Competency-based Medical Education Research Articles

Clinician Educator Milestones: Assessing and Improving Educators' Skills.

The importance of the clinician educator (CE) role in delivery of competency-based medical education is well recognized. There is, however, no formal mechanism to identify when faculty have the knowledge, skills, and attitudes to be successful CEs. In 2020, the Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, Association of American Medical Colleges, and American Association of Colleges of Osteopathic Medicine convened a workgroup of 18 individuals representing multiple medical specialties and diverse institutions in the United States, including nonphysician educators, a medical student, and a resident, to develop a set of competencies, subcompetencies, and milestones for CEs.A 5-step process was used to create the Clinician Educator Milestones (CEMs). In step 1, the workgroup developed an initial CEM draft. Through brainstorming, 141 potential education-related CE tasks were identified. Descriptive statements for each competency and developmental trajectories for each subcompetency were developed and confirmed by consensus. The workgroup then created a supplemental guide, assessment tools, and additional resources. In step 2, a diverse group of CEs were surveyed in 2021 and provided feedback on the CEMs. In step 3, this feedback was used by the workgroup to refine the CEMs. In step 4, the second draft of the CEMs was submitted for public comment, and the CEMs were finalized. In step 5, final CEMs were released for public use in 2022.The CEMs consist of 1 foundational domain that focuses on commitment to lifelong learning, 4 additional domains of competence for CEs in the learning environment, and 20 subcompetencies. These milestones have many potential uses for CEs, including self-assessment, constructing learning and improvement plans, and designing systematic faculty development efforts. The CEMs will continue to evolve as they are applied in practice and as the role of CEs continues to grow and develop.

Efficacy of Google Form-based MCQ tests for formative assessment in medical biochemistry education.

Biochemistry, being a vast and complex subject, can be challenging for Phase I MBBS students to comprehend and retain. Embracing rapidly evolving technology can facilitate a more accessible learning experience. In this study, we investigated the effectiveness of using Google Form-based multiple-choice question (MCQ) tests as a formative assessment tool after each biochemistry lecture series. The aim was to assess the improvement and gather feedback of Phase I MBBS students on the utility of this assessment tool. This educational prospective longitudinal study was conducted by the Department of Biochemistry at a university-affiliated medical college and tertiary care hospital. The study included 150 Phase I MBBS students as participants. Google Form-based MCQ tests were implemented as educational interventions after each lecture series during the study period. The study compared the internal assessment (IA) MCQ marks of students before and after the implementation of the intervention. In addition, feedback questionnaires were collected from the students. There was a significant improvement in students' scores between the first IA (mean ± standard deviation [SD], 8.16 ± 3.08) and second IA (mean ± SD, 17.64 ± 2.02) (P < 0.0001). According to students' feedback, 149 out of 150 (99.3%) students found the use of Google Form-based MCQ tests as a formative assessment tool in the teaching-learning process to be highly beneficial and motivated them to engage in their biochemistry studies. With the shift toward competency-based medical education (CBME) in India, it is crucial for educators to embrace novel teaching-learning and evaluation approaches. Our study highlighted the efficacy of employing Google Form-based MCQ tests in enhancing students' comprehension of the biochemistry subject, evaluating their scores and improving the overall quality of learning. Through this mode of assessment, teachers were able to provide targeted feedback on areas that required improvement, thereby enhancing the learning experience.

Defining competencies in robotic thyroidectomy: development of a model assessing an expert operator's intraoperative performance skills and cognitive strategies.

The changing medical education environment emphasizes the need for time efficiency, increasing the demand for competency-based medical education to improve trainees' learning strategies. This study was performed to determine the competencies required for successful performance of robotic thyroidectomy (RT) and to determine the consensus of experts for performance of RT. Data were collected through 12 semi-structured interviews with RT experts and 11 field observations. Cognitive task analysis was performed to determine the competencies required for experts to perform RT. A modified Delphi methodology was used to determine how 20 experts rated the importance of each item of RT performance on a Likert 7-point scale. The criteria for the Delphi consensus were set at a Cronbach's α≥0.80 with two survey rounds. After 11 field observations and 12 semi-structured interviews, 89 items were identified within six modules. These items were grouped into sub-modules according to their theme. The modified Delphi survey, involving 21 experts, reached the consensus standard during the second round (Cronbach's α=0.954), enabling the identification of the 64 most important items within six modules related to RT performance: midline incision to isthmectomy (MID module; n=8), lateral dissection (LAT module; n=7), preservation of inferior parathyroid glands (INF module; n=16), preservation of recurrent laryngeal nerve and dissection of the ligament of Berry (BER module; n=21), dissection of the thyroid upper pole (SUP module; n=10), and specimen removal and closure (END module; n=2). This mixed-method study combining qualitative and quantitative methodology identified modules of core competencies required to perform RT. These modules can be used as a standard and objective guide to train surgeons to perform RT and evaluate outcomes.

Impact of Foundation Course on First MBBS Students and Their Level of Satisfaction – A Programme Evaluation

Abstract Background: The competency-based medical education new curriculum stresses on the foundation course at the beginning of the MBBS programme, with an objective to orient the students on new knowledge and skills that will aid them in adapting to the new professional environment, providing the opportunity for faculty and peer interactions and sensitisation towards various teaching–learning methods. Aims: The Aim of the study was to analyse the student’s feedback on the foundation course and to determine the level of satisfaction of the learners towards the course. Patients and Methods: This was a programme evaluation of foundation course for newly joined MBBS students in Mamata Academy of Medical Sciences, Hyderabad, Telangana, India, during December from 12th to 19th for 7 days. Results: On feedback analysis, around 90% of the students were satisfied with all the sessions and the students have expressed a high level of satisfaction towards the sessions of teamwork, leadership skills, interpersonal communication skills, Basic Life Support (BLS), first aid, field visit and Indian Medical Graduate (IMG) goals. A statistically significant difference between the mean scores of pre and post test was found. Conclusions: The overall feedback on the foundation course was satisfactory. Students have gladly received the foundation course and they were well sensitised by the topics covered and activities conducted. There was a significant improvement in their assessment scores. Thus, the impact of the foundation course will definitely help in accomplishing the goals of IMG effectively.

Learner’s perspectives and outcomes of peer role play as a teaching learning method for prescription communication skills in second year medical students at a tertiary teaching hospital in India

Background: Medical education in India is experiencing a positive shift from traditional curriculum to competency-based medical education. Among the different initiatives, inclusion of role-play with specific aim of improving prescription communication skills in the current curriculum, could lead to beneficial patient- response outcomes. This study aims to evaluate the undergraduate medical student’s perspectives on implementing role-play for learning about prescription communication. Methods: This was a cross-sectional observational study conducted in the department of pharmacology involving second-year medical students of Vydehi institute of medical science and research centre participating for a month-long duration. An internally validated questionnaire was used to assess students’ perspectives on role-play in prescription communication. The outcome was evaluated based on students’ performance in prescription writing and appropriate communication before and after the role-play session. The data obtained was analysed using the SPSS software. Results: The mean score for the overall benefit of role play for prescription communication for all responding participants (n=163) was 4.2 out of 5. In this study, 89.4% of students agreed that role-play in prescription communication should be an essential aspect of their training in the curriculum and is worth taking this additional effort. 84.6% of students found that, the sessions helped to understand and share the pharmacology concepts better. Mean pre and post role play prescription writing assessment scores in students was 7.59 and 9.01 out of 10 respectively. Conclusions: Role-play was well received by the students as a low-cost innovative teaching methodology for better understanding of Pharmacology concepts as mandated by the CBME curriculum. It helps in understanding the importance of teamwork and error-free prescription communication for future clinical practice. Overall, following appropriate demonstration, use of role-play showed significant improvement in student performance in prescription communication.

Developing a competency framework for training with simulations in healthcare: a qualitative study

BackgroundSimulation is a technique used to create an experience without going through the real event. Competency-based medical education focuses on outcomes and ensures professionals have the necessary knowledge, skills, and attitudes. The purpose of this study was to develop a set of competencies for the instructors providing basic and advanced levels of simulation-based training in healthcare.MethodsWe conducted a qualitative study in three steps, with each next step building on and influenced by the previous one. First, we conducted a literature review, then a consensus development panel, and finally a three-step Delphi process. The participants were experts in the fields of healthcare, education, and simulations.ResultsThe six main competencies identified for the instructor providing simulation-based training at the basic level in healthcare include knowledge of simulation training, education/training development, education/training performance, human factors, ethics in simulation, and assessment. An instructor providing simulation-based training at an advanced level in healthcare should also possess the following five competencies: policies and procedures, organisation and coordination, research, quality improvement, and crisis management.ConclusionThe identified competencies can serve as a valuable resource for simulation educators and organisations involved in simulation education, to plan curriculum and implement a continuous train-the-trainers programme.

Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans.

Curricula for postgraduate medical education have transformed since the introduction of competency based medical education (CBME). Postgraduate training plans offer broader training with different competencies and an outcome-based approach, in addition to the medical technical aspects of training. However, CBME also has its challenges. Over the past years, critical views have been shared on the potential drawbacks of CBME, such as assessment burden and conflicts with practicality in the workplace. Recent studies identified a need for a better understanding of how the evolving concept of CBME has been translated to curriculum design and implemented in the practice of postgraduate training. The aim of this study was to describe the development of CBME translations to curriculum design, based on three consecutive postgraduate training programs spanning 17 years. We performed a document analysis of three consecutive Dutch gynecology and obstetrics training plans that were implemented in 2005, 2013, and 2021. We used template analysis to identify changes over time. Over time, CBME-based curriculum design changed in several domains. Assessment changed from a model with a focus on summative decision to one with an emphasis on formative, low-stakes assessments aimed at supporting learning. The training plans evolved in parallel to evolving educational insights, e.g., by placing increasing emphasis on personal development. The curricula focused on a competency-based concept by introducing training modules and personalized authorization based on feedback rather than on a set duration of internships. There was increasing freedom in personalized training trajectories in the training plans, together with increasing trust towards the resident. The way CBME was translated into training plans has evolved in the course of 17 years of experience with CMBE-based education. The main areas of change were the structure of the training plans, which became increasingly open, the degree to which learning outcomes were mandatory or not, and the way these outcomes were assessed.

Competency in medical training: current concepts, assessment modalities, and practical challenges.

In the past two decades, competency-based medical education (CBME) has rapidly become the cornerstone of medical training and accreditation programmes worldwide. It has increasingly replaced traditional time-based educational approaches which were often rigid, fragmented, and overly emphasized clinical content knowledge over practical skillsets and attitudes. CBME adoption was in the hope of better preparing medical graduates for the demands and responsibilities of real-world clinical practice. For all the supposed merits of CBME, there hitherto remains difficulties in arriving at comprehensive and practical 'competency' definitions, and actual challenges with implementation of clinical competency assessment modalities pertaining to construct validity, reliability, and applicability with the use and interpretation of evaluation metrics. Therefore, in this article, we describe the various conceptualizations of 'competency' in medical education literature and attempt to refine its usage in practice to meet the evolving needs and expectations of healthcare stakeholders, as well as incorporate emerging concepts in the medical education discourse. We herein propose that clinical 'competencies' should be defined as multi-domain clinical expertise, comprising medical knowledge, skills, attitudes and metacognitive capabilities that reflects the prevailing needs of healthcare stakeholders, and is inferred from performance evaluations of medical trainees. In order to attain 'competence', there must then be a process of integrating multi-domain competencies into meaningful professional identity formation that is commensurate with the context and stage of medical training. In addition, we review the current competency assessment modalities, including common pitfalls with their usage, and sought to provide practical strategies to mitigate the identified challenges.

Current use of simulation for EPA assessment in emergency medicine.

Approximately five years ago, the Royal College emergency medicine programs in Canada implemented a competency-based paradigm and introduced the use of Entrustable Professional Activities (EPAs) for assessment of units of professional activity to assess trainees. Many competency-based medical education (CBME) based curricula, involve assessing for entrustment through observations of EPAs. While EPAs are frequently assessed in clinical settings, simulation is also used. This study aimed to characterize the use of simulation for EPA assessment. A study interview guide was jointly developed by all study authors and followed best practices for survey development. A national interview was conducted with program directors or assistant program directors across all the Royal College emergency medicine programs across Canada. Interviews were conducted over Microsoft Teams, interviews were recorded and transcribed, using Microsoft Teams transcribing service. Sample transcripts were analyzed for theme development. Themes were then reviewed by co-authors to ensure they were representative of the participants' views. A 64.7% response rate was achieved. Simulation has been widely adopted by EM training programs. All interviewees demonstrated support for the use of simulation for EPA assessment for many reasons, however, PDs acknowledged limitations and thematic analysis revealed certain themes and tensions for using simulation for EPA assessment. Thematic analysis revealed six major themes: widespread support for the use of simulation for EPA assessment, concerns regarding the potential for EPA assessment to become a "tick- box" exercise, logistical barriers limiting the use of simulation for EPA assessment, varied perceptions about the authenticity of using simulation for EPA assessment, the potential for simulation for EPA assessment to compromise learner psychological safety, and suggestions for the optimization of use of simulation for EPA assessment. Our findings offer insight for other programs and specialties on how simulation for EPA assessment can best be utilized. Programs should use these findings when considering using simulation for EPA assessment.

Making assessment a team sport: a qualitative study of facilitated group feedback in internal medicine residency.

Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.

Competency-Based Medical Education at Scale: A Road Map for Transforming National Systems of Postgraduate Medical Education.

In the past decade, the Canadian system of postgraduate medical education has been transformed with the implementation of a new approach to competency based medical education called Competence by Design. The Royal College of Physicians and Surgeons of Canada (Royal College) developed an approach to time-variable competency based medical education and adapted that design for medical, surgical, and diagnostic disciplines. New educational standards and entrustable professional activities consistent with this approach were co-created with 67 specialties and subspecialties, and implementation was scaled up across 17 universities and over 1000 postgraduate training programs. Partner engagement, systematic design of workshops to create discipline specific competency-based standards of education, and agile adaptation were all key ingredients for success. This paper describes the strategies applied by the Royal College, lessons learned regarding transformative change in the complex system of postgraduate medical education, and the current status of the Competence by Design initiative. The approach taken and lessons learned by the Royal College may be useful for other educators who are planning a transformation to CBME or any other major educational reform.

Competence by Design: The Role of High-Stakes Examinations in a Competence Based Medical Education System.

Competency based medical education is developed utilizing a program of assessment that ideally supports learners to reflect on their knowledge and skills, allows them to exercise a growth mindset that prepares them for coaching and eventual lifelong learning, and can support important progression and certification decisions. Examinations can serve as an important anchor to that program of assessment, particularly when considering their strength as an independent, third-party assessment with evidence that they can predict future physician performance and patient outcomes. This paper describes the aims of the Royal College of Physicians and Surgeons of Canada's ("the Royal College") certification examinations, their future role, and how they relate to the Competence by Design model, particularly as the culture of workplace assessment and the evidence for validity evolves. For example, high-stakes examinations are stressful to candidates and focus learners on exam preparation rather than clinical learning opportunities, particularly when they should be developing greater autonomy. In response, the Royal College moved the written examination earlier in training and created an exam quality review, by a specialist uninvolved in development, to review the exam for clarity and relevance. While learners are likely to continue to focus on the examination as an important hurdle to overcome, they will be preparing earlier in training, allowing them the opportunity to be more present and refine their knowledge when discussing clinical cases with supervisors in the Transition to Practice phase. The quality review process better aligns the exam to clinical practice and can improve the educational impact of the examination preparation process.

Enabling Implementation of Competency Based Medical Education through an Outcomes-Focused Accreditation System.

Competency based medical education is being adopted around the world. Accreditation plays a vital role as an enabler in the adoption and implementation of competency based medical education, but little has been published about how the design of an accreditation system facilitates this transformation. The Canadian postgraduate medical education environment has recently transitioned to an outcomes-based accreditation system in parallel with the adoption of competency based medical education. Using the Canadian example, we characterize four features of an accreditation system that can facilitate the implementation of competency based medical education: theoretical underpinning, quality focus, accreditation standards, and accreditation processes. Alignment of the underlying educational theories within the accreditation system and educational paradigm drives change in a consistent and desired direction. An accreditation system that prioritizes quality improvement over quality assurance promotes educational system development and progressive change. Accreditation standards that achieve the difficult balance of being sufficiently detailed yet flexible foster a high fidelity of implementation without stifling innovation. Finally, accreditation processes that recognize the change process, encourage program development, and are not overly punitive all enable the implementation of competency based medical education. We also discuss the ways in which accreditation can simultaneously hinder the implementation of this approach. As education bodies adopt competency based medical education, particular attention should be paid to the role that accreditation plays in successful implementation.

Incorporating ABC in physiology education: Active learning, blended learning and curricular changes.

Physiology is of central importance in medicine. Teaching the complex physiological frameworks to the current generation of students with the implementation of competency-based medical education (CBME) has become a challenging task. Development of digital technology in educational field during Covid-19 pandemic has made medical educators modify their teaching learning strategies from traditional to blended mode. We offer tips to embrace the three major challenges namely, generational diversity with active learning strategies, technological growth with blended learning, and strategies to implement curricular changes in physiology education. Adult learning principles involve active learning as a crux component. Various simple active teaching strategies that can be adapted for large and small group teaching are highlighted. Blended learning is characterized by self-paced learning, and face-to-face training sessions with online collaborative learning. Simple ways to incorporate the blended mode of teaching strategies with the use of virtual platforms and learning management system (LMS) are described. Further, we discuss the nuances that help to adapt the various curriculum changes brought about by the implementation of CBME. Teaching physiology is an ever-challenging task. With an appropriate mindset, medical educators can turn these challenges into opportunities and make teaching learning a better experience.

Teaching Systems and their Sub-Topics Under Competency-Based Medical Education (CBME) to Undergraduate Medical Students in a Stepwise Approach.

Medical education in India is confronting a charismatic transformation from traditional curriculum to competency-based medical education (CBME). It is more clinically oriented; skill-based and claims to produce competent Indian medical graduates. CBME has divided subjects into competencies and related topics are scattered over different competencies. The intention behind teaching should not be merely students' learning, but contemplation should be towards concept building, imagination, creativity, self-motivated thinking, and the rightful application of knowledge in day-to-day life. Hence a well-formulated, organized, effective, and practically assessable design and an efficient approach are essential not only to link these spread-over pieces of the topic but to teach that topic in a certain flow and rhythm to a medical student also. Therefore, a stepwise approach has been proposed to teach a CBME-driven curriculum to medical students.

Exploring the Quality of Feedback in Entrustable Professional Activity Narratives Across 24 Residency Training Programs.

Background Competency-based medical education (CBME) has been implemented in many residency training programs across Canada. A key component of CBME is documentation of frequent low-stakes workplace-based assessments to track trainee progression over time. Critically, the quality of narrative feedback is imperative for trainees to accumulate a body of evidence of their progress. Suboptimal narrative feedback will challenge accurate decision-making, such as promotion to the next stage of training. Objective To explore the quality of documented feedback provided on workplace-based assessments by examining and scoring narrative comments using a published quality scoring framework. Methods We employed a retrospective cohort secondary analysis of existing data using a sample of 25% of entrustable professional activity (EPA) observations from trainee portfolios from 24 programs in one institution in Canada from July 2019 to June 2020. Statistical analyses explore the variance of scores between programs (Kruskal-Wallis rank sum test) and potential associations between program size, CBME launch year, and medical versus surgical specialties (Spearman's rho). Results Mean quality scores of 5681 narrative comments ranged from 2.0±1.2 to 3.4±1.4 out of 5 across programs. A significant and moderate difference in the quality of feedback across programs was identified (χ2=321.38, P<.001, ε2=0.06). Smaller programs and those with an earlier launch year performed better (P<.001). No significant difference was found in quality score when comparing surgical/procedural and medical programs that transitioned to CBME in this institution (P=.65). Conclusions This study illustrates the complexity of examining the quality of narrative comments provided to trainees through EPA assessments.

Competency-Based Medical Education in Residency Education.

Competency-Based Medical Education in Residency Education.

A survey on practices of embalming techniques and usage of soft embalming methods in Indian medical institutes

BackgroundSoft cadavers are becoming increasingly popular for surgical skills development in competency-based medical education curricula. However, few studies evaluate this strategy's viability, dependability, and validity, particularly in India. This study intends to investigate embalming procedures and procedural skills practices at medical institutions. MethodsA validated questionnaire gathered information on demographic details, embalming practices, surgical skill training, willingness to adopt modern embalming techniques and awareness and practice of soft embalming methods. A total of 350 Indian medical institutions were forwarded the questionnaire via email. Responses were analyzed using SPSS version 16, and the Chi-square test was used to examine the association between the two categorical variables. ResultsA study of 350 Indian medical institutions found a 62% response rate. In the studied population, 53.5% (N = 116) of institutes demonstrated procedural skills in undergraduate education as a part of early clinical experience. A total of 54.4% (N = 118) of institutes conducted hands-on surgical training. For postgraduates in surgical departments, voluntary cadaver dissection was offered at 53.9% (N = 117) of institutes. In 78.3% (N = 170) of the institutes, surgical training was performed on formaldehyde-embalmed cadavers. Institutions used proprietary solutions, fresh frozen approaches, Thiel solution, phenol, and saturated salt solutions for embalming. ConclusionThe study highlights disparities in undergraduate teaching and surgical skill training in medical institutes, emphasizing the need for re-evaluating embalming practices to ensure the safety and educational quality. It also highlights underutilization of soft embalming methods, highlighting need for improved training programs and strategies to enhance medical education quality.

Promotion in Place: A Model for Competency-Based, Time-Variable Graduate Medical Education.

Competency-based medical education is increasingly regarded as a preferred framework for physician training, but implementation is limited. U.S. residency programs remain largely time based, with variable assessments and limited opportunities for individualization. Gaps in graduates' readiness for unsupervised care have been noted across specialties. Logistical barriers and regulatory requirements constrain movement toward competency-based, time-variable (CBTV) graduate medical education (GME), despite its theoretical benefits. The authors describe a vision for CBTV-GME and an implementation model that can be applied across specialties. Termed "Promotion in Place" (PIP), the model relies on enhanced assessment, clear criteria for advancement, and flexibility to adjust individuals' responsibilities and time in training based on demonstrated competence. PIP allows a resident's graduation to be advanced or delayed accordingly. Residents deemed competent for early graduation can transition to attending physician status within their training institution and benefit from a period of "sheltered independence" until the standard graduation date. Residents who need extended time to achieve competency have graduation delayed to incorporate additional targeted education. A proposal to pilot the PIP model of CBTV-GME received funding through the American Medical Association's "Reimagining Residency" initiative in 2019. Ten of 46 residency programs in a multihospital system expressed interest and pursued initial planning. Seven programs withdrew for reasons including program director transitions, uncertainty about resident reactions, and the COVID-19 pandemic. Three programs petitioned their specialty boards for exemptions from time-based training. One program was granted the needed exemption and launched a PIP pilot, now in year 4, demonstrating the feasibility of implementing this model. Implementation tools and templates are described. Larger-scale implementation with longer-term assessment is needed to evaluate the impact and generalizability of this CBTV-GME model.

Case Curve: A Novel Web-Based Platform and Mobile Phone Application to Evaluate Surgical Competence in Graduate Medical Education.

Competency-based medical education is well established, yet methods to evaluate and document acquisition of surgical skill remain underdeveloped. We describe a novel web-based application for competency-based surgical education at a single neurosurgical department over a 3-year period. We used a web-based application to track procedural and cognitive skills acquisition for neurosurgical residents. This process included self-assessment, resident peer evaluations, evaluations from supervising attending physicians, and blinded video reviews. Direct observation by faculty and video recordings were used to evaluate surgical skill. Cases were subdivided into component skills, which were evaluated using a 5-point scale. The learning curve for each skill was continuously updated and compared with expectations. Progress was reviewed at a monthly surgical skills conference that involved discussion and analysis of recorded surgical performances. During an escalating 3-year pilot from 2019 to 2022, a total of 1078 cases in 39 categories were accrued by 17 resident physicians with 10 neurosurgical faculty who participated as evaluators. A total of 16 251 skill performances in 110 categories were evaluated. The most evaluated skills were those that were common to several types of procedures, such as positioning, hemostasis, and wound closure. The concordance between attending evaluations and resident self-evaluations was 76%, with residents underestimating their performance in 17% of evaluations and overestimating in 7%. We developed a method for evaluating and tracking surgical resident skill performance with an application that provides timely and actionable feedback. The data collected from this system could allow more accurate assessments of surgical skills and deeper insights into factors influencing surgical skill acquisition.