Competency-based Medical Education Model Research Articles

Competence-based Educational Design Model for Medical Sciences Based on the Community of Inquiry

Introduction: Achieving competence as the main goal in medical education requires a dynamic and active learning process that includes the characteristics of a community of inquiry framework. This theoretical framework provides an overall and coherent structure of an interactive educational experience with a focus on the learning process. Therefore, the purpose of this research was to develop a competency-oriented educational model for medical sciences based on the framework of the community of inquiry. Methods: This was a qualitative and quantitative research. The qualitative part was conducted using qualitative content analysis of documents and focus group discussions, while the quantitative part involved internal validation of the educational design model through a descriptive survey method (based on experts' opinions) and a researcher-made questionnaire. The sampling method was purposeful, focusing on specific or unique cases continuing until theoretical saturation was reached. Results: Using qualitative content analysis (36 documents, 33 articles, and three books) and focus group discussions (with the participation of 14 experts in medical education), the dimensions of competence, principles of competency-based medical education, and principles of inquiry community were identified. Based on theoretical foundations, these were categorized into three domains: affective, cognitive-skills, and metacognitive, along with their subcategories. The alignment of these dimensions led to the formation of a competency-based medical education model, grounded in the inquiry community framework. Internal validation of the developed model was conducted using a researcher-made questionnaire and the participation of 14 experts in educational technology and medical education. According to the specialists' opinions, the developed model achieved a relatively high internal validity (T=14.52, P<0.0001). Conclusion: In this study, the competency-based educational design model for medical education, based on the inquiry community, exhibited appropriate design and organization, flexibility, and adaptability to individual learning needs, even in unpredictable situations within medical education. Its design and organization can be continuously refined and improved throughout the educational experience. Given that it achieved a relatively good internal validity according to the opinions of specialists in medical education and educational technology, it can be introduced as a suitable model in the field of competency-based medical education.

Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education

ABSTRACT Introduction Since 2022, all Canadian post-graduate medical programs have transitioned to a Competence by Design (CBD) model within a Competency-Based Medical Education (CBME) framework. The CBME model emphasized more frequent, formative assessment of residents to evaluate their progress towards predefined competencies in comparison to traditional medical education models. Faculty members therefore have increased responsibility for providing assessments to residents on a more regular basis, which has associated challenges. Our study explores faculty assessment behaviours within the CBD framework and assesses their openness to opportunities aimed at improving the quality of written feedback. Specifically, we explore faculty’s receptiveness to routine metric performance reports that offer comprehensive feedback on their assessment patterns. Methods Online surveys were distributed to all 28 radiology faculty at Queen’s University. Data were collected on demographics, feedback practices, motivations for improving the teacher-learner feedback exchange, and openness to metric performance reports and quality improvement measures. Following descriptive statistics, unpaired t-tests and one-way analysis of variance were conducted to compare groups based on experience and subspecialty. Results The response rate was 89% (25/28 faculty). 56% of faculty were likely to complete evaluations after working with a resident. Regarding the degree to which faculty felt written feedback is important, 62% found it at least moderately important. A majority (67%) believed that performance reports could influence their evaluation approach, with volume of written feedback being the most likely to change. Faculty expressed interest in feedback-focused development opportunities (67%), favouring Grand Rounds and workshops. Conclusion Assessment of preceptor perceptions reveals that faculty recognize the importance of offering high-quality written feedback to learners. Faculty openness to quality improvement interventions for curricular reform relies on having sufficient time, knowledge, and skills for effective assessments. This suggests that integrating routine performance metrics into faculty assessments could serve as a catalyst for enhancing future feedback quality.

A Program of Assessment Model for Point-of-Care Ultrasound Training for Pediatric Critical Care Providers: A Comprehensive Approach to Enhance Competency-Based Point-of-Care Ultrasound Training.

Point-of-care ultrasound (POCUS) is increasingly accepted in pediatric critical care medicine as a tool for guiding the evaluation and treatment of patients. POCUS is a complex skill that requires user competency to ensure accuracy, reliability, and patient safety. A robust competency-based medical education (CBME) program ensures user competency and mitigates patient safety concerns. A programmatic assessment model provides a longitudinal, holistic, and multimodal approach to teaching, assessing, and evaluating learners. The authors propose a fit-for-purpose and modifiable CBME model that is adaptable for different institutions' resources and needs for any intended competency level. This educational model drives and supports learning, ensures competency attainment, and creates a clear pathway for POCUS education while enhancing patient care and safety.

Transitioning to virtual ambulatory care during the COVID-19 pandemic: a qualitative study of faculty and resident physician perspectives.

Background:The COVID-19 pandemic resulted in a rapid shift from in-person to virtual care delivery for many medical specialties across Canada. The purpose of this study was to explore the lived experiences of resident physicians and faculty related to teaching, learning and assessment during ambulatory virtual care encounters within the competency-based medical education model.Methods:In this qualitative phenomenological study, we recruited resident physicians (postgraduate year [PGY] 1–5 trainees) and faculty from the Departments of Surgery and Medicine at Queen’s University, Ontario, via purposive sampling. Participants were not required to have exposure to virtual care. Interviews were conducted from September 2020 to March 2021 by 1 researcher, and 2 researchers conducted focus groups via Zoom to explore participants’ experiences with the transition to virtual care. These were audio-recorded and transcribed verbatim; qualitative data were analyzed thematically.Results:There were 18 male and 19 female participants; 20 were resident physicians and 17 were faculty; 19 were from the Department of Surgery and 18 from the Department of Medicine. All faculty participants had participated in virtual care during ambulatory care; 2 PGY-1 residents in surgery had not actively participated in virtual care, although they had participated in clinics where faculty were using virtual care. The mean age of faculty participants was 38 (standard deviation [SD] 8.6) years, and the mean age of resident physicians was 29 (SD 5.4) years. Overall, 28 interviews and 4 focus groups (range 2–3 participants per group) were conducted, and 4 themes emerged: teaching and learning, assessment, logistical considerations, and suggestions. Barriers to teaching included the lack of direct observations and teaching time, and barriers to assessment included an absence of specific Entrustable Professional Activities (EPAs) and feedback focused on virtual care–related competencies. Logistical challenges included lack of technological infrastructure, insufficient private office space and administrative burdens. Both resident physicians and faculty did not foresee virtual care limiting resident physicians’ ability to progress within competency-based medical education. Benefits of virtual care included increased accessibility to patients for follow-up visits, for disclosing patients’ results and for out-of-town visits. Suggestions included faculty development, improved access to technology and space, educational guidelines for conducting virtual care encounters, and development of virtual care–specific competencies and EPAs.Interpretation:In the postgraduate program we studied, virtual care imposed substantial barriers on teaching, learning and assessment during the first year of the COVID-19 pandemic. Adapting to new circumstances such as virtual care with suggestions from resident physicians and faculty may help to ensure the continuity of postgraduate medical education throughout the COVID-19 pandemic.

Barriers to Effective Utilization of Teaching-Learning Methods: A Qualitative Study Using Focus Group Discussions among First-Year Bachelor of Medicine, Bachelor of Surgery Students in a South Indian Medical College

Background: Lecture, practical, and dissection classes have been the mainstay of teaching in first-year bachelor of medicine, bachelor of surgery (MBBS) courses. Competency-based medical education (CBME) implemented by the National Medical Commission (NMC) in 2019 aims to improve teaching-learning experiences and outcomes. A clear idea about attitudes and perceptions of students toward the present teaching-learning methods will help better implement CBME. Objectives: (1) To find the attitudes and practices of first-year MBBS students toward lecture, practical, and dissection classes, using a focus group discussion (FGD) as a tool of a qualitative study. (2) To analyze the factors that prevent active students from participating in different teaching-learning methods in pre-clinical subjects. Methods: This qualitative study using an FGD was performed after obtaining the Institutional Ethics Committee (IEC) approval in 36 first-year MBBS students, both female and male, divided into six groups. Written informed consent for the audio recording was obtained. A semi-structured interview guide with open-ended questions was used. The FGD was recorded, transcribed in spoken language, and converted into English. Content analysis was performed, key concepts were extracted and coded manually, and common themes were generated. Results: The following seven themes emerged: (1) Attendance being prioritized by students, (2) Note-taking done as a chore during lecture classes, (3) The time duration of the lectures as a hindrance to effective learning, (4) Inadequacy of self-directed learning, (5) Preference of practical sessions over theory sessions, (6) Cell phone usage as a reason for not being attentive in the class, and (7) Interest in interactive methods. Conclusions: This study identifies factors that impede the utilization of teaching-learning methods by medical students. The CBME model addresses many of these problems. Further studies on students under the new curriculum will help refine our teaching-learning methods. The strength of this study is the FGD sessions conducted by a medical student, which would have put the participants at ease.

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.

Call for Collaboration: The Role of Accreditation in the Transformation, Accountability, and Sustainability of Education in Social Determinants of Health.

Call for Collaboration: The Role of Accreditation in the Transformation, Accountability, and Sustainability of Education in Social Determinants of Health.

Could Entrustable Professional Activities mediate community-based teaching in care integration services?

Competency-based medical education (CBME) is currently the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transfer of the competency-based curriculum into physicians’ professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors’ experience in teaching community-based health care integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections presented here allow suggesting that, although it is a challenging process, incorporating EPA into undergraduate medical education is appropriate to improve the provision of primary health care to individuals, families, and communities in general.

Western University Schulich School of Medicine & Dentistry.

Western University Schulich School of Medicine & Dentistry.

The "teaching time-out": a novel framework for surgical education.

In the decade since its inception, the World Health Organization's surgical safety checklist has fundamentally changed the conduct of surgery the world over. A critical component of the checklist - the "pause" or "time-out" - requires all operating room staff to stop other activities and together review critical information about the case to ensure that nothing is missed. Surgical trainees in Canada are transitioning to a competency-based medical education model; a core aspect of this model requires trainees to advocate for their own learning goals. We propose the use of a detailed and formalized preoperative pause as a means to enable superior and more targeted intraoperative learning for surgical trainees.

Ureter Visualization With Transvaginal Ultrasound: A Learning Curve Study.

To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competency-based medical education model in learning US for identifying the ureters.

Practical solutions for implementation of Transition to Practice curricula in a competency-based medical education model.

BackgroundAlthough transition from residency to practice represents a critical learning stage, there is a paucity of literature to inform local curriculum development and implementation.ObjectivesTo describe local curriculum development for Transition to Practice (TTP) for use within a competency-based medical education model, including important content and suitable teaching and assessment strategies.DesignWe reviewed the literature to construct a definition and develop initial curriculum content for TTP. We then gathered local residency program directors’ views on TTP content, teaching, and assessment via online survey and an international educational conference workshop.ResultsWe identified 21 important TTP content areas in the literature and analyzed 35 survey responses, representing 33 residency programs. Survey participants viewed Further sophistication of clinical skills, How to set up a practice, and Time management skills as the three most important content areas. Views on content importance varied by program. For teaching and assessment strategies, most respondents preferred: assessing what residents could do, providing real-life practice opportunities, and offering workplace-based assessments.ConclusionsTTP curricula implementation should reflect nationally set, specialty-specific curriculum elements; locally developed priority content; and assessment and teaching strategies. Individual learner needs and imminent practice context should guide faculty approaches to curriculum delivery.Résumé

The Role of Resident-Run Clinics for Aesthetic Surgery Training in the Context of Competency-based Plastic Surgery Education.

Resident-run clinics (RRCs) have been suggested as a clinical teaching tool to improve resident exposure in aesthetic plastic surgery education. In exchange for reduced cost aesthetic services, RRCs offer trainees the opportunity to assess, plan, execute, and follow surgical procedures in an independent yet supervised manner. With the transition into a competency-based medical education model involving a switch away from a time-based into a milestones-based model, the role of RRCs, within the context of the evolving plastic surgery curriculum has yet to be determined. To that end, the present study summarizes current models of aesthetic surgery training and assesses RRCs as an adjunct to aesthetics education within the framework of competency-based medical education. Explored themes include advantages and issues of RRCs including surgical autonomy, feasibility, exposure, learners’ perception, ethics, and quality improvement. In addition, attention is focused on their role in cognitive competency acquisition and exposure to non-surgical techniques. RRCs are considered an effective educational model that provides an autonomous learning platform with reasonable patient satisfaction and safety profiles.

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.

Burn Care and Surgical Exposure amongst Canadian Plastic Surgery Residents: Recommendations for Transitioning to a Competency-Based Medical Education Model

With the ongoing implementation of a competency-based medical education (CMBE) model for residency programs in North America, emphasis on the duration of training has been refocused onto ability and competence. This study aims to determine the exposure of burn-related core procedural competencies (CPCs) in Canadian Plastic Surgery Residents in order to enhance curricular development and help define its goals. A retrospective review of burn-related resident case logs encompassing all 10 English-speaking plastic surgery residency programs from 2004 to 2014 was performed, including analysis of personal competence scores and resident role by Postgraduate Year (PGY)-year. Case logs of a total of 55 graduating plastic surgery residents were included in the study. Overall, 4033 procedures in burn and burn-related care were logged, accounting for 6.8% of all procedures logged. On average, each resident logged 73 burn procedures, 99% of which were CPCs. The most frequently performed procedure was harvest and application of autograft, allograft, or xenograft, while emergent procedures such as escharotomy and compartment release were performed on average less than one time per resident. Personal competence scores as well as role of the resident (surgical responsibility) increased as PGY-year progressed during residency. Canadian plastic surgery residency programs provide adequate exposure to the majority of the scope of burn care and surgery. However, infrequently encountered but critical procedures such as escharotomy and fasciotomy may require supplementation through dedicated educational opportunities. CMBE should identify these gaps in learning through facilitation of resident competency evaluation. With consideration for the amount of exposure to burn-related CPCs as identified, plastic surgery residency programs can work toward achieving competency in all aspects of burn care and surgery prior to the completion of residency.

Competency-Based Education Assessment Tools for Laser Capsulotomy, Peripheral Iridotomy, and Selective Laser Trabeculoplasty

To produce Competency-Based Education Assessment Tools (C-BEAT) for performance of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, laser peripheral iridotomy (LPI), and selective laser trabeculoplasty (SLT) on an artificial eye model that can be used in competency-based medical education (CBME) of ophthalmology residents. Survey. Eight content experts (residency program director and faculty members involved in ophthalmology resident training). Task-specific checklists were created to assess the performance of Nd:YAG capsulotomy, LPI, and SLT on artificial eye models designed for each of these procedures, as well as a global rating scale (GRS). A modified Delphi process was used to establish face and content validity of the C-BEAT for lasers. Eight content experts participated in the Delphi process, and the consensus was achieved after 4 rounds. Survey responses. Final versions of checklists for Nd:YAG capsulotomy, LPI, and SLT, and a GRS for these laser procedures were produced with face and content validity. Modifications to the energy settings and the number of applications in the capsulotomy and peripheral iridotomy were implemented into the checklist and instructions, because the artificial models were not identical in their responses to the laser applications compared with real tissue. The C-BEAT for lasers can be used in an examination setting within ophthalmology residency training programs to establish competency in these procedures before performing them on real patients. These tools help to meet the demand for assessment modalities within a CBME model that is being implemented into residency training worldwide. To establish interrater and construct validities, further studies are required.

"All the ward's a stage": a qualitative study of the experience of direct observation of handoffs.

Direct observation of clinical skills is central to assessment in a competency-based medical education model, yet little is known about how direct observation is experienced by trainees and observers. The objective of the study is to explore how direct observation was experienced by residents and faculty in the context of the I-PASS Handoff Study. In this multi-center qualitative study, we conducted focus groups and semi-structured interviews of residents and faculty members at eight tertiary pediatric centers in North America that implemented the I-PASS Handoff Bundle. We employed qualitative thematic analysis to interpret the data. Barriers to and strategies for direct observation were described relating to the observer, trainee, and clinical environment. Residents and faculty described a mutual awareness that residents change their performance of handoffs when observed, in contrast to their usual behavior in a clinical setting. Changes in handoff performance may depend on the nature of the observer or 'audience'. Direct observation also highlighted the importance of handoffs to participants, recognized as a clinical activity that warrants feedback and assessment. Dramaturgical theory can be used to understand our finding of 'front-stage' (observed) versus 'backstage' (unobserved) handoffs as distinct performances, tailored to an "audience". Educators must be cognizant of changes in performance of routine clinical activities when using direct observation to assess clinical competence.

Results from the 2017 Survey of Radiation Oncology Residents in Canada

Previous Pan-Canadian surveys of Radiation Oncology (RO) residents performed in 2003 and 2009 identified job availability as a major concern, and characterized a perceived decline in employment opportunities for radiation oncologists in Canada. The Canadian post-MD education registry indicates that Canadian RO trainee levels rose from 130 in 2003 to reach a peak of 209 in 2009 before declining to approximately 130 in 2017. Recognizing that RO has entered another period of transition, we investigated resident perspectives among a more contemporary cohort of RO trainees in Canada. Surveys were distributed electronically to residents at each RO training program in Canada. Surveys consisted of 116 multiple choice and open-ended questions assessing center demographics, motivations for choosing RO, clinical experiences, didactic learning, research experiences, professional relationships, resident satisfaction, and career aspirations. Questions were constructed based on the 2003 and 2009 Canadian survey, and on previous Association of Residents in Radiation Oncology reports from the United States. Anonymized, aggregate responses from completed surveys were abstracted, and descriptive statistics were calculated. Out of 128 eligible residents, 84 completed the survey (65.6% response rate) with representative sampling from each training year (17.1% - 22.4% each year). Demographics reveal 52.6% were male, 68.4% were Canadian medical school graduates (CMGs), 22.4% held either a master’s degree or doctorate, and 2.6% held additional medical certification. Nearly all respondents (97.9%) were satisfied with their specialty and training program. The most frequently perceived weakness in training was feeling unprepared to be competitive in the job market (42.6%), and 78.7% plan to pursue a post-residency fellowship. Most CMGs (86.1%) plan to practice in Canada, but only 12.8% of respondents believe there is strong demand for RO in Canada. Few respondents believe they can obtain staff positions treating their preferred tumor sites (38.3%), and at their preferred geographic location (27.7%). The job market was perceived by 40.4% to be less competitive than it was 5 years ago, and 59.6% predict it will be less competitive 5 years from now. Canadian RO residents feel adequately trained as competent physicians, and a majority of trainees pursue post-residency fellowships, similar to prior surveys. Although current perceptions of the Canadian job market remain guarded, RO residents are highly satisfied with their choice of specialty and training program, and are more optimistic about their future job prospects. Our survey update provides continued insights into RO residency training in Canada, and identifies opportunities for improvement that could be addressed by the incoming competency-based medical education model for RO.

Are Clerks Ready For Clerkship? Third Year Medical Students' Anatomical Science Knowledge vs. Clerkship Director Expectations

IntroductionCompetency‐based medical education (CBME) has been mandated across Canada for residency programs, encouraging undergraduate medical education (UME) programs to adopt this model. Schulich is undergoing a curriculum renewal to implement CBME at the UME level; however, there is limited research on how to effectively integrate anatomical sciences into a CBME model. Further, the anatomical concepts taught, and pedagogical methods employed, varies widely across curricula. Currently at Schulich, the anatomical science knowledge that clerkship directors expect students to learn prior to clerkship, and how much anatomical science knowledge current students retain, is unclear. By determining the effectiveness of the current anatomical science curriculum, we can inform the design and delivery of anatomical sciences into the CBME model. Thus, the specific aims of this research are to: (1) determine which anatomical science concepts are necessary for clerkship, and (2) assess third‐year medical students' anatomical science knowledge retention prior to and at the completion of each clerkship rotation. It was hypothesized that (1) paediatrics clerkship directors would deem embryology more important, compared to clerkship directors for surgery, where gross anatomy would take precedence. Furthermore, (2) third‐year medical students would score low on the pre‐test, due to limited knowledge retention after completing pre‐clerkship, and score higher on the post‐test as a result of the learning that takes place during clerkship.Methods(1) Questionnaires were created and used to guide interviews with all UME clerkship directors to determine which anatomical science concepts are thought to be necessary for each clerkship rotation. Interviews were transcribed and coded according to anatomical science themes mentioned. (2) Using information from Aim 1, a multiple choice assessment was created for each rotation to measure students' anatomical knowledge prior to and at the completion of each clerkship rotation.ResultsEmbryology was the most prevalent anatomical science theme, and histology was the least. When analyzing each rotation, embryology was most prevalent for surgery, paeds, and family med., while imaging, neuroanatomy, and gross anatomy took precedence for internal med., psychiatry, and OB/GYN, respectively. Preliminary assessment results for four rotations reveal that students entering OB/GYN, family med., and psychiatry rotations achieved an average passing grade (>60%) on the pre‐test, while students entering paeds did not. When comparing the pre‐ and post‐tests, there was a significant improvement for students completing the paeds rotation (p=.009, d=.95).ConclusionEmbryology being the most prevalent theme in surgery, paeds, and family med., and second most frequent in OB/GYN, suggests that these specialties rely on knowledge of normal development. Preliminary assessment data indicated that even though students entering paeds did not achieve an average passing grade on the pre‐test, which could be due to the challenging embryological concepts, this group of students displayed significant improvement on the post‐test, suggesting that learning of embryological concepts occurs during the rotation. The concepts deemed necessary by clerkship directors will be mapped to where and how they are taught within the current curriculum, which will elucidate curricular strengths and weaknesses, and help guide the curriculum reform.Support or Funding InformationOntario Graduate ScholarshipThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Criterion-Based Assessment in a Norm-Based World: How Can We Move Past Grades?

In the United States, the medical education community has begun a shift from the Flexnerian time-based model to a competency-based medical education model. The graduate medical education (GME) community is substantially farther along in this transition than is the undergraduate medical education (UME) community.GME has largely adopted the use of competencies and their attendant milestones and increasingly is employing the framework of entrustable professional activities (EPAs) to assess trainee competence. The UME community faces several challenges to successfully navigating a similar transition. First is the reliance on norm-based reference standards in the UME-GME transition, comparing students' performance versus their peers' with grades, United States Medical Licensing Examination Step 1 and Step 2 score interpretation, and the structured Medical School Performance Evaluation, or dean's letter. Second is the reliance on proxy assessments rather than direct observation of learners. Third is the emphasis on summative rather than formative assessments.Educators have overcome a major barrier to change by establishing UME outcomes assessment criteria with the advent and general acceptance of the physician competency reference set and the Core EPAs for Entering Residency in UME. Now is the time for the hard work of developing assessments steeped in direct observation that can be accepted by learners and faculty across the educational continuum and can be shown to predict clinical performance in a much more meaningful way than the current measures of grades and examinations. The acceptance of such assessments will facilitate the UME transition toward competency-based medical education.