Presentation Description
Holly Caretta-Weyer1
1 Stanford University School of Medicine
1 Stanford University School of Medicine
Problem:
Competency-based medical education (CBME) has established itself as the predominant paradigm for the future of medical education. CBME is comprised of five core components: 1) An outcomes framework, 2) Progressive sequencing of competencies to support progression, 3) Individualized learning experiences, 4) Teaching tailored to competencies, and 5) Programmatic assessment with emphasis on workplace-based assessment (WBA). Each of these components has given rise to both significant promise and potential pitfalls.
Competency-based medical education (CBME) has established itself as the predominant paradigm for the future of medical education. CBME is comprised of five core components: 1) An outcomes framework, 2) Progressive sequencing of competencies to support progression, 3) Individualized learning experiences, 4) Teaching tailored to competencies, and 5) Programmatic assessment with emphasis on workplace-based assessment (WBA). Each of these components has given rise to both significant promise and potential pitfalls.
Summary of Work:
We embarked on implementing the core components of CBME within Emergency Medicine (EM) across 9 pilot sites representative of the specialty in the US. This included the development and implementation of EPAs that span the continuum of EM training, the mapping of developmental milestones to the EPAs, implementation of an adaptable coaching program and individualized learning plan (ILP), and the adoption of programmatic assessment. We subsequently performed a realist evaluation to analyze the implementation across the pilot sites.
We embarked on implementing the core components of CBME within Emergency Medicine (EM) across 9 pilot sites representative of the specialty in the US. This included the development and implementation of EPAs that span the continuum of EM training, the mapping of developmental milestones to the EPAs, implementation of an adaptable coaching program and individualized learning plan (ILP), and the adoption of programmatic assessment. We subsequently performed a realist evaluation to analyze the implementation across the pilot sites.
Results:
Variability in EPA implementation, ranges of milestones ratings tagged to each EPA, disparate coaching models, adaptations to ILPs, and differences in technology to collect WBA data as well as aggregation and use of programmatic assessment data were identified. Additionally, challenges around faculty development, implementation, and feasibility were identified.
Variability in EPA implementation, ranges of milestones ratings tagged to each EPA, disparate coaching models, adaptations to ILPs, and differences in technology to collect WBA data as well as aggregation and use of programmatic assessment data were identified. Additionally, challenges around faculty development, implementation, and feasibility were identified.
Discussion/Conclusions:
Our realist evaluation of a pilot of implementation of CBME within a single specialty in the US reveals substantial variability in how the core components are actualized. When implementing across an entire specialty, it is essential to consider feasibility based upon context, what can be transferrable across all programs, and what represents acceptable variability.
Our realist evaluation of a pilot of implementation of CBME within a single specialty in the US reveals substantial variability in how the core components are actualized. When implementing across an entire specialty, it is essential to consider feasibility based upon context, what can be transferrable across all programs, and what represents acceptable variability.
Next Steps:
Formal realist and rapid cycle evaluation of the implementation of CBME within Emergency Medicine will be expanding specialty-wide as we engage further with our national partners and will provide further lessons learned based upon our broader implementation as the project progresses to completion.
References (maximum three)
1. Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J, et al. A core components framework for evaluating implementation of competency-based education programs. Acad Med. 2019;94(7):1002-9.