A Systematic Review of Competency-Based Education Effort in the Health Professions

Quality healthcare cannot be achieved without competent health professionals. Competency-based education (CBE) is an educational delivery option that may prove to be effective in meeting that need. Through a systematic literature review using content analysis techniques, this chapter explores the conceptual complexity and operational challenges of using CBE in health professions education. Drawing a picture of how competencies are defined and developed in the context of health professions education, this chapter summarizes current practices of integration, delivery, and assessment of competencies. Challenges, emerging trends, and future research directions are also identified. This review found that, unlike in medical education, there are different sets of competencies for most various healthcare disciplines and sub-disciplines and this review suggests that CBE can be a viable model that will enable health professions education to address the diverse needs of health professionals.

Measuring What Matters

This chapter demonstrates that competency-based education requires a different set of student success metrics, and introduces the metrics framework developed by and for the University of Wisconsin's UW Flexible Option (UW Flex). UW Flex is a direct assessment competency-based self-paced model for earning degrees and certificates from institutions in the UW System. It was supported by a grant from Lumina Foundation to develop a competency-based education blueprint for success and includes a set of student-centric metrics meaningful to the model, the curriculum, and the students who are being served in Flex programs. The framework defines student success as students moving through programs at their own pace, demonstrating mastery of subject matter, and meeting academic goals. Program-level metrics aggregate each of these three student-level metrics to provide useful information about the success of a program. The authors also build the case that strategic management of resources is required to overcome challenges inherent in implementing the UW Flexible Option metrics framework.

Designing and Developing Competency-Based Education Courses Using Standards

Standards provide designers and developers of competency-based education courses and programs with a structure and framework that serve as a way to create quality learning environments that align objectives, instruction, and assessments. At the micro-level, standards facilitate direction of the structure, format, and content of a competency-based course that ensures a high-quality product. At the macro-level, standards help institutional administrators and faculty make good, informed decisions about program policies and procedures.

The Next-Generation CBE Architecture

Institutions looking to adopt competency-based education often struggle with the technological challenges of supporting this model. In response, this chapter proposes a “born-CBE” infrastructure intentionally designed to support the data exchanges and workflows required by CBE. This modular infrastructure contains a system of record, a digital learning environment, a recommendation engine, a financial aid processor, a competency dashboard, and a competency transcript. In order for these components to work together cohesively, data standards for interoperability (LIS, OneRoster, and LTI) are essential. The authors then discuss the essential capabilities of the learning infrastructure. These include support for backward design, authentic assessments, various learning workflows, personalization and adaptivity, and learning and performance analytics.

Building Competence

A flurry of new instructional approaches has recently emerged in post-secondary education; one approach receiving the most attention is competency-based education (CBE). While many think CBE is relatively new, its roots are deeply seeded in decades-old pedagogical philosophies. The frequency with which CBE is now appearing in conversations about higher education instruction and reform gives the false impression that most practitioners actually know what CBE is, or how it contrasts with other instructional approaches. In fact, the modern dilemma faced by many in higher education is that few institutional leaders have a comprehensive understanding of what CBE is, how it differs from other instructional approaches, the historical significance behind it, and how it might be used to effect pedagogical change and instructional innovation. This chapter explores the historical basis of CBE, its benefits and detriments, and its operational elements.

Using Communities of Practice to Identify Competencies

While there is currently a significant amount of work being done to promote competency-based education (CBE), many efforts are focused on the design, development, administration, and technology of CBE programs. Yet CBE programs will be successful only if they begin with an accurate and comprehensive identification of required competencies and the key performance indicators (KPI) necessary for effective instructional planning and assessment. This continues to be an area of ongoing debate in competency-based education, particularly in regard to the identification of 21st century competencies and those that reflect higher-order thinking skills. This article suggests that communities of practice (COP) can be integral partners in the effort to identify competencies, establish levels of proficiency that support common divisions of labor within industries, and distinguish the novice from the expert.

A Return to Doing

Elements that define competency-based education are provided, and followed by a history and evolution of this educational philosophy that has become increasingly attractive and necessary to both institutions and learners. Authentic assessment is introduced as the heart of competency-based education and as the instrumental element that differentiates competency-based education from traditional approaches. Examples of authentic assessment are provided from field-specific domains. Drivers from industry, government, and learners are described and linked with the progression of authentic assessment. The design and evaluation of authentic assessment is explored with a thorough explanation of the ways in which properties of reliability and validity are established. The chapter concludes with a forecast for the change that authentic assessment will bring in competency-based education.

Challenges and Opportunities in the Currency of Higher Education

In 2013, the American Council on Education and Blackboard began joint research on competency-based education (CBE) to identify challenges and potential solutions for higher education CBE stakeholders. A key premise is that while credit-hour processes are likely to remain deeply embedded in post-secondary systems for some time, there is ample opportunity for innovation with competencies as a parallel and complementary currency. Credit hours provide a basis for current models of exchange in higher education, including credits for degree attainment, financial aid, and other critical functions. Competencies provide representations of learning outcomes that are more flexible and transparent and can be applied in multiple contexts within and outside educational institutions. This chapter provides scenarios that illustrate how competencies provide broad value in educational processes, not only as a means of documenting student achievement, but also to create meaningful connections between jobseekers and employment, for faculty and staff development, and for economic development.

FLEX Path

Capella University was founded in 1993 to serve adults who wanted access to high-quality higher education to maximize their personal and professional potential. In the early 2000s, to better serve its mission, Capella extended its online education focus and begin offering competency-based curriculum. Already a leader in online, adult-serving higher education, Capella responded to the external pressures of access and completion, affordability, and filling the gap between employers' hiring needs and satisfaction with recent graduates. The response was the development of FlexPath, a competency-based education and direct assessment option to pursue a degree that signifies clear demonstration of professionally relevant competencies. In 2013 FlexPath was the first direct assessment option to receive approval by a regional accreditor (the Higher Learning Commission) and the Department of Education for federal financial aid eligibility at the bachelor's and master's levels.

Polk State College's Engineering Technology OEEE Associate's Degree

This case study describes an Open Entry Early Exit (OEEE) program focused on untangling the web of systems, assumptions, roles, relationships, and interagency processes to address the national emphasis on affordable, compressed and flexible degree attainment, particularly in science, technology, engineering, and math (STEM) talent gap areas. To this end, Polk State College has empowered non-traditional students with an affordable, accessible option that was initiated as a result of a National Science Foundation's Advanced Technological Education (NSF-ATE) project award. The project was designed to transition a traditional Engineering Technology Associate in Science degree program to a hybrid competency-based, modular, non-term, self-paced, learner-centered, faculty-mentored format. As a work in progress, the OEEE program team has undertaken and resolved numerous challenges, many of which are still emergent, and identified significant breakthroughs to provide a catalyst to the reconceptualization of higher education.