Competency Based Medical Education is Wrong for Surgery

Abstract

Abstract-Competency Based Medical Education CBME has been pushed into place as the dominant paradigm for medical and surgical education. Premised on the notion that medical proficiency can be rendered into predefined observable behaviors, CBME takes an explicitly reductionistic and behaviorist approach to professional education. Unfortunately, this approach is fatally flawed, relying on false premises of human action, employing unworkable methods, and unsupported by empirical data. Deployment of CBME has produced disintegration of surgical training, with loss of technical ability, degradation of professional ownership, and worsening clinical judgment. In contrast, an approach that updates working Halstedian techniques, explicitly favors cognitive integration, and deemphasizes artificial metrics of advancment holds more promise for creating proficient surgeons. (Preprint, Jan 2017)

Introductory Chapter: Navigating Challenges and Opportunities in Modern Graduate Medical Education

“…GME represents the gradual transition between what is traditionally understood as "undergraduate education" (including medical school) and one's full professional engagement within a medical or surgical specialty [4,5]. The concept of "readiness for practice" has emerged as an important driver of how graduate medical training is adapting to each trainee's individual needs and accomplishments, with milestone-based re-calibrations throughout the learning continuum [6,7]. This results in the creation of a highly competent medical workforce ready to meet the expectations and sophistication of a busy, modern-day clinical practice [5,8].…”

Introductory Chapter: A Quest to Transform Graduate Medical Education into a Seamless Journey toward Practice Readiness

“…Graduate medical education (GME) represents the transition between the traditionally understood world of "undergraduate education," including the medical school, and the realm of fully professional engagement within a medical or surgical specialty [1,2]. Due to the relative shielding of trainees from full spectrum exposure to "real-life practice" environments and responsibilities, important gaps in readiness exist [3,4]. In response, residency and fellowship programs are undergoing significant transformation to more effectively prepare graduates to meet the expectations of a busy, modern day clinical practice [2,5].…”