Outcome (competency) based education: an exploration of its origins, theoretical basis, and empirical evidence

Abstract

Outcome based or competency based education (OBE) is so firmly established in undergraduate medical education that it might not seem necessary to ask why it was included in recommendations for the future, like the Flexner centenary report. Uncritical acceptance may not, however, deliver its greatest benefits. Our aim was to explore the underpinnings of OBE: its historical origins, theoretical basis, and empirical evidence of its effects in order to answer the question: How can predetermined learning outcomes influence undergraduate medical education? This literature review had three components: A review of historical landmarks in the evolution of OBE; a review of conceptual frameworks and theories; and a systematic review of empirical publications from 1999 to 2010 that reported data concerning the effects of learning outcomes on undergraduate medical education. OBE had its origins in behaviourist theories of learning. It is tightly linked to the assessment and regulation of proficiency, but less clearly linked to teaching and learning activities. Over time, there have been cycles of advocacy for, then criticism of, OBE. A recurring critique concerns the place of complex personal and professional attributes as ''competencies''. OBE has been adopted by consensus in the face of weak empirical evidence. OBE, which has been advocated for over 50 years, can contribute usefully to defining requisite knowledge and skills, and blueprinting assessments. Its applicability to more complex aspects of clinical performance is not clear. OBE, we conclude, provides a valuable approach to some, but not all, important aspects of undergraduate medical education.

Students' perspectives about the medical humanities curriculum at the Catholic University of Korea

“…36,37 Educators agree that assessment drives learning. Assessment can motivate and focus both learners and teachers to address learning gaps they might overlook.…”

From humble beginnings … the evolution of the FRACS (Urology)

“…23 The challenge ahead, as a result of moving away from earlier models, was that there remained complexities in globally defining competency. 24,25 There was an implication from CBT that, upon completion, a surgeon would be competent. 26 Opponents suggested that the CBT style of education could be reductive and that it ignored the richness of the global traditional model.…”

Dichotomy and dialogue in conceptualizations of competency in health professionals’ education

“…Most define "competence" as the aspect of a job that an individual is able to perform, and "competency" as the behavior underpinning such performance. [8,9] Others suggest that "competence" would be the potential to perform, whereas "competency" would be the actual performance in accordance with established policies in a specific situation. [10] Another conceptual issue resides in the persisting confusion between "competence" and "performance".…”