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Competency Based Medical Education and Assessment
Maria Lucarelli, MDAssociate Program Director Internal Medicine Residency
January 13, 2015
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Conflict of Interest
None
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Describe the characteristics and benefits of competency assessments in medical education
Define types of competency assessments that may be applicable to your medical education area
Identify existing competency assessment tool in your medical education area
Objectives
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Competency Based Education
Competency-based education (CBE) is an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from analysis of societal and patient needs. It deemphasizes time-based training and promises greater accountability, flexibility, and learner centeredness
J. R. Frank et al. 2010; 32: 631–637 Medical Teacher
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Competency Based Education
Outcomes Based Evaluation integrates knowledge, skills and attitudes Time-independent Learning is Individualized Learning occurs in the workplace
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Process versus Competency based Programs
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Carraccio, C, Wolfsthal, SD, Englander, R, Ferentz, K, Martin C “Shifting Paradigms: From Flexner to Competencies” Acad Med (2002) 77:361-367.
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Competency Based Education
Requires continuous, comprehensive assessment Majority of assessment should happen in clinical
environment Requires ongoing, highly effective feedback
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Milestones
A significant point in development and helps define the appropriate trajectory of a trainee
Identify discrete knowledge, skills and attitudes expected of learners as they progress through training
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Milestones
Can demonstrate individual trajectory of competency acquisition
Provides clear path of progress Can help focus assessment Allows for richer feedback
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Competency
Observable Measurable Integrating multiple components such as knowledge,
skills, values, and attitudes Can be assembled for progressive development Descriptors of physicians
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Competence
Abilities across multiple domains or aspects of performance in a certain context
Multi-dimensional and dynamic. It changes with time, experience, and setting.
Requires qualifiers Relevant abilities Context Stage of training
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Competent
Possessing the required abilities in all domains in a certain context at a defined stage of medical education or practice.
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Dreyfus Model
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Expert
Proficient
Competent
Advanced Beginner
Novice
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Statement of Awarded Responsibility
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Expert
Proficient
Competent
Advanced Beginner
Novice
Providing supervision to others
Acting unsupervised
Acting with supervision available within minutes
Acting with direct
supervision present in the room
Observing the Activity
A case for competency-based anaesthesiology training with entrustable professional activities: An agenda for development and research.Jonker, Gersten; Hoff, Reinier; ten Cate, Olle
European Journal of Anaesthesiology. 32(2):71-76, February 2015.DOI: 10.1097/EJA.0000000000000109
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Entrustable Professional Activities (EPA)
Specific knowledge, skills and attitudes acquired over the course of training critical to performing as a physician
Ten Cate Academic Medicine, Vol. 82, No. 6 / June 2007
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EPA
Competency
Subcompetencies
Milestones
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End-of-
Training EPA
Step 1Description and Tasks
Step 2Related Curricular Milestones
(Abbreviations on AAIM Website)
Step 3Assessment
Methods/Tools
1. Manage the care of patients with acute common diseases across multiple care settings
Internal medicine physicians entering into unsupervised practice are able to diagnose and manage common acute medical symptoms (e.g., joint pain, chest pain, and headache) and conditions (e.g., uncontrolled HTN, decompensated HF, and COPD exacerbation) in community, ambulatory, and hospital settings. The tasks required: Obtain accurate and complete
information sufficient to develop differential diagnosis and inform care plan;
Knowledge of diseases common to internal medicine;
Communicate plans of care to patients, families and care givers
Adapt care plans to changing clinical information
Patient Care (PC) A2, A3, B1, B2, C2, C3, D1, E1, F8
Multisource feedbackChart stimulated recallChart auditsDirect observationsStandardized patient/OSCEIn-training examination
Medical Knowledge (MK) A2, A3, B1, B3
Practice-Based Learning & Improvement (PBLI)
B1, B2, B3, D4, E1, E2
Interpersonal & Communication Skills (ICS)
A3, A4, A5, A7, B1, B3, D3, F1
Professionalism (P) B1, B3, D2, E1, F1, F2, F3 G2, H1, I1, I2, K3
Systems-Based Practice (SBP)
A3, B2, D2, D4, E1, E3
Building Assessments for an EPA in Three Steps. AAIM Conect
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© 2015 European Society of Anaesthesiology. Published by Lippincott Williams & Wilkins. 2
Fig. 1A case for competency-based anaesthesiology training with entrustable professional activities: An agenda for development and research.Jonker, Gersten; Hoff, Reinier; ten Cate, Olle
European Journal of Anaesthesiology. 32(2):71-76, February 2015.DOI: 10.1097/EJA.0000000000000109
Fig. 1 . Acquisition of competence. (a) Acquisition of competence, showing the competence threshold (corresponding to proficiency level IV) and continuing growth of expertise after delegation of a clinical activity. (b) Acquisition of competence for 5 different EPAs. At reaching the competence threshold, an informed and justified delegation decision can be made. Adapted with permission from 20.
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Role of Assessment
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Deficiencie
s
Advanced
• Earlier identification• Customized
remediation plans• Earlier and fair exit
from training when necessary
• Earlier identification• Customized training• More rapid
advancement
Holmboe et al The role of assessment in competency based medical education. 2010; 32:676-82. Medical Teacher
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Assessments
Needs to be continuous and frequent Formative > summative Allows for deliberate practice
Needs to be coupled with effective feedback and ongoing mentoring/coaching
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Assessments
Criterion Based Allows for appropriate expectations Developmental (milestones) Blueprint for assessment and informs appropriate
methods/tools for assessment
Take place in the clinical environment Does not eliminate the role of simulation Heavily dependent upon faculty
observations/assessment
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Assessment
Requires the use of high quality assessment tools One single evaluation may not be perfect Consider the use of multiple tools
Qualitative approaches to assessment can be valuable
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Narrative descriptions should replace grades and numerical ratings for clinical performance in medical education in the United StatesJanice L. Hanson*, Adam A. Rosenberg and J. Lindsey Lane Front. Psychol., 21 November 2013
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360 evaluations
Patient surveys
Knowledge assessments
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Mapping Milestones
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A Tool for Mapping the ACGME Milestones to Evaluation SourcesLinda Myerholtz Ph.D.
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Resources
PM&R Milestones Central www.physiatry.org
Society of Teachers of Family Medicine www.fmdrl.org
Alliance For Academic Internal Medicine www.im.org