Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership – the International CBME Collaborators – to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.

/pdf/competency-based-medical-education-theory-to-practice-2vj42r6ovw.pdf

Competency-based medical education: theory to practice.

The Bologna Declaration The Bologna Declaration of June 1999 calls for the establishment by 2010 of a coherent, compatible and competitive European Higher Educatio n Area, attractive for European students and for students and scholars from other c ontinents. The European Education Ministers identified six action lines in Bologna an d they have added three more in Prague in May 2001 and one more in Berlin in September 2003:

/pdf/tuning-educational-structures-in-europe-150zyrlzah.pdf

Tuning Educational Structures in Europe

Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions’ competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges’ (AAMC’s) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites. The authors used the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties six domains of competence and 36 competencies delineated by the ACGME as their foundational reference list. They added two domains described by other groups after the original six domains were introduced: Interprofessional Collaboration (4 competencies) and Personal and Professional Development (8 competencies). They compared the expanded reference list (48 competencies within eight domains) with 153 competency lists from across the medical education continuum, physician specialties and subspecialties, countries, and health care professions. Comparison analysis led them to add 13 “new” competencies and to conflate 6 competencies into 3 to eliminate redundancy.

/pdf/toward-a-common-taxonomy-of-competency-domains-for-the-22r0xu0tsz.pdf

Toward a common taxonomy of competency domains for the health professions and competencies for physicians.

Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direc...

AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician.

With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from a time- and process-based system to a competency-based training framework. Implementing competency-based training in postgraduate medical education poses many challenges but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Making this transition requires change at virtually all levels of postgraduate training. Key components of this change include the development of valid and reliable assessment tools such as work-based assessment using direct observation, frequent formative feedback, and learner self-directed assessment; active involvement of the learner in the educational process; and intensive faculty development that addresses curricular design and the assessment of competency.

Competency-based medical education in postgraduate medical education

This paper describes a set of learning outcomes that clearly define the abilities of medical graduates from any of the five Scottish medical schools. The outcomes are divided into 12 domains that fit into one of three essential elements for the competent and reflective medical practitioner.

https://medu.au.dk/fileadmin/www.medu.au.dk/uddannelse/undervisningsudvikling/studiereform/baggrundspapirer/thescottishdoctor.pdf

G F McPhate

Papers

The Scottish doctor--learning outcomes for the medical undergraduate in Scotland: a foundation for competent and reflective practitioners