Medical Education 2012: 46: 357–365 Context  Current debate in medical education focuses on the nature of ‘competency‐based medical education’ (CBME) and whether or not it should be adopted. Many medical schools claim to run ‘competency‐based’ curricula, but the structure of their programmes can differ radically. A review of the existing CBME literature reveals that little attention has been paid to defining the concept of competence. A straightforward examination of what is meant by the term ‘competence’ is noticeably missing from the literature, despite its impact on medical training. Objectives  This paper aims to illustrate the varying conceptions of ‘competence’ by comparing and contrasting definitions provided in the health sciences education literature and discussing their respective impacts on medical education. Methods  A systematic review of recent publications in medical education journals published in English and French was conducted to extract definitions of competence or, if definitions were not explicitly stated, to derive the authors’ implicit conception of competence. A sample of 14 definitions from articles in the health sciences education field was studied using thematic analysis. Results  There is agreement that competence is composed of knowledge, skills and other components. Although agreement about the nature of these other components is lacking, attitudes and values are suggested to be essential ingredients of competence. Furthermore, a clear divergence in conceptions of how a competent person utilises these components is apparent. One view specifies that competence involves selecting components according to specific situations, as required. A second view places greater emphasis on the synergy that results from the use of a combination of components in a given situation. Conclusions  These conceptual distinctions have many implications for the way CBME is implemented. A conception of competence as the selection of components may lead to a greater emphasis, in a training setting, on the mastery of each component separately. A conception of competence as the use of a combination of components leads to greater emphasis on the synergy that results as they are deployed in clinical situations.

Background: Over the last 6 years, an institutional project was undertaken to define the preclinical PBL tutor role and to develop a comprehensive tutor training system. Description: A system of tutor training accompanied the Sherbrooke School of Medicine major shift to a student-centered, PBL community-oriented curriculum which was successfully completed. Purposes: Eight specific tutor tasks were identified and then validated by PBL tutors from five international schools. Thirty-four competencies related to tutor tasks were then validated by Sherbrooke tutors, as they gained experience with the Sherbrooke PBL method. A comprehensive training system was established wherein the basic workshop, tutoring experience, weekly tutors' meeting, monitoring during the PBL unit, and yearly update workshops were all linked in a continuous system of tutor competencies improvement. Evaluation: A self-assessment grid gave teachers the opportunity to appreciate their motivation and their sense of learning, and administrators a tool to tailor the tutor training system according to the specific contextual conditions. Conclusions: The systematic and comprehensive definition of tutor tasks has become the cornerstone of the training program. The yearly half-day update workshops have become a necessary component of PBL tutor continuing education. This project has demonstrated a systematic process of PBL tutor training that responds continuously to teachers' needs.

Résumé -Contexte : Les cartes conceptuelles peuvent répondre à des usages multiples en éducation en sciences de la santé, comme stratégie de communication, comme aide à l'apprentissage, comme aide à la planification ou comme soutien à l'évaluation. Mais leur utilisation réelle dans le champ de la formation en sciences de la santé est mal connue. But : Les buts de cette étude exploratoire étaient : de documenter les pratiques actuelles d'utilisation des cartes conceptuelles dans le quotidien des professeurs en sciences de la santé ayant suivi une formation en ce domaine ; d'identifier les conditions perçues comme favorisant ou freinant leur utilisation. Méthodes : La population visée était les professeurs en sciences de la santé ayant suivi une formation sur les cartes conceptuelles dans deux universités qué-bécoises (n = 55). Un questionnaire en ligne a été conçu spécifiquement pour cette étude exploratoire. Une analyse comparative du contenu permettant de faire ressortir les similitudes et différences a été réalisée. Résultats : Plus de trois quart des répondants (n = 26/33) rapportent utiliser les cartes conceptuelles. Leur utilisation est très variée : simple ou complexe, en prestation d'enseignement ou en évaluation, carte créée par le professeur et/ou les étudiants, construite en mode individuel ou collaboratif, en petit ou grand groupe. L'apprentissage signifiant est identifié comme un avantage important des cartes conceptuelles alors que le temps supplémentaire requis est perçu comme un des obstacles à leur utilisation. Conclusion : Les pratiques actuelles d'utilisation des cartes conceptuelles en éducation en sciences de la santé sont diversifiées et les obstacles identifiés apparaissent surmontables, ce qui est prometteur pour l'avenir.Article publié par EDP Sciences The target group included all health science professors who were trained in concept mapping in two Quebec's universities (n = 55). Data were collected using an exploratory on line questionnaire developed specifically for this study. A comparative analysis of the content helped identify similarities and differences. Results: More than three quarters of respondents (n = 26/33) reported using concept maps in one or several courses. Their use varied greatly, from simple to complex, in individual or collaborative mode, in small or large size groups, from teaching strategies to assessments and maps created by teachers or students. Meaningful learning came out as an advantage while the extra time needed proved to be a hurdle. Conclusion: Current concept map practices in health sciences are varied. Hurdles could be overcome, which is promising for the future.