Addressing the Challenges of Implementing Competency-Based Curricula From Undergraduate Medical Education to Graduate Medical Education

• In Event: 28.090 - MTCC Roundtable Session Nine
  In Roundtable Session: 28.090-8 - Challenges to the Development of Assessment Systems for Competency-Based Education in the Health Professions

Abstract

The first challenge to be addressed is shifting to a culture of competency-based education. This can be difficult as culture is deep-seated, slow to change, and inherent throughout an organization with a culture shift that needs to take place to move toward a culture of competence and assessment (Roberts, Borden, Christiansen, & Lopez, 2005). Are there ways to get champions of change toward competency-based assessment on board along with helping those who are resistant to a new model move toward adaptation and buy-in? Leadership is also important as senior administrators within the various types of health professions schools need to understand this model, how it is being used and defined in their own professions, and whether or not their colleges, schools, and/or programs are willing to prioritize working toward a competency-based education model, and to what extent.

The next issue to be addressed is available resources for shifting to a competency-based education model and assessment system. In a competency-based context, assessment should be a dynamic, evolving process and attempt to address issues at the forefront of curriculum development, rather than from a reactive approach. Assessment tools in this context should use formative feedback, direct observation, and self-directed learner assessment (Iobst et al., 2010). However, being able to devote resources to continuously improving assessment is challenging, particularly when coupled with other demands that are required, such as reporting to accreditation organizations. Furthermore, limited faculty development and inconsistent definitions of competency-based education also hinder a successful transition to this model of education and training (Hawkins et al., 2015). The question remains: how can we integrate both continual improvement of medical education while simultaneously meeting requirements in a static environment?

Finally, a specific example in how to bridge the divide between and better integrate undergraduate medical education (UME) and graduate medical education (GME) assessment, particularly from a competency-based education standpoint, will be discussed. This proves to be a challenge as both UME and GME still prescribe to time-to-measure outcomes, whether that be semester credit hours and/or years in an UME or GME program with requirements to be met at certain times (e.g., board exams, end-of-semester course grades, etc.). The creation of the Accreditation Council for Graduate Medical Education’s (AGCME) milestones has propelled GME toward competency-based medical education, with UME attempting to emulate the model through the Association of American Medical College’s Entrustable Professional Activities (EPAs) for entering residency and institutional/program specific initiatives to push toward new education models (Chen, van den Broek, ten Cate, 2015). Some of AAMC’s EPAs include: “Collaborate as a member of an interprofessional team”, “Perform general procedures of a physician”. Still, challenges exist to ensuring smoother transitions from UME to GME.

Author

• Ah Ra Cho, The University of Arizona