Competency-based Medical Education Framework Research Articles

Challenges in Learning Anatomy and Preference of Assessment Methods among CBME Phase I Students in a Medical Collage in Andhra Pradesh

Introduction: The study of anatomy presents notable challenges for medical students, particularly within the frameworkof Competency-Based Medical Education (CBME). This approach emphasizes integrated learning and competencydevelopment, complicating traditional anatomy teaching. Students often struggle with content complexity and the application of knowledge in clinical settings. This study investigates the difficulties encountered by Phase I CBME students in anatomy and their preferences for teaching and assessment methods. Methods: A cross-sectional study was conducted with 150 Phase I MBBS students at Konaseema Institute of Medical Sciences, Andhra Pradesh. Data were collected using a structured questionnaire administered via Google Forms. Thequestionnaire explored challenges in learning anatomy and preferences for teaching and assessment methods. Statistical analysis was performed using SPSS software version 20. Results and Discussion: Among participants, 53.3% identified embryology as the most challenging subdivision of anatomy, followed by gross anatomy (31.3%). Key challenges included difficulty recalling content and correlating theoretical knowledge with practical applications. Regarding assessment, 57.3% preferred structured descriptive questions for theory and 56.3% supported spotters with specimen discussions for practical evaluations. Students highlighted the needfor increased use of audiovisual aids, frequent revisions, and teaching that integrates clinical relevance. The findings emphasize the importance of tailored approaches to address learning difficulties and improve student engagement in anatomy education. Conclusion: Anatomy education under the CBME framework necessitates innovative strategies to address student challenges. Implementing integrated teaching methods, leveraging technology, and refining assessment practices can enhance comprehension and retention. This study provides insights to optimize anatomy education, ensuring alignment with CBME goals and better preparing students for clinical roles. Keywords: education, Competency-Based Medical Education, learning challenges, assessment preferences, teaching methods,

The Role of Faculty in Assessment: Traditional vs. CompetencyBased Medical Education in Toxicology Learning

Toxicology is a very important subject in medical science which deals with the study of poisons and their effects in all aspects. Teaching of toxicology in medical school must be evaluated and assessed effectively to know the actual delivery of content and understanding of students. Faculty plays a critical role in the assessment of toxicology education, influencing the effectiveness and outcomes of both traditional and Competency-Based Medical Education (CBME) models. This article compares the roles and responsibilities of faculty in traditional and CBME frameworks within toxicology learning. It highlights specific examples of assessments and discusses various types of faculty training required to excel in these educational models. The analysis underscores the need for faculty development to adapt to the evolving demands of toxicology education. In Indian medical colleges, CBME has already been adopted and now it is time to create an excellent faculty development program to enhance assessment levels, particularly in the field of toxicology.

Research in Psychiatry Medical Education through "MUST Enrich Grant": A Scoping Review.

The Indian Teachers of Psychiatry (IToP) forum introduced a unique research grant scheme- IToP-MUST (Minds United Scholarship for Teachers) Enrich Research Grant- for conducting research in psychiatry education. This scoping review's objectives are to (a) assess the research areas and methodologies of MUST Enrich grant-supported research, (b) identify strengths and limitations of these research works, and (c) inform the researchers and funding agency concerning robust methodologies and study areas that can be considered in the future. We included all MUST-funded original educational research projects from their inception (2020) to the present, which were either published or, although unpublished, available in the public domain. Eleven research projects were identified. Most awardees were junior academic faculty members (n = 9, 82%). Eight (73%) studies were related to Competency-Based Medical Education (CBME) and were based on teaching-learning (TL) or related methods under the CBME framework, focusing on newer TL methods. Seven of eight (88%) were based on undergraduate TL. Most (n = 8, 73%) of the studies had an observational cross-sectional design, whereas the rest were interventional studies. Almost all were quantitative studies (n = 10, 91%). The prime themes of the research were students' and teachers' perspectives on the study topic, innovations in psychiatry TL, and their educational impact. This review's findings will inform funders and researchers about future research areas and help formulate robust methodologies. Other funders must earmark their funding for educational research to grow this field.

Applying a Competency-Based Medical Education Framework to Development of Residents' Feedback Skills.

Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents' skills in providing feedback to medical students. In 2018-2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.

Motivations for Entrustable Professional Activity Assessment: Gaps Between Curriculum Theory and Resident Reality.

Background Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. Objective This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. Methods This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents' primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Results Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Conclusions Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.

Assessing the impact of adopting a competency-based medical education framework and ACGME-I accreditation on educational outcomes in a family medicine residency program in Abu Dhabi Emirate, United Arab Emirates.

Competency-Based Medical Education (CBME) is now mandated by many graduate and undergraduate accreditation standards. Evaluating CBME is essential for quantifying its impact, finding supporting evidence for the efforts invested in accreditation processes, and determining future steps. The Ambulatory Healthcare Services (AHS) family medicine residency program has been accredited by the Accreditation Council of Graduate Medical Education-International (ACGME-I) since 2013. This study aims to report the Abu Dhabi program's experience in implementing CBME and accreditation. Compare the two residents' cohorts' performance pre-and post-ACGME-I accreditation.Study the bi-annually reported milestones as a graduating residents' performance prognostic tool. All residents in the program from 2008 to 2019 were included. They are called Cohort one-the intake from 2008 to 2012, before the ACGME accreditation, and Cohort two-the intake from 2013 to 2019, after the ACGME accreditation, with the milestones used. The mandatory annual in-training exam was used as an indication of the change in competency between the two cohorts. Among Cohort two ACGME-I, the biannual milestones data were studied to find the correlation between residents' early and graduating milestones. A total of 112 residents were included: 36 in Cohort one and 76 in Cohort two. In Cohort one, before the ACGME accreditation, no significant associations were identified between residents' graduation in-training exam and their early performance indicators, while in Cohort two, there were significant correlations between almost all performance metrics. Early milestones are correlated with the graduation in-training exam score. Linear regression confirmed this relationship after controlling the residents' undergraduate Grade Point Average (GPA). Competency development continues to improve even after residents complete training at Post Graduate Year, PGY4, as residents' achievement in PGY5 continues to improve. Improved achievement of residents after the introduction of the ACGME-I accreditation is evident. Additionally, the correlation between the graduation in-training exam and graduation milestones, with earlier milestones, suggests a possible use of early milestones in predicting outcomes.

Comparative assessment of medical professionalism in medical interns of old and competency-based medical education curricula

Background: Medical professionalism is crucial for health-care practitioners, ensuring public trust, patient safety, and quality care. It comprises attitudes, behaviors, and values guiding medical students and physicians in interactions with patients, colleagues, and the health-care system. With introduction of competency-based medical education (CBME) curriculum, it is important to investigate how CBME curriculum influences the development of professionalism among medical students. Aims and Objectives: The present study is planned with the objective to evaluate and compare medical professionalism dimensions using the learners’ attitude of medical professionalism scale (LAMPS) among medical interns from traditional/old and CBME curricula. Materials and Methods: The study involved medical interns from both traditional and CBME curricula, selected based on voluntary participation and informed consent. Data were collected using the validated LAMPS, assessing attitudes and behaviors related to professionalism. Google Forms, an online survey tool, facilitated efficient data collection and management through questionnaire surveys. Results: The study assessed medical professionalism in domains such as duty/accountability, excellence/autonomy, honor/integrity, altruism, and respect. Mean scores were comparable between the traditional and CBME curriculum groups. For instance, in duty/accountability, the old curriculum scored 3.8673 (standard deviation [SD] ± 0.9954) compared to 3.7477 (SD ± 1.0066) for CBME. Statistical analysis showed no significant differences in professionalism scores between the two groups across all domains, as indicated by t-statistics and P-values. Conclusion: While both curricula demonstrate similar professionalism levels among interns, contextual factors such as curriculum implementation challenges, resource constraints, pandemic-related disruptions, survey timing, and participation rates may contribute to the observed outcomes. Addressing these factors could enhance the effectiveness of professionalism education within CBME frameworks.

DEATH AND DYING EDUCATION IN US MEDICAL SCHOOLS: A SCOPING REVIEW

Abstract With an aging population, knowledge about death, dying, loss, grief, and end-of-life (EOL) care is an essential skill for most physicians. However, EOL education has been minimally incorporated into medical school curricula in the United States (U.S.); there is a significant need to better prepare medical students for the unique challenges of improving patient wellbeing at end-of-life. To understand how death and dying topics have been incorporated into U.S. medical school education, we conducted a systematic scoping review, using PRISMA guidelines, of published research on death education for medical students between 2010 through 2022. An initial search in EMBASE and PubMed yielded 3,443 citations; 265 articles met the initial inclusion criteria (e.g., research-based, EOL education specific), with 97 articles selected for full-text review. Overall, we found significant variation in the type and content of EOL training in U.S. medical schools. Using a competency-based medical education framework that reflects tangible knowledge, skills, and attitudes as a guide to ensure proper EOL training, a deductive coding approach yielded several themes including: reliance on brief, skills-based workshop interventions and limited longitudinal integration into curricula; general research on student attitudes and wellbeing; and an emphasis on needs assessments highlighting gaps in evidence-based EOL training interventions. Using these findings, we offer applied considerations for teaching EOL related skills in U.S. medical schools. In turn, this work contributes to the enhancement of health across the lifespan and might ultimately lead to a society where a “good death” is not an exception, but a reality.

Family adoption program in medical education and role of community medicine in its implementation in India: An overview

Abstract The Family Adoption Program (FAP) is an innovative and crucial aspect of the latest competency-based medical education (CBME) curriculum proposed by the National Medical Commission. This review article provides an in-depth analysis of the FAP’s incorporation into the CBME framework, highlighting its potential impact on medical education, and patient care. We explore the rationale behind its implementation, the core competencies it aims to develop, and the benefits it offers to both medical students and the community. Furthermore, we discuss the role of community medicine in its implementation. Lastly, we analyzed the challenges and future prospects of the FAP in shaping the healthcare landscape.

Improving Postgraduate Anaesthesiology Training in a Low-Middle Income Country by Embracing the New Trends in Medical Education.

Postgraduate medical training has increasingly adapted to competency-based medical education (CBME). In an endeavour to stay abreast with the new trends in medical education and adapt to CBME frameworks, an in-depth review and revision of the Anaesthesiology training curriculum were conducted. The authors worked on the task from December 2020 to December 2021. Learning outcomes were defined and corresponding competencies were identified and relevant teaching, learning and assessment strategies were aligned with each learning outcome. Additionally, lists were devised for topics to be covered through didactic lectures and simulation-based workshops. The revised curriculum is currently being implemented in a phased manner. Formative workplace-based assessment tools are being introduced to complement CBME. Moreover, daily clinical assessments, entrustable professional activity (EPA), simulation-based workshops and assessments have been introduced. Key Words: Anaesthesiology, Postgraduate training, Curriculum revision, Competency-based medical education, Low-middle income country, Simulation-based training.

Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula.

Inherent in every clinical preceptor's role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts - troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity - can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner's capacity to act competently as they develop their identity at various stages of training.

A80 DEVELOPMENT OF COMPETENCY BASED MEDICAL EDUCATION CURRICULUM FOR INFLAMMATORY BOWEL DISEASE ADVANCED TRAINING PROGRAM IN CANADA

Abstract Background Inflammatory bowel disease (IBD) advanced training programs in Canada are heterogenous in their education, structure, and case exposure, resulting in differences in trainee experience. While competency based medical education (CBME) is becoming the primary educational framework in residency training, there is no CBME-based curriculum for IBD advanced training programs. Adopting a CBME framework for IBD fellowships may help standardize training to increase competence. Purpose The purpose of this study was to develop a CBME-based curriculum for IBD advanced training programs in Canada. Method Strategic groups consisting of 25 IBD experts were assigned to develop 15 entrustable professional activities (EPAs), which were then refined by experts in medical education and curriculum development. Acceptable EPAs were assessed using an electronically administered round-less Delphi panel. Panel members evaluated each EPA using a Likert scale, which asked participants to consider appropriateness of each EPA for an advanced IBD curriculum. A consensus strength greater than 70% was the acceptable threshold for inclusion into the final curriculum. Milestones were modelled after CanMED roles for each EPA. Result(s) Of the 15 initial EPAs, nine were recommended for the roundless Delphi panel by the selection committee: (1) identification, diagnosis, and treatment of new onset IBD; (2) assessment and treatment of outpatients with IBD; (3) the endoscopic evaluation of disease activity and the effective communication of endoscopic findings for patients with IBD; (4) provide effective inpatient management and coordinate transition to outpatient care for patients with IBD; (5) recognize and institute preventive health maintenance strategies in patients with IBD; (6) management and treatment of special populations with IBD; (7) identification, diagnosis, and treatment of the various extraintestinal manifestations of IBD; (8) Engage health care systems to improve the quality of care for patients with IBD; (9) engage in scholarly activities related to IBD. Eight of the nine EPAs achieved a consensus score greater than 70%, with the EPA, ‘engage in scholarly activities related to IBD’ failing to meet this cut-off. Associated milestones were developed for the eight final EPAs. Image Conclusion(s) This study was the first attempt to develop a CBME-based IBD curriculum in Canada. With proper funding and guidance, we hope our model can be implemented across Canada in IBD advanced training programs. These methods may also help facilitate the development of CBME curricula for other advanced training programs. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Competency-Based Assessments: Leveraging Artificial Intelligence to Predict Subcompetency Content.

Faculty feedback on trainees is critical to guiding trainee progress in a competency-based medical education framework. The authors aimed to develop and evaluate a Natural Language Processing (NLP) algorithm that automatically categorizes narrative feedback into corresponding Accreditation Council for Graduate Medical Education Milestone 2.0 subcompetencies. Ten academic anesthesiologists analyzed 5,935 narrative evaluations on anesthesiology trainees at 4 graduate medical education (GME) programs between July 1, 2019, and June 30, 2021. Each sentence (n = 25,714) was labeled with the Milestone 2.0 subcompetency that best captured its content or was labeled as demographic or not useful. Inter-rater agreement was assessed by Fleiss' Kappa. The authors trained an NLP model to predict feedback subcompetencies using data from 3 sites and evaluated its performance at a fourth site. Performance metrics included area under the receiver operating characteristic curve (AUC), positive predictive value, sensitivity, F1, and calibration curves. The model was implemented at 1 site in a self-assessment exercise. Fleiss' Kappa for subcompetency agreement was moderate (0.44). Model performance was good for professionalism, interpersonal and communication skills, and practice-based learning and improvement (AUC 0.79, 0.79, and 0.75, respectively). Subcompetencies within medical knowledge and patient care ranged from fair to excellent (AUC 0.66-0.84 and 0.63-0.88, respectively). Performance for systems-based practice was poor (AUC 0.59). Performances for demographic and not useful categories were excellent (AUC 0.87 for both). In approximately 1 minute, the model interpreted several hundred evaluations and produced individual trainee reports with organized feedback to guide a self-assessment exercise. The model was built into a web-based application. The authors developed an NLP model that recognized the feedback language of anesthesiologists across multiple GME programs. The model was operationalized in a self-assessment exercise. It is a powerful tool which rapidly organizes large amounts of narrative feedback.

Competency-Based Frameworks in Medical School Education Programs: A Thematic Analysis of the Academic Medicine Snapshots, 2020.

Educational program objectives (EPOs) provide the foundation for a medical school's curriculum. In recent years, the Liaison Committee on Medical Education (LCME) endorsed an outcomes-based approach to objectives, to embrace the movement toward competency-based medical education (CBME). The purpose of this study was to explore the CBME frameworks used by medical schools in formulating their EPOs. A secondary aim was to determine factors related to the selection of specific frameworks. The authors performed a quantitative content analysis of entries to the 2020 Academic Medicine Snapshot. Publicly available data gathered included demographic features of each program (e.g., year founded, accreditation status, affiliation, etc.), participation in national medical education consortia, and presence of specific CBME frameworks identified in EPOs. Descriptive statistics were used to examine trends in frameworks used by medical schools. Bivariate comparisons between factors and frameworks were conducted using chi-square tests. Logistic regression was used to examine factors predicting use of more recently developed CBME frameworks. A total of 135 institutions submitted Snapshots (RR = 88%). All institutions endorsed 1 or more CBME frameworks, with 37% endorsing 2 and 20% endorsing 3 or more. The most common was the Accreditation Council for Graduate Medical Education core competencies (63%). In addition to published frameworks, 36% of institutions developed their own competencies. Schools with pending LCME visits were 2.61 times more likely to use a more recently developed curricular framework, P = .022. Medical schools in the United States have embraced the CBME movement through incorporation of competency-based frameworks in their EPOs. While it is encouraging that CBME frameworks have been integrated in medical school EPOs, the variability and use of multiple frameworks identifies the pressing need for a unified CBME framework in undergraduate medical education.

An adaptation-focused evaluation of Canada’s first competency-based medical education implementation in radiology

ObjectivesSystematic program evaluation of the Queen's University diagnostic radiology residency program following transition to a competency-based medical education (CBME) curriculum. MethodsRapid Evaluation methodology and the Core Components Framework were utilized to measure CBME implementation. A combination of interviews and focus groups were held with program leaders (n = 6), faculty (n = 10), both CBME stream and traditional stream residents (n = 6), and program staff (n = 2). Interviews and focus groups were transcribed and analyzed abductively. Study team met with program leaders to review common themes and plan potential adaptations. ResultsStrengths of CBME implementation included more frequent and timely feedback as well as the role of the Academic Advisor. However, frontline faculty felt insufficiently supported with regards to the theory and practical implementation of the new curriculum and found assessment tools unintuitive. The circumstances surrounding the curricular implementation also resulted in some negative sentiment. Additional faculty and resident education workshops were identified as areas for improvement as well as changes to assessment tools for increased clarity. Residents overall viewed the changes favorably, with traditional stream residents indicating that they also had a desire for increased feedback. ConclusionsRapid Evaluation is an effective method for program assessment following curricular change in diagnostic radiology. A departmental champion driving enthusiasm for change from within may be valuable. Adequate resident and faculty education is key to maximize change and smooth the transition. Advances in knowledge: This study provides insights for other radiology training programs transitioning to a CBME framework and provides a structure for programmatic assessment.

Competency-based medical education across the continuum: How well aligned are medical school EPAs to residency milestones?

Introduction Competency-based medical education (CBME) provides a framework for describing learner progression throughout training. However, specific approaches to CBME implementation vary widely across educational settings. Alignment between various methods used across the continuum is critical to support transitions and assess learner performance. The purpose of this study was to investigate alignment between CBME frameworks used in undergraduate medical education (UME) and graduate medical education (GME) settings using the US context as a model. Method The authors analyzed content from the core entrustable professional activities for entering residency (Core EPAs; UME model) and residency milestones (GME model). From that analysis, they performed a series of cross-walk activities to investigate alignment between frameworks. After independent review, authors discussed findings until consensus was reached. Results Some alignment was found for activities associated with history taking, physical examination, differential diagnosis, patient safety, and interprofessional care; however, there were far more examples of misalignment. Conclusions These findings highlight challenges creating alignment of assessment frameworks across the continuum of training. The importance of these findings includes implications for assessment and persistence of the educational gap across UME and GME. The authors provide four next steps to improve upon the continuum of education.

Usability and reproducibility of three tools to assess medical students and residents in emergency medicine.

It is critical to assess competency of medical students and residents in emergency medicine (EM) during undergraduate and graduate medical education. However, very few valid tools exist to assess both technical and nontechnical skills in the specific context of EM. Three Acute Care Assessment Tools (ACAT 1, 2, and 3) have been previously developed for three acute care conditions: cardiac arrest (1), coma (2), and acute respiratory failure (3). This study aimed to evaluate the reproducibility of the tools. The tool was tested using recorded videos of simulation sessions of fourth year medical students and first year residents in EM. Raters independently reviewed the videos two times in a 3-month interval, and interrater and intrarater reliability using intraclass correlation (ICC) was calculated. Secondary endpoints included the completeness rate and relevance of the ACAT. Sixty-two sessions were recorded and 48 videos analyzed (18 for CA and 15 for both respiratory failure and coma. The learners were residents in 32 (66%) of videos. Interrater reliability was excellent (ICC >0.9 for all three contexts) and so was the intrarater reliability (>0.88), both upon first review (month 0, M0) and at 3months (M3). The usability of the ACAT was good, with a completeness of the items that ranged from 96% to 100%. Only one item of the ACAT 1 had a relevance of 27%, as it could not be completed in 13 scenarios out of 18. The results demonstrate educators can evaluate students similarly utilizing video recordings of simulated medical scenario. The excellent completeness of the rated items advocated for good usability. The three ACATs can be utilized to assess for completeness of predefined tasks in three acute care broad scenario in a competency-based medical education framework.

Analyzing the Administrative Burden of Competency Based Medical Education.

Postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) system. Within this system, resident performance is documented through frequent assessments that provide continual feedback and guidance for resident progression. An area of concern is the perception by faculty of added administrative burden imposed by the frequent evaluations. This study investigated the time spent in the documentation and submission of required assessment forms through analysis of quantitative data from the Queen's University Diagnostic Radiology program. Data regarding time taken to complete Entrustable Professional Activities (EPA) assessments was collected from 24 full-time and part-time radiologists over a period of 18 months. This data was analyzed using SPSS to determine mean time of completion by individuals, departments, and by experience with the assessment process. The average time taken to complete an EPA assessment form was 3 minutes and 6 seconds. Assuming 3 completed EPA assessment forms per week for each resident (n = 12) and equal distribution among all staff, this averaged out to an additional 18 minutes of administrative burden per staff member over a 4 week block. This study investigated the perception by faculty of additional administrative burden for assessment in the CBME framework. The data provided quantitative evidence of administrative burden for the documentation and submission of assessments. The data indicated that the added administrative burden may be reasonable given mandate for CBME implementation and the advantages of adoption for postgraduate medical education.

Defining competency for Royal Australian and New Zealand College of Obstetricians and Gynaecologists training: An exploratory study of Victorian Integrated Training Program coordinators' understanding of competency.

Competency-based medical education (CBME) is increasingly employed by postgraduate training programs worldwide, including obstetrics and gynaecology. Focusing on assessment of outcomes rather than time-in-training, and utilising a well-defined curricular framework, CBME aims to train doctors capable of meeting the needs of modern society. When this study was undertaken, in 2019, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) had a time-based curriculum and was due to undergo a curriculum review starting in 2020. To explore Victorian RANZCOG Integrated Training Program (ITP) coordinators' understanding of the concept of competency and how it is taught and assessed within RANZCOG training. A qualitative, grounded theory design using semi-structured interviews was employed. Victorian RANZCOG ITP coordinators from inner and outer metropolitan, and regional sites, were approached to participate. Transcripts were coded and analysed using thematic analysis. Themes identified were: Competence, Vision and Innovation, Structures, ITP Coordinator Role and Teaching and Learning. Competence was defined as a combination of independent practice and understanding of ones' own limits, in addition to required clinical skills and knowledge. Enablers and barriers to achieving competency were identified and associated with structures, human and logistical factors. Victorian ITP coordinators believed the current training program has positive elements but could be further improved. Several areas for future research were identified regarding understanding of competency, relevant if RANZCOG is to introduce a CBME framework. Replicating this research across all RANZCOG jurisdictions in Australia and New Zealand would be prudent to determine if the themes are universal.

A Systems Thinking Approach for the Creation of Super Clinicians using a Competency-based Medical Education Framework

We think that the article titled “National Competency Frameworks for Medical Graduates: Is it Time for the “SudanMeds”? published in the Sudan Journal of Medical Sciences [1] is a timely publication. Competency-based medical education (CBME) is considered as a paradigm shift in medical education, the ultimate aim of which is the improvement of patient and society’s quality of care by training and creating highly skilled clinicians. A paradigm as defined by the Cambridge Dictionary is a situation in which the usual and accepted way of doing or thinking about something changes completely. The magnitude of change is so profound to the extent that it leads to a fundamental change in the approach or underlying assumptions, an example being the introduction of the Internet. Several such major “contemporary” shifts have colored the thinking processes and actions of healthcare professionals and leaders. For example, the Patient Safety Paradigm and the Evidence-based Practice Paradigm.