Defining the key clinician skills and attributes for competency in managing patients with osteoporosis and fragility fractures

Abstract

Osteoporosis and fragility fractures are managed by clinicians across many medical specialties. The key competencies of clinicians delivering bone health care have not been systematically established. We aimed to develop a decision rule to define the threshold of adequate skills and attributes associated with clinical competency in bone health for a clinician serving as a referral source for bone health care. Using a modified-Delphi method, we invited clinicians with expertise in treating osteoporosis and representatives of patient advocacy groups focused on bone health to create a list of desirable characteristics of a clinician with bone health competency. Characteristics were defined as "attributes" with "levels" within each attribute. Participants prioritized levels by perceived importance. To identify the cut points for defining adequate competency, participants next ranked 20 hypothetical clinicians defined by various levels of attributes from highest to lowest likelihood of having adequate bone health competency. Lastly, we conducted a discrete choice experiment (DCE) to generate a weighted score for each attribute/level. The threshold for competency was a priori determined as the total weighted score at which ≥70% of participants agreed a clinician had adequate bone health competency. Thirteen participants generated lists of desirable characteristics, and 30 participants ranked hypothetical scenarios and participated in the DCE. The modified-Delphi exercise generated 108 characteristics, which were reduced to 8 categories with 20 levels with associated points. The maximum possible score was 25 points. A summed threshold score of >12 points classified a clinician as having adequate bone health competency. We developed a numeric additive decision rule to define clinicians across multiple specialties as having adequate competency in managing bone health/osteoporosis. Our data provide a rigorously defined criteria for a clinician with competency in bone health and can be used to quantitate the skills of clinicians participating in bone health research and clinical care.

Keywords: clinical trial; competency; fragility fracture; osteoporosis.

Graphical Abstract

Figure 1

Procedural diagram of the study process.

Figure 2

Box and whisker plot displaying experts’ rankings of the relative likelihood that each of the 20 “paper cases” represents a clinician with adequate competency in bone health. The hypothetical cases are presented in the order of the overall median rank (x-axis) and rounded to nearest whole number (shown in parenthesis over each case). The median ranking with interquartile range (IQR) of cases as assigned by each participant is shown in the y-axis. Outliers are displayed as a dot over or beneath each whisker plot. The dotted line indicates the threshold cut point for competency.