역량바탕교육(CBME, CBE): 프로그램 설계와 시행의 과제(Med Educ, 2016)

역량바탕교육(CBME, CBE): 프로그램 설계와 시행의 과제(Med Educ, 2016)

Competency-based education: programme design and challenges to implementation

Larry D Gruppen,1 John C Burkhardt,1,2 James T Fitzgerald,1,3 Martha Funnell,1 Hilary M Haftel,1,4

Monica L Lypson,1,5 Patricia B Mullan,1 Sally A Santen,1,2 Kent J Sheets,1,6 Caren M Stalburg1,7 &

John A Vasquez

INTRODUCTION

보건전문직 교육이 CBE / CBME 로 옮겨가고 있다. GME는 CBME 도입의 주요 동력이며, CBME는 학생과 practising professionals 까지 퍼져나가고 있다. 고등교육에서도 CB(M)E를 하고 있지만 보건전문직과는 목표가 다르다. HPE가 졸업생의 역량을 ensuring하는데 목적이 있다면, 고등교육은 학습성과의 달성 외에도 accessibility, affordability and transparency에 목적이 있다.

There has been a recent shift to competency-based education (CBE) for health professionals. Grad- uate medical education was a major driver in adopt- ing CBE,2–4 and CBE is rapidly expanding to practising professionals as well as to undergraduate health profession students. Higher education is also exploring CBE8 but with different goals from those in the health professions. Whereas health professions education has focused on ensuring competence in its graduates, higher education has examined CBE to promote accessibil- ity, affordability and transparency, in addition to improved learning outcomes.9

학습자 성과를 평가하고 대중의 신뢰와 진료전문성 얻기 위해서 혁신의 기회는 HPE교육자들로 하여금 CBME교육과정을 만들게 하였다.

The opportunity for innovation has encouraged health professions educators to develop compe- tency-based curricula in order to both assess learner outcomes and ensure public trust and practice proficiency.1,10

Frank 등은 네 개의 특징을 언급했다. 

Frank et al.11 identified four features that distin- guish CBE from more traditional approaches. These are:

• (i) 성과를 강조 a focus on outcomes,

• (ii) 능력을 강조 an emphasis on abilities,

• (iii) 시간-기반 훈련에에 대한 강조 감소 a reduced emphasis on time-based training, and

• (iv) 학습자-중심 강조 the promotion of learner centred- ness.

 

이 네 가지 각각이 CBME 설계와 도입에 과제가 된다.

Each poses challenges and implications for designing and implementing CBE,

 

성과를 강조

FOCUS ON OUTCOMES

 

 

전통적인 교육은 교육 성과를 검증하지 못하고 너무 자주 빈번하게 specific intended outcome를 명백히하지 못하는 것에 대한 비판을 받아왔다 .10) 많은 전통적인 프로그램은 "교수진이 중요하다고 정의한 내용"을 폭넓게 다루도록 고안되었지만 다른 outcome를 무시했다.

Traditional education has been criticised for failing to verify educational outcomes and, too frequently, failing even to make the specific intended outcomes explicit.1,10 Many traditional programmes were designed to provide a broad coverage of the content that faculty experts define as important, but neglected other outcomes.

대조적으로, CBE는 학습 내용이 cover되었다는 것 만으로 학습이 이루어진 것으로 가정하기보다는, 학습 성과를 측정하는 데 초점을 맞춘다. (그림 1) CBE는 이해 관계자의 요구를 반영하는 역량을 정의한 다음, 해당 역량을 사용하여 커리큘럼과 평가를 guide합니다. 따라서 CBE 커리큘럼은 발달과 학습의 근거를 support하며, 그 support에 도움이 되지 않는 것은 불필요하다 .11,16,17

By contrast, CBE focuses on measuring the out- comes of learning12–15 rather than merely assuming that learning has taken place because content was ‘covered’. (Fig. 1), CBE defines competencies that reflect stakeholder needs and then uses those competencies to guide the curriculum and assessment. Thus, CBE curric- ula, support the devel- opment and evidence of learning, and anything that does not add to that support is dispensable.11,16,17

CBME는 성과에 중점을두고 있기 때문에 이러한 결과를 평가하는 데 더 많은 관심와 투자가 필요합니다. CBME는 시간이 역량의 '대리자'로 충분하다고 가정하지 않기 때문에 평가에 더 중대한 의미를 갖는다.

Because of this emphasis on outcomes, CBE requires greater attention to and investment in assessing those outcomes. CBE has a greater empha- sis on assessment because it does not assume that time is sufficient as a surrogate for competence.

 

 

기술과 능력의 강조

EMPHASIS ON SKILLS AND ABILITIES

 

CBME는 단순한 지식 그 이상에 초점을 맞추며, 경쟁력이란 '특정 맥락에서 여러 영역에 걸친 능력의 array 또는 의사가 수행해야 하는 측면들'라고 정의합니다. 역량을 기술하기 위해서는 relevant abilities, context, and stage of training등을 정의하기 위한 descriptive qualifier가 필요하다. 역량은 다차원적이고 역동적입니다. 그것은 시간, 경험, 세팅에 따라 변합니다 . 기술과 능력에 초점을 맞추는 것이 CBE만 그런 것은 아니다. 많은 세련된 전통적인 커리큘럼도 점을 강조하는 점은 공통이지만, CBME를 정의하는 특징 중 하나입니다.

 

CBE focuses on more than just knowledge and defines compe- tence as ‘the array of abilities across multiple domains or aspects of physician performance in a certain context. Statements about competence require descriptive qualifiers to define the relevant abilities, context, and stage of training. Competence is multi-dimensional and dynamic. It changes with time, experience, and setting’.11 The focus on skills and abilities is not unique to CBE. Many sophisti- cated traditional curricula share this emphasis, but it is a defining feature of CBE.

시간-기반 훈련 최소화

REDUCED EMPHASIS ON TIME-BASED TRAINING

CBE와 전통적인 교육적 관점을 명확하게 구별하는 한 가지 측면은 시간의 역할입니다. 시간 기반 교육에서 시간이 고정되어 있고 결과 (졸업 능력)가 가변적 인 반면 CBE에서는 산출물이 고정되어 있고 시간이 가변적이라는 것입니다. 

One dimension that clearly distinguishes CBE from traditional educational perspectives is the role of time. A common aphorism is that in time-based education, time is fixed and outcomes (graduating competence) are variable, whereas in CBE, out- comes are fixed and time is variable.

프로그램을 끝내려면 최소 수의 과목 또는 학점이 필요하며 이는 프로그램 전체의 최소 시간으로 해석됩니다. CBME에서는 학기 나 과목에 제약받지 않고 능력을 획득하고 demonstrated 할 수 있습니다. 프로그램 참여과정에서 역량의 습득은 학습자의 사전 역량 수준, 이전의 전문 활동, 동기 부여 및 학습 기회에 따라 신속하거나 느리게 발생할 수 있습니다. 따라서 CBE는 프로그램 완료에 필요한 시간에 대해서 훨씬 더 유연한 관점을 가지고 있으며, 학습자의 고유한 requirement에 따라 프로그램 기간 및 활동이 달라진다.
A minimum number of courses or credits is required to finish the programme, which translates into a minimum amount of time for the programme as a whole. In CBE, competence can be attained and demonstrated without being con- strained by semesters or courses. Competence that is acquired through participation in the programme may take place quickly or more slowly, depending on the learner’s prior competence level, prior pro- fessional activities, motivation and learning opportu- nities. Thus, CBE takes a much more flexible view of the time needed for programme completion, adapting the programme duration and activities to a learner’s unique requirements.

학습자 중심

PROMOTION OF LEARNER CENTREDNESS

 

역량 기반 교육은 학습자의 사전 학습, 현재 진행 상황, 학습 기회 및 평가 피드백을 포함하는 개별 학습 계획에 중점을 둡니다. 학습자 중심으로의 전환은 '가르침'이 아니라 '학습'에 초점을 맞추는 것으로 보완됩니다. 교수진의 역할은 전문 지식의 원천에서 촉진자 및 학습 코치로 변화합니다

Competency-based education focuses on individu- alised learning plans that encompass the learner’s prior learning, current progress, learning opportuni- ties and assessment feedback. The shift to learner centredness is comple- mented by a shift from focus on ‘teaching’ to a focus on ‘learning’. The role of the faculty member changes from being a source of expert knowledge to being a facilitator and learning coach.

이러한 변화는 learner practice에 지식을 더 lasting and meaningful하게 통합할 수 있게 촉진하려는 원칙에 따른 것이다. 학습자 중심성은 시간과 공간 모두에서 융통성이 필요하며, 시간과 장소에 제약을 받는 topic-focused course에 의해 방해받는다. 이 접근법의 이점은 학습자가 자신의 속도와 일정으로 다양한 활동을 통해 학습 할 수 있다는 것입니다.

This shift is in keeping with the principle of promoting more lasting and meaningful incorpora- tion of knowledge into learner practice.20 Learner centredness requires flexibility in both time and space and may be hindered by topic-focused courses held at a set time and place. The benefit of this approach is that learners can learn through a wide range of activi- ties at their own speed and schedule.21

학습자 중심성의 또 다른 구성 요소는 피드백의 중요성이다 .22-24 CBME에서는 형성적인 피드백을 위하여 학습자의 목표와 필요 따른 평가를보다 빈번하게 시행해야 한다.

Another component of learner centredness is the importance of feedback.22–24 This formative feedback demands more frequent, if lower stakes, assessments in CBE that are aligned with the lear- ner’s goals and needs.

ENTRUSTABLE PROFESSIONAL ACTIVITIES

CBME의 맥락에서 EPA가 개발되었으며, 여러 CBME프로그램의 공통요소가 되었다. EPA는 지식과 술기를 요구하는 professional work이며, 사회가 qualified personnel을 신뢰할 수 있도록 recognizable output을 낼 수 있어야 한다. EPA는 '역량의 집합'을 반영하며, 주어진 영역에서 canonical mapping 된다.

Although not a defining attribute of CBE, entrusta- ble professional activities (EPAs) have been devel- oped in the context of CBE and have become a common component of many CBE programmes. Originally developed by Olle ten Cate,25 an EPA is a part of professional work that requires knowledge and skills and leads to recognisable outputs, which are entrusted by society to qualified personnel. Any given EPA reflects a set of competencies and, in aggregate, they are proposed as a canonical map- ping of a given domain.5–7

CBME를 현실로

PUTTING CBE INTO PRACTICE

 

여러가지 과제가 있다. CBME도입을 위한 대부분의 노력은 '역량을 정의'하는 것에 집중되는데, 이는 고작 '기존의 목적과 목표를 '역량'에 맞게 재기술recast하는 수준에서 이뤄진다. 이는 특히 ACGME의 여섯 역량이나 CanMEDS의 일곱 역할을 기반으로 한 역량 프레임워크를 도입한 학부교육과정에서 그러하다.

 the implementation that various challenges emerge. Most efforts to implement CBE have focused on defining competencies and often pro- ceed only as far as recasting previous curriculum goals and objectives in the new language of compe-tencies. This is particularly true for many under- graduate curricula that adopt a competency framework based on the ACGME six-competency model or the CANMED seven roles.

CBME의 핵심 원칙 중 가장 도입이 안 되고 있는 것은 시간에 관한 것인데, 교육프로그램에 따라 variable duration의 형태여야 한다는 것이다. 극히 일부를 제외하면, CBME를 도입했다고 하는 프로그램은 그 기간이 여전히 time-based definition을 가지고 있으며, 이들 프로그램에서 역량과 평가는 quality assurance의 목적이지, 프로그램에 걸친 progression의 guide목적이 아니다.

The key principle of competency-based medical edu- cation (CBME) that has been the slowest to be adopted is that of time in the form of variable dura- tion of educational programmes. With very few exceptions,28 the programmes that have adopted CBME still maintain a time-based definition of the programme length. In these programmes, compe- tencies and their assessment are more often quality assurance concerns (verifying that graduates are competent) than they are guides to progression through the programme.

 

 

도입의 과제: 사례 묘사

CHALLENGES IN IMPLEMENTING CBE: AN ILLUSTRATIVE CASE STUDY

As a case study of the expected and unexpected challenges and lessons in implementing CBE, we examine the University of Michigan Master of Health Professions Education (UM-MHPE) pro- gramme.29 However, a detailed examination of the programme descriptions con- tained in the Foundation for Advancement of Inter- national Medical Education and Research (FAIMER) list of Masters degree programmes around the world33 suggests that the UM-MHPE programme is unique in applying CBE to health professions education.

The UM-MHPE breaks with traditional time-based pro- grammes, focusing instead on ensuring competence in its graduates. Although competence as a goal does not distinguish CBE from traditional educational frameworks, key differences between CBE and traditional educational frameworks lie in the structure and process of education.

 

일반 특징

Briefly, the key features of the UM-MHPE are as fol- lows.

• 역량 The degree is centred around demonstrating competence in 12 educational competencies (e.g. understand and apply principles of assessment, develop a programme of educational scholarship, and understand the background of medical educa- tion so as to provide a context for current educa- tional issues and problems [see the UM-MHPE web page29 for a full description]).

• EPA Evidence of compe- tence is provided by completion of entrustable pro- fessional activities (EPAs)5–7 in education that are mapped to identified educational competencies. Our programme identifies 20 EPAs (e.g. select a learning outcome and design, select and develop an appropriate assessment method; design and imple- ment a research study; design and implement a cur- ricular intervention) that map onto the 12 competencies (Fig. 2).

• 멘토 Learners work closely with programme mentors to create an individualised learning plan that selects and sequences these EPAs. EPAs are designed to be completed in conjunction with the educational responsibilities and activities of the learners in their professional roles as health pro- fessions educators. This embeds learning in an applied context and highlights existing opportuni- ties for these educational activities. The EPAs pro- vide both evidence for assessing competence and the vehicle for learning.

• 과목이 없음 The UM-MHPE has no courses; all learning is done in the context of EPAs and utilises any viable instructional resource or format.

시간에 관련된 특징. EPA근거를 제출해서 인정받으면 추가적인 평가를 받을 필요가 없다.

In keeping with the CBE principle of disregarding ‘time in training’ as a key component of a pro- gramme, the UM-MHPE can be completed within variable time intervals, depending on learner initia- tive, prior competence and rate of demonstrated acquisition of competence. Learners who can demonstrate competence that is derived from prior experience and learning can receive credit for it once they submit the required EPA evidence; they do not need to spend time in areas in which they are already assessed to be competent. Conversely, learners cannot graduate until they demonstrate the requisite level of performance in all competencies, regardless of how long that requires them to stay in the programme.

 

평가에 관련된 특징. 평가에 투자를 많이 하였음.

The focus on competence rather than time taken for progression through the programme highlights the importance of rigorous and trustworthy assess- ment of competence.34 The UM-MHPE invests heav- ily in a competency assessment process in which learner-generated evidence of performance is evalu- ated by a designated assessment committee of pro- gramme faculty members. The assessment process explicitly recuses (배제하다) any faculty member who worked with a given learner on the EPA being assessed. This is intended as a means of minimising bias as a result of the relationship between the learner and teacher35–39 and promotes a more objective, unbi- ased judgement of the evidence provided. In addi- tion to the summative judgements of competence in a given EPA, the assessment committee also pro- vides formative feedback on how the EPA can be improved and where performance does not meet the standards.

교수의 역할

Rather than teach courses, faculty members serve as subject-matter experts for each EPA in order to guide learners towards specific resources to address identified gaps. They also advise on the selection and presentation of evidence within the EPA sub- mission to the assessment committee. Finally, pro- gramme faculty members also serve as mentors and as members of the assessment committees.

'과목'은 역량과 EPA로 대체될 수 있다.

COMPETENCIES AND EPAS CAN REPLACE COURSES

학생의 적응

Abandoning traditional courses in favour of EPAs as a curricular structure was one of the more radi- cal innovations in the UM-MHPE, so there was con- cern about how well this would be accepted by students and function as a vehicle for learning. Although there were a few puzzled inquiries about a course list, learners have quickly understood the nature and value of the EPAs as reflections of the work of a health professions educator and as opportunities to learn by doing. The fact that most learners make use of EPAs that build on their existing responsibilities is seen as an added advan- tage that makes learning relevant. Although learn- ers were open to the EPA framework, building the case within universities and higher education that competencies and EPAs could rigorously replace traditional courses required considerable time and effort.

EPA의 두 가지 용도: 학습과 평가

The use of EPAs for both learning and for assess- ment has worked well, providing authentic evi- dence of performance and relevant learning opportunities. This dual use of the EPAs has made providing feedback more complex, however. When an EPA is submitted to the assessment committee, learners frequently have to revise their EPAs to respond to assessment committee feedback and resubmit them before the evidence is considered of sufficient quality to be judged competent. Most often, a single revision is adequate but there have been instances of multiple resubmissions before the evidence is judged to meet the standards. These resubmissions provide opportunities for fur- ther and deeper learning in the context of the EPA, but learners seem to be more familiar with assessment as an evaluation process rather than as a guide to learning. The individualised nature of the EPAs, each of which reflects the particular opportunities and unique context of the individual learner, and the individualised scheduling of EPAs has required considerable flexibility on the part of the assessment committee.

Time-bound world에서 Timeless되기

BEING TIMELESS IN A TIME-BOUND WORLD

기대했던 것보다 상당한 도전과제가 있었다.

The contrast between CBE and traditional, time- based education has been one of the greatest com- plexities of the UM-MHPE. Although we anticipated that the decision to not base progress on time would be challenging, the extent of the challenges has been somewhat surprising.

 

학습자는 빠르게 적응하였다.

The learners have adapted to the framework quite readily and relish(즐기다) the idea of being able to finish the programme more or less quickly.

 

학생 간 학습속도의 차이

We have found considerable variation among learners in the rate at which they achieve and provide evidence of competence.

• Some enter the programme with considerable levels of competence and only need to demonstrate these to the assessment commit- tee.

• Others have little experience and require more time and work to acquire the necessary knowledge, skills and values to then establish their competence.

학생 간 학습강도의 차이

There is also considerable variation in how intensively learners can work on the programme; a few have some protected time for the programme but many are very much part-time learners.

 

행정구조상의 과제. 등록/등록금계산/재정지원/과목설명시스템 등등.

A competency-based programme is a challenge to traditional university administrative structures that are designed around credit hours and semester-long courses. The UM-MHPE does not fit well into the University of Michigan’s registration, tuition compu- tation, financial aid or course transcript systems, so we have adapted and ‘translated’ our CBE structures into elements that the university can accommodate. This translation is not always ideal and has created additional administrative overheads that would not be necessary in a system designed with CBE in mind.

정부 재정지원 관련 

Specifically related to accepting financial aid (e.g. student loans, etc.), the UM-MHPE is classified as a ‘direct-assessment’ programme, which requires review and approval by the United States Depart- ment of Education in order for financial aid to be awarded to learners. The Department of Education determines whether the programme meets the mini- mum requirements for an academic year and is the basis for payment periods and award calculations.40

개별화의 댓가는 비싸다

INDIVIDUALISATION WORKS BUT IS NOT CHEAP

UM-MHPE는 학습 계획, EPA 구현, 순서 및 일정, 그리고 학습 맥락에서 매우 높은 수준의 개별성을 가지고 있습니다. 학습자는 이러한 개인 성을 높이 평가하며 프로그램은 이러한 개별화를 효과적으로 지원합니다. 그러나 이런 것을 우선적으로 하기 위해 들어가는 실제 비용이 있습니다.

The UM-MHPE has a very high level of individuali- sation in its learning plan, EPA implementation, sequencing and schedule, and its professional con- text for learning. Learners value this individualisa- tion highly and the programme has operated effectively to support this individualisation. There are, however, real costs that stem from this priority.

 

전통적인 코스 기반 프로그램은 특정 시간에 학습자에 대한 그룹 수업 및 상당히 균일 한 경험을 강조하는 경향이있어 학습자가 프로그램과 교수의 일정을 수용하도록 요구합니다. 전통적인 교육에서 한 명의 교수진이 여러 명의 학습자를 가르 칠 수있는 "규모의 경제"를 제공합니다. 개별 교육은 종종 규모의 경제를 상당히 줄입니다.

Traditional, course-based programmes tend to emphasise group instruction and fairly uniform experiences for learners at specific times, requiring learners to accommodate the schedule of the pro- gramme and faculty. This provides economies of scale that enable one faculty member to teach mul- tiple learners. Individualised education reduces the economies of scale, sometimes significantly.

 

UM-MHPE 프로그램의 개별화는 학습자가 각각 다른 주제 전문가 (SME)와 상호 작용하고, 다른 EPA에서 작업하며, 다양한 순서와 활동 일정을 조정하고, 다른 목표를 추구합니다. 전통적 프로그램에서도 학습의 학생마다 다양한 양상을 보이지만, 코스 제목, 강의 계획서, 목표, 평가 방법 및 프로그램 일정 등 "겉으로 드러나는 일관성"으로 위장하고 있다. 개별화는 교수자가 학습 프로그램을 공동으로 설계하고, 학습자에게 자원에 대해 조언하고, 학습자의 질문, 발견 및 평가와 상호 작용하는 데 더 많은 관심을 기울여야 할 것을 요구합니다.
Individualisation also highlights the fact that learn- ers in the UM-MHPE programme each have very different experiences as they interact with differ- ent subject-matter experts (SMEs), work on differ- ent EPAs, arrange different sequences and schedules of activities, and pursue different goals.

Such individual variability in learning is also true in traditional programmes as students bring differ- ent backgrounds, interests and experiences to the same course and draw their own conclusions, work on their own projects and write their own papers. However, this diversity is often camouflaged in tra- ditional programmes by the apparent uniformity of course titles, syllabi, objectives, assessment methods and programme schedules. Individualisa- tion requires faculty members to give considerably more attention to

• collaboratively designing a learning programme,

• advising the learner on resources, and

• interacting with learners’ questions, discoveries and assessments.

의도적인 커뮤니티 빌딩이 필요하다

COMMUNITY BUILDING MUST BE INTENTIONAL

학습자공동체를 만들어주는 것이 과제이다. 학생들이 동일한 물리적 위치에 있지 않기에 고립된 상태에 놓일 위험이 있다.

The individualised character of the UM-MHPE is a key feature but it carries with it new challenges in building a community of learners. When learners are pursuing their own learning programmes, activities and mentored instruction instead of common course- work, they are seldom in the same physical location. The typical casual interactions that occur naturally in face-to-face settings are often missing and the learn- ers are at greater risk of being isolated.

학습자 상호작용에 의한 교육적 장점이 명시적으로 장려될 필요가 있다

Community building is also challenged by the asyn- chronous and dispersed nature of the learner cohort. It has become clear that the educational benefits of learner interactions need to be explicitly fostered and promoted. The learners have taken the lead on this in several ways and the programme con- tinues to evolve to promote a community of learn- ers, alumni and faculty members.

결론

CONCLUSIONS

Competency-based education is a broad framework for education that has utility for many fields. The UM-MHPE reflects the trend towards CBE in the health professions as well as in higher education more generally. We believe the UM-MHPE represents a bold new direction for the education of health professional educators. It is appealing to learners, exciting for faculty members, but often challenging for administrators. It demonstrates that CBE ‘works’ in this setting and fits the needs and goals of learners. The programme’s CBE format allows learners to fully integrate their learning into their own interests and career goals. It assesses competence in authentic, workplace-based activities and certifies that graduates have demonstrated competence.

5 ten Cate O, Billett S. Competency-based medical education: origins, perspectives and potentialities. Med (3):325–32. Educ 2014;

8 Johnstone SM, Soares L. Principles for developing competency-based education programs. Chang Mag (November):12–9. High Learn 2014;

11 Frank JR, Snell LS, ten Cate O et al. Competency- based medical education: theory to practice. Med (8):638–45. Teach 2010;

37 Kogan JR, Conforti LN, Iobst WF, Holmboe ES. Reconceptualizing variable rater assessments as both an educational and clinical care problem. Acad Med (5):721–7. 2014; 89

 

 

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Med Educ. 2016 May;50(5):532-9. doi: 10.1111/medu.12977.

Competency-based education: programme design and challenges to implementation.

Gruppen LD1, Burkhardt JC1,2, Fitzgerald JT1,3, Funnell M1, Haftel HM1,4, Lypson ML1,5, Mullan PB1, Santen SA1,2, Sheets KJ1,6, Stalburg CM1,7, Vasquez JA1.

Author information

• 1Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
• 2Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
• 3Ann Arbor VA Geriatrics Research, Education and Clinical Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.
• 4Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.
• 5Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
• 6Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
• 7Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Abstract

CONTEXT:

Competency-based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time-based training, and promotion of learner centredness. Each of these features has implications and potential challenges for implementing CBE.

METHODS:

As an experiment in CBE programme design and implementation, the University of Michigan Master of Health Professions Education (UM-MHPE) degree programme was examined for lessons to be learned when putting CBE into practice. The UM-MHPE identifies 12 educational competencies and 20 educational entrustable professional activities (EPAs) that serve as the vehicle for both learning and assessment. The programme also defines distinct roles of faculty members as assessors, mentors and subject-matter experts focused on highly individualised learning plans adapted to each learner.

CONCLUSIONS:

Early experience with implementing the UM-MHPE indicates that EPAs and competencies can provide a viable alternative to traditional courses and a vehicle for rigorous assessment. A high level of individualisation is feasible but carries with it significant costs and makes intentional community building essential. Most significantly, abandoning a time-based framework is a difficult innovation to implement in a university structure that is predicated on time-based education.

© 2016 John Wiley & Sons Ltd.

PMID:

 

27072442

 

DOI:

 

10.1111/medu.12977