Competency-based Curriculum - An Overview on Development, Implementation & Accreditation

AAMC Annual Meeting – November 8, 2011

Current Directions in Competency Based Learning and Assessment

Robert Englander, MD, MPH

“The best thing for being sad. . .is to learn something.  That is the only thing that never fails.  You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins… you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds.  There is only one thing for it then--to learn.  Learn why the world wags and what wags it.  That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting.  Learning is the thing for you.”

Merlyn from TH White’s The Once and Future King

Learning Objectives:

1. Briefly explore the rationale for the paradigm shift to CBME

2. Enumerate challenges in the transition to CBME

3. Discuss current AAMC efforts to advance CBME

4. Begin to envision and create the future!

Competency-Based Medical Education: Why switch?

Why Switch?

1980s-1990s-Increased pressure from public for physician ACCOUNTABILITY and QUALITY

Why Switch?IOM was addressing the public’s concerns through an evaluation of Quality in Health Care, resulting in:

To Err is Human (1999) Crossing the Quality Chasm (2001)

Why Switch?Simultaneously and in response to the public outcries, the AAMC and ACGME focused on how we educate and evaluate physiciansThe MSOP and the ACGME Outcome Projects• Shifted focus from input (curriculum and teacher-driven)

to outcomes (learner-driven)• Defined the medical professional through “domains” of

competence

Why Switch?Thus, the focus on competency-based outcomes is the medical profession’s response to a public outcry• Outcomes drive curriculum increased accountability

The Paradigm ShiftVariable Structure/

ProcessCompetencyBased

Driving Force for Curriculum

Content & Knowledge Acquisition

Outcomes &Knowledge application

Driving Force for Process

Teacher Learner (s)

Path of Learning Hierarchy No Hierarchy

Responsibility For Learning

Teacher Student and Teacher

Framework for Evaluation of CompetenceVariable Structure/

ProcessCompetency-Based

Typical Assessment Tool

Proxy Authentic

Location of Assessment

Removed In the trenches

Evaluation Norm Referenced Criterion Referenced

Framework for Evaluation of Competence

Variable Structure/Process

Competency-Based

Typical Evaluation Tool

Subjective and Single

Objective and Multiple

Timing of Evaluation

Emphasis on summative

Emphasis on formative

Design Down ProcessGeneration of exit outcomes Course outcomes Outcomes for individual learning experiences

From Harden et al. An introduction to outcome-based education. Medical Teacher 200

Defining the Competencies

Patient Care (PC)Medical Knowledge (MK)Practice-Based Learning and Improvement (PBLI)Interpersonal and Communication Skills (ICS)Professionalism (P)Systems-Based Practice (SBP)

Sub-Competencies:Patient CareGather essential informationMake informed diagnostic/therapeutic decisionsCarry out management plansCounsel patients and familiesProvide health maintenance/anticipatory guidanceUse information technology to optimize care

The Perfect Storm• MSOP• Outcome Project• IOM reports• MOC/MOL• Carnegie Report -100 years after Flexner

Phase 1: July 2001 – June 2002

Phase 2: July 2002 – June 2006

Phase 3: July 2006 – June 2011

Phase 4: July 2011 and beyond

Response to the Change in Requirements

Focusing the Definitions and Assessments of the 6 Competencies

Full Integration of Competency Assessment and Clinical Care Outcomes

Expansion….. Develop and Share Models of Excellence

Adapted from www.acgme.org

ACGME Core Competencies2002

Programs were provided:

Little guidance

No tools for assessment

Little time for preparation

Challenge #1Assessment of competencies, including defining and recognizing “competence” at key transition points, such as:• Transition to clinical clerkships• Transition to junior resident (primary caregiver

with supervision)• Transition to supervisory resident• Transition to fellowship• Transition to practice

SolutionsThe Milestones Project (ACGME and ABMS sponsored)• Advanced stage for Pediatrics, Surgery and IM• In process for Ob/Gyn, Urology• Developing teams to work on Milestones for

most other specialties

Solutions

EPAC: Education in Pediatrics Across the Continuum (Debbie Powell leads with AAMC as key sponsor, partnering with ACGME, ABP)

Challenge #2

Reductionist vs Holistic Approach. Bringing Assessment into Real World Context

Solutions

Entrustable Professional Activities1-2: EPAsEPAC seeks to use EPAs to define competence at the various transition points

1. ten Cate O. Entrustability of professional activities and competency-based training. Medical Education. 2005;39(12):1176-1177.

2. ten Cate O, Scheele F. Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine. Jun 2007;82(6):542-547.

Challenge #3

Completing the transition to competency-based education• Seamless approach from pre-medical

requirements through the span of a physician’s career

• Variable time, learner-centered education (moving away from one-size-fits-all)

Solutions

• EPAC• Other specialties?

Challenge #4

Understanding, teaching, and assessing the new competencies :PBLI and SBP

Solutions• Inter-professional Education Collaboration

(IPEC) Competencies defined Pilot projects starting

• MedEdPortal: Over 150 curriculum focused on PBLI and SBP defined and linked to the competencies

• Aligning and Educating for Quality (AE4Q)• Medical School Admissions Transformation

Challenge #5Documenting performance levels in a manner that informs:• Life-long learner-centered improvement• Efficient documentation of competence for

licensing, credentialing, and certification• Programmatic opportunities for improvement

(UME, GME, CME)• Accountability to the public

Solutions

eFolio Connector (eFC)Joint project of the NBME and AAMC

Challenge #6

Faculty development for all of the above!

Solution

Teaching 4 Quality(Te4Q)

Thank you!

Questions?

Competency-based medical education at UCSF

Susan Masters, PhDAssociate Dean, CurriculumUndergraduate Medical EducationUniversity of California, San Francisco

CBME is being integrated into existing UCSF curriculum

1st yearFoundations of Patient Care (FPC)FPC

PrologueOrgans CV Organs P/R M&N BMB

4th year AdvanClerk

AdvanClerk

AdvanClerk

AdvanClerk

AdvanClerk

AdvanClerk

AdvanClerk

AdvanClerkCodaAdvan

Clerk

2nd year I-3 Life CycleFPC

M-3FPC Core Clerkship

Block 1CC2

Sept Nov Jan Mar May July

Core Clerkship Block 4

Core Clerkship Block 3

Core Clerkship Block 5

Core Clerkship Block 6

AdvanClerk

AdvanClerk

AdvanClerk

CC23rd year

CBME at UCSF has come a long wayTEAM/RESOURCES STAGES

TARGET

SUCCESSFACTORS

True CBME

All those thingsBob said!

2005 20112007 2009 2010

Key curriculum committee charged re student assess-ment(COSA)

Key portfolio committee charged

Course and clerkship objectives linked to competency

Focus on critical reflection curriculum

2nd key curriculum committee (eCAMP)

Key shift in competency advising (to faculty closer to students)

Competency directors appointed

Milestones for all 4 yrs

MD Portfolio introduced for 1st yrs

More assess-ments reported in competency language

Med Ed leadership

Educational technology gp

Educational research gp

Course & clerk-ship directors

Student ambassadors

Thoughtfulresearch

Educator culture shift

Meaningful to learners

Confidence in measures

CBE Partnerships at UCSF

CBME at UCSF, including milestones: http://medschool.ucsf.edu/curriculum/competencies/

More information:

UCSF’s MD Portfolio: http://medschool.ucsf.edu/curriculum/competencies/portfolio.aspx

• Co-curricular programs (MSTP, Pathways to Discovery)

• Interprofessional health education

• GME programs

Thank you!

Questions?

Design a Comprehensive Assessment System in Preparation for Curricular Change

Cynthia H Ledford, MD, FAAP, FACPAssistant Dean of Evaluation and AssessmentOhio State University College of Medicine

Why Now? Build on Past Successes

• Personalized Medical Education

• Deliberate Practice• Horizontal and Vertical

Integration of Learning• Advanced Competencies

Institutional tradition of innovation and continuous educational improvement and change

Response to external indicators and forces calling for medical education reform

LeadServeInspire Curriculum Design

Instruction

Clinical Practice

Things to notice:Career ExplorationComprehensive Assessment Periods

LeadServeInspireKey Features• Fully integrated• Flexible learning• Competency Based

EFFICIENT and EFFECTIVE Allows students to explore and

achieve more

Key Benefits• Personalized Medical

Education• Mentored Educational Portfolio• Advanced Competencies• Assured Competency• Systematic Assessment of

Progress• Defined Levels of Competency

LeadServeInspire

Longitudinal ProjectsCommunity Health Education Longitudinal Health Coach

Interprofessional Systems Based Thinking Patient Safety

Part ThreeAdvanced

Clinical Management

4 Years18 months 12 months 18 months

LeadServeInspire

• Mentored Portfolio

• Clear Milestones

• Opportunities for More

Keys to Success

LeadServeInspire

Doing More

•Formalized deliberate career exploration during flexible times (Part 1 through 3)

•Longitudinal project work – make a real difference

•Specialty focused Advanced Clinical Tracks

•Advanced competencies

LeadServeInspireChallenges:• In the setting of Personalized Medical Education (high

degree of flexibility), what are the best methods for tracking and managing individual learning?

• Given the complexity of the Core Educational Objectives, what strategies can be used to assure every student meets every competency at each level of the curriculum?

• Are faculty prepared for this type of curriculum?

How do you want to learn this?

Are you ready to be assessed?

Do you know how this connects to

learning before/after and

your core educational objectives?

Are you ready to move on? Let’s add this to your learning

PortfolioFor each Stepwise Learning Outcome

LeadServeInspire Faculty Development & Retention Task Force

• Role specific faculty development• Sets them up for success in their roles• Flexible delivery models

Challenges:• Faculty needs assessment

• Identify roles and essential skills• Identifying and recruiting teaching experts• Utilizing technology in the classroom and beyond

• Innovation grants to support mobile app development• Technology showcases• In-place technology training (department meetings)

LeadServeInspire Faculty DevelopmentFaculty Development for Medical Educators

(FD4ME)• Online modules• Earn CME• Scheduling and

Tracking Database

FD4ME.osu.edu

Thank you!

Questions?