Thoughtful Thursday: Competency-Based Clinical Training - What It Really Could Be

There is so much more to competency-based education (CBE) than having a list of professional competencies as a small part of our educational programming. Just so you know, this is something that I am passionate about as we move into newer ways of educating and training future music therapists. This has been the topic of research projects of mine in the past (submitted for publication and loved by one reviewer and bitterly hated by the other reviewer - how can you ever hope to make it to publication when reviewers are that far apart in views?), and it continues to be something that I want to talk to music therapists about, so I do!

My expertise, of course, is in using the American Music Therapy Association Professional Competencies in pre-internship and internship clinical training. I have developed a competency-based evaluation that I use in my internship program, and I developed the same thing for my educational program during my time as a graduate student. I find the AMTA competencies to be less than adequate when it comes to educational and clinical outcomes for students. I am hoping that the 21st Century Commission yadda, yadda will be making recommendations about the competencies as an essential and objective part of our profession very soon, but I sincerely doubt that they will take up that topic of discussion. I hope to be surprised, but nothing has been all that surprising about what the Commission has presented so far.

As a clinical trainer in an internship program, I found that the AMTA competencies are not extremely robust when it comes to evaluation. There is lots of room for interpretation and misunderstanding in the competencies as written. My favorite example is good old Competence 1.1 - Recognize standard works in the literature. This is listed under Music Foundations and Theory and History. What frosts my cookies about this competence is that there is no "standard" when it comes to music therapy literature. My standard works are significantly different from the standard works of someone who works with premature babies. Those works are significantly different from the standard works of someone who works in a practice where they work with people of all ages. We cannot evaluate this competence without a clear understanding of what constitutes "standard works in the literature."

There are many competencies that are similar to the first one that we have included in our list. Most of them are not easily defined outside of a particular context. This is a problem, and one that we need to address if we are to use the competencies as our educational foundation. I have to know that a professor is going to be evaluating the competencies in a way that makes sense to me - a clinician that works with interns. For a professor to indicate that their student does indeed recognize "standard works" and then send that student out with absolutely no idea about current music is a problem for me in my role.

Before internship agreements were standard, I would send my evaluation to professors to have them rate their students' skills based on my ideas of what the competencies mean in my internship program. Now, I get ratings that are pretty much useless as soon as they arrive. I have no context about what skills are expected in these programs compared to the skills that I expect from interns. This is one reason I refuse to take an intern without actually seeing them interact with my clients - I trust my own evaluation more than that of music therapy professors who may or may not have been a full-time clinician in many years. I also trust my evaluation of what skills my clients need in a music therapy intern more than a professor who has never worked with adolescents. I have to be able to trust my evaluation because I am the one who has to translate the learning into experience.

So, I have developed my own competency-based evaluation based on the skills and knowledge that my facility, job requirements, and clients demand. Some of my requirements are tied to my facility. That is true for everyone at their jobs. We have specific training and behavior strategies that are unique to us. There are some things that I can't evaluate - I just have to teach those things. My deep dive into the AMTA competencies allows me to identify the things that I want my interns to know before they take the first step into my internship on day one as well as the ones that I will be responsible for teaching and modeling. Since I have taken the time and made the effort to base my clinical training program on the competencies, I have had very little argument about my evaluations of my interns.

I base all of my ranks on the concept that a competency-based program is a pass or fail program. I have never had to fail an intern because the expectation is that we will continue to work on skills until the intern can complete them appropriately. My interns can use the evaluation to see what skills I expect. They can see why I have certain assignments included in their time with me. They can identify places where their understanding of the competencies and my own differ. This has been a wonderful tool for me over the years, and I am ready to do more with this.

If you are interested in using my evaluation as a starting point for your own, let me know. I am happy to share my work with others - just, please, cite me as the original developer. Send me a personal message on social media or leave a comment here with your email address - all comments are held for review - nothing with an email address will be published. Join others who have found this system to be helpful in clinical training while using a competency-based system!