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Performance Framework Specifications

 

 

 

 

 

 

 

 

 

Version: 0. 3 2
Date: August 5 July 3 , 2013
Author: Valerie Smothers
Author email: vsmothers@jhmi.edu

 


Version History

 

Version No.

Date

Changed By

Changes Made

0.1

2013-05-08

 

Initial draft

0.11

2013-05-23

Valerie Smothers

Changes BestScore to MostCompetent and WorstScore to LeastCompetent; Changed LevelScale to PerformanceScale and made required, added further documentation.

0.12

2013-06-07

Valerie Smothers

Changed Criterion to Indicator. Added introduction and examples. Deleted recommendation to include lom title.

0.2

2013-07-03

Valerie Smothers

Added AdditionalInformation to Component, PerformanceLevel, and indicator. Deleted Background, References, Resources, and Notes. Deleted ScoreValue from PerformanceLevel; added Score with possible single value or range. Adding details on the use of the dcterms:references element.

0.3

2013-08-05

Valerie Smothers

Added threshold element and subelements to component.


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Table of Contents

1 Acknowledgements

2 Documentation Conventions

3 Conformance

4 Common Data Types

5 Introduction

6 Other Standards, Specifications, or Schemas Referenced

7 Schema Grammar

7.1 PerformanceFramework

7.2 Lom Required and recommended Elements

7.3 SupportingInformation

7.4 PerformanceScale

7.5 Component

7.5.1 Competency

7.5.2 Threshold

7.5.3 AdditionalInformation

7.5.4 PerformanceLevelSet

7.6 Using dcterms:references

8 Sample XML Document UPDATE

9 References

1 Acknowledgements ........................................................................................................................... 6

2 Documentation Conventions ............................................................................................................ 8

3 Conformance ...................................................................................................................................... 9

4 Common Data Types ...................................................................................................................... 10

5 Introduction ....................................................................................................................................... 11

6 Other Standards, Specifications, or Schemas Referenced ....................................................... 12

7 Schema Grammar ........................................................................................................................... 13

7.1 PerformanceFramework ......................................................................................................... 13

7.2 Lom Required and recommended Elements ....................................................................... 17

7.3 SupportingInformation ............................................................................................................. 26

7.4 PerformanceScale ................................................................................................................... 27

7.5 Component ............................................................................................................................... 28

7.5.1 Competency ..................................................................................................................... 34

7.5.2 Background ...................................................................................................................... 37

7.5.3 Resources ......................................................................................................................... 38

7.5.4 References ....................................................................................................................... 40

7.5.5 PerformanceLevelSet ...................................................................................................... 41

8 Sample XML Document .................................................................................................................. 52

9 References ....................................................................................................................................... 56

 

 

 


1          Acknowledgements

The development of this specification is made possible as part of an accelerated standards development project funded by the Association of American Medical Colleges.

The MedBiquitous Consortium wishes to acknowledge the MedBiquitous Competencies Working Group members, invited experts, and other individuals that contributed to the creation of this document.

Co-chairs:

  • Rosalyn Scott , MD, Department of Veteran's Affairs
  • Tim Willett, MD, SIM-one

Members:

  • Susan Albright, Tufts University
  • Mary Pat Aust, American Association of Critical-Care Nurses
  • Dana Bostrom, Association of American Medical Colleges 
  • Terri Cameron, Association of American Medical Colleges
  • Mary Jo Clark, PhD, RN, American Association of Colleges of Nursing
  • Stephen Clyman, MD, National Board of Medical Examiners
  • Matthew Cownie, University of the West of England
  • Robert Englander, MD, Association of American Medical Colleges
  • Ted Hanss, University of Michigan
  • Sean Hilton, MB BS, St. George's University of London
  • Joshua Jacobs, MD, National University of Singapore
  • PJ Kania, Association of American Medical Colleges
  • David Kiger, Tufts University
  • JB McGee, MD, University of Pittsburgh
  • David Price, MD, American Board of Family Medicine
  • Isarin Sathitruangsak, Tufts University 
  • Lesley Southgate, M.D., St. George's University of London
  • Nabil Zary, PhD, Karolinska Institute

Invited Experts:

  • Connie Bowe, MD, Partners HealthCare International
  • Kelly Caverzagie, MD, University of Nebraska Medical Center
  • Allan Cumming, MD, University of Edinburgh
  • Rachel Ellaway, PhD, Northern Ontario School of Medicine
  • Simon Grant, JISC-CETIS
  • Linda Gwinn, Georgetown University
  • Robyn Herring, University of Mississippi
  • Kevin Krane, MD, Tulane University
  • Steven Lieberman, MD, University of Texas Medical Branch
  • Linda Lewin, MD, University of Maryland
  • Karen Macauley, DNP, PhD, University of San Diego Hahn School of Nursing and Health Science 
  • Chandler Mayfield, University of California, San Francisco
  • Daniel Rehak, PhD
  • Juliane Schneider, Harvard University
  • Eric Warm, MD, University of Cincinnati

Specification authors also received technical guidance from members of the MedBiquitous Technical Steering Committee.

  • Joel Farrell , IBM, Technical Steering Committee Chair
  • James Fiore, American Board of Surgery
  • Steve Kenney, American Osteopathic Association
  • Andrew Rabin, CECity
  • Dan Rehak, Learning Technologies Architect

 

 


2          Documentation Conventions

This document uses the following conventions:

Convention

Description

Bold Text

When used with an XML element name, indicates that the element contains sub-elements.

Italics

When used in an XML element description, an attribute of the XML element.

Monospaced type

Sample XML tags, code, schema, or portion thereof.

 

The document uses graphics generated by Altova XML Spy® software, which uses the following graphical conventions.

 

address-example_schemadiagram.png


3          Conformance

To conform to the MedBiquitous Performance Framework specification, an XML document shall:

 


4          Common Data Types

Most of the elements and attributes in MedBiquitous XML documents use the data types defined by the W3C XML schema definition. In some cases MedBiquitous creates its own datatypes as part of its best practices or to meet a specific requirement. Commonly used datatypes are described below.

Non-null string

Non-null string is a datatype derived from the XML string datatype.  Non-null string imposes a minimum length of one character on a string and ensures that required elements are complete.

5          Introduction

This document describes the MedBiquitous Performance Framework Schema in detail. It is intended for use by anyone who wants to create, implement, or create interoperable tools based on this specification.

The objective of the Performance Framework Schema is to provide a data structure that allows one to represent expected levels of performance related to a competency in a standard format. This structure may be referenced from other specifications to enable the exchange of data based on those performance scales, including learner assessment data.

The standard allows extensions so that data beyond the core set identified in this document may be incorporated. This specification is intended to work in concert with other specifications.

Competency-based learning and assessment is increasingly being applied within health professions education at all levels across the continuum. An important component of competency-based learning is the concept of milestones, expected levels of performance related to a competency. In the US, the Accreditation Council for Graduate Medical Education (ACGME) has convened working groups to develop Milestones for each of the 26 specialties in its purview. In undergraduate medical education, several medical schools, including the University of California, San Francisco, are implementing milestones related to the developmental achievement of competence. In Nursing and other health professions, levels of performance are associated with the assessment and development of competence. Standards are essential to make performance data portable and easily understood across the continuum of a learner’s career.

 

 


6          Other Standards, Specifications, or Schemas Referenced

 

This standard references the following standards, specifications, or schemas. The informative references here, which describe how these references are used, link to formal references appearing later in this document.

 

  • DCMI Metadata terms [ DCMI ]
    The Performance Framework uses the DCMI references element to link to competencies, competency frameworks, and supporting information.

 

  • MedBiquitous Competency Framework [ Competency Framework ]
    Competency Framework provides a way of specifying the hierarchical and non-hierarchical relationships among a set of related competencies, learning objectives, learning outcomes, etc. The Performance framework may define performance for competencies in a competency framework.

 

  • MedBiquitous Competency Object [ Competency Object ]
    Competency Object provides a common format for representing competencies, learning objectives, learning outcomes, etc. The Performance framework may define performance for specific competencies.

 

  • Resource Description Framework [ RDF ]
    RDF is used in conjunction with DCMI to link to competencies , competency frameworks, and additional information as necessary. RDF is the technology used to establish semantic web relationships.

 


7          Schema Grammar

The following sections explain the Performance Framework Schema grammar. Values in bold under XML Tags column indicate that the element has sub-elements.

All the elements having sub-elements will be defined in separate sections. All elements without sub-elements will be defined within the appropriate element sections that use them.

7.1        PerformanceFramework

PerformanceFramework is the root element. It contains subelements that describe one or more sets of performance levels to be used in assessing competence or performance.

performanceframework.png

PerformanceFramework Element Information

Element

Description

Required

Multiplicity

Datatype

PerformanceFramework

PerformanceFramework is the root element. It contains subelements that describe one or more sets of performance levels to be used in assessing competence or performance.

Required

1

Container

lom

Lom contains subelements that define title, publisher, and other descriptive information about this performance framework. 

The lom element is defined in the Healthcare Learning Object Metadata standard defined by MedBiquitous. Please see the Healthcare Learning Object Metadata Specifications and Description document for more information on the sub-elements of lom. For information on which subelements of lom are required or recommended for Performance Frameworks, see section Lom Required and Recommended Elements.

Required

1

Container

For more information, see  [ Healthcare LOM ] and [ LOM ].

EffectiveDate

The date this performance framework becomes or became effective.

Optional

0 or 1

Date

RetiredDate

The date upon which this performance framework was retired.

Optional

0 or 1

Date

Replaces

A related performance framework that is supplanted, displaced, or superseded by the described framework.

Implementers must use a URI to represent the related framework.

Replaces is based on the Dublin Core term replaces. For more information, see [ DCMITerms ].

Optional

0 or more

anyURI

IsReplacedBy

A related performance framework that supplants, displaces, or supersedes the described framework.

Implementers must use a URI to represent the related framework.

IsReplacedBy is based on the Dublin Core term isReplacedBy. For more information, see [ DCMITerms ].

Optional

0 or more

anyURI

SupportingInformation

SupportingInformation contains subelements that include or point to supporting information, such as descriptions of the rationale for developing the framework and its intended use. See section SupportingInformation for more information.

Optional

0 or more

Container

PerformanceScale

PerformanceScale contains subelements that define a numeric scale used in this performance framework. See section PerformanceScale for more information.

Required

1 or more

Container

Component

Component contains subelements that define a component of this performance framework. See section Component for more information.

Required

1 or more

Container

Elements from other namespaces

PerformanceFramework may include elements from other namespaces provided those elements are namespace qualified.

Optional

0 or more

any

 

Example:\

<PerformanceFramework>

  <lom:lom>

. . .

  </lom:lom>

  <EffectiveDate>2013-01-01</EffectiveDate>

  <SupportingInformation>

. . .

  </SupportingInformation>

  <PerformanceScale id="xyz">

. . .

  </PerformanceScale>

  <Component id="c123">

. . .

  </Component>

  <Component id="c234">

. . .

  </Component>

  <Component id="c345">

. . .

  </Component>

. . .

</PerformanceFramework>

 

7.2        Lom Required and recommended Elements

Lom contains subelements that define title, publisher, and other descriptive information about this performance framework. 

lom

The table that follows indicates which elements of healthcare lom are required or recommended for use in the Performance Framework. Note that additional lom elements may be used.


lom Element Usage Information

Element

Description

Required

Multiplicity

Datatype

lom

lom contains subelements that define title, publisher, and other descriptive information about this performance framework. 

For more information on these elements, see [ LOM ] and [ Healthcare LOM ].

Required

1

Container

For more information on lom and its subelements, see  [ Healthcare LOM ] and [ LOM ].

general

A container for general metadata elements.

Required

1

Container

general:identifier

A container for identifier information.

Required

1 or more

Container

general:identifier:catalog

The cataloging system for the unique identifier. For performance frameworks, the catalog must be URI.

Note that organizations may include a catalog other than URI for use within local systems as long as a URI identifier is present in the XML document.

Required

1

Restricted. See Description for details.

general:identifier:entry

Defines a unique identifier for the performance framework. For performance frameworks, identifiers must be in the form of a URI.

Note that organizations may include an entry other than a URI for use within local systems as long as a URI identifier is present in the XML document.

Required

1

anyURI

general:title

Defines the title for this performance framework in one or more languages.

Required

1

LanguageString

general: description

A short description of the performance framework.

Recommended

0 or more

LanguageString

lifecycle

A container for elements relating to the lifecycle of the framework.

Recommended

0 or 1

Container

lifecycle: status

A container for elements describing the status of the performance framework.

Recommended

0 or 1

Container

lifecycle: status: source

The source of the vocabulary for status.  Use LOMv1.0.

Recommended

0 or 1

Restricted See Description for details.

lifecycle: status: value

The status of the performance framework. Valid values are: draft, final, revised, unavailable.  Use of draft and final values is recommended.

Recommended

0 or 1

Restricted. See Description for details.

lifecycle: contribute

A container for elements the people and organizations that have contributed to the performance framework.

Recommended

0 or 1

Container

lifecycle: contribute: role

A container for elements describing the publisher and other entities involved in the development of this framework. Use the role and entity elements within the lifecycle element to indicate the publisher of the performance framework. Role should have a value of publisher and be paired with an entity describing the publisher.

Recommended

0 or more

Container

lifecycle: contribute: role:source

The source of the vocabulary for role.  When describing the publisher, use LOMv1.0.

Recommended

0 or 1

Restricted. See Description for details.

lifecycle: contribute: role: value

The role being described.  To describe the publisher, value should be publisher.

Recommended

0 or 1

Restricted. See Description for details.

lifecycle: contribute: entity

Use the role and entity elements within the lifecycle element to indicate the publisher of the performance framework.  Entity includes a vcard reference to the publisher and should be paired with a role that has a value of publisher.

Recommended

0 or more

CharacterString in VCARD format. See [ LOM ] for details.

educational

A container element for elements related to the educational aspects of the framework.

Recommended

0 or 1

Container

educational: context

 

A container for elements describing the educational environment for which the performance framework is intended.

Recommended

0 or more

Container

educational: context:source

The source of the vocabulary for educational context.  To use the MedBiquitous vocabulary, use HEALTHCARE_LOMv1.

Recommended

0 or 1

Restricted. See Description for details.

educational:context:value

The educational context for which the framework is intended. Use a term from the following MedBiquitous vocabulary (described in HealthcareLOM):

  • patient education
  • caregiver education
  • primary education
  • secondary education
  • vocational training
  • undergraduate education
  • undergraduate professional education
  • graduate professional education
  • continuing professional development

Recommended

0 or 1

Restricted. See Description for details.

rights

A container element for information on copyright and other restrictions.

Recommended

0 or 1

Container

rights: copyrightAndOtherRestrictions

 

A container for elements indicating whether or not copyright or other restrictions exist on the competency framework.

Recommended

0 or 1

Container

rights: copyrightAndOtherRestrictions:source

The source of the vocabulary used to describe copyright and other restrictions. To use the lom vocabulary, use LOMv1.0.

Recommended

0 or 1

Restricted. See Description for details.

rights: copyrightAndOtherRestrictions:value

Indicates whether or not copyright and other restrictions exist. Valid values are yes and no.

Recommended

0 or 1

Restricted. See Description for details.

rights: description

 

The description element within rights provides a brief description of the copyright or other constraints on the performance framework. The description may include a link to a license.

Recommended

0 or 1

LanguageString

healthcareMetadata

A container element for healthcare related metadata.

Recommended

0 or 1

Container

healthcareMetadata:healthcareEducation

A container element for healthcare education related metadata.

Recommended

0 or 1

Container

healthcareMetadata:healthcareEducation targetAudience

A container element for information  about the target audience for whom this framework is intended.

Recommended

0 or 1

Container

healthcareMetadata: healthcareEducation:targetAudience: profession

 

The health profession for which this performance framework is intended.

Recommended

0 or 1

LanguageString

 

< lom:lom >

    < lom:general >

< lom:identifier >

< lom:catalog > URI </ lom:catalog >

< lom:entry > http://www.example.com/internal_medicine_milestones_2013_us </ lom:entry >

</ lom:identifier >

< lom:description >

< lom:string > The framework is designed only for use in evaluation of resident physicians in the context of their participation in accredited residency programs. The framework is for the assessment of the development of the resident physician. It does not represent the entirety of  physician competency. </ lom:string >

</ lom:description >

    </ lom:general >

    < lom:lifeCycle >

< lom:status >

< lom:source > LOMv1.0 </ lom:source >

< lom:value > final </ lom:value >

</ lom:status >

< lom:contribute >

< lom:role >

< lom:source > LOMv1.0 </ lom:source >

< lom:value > publisher </ lom:value >

</ lom:role >

< lom:entity > BEGIN:VCARD\nFN:Fictional Board of Internal MedicineEND:VCARD </ lom:entity >

</ lom:contribute >

    </ lom:lifeCycle >

  </ lom:lom >

 


7.3        SupportingInformation

SupportingInformation contains subelements that include or point to supporting information, such as descriptions of the rationale for developing the framework and its intended use.

supportinginformation.png

Element

Description

Required

Multiplicity

Datatype

SupportingInformation

SupportingInformation contains subelements that include or point to supporting information, such as descriptions of the rationale for developing the framework and its intended use. See section SupportingInformation for more information.

Optional

0 or more

Container

dcterms:references

A reference to the supporting information.

MedBiquitous uses RDF and DCMI subelements to specify details about references. See section Using dcterms:references for more information.

 

Either dcterms:references or xhtml:div is required

0 or 1

anyType

 

MedBiquitous uses dcterms: references as a container.

xhtml:div

A div element is a mixed type element referenced from XHTML. The div element can include a mix of text and XHTML tags as specified by the XHTML schema.

Either dcterms:references or xhtml:div is required

0 or 1

Container

For more information, see [ XHTML ].

 

Example: TBD

7.4        PerformanceScale

PerformanceScale contains subelements that define a numeric scale used in this performance framework.

performancescale.png

PerformanceScale Element Information

Element

Description

Required

Multiplicity

Datatype

PerformanceScale

PerformanceScale contains subelements that define a numeric scale used in this performance framework.

PerformanceScale has the following attribute:

id
a unique identifier for this performance scale. The identifier must be unique within the scope of this report. Use of the id attribute is required.

Required

 

1 or more

Container

LeastCompetent

The score indicating the lowest level of competence on this scale.

Required

1

Int

(integer)

MostCompetent

The score indicating the highest level of competence on this scale.

Required

1

Int

(integer)

 

Example:

  < PerformanceScale id =" scale_1to5 ">

    < LeastCompetent > 1 </ LeastCompetent >

    < MostCompetent > 5 </ MostCompetent >

  </ PerformanceScale >

7.5        Component

Component contains subelements that define a component of this performance framework. A component may have nested components defined. Each component describes a spectrum of performance levels and related background or descriptive information.

 

Component Element Information

Element

Description

Required

Multiplicity

Datatype

Component

Component contains subelements that define a component of this performance framework.

Component has the following attribute:

id
a unique identifier for this component. The identifier must be unique within the scope of this report. Use of the id attribute is required.

Required

1 or more

Container

Title

The title of this component. Often the title mirrors the title of the competency for which the performance levels are detailed.

Required

1

NonNullString

Abbreviation

An abbreviation for the component.

Optional

0 or 1

NonNullString

Competency

Competency contains subelements that reference a competency in a competency framework. See section Competency for more information.

Optional

0 or more

Container

Author

An author of this component of the performance framework.

Optional

0 or more

NonNullString

Reviewer

A reviewer of this component of the performance framework.

Optional

0 or more

NonNullString

Threshold

Threshold contains subelements that define a threshold score for a particular action or decision, such as progression in training or entrustment. See section Threshold for more information.

Optional

0 or more

Container

AdditionalInformation

Additonal information, such as background, references., resources, etc. about this component.

See section AdditionalInformation for more information.

Optional

0 or more

Container

ComponentReference

The ID of a nested Component.

Add order attribute ?

Either ComponentReference or PerformanceLevelSet is required.

0 or more

IDREF

PerformanceLevelSet

PerformanceLevelSet contains subelements that define a spectrum of performance levels. See section PerformanceLevelSet for more information.

Either ComponentReference or PerformanceLevelSet is required

0 or 1

Container

 

Example: UPDATE

  < Component id =" comp_sbp4 ">

  < Title > Transitions patients effectively within and across health delivery systems. </ Title >

    < PerformanceLevelSet >

< PerformanceScaleReference > scale_1to5 </ PerformanceScaleReference >

        < PerformanceLevel >

          < DisplayOrder > 1 </ DisplayOrder >

          < ScoreValue > 1 </ ScoreValue >

          < Label > Critical Deficiencies </ Label >          

          < Indicator id =" sbp4_1_1 ">

< Description > Disregards need for communication at time of transition </ Description >

  </ Indicator >

  < Indicator id =" sbp4_1_2 ">

< Description > Does not respond to requests of caregivers in other delivery systems </ Description >

   </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 2 </ DisplayOrder >

          < ScoreValue > 2 </ ScoreValue >

          < Indicator id =" sbp4_2_1 ">

< Description > Inconsistently utilizes available resources to coordinate and ensure safe and effective patient care within and across delivery systems </ Description >

  </ Indicator >

  < Indicator id =" sbp4_2_2 ">

< Description > Written and verbal care plans during times of transition are incomplete or absent </ Description >

  </ Indicator >

  < Indicator id =" sbp4_2_3 ">

< Description > Inefficient transitions of care lead to unnecessary expense or risk to a patient (e.g. duplication of tests readmission </ Description >

  </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 3 </ DisplayOrder >

          < ScoreValue > 3 </ ScoreValue >

  < Indicator id =" sbp4_3_1 ">

< Description > Recognizes the importance of communication during times of transition </ Description >

  </ Indicator >

  < Indicator id =" sbp4_3_2 ">

< Description > Communication with future caregivers is present but with lapses in pertinent or timely information </ Description >

  </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 4 </ DisplayOrder >

          < ScoreValue > 4 </ ScoreValue >

          < Label > Ready for unsupervised practice </ Label >

          < Indicator id =" sbp4_4_1 ">

< Description > Appropriately utilizes available resources to coordinate care and ensures safe and effective patient care within and across delivery systems </ Description >

  </ Indicator >

  < Indicator id =" sbp4_4_2 ">

< Description > Proactively communicates with past and future care givers to ensure continuity of care </ Description >

  </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 5 </ DisplayOrder >

          < ScoreValue > 5 </ ScoreValue >

          < Label > Aspirational </ Label >

          < Indicator id =" sbp4_5_1 ">

< Description > Coordinates care within and across health delivery systems to optimize patient safety, increase efficiency and ensure high quality patient outcomes </ Description >

  </ Indicator >

  < Indicator id =" sbp4_5_2 ">

< Description > Anticipates needs of patient,

                            caregivers and future care

                            providers and takes

                            appropriate steps to address

                            those needs </ Description >

  </ Indicator >

  < Indicator id =" sbp4_5_3 ">

< Description > Anticipates needs of patient,

                            caregivers and future care

                            providers and takes

                            appropriate steps to address

                            those needs </ Description >

  </ Indicator >

  < Indicator id =" sbp4_5_4 ">

< Description > Role models and teaches

                            effective transitions of care </ Description >

  </ Indicator >

        </ PerformanceLevel >

    </ PerformanceLevelSet >

  </ Component >

 

 

7.5.1         Competency

Competency contains subelements that reference a competency in a competency framework. These subelements indicate a competency to which the defined components or performance levels apply.

competency.png

Competency Element Information

Element

Description

Required

Multiplicity

Datatype

Competency

Competency contains subelements that reference a competency in a competency framework.

Optional

0 or more

Container

dcterms:references

A reference to a competency object or competency framework.

dcterms:references should occur twice: once to reference a competency object, once to reference the relevant competency framework including the referenced competency object.

MedBiquitous uses RDF and DCMI subelements to specify details about references. See section Using dcterms:references for more information.

Required

2

anyType

MedBiquitous uses dcterms: references as a container.

 

Example:

TBD

 

Threshold

Threshold contains subelements that define a threshold score for a particular action or decision, such as progression in training or entrustment. For example, a regulatory body may wish to indicate that a score of 2 on this component is required to progress to the second phase of training.

 

Element

Description

Required

Multiplicity

Datatype

Threshold

Threshold contains subelements that define a threshold score for a particular action or decision, such as progression in training or entrustment

Optional

0 or more

Container

Title

The title of this threshold. For example, Progression to Phase 2

Required

1

NonNullString

Description

A description of the threshold .

Optional

1

NonNullString

Score

The score associated with this threshold.

Required

1

Decimal

 

Example:

    < Threshold >

< Title > Entrustment </ Title >

< Description > The level of attainment trainees must demonstrate to be considered eligible for e ntrustment with regard to th i s competency . < / Description >

< Score > 4 </ Score >

    </ Threshold >

 

7.5.2         AdditionalInformation

Additonal information allows framework developers to include additional information in a performance framework, including background, references, resources, assessment methods, examples, and notes, to name a few. Additional   Infomration Information may be associated with a Component, Performance level, or Indicator.

additionalinformation.png

AdditionalInformation Element Information

Element

Description

Required

Multiplicity

Datatype

AdditionalInformation

AdditionalInformation includes subelements that provide additional information about a component, performance level, or indicator.

AdditionalInformation has the following attributes:

label
A label for this additional information. Recommended values are: assessment method, background, example, note, reference, and resource. Use of the label attribute is required.

position
An integer indicating the position of this additional information in relation to other additional information with the same label. Potiion can be used to order notes, references, etc.

Optional

0 or more

Container

Text

The text of the additional information.

Required

1

NonNullString

dcterms:references

A reference to an external resource.

MedBiquitous uses RDF and DCMI subelements to specify details about references. See section Using dcterms:references for more information.

Optional

0 or 1

anyType

MedBiquitous uses dcterms: references as a container.

xhtml:div

A div element is a mixed type element referenced from XHTML. The div element can include a mix of text and XHTML tags as specified by the XHTML schema.

Optional

0 or 1

Container

For more information, see [ XHTML ]

 

Example:

TBD

 


7.5.3         PerformanceLevelSet

PerformanceLevelSet contains subelements that define a spectrum of performance levels.  A performance level set may be defined to describe the spectrum of performance for a specific competency, or a performance level set may be defined to be generally applied across competencies.

performancelevelset.png

PerformanceLevelSet Element Information

Element

Description

Required

Multiplicity

Datatype

PerformanceLevelSet

PerformanceLevelSet contains subelements that define a spectrum of performance levels. 

Either a ComponentReference or a PerformanceLevelSet is required.

0 or 1

Container

PerformanceScaleReference

The identifier of a PerformanceScale defined in this document. The PerformanceScaleReference indicates the scale used for this performance level set.

Required

1

IDREF

PerformanceLevel

Performancelevel contains subelements that describe a single level of performance within this performance level set. See section PerformanceLevel for more information.

Required

2 or more

Container

 

Example:

< PerformanceLevelSet >

< PerformanceScaleReference > scale_1to5 </ PerformanceScaleReference >

        < PerformanceLevel >

. . .

        </ PerformanceLevel >

        < PerformanceLevel >

. . .

        </ PerformanceLevel >

        < PerformanceLevel >

. . .

        </ PerformanceLevel >

    </ PerformanceLevelSet >

 


7.5.3.1        PerformanceLevel

The subelements of PerformanceLevel define a single level of performance in detail.  There are multiple performance levels in a set. Together, they create a scale of performance with behavioral measures.

performancelevel.png

 

PerformanceLevel Element Information

Element

Description

Required

Multiplicity

Datatype

PerformanceLevel

Performancelevel contains subelements that describe a single level of performance within this performance level set.

Required

2 or more

Container

DisplayOrder

A positive integer indicating the order of display for this performance level in relation to other performance levels in the performance level set.

Required

1

int

Score

Score contains subelements that describe either a single score value or a range of values associated with this performance level. See section Score for more information.

Required

1

Container

Label

A label associated with this performance level. For example, Aspirational.

Optional

0 or 1

NonNullString

Indicator

Indicator contains subelements that describe an indicator or behavioral marker associated with this performance level. See section Indicator for more information.

Required

1 or more

Container

AdditionalIInformation

Additonal information, such as background, references., resources, etc. about this performance level.

See section AdditionalInformation for more information.

Optional

0 or more

Container

 

 

 

 

 

 

 

 

 

 

 

Example: UPDATE

< PerformanceLevel >

   < DisplayOrder > 1 </ DisplayOrder >

   < ScoreValue > 1 </ ScoreValue >

   < Label > Critical Deficiencies </ Label >          

   < Indicator id =" sbp4_1_1 ">

< Description > Disregards need for communication at time of transition </ Description >

   </ Indicator >

   < Indicator id =" sbp4_1_2 ">

< Description > Does not respond to requests of caregivers in other delivery systems </ Description >

   </ Indicator >

</ PerformanceLevel >

 

7.5.3.2        Score

Score contains subelements that describe either a single score value or a range of values associated with a performance level.

Score.png

Score Element Information

Element

Description

Required

Multiplicity

Datatype

Score

Score contains subelements that describe either a single score value or a range of values associated with this performance level.

Required

1

Container

SingleValue

An integer indicating a single score associated with this performance level.

Either SingleValue or Range is required

0 or 1

Integer

Range

Range contains subelements that describe a range of scores associated with this performance level. See section Range for more information.

Either SingleValue or Range is required

0 or 1

Container

 

Example:

TBD

7.5.3.3        Range

Range contains subelements that describe a range of scores associated with this performance level.

range.png

Range Element Information

Element

Description

Required

Multiplicity

Datatype

Range

Range contains subelements that describe a range of scores associated with this performance level.

Either SingleValue or Range is required

0 or 1

Container

MinScore

The minimum score associated with this performance level.

Required

1

Integer

MaxScore

The maximum score associated with this performance level.

Required

1

Integer

 

Example:

TBD

7.5.3.4        Indicator

Indicator contains subelements that describe anindicator or behavioral marker associated with this performance level.

indicator.png

Indicator Element Information

Element

Description

Required

Multiplicity

Datatype

Indicator

Indicator contains subelements that describe an indicator or behavioral marker associated with this performance level.

Indicator has the following attribute:

id
A unique identifier for this indicator. The identifier must be unique within the scope of this report. Use of the id attribute is required.

Required

1 or more

Container

Description

A description of the indicator or behavioral marker   associated with this performance level.

Required

1

NonNullString

AdditionalInformation

Additonal Additional information, such as background, references, resources, etc. about this indicator.

See section AdditionalInformation for more information.

Optional

0 or more

Container

 

Example:

< Indicator id =" sbp4_1_1 ">

< Description > Disregards need for communication at time of transition </ Description >

</ Indicator >

 

 

7.6        Using dcterms:references

MedBiquitous uses the Dublin Core metadata initiative’s [ DCMI ] references element in combination with Resource Description Framework [ RDF ] elements to establish links to external documents, including competency objects and competency frameworks.  Use the following format for any use of dcterms:references in this specification.


dcterms:references usage information

Element

Description

Required

Multiplicity

Datatype

dcterms:references

A reference to the supporting information.

MedBiquitous uses RDF and DCMI subelements to specify details about references.

Determined by the datatype using dcterms:references.

Determined by the datatype using dcterms:references.

anyType

MedBiquitous uses dcterms: references as a container.

r R df : ; Description

The resource being referenced.

MedBiquitous uses the following attribute with rdf:Description:

rdf:about
The URI for the resource being referenced. For example, http://www.example.org/milestone/SBP4.xml .

Required

1

Empty

rdf:type

The type of resource being referenced.

MedBiquitous uses the following attribute with rdf:type:

rdf:resource
The URI of the namespace of the resource referenced. For example, when referencing an XML  competency object, use: http://ns.medbiq.org/competencyobject/v1 /

When referencing an XML competency framework, use: http://ns.medbiq.org/competencyframework/v1 /

Required for references to competency objects and competency frameworks. Optional for other references.

0 or 1 (depending on usage)

Empty

dc:format

The media type of the resource being referenced.  If the resource referenced is an XML document, use application/xml.

Optional

0 or 1

Media types as specified by IANA. See http://www.iana.org/assignments/media-types/

 

 


8          Sample XML Document UPDATE

 

<?xml version="1.0" encoding="UTF-8"?>

< PerformanceFramework xmlns:xsi =" http://www.w3.org/2001/XMLSchema-instance " xsi:schemaLocation =" http://ns.medbiq.org/performanceframework/v1/ performanceframework.xsd " xmlns =" http://ns.medbiq.org/performanceframework/v1/ " xmlns:lom =" http://ltsc.ieee.org/xsd/LOM " xmlns:cf =" http://ns.medbiq.org/competencyframework/v1/ " xmlns:cobj =" http://ns.medbiq.org/competencyobject/v1/ " xmlns:xhtml =" http://www.w3.org/1999/xhtml " xmlns:dcterms =" http://purl.org/dc/terms/ " xmlns:rdf =" http://www.w3.org/1999/02/22-rdf-syntax-ns# ">

  < lom:lom >

    < lom:general >

< lom:identifier >

< lom:catalog > URI </ lom:catalog >

< lom:entry > http://www.example.com/internal_medicine_milestones_2013_us </ lom:entry >

</ lom:identifier >

< lom:description >

< lom:string > The framework is designed only for use in evaluation of resident physicians in the context of their participation in accredited residency programs. The framework is for the assessment of the development of the resident physician. It does not represent the entirety of  physician competency. </ lom:string >

</ lom:description >

    </ lom:general >

    < lom:lifeCycle >

< lom:status >

< lom:source > LOMv1.0 </ lom:source >

< lom:value > final </ lom:value >

</ lom:status >

< lom:contribute >

< lom:role >

< lom:source > LOMv1.0 </ lom:source >

< lom:value > publisher </ lom:value >

</ lom:role >

< lom:entity > BEGIN:VCARD\nFN:Fictional Board of Internal MedicineEND:VCARD </ lom:entity >

</ lom:contribute >

    </ lom:lifeCycle >

  </ lom:lom >

  < EffectiveDate > 2013-01-01 </ EffectiveDate >

  <!-- SupportingInformation>

    <Link>http://www.acgme-nas.org/assets/pdf/Milestones/InternalMedicineMilestones.pdf</Link>

    <dcterms:references rdf:resource="http://www.acgme-nas.org/assets/pdf/Milestones/InternalMedicineMilestones.pdf" dcterms:hasFormat="application/pdf"/>

  </SupportingInformation -->

  < PerformanceScale id =" scale_1to5 ">

    < LeastCompetent > 1 </ LeastCompetent >

    < MostCompetent > 5 </ MostCompetent >

  </ PerformanceScale >

  < PerformanceScale id =" scale_1to2 ">

    < LeastCompetent > 1 </ LeastCompetent >

    < MostCompetent > 2 </ MostCompetent >

  </ PerformanceScale >

  < Component id =" comp_sbp4 ">

  < Title > Transitions patients effectively within and across health delivery systems. </ Title >

    <!-- CompetencyReference>

      <cf:Catalog>URI</cf:Catalog>

      <cf:Entry>http://www.example.org/im_milestones/SBP4.xml</cf:Entry>

    </CompetencyReference -->

    <!-- dcterms:references rdf:resource="http://www.example.org/im_milestones/SBP4.xml" rdf:type="http://ns.medbiq.org/competencyobject/v1" dcterms:hasFormat="application/pdf"/ -->

    < PerformanceLevelSet >

< PerformanceScaleReference > scale_1to5 </ PerformanceScaleReference >

        < PerformanceLevel >

          < DisplayOrder > 1 </ DisplayOrder >

          < ScoreValue > 1 </ ScoreValue >

          < Label > Critical Deficiencies </ Label >          

          < Indicator id =" sbp4_1_1 ">

< Description > Disregards need for

                            communication at

                            time of transition </ Description >

  </ Indicator >

  < Indicator id =" sbp4_1_2 ">

< Description > Does not respond to

                            requests of

                            caregivers in other

                            delivery systems </ Description >

   </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 2 </ DisplayOrder >

          < ScoreValue > 2 </ ScoreValue >

          < Indicator id =" sbp4_2_1 ">

< Description > Inconsistently utilizes

                            available resources to

                            coordinate and ensure safe

                            and effective patient care

                            within and across delivery

                            systems </ Description >

  </ Indicator >

  < Indicator id =" sbp4_2_2 ">

< Description > Written and verbal care

                            plans during times of

                            transition are incomplete

                            or absent </ Description >

  </ Indicator >

  < Indicator id =" sbp4_2_3 ">

< Description > Inefficient transitions of

                            care lead to unnecessary

                            expense or risk to a patient

                            (e.g. duplication of tests

                            readmission </ Description >

  </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 3 </ DisplayOrder >

          < ScoreValue > 3 </ ScoreValue >

  < Indicator id =" sbp4_3_1 ">

< Description > Recognizes the importance of

                            communication during times

                            of transition </ Description >

  </ Indicator >

  < Indicator id =" sbp4_3_2 ">

< Description > Communication with future

                            caregivers is present but with

                            lapses in pertinent or timely

                            information </ Description >

  </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 4 </ DisplayOrder >

          < ScoreValue > 4 </ ScoreValue >

          < Label > Ready for unsupervised practice </ Label >

          < Indicator id =" sbp4_4_1 ">

< Description > Appropriately utilizes available

                            resources to coordinate care

                            and ensures safe and effective

                            patient care within and across

                            delivery systems </ Description >

  </ Indicator >

  < Indicator id =" sbp4_4_2 ">

< Description > Proactively communicates with

                            past and future care givers to

                            ensure continuity of care </ Description >

  </ Indicator >

        </ PerformanceLevel >

        < PerformanceLevel >

          < DisplayOrder > 5 </ DisplayOrder >

          < ScoreValue > 5 </ ScoreValue >

          < Label > Aspirational </ Label >

          < Indicator id =" sbp4_5_1 ">

< Description > Coordinates care within and

                            across health delivery systems

                            to optimize patient safety,

                            increase efficiency and ensure

                            high quality patient outcomes </ Description >

  </ Indicator >

  < Indicator id =" sbp4_5_2 ">

< Description > Anticipates needs of patient,

                            caregivers and future care

                            providers and takes

                            appropriate steps to address

                            those needs </ Description >

  </ Indicator >

  < Indicator id =" sbp4_5_3 ">

< Description > Anticipates needs of patient,

                            caregivers and future care

                            providers and takes

                            appropriate steps to address

                            those needs </ Description >

  </ Indicator >

  < Indicator id =" sbp4_5_4 ">

< Description > Role models and teaches

                            effective transitions of care </ Description >

  </ Indicator >

        </ PerformanceLevel >

    </ PerformanceLevelSet >

  </ Component >

</ PerformanceFramework >

 

 


9          References

 

Competency Framework
ANSI/MEDBIQ CF.10.1-2012, Competency Framework. MedBiquitous Website. http://medbiq.org/std_specs/standards/index.html#Competencies . Accessed May 20, 2013.

Competency Object
MedBiquitous Competency Object Specifications and description Document. MedBiquitous Website. http://www.medbiq.org/sites/default/files/CompetencyObjectSpecification.pdf . Accessed June 16, 2011.

DCMI
DCMI Metadata Terms, October 11, 2010. Dublin Core Metadata Initiative Website. http://dublincore.org/documents/2010/10/11/dcmi-terms/ . Accessed May 9, 2013.

Healthcare LOM
ANSI/MEDBIQ LO.10.1-2008, Healthcare Learning Object Metadata, MedBiquitous Website. http://www.medbiq.org/std_specs/standards/index.html#HCLOM . Accessed May 9, 2013.

LOM
"IEEE Standard for Learning Technology-Extensible Markup Language (XML) Schema Definition Language Binding for Learning Object Metadata," IEEE Std 1484.12.3-2005 , vol., no., pp.0_1-46, 2005
doi: 10.1109/IEEESTD.2005.97889
URL:   http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=1532505&isnumber=32693

RDF
RDF Vocabulary Description Language 1.0: RDF Schema. W3C Recommendation 10 February 2004. W3C website. http://www.w3.org/TR/rdf-schema/ . Accessed May 9, 2013.

XHTML
XHTML™ 1.0 The Extensible HyperText Markup Language (Second Edition), A Reformulation of HTML 4 in XML 1. 0. W3C Recommendation 26 January 2000, revised 1 August 2002.  W3C website. http://www.w3.org/TR/2002/REC-xhtml1-20020801 . Accessed September 6, 2011.

XSD
Extensible Markup Language (XML) 1.0 (Fifth Edition) , W3C Website.  26 November 2008 http://www.w3.org/TR/2008/REC-xml-20081126/ . Accessed March 20, 2012.