Curriculum Inventory in Context June 2015 Volume 2, Issue 6

Competency Mapping Across the Medical Student Curriculum

Click to view larger chart online

Susan Masters, PHD, University of California, San Francisco School of Medicine The remarkable transition of medical education to a competency-based framework over the past two decades presents challenges and opportunities to curriculum mapping efforts. Before competency-based medical education became the new norm, undergraduate medical education (UME) curriculum mapping focused more narrowly on content and delivery. As preclerkship UME curricula shifted from discipline-based to integrated courses, curriculum mapping became invaluable for ensuring that traditional and emerging foundational and clinical science disciplines are adequately "covered." This is often accomplished by carefully tagging courses and sessions with a set of core topics and then, as described by Ms. Carrie Calloway at West Virginia University School of Medicine (1), reviewing reports based on these tags to identify gaps, redundancies, and better ways to integrate topics across the curriculum.

1 | P a g e

Comprehensive cataloging of topic content is critical for curriculum planning, is an important component of the Liaison Committee on Medical Education standards for accreditation (2), and can be matched with data from the AAMC Graduation Questionnaire, AAMC Curriculum Inventory Reports, and USMLE performance summaries to generate a comprehensive view of the content the UME curriculum is delivering. Beyond the application of UME curriculum mapping for monitoring content, how do we use mapping to ensure that the curriculum provides education strategies that lead to the desired graduating medical student outcomes or competencies? The extensive literature on competency-based medical education (3-6) calls for a UME curriculum that intentionally supports a developmental, reflective process of knowledge, skills and attitude acquisition. An important step toward molding UME curricula to this framework is the definition by medical schools of graduation (or program) competency objectives, competency milestones, and outcome measures. To facilitate a continuum from UME to GME curricula, medical schools aligned their UME competency domains with those defined by the Accreditation Council for Graduate Medical Education (ACGME) in the early 2000's. More recently, medical schools have mapped their graduation competency objectives to the Physician Competency Reference Set (PCRS) (7), which are used by the AAMC Curriculum Inventory to allow comparisons among participating medical schools. Many medical schools have also spent much effort defining course and clerkship objectives, and objectives for every learning activity. By linking all levels of learner-centered objectives, we can monitor how well the curriculum supports the expected progression across all of the competency domains – from those traditionally heavily emphasized such as medical knowledge to those more recently emphasized in UME such as systems-based practice and interprofessional collaboration. Additionally, learners and their mentors can employ a competency-based curriculum map to monitor student competency-based progression. A Curriculum Inventory report of the number of medical schools implementing competencies in four non-medical knowledge competency domains – Practice-Based Learning and Improvement (3.1); Interpersonal & Communication Skills (4.3); Professionalism (5.5) and Systems-Based Practice (6.5) reveals the encouraging evidence that UME curricula are embracing the full spectrum of competencies across the curriculum, especially during the pre-clerkship curriculum. Surprisingly, the number of schools indicating that the presence of these four specific PCRS objectives in their pre-clerkship curricula is GREATER than in their clerkship curriculum. The meaning of this discrepancy is a unclear and, now revealed, will challenge schools to reassess the balance of competency distribution across their curricula. While these new data are exciting, challenges in competency-based UME curriculum mapping certainly lie before us. At the University of California, San Francisco, we are puzzling over ways to bring our curriculum management system and our separate competency-based assessment tracking systems into greater alignment. We also are looking for ways to employ a more aligned system to help students and their mentors better individualize their curriculum to support competency-based versus strictly time-based progression. Also, upon the horizon is the need to integrate curricular and assessment support for entrustable professional activities (EPAs) into UME curricular mapping frameworks. Once again, UME is following graduate medical education in efforts to improve learner assessment (8) and soon we will need to integrate an EPA lens into our UME curriculum mapping systems.

2 | P a g e

The ultimate goal of UME curriculum mapping is to support our learners in their transformation into 21st century physicians with the knowledge, skills and attitudes needed to care for patients and populations in rapidly evolving medical systems. To achieve this goal with UME curricula that are complex and constantly progressing, it is important to use multiple lenses for mapping efforts – topic-based, competency-based, and – soon – EPA-based. About the Author Susan Masters, PhD, is the Associate Dean for Curriculum and a Professor in the Department of Cellular and Molecular Pharmacology at the University of California, San Francisco School of Medicine. References

1. Calloway, C. Curriculum Mapping: A Shared Leadership Model. Curriculum Inventory in Context, 2(1), 2015.

2. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Liaison Committee on Medical Education. 2015 (Link)

3. Cooke, M, Irby, DM, O'Brien, BC. Chapter 3: Being a Doctor – Foundations of Professional Education in Educating Physicians: A Call for Reform of Medical School and Residency. The Carnegie Foundation for the Advancement of Teaching. Jossey-Bass, San Francisco (Publisher), 2010.

4. Leach, DC. Competence is a Habit. JAMA 287(2): 243, 2002. 5. Swing, SR. Perspectives on Competency-Based Medical Education From the Learning Sciences,

Medical Teacher, 32(8):663, 2010. 6. Ten Cate, Billett, S. Competency-Based Medical Education: Origins, Perspectives and Potentialities.

Medical Education 48(3): 325, 2014. 7. Englander, R, Cameron, T, Ballard, AJ, et al. Toward a Common Taxonomy of Competency Domains

for the Health Professions and Competencies for Physicians. Academic Medicine, 88(8):1088, 2013.

8. Chen, HC, van den Broek, WE, Ten Cate, O. The Case for Use of Entrustable Professional Activities in Undergraduate Medical Education. Academic Medicine, 90(4):431-6, 2015.

3 | P a g e