Competency based medical education

Medical education is changing to meet the demands of our evolving health care system. One of these changes is the development and implementation of competency-based medical education (CBME).

1. CBME(Competency Based Medical Education) : Methodologies and challenges in assessment Dr Mohit Kher Senior Resident Pharmacology, LHMC

2. OUTLINE CBME Difference between old and new curriculum Components Teaching methods Competencies Challenges

3. Introduction Competency‐based medical education (CBME), originally introduced in 1978, has regained momentum over the past decade. Competency – It is defined as “ the ability to do something successfully and efficiently”. According to international CBME Collaborators, 2009 : An observable ability of a health professional, integrating multiple components such as knowledge, skills, values and attitudes. Measurable Descriptors of physicians

4. International CBME Collaborators ICBME have been working since 2009 to promote the application of CBME in different medical institutions worldwide. Principles outlined by ICBME in 2013 summit: 1. Based on the health needs of the population 2. Primary focus is desired outcomes for learners 3. Formation of the physician should be seamless

5. CBME: Key Features Outcome based Learner centric Focusses on three domain of learning (K/S/A): Knowledge, Skill and attitude Evaluation integrates all domains Self directed learning Time independent Learning is individualized

6. CBME: Components Competencies Entrustable professional activity (EPA) Milestones These are used as tools for assessment

7. Competencies expected of an Indian medical graduate (IMG) COMPETENCY DESCRIPTION Clinician Who understands and provides preventive, promotive, curative, palliative and holistic care with compassion Leader and member of the health care team and system With capabilities to collect, analyze, synthesize and communicate health data appropriately Communicator With patients, families, colleagues and community Life longer learner Committed to continuous improvement of skills and knowledge Professional Who is committed to excellence is ethical, responsive and accountable to patients, community and profession

8. Entrustable Professional Activity (EPA) EPA means the work that defines a profession. For a medical student, EPA includes the role of clinician, communicator and professional.

9. Milestones in CBME Milestones in CBME refers to a significant point in development where competencies are achieved gradually step by step. Milestones gives information on individual’s trajectory of competency acquisition. Guides self assessment by learner.

10. Different teaching learning methods in CBME Teacher centric/Passive learning: Lecture cum demonstration, Seminars and audio/video recordings Learner centric/Cognitive learning: Self directed learning/E-learning, Roleplay and simulation/real life patient. Learner centric with deeper discussion: Case study, small group discussions, DOAP and workshops.

11. Challenges Novice faculty/poor acceptance for CBME Duration of second professional reduced by 6 months I ncreased administrative requirements N eed for faculty development L ack of models for flexible curriculum I nconsistencies in terms and definitions L ack of good assessments for some competencies A bsence of a vision and a plan to bring about the reforms in curricular delivery

12. I nfrastructure, learning resources and financial support R eluctant teaching staff and resistance to change N o guidelines from the regulatory body for the mandatory implementation P oor coordination between the undergraduate and postgraduate curriculum N o comprehensive plan and periodicity to streamline student assessment Lack of clarity about CBME among Postgraduates (no sensitization)

13. CONCLUSION

14. REFERENCES Shrivastava, Saurabh Rambiharilal , and Prateek Saurabh Shrivastava. “Qualitative study to identify the perception and challenges faced by the faculty of community medicine in the implementation of competency-based medical education for postgraduate students.”  Family medicine and community health  vol. 7,1 e000043. 24 Jan. 2019, doi:10.1136/fmch-2018-000043 Ramanathan R, Shanmugam J, Sridhar MG, Palanisamy K, Narayanan S. Exploring faculty perspectives on competency-based medical education: A report from India.  J Educ Health Promot . 2021;10:402. Published 2021 Oct 29. doi:10.4103/jehp.jehp_1264_20 Shah N, Desai C, Jorwekar G, Badyal D, Singh T. Competency-based medical education: An overview and application in pharmacology.  Indian J Pharmacol . 2016;48( Suppl 1):S5-S9. doi:10.4103/0253-7613.193312 Hamza DM, Ross S, Oandasan I. Process and outcome evaluation of a CBME intervention guided by program theory.  J Eval Clin Pract . 2020;26(4):1096-1104. doi:10.1111/jep.13344

15. What should be done C urtailing the duration of foundation course S ensitization of all medical teachers through faculty development programs B etter synchronized vertical integration I ncreasing the strength of faculty in each department A dequate infrastructure for skills laboratory