CBME - what is needed to implement this framework in modern healthcare educational programs

#Competencybasedmedicaleducation #Healthcare #HigherEducation

This is the follow up article to the introduction of the competency-based medical education framework that I discussed a few weeks ago. In that article I described and defined CBME and emphasized the growing importance of this newer form of learning and assessment in health professions education. Again, “CBME is an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities.” So, let me describe here what is needed to realize a fully operational CBME focused educational setting (at least from an assessment point of view)

In undergraduate medical education in the United States, students must undergo four years of both pre-clinical and clinical education and gain a certain amount of knowledge and skills that prepare them to treat patients under their care. As medical knowledge now doubles roughly every 74 days, it is impossible for student to know all the information that is available. In addition, it is certainly possible to expect students to gain the skills necessary to do their jobs as a medical doctors, but it is difficult to ensure that each and every skill that might be needed is mastered at the expertise level. Finally, there are many other attributes such as professionalism, communication, systems thinking and teamwork that we desire from our medical trainees. So, schools have had to pivot and change their assessment and teaching to reflect the fact that 1) we will never be able to expose student to all the knowledge they will need and 2) that we need to observe skills at the bedside and the doctors office (for example) and soft skills by ensuring their is ample opportunity for students to display them (teamwork and professionalism). Thus, we need to work backwards and ask, "what is it that we want our student to do" by the time they graduate and to what level. From there, we develop our curriculum and our teaching spaces and opportunities to capture these and then we map out the assessments (summative, formative, narrative, oral, etc.). In the past, nearly 100% multiple choice questions would suffice - now, they are wholly insufficient.

So, schools must now capture more diverse learning in a large variety of manners (e.g. feedback following a team activity, tracking attendance to clinical sites, patient feedback, evaluations from instructors and fellow students, etc.). In addition, faculty must be taught how to provide feedback that is supportive and that drives learning. New feedback and evaluation processes must be developed that include rubrics (a scoring tool with specific learning expectations or criteria for each domain being evaluated). It is not uncommon to now see many more assessment data points collected on each and every student than what was routinely collected before. Test scores are no longer the ONLY source of useful data.

So now that more robust and hopefully more holistic assessment data is being collected for each medical trainee, the program needs to translate that information to the student. As there are more data points now and there are many competencies, it is very important for student to understand where they are and where they need to be at any given time. Programs that have academic coaches, who are trained to understand where students should be at a given time, who have access to their academic performance and who understand how to speak to a student from a 'growth mindset' perspective will truly be able to close the loop with their trainees. So, CBME requires more assessment points (observations, tests, etc.), trained faculty who can properly evaluate each student, a robust data collection system and academic coaches who can navigate the student data with each trainee.

In the next article, we will focus on the growth mindset and the master adaptive learner which complements any CBME program.