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MedEdWorld Updates highlight useful and easily accessible sources of information on key and important topics in medical education contributed by leading experts from around the world.

U P D AT E O N OUTCOME/

COMPETENCY-BASED MEDICAL EDUCATION

Useful resources on MedEdWorldDr Catherine Kennedy, AMEE Education Officer

GLOSSARY Outcome-based education is a performance-based approach that has been defined as, ‘results-orientated thinking’ (Harden and Laidlaw, 2012:37-38). It requires:

• Learning outcomes of what is expected at the end of each phase of training to be clearly stated, explicit and communicated;

• Decisions about the curriculum (content, educational strategies, teaching methods and assessment) to be based on agreed learning outcomes; and

• An agreed vision that students will succeed by achieving the exit outcomes before the end of their studies (Harden and Laidlaw, 2012:37).

Competency-based education has been defined as:

“…an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organised around competencies derived from an analysis of societal and patient needs. It de-emphasises time-based training and promises greater accountability, flexibility and learner-centeredness.” (Frank et al., 2010:636).

As a result it may be argued that the terms ‘outcome’ and ‘competency’ – based have much in common, with a difference in terminology a function on the geographical origin of the work.

References FRANK, J. R., MUNGROO, R., AHMAD, Y., WANG, M., DE ROSSI, S. & HORSLEY, and T. (2010) ‘Toward a definition of competency-based education in medicine: a systematic review of published definitions’. Medical Teacher, 32, 631-637.

HARDEN, R. & LAIDLAW, J. (2012) Essential Skills for a Medical Teacher: An Introduction to Teaching and Learning in Medicine. Edinburgh: Churchill Livingstone Elsevier.

The MedEdWorld Glossary can be accessed at www.mededworld.org/Glossary.aspx

MedEdWorldA global online medical education community

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SHUMWAY, J. M. & HARDEN, R. M. (2003) ‘AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician’. Medical Teacher, 25, 569-584.www.mededworld.org/Publications/Articles/AMEE-Guide-No-25-The-assessment-of-learning-outcom.aspxThis article contains a list of recommendations set out by the UK GMC regarding assessment and a comprehensive list of assessment methods in use.

SWING, S. R. (2010) ‘Perspectives on competency-based medical education from the learning sciences’. Medical Teacher, 32, 663-668.www.mededworld.org/Publications/Articles/Perspectives-on-competency-based-medical-education.aspx CBME from the perspective of the learning sciences.

TABER, S., FRANK, J. R., HARRIS, K. A., GLASGOW, N. J., IOBST, W. & TALBOT, M. (2010) ‘Identifying the policy implications of competency-based education’. Medical Teacher, 32, 687-691.www.mededworld.org/Publications/Articles/Identifying-the-policy-implications-of-competency.aspxAn examination of the concepts of CBME through a broad educational policy lens.

TEN CATE, O. (2014) ‘The false dichotomy of quality and quantity in the discourse around assessment in competency-based education’. Advances in Health Sciences Education, 1-4.www.mededworld.org/Publications/Articles/The-false-dichotomy-of-quality-and-quantity-in-the.aspxThe author argues that the common dichotomy of either having competency-based or time and procedures based education is not useful, and may even compromise education.

TEN CATE, O. & BILLETT, S. (2014) ‘Competency-based medical education: origins, perspectives and potentialities’. Medical Education, 48, 325-332.www.mededworld.org/Publications/Articles/Competency-based-medical-education-origins,-perspe.aspxPart of the ‘Dialogue’ series, a transcription of an email discussion between two leading scholars.

TEN CATE, T. J. O., SNELL, L. & CARRACCIO, C. (2010) ‘Medical competence: The interplay between individual ability and the health care environment’. Medical Teacher, 32, 669-675.www.mededworld.org/Publications/Articles/Medical-competence-The-interplay-between-individua.aspxThe authors’ propose that competence and competencies be approached in the context of the particular clinical environment, and assessment of competence is tied to a trainee’s performance of essential clinical activities that define the profession.

VAN DER VLEUTEN, C. P. M. & SCHUWIRTH, L. W. T. (2005) ‘Assessing professional competence: from methods to programmes’. Medical Education, 39, 309-317.www.mededworld.org/Publications/Articles/Assessing-professional-competence-from-methods-to.aspxProgrammatic instructional design hinges on a careful description and motivation of choices, whose effectiveness should be measured against the intended outcomes.

WASS, V., VAN DER VLEUTEN, C., SHATZER, J. & JONES, R. (2001) ‘Assessment of clinical competence’. Lancet, 357, 945-9.www.mededworld.org/Publications/Articles/Assessment-of-clinical-competence.aspxThe paper explains the levels on Miller’s pyramid and provides examples of assessment methods for the different levels and shows the concept of “blueprinting” of assessments.

WEINBERGER, S. E., PEREIRA, A. G., IOBST, W. F., MECHABER, A. J. & BRONZE, M. S. (2010) ‘Competency-Based Education and Training in Internal Medicine’. Annals of Internal Medicine, 153, 751-756.www.mededworld.org/Publications/Articles/Competency-Based-Education-and-Training-in-Interna.aspxThe Alliance for Academic Internal Medicine Redesign Task Force II examines the advantages and challenges of a competency-based educational framework for medical residents.

MedEdPUBLISHFitzgerald, A., Ashar, B., Feldman, L., Gibbons, M.C. & Stewart, R.W. (2013) Applying a leadership model to the Johns Hopkins Urban Health residency training program. MedEd Publishwww.mededworld.org/MedEdWorld-Papers/Papers-Items/Applying-a-leadership-model-to-the- Johns-Hopkins-U.aspxThe development of a leadership skill-set model at Johns Hopkins University School of Medicine (JHUSOM) for application to physicians at all levels of training and in all fields.

Ma, I., Chapelsky, S., Bhavsar, S., Connors, W., Fisher, M., Schaefer, J. & Bacchus, M. (2013) Procedural Certification Program: Enhancing Resident Procedural Teaching Skills. MedEd Publishwww.mededworld.org/MedEdWorld-Papers/Papers-Items/Procedural-Certification-Program-Enhancing-Residen.aspxResidents are frequently asked to supervise bedside procedures. This study aims to evaluate the effectiveness of the Procedural Certification Program in improving residents’ procedural teaching skills.

Sandhu, G., Rich, J. & Walker, G.R (2013) New ways to talk about the C-word: Pssst…it’s still CanMEDS. MedEd Publishwww.mededworld.org/MedEdWorld-Papers/Papers-Items/New-ways-to-talk-about-the-C-word-Pssst%E2%80%A6it%E2%80%99s-still.aspxThis study approached residents and faculty members involved in Postgraduate Medical Education at Queen’s University, Ontario, to learn why many were tired of hearing about CanMEDS.

Wang, C., Bratu, I., Lewis, M., Voaklander, D., & Gladwin, C. (2013) Pediatric trauma, advocacy skills and medical students. MedEd Publishwww.mededworld.org/MedEdWorld-Papers/Papers-Items/Pediatric-trauma,-advocacy-skills-and-medical-stud.aspxThis study utilised paediatric trauma prevention as a stepping stone for assessing advocacy competency.

RESOURCESConference video: Large Group Session: CanMEDS and outcomes-based educationwww.mededworld.org/Resources/Resources-Items/Large-Group-Session-CanMEDS-and-outcomes-based-edu.aspxJason R Frank at AMEE 2009.

Conference video: Large Group Session: Competency-based postgraduate training and the concept of entrustmentwww.mededworld.org/Resources/Resources-Items/Large-Group-Session-Competency-based-postgraduate.aspxOlle ten Cate at AMEE 2009.

Conference video: Large Group: Discussion: Competency-based postgraduate education www.mededworld.org/Resources/Resources-Items/Large-Group-Competency-based-postgraduate-educatio.aspxDavid Gordon, Jason Frank and Olle Ten Cate at AMEE 2009.

Video lecture: Rethinking the Discourse of Competence in the Context of Teamwork: Collective Competence? www.mededworld.org/Resources/Resources-Items/Collective-Competence-Rethinking-the-Discourse-of.aspxPresentation by Lorelei Lingard.

Video lecture: Are We Serious about Practicing What We Preach?: Competency-Based vs. Faith-Based Educationwww.mededworld.org/Resources/Resources-Items/Competency-Based-vs-Faith-Based-Education- Are-We-S.aspxPresentation by Marry Gruppen.

FORUMSMethod of the Month – Competency-based medical educationwww.mededworld.org/Forums/f129/fp1/t9053/Competency-based-medical-education.aspxPost your queries, ideas and suggestions about CBME here for discussion with colleagues.

You can also add your recommendations on topics for discussion to a forum available on the MedEdWorld site.

Including reports, websites, video clips, images and diagrams.

A space for debating a wide range of topics of current interest to the health professions.

Copies of this and other MedEdWorld Updates can be located in the Resources section of MedEdWorld. This will give you direct access through hyperlinks to all the webpages listed in the summary.

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WEBINARSAn Introduction to Competency-Based Outcomes EducationDate: 2013Presenter: Jason R Frank Host Institution: Royal College of Physicians and Surgeons of Canada, University of Ottawa, Canadawww.mededworld.org/Webinars/Webinar-Items/An-Introduction-to- Competency-based-Outcomes-E.aspx This webinar introduces the key concepts and planning process for a CBME programme. This session is a “must-do” for all those contemplating using competencies as an organising framework for a new curriculum.

CBME 201: Step-by-Step Implementation of Competency-Based Medical EducationDate: 2013Presenter: Jason R Frank Host Institution: Royal College of Physicians and Surgeons of Canada, University of Ottawa, Canadawww.mededworld.org/Webinars/Webinar-Items/AMEE-MEW-Webinar-79-CBME-201-Step-by-Step- Imple.aspxThis intermediate level session reviews an approach to designing your own CBME curriculum, big or small. By the end of this intermediate level session, participants will be able to apply the concepts of CBME and begin the design of their own CBME programme.

Outcome-Based Education (OBE) for the practising teacherDate: 2010 Presenter: Ronald HardenHost Institution: AMEEwww.mededworld.org/Webinars/Webinar-Items/Outcome-based-Education-%28OBE%29-for-the-practising-t.aspxThis webinar explores the implications of implementing an OBE approach in undergraduate or postgraduate medical education.

Assessment of Competence in a Post-Psychometric EraDate: 2010 Presenter: Brian Hodgeswww.mededworld.org/Webinars/Webinar-Items/Assessment-of-Competence-in-a-Post-Psychometric- Er.aspxThis webinar explores the implications of a shift to competence-based and workplace-based assessment.

TEXTBOOKSBURKE, J. W. (ed.) (1989) Competency Based Education and Training, Lewes, East Sussex: The Falmer Press.www.mededworld.org/Publications/Textbooks/Competency-Based-Education-and-Training.aspxAn edited collection by leading educationalists.

CURRY, L. & Wergin, J.F. (1993) Educating Professionals: Responding to New Expectations for Competence and Accountability, London, John Wiley and Sons.www.mededworld.org/Publications/Textbooks/Educating-Professionals-Responding-to-New- Expectat.aspxEducating professionals for the 21st century requires stronger bonds between educational systems and practice––including more accurate measures of competence and integrated continuing professional education.

HARDEN, R. M. (2013) ‘Outcome-based education’. In: DENT, J. A., & HARDEN, R.M. (ed.) A Practical Guide for Medical Teachers. 4 ed. London: Churchill Livingstone Elsevier.www.mededworld.org/Publications/Textbooks/A-Practical-Guide-for-Medical-Teachers-%284th-Ed-%29.aspxChapter 18.

HARDEN, R. & LAIDLAW, J. (2012) Essential Skills for a Medical Teacher: An Introduction to Teaching and Learning in Medicine. Edinburgh: Churchill Livingstone Elsevier.www.mededworld.org/Publications/Textbooks/Essential-Skills-for-the-Medical-Teacher.aspxSection 2 on Learning outcomes and outcome-based education.

Hour-long interactive presentations with experts in medical education

A selection of texts recommended on MedEdWorld

A selection of key articles recommended by the MedEdWorld Community

HODGES, B. D., & LINGARD, L. (ed.) (2012) The Question of Competence: Reconsidering Medical Education in the Twenty-First Century (The Culture and Politics of Health Care Work), Ithaca, NY: ILR Press.www.mededworld.org/Publications/Textbooks/The-Question-of-Competence-Reconsidering-Medic-%281%29.aspxThe authors in this collection explore different perspectives on competency-based medical education.

HOLMBOE, E. S., & HAWKINS, R.E. (2008) Practical Guide to the Evaluation of Clinical Competence, Mosby.www.mededworld.org/Publications/Textbooks/Practical-Guide-to-the-Evaluation-of-Clinical-%282%29.aspxA practical guide to outcomes-based assessment in clinical education delivers important evaluation methods, tools, and faculty training approaches for all medical educators.

JOURNAL ARTICLESBOK, H., TEUNISSEN, P., FAVIER, R., RIETBROEK, N., THEYSE, L., BROMMER, H., HAARHUIS, J., VAN BEUKELEN, P., VAN DER VLEUTEN, C. & JAARSMA, D. (2013) ‘Programmatic assessment of competency-based workplace learning: when theory meets practice’. BMC Medical Education, 13, 123.www.mededworld.org/Publications/Articles/Programmatic-assessment-of-competency-based-workpl.aspxThe interaction of current theories on programmatic assessment with educational practice in a competency-based curriculum.

BRIGHTWELL, A. & GRANT, J. (2012) Competency-based training: who benefits? Postgraduate Medical Journal.www.mededworld.org/Publications/Articles/Competency-based-training-who-benefits.aspxThis paper examines who benefits from a competency based approach to medical education: regulators and service providers, assessors, or the doctor in training?

CAMPBELL, C., SILVER, I., SHERBINO, J., CATE, O. T. & HOLMBOE, E. S. (2010) ‘Competency-based continuing professional development’. Medical Teacher, 32, 657-662.www.mededworld.org/Publications/Articles/Competency-based-continuing-professional-developme.aspxThis paper describes the assumptions, advantages, and challenges of establishing a CPD system focused on competencies that improve physician performance and the quality and safety of patient care.

DATH, D. & IOBST, W. (2010) ‘The importance of faculty development in the transition to competency-based medical education’. Medical Teacher, 32, 683-686.www.mededworld.org/Publications/Articles/The-importance-of-faculty-development-in-the-trans.aspxA rationale for faculty development as an essential element of the implementation of CBME programmes.

FRANK, J. R., MUNGROO, R., AHMAD, Y., WANG, M., DE ROSSI, S. & HORSLEY, T. (2010) ‘Toward a definition of competency-based education in medicine: a systematic review of published definitions’. Medical Teacher, 32, 631-637.www.mededworld.org/Publications/Articles/Toward-a-definition-of-competency-based-education.aspxA systematic review of competency-based education-related literature in order to identify key terms and constructs to inform the development of a useful working definition of CBE for medical education.

FRANK, J. R., SNELL, L. S., CATE, O. T., HOLMBOE, E. S., CARRACCIO, C., & SWING, S. R. et al. (2010) ‘Competency-based medical education: theory to practice’. Medical Teacher, 32, 638-645.www.mededworld.org/Publications/Articles/Competency-based-medical-education-theory-to-pract.aspxA review of the scholarly literature, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators, and exploring future directions for preparing health professionals.

GINSBURG, S., MCILROY, J., OULANOVA, O., EVA, K. & REGEHR, G. (2010) ‘Toward Authentic Clinical Evaluation: Pitfalls in the Pursuit of Competency’. Academic Medicine, 85, 780-786. www.mededworld.org/Publications/Articles/Toward-Authentic-Clinical-Evaluation-Pitfalls-in-t.aspxThe purpose of this study was to better understand the tensions that exist between competency frameworks and faculty’s real-life experiences in evaluating residents.

GOTTERER, G. S., PETRUSA, E., GABBE, S. G. & MILLER, B. M. (2009) ‘A Program to Enhance Competence in Clinical Transaction Skills’. Academic Medicine, 84, 838-843. www.mededworld.org/Publications/Articles/A-Program-to-Enhance-Competence-in-Clinical-Transa.aspxThe development of a structured curriculum at Vanderbilt Medical School, integrated into the traditional clerkships of the third and fourth years, to ensure students receive instruction in clinical transaction skills.

HARRIS, P., SNELL, L., TALBOT, M. & HARDEN, R. M. (2010) ‘Competency-based medical education: implications for undergraduate programs’. Medical Teacher, 32, 646-650.www.mededworld.org/Publications/Articles/Competency-based-medical-education-implications-fo.aspxThis article reviews a number of issues raised by CBME in the context of undergraduate programmes and provides examples of best practices that might help to address these issues.

HOLMBOE, E. S., SHERBINO, J., LONG, D. M., SWING, S. R. & FRANK, J. R. (2010) ‘The role of assessment in competency-based medical education’. Medical Teacher, 32, 676-682.www.mededworld.org/Publications/Articles/The-role-of-assessment-in-competency-based-medical.aspxAn overview of some of the requirements necessary when designing an assessment system for competency-based medical education (CBME).

HOLMBOE, E. S., WARD, D. S., REZNICK, R. K., KATSUFRAKIS, P. J., LESLIE, K. M., PATEL, V. L., RAY, D. D. & NELSON, E. A. (2011) ‘Faculty Development in Assessment: The Missing Link in Competency-Based Medical Education’. Academic Medicine, 86, 460-467. www.mededworld.org/Publications/Articles/Faculty-Development-in-Assessment-The-Missing-%281%29.aspxSuggestions on where faculty development efforts should be focused and how such initiatives might be accomplished.

IOBST, W. F., SHERBINO, J., CATE, O. T., RICHARDSON, D. L., DATH, D., SWING, S. R., HARRIS, P., MUNGROO, R., HOLMBOE, E. S. & FRANK, J. R. (2010) ‘Competency-based medical education in postgraduate medical education’. Medical Teacher, 32, 651-656. www.mededworld.org/Publications/Articles/Competency-based-medical-education-in-postgraduate.aspxA review of the rationale and the implications of a competency-based approach to PGME.

JOLLY, B. (2012) ‘Shining light on competence’. Medical Education, 46, 346-348.www.mededworld.org/Publications/Articles/Shining-light-on-competence.aspxA commentary.

LOWRY, B. N., VANSAGHI, L. M., RIGLER, S. K. & STITES, S. W. (2013) ‘Applying the Milestones in an Internal Medicine Residency Program Curriculum: A Foundation for Outcomes-Based Learner Assessment under the Next Accreditation System’. Academic Medicine, 88, 1665-1669. www.mededworld.org/Publications/Articles/Applying-the-Milestones-in-an-Internal-Medicine-Re.aspxThis article reviews the implementation process, and discusses work to create a documentation system for direct observation of entrustable professional activities.

LURIE, S. J. (2012) ‘History and practice of competency-based assessment’. Medical Education, 46, 49-57.www.mededworld.org/Publications/Articles/History-and-practice-of-competency-based-assessmen.aspxThe historical trends towards framing the expectations of doctors in terms of global competencies.

LURIE, S. J., MOONEY, C. J. & LYNESS, J. M. (2011) ‘Commentary: Pitfalls in Assessment of Competency-Based Educational Objectives’. Academic Medicine, 86, 412-414.www.mededworld.org/Publications/Articles/Commentary-Pitfalls-in-Assessment-of-Competency-Ba.aspxThis commentary highlights some of the difficulties in the assessment of competency-based educational objectives which may affect test validity.

MOOKHERJEE, S., CHANG, A., BOSCARDIN, C. K. & HAUER, K. E. (2013) ‘How to develop a competency- based examination blueprint for longitudinal standardized patient clinical skills assessments’. Medical Teacher, 35, 883-890.www.mededworld.org/Publications/Articles/How-to-develop-a-competency-based-examination-blue.aspxThe development of an examination blueprint to optimise assessment and feedback to learners with purposeful sequence of longitudinally integrated assessments based on performance milestones.

MORCKE, A., DORNAN, T. & EIKA, B. (2013) ‘Outcome (competency) based education: an exploration of its origins, theoretical basis, and empirical evidence’. Advances in Health Sciences Education, 18, 851-863.www.mededworld.org/Publications/Articles/Outcome-%28competency%29-based-education-an-exploratio.aspxThis paper explores the underpinnings of outcome-based education (OBE), its origins, theoretical basis and empirical evidence of its effects.

NORMAN, G., NORCINI, J. & BORDAGE, G. (2014) ‘Competency-Based Education: Milestones or Millstones?’ Journal of Graduate Medical Education, 6, 1-6.www.mededworld.org/Publications/Articles/Competency-Based-Education-Milestones-or-Millstone.aspxA constructive critique of competency-based education.

ORGILL, B. D. & SIMPSON, D. (2014) ‘Toward a Glossary of Competency-Based Medical Education Terms. Journal of Graduate Medical Education’, Journal of Graduate Medical Education, 6, 203-206.www.mededworld.org/Publications/Articles/Toward-a-Glossary-of-Competency-Based-Medical-Educ.aspxIn this paper the authors attempt to identify the “key elements” of commonly used CBME terms to create a succinct definition for each term.

SCICLUNA, H., GRIMM, M., O’SULLIVAN, A., HARRIS, P., PILOTTO, L., JONES, P. & MCNEIL, H. (2012) ‘Clinical capabilities of graduates of an outcomes-based integrated medical program’. BMC Medical Education, 12, 23.www.mededworld.org/Publications/Articles/Clinical-capabilities-of-graduates-of-an-outcomes.aspxThis paper presents an initial evaluation of an innovative new 6-year undergraduate entry outcomes-based integrated medical programme at the University of New South Wales in 2004.







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