Safety in numbers 2: Competency modelling and diagnostic error assessment in medication dosage calculation problem-solving

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Abstract

Accurately defining and modelling competence in medication dosage calculation problem-solving (MDC-PS) is a fundamental pre-requisite to measuring competence, diagnosing errors and determining the necessary design and content of professional education programmes. In this paper we advance an MDC-PS competence model that illustrates the relationship between conceptual competence (dosage problem-understanding), calculation competence (dosage-computation) and technical measurement competence (dosage-measurement). To facilitate bridging of the theory–practice gap it is critical that such models are operationalised within a wider education framework that supports the learning, assessment and synthesis of cognitive competence (the knowing that and knowing why of MDC-PS) and functional competence (the know-how and skills associated with the professional practice of MDC-PS in clinical settings).

Within the context of supporting the learning and diagnostic assessment of MDC-PS we explore PhD fieldwork that challenges the value of pedagogical approaches that focus solely on abstract information, that isolate the process of knowledge construction from its application in practice settings and contribute to the generation of conceptual errors. We consider misconceptions theory and the concept of mathematical ‘dropped stitches’ and offer an assessment model and program designed to diagnose flawed arithmetical operation and computation constructs.

Section snippets

Past, present & future challenges in medication dosage calculation problem-solving (MDC-PS) education

When children are presented with information that is divorced from their experience, they strive to connect it with the most approximate reality with which they are familiar. Eric Midwinter gives a memorable example of this,

Some time ago I inspected a child's drawing of ‘Silent night; Holy night’. As well as the traditional complement of holy family, wise men, shepherds, oxen and asses, there was also a cheerful, stout fellow in a brown jerkin gazing benignly into the crib. “Who is that?” we

Methodology

In this paper we explore the problem assessment and framing phase of a 20-year programme of medication dosage calculation problem-solving (MDC-PS) education action research. In Weeks et al. (2013a) we explain the basis of the education action research process, and here we describe the fieldwork that preceded a PhD research programme undertaken at a large UK university. This work took place in the early years of the programme and describes the work with nursing students who had mostly been

Defining competence in MDC-PS

Facilitating the construction of professional knowledge and its application to professional competence development, performance, assessment and evaluation is a key mission of professional healthcare education and lies at the heart of professional registration and maintaining patient safety in clinical practice. However, in nursing education we have traditionally made a distinction between the teaching and assessment of knowledge and the teaching and assessment of competent and skilled

The classroom environment

Our classroom-focused fieldwork at the study site revealed that students were taught via traditional classroom-based ‘chalk and talk’ pedagogies using word-based dosage calculation problems, formulae and number-based equations via (see Fig. 4) and assessed via word-based problems of the type illustrated in Fig. 5.

Traditional classroom-based pedagogies attempt to transmit knowledge of the medication dosage calculation problem-solving (MDC-PS) process, yet these abstractions (words and numbers)

Conclusion

The definition, articulation, development, assessment and evaluation of competence are central to maintaining patient safety and education practice in the domain of medication dosage calculation problem-solving (MDC-PS). As the first component of the education action research process we have presented a MDC-PS competence model that illustrates the relationship between conceptual competence (dosage problem-understanding), calculation competence (dosage-computation) and technical measurement

Conflict of interest statement

Professor Keith W Weeks, Norman Woolley & Lester Lewis are Directors of Authentic World Ltd, a spin-out company of the University of Glamorgan & Cardiff University. safeMedicate and eDose are trademarks of the MDC-PS authentic web-based virtual environments distributed respectively by Authentic World Ltd (UK and Ireland) and CAE Healthcare (International).

Dr Meriel Hutton has no commercial interest in Authentic World Ltd or CAE Healthcare.

Dr Simon Young has no commercial interest in Authentic

Acknowledgements

Graphics & Animations © Authentic World Ltd: Matt Brown & Norman Woolley.

Supervision of the original PhD programme of research: Professor Colin Torrance and Dr Sandy Kirkman.

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