What is Competency Based Medical Education? Medical Education 101 #1
In this article, we gonna talk about the most important concept of medical education emerged in the last thirty years, Competency-Based Medical Education. It will be explained in a short time and in a way that anyone can understand why it is so important.
Here is 4 minutes video version of this article: https://youtu.be/b7ZGXjtOTS0
At the end of nineteenth century, medical education was carried on mostly by using books. One man, William Osler appeared and said “Medical students! If you want to learn medicine, you must go to hospital wards, you should spend time with patients, books are not enough to learn medicine”. It was a good step to forward for those days.
Since those days, however, the traditional medical education was teacher-centered. The only source of information was teacher. Education mostly based on information gathering, not improving higher level skills such as clinical reasoning and learning to learn. It was discipline based and hospital based. It had a standard program. There was apprenticeship model that students solely copy what a professor do. It was an opportunistic education that provides some random and irregular opportunities to learn.
Assessment was only at the end of the education. It was norm-referenced.
What is that? The pass and fail decisions are up to the other students’ levels. If you are in a group that consists of students who have high levels, you fail. If you are in a low level students group, you pass even if you have the same level as you failed before.
The prominent requirement of graduation was the time. For instance, let’s say you are a resident in internal medicine. If you make rotations between departments for four years, congrats, you deserved being graduated. It’s not important how you spend your time within that period or no matter the quality of learning. The traditional medical education had such a shape. Complete your years, be doctor. What a dark time.
In 1990’s, something has changed. It was a gradual change that started before 90’s but there was a rapid transform in 90’s. The name of the change was Outcome Based and Competency Based Medical Education (CBME).
In CBME, the pass/fail decisions are not given according to the required amount of time. The only important thing is outcome and this outcome should be competence at least. You cannot deserve graduation certificate since you just spend your years inside the borders of the medical environment. You have to show that you are competent.
The competency areas and levels are certain before you enter. You know what the target is before starting your education journey. Until the graduation time, any method can be used to reach competency level that you need.
What are the levels? For instance, Dreyfus and Dreyfus defined them in their framework:
Novice
Advanced Beginner
Competent
Proficient
Expert
If you want to get MD degree, you have to reach the “competent” level minimum and prove that you reached. In CBME, assessment is not norm-referenced, it is criterion-referenced. What does it mean?
It means that there are certain levels that a student has to reach regardless of the group of students’ level.
In short, CBME does not focus on time, its focus is to determine whether the student is competent.
What has Thomes Fuller said once? A good archer is not known by his arrows but by his aim. Let being competent to be your aim. You will achieve, no matter how.
You can find the further reading materials in the description section of the video: https://youtu.be/b7ZGXjtOTS0
See you and adios para amigos.
And also, don’t forget the flamingos.
