Competency-based Medical Education Research Articles

The evolution of academic advisor and resident dyadic coaching relationships: a two-year longitudinal qualitative study.

Implementing competency based medical education (CBME) has generated enormous amounts of assessment data. To help residents synthesize and use these data, some programs have appointed academic advisors (AA) to 'coach over time'. This study explored how resident and faculty AA dyads perceived their relationship developing and evolving, and the extent to which it aligned with 'coaching over time'. Over a two-year period at four separate time-points, we conducted longitudinal qualitative interviews with nine dyads of Internal Medicine residents (32 interviews) and their paired AA (27). We used constructivist grounded theory to develop a conceptual understanding of how AA-resident relationships evolved. Three major themes were identified. 'Building the Relationship' included elements perceived to facilitate or impede growth of the relationship. Most relationships flourished, facilitated by passage of time, 'fit' between the two, and often by working together clinically. Still, many residents perceived the need to 'save face' with their AAs. 'Enacting the AA Role' had features that appeared to align more with mentorship than coaching. 'Finding Meaning in the Relationship' underscored the perceived value fostered by the longitudinal pairing. The relationships often, but not always, achieved far-reaching benefits, though not necessarily limited to those intended by the program. Our study helps us understand what 'coaching over time' might look like for large residency programs wherein residents rotate through many sites and services. The dyads created an opportunity for a coaching relationship to form and develop in beneficial ways, though it was different to and went beyond the narrower focus on meeting CBME requirements.

Readiness of undergraduate medical students to health research and factors influencing it in a medical college – A cross-sectional study

Objectives: Developing, maintaining, and sustaining undergraduate medical students’ research involvement will enable future healthcare practitioners to practice more appropriate evidence-based clinical medicine. This study aim to assess the readiness for health research and factors promoting it among Undergraduate medical students. Materials and Methods: A descriptive cross-sectional study was conducted among undergraduate medical students in Puducherry over 3 months (August–October 2023). Systematic random sampling was applied to recruit 360 study participants. A validated pre-tested semi-structured self-administered questionnaire was used to gather data on sociodemographic, readiness, participation, attitude, perceived motivational factors, and barriers toward health research. Data were entered in MS EXCEL 2019 and analyzed using the Statistical Package for the Social Sciences v16.0. The quantitative variables were represented in mean and qualitative variables in proportion. Chi-square test and logistic regression analysis were applied to identify the factors influencing readiness to health research among undergraduate Bachelor of Medicine and Bachelor of Surgery students. Results: A total of 360 participants with a mean age of 20.7 ± 0.64 were recruited, demonstrating a nearly equal gender distribution (male 48.3% and female 51.7%). Approximately 76.4% scored ≥60% in their recent university examinations, and 86.7% resided in hostels. While 11.4% reported prior participation in health research, 32.5% expressed readiness to participate, influenced by factors such as the competency-based medical education (CBME) approach and academic performance (P = 0.043). Major barriers identified included lack of funding (88.8%), lack of time (80.3%), and mentorship (52.9%). Logistic regression analysis revealed that higher examination grades significantly increased readiness to research (aOR: 1.936, P = 0.027) and also participation for health research (aOR: 3.366, P = 0.029), while non-CBME participants showed lower odds of participation (aOR: 0.321, P = 0.006). Conclusion: Medical institutes should implement structured mentorship programs, require research courses as part of the curriculum, and provide sufficient funding for student-led projects. Addressing these strategies within the institutes could foster a research-oriented culture, thus ultimately improve quality patient care and broader medical knowledge.

A Rollercoaster of Grades Versus Growth in the Clerkship Year: A Phenomenological Study of Medical Student Experience with Competency Development.

As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated. In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles. These students experienced the same clerkship curriculum and requirements with additional CBME components such as coaching, an entrustment committee to review their data, a dashboard to visualize their assessment data in real-time, and meeting as a community of practice. Students shared their experiences with growth during the clerkship year. They conveyed the importance of learning from mistakes, but pushing past their discomfort with imperfect performance was a challenge when they feel pressure to perform well for grades. This tension led to significant effort spent on impression management while also trying to identify their role, clarify expectations, and learn to navigate feedback. Tension exists in the clinical environment for clerkship students between an orientation that focuses on maximizing grades versus maximizing growth. The former defined an era of medical education that is fading, while the latter offers a new vision for the future. The threats posed by continuing to grade and rank students seems incompatible with goals of implementing CBME.

In the Eye of the Beholder: A Stakeholder Analysis of the Value of the "Promotion in Place" Competency-Based Time-Variable Graduate Medical Education Pilot.

Competency-based time-variable (CBTV) graduate medical education (GME) has been implemented in Canada, Europe, and the United States, yet its perceived value has not been explored. Promotion in Place (PIP) is a CBTV GME program in which residents graduating early advance to attending status with "sheltered independence" until the standard graduation date. This study describes perceived value of CBTV GME and PIP at Mass General Brigham by capturing diverse stakeholder perspectives. In this stakeholder analysis using semistructured interviews (June 2022-August 2023), 49 participants were invited (44 representative members and 5 external stakeholders) from 11 GME programs: PIP eligible residents, program directors (PDs), chairs, service chiefs, and external national medical education organization leaders. Authors' understanding of value was informed by Harvey and Green's conceptualization of quality in higher education as "fit for purpose," "standards monitoring," "transformation," and "value for the money." Deductive codes and inductive subcodes captured diverse perspectives of value. Of the 49 invited stakeholders, 34 (69%) were interviewed across 5 stakeholder groups. Nearly all groups cited aspects of PIP that are "fit for purpose" as evidence of value; PIP supported "workforce readiness" and provided "sheltered independence" as intended. External stakeholders, PDs, service chiefs, hospital leadership, and faculty cited value aligning with "standards monitoring" (e.g., PIP must maintain or improve patient and resident outcomes). Nearly all groups cited aspects of PIP aligning with "transformation" as evidence of value. PIP promoted "independent decision-making" and enhanced trainee confidence. Chairs cited aspects of PIP aligning with "value for the money" (e.g., "cost neutral" as optimal for sustainability and avoidance of "hidden costs" such as assessment burden). Understanding perceptions of PIP and CBTV GME value is critical to engaging diverse stakeholders and extending CBTV GME to more programs and specialties. PIP's transformative nature underscores the added value of CBTV GME.

Objective Structured Clinical Examination to Assess Patient Safety Competencies of Japanese Medical Students: Development and Validation Argument.

Background The growing emphasis on improving patient safety over the past two decades has received more focus in the undergraduate curricula, and the appropriate assessment of patient safety competencies at graduation is crucial in competency-based medical education. However, there is no valid method for assessing patient safety competencies because current assessment methods in medical education focus less on behavior. The objective structured clinical examination (OSCE) is a method to assess clinical performance and has been implemented by medical schools in Japan for summative assessment at graduation. However, stations with sufficient validity to assess patient safety competencies have not yet been developed. Thus, this study aimed to evaluate, under a contemporary validity framework, an OSCE station for assessing patient safety competencies that students are expected to achieve at graduation from medical schools in Japan. Methods A validity argument was conducted using Messick's validity framework, which includes content, response process, relations to other variables, internal structure, and consequences. First, we applied a modified Delphi study to develop OSCE stations for assessing patient safety competencies based on the national model core curriculum at graduation. The panel survey recruited members who have expertise in clinical education and patient safety. The draft stations simulated various situations associated with patient safety. Final-year medical students then took the OSCE. We analyzed the results of the OSCE, compared the scores with those of the clinical reasoning examination, and evaluated its reliability. Results Out of 30 panelists, 22 (73.3%) fully participated in the Delphi rounds. After two Delphi rounds, we established four stations to assess patient safety competencies. They met the content dimension of the validity framework. The OSCE results showed low correlation with clinical reasoning, suggesting that patient competencies cannot be inferred from clinical reasoning. Each station had satisfactory reliability. The entire process minimized possible assessment bias. Conclusions The OSCE scenario designed through the modified Delphi study met the five criteria of Messick's validity framework. The results show that it is a valid strategy for assessing patient safety competencies at graduation.

Navigating the Global Landscape of Social Obligation in Medical Education: An Independent Comprehensive Exploration

This paper examines social accountability in medical education, focusing on its potential to address health inequities. Social accountability, as defined by the World Health Organization, encourages medical institutions to align education, research, and service activities with community health priorities. Through frameworks like ASPIRE and CARE, medical schools worldwide are incorporating social accountability, with notable examples such as Northern Ontario School of Medicine (NOSM) and Patan Academy of Health Sciences serving under-resourced communities. However, challenges remain, including the absence of standardized assessment metrics, resource limitations, and varied interpretations of social accountability across regions. International efforts underscore the importance of community collaboration in developing socially accountable curricula. In India, social accountability initiatives address healthcare challenges through community placements, telemedicine, and collaborations with global partners. The Competency-Based Medical Education (CBME) model presents an opportunity to integrate social responsibility across training and patient care. Despite advancements, there is a need for adaptable frameworks and tools to measure the impact of social accountability in diverse contexts. This paper advocates for a unified yet context-sensitive approach, allowing institutions to respond effectively to local health needs while contributing to broader global health goals. Limitations include the study’s focus on existing global practices, without detailing novel, region-specific strategies for implementing and assessing social accountability programs.

Perception and Impact of the Family Adoption Program (FAP) Among Indian Medical Students: Benefits and Challenges.

Background The National Medical Commission of India recommends the Family Adoption Program (FAP) under Competency-Based Medical Education (CBME) in the MBBS curriculum. Medical students can witness firsthand the living situations of the people they treat as patients in the hospital through community participation. Students also learn how various health factors impact patients in real-world settings. This study aimed to assess the perceived benefits and impact of FAP in the educational and professional development of medical students and explore the challenges and critical facilitators for medical students participating in FAP. Methodology First, second, and third-year medical undergraduate students who were enrolled in FAP by the Department of Community Medicine participated in an observational study during the last visit of FAP by using a structured questionnaire on the perception of the benefits of FAP and its possible future impact, as well as an investigation of the obstacles and enablers encountered when conducting FAP. Results Approximately 90% of the 305 students who participated believed that FAP is beneficial for their own personal and professional growth. Additionally, they mentioned that faculty engagement was the main factor that encouraged them to participate in FAP, with the benefits outweighing the challenges. Conclusions Medical students often find it difficult to get involved in family adoption programs, but they can be helped by a friendly environment, the correct tools, and mentorship. Medical schools can encourage a future generation of healthcare providers who are more involved and empathetic by addressing these issues and strengthening essential facilitators.

A Mixed-Methods Investigation of First-Year Medical Students’ Professionalism Competency Development over the Gross Anatomy Course

Abstract Background While competency-based medical education (CBME) and competency assessment in clinical training are well documented, they are less commonly included in preclinical medical education. The gross anatomy laboratory is an opportune setting to incorporate competency assessment and reflection during preclinical medical education. This mixed-methods study determined how first-year medical student assessments of professionalism skills in the gross anatomy lab change over time and analyzed student reflections to contextualize the experiences they had developing the Professionalism competency. Methods First-year medical students at the University of Louisville completed self- and peer-assessments using the Professionalism Assessment Scale (PAS) at the beginning and end of their gross anatomy course (n = 83). The students also completed three competency development portfolio (CDP) entries throughout the course (n = 83). Qualitative thematic analysis with grounded theory was used to analyze comments related to professionalism skill development in the CDP reflections during the course. Results There was no statistical difference in PAS self-assessment scores from Time 1 (M = 4.81, SD = .209) to Time 2 (M = 4.85, SD = .217), p = .108. There was a statistically significant increase in PAS-peer-assessment scores from Time 1 (M = 4.89, SD = .165) to Time 2 (M = 4.93, SD = .127), p = .005. Thematic analysis of CDPs revealed that students believed they developed interpersonal relations/social skills, responsibility skills, and gross anatomy lab-specific skills over the gross anatomy course. Conclusions The Professionalism competency is inherently present and able to be assessed in the gross anatomy lab context for first-year medical students.

Competency-based medical education in interventional pulmonology: current state and future opportunities.

This chapter examines the evolution and current status of competency-based medical education (CBME) in interventional pulmonology, focusing on procedural skills assessment and training. Traditionally, interventional pulmonology training has used an apprenticeship model with case logs and director attestation, leading to inconsistent outcomes due to a lack of standardized curricula. CBME, established to address these issues, relies on outcome-based assessments to ensure trainees achieve necessary competencies. The chapter reviews various assessment tools, including global rating scales, checklists, and simulation-based methods, and their effectiveness in skill acquisition and clinical evaluation. It also covers specific procedures such as EBUS-TBNA, electromagnetic navigation bronchoscopy, and rigid bronchoscopy, discussing their assessment tools and learning curves. The chapter emphasizes the need for standardized assessment tools and suggests using entrustable professional activities (EPAs) to improve competency evaluation. Future directions include integrating real-time artificial intelligence feedback, addressing high-risk low-volume procedures, and enhancing workplace-based assessments to improve interventional pulmonology training and patient care quality. This chapter reviews the transition from traditional apprenticeship models to CBME in interventional pulmonology, highlighting advancements in procedural skills assessment, the effectiveness of various assessment tools, and future directions for improving training and patient care.

KNOWLEDGE, ATTITUDES, AND PRACTICES REGARDING CHATBOTS AMONG HEALTHCARE PROFESSIONALS IN A TERTIARY CARE HOSPITAL

Objective: (1) Primary: Determine healthcare professionals’ knowledge, attitudes, and practices (KAP) related to AI Chatbots. (2) Secondary: Assess healthcare professionals’ perspectives on using Chatbots as teaching tools and implementing them in the Competency-Based Medical Education curriculum. Methods: An online questionnaire was distributed to 132 health professionals, including faculty and CRMIs, through Google Forms. Data on artificial intelligence (AI)-related KAP and barriers were collected following IHEC approval. The KAP scores, along with the relationship between categorical variables – such as population type and the use of AI Chatbots – were analyzed using Statistical Package for the Social Sciences software. Results: The study revealed that participants had a moderate level of knowledge about AI Chatbots. Attitudes were mixed, with some skepticism about AI replacing human teachers but also recognition of its benefits. Most participants infrequently used AI Chatbots in their daily activities. Barriers to usage included lack of knowledge, limited access, time constraints, and curriculum gaps. Conclusion: This study underscored the need to enhance medical education with AI topics and address existing barriers. It is crucial to better prepare health professionals for AI integration to leverage AI’s potential for improving patient care and training.

Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study.

Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020-2022) were compared with class and graduated resident (classes of 2016-2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education.

Eight ways to support faculty with Entrustable Professional Activities.

Competency Based Medical Education (CBME) is pushing the medical profession to be more accountable in our standards of assessment. This has led us to focus our efforts at the top of Miller's pyramid, where we aim to see what the trainee 'does' in the clinical environment. In Canadian Royal College specialty training, this has come in the form of workplace-based supervision of trainees performing Entrustable Professional Activities (EPAs). This is unfamiliar territory for many residents and faculty, and implementation of an additional assessment process into already busy clinical practice has been particularly challenging. Because EPA assessments serve as significant contributors in new programs of assessment, failure to collect high quality EPA assessments threaten the validity of this new system. Understanding the barriers to and enablers of EPA acquisition can inform faculty development initiatives to ensure success. Based on our previous work studying early experiences of EPA assessment acquisition in Emergency Medicine, we have identified eight key concepts to guide faculty development initiatives, namely: the rationale for CBME, the 'behind the scenes' of CBME, how to construct rich narrative comments, effective use of supervision scales, the tension of EPA assessments being both formative and summative, the importance of a shared responsibility between residents and faculty for EPA assessment completion, familiarity with the suite of EPAs, and tips and tricks for incorporating EPA assessment completion into busy clinical practice. These key concepts can be integrated into an overall faculty development strategy for building this now essential skill set.

Role of AI in Competency-Based Medical Education: Using EPA as the Magicbox.

Role of AI in Competency-Based Medical Education: Using EPA as the Magicbox.

The Importance of a Champion in Leading Major Improvements in Residency Programs.

Residency programs are expected to meet many requirements in training their residents, including providing adequate numbers of pediatric visits and procedures opportunities. In the residency program studied here, these numbers were inadequate, despite the efforts of faculty members over the years. A self-designated faculty champion (with traits including vision, persuasiveness, proactivity, and tenacity) launched a series of clinical initiatives to combat these problems. The number of pediatric visits in the Family Medical Center (FMC) were tracked and compared from 2012, prior to the intervention led by the faculty champion, through 2023. The number of procedures performed in the FMC were tracked and compared from 2015, when the procedures-only clinic was launched by the faculty champion, through 2023. The number of pediatric visits in the FMC in 2012-2013 was a total of 12. By 2022-2023, that number had grown to 1,454. The number of procedures in the FMC was four in 2015-2016, but by 2022-2023 had grown to 470. The improved numbers support competency-based medical education, with increased faculty observation, teaching, and evaluation. For procedures training, the improved numbers support faculty members in using the Procedural Competency Assessment Tools to evaluate resident performance. A faculty champion who is interested, self-motivated, persistent, and focused on leading the project from beginning to end can bring about significant improvements in a residency program, despite the program's track record of difficulty in making such improvements.

Transformational learning and professional identity formation in postgraduate competency-based medical education.

Residency programmes are in transition to a framework for competency-based medical education (CBME). The intersection of CBME with transformational learning (TL) experiences and professional identity formation (PIF) - particularly within senior learners in transitional states - is unknown but important to understand in order to develop and implement strategies to support trainees' professional development. Through inductive qualitative methods, we conducted semi-structured interviews (n= 22) of current trainees and recent graduates from adult cardiology residency training programmes within Canada to explore the impact of TL experiences on residents' professional growth and identity formation. Interviews were analysed using thematic analysis informed by TL theory. CBME did not appear to influence trainees' experiences of disorienting dilemmas and TL. Important clinical encounters and interpersonal relationships - in particular, those between mentor and mentee - shaped trainees' professional development as cardiologists ('enabling factors' for TL and PIF). 'Imposter phenomenon' was widely prevalent in our sample study population even among graduates who had already completed their training. Requisite elements for transformation (disorienting dilemmas, critical reflection, discourse and action) also contributed to PIF. TL experiences influenced PIF in senior learners but infrequently intersected with CBME; these experiences were more commonly prompted by disorienting dilemmas relating to clinical outcomes or interpersonal interactions independent of CBME-specific architecture.

Developing Competencies and Milestones: Putting the Pieces Together for Student Success

Abstract Competency-based medical education has become a means in physician assistant (PA) education to ensure learner readiness for practice; align educational expectations; and assess knowledge, skills, and attitudes. Competency-based education may also serve to meet accreditation requirements. Creating program-defined competencies and associated milestones can help a PA program align with their mission and vision, developmentally guide learners through the curriculum, and ensure program assessments measure the tasks required of practice-ready graduates. This review provides an overview of a single program's process for developing program-defined competencies and associated milestones. Beginning with a literature search, the program was able to develop a working list of competencies that was then further refined into competencies with building block milestones that support the development of competency in various domains. Involving faculty in defining a program's competencies is an Accreditation Review Commission on Education for the Physician Assistant requirement that can be done from the ground up or by using previously published competencies that are refined and tailored for the program. The process of creating the competencies provides significant insight into a program's curriculum, goals and expectations for students, and assessment methods.

Precision surgical education

Information and data are accelerating the implementation of competency-based medical education. The adoption of precision education can contribute to this purpose. This article discusses the extent to which precision surgical education can be used in assessing the minimum reliability standards of future surgeons - given the advent of Entrustable Professional Activities - and as an option to strengthen the career trajectory of residents.

Time-based versus competency-based medical education: Opportunities and challenges.

Time-based versus competency-based medical education: Opportunities and challenges.

Redefining professionalism to improve health equity in competency based medical education (CBME): A qualitative study.

There is a pressing need to address all forms of anti-oppression in medicine, given systemic harm and inequities in care and outcomes for patients and health care professionals from equity-deserving groups. Revising definitions of professionalism used in competency-based education can incorporate new professional competencies for physicians to identify and eliminate the root causes of these inequities. This study redefined the CanMEDS Professionalism definition to centre perspectives of equity-deserving groups. In this qualitative study there were two phases. The authors conducted individual semi-structured interviews with participants representing equity-deserving population groups to understand their perspectives on and iteratively build a definition of medical professionalism. Then, the authors undertook a consensus-building process, a modified nominal group technique, using focus groups with community members from equity-deserving groups and healthcare providers to verify findings and arrive at an updated definition of medical professionalism. Four main themes were identified: 1) healthcare at the margins; 2) equity-oriented domains of professionalism; 3) structural professionalism; and 4) supporting improved professionalism. These themes were incorporated into a consensus-based definition of medical professionalism, with a focus on anti-oppression, anti-racism, accountability, safety, and equity. The authors propose a new definition of medical professionalism that embeds anti-oppression, including anti-racism, as critical competencies in clinical practice and education.

Assessment of communication skills in health professions education; Ottawa 2024 consensus statement

Despite the increasing inclusion of communication skills in accreditation standards and an increase in time dedicated to teaching these skills, communication is often regarded as a separate skill and is therefore, not consistently represented in overall systems of assessment in Health Professions Education (HPE). The ascendence of competency-based medical education, programmatic assessment, artificial intelligence, and widespread use of telehealth, alongside changing patient expectations warrant an update in thinking about the assessment of communication skills in health professions education. This consensus statement draws on existing literature, expert pinion, and emerging challenges to situate the assessment of communication skills in the contemporary health professions education context. The statement builds on previous work to offer an update on the topic and include new developments related to assessment, particularly: the challenges and opportunities associated with systems of assessment; patient and peer perspectives in assessment; assessment of interprofessional communication, cross-cultural communication, digital communication; and assessment using digital technologies. Consensus was reached through extensive discussion among the authors and other experts in HPE, exploration of the literature, and discussion during an Ottawa 2024 conference workshop. The statement puts forward a summary of available evidence with suggestions for what educators and curriculum developers should consider in their planning and design of the assessment of communication.