Learners’ Perspectives on Competency-based Education

Abstract

I n the last decade of the 20th century, competency garnered a great deal of attention in medical education. Spurred by broader educational trends, many medical educators, administrators, and accrediting agencies shifted their educational emphasis from inputs to outputs, focusing less on what educators teach and more on what learners should be capable of doing. This fostered a great deal of discussion regarding which competencies physicians at various levels of training should be able to demonstrate. What should all graduating fourth-year medical students be able to do?What additional abilities should radiology residents be able to demonstrate by the end of their training? In 1999, the Accreditation Council of Graduate Medical Education endorsed new core competencies, expecting residency and fellowship programs to demonstrate their educational effectiveness in each of the following six areas: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Residents and fellows must demonstrate that they have achieved competence in each of these areas, and programs must prove that they are not only teaching but assessing and documenting learner performance. Also in 1999, the Indiana University School of Medicine adopted a competency-based curriculum, consisting of the following nine competencies: effective communication; basic clinical skills; using science to guide diagnosis, management, therapeutics, and prevention; lifelong learning; selfawareness, self-care, and personal growth; the social and community contexts of health care; moral reasoning and ethical judgment; problem solving; and professionalism and role recognition. Students are expected to achieve intermediate knowledge and skill in all areas by the end of the first 2 years, then progress to proficiency in all by the end of the third year, and finally to demonstrate advanced knowledge and skill in three of these areas by the end of the fourth year. Developing, implementing, and evaluating competencybased curricula at both the graduate and postgraduate levels