Training the complex care workforce: Reflections on developing core competencies

Building the complex care field Care management & redesign Workforce development

By Anna Doubeni, Associate Professor of Clinical Family Medicine and Community Health, University of Pennsylvania, Perelman School of Medicine
Education Vice Chair of the complex care core competencies working group

As the impact of both the COVID-19 pandemic and social injustice unfold around us and we struggle as a society to find our grounding, I am amazed that it was just 3 months ago that I met the other members of the complex care core competencies working group, convened by the National Center for Complex Health and Social Needs. Our task was to develop core competencies relevant to the delivery of complex care across disciplines and service deliverers.

As we embraced the complexity of our own humanity, we were excited to delve into defining the competencies needed to truly help people experiencing complex needs as they work toward a focus on health and well-being.

I remember a sense of elation on that blustery, sunny afternoon in late February as I drove home from Camden across Philadelphia. We all felt the time was ripe to define the skills and behaviors needed to serve those for whom the intersection of poverty, illness, and social injustice define their experience with health care delivery and health outcomes. We had no idea how ripe that time was.

Having been steeped in academic medicine for close to 20 years, the concept of competencies is not new to me. The American College of Graduate Medical Education has well-mapped out competencies with milestones that we use to design curricula for teaching medical students and training resident physicians.

But this task of defining core competencies in the relatively new field of complex care is more challenging. How do we identify the core attributes of a complex care provider, irrespective of discipline, and then distill that into competencies that are specific, measurable, attainable, and relevant so that curricula can be developed, learners can be trained, and employees’ work can be evaluated?

Because of the magnitude of the project and the importance of the work to the field of complex care, the National Center has been extremely thoughtful in pulling together a cross-sector group of 15 people who have experience across the spectrum of complex care. Through guidance and facilitation from the National Center staff and leadership, we have been meeting since October 2019 to fulfill the first recommendation of the Blueprint for Complex Care — to create core competencies for frontline complex care providers. We discussed our individual understanding of complex care and our educational and experiential biases that impact our thinking and we developed domains and competencies, which we continue to iteratively distill down to the essence of what it means to do high-quality work in the field of complex care delivery.

As we come to the final stretch in this part of the project, I am surprised at how clarifying the work has been. To have open discussion, inclusive of the voices of those experiencing complex health and social needs, has been humbling. To hear ways in which I and my colleagues have contributed to the marginalization of those in need and can shift to provide better care has caused me to reflect on how current standard training has the potential to detract from the very competencies needed to engage in the delivery of complex care.

Over the past 7 weeks, as I shifted my focus from my traditional delivery of healthcare to focus for a short time on home care of post-hospital discharges for COVID-ill patients, I have also shifted my team-based work and my Socratic teaching to physical therapists, occupational therapists, and nurses. Echoing in the back of my mind are the working group’s thoughts around flattened team structures and respect for each other’s areas of expertise.

To have my own understanding expanded by the voices of the other group members and then distilled and clarified has been an amazing way for me to find purpose and joy in my work.

As we move into the next phase of the core competency work, I think about the next phase of the country’s pandemic response. I wonder how the delivery of complex care will be impacted and redefined by the need to prevent further spread of infection while at the same time recognizing and addressing the needs of people suffering from the impact of poverty, illness, and social injustice.I will remember that time in February when we could meet together and share the same space. I will remember the feeling of elation and accomplishment from coming together with a common goal and embracing our own complexity. These draft core competencies are a step toward defining the skills, knowledge, and attitudes necessary to expand a workforce capable of caring for those experiencing complex needs. As our field works toward a greater focus on health and well-being, during this current crisis and after, I hope you will take the time to review what we’ve drafted and fill out this survey with your feedback.

Learn more about core competencies for complex care