 24 Using a contextualized competency framework to develop rehabilitation programmes and their curricula or modifying educational approaches, should also occur at set intervals, acknowledging the resources required to perform this revision thoroughly. The regularity of these intervals should also reflect the indications to do so, or lack thereof, based on the feedback derived from evaluation processes. Avoiding potential pitfalls Potential pitfalls: Mitigation strategies: Neglect of culturally-significant competencies, such as establishing rapport, in favour of competencies related to performance of rehabilitation interventions (i.e. skewing curriculum focus to activities, especially those linked to employment) (2, 8). • Ensure courses and assessments place weight on learning objectives related to cultural and other “soft” competence. • Ensure evaluation processes review cultural, and other “soft” competencies. A focus on individual components of performance, often activities, leading to an underemphasis of comprehensive performance (i.e. “checkbox education”) (6, 11). • Ensure ample exposure to authentic learning environments that enable learners to integrate and develop a range of competencies and activities. • Ensure assessment places proportional emphasis on competencies in the context of performance of activities. A prohibitive assessment burden (11). • A combination of formative and summative assessment, as well as assessment in authentic environments, is integral to competency-based education. Curricula can explore approaches to economize assessment (such as through use of technology). Institutional capacity needs to accommodate the assessment load. 25 REFERENCES 1. Mills J-A, Middleton JW, Schafer A, Fitzpatrick S, Short S, Cieza A. Proposing a re-conceptualisation of competency framework terminology for health: a scoping review. Human Resources for Health. 2020;18(15). 2. UNESCO-IBE. Training tools for curriculum development. A resource pack. Geneva: UNESCO-IBE; 2013. 3. World Health Organization. Global Competency Framework for Universal Health Coverage: Addressing population health needs through competency-based education. Geneva: WHO Press; 2020. 4. World Confederation for Physical Therapy. WCPT guideline for physical therapist professional entry level education. London: WCPT Secretariat; 2011. 5. Association for Prevention Teaching and Research, Columbia School of Nursing Centre for Health Policy. Competency-to-curriculum toolkit. New York. 2008. 6. Gruppen LD, Mangrulkar RS, Kolars JC. The promise of competency-based education in the health professions for improving global health. Human Resources for Health. 2012;10(43). 7. Taha WS. A guide to developing a competency based curriculum for a residency training program – orthopaedic prospective. Journal of Taibah University Medical Sciences. 2015;10(1):109–15. 8. Carol Carraccio SDW, Robert Englander, Kevin Ferentz, Christine Martin. Shifting paradigms: from Flexner to competencies. Academic Medicine. 2002;77(5):361–7. 9. Lee A, Steketee C, Rogers G, Moran M. Towards a theoretical framework for curriculum development in health professional education. Focus on health professional education: a multi-disciplinary journal. 2013;14(3):70–83. 10. Olle ten Cate HCC, Reinier G. Hoff, Harm Peters, Harold Bok, Marieke van der Schaaf. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Medical Teacher. 2015;37(11):983–1002. 11. Jocelyn Lockyer CC, Ming-Ka Chan, Danielle Hart, Sydney Smee, Claire Touchie et al. & on behalf of the ICBME Collaborators. Core principles of assessment in competencybased medical education. Medical Teacher. 2017;39(6):609–16. 12. Vleuten Cvd, Sluijsmans D, Brinke DJ-t. Competence assessment as learner support in education. In: Mulder M, editor. Competence-based vocational and professional education; Technical and vocational education and training: Issues, concerns and prospects. Switzerland: Springer International Publishing; 2017. p.607–30. 13. Vleuten Cvd. The assessment of professional competence: developments, research and practical implications. Advances in Health Sciences Education. 1996;1(1):41–67. 14. Wass V, Vleuten CVd, Shatzer J, Jones R. Assessment of clinical competence. The Lancet. 2001;357(9260):945–9. 15. Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine. 1990;65:S63–7. 26 Using a contextualized competency framework to develop rehabilitation programmes and their curricula 27 ANNEX 1. CHECKLIST FOR COMPETENCY-BASED EDUCATION The following checklist endeavours to capture the key components of competency-based education, and is based on the competency-based education implementation framework proposed by Melle et al.1 Competencies and activities are based on rehabilitation needs in the population Competencies and activities to be attained are clearly articulated in the curriculum Competencies and activities and their developmental markers are sequenced progressively in the curriculum plan Learning materials and experiences facilitate the developmental acquisition of competencies and activities Learning takes place in settings that model practice Educational approaches promote the developmental acquisition of competencies and activities Formative and summative assessment supports and documents the developmental acquisition of competencies and activities Programmatic assessment allows for valid and reliable decision-making Learner progression through, and from, the programme is based on multiple points of information, careful interpretation, observation, and feedback Assessment thresholds that determine a learner’s progression from the programme reflect the expectations and responsibilities of learners once they graduate 1 Melle EV, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. A core components framework for evaluating implementation of competency-based medical education programs. Academic Medicine. 2019;94(7):1002–9. 28 ANNEX 2. TEMPLATE FOR COMPETENCY-BASED REHABILITATION PROGRAMME AND CURRICULUM The following template provides a structure for documenting a rehabilitation programme and its curriculum. The template should be adapted as needed, and amended to suit the requirements of the institution. 1. Introduction a. Description and history of the profession b. Rehabilitation needs within the population c. Overview of the health system d. Contribution of the profession to population health e. Rational for curriculum development 2. Vision, mission and values 3. Academic qualification awarded 4. Programme duration 5. Requirements for admission 6. Requirements for graduation 7. Governance and management of the programme 8. Faculty requirements, availability, and recruitment 9. Curriculum a. Competencies and behaviours of the curriculum b. Activities and tasks of the curriculum c. Learning objectives, knowledge and skills d. Key learning materials e. Learning experiences f. Educational approaches g. Assessment i. Assessment strategies ii. Remediation policy h. Curriculum lifecycle i. Evaluation strategies ii. Evaluation and review intervals 10. Curriculum plan (see Annex 3) 11. Evaluation forms 29 AN NE X 3. TE M PL AT E F OR C OM PE TE NC Y- BA SE D RE HA BI LI TA TI ON C UR RI CU LU M P LA N Th e f ol lo wi ng te m pl at e p ro vid es a str uc tu re fo r a cu rri cu lu m pl an . It sh ou ld be ad ap te d a cc or di ng to th e p ro gr am m e d ur at io n, st ru ct ur e o f t he ac ad em ic ye ar (n um be r o f s em es te rs ), an d th e n um be r o f c ou rs es in clu de d in ea ch se m es te r. T he co ur se p la n sh ou ld in di ca te w hi ch co ur se s a re co re /c om pu lso ry an d wh ich ar e e le ct ive . Ye ar Se m es te r Co ur se ti tle Co ur se co de De sc rip tio n Re le va nt p ro gr am m e le ar ni ng o bj ec tiv es W ei gh t (u ni ts ) Le ar ni ng ho ur s 1 1 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t 2 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t 30 Using a contextualized competency framework to develop rehabilitation programmes and their curricula Ye ar Se m es te r Co ur se ti tle Co ur se co de De sc rip tio n Re le va nt p ro gr am m e le ar ni ng o bj ec tiv es W ei gh t (u ni ts ) Le ar ni ng ho ur s 2 1 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t 2 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Annex 3. Template for competency-based rehabilitation curriculum plan 31 Ye ar Se m es te r Co ur se ti tle Co ur se co de De sc rip tio n Re le va nt p ro gr am m e le ar ni ng o bj ec tiv es W ei gh t (u ni ts ) Le ar ni ng ho ur s 3 1 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t 2 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t 32 Using a contextualized competency framework to develop rehabilitation programmes and their curricula Ye ar Se m es te r Co ur se ti tle Co ur se co de De sc rip tio n Re le va nt p ro gr am m e le ar ni ng o bj ec tiv es W ei gh t (u ni ts ) Le ar ni ng ho ur s 4 1 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t 2 Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t Su m m ar y Co ur se le ar ni ng o bj ec tiv es As se ss m en t

A d a p ting the Re ha b ilita tio n C o m p e te nc y Fra m e w o rk fo r a sp e c ifi c co nte xt

运用情景化胜任力架构 开发康复教育项目和课程 教育项目和课程开发者分步骤指南 现场测试版 邱卓英 郭键勋 姚梅林 许光旭 季林红 主译审 井 淇 李安巧 王少璞 郝传萍 邹 敏 主 译 运用情景化胜任力架构 开发康复教育项目和课程 教育项目和课程开发者分步骤指南 现场测试版 运用情景化胜任力架构 开发康复教育项目和课程 教育项目和课程开发者分步骤指南 现场测试版 iii 运用情景化胜任力架构开发康复教育项目和课程: 教育项目和课程开发者分步骤指南(现场测试 版)/邱卓英，郭键勋，姚梅林，许光旭，季林红 主译审. 井淇，李安巧，王少璞，郝传萍，邹 敏 主译.-香港:香港复康会，2021.09 ISBN 978-988-16535-6-7 © 中国康复研究中心/潍坊医学院/康复大学/香港复康会 2021 保留部分版权。本著作根据创意公用授权-非商业-相同方式共享许可证3.0IGO(Creative Commons-Attribution- NonCommercial-ShareAlike 3.0 IGO License) (CC BY-NC-SA 3.0 IGO; https:// creativecommons.org/licenses/by-nc-sa/3.0/igo). 由世界卫生组织授予中国康复研究中心/潍坊医学 院/中国ICF研究院/康复大学/世界卫生组织国际分类家族合作中心和香港复康会/世界卫生组 织康复协作中心（香港）中文版本翻译版权。 根据本许可证的条款，可以为非商业目的复制、分发和修改本著作，前提是须适当说明来源。 在利用本著作的任何情况中，都不应该暗示世界卫生组织认可任何特定的组织、产品或服务。 不允许使用世界卫生组织的徽标。如果修改本著作，贵方著作就必须获得相同或相当的创意 公用许可证。如果对本著作进行翻译，就应该随同建议的引用说明添加以下免责声明:“本译 文并非源自世界卫生组织。世界卫生组织对译文的内容或准确性概不负责。英文原版Using a contextualized competency framework to develop rehabilitation programmes and their curricula:A stepwise guide for programme and curriculum developers. Version for field testing; 2019. Licence: CC BY-NC-SA 3.0 IGO应作为具有约束力的标准文本”。 对根据该许可证产生的相关争议进行任何调解，均应按照世界知识产权组织的调解规则进行。 建议使用的引文。运用情景化胜任力架构开发康复教育项目和课程/邱卓英，郭键勋，姚梅 林，许光旭，季林红 主译审. 井淇，李安巧，王少璞，郝传萍，邹敏 主译.-香港:香港复康 会，2021.09. 本翻译遵循Licence:CC BY-NC-SA 3.0. iii 目录 致谢 v 中文版致谢 vii 出版者序 xv 翻译出版说明 xvii 术语 xix 1.概述 1 2.运用情景化胜任力架构开发康复教育课程的良好实践 5 3.运用情景化胜任力架构开发康复教育项目和课程时应考虑的关键性因素 7 4.运用情景化胜任力架构开发康复教育项目和课程的过程 9 参考文献 23 附件1 基于胜任力的教育检查表 25 附件2 基于胜任力的康复教育项目及课程模板 26 附件3 基于胜任力的康复课程体系规划模板 27 iv 运用情景化胜任力架构开发康复教育项目和课程 v iv 运用情景化胜任力架构开发康复教育项目和课程 v 致谢 世界卫生组织（WHO）对为制定本资源文件作出努力并贡献专业知识的全体人员表 示感谢。《运用情景化的胜任力架构开发康复教育项目和课程指南》是在世界卫生 组织非传染性疾病司感觉功能、残疾和康复部主任Alarcos Cieza博士的督导下制定而 成。世界卫生组织康复项目部Jody-Anne Mills负责协调和制定本指南。世界卫生组织 的以下工作人员也为制定该文件提供了宝贵意见，他们是：Siobhan Fitzpatrick,Pauline Kleinitz和Elanie Marks。 特别感谢美国康复项目和课程发展的独立顾问Cheryl Burditt Footer博士, 物理治疗师, 以及康复胜任力架构技术工作组的成员，他们就指南草案提供了专业指导，他们是： 美国南佛罗里达大学传播科学与障碍学系荣誉教授Harvey Abrams、英国国际传播科 学与障碍协会（IALP）主席Pamela Enderby、加拿大国际假肢与矫形学会主席Edward Lemaire、印度全印医学科学研究所神经科学中心教授Ashima Nehra、美国国际大学加 利福尼亚专业心理学院教授Alliant Rhoda Olkin、美国加利福尼亚州立大学护理学院荣 誉教授Stephanie Vaughn。可以在线获取各位专家的专业简介。 本指南是在美国国际开发署(USAID)支持下完成的。 vi 运用情景化胜任力架构开发康复教育项目和课程 vii vi 运用情景化胜任力架构开发康复教育项目和课程 vii 中文版致谢 《运用情景化胜任力架构开发康复教育项目和课程指南》，是世界卫生组织颁布 的《康复胜任力架构》文件的配套指南。该指南是卫生和康复部门制定康复人力资源 规划，指导康复教育机构设立不同的康复教育项目与开发康复教育课程，指导康复监 管部门建立康复工作者的职业标准和职业认证与鉴定，以及指导康复服务机构建立评 价康复工作者绩效的方法和工具。本指南是世界卫生组织《康复胜任力架构》及其配 套指南翻译项目，整个项目在邱卓英博士和郭键勋博士协调和指导下，完成了中文 版本翻译和审校工作。感谢下列专家对本文件翻译、审校和出版工作作出的贡献。 翻译项目协调人与主译审 Coordinators and Chief Translators 邱卓英 博士、教授、研究员 世界卫生组织国际分类家族合作中心联合主任、中国ICF 研究院院长。世界卫生组织《健康服务体系中的康复》指南制定专家小组成员、世界 卫生组织《康复胜任力架构》及相关指南翻译项目协调人和主译审。 Zhuoying Qiu Ph.D,Professor Co-Chair of WHO Family International Classifications (FIC) Collaborating Center in China/ Director of China Academy of ICF, Member of WHO Guideline Development Group, Coordinator and Chief Translator of Rehabilitation Competency Framework and related guides. 郭键勋(香港特别行政区)博士、香港复康联会副主席、康复国际全球社会委员会副 主席、香港复康会世界卫生组织复康协作中心联席主席、世界卫生组织《康复胜任 力架构》及相关指南翻译项目协调人和主译审之一。 Joseph Kwok PhD, Vice-Chair, Hong Kong Joint Council for People with Disabilities; Vice Chair, Rehabilitation International, Global Social Commission; Co-Chair, The Hong Kong Society for Rehabilitation, World Health Organization Collaborating Centre for Rehabilitation; Coordinator and Chief Translator of Rehabilitation Competency Framework and related guides. 姚梅林 博士、教授 北京师范大学心理学部，中国心理学会教育心理学专业委员会副 主任 Meilin Yao, PhD, Professor of Faculty of Psychology of Beijing Normal University. Associate Director of Educational Psychology Division, Chinese Psychological Society 许光旭 教授、主任医师 南京医科大学康复医学院院长，江苏省人民医院老年康复医 学科主任 Guangxu Xu M.D, Professor and Chief Physician,Dean of school of Rehabilitation Medicine, Nanjing Medical University,Director of Department of Geriatric Rehabilitation Medicine of Jiangsu Province's Hospital. 季林红 博士 教授，清华大学机械工程系智能与生物机械研究室主任 Linhong Ji PhD, Professor,Lab. Head of Intelligent & Biomimetic Machinery, Department of Mechanical Engineering,Tsinghua university. 井 淇 博士、副教授 世界卫生组织国际分类家族中国合作中心专家，潍坊医学院中 国ICF研究院/管理学院 Qi Jing PhD,Associate Professor Member of WHO-FIC CC China, China Academy of ICF, School of Management, Weifang Medical University 李安巧 硕士 助理研究员 世界卫生组织国际分类家族合作中心，中国ICF研究院 Anqiao Li M.A.,Associate Researcher,Member of WHO-FIC CC China, China Academy of ICF viii 运用情景化胜任力架构开发康复教育项目和课程 ix 王少璞 硕士、助理研究员 世界卫生组织国际分类家族合作中心，中国ICF研究院 Shaopu Wang M.A.,Associate Researcher,Member of WHO-FIC CC China, China Academy of ICF 郝传萍 硕士、副教授 北京联合大学特殊教育学院 Chuanping Hao M.A.,Associate Professor of Special Education College of Beijing Union University 邹 敏 博士、副教授 潍坊医学院心理学院，中国ICF研究院秘书长 Min Zou PhD, Secretary of China Academy of ICF, Associate Professor of School of Psychology, Weifang Medical University 翻译专家委员会 Expert Advisory Committee on Translation 邱卓英 博士、教授、研究员 世界卫生组织国际分类家族合作中心联合主任、中国ICF 研究院院长。世界卫生组织《健康服务体系中的康复》指南制定专家小组成员、世界 卫生组织《康复胜任力架构》及相关指南翻译项目协调人和主译审。 Zhuoying Qiu PhD,Professor, Co-Chair of WHO Family International Classifications (FIC) CC in China,Director of China Academy of ICF, Member of WHO Guideline Development Group, Coordinator and Chief Translator of Rehabilitation Competency Framework and related guides. 郭键勋 博士 (香港特别行政区) 香港复康联会副主席、康复国际全球社会委员会副 主席、香港复康会世界卫生组织复康协作中心联席主席、世界卫生组织《康复胜任 力架构》及相关指南翻译项目协调人和主译审之一。 Kin-fun Joseph KWOK PhD, Vice-Chair, Hong Kong Joint Council for People with Disabilities; Vice Chair, Rehabilitation International, Global Social Commission; Co-Chair, The Hong Kong Society for Rehabilitation, World Health Organization Collaborating Centre for Rehabilitation; Coordinator and Chief Translator of Rehabilitation Competency Framework and related guides. 陈智轩 博士、教授 (香港特别行政区) 香港教育大学副校长(研究与发展) 、利定昌 心理学讲座教授 Che-hin Chetwyn CHAN PhD, Vice-President (Research and Development), Peter T. C. Lee Professor of Psychology, The Education University of Hong Kong 吴世彩 博士、教授 中国康复研究中心主任 Shicai Wu PhD,Professor and Director of China Rehabilitation Research Center 吕 军 博士、教授 复旦大学公共卫生学院中国残疾问题研究中心主任 Jun Lv PhD,Professor, Director of China Research Center on Disability,School of Public Health, Fudan University 孙宏伟 博士 、教授 世界卫生组织国际分类家族合作中心专家，潍坊医学院中国ICF 研究院执行院长 Hongwei Sun PhD,Professor Member of WHO-FIC CC China, and Director of China Academy of ICF, Weifang Medical University. 王国祥 博士、教授 世界卫生组织国际分类家族中国合作中心专家，苏州大学体育学 院院长、苏州大学运动康复研究中心主任 viii 运用情景化胜任力架构开发康复教育项目和课程 ix Guoxiang Wang PhD, Professor, Member of WHO-FIC CC China, Dean of School of Physical Education and Director of Exercise Rehabilitation Research Center, Soochow University 周晓英 博士、教授 中国人民大学信息资源管理学院 Xiaoying Zhou PhD,Professor,School of Information Resources Management, Renmin University of China 李欣章 教授 康复大学 Xinzhang Li Professor,University of Health and Rehabilitation Sciences 井 淇 博士、副教授 世界卫生组织国际分类家族中国合作中心专家，潍坊医学院中 国ICF研究院/管理学院 Qi Jing PhD,Associate Professor,Member of WHO-FIC CC in China, China Academy of ICF, School of Management, Weifang Medical University 姚梅林 博士、教授 北京师范大学心理学部，中国心理学会教育心理学专业委员会副 主任 Meilin Yao, PhD, Professor of Faculty of Psychology of Beijing Normal University. Associate Director of Educational Psychology Division, Chinese Psychological Society 季林红 博士 教授，清华大学机械工程系智能与生物机械研究室主任 Linhong Ji PhD, Professor,Lab. Head of Intelligent & Biomimetic Machinery, Department of Mechanical Engineering,Tsinghua university. 许家成 教授 北京联合大学、重庆师范大学特聘教授 Jiacheng Xu , Professor of Beijing Union University and distinguished professor of Chongqing Normal University. 许光旭 教授、主任医师 南京医科大学康复医学院院长，江苏省人民医院老年康复医 学科主任 Guangxu Xu M.D, Professor and Chief Physician,Dean of school of Rehabilitation Medicine, Nanjing Medical University,Director of Department of Geriatric Rehabilitation Medicine of Jiangsu Province's Hospital. 周惠仪 (澳门特别行政区) 澳门扶康会总干事 Wai-I Jennifer CHAU, Director, Fuhong Society of Macau 何婉玲 (香港特别行政区) 香港复康会执行委员会委员、持续照顾委员会副主席 Yuen-ling Josephine HO, Executive Committee member, Hong Kong Society for Rehabilitation; Vice-Chairperson, Long Term Care Committee 许卢万珍 博士 (香港特别行政区) 原香港理工大学讲师、社会工作实习导师、扶康会 董事、香港复康联盟执行委员会委员 Man-chun Jenny HUI LO PhD, Lecturer, The Hong Kong Polytechnic University (before retirement); Social Work Fieldwork Supervisor; Council member, Fu Hong Society; Executive committee member, Rehabilitation Alliance Hong Kong x 运用情景化胜任力架构开发康复教育项目和课程 xi 梁佩如 博士 (香港特别行政区) 香港复康会总裁 Pui-yu Pamela LEUNG PhD, Chief Executive Officer, The Hong Kong Society for Rehabilitation 梁惠玲 (香港特别行政区) 协康会行政总裁 Wai-ling Rachel LEUNG Chief Executive Officer, Heep Hong Society 李凤仪 (香港特别行政区) 香港复康联会秘书长、香港社会服务联会复康总主任 Fung-yee Teresa LI General Secretary, The Hong Kong Joint Council for People with Disabilities; Chief Officer (Rehabilitation Service), The Hong Kong Council of Social Service 陆慧妍 (香港特别行政区) 注册社工、管理顾问及培训师、原扶康会总干事 Wai-yin Becky LUK Registered Social Worker; Management Consultant and trainer; Ex-Chief Executive Officer of Fu Hong Society 伍杏修 (香港特别行政区) 粤港澳大湾区香港社会服务专业联盟 秘书长 Hang-sau NG Secretary General, Hong Kong Social Service Professional Alliance of the GuangDong-Hong Kong-Macau Greater Bay Area (GBSSPA) 施达明 (澳门特别行政区) 澳门大学教育学院副教授 Tat-ming SZE Associate Professor of Faculty of Education, University of Macau 吴弦光 教授 《中国康复理论与实践杂志》主编 Xianguang Wu Professor ,Editor-in-chief of Chinese Journal of Theory and Practice of Rehabilitation 周谋望 教授 北京大学第三医院康复医学科主任医师 Mouwang Zhou Professor ,Chairman of Department of Rehabilitation Medicine,Peking University Third Hospital 郑洁皎 教授 华东医院康复医学科主任、主任医师 Jiejiao Zheng Professor, Chief Physician and Director of Department of Rehabilitation Medicine, Huadong Hospital 卢 雁 博士、教授 北京体育大学残疾人体育运动研究中心主任 Yan Lu PhD, Professor of China Research Center on the Sports of Persons with Disabilities, Beijing Sport University 陈 迪 博士 世界卫生组织国际分类家族合作中心专家，中国康复研究中心/中国康复 科学所 Di Chen PhD, Member of WHO-FIC CC in China, Institute of Rehabilitation Information, China Rehabilitation Research Center/China Rehabilitation Research Institute 邱服冰 硕士、副教授 世界卫生组织国际分类家族中国合作中心专家, 深圳大学体育 部体育与健康科学研究中心主任 Fubing Qiu M.A.,Associate Professor, Member of WHO-FIC CC China, Director of Center of Physical Education, Sport and Health Sciences, Department of Physical Education, Shenzhen University. x 运用情景化胜任力架构开发康复教育项目和课程 xi 李 伦 硕士 世界卫生组织国际分类家族合作中心特邀专家 Lun Li M.A.,Invited expert of WHO-FIC CC China 谢欲晓 硕士、教授 中日友好医院康复医学科主任医师 Yuxiao Xie MD, Chief Physician and Professor of Department of Rehabilitation Medicine, China- Japan Friendship Hospital 张鸣生 博士、教授 广东省人民医院康复医学科主任医师 Mingsheng Zhang PhD,Professor of Chief Physician and Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital 石秀娥 陕西省康复中心医院主任医师、医院院长 XiuE Shi Chief Physician and President of Shanxi Rehabilitation Center Hospital 王 松 博士、教授 武汉体育学院研究生院院长 Song Wang PhD, Professor and Director of Graduate School ,College of Health Science, Wuhan Sports University, Wuhan, Hubei, China 蒋长好 博士、教授 首都体育学院脑成像实验室主任 Changhao Jiang PhD, Professor and Director of Brain Imaging Laboratory, Capital University of Physical Education and Sports 郭凤宜 博士、教授 美国印第安那大学医学院康复学术研究与教育 Fengyi Kuo PhD,Professor Rehabilitation Research & Education, School of Medicine, Indiana University, USA 刘巧云 博士、教授 华东师范大学教育学部教育康复学系主任 Qiaoyuan Liu PhD,Professor ,Director of Department of Education & Rehabilitation, Faculty of Education, East China Normal University 杨 剑 博士、教授 世界卫生组织国际分类家族合作中心专家，华东师范大学体育与 健康学院/青少年健康评价与运动干预教育部重点实验室 Jian Yang PhD,Professor Member of WHO-FIC CC China, Professor of School of Sport and Health, Key Laboratory of Health Evaluation and Sport Intervention of Ministry of Education, East China Normal University 许 涛 博士、副教授 华中科技大学同济医学院附属同济医院康复医学科主任医师 Tao Xu PhD,Associate Professor and Chief Physician of Department of Rehabilitation Medicine,Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology 侯晓晖 博士、教授 广州体育学院运动与健康学院运动医学康复中心主任、残疾人运 动与健康国际协同创新中心负责人 Xiaohui Hou PhD, Prof. of School of Exercise and Health, Director of Sports medicine and rehabilitation center, Director of International Collaboration & Innovation Center for People with Disability, Guangzhou Sports University xii 运用情景化胜任力架构开发康复教育项目和课程 xiii 郝传萍 副教授 北京联合大学特殊教育学院 Chuanping Hao Associate Professor of Special Education College of Beijing Union University 马洪卓 副教授 世界卫生组织国际分类家族合作中心专家，中国ICF研究院研究部主任 Hongzhuo Ma Member of WHO-FIC CC China, Associate Professor and Director of Research Department of China Academy of ICF 李沁燚 硕士 世界卫生组织国际分类家族合作中心专家 Qinyi Li M.A.,Member of WHO-FIC CC China 邹 敏 博士、副教授 潍坊医学院心理学院，中国ICF研究院秘书长 Min Zou PhD, Secretary of China Academy of ICF, Associate Professor of School of Psychology, Weifang Medical University 肖晓飞 博士、副教授，滨州医学院康复医学院 Xiaofei Xiao PhD Associate Professor,School of Rehabilitation Medicine, Binzhou Medical University 王忠彦 博士 康复大学规划部/滨州医学院 Zhongyan Wang PhD,Department of Planning ,University of Health and Rehabilitation Sciences/Binzhou Medical University 萧敦武 硕士，中国康复研究中心/世界卫生组织国际分类家族合作中心专家 Dunwu Xiao M.A., China Rehabilitation Research Center,Member of WHO-FIC CC in China 编审委员会 Editorial Board 邱卓英 博士、教授、研究员 世界卫生组织国际分类家族合作中心联合主任、中国ICF 研究院院长。世界卫生组织康复指南《健康服务体系中的康复》制定专家小组成员、 世界卫生组织《康复胜任力架构》及相关指南翻译项目协调人和主译审。 郭键勋(香港特别行政区)博士 香港复康联会副主席、康复国际全球社会委员会副主 席、香港复康会世界卫生组织复康协作中心联席主席、世界卫生组织《康复胜任力 架构》及相关指南翻译项目协调人和主译审之一。 孙宏伟 博士 、教授 世界卫生组织国际分类家族合作中心专家，潍坊医学院中国ICF 研究院执行院长。 邱服冰 硕士、副教授 深圳大学体育部体育与健康科学研究中心主任。 姚梅林 博士、教授 北京师范大学心理学部，中国心理学会教育心理学专业委员会副 主任 许光旭 教授、主任医师 南京医科大学康复医学院院长，江苏省人民医院老年康复医 学科主任 季林红 博士、教授 清华大学机械工程系智能与生物机械研究室主任 井 淇 博士、副教授 世界卫生组织国际分类家族中国合作中心专家，潍坊医学院中 国ICF研究院/管理学院 郝传萍 硕士、副教授 北京联合大学特殊教育学院 xii 运用情景化胜任力架构开发康复教育项目和课程 xiii 邹 敏 博士、副教授 潍坊医学院心理学院，中国ICF研究院秘书长 陈 迪 博士 世界卫生组织国际分类家族合作中心专家，中国康复研究中心/中国康 复科学所，编审与排版制作 井 淇 博士、副教授 世界卫生组织国际分类家族合作中心专家，潍坊医学院中国 ICF研究院/管理学院 翻译与审校 刘淑燕 香港复康会国际及中国部高级经理 王少璞 硕士，助理研究员，世界卫生组织国际分类家族合作中心，中国ICF研究院 李安巧 硕士，助理研究员，世界卫生组织国际分类家族合作中心，中国ICF研究院 付雨萌 硕士，中国康复研究中心/中国康复科学所 朱 婷 助理研究员，世界卫生组织国际分类家族合作中心，中国ICF研究院 姜静远 硕士，中国ICF研究院/苏州大学体育学院/苏州大学运动康复研究中心 张 萌 硕士，中国ICF研究院/苏州大学体育学院/苏州大学运动康复研究中心 汤修齐 硕士，中国ICF研究院/武汉理工大学体育部/武汉理工大学体育科学研究所 刘 静 硕士，中国ICF研究院/武汉理工大学体育部/武汉理工大学体育科学研究所 段明雪 潍坊医学院公共卫生学院 吴 芳 潍坊医学院公共卫生学院 排版制作 陈 迪 博士，世界卫生组织国际分类家族合作中心专家，中国康复研究中心/中国 康复科学所助理研究员，审校与排版制作 王少璞 硕士，助理研究员，世界卫生组织国际分类家族合作中心，中国ICF研究院， 审校与排版制作 李安巧 硕士，助理研究员，世界卫生组织国际分类家族合作中心，中国ICF研究院， 审校与排版制作 付雨萌 硕士，中国康复研究中心/中国康复科学所，审校与排版制作 xiv 运用情景化胜任力架构开发康复教育项目和课程 xv 致谢机构 感谢世界卫生组织总部授权中文翻译版权并提供了版权和技术等方面的协助。 视、听、康复和残疾项目协调员、指南编写总协调员Alarcos Cieza 博士、康复项目 (Rehabilitation programme)Elanie Marks女士和 世界卫生组织出版社Catalina Gradin技术 助理为《康复胜任力架构》中文版本翻译出版提供了版权和技术协助。 世界卫生组织国际分类家族合作中心 WHO Family International Classifications Collaborating Center in China 香港复康会/世界卫生组织复康协作中心 The Hong Kong Society for Rehabilitation/World Health Organization CC for Rehabilitation 中国ICF研究院/潍坊医学院 China Academy of ICF/Weifang Medical University 中国康复研究中心/中国康复科学所 China Rehabilitation Research Center/China Rehabilitation Science Institute 康复大学 University of Health and Rehabilitation Sciences 北京师范大学 Beijing Normal University 南京医科大学康复医学院 School of Rehabilitation Medicine, Nanjing Medical University 北京联合大学特殊教育学院 Special Education College，Beijing Union University 复旦大学公共卫生学院中国残疾问题研究中心 China Research Center on Disability Department of Health Policy and Management,School of Public Health, Fudan University 北京体育大学中国残疾人体育运动研究中心 China Research Center on the Sports of Persons with Disabilities,Beijing Sport University 苏州大学体育学院/运动康复研究中心 School of Physical Education/ Exercise Rehabilitation Research Center, Soochow University 深圳大学体育部体育与健康科学研究中心 Center of Physical Education, Sport and Health Sciences, Department of Physical Education, Shenzhen University xiv 运用情景化胜任力架构开发康复教育项目和课程 xv 《运用情景化胜任力架构开发康复教育项目 和课程指南》出版者序 《运用情景化胜任力架构开发康复教育项目和课程指南》，是世界卫生组织颁布的《 康复胜任力架构》文件的配套指南，该指南是对《康复胜任力架构》文件和《基于特 定情景调整康复胜任力架构：胜任力架构开发者分步骤指南》的补充，构建了系统的 基于能力（胜任力）本位的教育方法论，提出了康复教育项目以及康复课程开发的具 体步骤和流程，该指南将《康复胜任力架构》有关胜任力和活动转化为学习目标， 运用这种基于能力（胜任力）本位的教育方法，可以建立综合性的康复课程体系。 康复教育项目是为提供功能最大化和降低残疾相关的健康工作者提供教育和培训。 康复教育项目涉及听力学、作业疗法、假肢和矫形学、物理治疗学、语言和语言治 疗学、康复医学、护理学、以及康复心理学等领域。康复教育项目的从层次上看， 可以分为本科、硕士和博士三个层次的教育，也包括一些短期的非学历的证书培训 和继续教育项目。该指南是实施世界卫生组织《康复胜任力架构》的重要工具。 本指南得以翻译完成，首先要衷心感谢翻译项目协调人与主译审以及主要翻译人员， 主译审分别为邱卓英博士、郭键勋博士、姚梅林博士、许光旭教授和季林红博士 。本 指南主译分别为：井淇博士、李安巧硕士、王少璞硕士、郝传萍硕士、邹敏博士。 邱卓英博士是世界卫生组织国际分类家族合作中心主任、世界卫生组织《运用情景 化胜任力架构开发康复教育项目和课程指南》翻译项目协调人，全程领导及督导并 审校翻译工作。康复国际执行委员会委员、社会委员会副主席及香港复康会世界卫 生组织复康协作中心联席主席郭键勋博士积极推动及指导翻译工作。 此外，亦特别感谢世界卫生组织总部视、听、康复、残疾项目协调员Alarcos Cieza博 士、康复项目技术主任Elanie Marks女士提供了版权和翻译技术协助。 最后，我们还要感谢鼎力支持是次翻译出版的单位，包括世界卫生组织国际分类家族 合作中心、中国ICF研究院/潍坊医学院、香港复康会/世界卫生组织康复协作中心、康 复大学、中国康复研究中心/中国康复科学所、北京师范大学、南京医科大学康复医 学院、北京联合大学特殊教育学院、苏州大学、深圳大学、华东师范大学、复旦大 学、中国心理学会康复心理学专业委员会和中国残疾人康复协会残疾分类研究专业 委员会等。感谢香港复康会和澳门扶康会资助出版康复胜任力架构及两个配套指南。 《运用情景化胜任力架构开发康复教育项目和课程指南》作为应用《康复胜任力架 构》的工具，为康复政策的制定者、相关的研究人员、康复教育工作者以及康复服 务机构建构了标准化的方法和工具，期望这种结构化方法的系统应用将推动康复教 育、认证与鉴定发展以及绩效评估等工作的发展，开发高素质康复人力资源，进而 进一步提升康复服务的覆盖率和康复服务质量。 方津生医生 SBS, JP 香港复康会会长 xvi 运用情景化胜任力架构开发康复教育项目和课程 xvii xvi 运用情景化胜任力架构开发康复教育项目和课程 xvii 世界卫生组织《运用情景化胜任力架构开发 康复教育项目和课程指南》翻译出版说明 康复是针对身体功能和结构、活动和参与、环境因素和个人因素采取的一系列措施。 这些措施有助于个体在与环境相互作用过程中获得及维持最佳功能状态。现代康复 服务是健康服务的重要组成部分，是实现联合国2030年可持续发展目标中全民健康 覆盖目标的关键。 根据世界卫生组织健康服务体系的构成要素理论，康复人力资源是现代康复服务体 系的重要领域，直接关系到康复服务的覆盖率和服务质量。随着健康体系在实现全 民健康覆盖领域的发展进程，以及慢性非传染性疾病流行率提升、人口老龄化程度 加深，人们的康复需求进一步增强，打造一支综合水平高、服务能力强的康复人才 队伍显得尤为重要。 为了推动康复事业发展，提升康复人力资源的规模和质量，世界卫生组织颁布了第一 部《康复胜任力架构》文件。该理论架构是世界卫生组织根据全民健康覆盖（UHC） 的全球胜任力架构（2020）有关卫生与健康人力胜任力的战略方法，根据康复科学与 康复服务的情景要求，建立的适用于康复情景的特殊胜任力架构。 《康复胜任力架构》是有关康复情景下健康人力资源的胜任模型，该模型由实践、 专业精神、教育和发展、管理和领导力以及研究五大领域构成，在各领域中，包含 四个方面的胜任特征，它们是：1）核心价值观和信念、2）胜任力以及表现这些胜 任力的行为、3）活动以及它们所包含的任务、以及4）知识和技能。该康复胜任力 架构采用了标准化、一致化的结构和术语，便于应用于康复各领域。 康复胜任力架构确认了康复工作者在康复情景下完成的不同类型的活动，以及有效 地完成这些活动的核心胜任力，这些胜任力对于康复相关服务部门、学术机构、教 育工作者、职业认证机构和监管机构而言意义非凡。该理论架构不仅可以用于指导 康复教育机构设立不同的康复专业及开发康复教育课程，指导康复监管部门建立康 复工作者的职业标准和职业认证与鉴定标准，还是指导康复服务机构评价康复工作 者绩效的方法和工具。 《运用情景化胜任力架构开发康复教育项目和课程指南》，是世界卫生组织颁布的 《康复胜任力架构》文件的配套指南，该指南是对《康复胜任力架构》文件和《调 整康复胜任力架构适用于特定情景：胜任力架构开发者分步骤指南》的补充，构建 了系统的基于能力（胜任力）本位的教育方法论，提出了康复教育项目以及康复课 程的开发的具体步骤和流程，该指南将《康复胜任力架构》有关胜任力和活动转化 为学习目标，运用这种基于能力（胜任力）本位的教育方法，可以建立综合性的康 复课程体系。 康复教育项目是为提供功能最大化和降低残疾相关的健康工作者提供教育和培训。康 复教育项目涉及听力学、作业疗法、假肢和矫形学、物理治疗学、语言和语言治疗学 以及康复医学、护理学、以及康复心理学等领域。康复教育项目的从层次上看，可以 分为本科、硕士和博士三个层次的教育，也包括一些短期的非学历的证书培训和继续 教育项目。该指南是实施世界卫生组织《康复胜任力架构》的重要工具。 世界卫生组织将《运用情景化胜任力架构开发康复教育项目和课程》指南的翻译版 权授予世界卫生组织国际分类家族合作中心/中国ICF研究院/中国康复研究中心/中国 康复科学所和香港复康会/世界卫生组织康复协作中心（香港特別行政区），本书由 邱卓英博士、郭键勋博士（香港特別行政区）、姚梅林博士、许光旭教授和季林红 博士作为主译审，井淇博士、李安巧硕士、王少璞硕士、郝传萍硕士、邹敏博士作 为主译，完成本指南的翻译审校工作，在翻译过程中得到了相关专家支持与指导， 参与本康复胜任力架构文件翻译项目的主要机构包括：世界卫生组织国际分类家族 合作中心/潍坊医学院中国ICF研究院、香港复康会/世界卫生组织复康协作中心（香 港特別行政区）、康复大学、中国康复研究中心/中国康复科学所、北京师范大学、 xviii 运用情景化胜任力架构开发康复教育项目和课程 xix 南京医科大学康复医学院、北京联合大学特殊教育学院、苏州大学、深圳大学、华 东师范大学、复旦大学、中国心理学会康复心理学专业委员会、中国残疾人康复协 会残疾分类研究专业委员会。 本文件及其配套指南是世界卫生组织发布的有关康复人力资源领域的重要文件，为 了保障翻译工作的质量，我们建立了由著名专家领衔的指南翻译审校专家委员会和 指南翻译编译审校委员会，组织来自相关大学和研究机构以及香港特別行政区、澳 门特別行政区从事康复、高等教育、公共卫生、卫生政策与管理等领域的著名专家 共同参与指南的翻译审校工作。 本文件及其配套指南适用于康复政策制定者、大学和研究机构的研究人员、康复教 育机构、康复服务提供专业机构、非政府组织和残疾人服务机构等，也可作为相关 专业人员参考工具书。感谢香港复康会和澳门扶康会资助出版康复胜任力架构及两 个配套指南。 本指南是世界卫生组织《康复胜任力架构》及其配套指南的重要文件，读者可以从 世界卫生组织网站下载指南的中文版本。 邱卓英 博士 郭键勋 博士 世界卫生组织 香港复康联会副主席 国际分类家族合作中心联合主任 康复国际全球社会委员会副主席 中国康复研究中心/中国康复科学所 香港复康会世界卫生组织复康 中国ICF研究院/潍坊医学院 协作中心联席主席 康复大学 xviii 运用情景化胜任力架构开发康复教育项目和课程 xix 术语 活动 包含一系列相关任务的某个工作领域。活动是有时间限制、可 训练，并且通过执行任务时的活动表现来进行测量。 行为 针对他人或者活动的可观察到的行为，代表一种能力。行为是持 续性的、可训练的和可测量的。(1) 胜任力 一个人可观察到的能力，在他们执行任务的过程中整合了知识、 技能、价值观和信念。能力是持久的、可训练的，通过行为来表 现且是可衡量的。(1) 课程 针对特定学科领域的若干独立学习单元。随着学习者完成课程， 课程通常会增加主题的深度 (2)。它们可能会被加权，通常使 用“单元”的度量来表明它们对学习项目的完成度。 课程体系 旨在实现特定学习目标的教育活动和环境。课程体系包括学习的 内容和目标、学习经历、教学方法和评估的形式，它还包括质量 改进和教育项目评估 (3)。 课程规划 对一个课程体系中学习内容的组织。课程规划展示了课程内容是 如何组织和排序的，以使学生逐步获得能力，并对学生将获得的 学习经验提供了更详细的描述(2)。 学习目标 可评估的学习单位，汇总反映了行为或任务的完成情况。本指南 区分了教育项目学习目标（记录行为或任务的单位）和课程学习 目标（记录与课程主题相关的知识、技能和态度）。 教育项目 为成功完成的学习者提供特定奖励或资格的课程的总体。 教学大纲 对课程所涵盖学科的范围和深度的描述，以及课程将涉及的具体 学习经历、材料和评估，通常比教育项目更详细。教学大纲向学 习者传达他们对课程的期望以及对他们的要求。 任务 作为活动一部分的可观察的工作单元，它利用知识、技能、态度 和行为。任务是有时间限制的、可训练和可测量的 (1)。 * 对术语的描述仅限于本指南。术语的解释和使用因语境而异。 1xx 运用情景化胜任力架构开发康复教育项目和课程 1xx 运用情景化胜任力架构开发康复教育项目和课程 1. 概述 本指南《运用情景化胜任力架构开发康复教育项目和课程》是对《康复胜任力架构》文件和《基于特 定情景调整康复胜任力架构》指南的补充。本指南为开发康复教育和培训项目以及课程提供了方法， 并可支持基于胜任力的教育(见图1)。下面方框中描述的阶段和步骤都与专业和职业相关，无论是开 发新的康复教育项目，还是修订现有康复教育项目的课程，下面方框中描述的阶段和步骤都与专业和 职业相关。除了概述课程开发的过程外，该方法还描述了如何利用康复胜任力架构中的胜任力和活动 模型来生成学习目标，以及如何将这些目标定位在综合课程体系中。需要注意的是，在本指南中使用 “基于胜任力的教育”是因为它是一个规范性术语，而康复胜任力架构区分了胜任力和活动，并包括 这两者（见表2）。 许多国家试图通过建立教育和培训项目来扩大他们的康复劳动力，这些专业在他们的健康服务体系中 或是不存在或者是新兴专业。建立一个新的康复教育项目是一个复杂过程，涉及到政策、法律和监管 等方面，需要一个系统的、合作的和协调的方法。最重要的是确保项目培养的毕业生有能力满足人们 的需求，并在健康服务体系中有效地发挥作用。精心的计划和合作可以确保计划的毕业生在法律上得到 承认，受到良好监管，并被吸收到职业岗位上。同时，教育项目课程可以确保毕业生拥有相关知识、 技能和态度，有效地满足人口的特定需求。 课程是所有康复教育项目的核心，它包括内容、结构、学习经历和评估方法，使毕业生能够掌握安全 和有效地履行其职责所需的能力（3-5）。传统的课程开发是回顾性地看待专业知识和技能的传承，而 支持以胜任力为基础的教育课程是根据教育和培训所需要产生的结果来设计的；以胜任力为基础的教 育着眼于未来，确定毕业生在满足人口需求方面会遇到什么问题，并相应地规划课程，使学习者能够 满足人群、相关专业人士、雇主和监管机构的要求（见表1）（6，7）。 指南的适用范围 本指南与哪些康复人员有关？ 康复项目面向那些为提供干预措施以优化功能和减少残疾的健康工作者提供教育和培训的人员。 使用本指南的工作人员通常包括听力学、作业治疗学、假肢与矫形学、物理治疗学、言语和语 言治疗学等领域做康复项目规划或在这些领域工作的人员，以及那些医疗、护理和心理康复专 家。此外，本指南也适用于培训康复助理、技术人员和社区康复人员的课程，或其他提供康复 服务的卫生干部。 本指南适用于何种层次和类型的康复教育项目及培训? 本指南所描述的过程直接与综合康复教育项目相关，如本科或研究生教育，包括颁发文凭如学士 或硕士学位的教育项目。然而，所提供的方法体系也能够经过调整并扩大教育的规模，适用于短 期课程，如用于职业发展的继续教育项目，以及包括课程学习的博士教育项目。 本指南适用于康复项目发展的哪个阶段? 本指南适用的情况包括建立新的康复教育项目和课程，或修订以及更新现有教育项目和课程的 阶段。 2 运用情景化胜任力架构开发康复教育项目和课程 3 图1 调整《康复胜任力架构》应用于教育和培训的过程 表1 传统教育与基于胜任力的教育的关键对比 (3, 7) 传统教育 基于胜任力的教育 学习目标集中在学习者应该知道什么 学习目标集中在学习者应该能做什么 注重教育过程 注重教育目标 课程在很大程度上是由过去教的知识而形成 课程内容在很大程度上取决于人们所需要的胜任力 隐含的将人群健康需要与课程内容联系起来 明确地将人群健康需求与学习者所需的胜任力联系 起来 本指南的作用是帮助那些制定或修订康复教育项目和课程的人们从基于胜任力视角看待教育和培训； 它可以应用于岗前或在岗的教育和培训与其结果和内容进行相应的调整。虽然该指南为康复教育项目 和课程的开发提供了一个系统方法，但它并没有为这两者定义内容或具体的教育方法。这些应该由机 构决定，反映学习目标，并适合当地情况和学习者的具体需求。此外，虽然适当设计的教育项目和课 程对基于胜任力的教育至关重要，但这只是其成功实施的一个方面。实施教育项目和讲授课程需要机 构有足够的能力；这包括训练有素的教师、学习资源、机会和环境，以及政策和法规支持（图2）(3) 。对基于胜任力教育的投资得到了现有证据的支持，是使教育和培训与卫生系统优先事项相一致的有 力机制（6, 8, 9）。投资对资源有限的国家具有特殊的价值，因为这些国家的康复人员的知识和技能 不仅需要反映和适应人口的健康状况，还需要反映卫生系统的优势和劣势（如劳动力的差距和分配不 均）（6）。 情景相关的特定胜 任力架构 人力资源规划 工作绩效评估 应用 课程指南 该指南提供了运用情 景化的胜任力架构开 发基于胜任力的康复 教育项目和课程 基于胜任力的 教育 监管和认证 基于特定情景调整 调整指南 康复胜任力 架构 2 运用情景化胜任力架构开发康复教育项目和课程 3 图 2 基于胜任力的教育架构 鼓励开发项目或设计课程的机构在本指南之外寻找丰富的相关证据和资源，并与专家合作。那些刚接触 项目开发、课程设计和基于胜任力的康复教育过程的人可以使用本指南在开发和设计过程中成为更了 解情况和积极的参与者。 投入 产出 结果 影响 • 基于 胜任力的 教育 • 有康复胜任力的 康复工作者 • 人口健康 • 课程体系 • 教师 • 团队 • 学习 材料 • 学习 环境 • 学习经历 4 运用情景化胜任力架构开发康复教育项目和课程 5 4 运用情景化胜任力架构开发康复教育项目和课程 5 2. 运用情景化的康复胜任力架构开发康复教育课程 的良好实践 《基于特定情景调整康复胜任力架构》（康复胜任力架构调整指南）列出了开发胜任力架构的良好实 践，同样的实践也适用于运用该架构开发或调整康复教育项目和课程。这些实践有助于确保教育项目 和课程体系在支持基于胜任力的教育时是可接受、可实施和有效的。具体实践内容如下： 采用包容性的方法 利益攸关方的参与不仅对支持基于胜任力的教育至关重要，对于发展一支卫生健康行业认可且工作积 极、有实际贡献的人力资源队伍也至关重要。政府各部门（卫生部门、教育部门、人力资源部门）、 服务的用户、专业协会、雇主和监管机构的代表以及该机构的主要协调中心应在一定程度上参与课程 制定过程，特别是在计划阶段（步骤1）。利益攸关方的参与不仅有助于课程内容的制定，也有助于提 高对该领域的认识和认可，能进一步促进了对该方案的所有权和支持。 从一开始就规划课程实施 课程开发只是有效实施基于胜任力的教育的康复教育项目的一部分，必须充分注意项目执行的政策和体 制环境，以及所需的机构能力和资源；从项目一开始就仔细考虑这些因素可以提高教育项目和课程的 价值，学习者能获得以人口需求为导向的知识和技能。尤其重要的是需要确保获得的资格得到认可， 监管机制到位，并且有足够的带薪职位提供给毕业生。 监测有效性 由于学习者预期胜任力水平受到各种内部和外部因素的影响，监测教育项目和课程的有效性可能具有 挑战性。尽管如此，定期审查教育和培训目标，批判性地审查学习者表现的潜在驱动力，仍然是项目 和课程管理的一个重要方面。应定期审查教育项目和课程，并根据反馈、评价结果、不断变化的机构 能力和不断变化的人口需要加以改进(步骤12)。 6 运用情景化胜任力架构开发康复教育项目和课程 7 6 运用情景化胜任力架构开发康复教育项目和课程 7 3. 运用情景化的胜任力架构开发康复教育项目和课 程时应考虑的关键因素 机构准备情况 无论是开发新的教育项目和课程，还是调整教育项目和课程，机构的准备情况都显得尤为重要。特别是 涉及到从传统的教育方式调整为基于胜任力的教育时。如前所述，实施基于胜任力的教育不仅需要训 练有素的教师；它还与巨大的评价负担有关，并依赖于学习者获得一系列实践的学习经历。在获得教 育机构的批准之前，教育项目和课程开发人员可能需要提倡基于胜任力的教育。一旦获得认可，机构 进行必要投资的机会就更大。 资源的可用性和合作关系 在许多国家，无论是人力资源还是物质资源，资源的有效利用都面临着挑战。特别是获得训练有素的 合格教师和实践主管对实施课程构成相当大的障碍。在首次引入教育项目或潜在教师稀缺的情况或背 景下，机构可能需要在国际范围内招聘，和/或与更容易获得教师的机构合作。这可以分阶段实施，在 中长期背景下实现机构自给自足（步骤 11）。 设备、基础设施和学习材料是成功实施康复课程的关键。根据已开设的课程而定，一些机构已经拥有 所需的大量物质资源，反之，则需要重新采购。 目标学习者 教育项目和课程所针对的学习者群体将决定方案的结果和课程的内容。例如，作为岗前或在岗教育的 一部分而实施（如本科生或研究生）将影响到学习者在进入该课程时应具备的知识和技能，以及教学 和评估应达到什么水平。值得考虑的是，通过课程开发的胜任力和活动是否已经被任何其他专业所代 表，以及如何在实践和法律上管理未来可能出现的执业范围的转变。 8 运用情景化胜任力架构开发康复教育项目和课程 9 8 运用情景化胜任力架构开发康复教育项目和课程 9 4.运用情景化的胜任力架构开发康复教育项目及课程 的过程 《运用情景化康复胜任力架构开发教育项目和课程》涵盖五个阶段，每个阶段都有一些具体步骤（图 3）。确定胜任力和活动（构成教育项目的学习成果）是这些阶段的前提。使用康复胜任力架构来确 定胜任力和活动，并使其符合实际情况的过程，在康复胜任力架构调整指南中已作说明，因此这里不 做介绍。即使不打算创建正式的胜任力架构，也鼓励尚未有胜任力架构或尚未确定与其教育项目相关 的胜任力和活动的教育项目和课程开发人员，参考康复胜任力架构调整指南。 图3 开发用于支持基于胜任力教育课程的阶段及步骤 第一阶段：规划 规划是教育项目和课程开发的一个关键阶段，在所有阶段中，可能需要投入最多时间。根据实际情况， 在几个月甚至几年的时间里进行规划是很正常的。规划为发展过程的所有未来阶段和步骤奠定了基础， 对成功实施至关重要。 规划 第1步：收集信息 第2步:利益攸关方对话 并作出关键决策 第3步：确认资源的有 效性和学习经历 阶段 1 第4步：明确要达到的胜 任力和活动，以及期望的 熟练程度 第5步：确定学习目标和 相关的知识与技能 第6步：构建学习者实现 学习目标所需的学习经历 和材料 第7步：构建课程 体系内容结构 第8步：为课程分 配时间和资源 第9步：为课程中的 每个学习目标设定 评估方法 第10步：确定课程 的进展或完成的 标准 第11步：构建机构能 力以实施教育项目 第12步：评估并修 订课程 构建 排序 评估 实施 阶段 阶段 阶段 阶段 2 3 4 5 10 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 11 规划过程应通过利益攸关方的协调努力来进行，通常由将在其中实施课程的机构或环境的指定联络人 以及可能的外部顾问或机构合作伙伴（例如来自具有既定同等课程的大学或学院）。利益攸关方可以 作为一个核心工作组运行，其成员可以与负责制定情景化的胜任力架构的小组成员相同(见《康复胜任 力架构调整指南》中的第4步) 第1步 收集信息 康复教育项目和课程不是凭空开发或实施的，它们应该认识到人口需求，特定的政策及监管环境，以 及国家或国际法律和监管架构，如专业协会和认证机构所规定的架构（图4）。 康复教育项目 机构环境 政策及监管环境 人群康复需求 图4 课程开发的生态环境模型 教育项目和课程开发的第一步是全面的资料收集过程，为应该考虑的关键因素提供信息，如前面第三 节中说明。信息收集可能包括与利益攸关方面谈、书面材料审查，或者二者兼有。具体而言： • 人口健康、人口学和地区分布概况信息：虽然这些都会反映在基于特定情景的胜任力架构中，但它 们也会影响到在课程中强调哪些特定胜任力、行为、活动和任务。例如，如果大多数人口居住在农 村地区，那么与城市为主的课程相比，课程可能会在初级卫生保健和社区康复实践的相关知识和技 能上投入更多的时间。 • 与教育项目和课程有关的法律和监管架构。它们是否存在？它们规定了哪些内容或条件？对于教育项 目和课程有何意义？是否有教师人数或资格的最低标准？是否规定了教育项目年限？如果有必要， 这些将被调整以满足新的或修订的教育项目的需要？ • 机构投资和能力：必须调查机构对该教育项目的投入程度和支持课程开发和实施的能力。 • 机构愿景和使命：愿景和使命是什么，它们如何影响该教育项目和课程？ • 现有相关教育项目和课程，如来自其他机构或康复专业的教育项目和课程。它们是否存在？它们是 最新的吗？它们能否作为有价值的参考文件？ 10 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 11 第2步：利益攸关方对话并作出关键决策 开发康复教育项目和课程与教育、人力资源和社会保障、卫生健康等部门的工作领域息息相关。正如 联合国教科文组织所指出的，教育项目和课程是 “由教育系统内外的机构和行为者共同培育的教育、 政策和社会产品”(6)。在早期规划阶段，让这些政府部门的代表以及教育机构和认证机构（如适用） 参与进来，对做出关键决策至关重要。利益攸关方的对话应考虑： • 授予的资格：学习者在完成课程后是否会获得证书、文凭、学士学位、硕士学位或博士学位？ • 认证和法律认可。该教育项目是否会得到当地认证机构的认可， 并且在卫生从业者法律监管下？需 要满足哪些要求，需要考虑哪些时间安排？ • 招募潜在学习者。该教育项目的入学标准是什么？与该机构的同等课程相比，入学的竞争力如何？ 学习者的费用是否会得到政府或其他组织的补贴？如何解决显示学习者群体多样性的问题？是否接 受国际学生，他们的费用与国内学生有何不同？招收国际学生是否有必要为教育项目提供资金，如 果有必要，这将对教育项目的授课方式和课程内容产生什么影响（例如，课程将以英语还是其他语 言授课，以适应更多学生的需要）？ • 招聘潜在的教育项目毕业生。估计有多少带薪职位将向获得资格的毕业生开放？这些职位将如何在 卫生健康行业的各个层面以及在公共和私人部门之间分配？这些问题对于确定招生规模，以及随着 时间的推移扩大招聘非常重要。 • 教育模式。课程是面对面授课，还是有在线部分？会以任何方式用技术来加强教育（步骤6）？这些 决定对基础设施和资源的影响是什么？ 第3步：确认资源的有效性和学习经历 • 虽然在规划过程中应考虑资源的有效性，但一旦做出关键决定，就可以对资源需求作出更详细的估 计。资源需求和相关考虑涉及但不限于以下方面： • 人力资源，包括行政和教学人员：考虑现有人力资源是什么，以及可能需要增加什么。例如，学习 者可能需要能够融入现有的医学和社会科学课程，但应考虑到增加学生额外评估负担，以及可能需 要对课程进行的具体修改。针对该教育项目开发的新课程可能需要新的教师，他们具有特定的资格 和经验，当地可能没有这些教师，他们可能需要接受培训和/或在国际上招聘（见表6关于当地/国 家教师能力建设的方法）。关于在哪里和如何寻找教师的决定，通常会受到教育项目所需的本国教 师配置数量和资格要求的规定影响。 • 物质资源，包括基础设施和学习材料：实施该教育项目和课程是否需要特定的基础设施，如健身房、 解剖实验室、临床实践场所、声学实验室、假肢车间等？学习材料，如与当地情况相关的资料，以 及用于教育和培训的临床和技术设备，特别是没有现成资料的情况，都应考虑其中。随着课程的开 发，还需要审查和完善这些资源。 • 学习经验：在真实环境中实践胜任力和活动是基于胜任力教育的一个基本特征；因此，学习者在这 些环境中实践的机会至关重要。康复教育项目和课程开发者应该考虑学习者应该接触的环境和经验 的范围，以及在这些环境中所需时间和投入的监督要求。 第2阶段：构建 表2 胜任力和活动的区别 胜任力 活动 与具体的康复工作者相关 与康复工作者的角色、要求和实践范围相关 持久（通过不同的活动持续下去) 有开始和结束 表现为行为 涵盖各种任务 12 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 13 第4步： 明确要达到的胜任力和活动以及期望的熟练程度 如前所述，确定通过康复教育项目的课程所掌握的胜任力和活动是实施本指南所描述阶段和步骤的先 决条件。胜任力和活动（两者的区别见表2），可以通过调整康复胜任力架构指南中详述的方法从康复 胜任力架构中提取和调整。即使认为没有必要建立胜任力架构，所述的许多步骤也有助于确定和调整 胜任力和活动，这些可以直接记录在课程中（步骤5）。 每项胜任力和活动所应达到的熟练程度（即预期从课程中获得的能力水平），应该明确并反映机构、 职业或专业的要求（6，8）。定义胜任力水平有助于确定掌握能力的标准，这应该是在课程中预先确 定的(10)。胜任力水平可以与康复胜任力架构中描述的熟练程度（初级—专家级）一致，也可以根据 学习者具体的期望进行修改。 第5步： 确定学习目标和相关知识与技能 将胜任力和活动转化为课程，以支持以胜任力为基础的教育项目，需要将与胜任力相关的行为与活动 相关的任务转化为学习目标。学习目标反映了学习者在完成学习活动之后将知道什么或应该做什么（3 ，5）。教育项目中的学习目标允许将行为或任务分解成学习单元，这些单元是可教授和评估的，直到 学习者能够胜任该行为或任务。表3提供了一个康复胜任力架构实践领域能力（C4）和相关行为的学习 目标的例子；表4提供了一个实践领域活动（A3）和相关任务的学习目标。这两个例子都是直接从康复 胜任力架构中提取的，熟练程度是四级中的高级。表3和表4一起显示了学习目标如何支持行为的发展 （例如，在本例中是解决问题和决策，但其他行为可能与沟通或以人为本有关），以及执行任务的能 力（这里举的例子是进行康复评估，但其他任务可能与实施干预措施、转诊或出院有关）。在定义学 习目标时，应该清楚地描述预期的绩效水平，并反映出实现该行为或任务的可用时间，以及学习者将 遇到的需求和其在完成教育项目后的自决程度。 表3 从《康复胜任力架构》中提取的胜任力和行为示例 胜任力 行为 课程学习目标* 课程完成后，学员能： C4.在解决问题和做 出决策时采取严格 的方法 C4.1 在明晰问题和确定 解决方案时考虑个人、环 境和健康因素 C4.1.1 描述国际功能、残疾和健康分类(ICF模型) C4.1.2 描述个人环境和健康因素对功能的潜在影响 C4.1.3 编制问题清单，列出个人及其家庭特有的个人环境 和健康因素 C4.2 在与个人及其家庭 解决问题和做出决定时， 整合来自多个来源的信息 C4.2.1 识别不同的信息来源 C4.2.2 展现处理不同来源的不一致信息的胜任力 C4.2.3 向个人及其家庭展示境况全貌，以帮助他们做出最 佳决策 C4.3 确定应对个人及其 家庭挑战的创新方法 C4.3.1 与个人及其家庭共同讨论解决问题的办法 C4.3.2 通过解决相关的个人、环境和健康因素，确定一系 列优化功能的解决方案 C4.3.3 确定有助于为个人及其家庭选择最合适的治疗方法 的因素 *学习目标只是例子它们并不适用于所有情景，也没有列出全部内容 12 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 13 表4 《康复胜任力架构》实践领域胜任力(C4)和相关行为学习目标的项目示例 活动 任务 课程学习目标* 完成课程后，学员能: A3.进行康复 评估 A3.1获得全面的健 康、环境和个人经 历，对健康和福祉决 定因素的范围和复杂 性进行深入了解 A3.1.1确定要收集信息的类型和目的 A3.1.2进行图表审查 A3.1.3对个人及其家人进行合理、系统的询问 A3.1.4识别并使用指定的替代信息源 A3.1.5确定个人及其家庭呈现的问题 A3.1.6确定影响个人及其家庭康复管理计划的重要因素 A3.2评估个人是否有 伤害自己和/或他人的 风险，并在适当的情 况下实施保护策略 A3.2.1识别一个人需要采取保护措施的症状 A3.2.2描述如何启动保护机制的法律义务与协议 A3.2.3描述如何识别有伤害风险者的潜在风险 A3.3独立进行身体结 构和功能的评估，根 据年龄、语言、文化 或障碍等特定因素进 行调整 A3.3.1描述与个人及其家庭相关的评估工具 A3.3.2调整环境，为评估提供最佳条件 A3.3.3使用标准化工具进行认知测试 A3.3.4对考核结果进行评分解释和报告 *学习目标只是举例，它们并不适用于所有情景，列表也不是全部 在制定学习目标时，可以确定与每个目标相关的主要知识与技能，同时承认通过学习活动还可能需要、 获得或巩固其他更一般的知识与技能。确定哪些知识与技能是学习目标的基础，这不仅对于学习者的 体验非常重要，对于确定教育模式也至关重要，这种教育模式将便于知识与技能的获取和评估。《康 复胜任力架构》对每个领域的核心和特定活动的知识与技能都进行了描述；在将知识与技能纳入课程 之前，应该根据需要对这些内容进行情景化和扩展。 第6步 构建学习者实现学习目标所需的学习经验和材料 知识与技能是通过一系列不同的学习经历获得的；虽然知识通常建立在理论基础上，但技能往往需要 应用才能掌握。建立知识与技能，尤其是在入门级，可能涉及有针对性的学习经历，这些经历解析或 专注于特定学科或技能。随着学习者的进步，他们开始在更实际、更现实的情景中整合知识和技能。 图 5 总结了以下学习经验：i) 有针对性和理论性（即经验考虑特定知识）；ii) 整合性和理论性（ 经验考虑一系列知识）；或 iii) 整合和应用（经验考虑了一系列与技能相关的知识）(3, 5)。最 终，胜任力和活动只有在整合和应用时才能得到充分发展，即当与不同胜任力相关的行为在活动的背 景下应用时。这要求学习者在对学习者提出不同要求的一系列环境中执行不同任务的同时，利用不同 的行为，将他们的熟练程度训练到所需的水平。例如，在对个人及其家庭进行评估时，学习者需要应 用与以人为本、协作、沟通和决策相关的胜任力（在康复胜任力架构实践领域），以及来自其他领域 的胜任力，例如专业精神和研究。此外，学习者只有将胜任力实践到实际环境中，才能认为他们有胜 任力开展某项活动。这些实际的环境可能包括资源获取有限的环境、与有不同需求的人一起工作，并 对他们的角色认识有限。因此，基于胜任力的教育要求学习者接触到一系列有针对性的、综合的、理 论的和应用的学习经历。 14 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 15 图5 为实现学习目标所需的有针对性和整合性的学习经历 在选择学习经历时，应考虑到资源的可用性和进入临床经验/场所的机会。例如，一些学习经历依 赖于基础设施，如有标本的解剖实验室、步态分析实验室、假肢和矫形器车间，可随时使用的计算 机和互联网连接，以及有培训和监督学员的政策和方法的设施。当康复教育项目和课程涉及一个在 国内还没有大量存在的新兴职业时，提供这样的培训和监督设施可能特别具有挑战性。在这种情况 下，学习者可能需要在国外完成实习，而与此相关的费用需要以包括尽可能多的潜在学习者的方式 进行规划和管理。随着技术的快速发展，教育机构拥有越来越多的平台来提供学习经历。虽然康复 教育项目传统上是面对面授课，学习者亲自到学习体验的场所，但许多机构正越来越多地使用在线 学习平台。虽然基于胜任力的教育是以学习者接触真实环境为前提，但某些课程或课程组成部分可 能有利于在线学习，尤其是那些理论性的课程。事实上，线上线下混合式学习正日益成为常态，它 的优点是更加灵活，减少差旅要求，培养数字素养，并能接触到更广泛的教育者，如国际专家。教 育相关技术的进步意味着数字平台具有支持高度互动式学习的功能。使用在线学习的条件是学习者 能够获得必要的基础设施，包括可靠的互联网连接，但这并不是在所有情况下都能实现。还有一种 方法是“网络强化混合学习”，即在现场进行学习，但由技术来提供内容和丰富的学习活动。这种 方法要求教育机构拥有一定程度的数字基础设施和网络连接，但在课堂之外则不需要。 第三阶段：排序 排序涉及将课程内容（包括学习目标和学习经历）组织成课程规划中有意义的组成部分。该规划记录 了使学习者达到所需胜任力和进行相关活动达到所需标准的途径(2)；它进一步定义了分配给课程各 组成部分的时间，依据是它们对达到某项胜任力或活动的权重或贡献、难度水平或学习者达到预期掌 握水平所需的时间。这样的决定具有很强的针对性，并且不可避免地反映了机构的价值观和偏好。因 此，尽管不同机构或国家的同等课程的一般课程内容可能相似或基于相同的国际标准，但其课程规划 可能是不同的。 学习成果 胜任力 行为 学习目标 活动 任务 学习目标 有针对性的，理论性的 整合性的，理论性的 整合性的，应用性的 所需要的学习经验 14 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 15 第7步：构建课程内容 课程体系规划通常包括项目组织，也就是课程体系内容在整个学习期间的结构。规划列出并描述了项 目中包含的课程，并指出哪些课程是必修课，哪些是选修课（即可以从一系列合适的选项中选择）。 该项目对教师来说是一份重要的参考文件，因为它指出了在哪里以及如何引入学习材料和经验，表明 了对不同知识和技能领域的重视。该规划是一个“路线图”，记录了从知识与技能到实现学习目标， 并最终达到胜任力的发展过程（8）。 课程内容的结构可以有多种方式，其中最好的方式既可以借鉴合理的教学法原则，也可以借鉴同等或 类似课程的经验。课程组织也是动态的，应该持续地从学习者和教师的反馈中获得信息（步骤12）。 以下问题可以帮助在课程规划中确定课程内容： • 哪些学习应该是理论性的，而不是应用性的？ 关于学习者何时应该接触到他们最终要工作的环境，有不同的观点。早期接触有助于知识的情景化 和技能的早期发展，后期接触可以在应用学习之前打下坚实的理论基础。出于实践的考量，能否在 临床环境中充分获得监督，也是决定性的因素(3)。 • 在一门课程中，可以涵盖何种深度与广度的学科内容？ 一门课程可以包含多少课程内容，以及学习者研究这些内容的深度，应该反映现有的或基准的知识 与技能（即学习者在进入课程时拥有的知识与技能，基于入学标准和完成的课程），以及分配给课 程的时间。 • 在不同的学习目标下，知识与技能是如何交叉和巩固的？ 教育项目的组成和课程规划的结构应该反映为实现学习目标所需积累的知识与技能。正如第6步所 讨论的，一些课程可能针对特定的知识与技能领域（如医学科学），而其他课程则需要一系列知识 与技能的整合和应用。前者可能不以实现课程学习目标为目的，而是制定一个课程学习目标，作为 在以后的课程中实现课程学习目标的一个基础性构成要素。课程应包括与预期学习相称的可管理的 课程内容，基于课程在教育项目中的定位(2)。 除了课程规划之外，内容可以组织到教学大纲中并进行更详细描述。教学大纲规定了课程的学习目标， 这些目标应该反映或与相关课程学习目标相一致，并且一般应规定该课程所针对的具体知识、技能或 价值观和信念。课程大纲进一步描述了如何在每一节课或每一周的基础上教授学习内容。学习者可以 通过教学大纲来了解他们对课程的期望，以及对他们的要求。尽管有关如何设计教学大纲的决定在很 大程度上取决于该机构所采用的教育方法，教学大纲通常由负责该课程的教育工作者主导完成的。 第8步：为课程分配时间和资源 落实课程规划的一个重要部分是确定课程中每门课程所需的时间和材料。分配给课程的时间应该反映 出学科的复杂性和它对实现课程学习成果的重要性。有些学科领域可能需要扩展到几门课程，以便充 分掌握其广度和深度的学科，而对于其他学科，学习者可能只需要浅显的或入门级的接触。 为不同的学习领域规定固定的时间与基于胜任力的教育的核心原则有些抵触，后者提倡一种高度灵活 的学习方法，即学习者在课程中的进展是由他们达到要求的行为或任务来决定的，而不是完成学习课 程。然而，重要的是要承认，胜任力不是静止的，将在课程内和课程外继续发展。将基于时间的课程 与基于胜任力的教育相协调是可能的，但前提是要明确达成课程的胜任力和课程的里程碑，以及各课 程间进展的标志（3）。 教育项目的学习材料可以极大地影响学习经历的质量，并应适合学习情景（即与教授和实施该课程的 国家和环境相关）。例如，一些在高收入或城市化环境中出版的材料可能需要补充与低收入或农村环 境相关的信息。学习材料也应该是最新的并反映出基于循证的实践。教育机构可以成为循证指南和方 案制定的重要利益攸关方。为教育项目确定学习材料的过程要突出差距和解决这些差距所需的资源。 第四阶段：评估 基于胜任力的教育的一个关键特征是对胜任力进行有意义的评估，这也是其实施的最大挑战之一（11 ）。第9步和第10步提出了一个系统的方法来制定评估策略，并确保评估与机构的资源有效性相一致。 16 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 17 第9步：为课程中的每个学习目标设定评估方法 课程的一些功能是描述所采用评估方法的类型，并展示对胜任力的有力保证和所需的熟练程度 (2)。 应通过多种评估方式来确定胜任力的获得和活动的掌握。 学习者的表现与其他人的表现以及环境因素 的相互作用需要观察学者在广泛的环境中执行活动，并在多种不同活动的环境中评估胜任力 (3, 6, 12)。因此，评估是基于胜任力的教育的一个复杂且资源密集的方面，需要仔细考虑和规划。 各种因素影响着评估方法的选择： • 适宜性：评估是否有利于测试学习目标？ • 可靠性：评估的表现是否一致，是否可信（3，13，14）？ • 有效性：评估是否实现了评估目的（3，13）？ • 资源要求：所需资源（人力和物力）是否可用（3）？ • 可行性：在考虑到群组规模、所需时间和/或后勤因素时，实施是否可能（3）？ 如下图所示，是基于米勒等级金字塔的过程评估示意图，该金字塔认为学习过程是从 “知道”到“做 到”的过程（图6）（15）。这个模型显示了评估方法是如何反映这种进展的，以及这种进展是如何与 评估的客观性和资源要求的转变相对应的，因为对真实评估环境的需求在增加。 知 识 和 技 能 的 整 合 与 应 用 评 价 环 境 真 实 性 的 必 要 评 估 方 法 的 客 观 性 评 估 所 需 资 源 对 知 识 明 确 评 估 对 知 识 隐 性 评 估 对 技 能 明 确 评 估 做 展示如何做 知道如何做 知道 对胜任力和活动的明确评估 对胜任力和活动的 隐形评估 图6 基于米勒等级金字塔的过程评估示意图 基于胜任力的教育涉及仔细调整评估方法与学习目标 (14)。表5提供了使用表3和表4的学习目标的示 例。表5中包含的评估方法应被解释为展示出可能适合不同目标的评估方法的多样性（并未提供详尽 的清单），以及如何将多种方法用于同一个目标。表5中所示的评估方法本身不应被解释是选择了最 合适的方法，因为这将取决于前面列出的因素如何应用于特定的课程环境(8)。可以使用相同的方法 评估多个学习目标，并在适当的情况下同时进行评估 (6)。 16 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 17 表5 用不同评估方法评估课程学习目标示例 课程学习目标 书 面 文 章 笔 试 口 试 案 例 讨 论 口 头 陈 述 自 我 评 价 同 行 评 价 可 观 察 到 的 表 现 报 告 C4.1.1 描述国际功能、残疾和健康分类(ICF)模型 X X C4.1.2 描述个人、环境和健康因素在影响功能方面的潜在 影响 X X X C4.1.3 编制问题清单，记录个人及其家庭特有的个人、环 境和健康因素 X X X C4.2.1 识别不同的信息来源 X X X C4.2.2 展现管理不同来源的冲突信息的胜任力 X X C4.2.3 向个人及其家庭介绍完整情况，以帮助他们做出最 佳决策 X X C4.3.1 与个人及其家庭共同讨论解决问题的方法 X X C4.3.2 通过解决相关的个人、环境和健康因素，确定一系 列优化功能的解决方案 X X X X X C4.3.3 确定有助于为个人及其家庭选择最合适的治疗方法 的因素 X X X X X A3.1.1 确定要收集的信息的类型和目的 X X A3.1.2 进行图表审查 X X A3.1.3 对个人及其家人进行逻辑、系统的询问 X X A3.1.4 识别并使用指定的替代信息源 X A3.1.5 识别个人及其家庭的当前问题 X X A3.1.6 识别影响个人及其家庭康复管理计划的重要因素 X X A3.2.1 识别一个人需要保护措施的迹象 X X A3.2.2 描述如何启动保护机制的法律义务和协议 X X A3.2.3 描述如何识别有伤害风险的人的潜在风险 X X A3.3.1 描述与个人及其家庭相关的评估工具 X X A3.3.2 管理环境，为评估提供最佳条件 X X A3.3.3 使用标准化工具进行认知测试 X X A3.3.4 对考核结果进行评分、解释和报告 X X X 在构建课程规划时，额外的评估是针对与每个课程相关学科的具体组成部分。根据机构采用的教育方 法，课程早期阶段的评估可能针对具体知识与技能，而不是行为或任务，一旦他们的信息基础建立起 来，就可以针对行为或任务。评估方法的选择需要考虑上述相同的因素。 在选择评估方法时，另一个重要的考虑是评估是形成性的还是总结性的。当评估主要是为了帮助学习（ 形成性评估）时，优先考虑的是提供一种学习经历，以及对学习目标进展的指示，表明学习需求（11 ）。这些通常在整个课程中出现的频率较高，因此，可以选择资源密集度较低的评估方法。总结性评 18 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 19 估主要评估学习者对学习目标的完成情况，并最终评估其胜任力的获得情况。信度和效度在总结性评 估中占有更重要的地位，鉴于学习者在总结性评估中的表现表明他们有胜任力在课程中取得进展或完 成课程，这也可能成为投入更多资源的理由。 第10步：确定课程的进展或完成的标准 需要预先确定学习者在通过课程进展或获得课程奖励之前需要达到什么目标。这类决定可能受以下因 素影响： • 机构政策； • 体现在学科领域、胜任力或活动方面已准备好取得进展的因素； • 该决定对实践的影响（即课程完成后，毕业生是否有资格进入劳动力市场，或者是否需要额外的评 估阶段，如执照考试？(3, 11); • 学习者完成课程后的工作条件（例如，他们将得到的监督和支持水平）(3)； • 学习者表现低于所需能力水平的潜在风险(3, 11) 在以基于胜任力的教育中，关于课程的进展或完成的决定不应该依靠单一的评估方法；而应该利用来 自多个总结性评估的信息，这些信息表明学习者在一系列环境中的胜任力和活动的表现（3，11，13） 。当胜任力与活动的表现充分与人群康复的需求相一致时，通过全面的总结性评估就可以保证毕业生 的质量和相关性（3）。 18 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 19 第五阶段：实施 第11步：建设机构能力以实施教育项目 确保基于胜任力教育的成功实施需要对机构能力进行投资，这包括强大的行政系统和工作人员，以及教学装 备和评估设施(8)。如果基于胜任力的教育是新实施的，为教师提供参观和学习成熟机构的机会会是有用的（ 表6描述了构建教师提供基于胜任力教育的胜任力的各种方法）。教师的持续专业发展对于确保教师的在岗和 教育质量也是必要的。机构需要确保教师和临床教育者与学习者的适当比例，以支持教育项目的实施，并注 意到基于胜任力的教育所带来的更大的评估负担。 还要考虑机构的研究能力。各机构应该制定一项战略，以便随着时间推移扩大这一领域，包括确定潜在的资 金拨款、伦理委员会，以及与国家和国际研究机构建立伙伴关系。这对提供研究生课程的机构尤其重要，但 对让本科生学习者接触研究也很有价值。 表6 提升教师能力以提供基于胜任力教育的方法 方法 注意事项 学习考察 教师们参观在提供基于胜任力的 教育方面具有良好声誉的教育 机构。在参观过程中，教师们观 察和研究这些方法，以便在他们 自己的机构中更好地实施这些方 法。通常情况下，在参观过程中 获得的经验会与其他教师分享， 以使时间和资源的投资效益最大 化。 派遣多名教师参观学习考察，在差旅费和时间上都要花费很大的资源。在 考察期间，当地教师要从他们的教学职责中分出部分精力接待，这可能会 扰乱课程的实施。 学习考察的价值在于它们提供了一种身临其境的体验，而这种体验是很难 通过其他方法复制的。它们还可以促进机构间的积极关系，并为项目提供 更广泛和更长期的利益。 教师指导 邀请来自在提供基于胜任力的教 育方面享有盛誉的教育机构的教 师，在特定时间段来教授和指导 当地教师。 将一位或几位基于胜任力的教育专家请到正在实施新项目的机构中来，可 能比派遣当地教师进行考察更有成本效益，但不能提供同样的沉浸式体 验。当地教师留在他们的机构的一个好处是教学计划不会被打断，当教师 数量非常有限时，这一点尤其重要。 持续专业课程发展 支持教师参加基于胜任力的教育 课程，如大学或师范学院提供的 课程。 支持教师参加基于胜任力教育的专业发展课程，包括允许他们有必要的时 间参与并达到课程的要求，以及可能支付课程的费用。 综合性的教学和学习课程 教师或潜在的教师可以得到支持，参加关于教学和学习的特定综合课程， 可以是强化课程，也可以是在职进修课程。这些课程可以由教师将在其中 工作的教育机构提供，也可以由外部提供。通常情况下，这些课程可能包 括以下主题。 • 教学和学习原则 • 教学大纲制定 • 课程设计 • 课程目标 • 教学方法 • 课堂教学 • 教与学的评估 • 评估评分标准制定（评分标准制定）。 综合性课程可能比渐进式培训或临时性专业发展培训需要更多的资源，也 可能更深入地涵盖广泛的内容。考虑到有效地提供教育和培训需要特定的 知识与技能，以及训练有素的教师是提供高质量教育的基础，因此应特别 考虑为教学经验有限甚至没有教学经验的教师提供综合课程。 20 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 21 方法 注意事项 综合性高等教育领导力课程 如上所述，教师或潜在的教师可以得到支持，参加关于高等教育领导力的 特定综合课程，可以是强化的课程单元，也可以是在职进修的课程。一般 来说，这些课程可能包括以下主题： • 个人领导力发展 • 领导他人 • 课堂上的领导力 • 诊所/卫生系统中的领导力 • 解决冲突 将要支持其他工作人员，或担任领导或管理角色的教师可以从这些课程中 受益，特别是在一个新的项目中，与建立课程有关的挑战需要明确的方向 和指导。 康复教育项目的教学与学习的整 合性课程 如果一个国家正在建立康复专业，而且师资力量非常有限，那么可以将教 学课程纳入康复课程，这样毕业生就有了一定的胜任力来担任教师的角 色。虽然教师最好是经验丰富并拥有研究生资格，但这种选择可能适合作 为一种逐步实现的机制。 第12步：评估并修订课程 定期评估和修订是课程体系的良好实践。评估应该从结果和就业方面考察教师的表现、课程和教育项 目的课程结构以及学习者的成果。可以成立一个课程评估小组，由教师、行政部门和学习者的代表组 成。该小组可以监督评估过程，其中一些评估过程可能已经由机构建立，并确保评估结果被彻底审查 和采取行动。表6提出了来自一系列团体的课程评估信息。 表7 课程评估方法的示例 评估主题 对象 形式 评估要点 课程内容 学习者 课程评估调查表 • 内容相关性 • 教学方法 • 学习材料 • 学习经历 • 困难程度 • 学习者准备情况 • 评估方法及负担 教育工作者 访谈或调查 • 学习者准备情况 • 评估方法及负担 • 学习材料 • 学习经历 • 教学支持的充分性 教育工作者/监管者 绩效 学习者 教育工作者/监管者 绩效 • 专业知识/技能 • 准备工作 • 组织工作 • 教学/督导风格 • 公平性 • 沟通 • 可用性 • 适用性 20 运用情景化胜任力架构开发康复教育项目和课程 4.运用情景化的胜任力架构开发康复教育项目及课程的过程 21 评估主题 对象 形式 评估要点 学习者的表现 教育工作者 和监管者 学习者绩效评估 • 学员/毕业生对实习的总体准备情况 • 学员/毕业生在相关领域的表现（实践、专 业性、学习和发展以及研究) • 学习者/毕业生的信心 • 学习者/毕业生的价值观和态度 项目质量 学习者和教 育工作者 项目评估表/焦点 小组 • 学习目标的实现 • 项目/课程组织质量 • 学习材料质量 • 学习经历质量 • 基础设施/设备质量 • 教师质量 • 总体满意度 毕业经历 学习者 调查/访谈 • 就业学生人数（按部门和地点分类) • 平均受雇时间 • 工作准备 • 知识和技能与人口需求一致性 服务利用者满意度 服务利用者 服务利用者调查 • 照顾质量 • 沟通和文化胜任力 应建立机制以迅速回应反馈，例如通过修改学习材料和教学风格，以及增加学习者与教育工作者接触 的机会。课程调整，包括取消或替换课程等大规模的调整，重新安排课程或调整教育方法，确认完成 这些调整所需的资源，都应在规定的时间间隔内完成。这些间隔的规律性还应根据评价过程所得到的 反馈展示这样做对依据。 避免潜在风险 潜在风险: 应对策略: 忽视了具有文化意义的胜任力，如建立融洽的关 系，而偏重于与执行康复干预有关的胜任力(即把 课程重点偏向活动，特别是与就业有关的活动） （2，8）。 • 确保课程和评估都重视与文化和其他“软”胜任力有 关的学习目标。 • 确保评估过程审查文化和其他“软”胜任力。 关注绩效的单个组成部分，通常是活动，导致对 综合绩效的重视不足（即“检查表式教育”）(6 ，11)。 • 确保充分接触到真实的学习环境使学习者能够整合和发 展一系列胜任力和活动。 • 在开展活动的背景下强调对胜任力进行评估。 过高的评估负担(11) • 形成性和总结性评估的结合，以及在真实环境中的评 估，都是基于胜任力的教育不可或缺的。课程可以探 索探讨节约评估的方法（如通过使用技术）。机构能 力需要适应评估负荷。 2322 2322 参考文献 1. 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Academic Medicine. 1990;65:S63–7. 24 运用情景化胜任力架构开发康复教育项目和课程 25 24 运用情景化胜任力架构开发康复教育项目和课程 25 附件1 基于胜任力的教育检查表 下面的清单试图提取基于胜任力教育的关键部分，并以Melle等人提出的基于胜任力的教育实施架构 为基础。1 胜任力和活动是基于人群的康复需求 课程中明确阐述了学习者的胜任力和活动 课程规划中的胜任力和活动及其发展过程是循序渐进的 学习材料和经验有助于发展及获得胜任力和活动 学习是在模拟实践的环境中进行的 教育方法提升了胜任力和活动获得 形成性和总结性评估能支持和记录胜任力和活动的发展获得 计划性评估有助于做出有效和可靠的决策 学习者在课程中的进展是基于多方面的信息，仔细的解读、观察和反馈 评估门槛决定学习者在课程中的进展，反映了学习者毕业后的期望和责任 1 Melle EV, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. A core components framework for evaluating implementation of competency- based medical education programs. Academic Medicine. 2019;94(7):1002–9. 附件3 基于胜任力的康复教育课程体系规划模板 2726 附件2 基于胜任力的康复教育项目及课程模板 下面的模板用于记录康复教育项目和课程。该模板应根据需要进行调整，以适应机构的要求。 1. 概述 a. 描述专业历史 b. 人口康复需求 c. 卫生系统概述 d. 专业对人口健康的贡献 e. 课程开发的合理性 2. 愿景、使命和价值观 3. 授予学术资格 4. 课程期限 5. 入学要求 6. 毕业要求 7. 项目的监督和管理 8. 师资要求、可用性和招聘 9. 课程设置 a. 课程的胜任力和行为 b. 课程的活动和任务 c. 学习目标、知识与技能 d. 关键学习材料 e. 学习经历 f. 教育方法 g. 评估 i. 评估策略 ii. 补救政策 h. 课程生命周期 i. 评价策略 ii. 评价和审查的时间间隔 10. 课程规划(见附件3) 11. 评估形式 附件3 基于胜任力的康复教育课程体系规划模板 2726 附 件 3 基 于 胜 任 力 的 教 育 康 复 课 程 体 系 规 划 模 板 下 面 的 模 板 提 供 了 一 个 课 程 体 系 规 划 的 结 构 。 它 应 根 据 课 程 期 限 、 学 年 结 构 （ 学 期 数 ） 以 及 每 个 学 期 的 课 程 数 量 进 行 调 整 。 课 程 体 系 规 划 应 注 明 哪 些 课 程 是 核 心 / 必 修 ， 哪 些 是 选 修 。 学 年 学 期 课 程 名 称 学 科 代 码 类 型 相 关 课 程 学 习 目 标 权 重 （ 单 位 ） 学 习 时 长 1 1 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 2 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 附件3 基于胜任力的康复教育课程体系规划模板 2928 学 年 学 期 课 程 名 称 学 科 代 码 类 型 相 关 课 程 学 习 目 标 权 重 （ 单 位 ） 学 习 时 长 2 1 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 2 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 附件3 基于胜任力的康复教育课程体系规划模板 2928 学 年 学 期 课 程 名 称 学 科 代 码 类 型 相 关 课 程 学 习 目 标 权 重 （ 单 位 ） 学 习 时 长 3 1 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 2 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 30 学 年 学 期 课 程 名 称 学 科 代 码 类 型 相 关 课 程 学 习 目 标 权 重 （ 单 位 ） 学 习 时 长 4 1 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 2 概 述 学 习 目 标 评 估 概 述 学 习 目 标 评 估 30