A Theoretical Framework and Competency-Based Approach to Training in Guideline Development

Background: There is increasing requirement to develop guidelines using transparent, standardized, and rigorous methods. Consequently, a better understanding of the knowledge, skills, and expertise necessary for guideline development is needed. The aim of this manuscript is to describe a theoretical framework of knowledge and skills that are required for individuals to serve on a guideline panel in varying capacities. Methods: Based on an iterative process and review of published manuscripts focused on guideline development, we identified competencies, subcompetencies, and milestones. Results: Using a competency-based approach to training and the Dreyfus model of skill acquisition, we identified three core competencies: (1) facilitate the development of guideline structure and setup, (2) make judgments about the quality or certainty of the evidence, and (3) transform evidence to a recommendation. Level 1 focuses on recognizing and acknowledging the importance of a specific skill or behavior. Levels 2 and 3 require learners to demonstrate progressive acquisition of knowledge and application to specific behaviors. Level 4 represents the individual who has acquired the requisite knowledge and can function independently, while level 5 represents the mastery/aspirational level. Discussion: We propose a preliminary competency-based education framework that will (1) help standardize the qualifications needed for individuals to serve on guideline panels in varying capacities or (2) help with curricula development for teaching and training of guideline panel members. This framework can also help enable guideline-producing organizations to identify guideline methodologists with the relevant and appropriate level of knowledge and skills to lead guidelines. Validation of the framework and further refinement of the competencies and milestones will be required before widespread adoption.