Competency-based Medical Education Approach Research Articles

IJCM_394A: Participation of Undergraduate Medical Students in Health Research and Factors Influencing It in a Medical College of Puducherry- A Cross-Sectional Study

Background: Developing, maintaining, and sustaining undergraduate medical students’ research involvement will enable future healthcare practitioners to practice more appropriate evidence-based clinical medicine. Objective: To assess the participation in health research and factors promoting it among undergraduate medical students in Puducherry. Methodology: A descriptive cross-sectional study was conducted among undergraduate medical students in Puducherry over a period of three months (August-October 2023). Systematic random sampling was applied to recruit 360 study participants based on Chellaiyan et al. A pre-tested, semi-structured questionnaire was used to collect the data, including socio-demographic characteristics, academic performance, participants’ attitudes, perceived motivational and barrier factors towards health research, and current involvement in health research. Data were entered in MS Excel 2019 and analyzed using SPSS v16.0. Results: A total of 360 participants were interviewed, of whom 51.6% were female and the majority (86.7%) were hostelers. Among the 360 study participants, only around one-tenth of the participants”41 (11.39%)” have participated in the health research. The factors of gender, competency-based medical education approach, and grade of the participants in the recent university exam were associated with participation in health research. The majority (90.4%) of the participants were highly motivated to participate in health research. The main barriers identified are lack of funds, collaboration, mentorship, time to conduct, and systematic training in the research methodology. Conclusion: Participation in health research has doubled since the introduction of competency-based medical education. Still, participation could be improved by addressing the identified barriers. Studentship programs, young researcher awards, systematic training programs integrated into the curriculum, etc. could also compute the participation in health research among undergraduate medical students.

Integration of simulation-based teaching in anaesthesiology curriculum.

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

Implementing competency-based medical education curriculum in undergraduate psychiatric training in India: Opportunities and challenges.

Medical education in India is undergoing a landmark transformation under the National Medical Commission implementing competency-based medical education (CBME). The CBME approach intends to ensure that medical graduates acquire the competencies needed to fulfill the health needs of the patient and society. This outcome-based approach shifts the focus from the traditional knowledge-based training to skill-based training valued on attitude, ethics, and communication (AETCOM) competencies. CBME thus aims to create medical professionals capable of providing holistic care with compassion and excellence embracing the global trends. The opportunity posed by the CBME should be utilized to sensitize and create interest among the learners about the science and scope of psychiatry. However, there are many challenges in the successful implementation of CBME, which have to be identified and addressed on time for serving the purpose. A basic tenet in CBME is to continue training until the desired competencies are achieved; in other words, to de-emphasize time-based learning. Moreover, the current COVID 19 pandemic is posing a significant influence on the execution of CBME implemented in August 2019. Online platforms could have several advantages in assisting the implementation of CBME; they provide an alternative to continue teaching-learning and assessment during these times and allow learners with the flexibility to learn at their own pace. In this article, we discuss the opportunities, including digital platforms and challenges to be overcame as well as the need for training the faculty toward assimilating the curriculum in the undergraduate psychiatric training.

The Residency Match: Escaping the Prisoner's Dilemma.

The Residency Match: Escaping the Prisoner's Dilemma.

Aligning Requirements of Training and Assessment in Radiation Treatment Planning in the Era of Competency-Based Medical Education

Radiation treatment planning (RTP) is a unique skill that requires interdisciplinary collaboration among radiation oncologists (ROs), dosimetrists, and medical physicists (MP) to train and assess residents. With the adoption of competency-based medical education (CBME) in Canada, it is essential residency program curricula focuses on developing competencies in RTP to facilitate entrustment. Our study investigates how radiation oncology team members' perspectives on RTP education align with requirements of the CBME approach, and its implications for improving residency training. This qualitative research study took place in the Department of Oncology at a midsize academic institution. Through convenience sampling, focus groups were conducted with radiation oncologists (n = 11), dosimetrists (n = 7), medical physicists (n = 7), and residents (n = 7). Thematic design was adopted to analyze the transcripts through open coding resulting in 3 overarching themes. The results identified existing strengths and weaknesses of the residency program and future opportunities to redesign the curriculum and assessment process within a CBME model. Three overarching themes emerged from the analysis: (1) the strengths of RTP in the CBME environment; (2) challenges of RTP in CBME; and (3) opportunities for change. Stakeholders were optimistic CBME will help enrich resident learning with the increased frequency and quality of competency-based assessments. Participants suggested building a library of cases and developing computer-based learning resources to provide a safe environment to develop skills in contouring, dosimetry, and plan evaluation, in accordance with CBME training. This study identified future opportunities to redesign the RTP curriculum and assessment process within a CBME model. The need for innovative teaching and learning strategies, including case libraries, computer-based learning, and quality assessments, were highlighted in designing an innovative RTP planning curriculum.

Competency-Based Postgraduate Medical Education: Past, Present and Future.

Since the turn of the twenty-first century, competency-based medical education (CBME) has become a dominant approach to postgraduate medical education in many countries. CBME has a history dating back half a century and is rooted in general educational approaches such as outcome-based education and mastery learning. Despite controversies around the terminology and the CBME approach, important national medical regulatory bodies in Canada, the United States, and other countries have embraced CBME. CBME can be characterized as having two distinct features: a focus on specific domains of competence, and a relative independence of time in training, making it an individualized approach that is particularly applicable in workplace training. It is not the length of training that determines a person’s readiness for unsupervised practice, but the attained competence or competencies. This shift in focus makes CBME different from traditional training. In this contribution, definitions of CBME and related concepts are detailed.

Resident education in orthopaedic trauma: the future role of competency-based medical education.

As residency training programmes around the globe move towards competency-based medical education (CBME), there is a need to review current teaching and assessment practices as they relate to education in orthopaedic trauma. Assessment is the cornerstone of CBME, as it not only helps to determine when a trainee is fit to practice independently, but it also provides feedback on performance and guides the development of competence. Although a standardised core knowledge base for trauma care has been developed by the leading national accreditation bodies and international agencies that teach and perform research in orthopaedic trauma, educators have not yet established optimal methods for assessing trainees' performance in managing orthopaedic trauma patients. This review describes the existing knowledge from the literature on assessment in orthopaedic trauma and highlights initiatives that have recently been undertaken towards CBME in the United Kingdom, Canada and the United States. In order to support a CBME approach, programmes need to improve the frequency and quality of assessments and improve on current formative and summative feedback techniques in order to enhance resident education in orthopaedic trauma. Cite this article: Bone Joint J 2016;98-B:1320-5.

Urology residency training: Time to enter the 21st century

Prior to the last century, surgeons perfected their craft through preceptorships. Early in the last century, Halsted introduced the German residency system of graded responsibility to North America.1 This system remains the cornerstone of surgical education. However, there has been tremendous change in surgical techniques, especially related to the practice of urology. We have witnessed the introduction of flexible ureteroscopy with laser lithotripsy and percutaneous nephrolithomy for the treatment of renal calculi. In addition, with the advent of laparoscopy and robotics, the surgical treatment of many urological diseases has changed dramatically. Despite this rapid evolution in urological practice, changes in surgical education and evaluation have lagged behind. The authors highlight the disparity in the use of novel teaching adjuncts among various programs.2 In addition, the incorporation of such adjuncts into formal assessments seems to be applied in a heterogeneous manner. Although many believe surgical expertise is a reflection of an individual’s intrinsic ability, empiric research has con-firmed the importance of practice.3,4 Simulators are instruments that reproduce, under artificial conditions, components of surgical tasks.5 Types of models include cadaver, animal, bench and computer software-based simulators. Cadaver models provide true anatomic representation, but the tissue quality might not be as realistic as living tissue. Live animals provide a model with appropriate tissue texture; however, anatomy may not be entirely representative of its human counterparts. Additionally, the use of human cadavers and live animals tends to be expensive and raises ethical issues. Bench models sacrifice fidelity for safety, availability, portability and lower overall cost.1,6 With advances in material technology and computer hardware and software, simulators have become more advanced, with higher fidelity and more capacity for assessment and feedback. Fidelity of a model refers to its realistic features. A simulator does not need to look realistic as long as the pertinent steps of the procedure are performed. That is, a low-fidelity simulator can provide the same benefit as a high-fidelity model.7 The most important outcome of simulators is the ability for skills learned on a model to be translated into improved performance in the clinical setting. This concept is referred to as transferability.3 Many bench and virtual reality simulators have been developed to reproduce many urological procedures.8 Some of these simulators are currently commercially available. While simulators can act as adjuncts for the acquisition of technical skills, they are no substitution to practice in real-life surgical conditions. The second aspect highlighted in this study is the lack of uniformity in assessing surgical skills across programs.2 The ideal components of a sound assessment test are reliability and validity. Reliability refers to the reproducibility of the results produced by the assessment; validity refers to whether a test measures what it purports to measure. Competency-based medical education (CBME) is an emerging concept in training that is being advocated as a substitute or, at least, a complement to the traditional time-based residencies. A white paper has been submitted to the Royal College of Physicians and Surgeons of Canada advocating a shift towards a CBME approach.9 In the United States, the Accreditation Council for Graduate Medical Education began an initiative in 1998 known as the outcome project; the program focuses on the competency domains.10 The Division of Orthopaedics at the University of Toronto and the Royal Australasian College of Psychiatry pilot projects are current examples of CBME.9 A successful shift towards a CBME approach requires three critical components: (1) identifying the required abilities; (2) identifying ways to teach the required abilities; and (3) identifying ways to assess these abilities. It is obvious that, as a specialty, we have a lot of work on these three fronts to move into a 21st century model of training.

Competency-based medical education: theory to practice

Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership – the International CBME Collaborators – to examine conceptual issues and current debates in CBME.We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals.In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education.We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.