Challenges of implementing competency-based medical education postgraduate training programs: the issue of context

Introduction: Competency-based medical education (CBME) is being adopted worldwide. The aim of this paper is to discuss the evolution of CBME and address some perceived challenges in CBME curriculum development and implementation in postgraduate (residency) medical education. Methods: This is an opinion paper based on lived experiences and personal beliefs. The authors have professional training in medical education and are actively involved in CBME research, curriculum development and implementation around the world. Results: The issue of local and system-wide context seems to be of particular importance to individuals, programs, institutions, governing bodies and other stakeholders involved in the development and implementation of CBME programs. CBME has evolved differently at different places, and there are concerns regarding the fidelity of implementation. Stakeholders have been dealing with challenging questions in their CBME journeys, which reflect the varied, complex and dynamic nature of health and education systems. Recently, scholars have established core components of any CBME program. Discussion and conclusions: CBME design should benefit from ground-up strategies that consider the local context. It is essential to approach implementation with a quality improvement lens and pay special attention to the fidelity and integrity of the core CBME components.

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Postgraduate medical education: The history and development of competency-based training program in Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i1.36243 ◽

2021 ◽

Vol 8 (1) ◽

pp. 102-112

Author(s):

Jay Narayan Shah ◽

Jenifei Shah ◽

Jesifei Shah ◽

Ashis Shrestha ◽

Nabees Man Singh Pradhan

Keyword(s):

Medical Education ◽

Healthcare System ◽

Postgraduate Training ◽

Core Competencies ◽

Health Sciences ◽

Medical Council ◽

Competency Based Medical Education ◽

Surgical Workforce ◽

Competency Based ◽

Medical Colleges

Nepal is a small, lower-middle-income country; with a population of around 30 million. As per WHO, Nepal has a low doctor-patient ratio (0.7/1000) and even lower specialists (e.g., surgical) workforce (0.003/1000); additionally, data from Nepal Medical Council show the number of postgraduate specialists is 1/3rd of the total registered doctors. The mismatch in the doctor-patient ratio is further aggravated by the overwhelming number of doctors in urban areas; when 80% of the population are in rural Nepal. This inequitable discrepancy in the healthcare system requires: proper training of competent medical graduates, a fair distribution across the country, and effective changes in the healthcare system. Competency-based medical education plays an important role in: standardizing education, training competent doctors, and deploying them where they are needed the most. The Government of Nepal has recently established Medical Education Commission-which plans to oversee the entrance exams; and expand the postgraduate training to be conducted by private hospitals, previously not affiliated with any medical colleges or universities. Historically, Civil Medical School started training compounders and dressers in Nepal in 1934. A big milestone was achieved with the establishment of the Institute of Medicine under Tribhuvan University in 1972, which has continued to train all categories of health manpower needed in the country. In 2006 Nepal Medical Council developed “Regulations for Post-graduate Medical education”. Thereafter, several institutions started providing postgraduate training, for example: the BP Koirala Institute of Health Sciences, Kathmandu University, National Academy of Medical Sciences, and Patan Academy of Health Sciences (PAHS). The PAHS conducts PG programs and post-PG fellowships in line with competency-based medical education. In addition to formative assessments, research thesis, and a publishable article; PAHS requires its trainees to be certified in a pre-set of entrustable professional activities (EPAs) and to master eight Core Competencies domains in: Professionalism, Patient-centered care, Procedural skills, Clinical Reasoning, Communication, Scholarship, Leadership, Community orientation. The number of medical colleges in Nepal has since expanded to 24 (medical 21 and dental colleges 3). Private medical colleges make up about 3/4th of the total medical colleges in Nepal. This makes the inclusion and regulation of more components of the competency-based curriculum in postgraduate training programs, and its monitoring, somewhat of a challenge.

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A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs

Academic Medicine ◽

10.1097/acm.0000000000002743 ◽

2019 ◽

Vol 94 (7) ◽

pp. 1002-1009 ◽

Cited By ~ 25

Author(s):

Elaine Van Melle ◽

Jason R. Frank ◽

Eric S. Holmboe ◽

Damon Dagnone ◽

Denise Stockley ◽

...

Keyword(s):

Medical Education ◽

Education Programs ◽

Competency Based Medical Education ◽

Core Components ◽

Competency Based

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Using the Five Core Components of Competency-Based Medical Education to Support Implementation of CBVE

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.689356 ◽

2021 ◽

Vol 8 ◽

Author(s):

Kristin P. Chaney ◽

Jennifer L. Hodgson

Keyword(s):

Medical Education ◽

Client Outcomes ◽

Original Design ◽

Veterinary Education ◽

Competency Based Medical Education ◽

Learner Centered ◽

Core Components ◽

Competency Based ◽

Outcome Competencies ◽

Outcomes Based Education

In recent years, veterinary education has begun the transition to competency-based models, recognizing that, like medical education, our goals include improved patient and client outcomes and the importance of learner-centered methods in education. Given that implementation of competency-based veterinary education (CBVE) is still in its relative infancy across many veterinary programs, we stand to gain from a unified approach to its implementation. As a guideline, the five core components of competency-based medical education (CBME) should serve to ensure and maintain fidelity of the original design of outcomes-based education during implementation of CBVE. Identified the essential and indispensable elements of CBME which include 1) clearly articulated outcome competencies required for practice, 2) sequenced progression of competencies and their developmental markers, 3) tailored learning experiences that facilitate the acquisition of competencies, 4) competency-focused instruction that promotes the acquisition of competencies, and 5) programmatic assessment. This review advocates the adoption of the principles contained in the five core components of CBME, outlines the approach to implementation of CBVE based upon the five core components, and addresses the key differences between veterinary and medical education which may serve as challenges to ensuring fidelity of CBVE during implementation.

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Black Ice: ways to get a grip on resident co-production within medical education change

Canadian Medical Education Journal ◽

10.36834/cmej.67919 ◽

2020 ◽

Author(s):

Jeffery D. Dagnone ◽

Samantha Buttemer ◽

Jena Hall ◽

Liora Berger ◽

Kristen Weersink

Keyword(s):

Medical Education ◽

Postgraduate Training ◽

Postgraduate Medical Education ◽

Change Leadership ◽

Successful Implementation ◽

Competency Based Medical Education ◽

Education Change ◽

Competency Based ◽

Queen's University ◽

National Approach

The Royal College of Physicians and Surgeons of Canada (RCPSC) is transforming its national approach to postgraduate medical education by transitioning all specialty programs to competency based medical education (CBME) curriculums over a seven-year period. Queen’s University, with special permission from the RCPSC, launched CBME curricula for all incoming residents across its 29 specialty programs in July 2017. Resident engagement, empowerment, and co-production through this transition has been instrumental in successful implementation of CBME at Queen’s University. This article aims to use our own experience at Queen’s in the context of current literature and rooted in change leadership theory, to provide a guide for educators, learners, and institutions on how to leverage the interest and enthusiasm of trainees in the transition to CBME in postgraduate training. The following ten tips provides a model for avoiding the “black ice” type pitfalls that can arise with learner involvement, and ensure a smoother transition for other institutions moving forward with CBME implementation.

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Exploring resident perceptions of initial competency based medical education implementation

Canadian Medical Education Journal ◽

10.36834/cmej.70943 ◽

2021 ◽

Author(s):

Shivani Upadhyaya ◽

Marghalara Rashid ◽

Andrea Davila Cervantes ◽

Anna Oswald

Keyword(s):

Medical Education ◽

Professional Activity ◽

Competency Based Medical Education ◽

Programmatic Assessment ◽

Resident Perceptions ◽

Societal Needs ◽

Core Components ◽

Competency Based ◽

Curricular Model ◽

Outcome Competencies

Background: Competence by design (CBD) is a nationally developed hybrid competency based medical education (CBME) curricular model that focuses on residents’ abilities to promote successful practice and better meet societal needs. CBD is based on a commonly used framework of five core components of CBME: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction and programmatic assessment. There is limited literature concerning residents’ perceptions of implementation of CBME. Objective: We explored resident perceptions of this transformation and their views as they relate to the intended framework. Methods: We recruited residents enrolled in current CBME implementation between August 2018 and January 2019. We interviewed residents representing eight disciplines from the initial two CBME implementation cohorts. Inductive thematic analysis was used to analyse the data through iterative consensus building until saturation. Results: We identified five themes: 1) Value of feedback for residents; 2) Resident strategies for successful Entrustable Professional Activity observation completion; 3) Residents experience challenges; 4) Resident concerns regarding CBME; and 5) Resident recommendations to improve existing challenges. We found that while there was clear alignment with residents’ perceptions of the programmatic assessment core CBME component, alignment was not as clear for other components. Conclusions: Residents perceived aspects of this transformation as helpful but overall had mixed perceptions and variable understanding of the intended underlying framework. Understanding and disseminating successes and challenges from the resident lens may assist programs at different stages of CBME implementation.

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Practical solutions for implementation of Transition to Practice curricula in a competency-based medical education model.

Canadian Medical Education Journal ◽

10.36834/cmej.67821 ◽

2020 ◽

Author(s):

Layli Sanaee ◽

Susan Glover Takahashi ◽

Marla Nayer

Keyword(s):

Medical Education ◽

Curriculum Development ◽

Teaching Strategies ◽

Transition To Practice ◽

Learning Stage ◽

Content Areas ◽

Competency Based Medical Education ◽

Learning And Teaching ◽

Competency Based ◽

Education Model

Background: Although transition from residency to practice represents a critical learning stage, there is a paucity of literature to inform local curriculum development and implementation.Objectives: To describe local curriculum development for Transition to Practice (TTP) for use within a competency-based medical education model, including important content and suitable teaching and assessment strategies. Design: We reviewed the literature to construct a definition and develop initial curriculum content for TTP. We then gathered local residency program directors’ views on TTP content, teaching, and assessment via online survey and an international educational conference workshop. Results: We identified 21 important TTP content areas in the literature and analyzed 35 survey responses, representing 33 residency programs. Survey participants viewed Further sophistication of clinical skills, How to set up a practice, and Time management skills as the three most important content areas. Views on content importance varied by program. For learning and teaching strategies, most respondents preferred: assessing what residents could do, providing real-life practice opportunities, and offering workplace-based assessments. Conclusions: TTP curricula implementation should reflect nationally set, specialty-specific curriculum elements; locally developed priority content; and learning and teaching strategies. Individual learner needs and imminent practice context should guide faculty approaches to curriculum delivery.

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