○역량, 티백모델, 시대의 종말

역량, 티백모델, 시대의 종말

Competencies, the tea bag model, and the end of time

LINDA S. SNELL1 & JASON R. FRANK2

1Office of Education, Royal College of Physicians and Surgeons of Canada, and McGill University Centre for Medical Education & Department of Medicine, Canada, 2Office of Education, Royal College of Physicians and Surgeons of Canada and University of Ottawa Department of Emergency Medicine, Canada

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요즘, 적어도 의학교육자들 사이에서는, 티백과 역량에 관한 이야기들이 많다. "의학교육의 티백 모델"이라는 별칭이, 학생들이 얼마나 많은 시간을 - 배우는 것도 별로 없이 - 특정한 상황에 파묻혀 지내는가에 대한 불만을 보여주는 것이라면 이는 요즘 의학교육의 가장 중요한 이슈에 대한 것이기도 하다. "모든 졸업생이 충분한 역량을 갖췄는지를 어떻게 확인할 수 있는가? 이 문제를 해결하기 위해서 전 세계적으로 의학교육의 "competency frameworks"를 도입하기 시작했다. 그 결과는 구조과 절차를 기반으로 한 모델에서 결과(성과)를 기반으로 한 모델로 옮겨가는 것이었고 새로운 용어, 논쟁, 토론이 이어졌다. 어떤 사람들은 CBME에 대해서 '역량의 압제'라며 개탄하며 '역량바탕접근'의 내제적 한계와 이로인해 생기는 갈등을 설명하기도 했다.

Talk of tea bags and of competencies is much in the air these days, at least among medical educators. If epithets such as the “tea bag model of medical education” reflect dissatisfaction with approaches that emphasize how much time learners spend immersed in a certain context, as opposed to what they actually learn there, they also speak to one of the most pressing issues in medical education today: How do we ensure that all of our graduates are competent? To address this challenge, many jurisdictions around the globe have adopted “competency frameworks” for medical education. The resultant movement from structure- and process-based models to an outcomes-based approach has, in turn, given rise to jargon, controversy, and debate. Some have spoken out against the emerging paradigm of competency-based medical education (CBME), deploring “the tyranny of competency” (Brooks 2009) and emphasizing what they view as the inherent constraints and conflicts of a competency-based approach (Reeves et al. 2009).

Medical Teacher는 이번 이슈에서 CBME와 이를 둘러싼 담론을 다루고자 한다. 

Medical Teacher has devoted this issue to the discourse around CBME and its implications for all of us who are engaged in educating health professionals. The papers in this theme issue have been authored by the International CBME Collaborators,1 a unique partnership of interested scholars, practitioners, educators, curriculum planners, and teachers from four continents who came together in mid-2009 to consider the concepts and controversies in this widely debated topic.

의학교육에 대한 담론이 출간되기 시작한 것은 20세기 초반이었지만, CBME에 대해서는 다양한 부류의 담론이 있어왔다. 이번 호에서 CBME의 다양한 측면을 보는 일련의 논문을 실었다. 

Although the published discourse on medical education stretches back to the early 20th century, CBME is experiencing a resurgence of sorts. In this issue, a series of papers explores different aspects of CBME from varied perspectives. 

In a systematic review of the literature Frank and colleagues review published definitions, identify common themes, and propose a definition to stimulate dialogue. The introductory theory-to-practice paper (Frank & Snell) describes the results of an international collaboration that identified controversies, proposed consensus definitions of key terms, described the benefits and challenges of competency-based approaches, and explored future directions. These concepts are applied across the continuum of medical education in papers describing implementation, challenges, and approaches at the level of undergraduate education (Harris et al.), postgraduate training (Iobst et al.), and practice, where CBME may foster a progression from competence to excellence (Campbell et al.). Theoretical background from the learning sciences is provided by Swing to form a foundation for further thought, and a paper by ten Cate and colleagues introduces the concept of “entrustable professional activities” and explores the idea of “competencies in context.” No issue describing a new curricular paradigm would be complete without giving attention to assessment and faculty development. Holmboe and co-authors address issues surrounding assessment, emphasizing the need for robust and multi-faceted assessment systems and evaluation methods. A paper on faculty development by Dath and Iobst describes the challenges of ensuring that faculty understand the concepts of CBME and are comfortable teaching in this context, and suggests solutions at the level of the medical teacher and of the institution. Finally, a paper on policy by Taber and co-authors acknowledges that CBME is not solely a curriculum model that will be used by educators, but will have an impact on and be shaped by the institutions and systems where it is implemented.

이 각각의 논문들로부터 공통의 주제를 이끌어내보면 다음과 같다.

Although each of these papers can be read as a “stand-alone” treatment of its topic, some common themes – including the challenges posed by CBME – emerge:

• 역량의 규정을 위한 명확하게 정의된 절차가 있어야 한다.
• CBME는 학습 과정에서의 자기주도성을 촉진하지만 특정 역량을 지정하거나 정의하지는 않는다. 따라서 학습자는 한 CBME모델에서 어떻게 학습할 것인가에 대한 더 큰 수준의 자유를 가지며, 반면 역량이 성문화(codified)될수록 어떤 것을 배울 것인가에 대한 자유도는 감소한다.
• "역량"은 학습목표의 나열과는 다르며 환원주의적 작업도 아니다. 역량은 의료의 지식, 술기, 행동을 통합을 필요로 하는 광범위한 목표이다.
• CBME는 시수를 기준으로 한 학습을 강조하지 않으며, 이것이 수련 기간을 감소시키는 결과로 이어질지는 두고 볼 일이다.
• 여전히 교수자와 학습자와 행정가들의 이해와 수용, 동의가 불완전하다.
• CBME는 교수 학습 과정, CBME실행의 가능성, 평가를 둘러싼 이슈 등에 대해 상당한 도전을 불러일으켰다.
• CBME를 현장에서 사용하는 사람들의 입장에서 실행과 관련한 현실적인 이슈가 이론적 잇점보다 중요하다.
• '순수한' CBME를 설계하고 실행하는 것에 주요한 문제가 있다면 적어도 초반에는 '하이브리드' 버전을 활용할 수 있다.
• CBME의 전제는 성과에 초점을 두고 졸업생의 역량을 확실하게 하는 것이다.

• There is a need to establish a clearly defined process for delineating the competencies.
• CBME promotes self-direction for the learning process, but not necessarily for the designation or definition of specific competencies. Thus, although learners will have more freedom to decide how to learn in a CBME model, they may have less freedom in deciding what to learn as competencies become codified.
• “Competence” does not equal a list of learning objectives or reductionist tasks; it is a broad objective that necessitates an integration of knowledge, skills, and behaviours in practice.
• CBME will lead to a decreased emphasis on time-based learning; whether this also leads to shorter training times remains to be seen.
• There is as yet an incomplete understanding, acceptance, and buy-in by teachers, learners, and educational administrators.
• CBME presents challenges in the areas of the teaching and learning process, the feasibility of implementation, and issues around assessment.
• For the on-the-ground “users” of CBME (teachers, curriculum planners, and learners), practical issues of implementation may seem to outweigh the theoretical advantages.
• These major challenges to designing and implementing CBME in its “pure” state mean that “hybrid” versions will be tried, at least initially.
• The compelling promise of CBME lies in its focus on outcomes and on ensuring the competence of graduates.

Overall, the papers in this theme issue suggest that, despite criticism and challenges to implementation, CBME is an attractive direction for health professions education. As with all new ideas, there will be resistance to change. Evidence of success of some early programs might quell the fears of those who oppose these concepts and encourage further developments.

From a conceptual standpoint, CBME offers great promise as a means of addressing the needs of society, assuring competent practitioners, and emphasizing the acquisition of skills, attitudes, and knowledge and their application to real-world practice. However, to be implemented successfully, CBME must be understandable, feasible, easy to teach and to learn in, and evaluable. Although we do not believe that the wide implementation of time-free curricula is possible tomorrow, we hope that the papers in this issue will promote critical debate, encourage the development of innovative curricula, stimulate further scholarship, and advance thought and progressive action to improve the effectiveness of medical education around the world.

Read More: http://informahealthcare.com/doi/full/10.3109/0142159X.2010.500707

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Med Teach. 2010;32(8):629-30. doi: 10.3109/0142159X.2010.500707.

Competencies, the tea bag model, and the end of time.

Snell LS1, Frank JR.

Author information

PMID:

 

20662572

 

[PubMed - indexed for MEDLINE]