Shifting Paradigms

Abstract

Realizing medical education is on the brink of a major paradigm shift from structure- and process-based to competency-based education and measurement of outcomes, the authors reviewed the existing medical literature to provide practical insight into how to accomplish full implementation and evaluation of this new paradigm. They searched Medline and the Educational Resource Information Clearinghouse from the 1960s until the present, reviewed the titles and abstracts of the 469 articles the search produced, and chose 68 relevant articles for full review. The authors found that in the 1970s and 1980s much attention was given to the need for and the development of professional competencies for many medical disciplines. Little attention, however, was devoted to defining the benchmarks of specific competencies, how to attain them, or the evaluation of competence. Lack of evaluation strategies was likely one of the forces responsible for the three-decade lag between initiation of the movement and wide-spread adoption. Lessons learned from past experiences include the importance of strategic planning and faculty and learner buy-in for defining competencies. In addition, the benchmarks for defining competency and the thresholds for attaining competence must be clearly delineated. The development of appropriate assessment tools to measure competence remains the challenge of this decade, and educators must be responsible for studying the impact of this paradigm shift to determine whether its ultimate effect is the production of more competent physicians.

The competency movement in the health professions: ensuring consistent standards or reproducing conventional domains of practice?

“…Typically, competency-based approaches are created through a combination of quantitative and qualitative methods (Carraccio et al 2002) by professional experts who define what the elements of 'competent' professional practice should be. The result of this process is that the competencies drafted reflect their particular views of what constitutes 'best practice' at the point in time they were created.…”

Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations

“…To complete this process, we still need to define performance levels for each competency (milestones), develop an assessment framework, and perform ongoing evaluation of the overall educational program to ensure that desired outcomes are met. 1 Specifically, the context and content addressed by qualifiers of competence must be evaluated using valid and reliable assessments at appropriate levels of training, thereby ensuring that students attain the requisite knowledge, skills, and attitudes.…”

“…1,2 Variability in clinical performance and increasing demand for accountability in practice resulted in the paradigm shift to competency-based education in modern health professional training. Defining the outcomes of such training has rapidly evolved over the past decade, with competencies varying by health professions, 3–5 geographic location, 6,7 and level of training 8 ; however, the exponential increase in the number and phraseology of these competencies has created redundancy and unnecessary difficulty in developing training milestones and assessment strategies for each competency.…”

A Competency Model for Clinical Physicians in China: A Cross-Sectional Survey

“…Historically, the emphasis has been on the educational process and the resources available to the students, including the facilities, faculty, content, and length of training. Recently, this focus has begun to shift to outcomes, the competencies a trainee must have on program completion [1, 2]. These competencies or outcomes are then used to decide who should be admitted to the program, the content of the curriculum, the nature of the training sites, and the qualifications of the faculty [3, 4].…”