Competency-based Medical Education Curriculum Research Articles

Facilitators and Barriers to Student Learning and Impact of an Undergraduate Clinical Posting in Psychiatry: A Thematic Analysis.

Background:There is an absence of information on empirical evaluation of undergraduate psychiatry training programs in India. We aimed to evaluate a clinical posting in psychiatry for undergraduate medical students.Methods:We employed levels one and two of Kirkpatrick’s four-level program evaluation model. The qualitative study used written feedback that was collected using a semistructured questionnaire. For quantitative metrics, we used end-of-posting assessment scores and frequencies of standard comments provided by examiners on case-based discussions with students to evaluate their clinical skills.Results:We obtained written feedback from 40 female and 19 male fifth-semester students. We identified facilitators (patient interaction, outpatient department observation and teaching, demonstration of signs, case presentation and discussion, evening posting, observation of clinical work, use of anecdotes while teaching, and lectures by senior faculty) and barriers (organizational issues related to evening posting and disinterest in didactic teaching) to the students learning psychiatry, and the perceived impact of the posting for the students (changed attitudes, knowledge, self-efficacy, and skills acquired). The mean total score on case-based discussion, assigned to 22 groups of students, was 3.86 out of 5.Conclusion:We described the impact of the posting and identified unique facilitators and barriers to students’ learning in psychiatry. These findings will inform the choice of teaching-learning methods in the context of the new Competency-Based undergraduate Medical Education (CBME) curriculum.

Continuum of Surgical Skill Acquisition for the Postgraduate Residents During COVID Pandemic: Role of Advanced Simulators in a Multipronged Modular Approach.

Skill acquisition with required competencies as defined by the National Medical Commission for the postgraduate surgical residents can happen in a step-wise manner from novice or advanced beginner to competent levels. This requires well-defined program-specific objectives, teaching-learning and assessment methods as per the competency-based medical education curriculum. Various modalities of teaching for the residents are adapted during the COVID pandemic to maintain the continuum of learning. In this study, we have attempted to develop, implement, and evaluate the effectiveness of acquiring laparoscopic surgical skills using advanced simulators and with large live animal in a real-life situation by a modular training approach. This skill-based program was developed and implemented for final year General Surgery postgraduate residents of Yenepoya Medical College for training laparoscopic surgical competencies. The training was conducted at Advanced Simulation Centres of Yenepoya (Deemed to be University), Mangalore, Karnataka, India. Three training modules were prepared based on the competency-based medical education curriculum for incremental training with advanced simulators and large live animals in a real-life situation which included the sessions on briefing, scenarios, simulations, hands-on activities, debriefing, feedback, and assessment methods. Assessment after the modular training showed statistically significant improvement in their scores, and they scaled up their skill acquisition ladder after each module. The residents and faculty felt that integration from different specialties has increased their confidence levels and communication skills, exploring team dynamics with 1:1 mentorship to make them competent emphasizing the effectiveness of simulation-based training even during the pandemic.

Efficacy Of Orientation Classes In Local Languages As A Part Of Foundation Course In New Competency Based Medical Education Curriculum

Efficacy Of Orientation Classes In Local Languages As A Part Of Foundation Course In New Competency Based Medical Education Curriculum

Knowledge and awareness of ethics among phase 1 medical students

Background: The increasing incidence of disconnect between doctors and patients in India makes it imperative to teach principles and practice of ethics to medical graduates before they move into substantive clinical practices. The competency-based medical education (CBME) curriculum was recently introduced in India. The CBME curriculum encompasses teaching ethics at the beginning of the undergraduate medical curriculum. The study was planned to assess the knowledge and awareness of ethics among first-year undergraduate medical students at the beginning of the foundation course and after 40h of ethics training during the course. Materials and Methods: A standard 35-item questionnaire was administered to the first-year medical students at the beginning of the foundation course and after 40h of ethics training/teaching scattered throughout the foundation course. No personal information was recorded on the questionnaire to ensure the confidentiality and anonymity of participants. Results: There was a significant increase in the knowledge regarding some of the items in the questionnaire, such as “patient’s wishes must always be adhered to,” “if the patient refuses to be treated on religious grounds, they should be instructed to find another doctor.” Similarly, there was an improvement in the students’ knowledge of the practice of ethics. The students generally agreed that an awareness of ethics is important and should be an integral part of the MBBS curriculum. Conclusion: To prevent ethical erosion, ethics education should be introduced early during the undergraduate years, and continuous reinforcement is vital. We should strive to promote discussions about real occurrences directly involving students.

Evaluation of Competency Based Medical Education Curriculum

There is an increasing interest in competency based medical education (CBME) due to the developments and changes in medical education and many medical schools have begun to apply it recently. Although its popularity in both practice and theoretical studies, there is a lack of studies focusing on evaluation of CBME curriculum. In that study, it is aimed to evaluate competency based medical education curriculum. This qualitative study is designed as a case study. It is also a curriculum evaluation study carried out systematically via Stufflebeam’s CIPP model. The study group consisted of fifteen faculty members and fifty students of a medical school in Turkey. The data was collected via semi-structured interview forms and analysed applying content analysis. Some of the important results reached in that study are the followings: The students have had mostly negative ideas about the competencies and the teaching-learning process while the faculty members have been satisfied with their practices. Both the students and the faculty members thought the CBME contributed to students’ academic and vocational developments. It is concluded that in order for CBME to provide the opportunities in medical education context, it needs to be developed, implemented and then evaluated in the frame of theoretical backgrounds and principals. Otherwise, because of the problems/deficiency in the development and implementation process, the efforts might end in vain. In the light of the results, it can be suggested that the faculty members should be supported on how to determine/write the competencies and the content; on effective teaching/learning methods. Also, CBME should be evaluated and revised regularly involving the faculty members and the students in the process.

Working Towards Competence: A Novel Application of Borderline Regression to a Task-Specific Checklist for Technical Skills in Novices

Demonstrated competence through frequent assessment is an expected goal for progressive development in competency-based medical education curricula. The Objective Structured Assessment of Technical Skill (OSATS) is considered a valid method of formative assessment, but in few instances have standards been set for determining competence. The present study used borderline regression methods to examine standard setting of performance on a complex technical task with novices assessed using an OSATS checklist. This was a single institution prospective single arm experimental design study. Participants were 58 non-medical undergraduate students with no previous surgical experience, who observed a computer-based training module on end-to-side vascular anastomosis. Subsequently, participants were provided two 20-minute training sessions, two weeks apart where they received expert feedback whilst performing the task on a low-fidelity model. After each training session, participants completed the task unaided. Sessions were recorded and assessed using an OSATS checklist retrospectively by experts. Paired t-test analyses indicate that for both the checklist total score (t(52) = 8.05, p < 0.001) and the global rating score (t(53) = 8.15, p < 0.001), individuals performed significantly better in Phase 2. Borderline regression analyses indicated that in Phase 1 (R2 = .60) and Phase 2 (R2 = .75), the OSATS checklist could adequately capture variation in performance in novices. Further, the checklist could reliably classify novices at three of the five global rating performance levels. Pass rates determined by regression equations improved from Phase 1 to Phase 2 on all global rating levels. With the increasing focus on competency-based medical education, it is imperative that training programs have the capacity to accurately assess outcomes and set minimum performance standards. Borderline regression methods can accurately differentiate novice learners of varying performance levels before and after training on a complex technical skill task using an OSATS checklist.

Twelve tips for learners to succeed in a CBME program

The international movement to competency-based medical education (CBME) marks a major transition in medical education that requires a shift in educators’ and learners’ approach to clinical experiences, the way assessment data are collected and integrated, and in learners’ mindsets. Learners entering a CBME curriculum must actively drive their learning experiences and education goals. For some, this expectation may be a significant change from their previous approach to learning in medicine. This paper highlights 12 tips to help learners succeed within a CBME model.

Teaching learning methods effective in improving communication skills among medical students: A systematic review

Background: Competency Based Medical Education curriculum has incorporated multiple changes from traditional curriculum one among which is teaching communication skills. This review focused on systematic analysis of research articles to identify various teaching learning methods found to be effective in improving communication skills among medical students. Methods: Articles on communication skills, written in English, published between the years 2000 to 2020 in Medline database were retrieved. All full text articles with intervention study design were included. A total of 1061 articles were retrieved using different search strategies. After removing duplications, title and abstract screening was done that was followed by full text review for quality assessment using Cochrane Effective Practice and Organisation of Care Review Group (EPOC) checklist. Results: Out of total 1061 articles retrieved, 22 were found to be focusing on communication skills training and assessment. Quality assessment were done using EPOC checklist which resulted in 18 articles for full text review. Among these 18 studies, 7 used role-plays performed either by peers/near peers or student themselves coupled with/without feedback by teachers, peers and reflection writing. Student-patient/standardized patient interaction with feedback by faculty/peers/standardized patients, recorded videoclips of roleplay/student-patient interaction, virtual simulation, structured scripts, workshop, and seminar were few other TL methods used. Conclusion: Role-play was the teaching learning method commonly used. Studies varied in TL methods, context of implementation, duration of intervention & follow up and assessment method. Since none of the articles reviewed were conducted in India, further studies with rigorous study design are needed to explore TL methods that would be effective in Indian context.

Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen's Fundamental Innovations in Residency Education)-Part 2: Core of Discipline Stage.

All postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) model divided into 4 stages of training. Queen's University has been the first Canadian institution to mandate transitioning to CBME across all residency programs, including Diagnostic Radiology. This study describes the implementation of CBME with a focus on the third developmental stage, Core of Discipline, in the Diagnostic Radiology residency program at Queen's University. We describe strategies applied and challenges encountered during the adoption and implementation process in order to inform the development of other CBME residency programs in Diagnostic Radiology. At Queen's University, the Core of Discipline stage was developed using the Royal College of Physicians and Surgeons of Canada's (RCPSC) competence continuum guidelines and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones for assessment. New committees, administrative positions, and assessment strategies were created to develop these assessment guidelines. Currently, 2 cohorts of residents (n = 6) are enrolled in the Core of Discipline stage. EPAs, milestones, and methods of evaluation for the Core of Discipline stage are described. Opportunities during implementation included tracking progress toward educational objectives and increased mentorship. Challenges included difficulty meeting procedural volume requirements, inconsistent procedural tracking, improving feedback mechanisms, and administrative burden. The transition to a competency-based curriculum in an academic Diagnostic Radiology residency program is significantly resource and time intensive. This report describes challenges faced in developing the Core of Discipline stage and potential solutions to facilitate this process.

Alignment and integration in competency-based medical education curriculum: An overview

Alignment and integration in competency-based medical education curriculum: An overview

Art of Paper Setting: The Blueprinting of MBBS Physiology Competency Based Curriculum

Introduction: Written examinations are integral component of students’ assessments at formative and summative level. There is no blueprint of question paper available for the new curriculum in Bachelor of Medicine and Bachelor of Surgery (MBBS) Physiology curriculum which may lead to variations in question paper setting. This lack of consistency in question papers affects the preparedness and performance of students. Aim: To prepare the blueprint of MBBS Physiology Competency Based Medical Education (CBME) curriculum and to do content validity by comparing with Preliminary Examination (PE) and University Examination (UE). Materials and Methods: This was a descriptive study conducted over a period of six months from July 2020 till December 2020. The study was conducted in Armed Forces Medical College, Pune. There are 15 topics and 140 outcomes for Physiology MBBS course as per new CBME curriculum is divided into paper I and II according to Maharashtra University of Health Sciences (MUHS) syllabus. The main topics in each paper were further subdivided into subtopics for preparing learning objectives. Marks were allotted to each system taking into consideration optimum marks 97 for subjective with included options and 20 marks Multiple Choice Questions (MCQs). The papers of UE and PE conducted with new format were analysed for content validity. Results: The blueprint of paper I (subjective) shows marks allotted for General Physiology 12, Haematology 13, Respiratory System (RS) 15, Cardiovascular (CVS) 17, Exercise 05, Renal system 15, Gastrointestinal System (GIT) 12, Lifestyle Aging and Meditation 03 and Attitude, Ethics and Communication. (AETCOM) 05 marks. The blueprint of paper II (subjective) shows marks for the Nerve-Muscle 16, Central Nervous System (CNS) 25, Special senses 14, endocrine system are 18, reproductive system 15, and temperature 09. MCQs were also allotted proportionate marks for each topic. Content analysis of papers showed exercise Physiology and body temperature regulation were not assessed in UE. Conclusion: There was disproportionate representation of topics in formative and summative examinations in absence of blueprint. The blueprint should be an integral part of assessments.

Learning by doing: To explore the influence of Simulation on Clinical Decision-Making Approaches on Final Year Medical Students at the University of Duisburg-Essen, Germany.

This article was migrated. The article was marked as recommended. Background: Final year medical students at the University Duisburg-Essen, Germany, are unsatisfied with their clinical judgement skills in common elective and emergency clinical situations. A competency based medical curriculum determines that clinical judgement is an essential tool in effective patient care, patient safety and limiting clinical error. Approaches to clinical judgement include either analytical, intuitive or a combination of both approaches. Novices show specific factors, which are typical in inexperienced clinicians. Simulation provides opportunities in a competency-based medical education curriculum. There is limited evidence showing that simulation can provide an effective environment for teaching and learning clinical decision-making skills. This project explores how final year medical students at the University of Duisburg-Essen approach the clinical decision-making process as well as how simulation influences this process. Methods: Ethics approval was obtained from the local ethics committee. After completing a 10-week simulation course,thirty-five students completed a clinical decision-making instrument to categorise their clinical decision-making approaches. The Novice Decision Making Model and the Cognitive Continuum Model were combined with learning theories in Simulation (Social Cognitive Theory) and used to explore and interpret data collected through questionnaires, interviews and observation. Results: The majority (60%) of students employed a predominantly analytic approach, some students showed intuitive tendencies in clinical situations. During interviews students displayed typical novice approaches to decision-making and expressed positive comments relating to simulation. Conclusions: Simulation presents an opportunity for teaching and learning clinical decision-making. Results show the need for further inquiry into learning clinical decision-making through simulation. This research provides initial evidence that simulation can be incorporated into curricular teaching of clinical decision-making.

Assessment toolbox for Indian medical graduate competencies.

The new competency-based medical education curriculum for Bachelor of Medicine and Bachelor of Surgery is being implemented in a phased manner in medical colleges across India since the year 2019. The Graduate Medical Education Regulations enlist a total of 35 global competencies for the five roles expected of an Indian medical graduate, the roles being clinician, communicator, leader, professional, and life-long learner. Along with an effective implementation of the new curriculum, both in spirit and in action, it is imperative to assess the listed competencies. The new curriculum demands a more careful and mature selection of assessment tools, based on the competency and its expected level of achievement. It is these two variables that make choosing the right assessment method not just a matter of choice, but also of expertise. An array of tools in our armamentarium can sometimes separate confuse and the teachers. So, using the right tool, in the right context, at the right juncture, supplemented by other tools, and backed by constructive feedback, can help nurture the good intent ingrained in the competency-based curriculum. Hence, an attempt was made to compile an assessment toolbox for various global competencies. A PubMed, Science Direct and Google Scholar search, with relevant keywords was carried out. To the initially extracted 90,121 articles, limitations were applied, duplicates were removed and screening for assessment of global competencies and its attributes was done to select 232 articles. Finally, 31 articles were used for designing the proposed toolbox. Prioritization for the tools for the global competencies was based on thorough literature review and extensive discussion. The evolved assessment toolbox is presented in this article, which would help teachers pick the most useful methods of assessment for global competencies.

Evaluation of the competency-based medical education curriculum

Evaluation of the competency-based medical education curriculum

Educational resources used by 1st-year medical students

Introduction: A dynamic teaching–learning environment is being established in Indian medical institutions with the implementation of a competency-based medical education curriculum. This new curriculum may change the previous pattern of usage of educational resources by the medical students. We aimed to explore the pattern of usage of resources by the 1st-year medical students. Material and Methods: We invited 1st-year medical students of three medical colleges for an online survey. There were 17 statements in the questionnaire with 5-point Likert-type response options to collect data on the preference of type of classes, frequency of collection of notes, pattern of reading, and usage of multimedia. Results: A total of 127 (response rate 42.6%) students participated in the survey. Practical classes were the most preferred type of class followed by small group teaching. Students preferred to take notes from 1-h lectures than making notes while reading books. Traditional textbooks were the most preferred material read by the students followed by the question–answer type book. E-book downloaded on the smartphone was preferred over the online e-book. Internet searches and watching YouTube™ videos were popular than watching e-content provided with the textbook. Discussion and Conclusion: In the age of smartphones and the internet, traditional learning resources are still popular among 1st-year medical students. However, learning is reinforced by widely available electronic content. Hence, blended teaching with both traditional and e-resource may be considered by medical teachers.

Yoga practicing medical and nursing students creating a ripple effect: An experience from a Government teaching institution

Yoga is scientifically validated health promotion intervention developed thousands of years ago in India. It is helpful in improving attention, memory and learning efficacy of students along with reduced incidence of depression and anxiety. Introducing yoga in medical curriculum will not only improve the health of students, it will also make them advocates of the same for their patients in future.1. To identify the students who are practicing yoga in medical and nursing college and assess the perceived benefits of yoga practice; 2. To use yoga practicing students to create a ripple effect in the institution for yoga awareness and practice; 3. To incorporate yoga module in the Competency Based Medical Education curriculum(CBME). Interventional study among all medical and nursing students. Started with a pre tested questionnaire. Descriptive statistics is used for analysis of data with Epi-Info7software.Yoga practicing students were motivated to influence the freshers to adopt yoga(Ripple effect). Among 200 students 83 yoga practicing students were selected as study subjects. Among them 38% of them are practicing for more than 1 year and 25% of them for less than 1 month. 78% of students favorably perceived the health benefits of yoga. Sensitization program had influenced the students positively. Students were aware of the importance of Yoga and all of them perceived some benefits by Yoga practice. Using yoga practicing student volunteers to create ripple effect is a novel method to spread awareness and practice.

Self-directed learning: assessment of students' abilities and their perspective.

The introduction of Competency-Based Medical Education Curriculum in India has endorsed many new concepts, like foundation course, self-directed learning (SDL), early clinical exposure, etc. Emphasis is being given to active teaching-learning approaches. One such approach is SDL. SDL is an active learning approach in which the students are responsible for their own learning outcome, with teacher acting as a facilitator of learning. A medical graduate, being a lifelong learner, should inculcate the habit of SDL. In the present study, the SDL abilities of first year Bachelor of Medicine, Bachelor of Surgery students were assessed using a questionnaire. Based on their experience, students were also asked about the prerequisites of SDL, how it can be promoted, and their expectations from the teachers. Students scored high in most of the SDL skills. However, they felt they need improvement in time management. Furthermore, the students are required to develop their interpersonal communication skills, and they also find it difficult to express messages effectively in oral presentations. Most of the students felt they need help in finding the correct learning resources. According to them, the students should be focused, motivated and stress-free, have time management skills, and be able to search learning resources for successful implementation of SDL. They felt that events that encourage active participation by students, if organized at regular intervals, could promote SDL. Some felt that evaluation of SDL would motivate them to take it seriously. According to the students, teacher should act as a facilitator, a mentor, as well as an evaluator.

Comparison of Objective Structured Practical Examination (OSPE) Versus Conventional Pathology Practical Examination Methods Among the Second-Year Medical Students-a Cross-sectional Study.

The medical education in India is moving towards competency-based medical education (CBME) with many cognitive and psychomotor skills needed to be taught and assessed in the various subjects of the undergraduate medical curriculum. In the Pathology subject, psychomotor skills such as haemoglobin estimation, blood grouping, urine examination, liver function test/cerebrospinal fluid interpretation, histopathology and haematology slide interpretation are taught and assessed for many years. Skill assessment by the conventional method, which is followed since many years, is subjective in nature and lack of scope for direct observation of the performance of skills. Objective structured practical examination (OSPE) is one of the methods to minimize the variations in subjectivity, thus enhancing the objectivity. Due to a technicality and labour intensity, it is implemented only in a few medical colleges and universities across India. Because of CBME curriculum on the roll, the assessment of practical skills in medical education needs to be shifted from conventional subjective methods to more objective OSPE methods. After institutional ethical clearance, the second-year medical students appearing for practical in Pathology were selected for the study. Practical skills of the students were assessed by both the conventional way and OSPE after obtaining the written consent. Among 104 students, 89 students were assessed by both methods. Adequate instructions about the pattern of the examination were given in both assessment methods. For the OSPE group, specific instructions about the role of observer, response stations and method of scoring were given. Practical performance of haemoglobin estimation and blood grouping by slide method was assessed, and scores were compared. Student and faculty perception regarding OSPE was assessed by a prevalidated questionnaire. In the conventional group, the mean score of 6.91 ± 1.08 was obtained, while in OSPE, it was 8.43 ± 1.41. In comparing both, a p value of > 0.001 was obtained, which is found to be significant. Student's perceptions appeared to favour the OSPE format rather than the traditional examination. This study showed a significant difference in scores obtained by OSPE in comparison with conventional practical examination. Thus, this information suggests that OSPE format was perceived better by the students, and resulted in a higher average score. Hence, the use of OSPE as a formative assessment tool will help in modifying teaching-learning strategies so that it is beneficial to students and teachers.

Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada.

Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.

Perception analysis of students and faculty of a recently implemented Interactive Teaching session in Anatomy using ‘Jigsaw Technique’ in a north Indian medical college

Introduction: In the new Competency Based Medical Education curriculum, interactive teaching learning has received a major thrust and it is mandated that two-thirds of the teaching schedules must comprise of interactive teaching sessions. Introduced by Elliot Aronson in 1971, the initial purpose of a Jigsaw classroom was to integrate students from different racial backgrounds. Just like every piece of a jigsaw is important to complete the picture, each student plays an important role in the jigsaw teaching session. Aim: To assess the perception of students and faculty towards a recently conducted Interactive teaching learning session using Jigsaw technique for 1st phase MBBS students in the department of Anatomy. Materials and Methods: All hundred students of 1st phase students of MBBS consented to be a part of the study. A total of 6 facilitators were part of the session. 2 rooms were used with each room having 50 students and seats pre-arranged in 10 groups with 5 seats in each group. Colour coding was followed to facilitate smooth conduct of the session. Students moved from their home groups to expert groups and back to home groups. After this the facilitators randomly selected 1 student from each of the 5 colours and asked them to present their sub-topic in front of the entire group of 50 students. At the end of the discussion, the students were administered an online quiz and an online feedback form. The principal author also conducted individual interviews with the other 5 facilitators to gather feedback. Results: An overwhelming majority of the respondents rated the session very highly. Most of the respondents agreed that apart from gaining knowledge about the topic, attending the Jigsaw session also generated their interest in the topic and motivated them to read further about the topic. Respondents also found the quiz very useful. Conclusion: Cooperative peer assisted learning empowers students and has the potential to reduce student dissatisfaction thereby