A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs

Abstract

Purpose The rapid adoption of competency-based medical education (CBME) provides an unprecedented opportunity to study implementation. Examining “fidelity of implementation”—that is, whether CBME is being implemented as intended—is hampered, however, by the lack of a common framework. This article details the development of such a framework. Method A two-step method was used. First, a perspective indicating how CBME is intended to bring about change was described. Accordingly, core components were identified. Drawing from the literature, the core components were organized into a draft framework. Using a modified Delphi approach, the second step examined consensus amongst an international group of experts in CBME. Results Two different viewpoints describing how a CBME program can bring about change were found: production and reform. Because the reform model was most consistent with the characterization of CBME as a transformative innovation, this perspective was used to create a draft framework. Following the Delphi process, five core components of CBME curricula were identified: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. With some modification in wording, consensus emerged amongst the panel of international experts. Conclusions Typically, implementation evaluation relies on the creation of a specific checklist of practices. Given the ongoing evolution and complexity of CBME, this work, however, focused on identifying core components. Consistent with recent developments in program evaluation, where implementation is described as a developmental trajectory toward fidelity, identifying core components is presented as a fundamental first step toward gaining a more sophisticated understanding of implementation.

Beyond summative decision making: Illuminating the broader roles of competence committees

“…Competence‐based approaches to medical education and curriculum design endeavour to systematically enhance trainees' capacities and skills to ensure that core competencies required for practice are achieved and maintained 30‐33 . These approaches necessitate a shift in assessment practices away from problem identification in favour of practices that promote developmental learning; they foster growth through the provision of individualised feedback and tailored learning experiences 34‐37 . Prioritising assessment for learning and increasing the quantity and quality of formative feedback for learners is resource‐intensive; the potential for assessment burden and fatigue has been well documented in the literature 19,38‐40 .…”

“…Given the complexity of the transition to CBME and the diversity of systems, programmes and learning contexts, customisation and adaptation are required to ensure that educational innovations can be meaningfully applied 31,34,45 . Adaptation, at all levels, is entangled with continuous quality improvement and driven by the aim to understand, which education and assessment practices work, for whom they work, why they work and what else needs to be done 32,46,47 …”

Prevalence and curriculum of sexual and gender minority education in Japanese medical school and future direction

“…In education, a framework is used as a roadmap, identifying teaching responsibilities demonstrated by empirical studies and theoretical research to promote student learning and outcomes [32]. With the recognition that a significant shift in behaviours would be warranted for SGM curriculum to be effectively implemented in Japan, we structured recommendations consistent with the competency-based Van Melle reforms framework, advocating transformative change to reflect the scale of the needed outcomes [33]. The Van Melle framework focuses on the learner, stressing curricular outcomes, and favouring the reinforcement and strengthening of abilities over standard time-based training [33].…”

“…With the recognition that a significant shift in behaviours would be warranted for SGM curriculum to be effectively implemented in Japan, we structured recommendations consistent with the competency-based Van Melle reforms framework, advocating transformative change to reflect the scale of the needed outcomes [33]. The Van Melle framework focuses on the learner, stressing curricular outcomes, and favouring the reinforcement and strengthening of abilities over standard time-based training [33]. Competency-Based Medical Education (CBME) leverages outcome competencies, sequenced progression, tailored learning experiences, competencyfocused instruction, and programmatic assessment to achieve stated competencies and desired outcomes [33].…”

Clinical feedback and coaching – BE‐SMART

“…Although we will describe these elements in a linear sequence, they are intended to be applied in an iterative and flexible way and can be used to facilitate any feedback conversation. The framework is specifically designed to align with the five core components of CBME: (i) outcome competencies grounded in clinical practice; (ii) progressive sequencing of competencies; (iii) learning experiences tailored to facilitating development of competencies; (iv) teaching tailored to facilitating development of competencies; and (v)programmatic assessment …”