Models for enhancing competency-based training and contextual clinical decision making.

BACKGROUND: In the era of quality care, competency and outcome-based education, new models of teaching and resident staff training are greatly needed. These should be based on adult learning principles and allow for high-quality, patient-centred, evidence-based care. CONTEXT: Three areas that need restructuring with specific conceptual frameworks to allow for seamless competency-based training, and also to assist in putting the decision-making process in context, are: case or topic presentation; diagnostic labelling; and immediate interventions for front-line caregivers. INNOVATION: Three models are proposed: the competency-structured presentation (CSP) model; the bedside clinical diagnosis, etiological cause and severity score diagnostic labelling (BESD) model; and the symptomatic, supportive, specific, specialty and site of care (5S) model. IMPLICATIONS: The models listed above may assist in the following domains of patient care. In a competency-structured presentation, the CSP model formalises case presentations and discussions in a competency-based structure, thereby supporting the development of a competency-focused thought process for patient care. The BESD and 5S models improve the understanding of patient problems within the appropriate context, and thus assists in achieving the following quality outcomes. The BESD model promotes better diagnostic labelling, thereby assisting in implementing individualised, evidence-based interventions. The 5S model promotes the cognitive conceptualisation of medical management, which will aid a more comprehensive, patient-centred, multidisciplinary care input, thereby reducing process errors and improving outcomes. © Blackwell Publishing Ltd 2012.