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Performance Framework Specifications

 

 

 

 

 

 

 

 

 

Version: 0. 6 5 1
Date:   August 22 October 27 , 2014
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.

0.4

2013-08-15

Valerie Smothers

Changed threshold Score element to MinimumAcceptableScore; removed Dublin Core reference element and replaced with reference element in the Performance Framework namespace.

0.41

2013-09-09

Valerie Smothers

Updated sample code and images where necessary.

0.42

2013-10-08

Valerie Smothers

Added Competency reference to performance level.

0.43

2014-04-28

Valerie Smothers

Corrected typos and prepared manuscript for review. Moved CompetencyReference from PerformanceLevel to Indicator. Pointed to Common specification for documentation of Reference.

0.44

2014-07-11

Valerie Smothers

Changes reflecting working group recommendations on Standards Committee comments: correcting typos; allowing Decimal values for scores; clarifying  most competent, least competent, additional information, Min score, and max score; change DisplayOrder to positive integer.

0.5

2014-07-17

Valerie Smothers

Changes reflecting working group recommendations on the representation of performance frameworks in multiple languages.

0.6

2014-10-27

Valerie Smothers

Added optional Reference element to indicator. Either Description or Reference is required.


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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. The original schema was created by Karl Burke, Johns Hopkins Medicine.

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
  • Kirstin Cirulis, Knowledge4You
  • 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
  • James Fiore, American Board of Surgery
  • Ted Hanss, University of Michigan
  • Sean Hilton, MB BS, St. George's University of London
  • Joshua Jacobs, MD, Association of American Medical Colleges
  • PJ Kania, Association of American Medical Colleges
  • David Kiger, Tufts University
  • Scott Kroyer, E*Value
  • JB McGee, MD, University of Pittsburgh
  • David Price, MD, American Board of Family Medicine
  • Isarin Sathitruangsak, Tufts University 
  • Valerie Smothers, MedBiquitous
  • Lesley Southgate, M.D., St. George's University of London
  • Laura Vail, Johns Hopkins University
  • Radu Vestemean, Knowledge4You
  • Nabil Zary, PhD, Karolinska Institute


Invited Experts:

  • S. Toufeeq Ahmed, Vanderbilt University Medical Center
  • Connie Bowe, MD, Partners HealthCare International
  • Kelly Caverzagie, MD, University of Nebraska Medical Center
  • Sascha Benjamin Cohen, University of California San Francisco School of Medicine
  • Rachel Ellaway, PhD, Northern Ontario School of Medicine
  • Ian Graham, MB.BS., Stawell Regional Health, East Wimmera Health Service, Beaufort & Skipton Health Service,West Wimmera Health Service, SED Clinical Education Practice and Learning
  • Simon Grant, JISC-CETIS
  • Linda Gwinn, Georgetown University
  • Robyn Herring, University of Mississippi
  • Kevin Krane, MD, Tulane University
  • Jason Ladicos, one45
  • 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
  • David Melamed, MD, MyEvaluations.com
  • Dan Nelson, New Innovations
  • Daniel Rehak, PhD
  • Paul Schilling, Schilling Consulting
  • Juliane Schneider, Harvard University
  • Eric Warm, MD, University of Cincinnati
  • Julie Wasson, University of Mississippi Medical Center
  • David Weiner, LCMS+

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
  • Carl Singer, CECity

 

 


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 [ XML ]. In some cases MedBiquitous creates its own datatypes as part of its best practices or to meet a specific requirement. Commonly used datatypes are defined in the common.xsd file. For more information about common datatypes, see: http://www.medbiq.org/sites/default/files/CommonSpecifications.pdf

 


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 are performance levels, 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. This specification is one step towards making that possible.

 

 


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 format element to indicate the format of a referenced resource.

 

  • MedBiquitous Common Specifications [ Common ]
    The MedBiquitous Common Specification defines datatypes commonly used across MedBiquitous specifications.

 

  • 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 to link to competencies , competency frameworks, and additional information as necessary. RDF is the technology used to establish semantic web relationships.

 


7          Performance Framework Schema

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.

Optional

0 or more

Container

Reference

A reference to the supporting information.

The Reference element uses the ReferenceType datatype from the MedBiquitous Common Specifications.

Either reference or xhtml:div is required

0 or 1

Container

For more information, see [ Common ].

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 Reference or xhtml:div is required

0 or 1

Container

For more information, see [ XHTML ].

 

Example:

  < SupportingInformation >

< Reference >

< rdf:Description rdf:about =" http://www.example.org/performanceguide2013.pdf "/>

< dcterms:format > application/pdf </ dcterms:format >

</ Reference >

</ SupportingInformation >

< SupportingInformation >

< xhtml:div >

< xhtml:h1 > Foreword </ xhtml:h1 >

< xhtml:p >

The College is committed to fostering the < xhtml:strong > highest standards </ xhtml:strong > of surgical care and professional

behaviour. Being a surgeon carries a responsibility for participation in lifelong learning, and a

willingness to monitor performance in the workplace.

</ xhtml:p >

< xhtml:p >

To aid these processes, and to complement the existing program, work was undertaken by the < xhtml:em >

Assessment Steering Committee </ xhtml:em > during 2010 and 2011, under the governance of the

< xhtml:em > Professional Development and Standards Board </ xhtml:em > .

</ xhtml:p >

</ xhtml:div >

  </ SupportingInformation >

 

7.4        PerformanceScale

PerformanceScale contains subelements that define a numeric scale used in this performance framework. Most often scales are defined with higher numbers indicating higher levels of competence, but scales may be defined so that lower numbers indicate higher levels of competence. For example, on a scale of 1 to 5, 1 may be least competent or most competent.

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

Decimal)

MostCompetent

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

Required

1

Decimal

 

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 or more

NonNullLanguage
StringType

For more information, see [ Common ].

Abbreviation

An abbreviation for the component.

Optional

0 or more

NonNullLanguage
StringType

For more information, see [ Common ].

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

NonNullStringType

For more information, see [ Common ].

Reviewer

A reviewer of this component of the performance framework.

Optional

0 or more

NonNullStringType

For more information, see [ Common ].

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.

 

Either Component
Reference or Performance
LevelSet is required.

0 or more

IDREF

PerformanceLevelSet

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

Either Component
Reference or Performance
LevelSet is required

0 or 1

Container

 

Example:

<Component id="comp_sbp4">

  <Title xml:lang= "en" >Transitions patients effectively within and across health delivery systems.</Title>

  <Abbreviation xml:lang= "en" >Transitions patients</Abbreviation>

<Competency>

. . .

</Competency>

<Author>Gertrude Stein</Author>

<Reviewer>Pablo Picasso</Reviewer>

   <Threshold>

. . .

   </Threshold>

    <AdditionalInformation>

. . .

</AdditionalInformation>

    <PerformanceLevelSet>

. . .

    </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

Reference

A reference to a competency object or competency framework.

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

The Reference element uses the ReferenceType datatype from the MedBiquitous Common Specifications.

Required

2

Container

For more information, see [ Common ].

 

Example:

  < Competency >

< Reference >

< rdf:description about =" http://www.example.org/milestone/SBP4.xml "/>

< rdf:type rdf:resource =" http://ns.medbiq.org/competencyobject/v1/ "/>

</ Reference >

< Reference >

< rdf:description about =" http://www.example.org/im_milestones.xml "/>

< rdf:type rdf:resource =" http://ns.medbiq.org/competencyframework/v1/ "/>

< dcterms:format > application/xml </ dcterms:format >

</ Reference >

</ Competency >

 

7.5.2         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 or more

NonNullLanguage
StringType

For more information, see [ Common ].

Description

A description of the threshold.

Optional

0 or more

NonNullLanguage
StringType

For more information, see [ Common ].

MinimumAcceptableScore

The minimum acceptable score associated with this threshold.

Required

1

Decimal

 

Example:

    < Threshold >

< Title xml:lang= "en" > Entrustment </ Title >

< Description xml:lang= "en" > The level of attainment trainees must demonstrate to be considered eligible for entrustment with regard to this competency. </ Description >

< MinimumAcceptableScore > 4 </ MinimumAcceptableScore >

    </ Threshold >

 

7.5.3         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. AdditionalInformation may be associated with a Component, Performance level, or Indicator.


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 attribute:

position
An integer indicating the position of this additional information in relation to other additional information with the same label. Position can be used to order notes, references, etc. Position should be unique within the scope of AdditionalInformation elements with the same label.

Optional

0 or more

Container

Label

A label for this additional information. Recommended values are: assessment method, background, example, note, reference, and resource.

Required

1 or more

NonNullLanguageStringType

Text

The text of the additional information.

Required

1 or more

NonNullLanguageStringType

For more information, see [ Common ].

Reference

A reference to an external resource.

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

Optional

0 or 1

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:

    <AdditionalInformation position="1">

<Label xml:lang= "en" >Note</Label>

<Text xml:lang= "en" >Residents must ensure excellent transitions of care when they are unable to provide direct care for patients. </Text>

</AdditionalInformation>

<AdditionalInformation label="resource">

<Text>The Joint Commission Transitions of Care Portal</Text>

<Reference>

<rdf:Description rdf:about="http://www.jointcommission.org/toc.aspx"/>

<dcterms:format>text/html</dcterms:format>

</Reference>

</AdditionalInformation>

 

7.5.4         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 >

 

 


7.5.4.1        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 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

positiveInteger

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 more

NonNullLanguage
StringType

For more information, see [ Common ].

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:

       < PerformanceLevel >

          < DisplayOrder > 1 </ DisplayOrder >

          < Score >

< SingleValue > 1 </ SingleValue >

  </ Score >

          < Label xml:lang= " en " > Critical Deficiencies </ Label >          

          < Indicator id =" sbp4_1_1 ">

  . . .

  </ Indicator >

  < Indicator id =" sbp4_1_2 ">

. . .

   </ Indicator >

        </ PerformanceLevel >

7.5.4.2        Score

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

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

Decimal

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

 

Example1 :

          < Score >

< SingleValue > 4 </ SingleValue >

  </ Score >

 

Example 2:

< Score >

< Range >

< MinScore > 1 </ MinScore >

< MaxScore > 3 </ MaxScore >

</ Range >

</ Score >

7.5.4.3        Range

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


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. A MinScore may be lower or higher than a MaxScore depending on how the PerformanceScale is defined.

Required

1

Decimal

MaxScore

The maximum score associated with this performance level. A MaxScore may be higher or lower than a MinScore depending on how the PerformanceScale is defined.

Required

1

Decimal

 

Example:

< Range >

< MinScore > 1 </ MinScore >

< MaxScore > 3 </ MaxScore >

</ Range >

7.5.4.4        Indicator

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

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.

Either Reference or Description is required   Required

1 or more

NonNullLanguage
StringType

For more information, see [ Common ].

Reference

A reference to an indicator from another document .

The Reference element uses the ReferenceType   datatype from the MedBiquitous Common Specifications.

Either R eference or Description is required

0 or more

Container

For more information, see [ Common ].

Competency

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

Optional

0 or more

Container

AdditionalInformation

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 >

< Competency >

. . .

</ Competency >

< AdditionalInformation >

. . .

</ AdditionalInformation >

</ Indicator >

< Indicator id =" sbp4_1_ 2 ">

< Reference >

< rdf: description about =" http://www.example.org/im_milestones.xml #spb 412 "/>

< rdf: type   rdf:resource =" http://ns.medbiq.org/ performance framework /v1/ "/>

< dcterms :format > application/xml </ dcterms:format >

</ Reference >

</ Indicator >

 

 

 


8          Sample XML Document s

 

8.1        Sample Document in one language

 

<?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>

<Reference>

<rdf:Description rdf:about="http://www.example.org/performanceguide2013.pdf"/>

<dcterms:format>application/pdf</dcterms:format>

</Reference>

</SupportingInformation>

<SupportingInformation>

<xhtml:div>

<xhtml:h1>Foreword</xhtml:h1>

<xhtml:p>

The College is committed to fostering the <xhtml:strong>highest standards</xhtml:strong> of surgical care and professional

behaviour. Being a surgeon carries a responsibility for participation in lifelong learning, and a

willingness to monitor performance in the workplace.

</xhtml:p>

<xhtml:p>

To aid these processes, and to complement the existing program, work was undertaken by the <xhtml:em>

Assessment Steering Committee</xhtml:em> during 2010 and 2011, under the governance of the

<xhtml:em>Professional Development and Standards Board</xhtml:em>.

</xhtml:p>

</xhtml:div>

</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>

  <Abbreviation>Transitions patients</Abbreviation>

<Competency>

<Reference>

<rdf:description about="http://www.example.org/milestone/SBP4.xml"/>

<rdf:type rdf:resource="http://ns.medbiq.org/competencyobject/v1/"/>

</Reference>

<Reference>

<rdf:description about="http://www.example.org/im_milestones.xml"/>

<rdf:type rdf:resource="http://ns.medbiq.org/competencyframework/v1/"/>

<dcterms:format>application/xml</dcterms:format>

</Reference>

</Competency>

<Author>Gertrude Stein</Author>

<Reviewer>Pablo Picasso</Reviewer>

    <Threshold>

<Title>Entrustment</Title>

<Description>The level of attainment trainees must demonstrate to be considered eligible for entrustment with regard to this competency.</Description>

<MinimumAcceptableScore>4</MinimumAcceptableScore>

    </Threshold>

    <AdditionalInformation position="1">

<Label>Note</Label>

<Text>Residents must ensure excellent transitions of care when they are unable to provide direct dare for patients. </Text>

</AdditionalInformation>

<AdditionalInformation>

<Label>Resource</Label>

<Text>The Joint Comission Transitions of Care Portal</Text>

<Reference>

<rdf:Description rdf:about="http://www.jointcommission.org/toc.aspx"/>

<dcterms:format>text/html</dcterms:format>

</Reference>

</AdditionalInformation>

    <PerformanceLevelSet>

<PerformanceScaleReference>scale_1to5</PerformanceScaleReference>

        <PerformanceLevel>

          <DisplayOrder>1</DisplayOrder>

          <Score>

<SingleValue>1</SingleValue>

  </Score>

          <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>

          <Score>

<SingleValue>2</SingleValue>

  </Score>

          <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>

          <Score>

<SingleValue>3</SingleValue>

  </Score>

  <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>

          <Score>

<SingleValue>4</SingleValue>

  </Score>

          <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>

          <Score>

<SingleValue>5</SingleValue>

  </Score>

          <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>

 

 


8.2        Sample Document in two languages

 

<?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/multilingual_framework</lom:entry>

</lom:identifier>

<lom:description>

<lom:string>The framework is designed to evaluate trainees. It is represented in both French and English.</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 MedicineEND:VCARD</lom:entity>

</lom:contribute>

    </lom:lifeCycle>

  </lom:lom>

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

  <SupportingInformation>

<Reference>

<rdf:Description rdf:about="http://www.example.org/performanceguide2013.pdf"/>

<dcterms:format>application/pdf</dcterms:format>

</Reference>

</SupportingInformation>

<SupportingInformation>

<xhtml:div lang="en">

<xhtml:h1>Foreword</xhtml:h1>

<xhtml:p>

The College is committed to fostering the <xhtml:strong>highest standards</xhtml:strong> of surgical care and professional

behaviour. Being a surgeon carries a responsibility for participation in lifelong learning, and a

willingness to monitor performance in the workplace.

</xhtml:p>

</xhtml:div>

</SupportingInformation>

<SupportingInformation>

<xhtml:div lang="fr">

<xhtml:h1>Foreword</xhtml:h1>

<xhtml:p>

Le Collège s'est engagé à promouvoir les normes <xhtml:strong> les plus élevées</xhtml:strong> de soins chirurgicaux et professionnel

comportement. Être un chirurgien exerce une responsabilité pour la participation à la formation continue, et une

volonté de surveiller le rendement en milieu de travail.

</xhtml:p>

</xhtml:div>

</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 xml:lang="en">Transitions patients effectively within and across health delivery systems.</Title>

  <Title xml:lang="fr">Transitions patients efficace au sein des systèmes de prestation de santé.</Title>

  <Abbreviation xml:lang="en">Transitions patients</Abbreviation>

  <Abbreviation xml:lang="fr">Transitions patients</Abbreviation>

<Competency>

<Reference>

<rdf:description about="http://www.example.org/milestone/SBP4.xml"/>

<rdf:type rdf:resource="http://ns.medbiq.org/competencyobject/v1/"/>

</Reference>

<Reference>

<rdf:description about="http://www.example.org/im_milestones.xml"/>

<rdf:type rdf:resource="http://ns.medbiq.org/competencyframework/v1/"/>

<dcterms:format>application/xml</dcterms:format>

</Reference>

</Competency>

<Author>Gertrude Stein</Author>

<Reviewer>Pablo Picasso</Reviewer>

    <Threshold>

<Title xml:lang="en">Entrustment</Title>

<Title xml:lang="fr">Charger</Title>

<Description xml:lang="en">The level of attainment trainees must demonstrate to be considered eligible for entrustment with regard to this competency.</Description>

<Description xml:lang="fr">Le niveau des stagiaires à atteindre doit démontrer à être admissible à charger à l'égard de cette compétence.</Description>

<MinimumAcceptableScore>4</MinimumAcceptableScore>

    </Threshold>

    <AdditionalInformation position="1">

<Label xml:lang="en">Note</Label>

<Label xml:lang="fr">Remarque</Label>

<Text xml:lang="en">Residents must ensure excellent transitions of care when they are unable to provide direct dare for patients. </Text>

<Text xml:lang="fr">Les résidents doivent assurer une excellente transition des soins quand ils sont incapables de fournir osent directe pour les patients.</Text>

</AdditionalInformation>

    <PerformanceLevelSet>

<PerformanceScaleReference>scale_1to5</PerformanceScaleReference>

        <PerformanceLevel>

          <DisplayOrder>1</DisplayOrder>

          <Score>

<SingleValue>1</SingleValue>

  </Score>

          <Label xml:lang="en">Critical Deficiencies</Label>

          <Label xml:lang="fr">Lacunes critiques</Label>        

          <Indicator id="sbp4_1_1">

<Description xml:lang="en">Disregards need for

                            communication at

                            time of transition</Description>

            <Description xml:lang="fr">Ignore besoin de communication au moment de la transition</Description>

  </Indicator>

  <Indicator id="sbp4_1_2">

<Description xml:lang="en">Does not respond to

                            requests of

                            caregivers in other

                            delivery systems</Description>

                <Description xml:lang="fr">Ne pas répondre aux demandes des soignants dans d'autres systèmes de livraison</Description>

   </Indicator>

        </PerformanceLevel>

        <PerformanceLevel>

          <DisplayOrder>5</DisplayOrder>

          <Score>

<SingleValue>5</SingleValue>

  </Score>

          <Label xml:lang="en">Aspirational</Label>

          <Label xml:lang="fr">Ambitieux</Label>

          <Indicator id="sbp4_5_1">

<Description xml:lang="en">Coordinates care within and

                            across health delivery systems

                            to optimize patient safety,

                            increase efficiency and ensure

                            high quality patient outcomes</Description>

                <Description xml:lang="fr">Coordonner les soins à l'intérieur et à travers les systèmes de prestation de santé afin d'optimiser la sécurité des patients, accroître l'efficacité et d'assurer des résultats de haute qualité pour les patients</Description>

  </Indicator>

  <Indicator id="sbp4_5_2">

<Description xml:lang="en">Anticipates needs of patient,

                            caregivers and future care

                            providers and takes

                            appropriate steps to address

                            those needs</Description>

                    <Description xml:lang="fr">Anticipe les besoins de patients, les soignants et les futurs fournisseurs de soins et prend les mesures appropriées pour répondre à ces besoins</Description>

  </Indicator>

        </PerformanceLevel>

    </PerformanceLevelSet>

  </Component>

</PerformanceFramework>

 

 

 


9          References

 

Common
MedBiquitous Common Specifications. MedBiquitous Website.
http://www.medbiq.org/sites/default/files/CommonSpecifications.pdf   . Accessed April 28, 2014.

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.