The education passport: connecting programmatic assessment across learning and practice

Abstract

Competency-based medical education (CBME) shifts us from static assessment of learning to developmental assessment for learning. However, implementation challenges associated with CBME remain a major hurdle, especially after training and into practice. The full benefit of developmental assessment for learning over time requires collaboration, cooperation, and trust among learners, regulators, and the public that transcends each individual phase. The authors introduce the concept of an “Education Passport” that provides evidence of readiness to travel across the boundaries between undergraduate medical education, graduate medical education, and the expanse of practice. The Education Passport uses programmatic assessment, a process of collecting numerous low stakes assessments from multiple sources over time, judging these data using criterion-referencing, and enhancing this with coaching and competency committees to understand, process, and accelerate growth without end. Information in the Passport is housed on a cloud-based server controlled by the student/physician over the course of training and practice. These data are mapped to various educational frameworks such Entrustable Professional Activities or milestones for ease of longitudinal performance tracking. At each stage of education and practice the student/physician grants Passport access to all entities that can provide data on performance. Database managers use learning analytics to connect and display information over time that are then used by the student/physician, their assigned or chosen coaches, and review committees to maintain or improve performance. Global information is also collected and analyzed to improve the entire system of learning and care. Developing a true continuum that embraces performance and growth will be a long-term adaptive challenge across many organizations and jurisdictions and will require coordination from regulatory and national agencies. An Education Passport could also serve as an organizing tool and will require research and high-value communication strategies to maximize public trust in the work.

Precision Education: The Future of Lifelong Learning in Medicine

“…The model can be applied at a microlevel for individual learners, at a mesolevel for educational programs such as medical schools or training programs, and at a macrolevel for institutions, health systems, and national organizations. 8 Indeed, those touched by medical education can derive value from PE systems at each of these levels using different data sets and analytic approaches.…”

“…PE systems have 4 key components—inputs, insights, interventions, and outcomes—with processes (analytics, planning, learning and assessing, and adjusting) linking them to one another (see Figure 1). The model can be applied at a microlevel for individual learners, at a mesolevel for educational programs such as medical schools or training programs, and at a macrolevel for institutions, health systems, and national organizations 8 . Indeed, those touched by medical education can derive value from PE systems at each of these levels using different data sets and analytic approaches.…”

“Dismantling Fixed Time, Variable Outcome Education: Abandoning ‘Ready or Not, Here they Come’ is Overdue”

“…Our focus here, however, will be on the education and training aspects as the first step in getting to a plan for time variable competency-based medical education. We see the logistics reflecting more deeply rooted problems, including lack of: 1) agreement on specific markers of achievement for transitioning from one phase to the next, 2) education handovers that provide a meaningful picture of both learners' strengths and improvement opportunities, and 3) compassionate off ramps for those needing an alternative career [12,13]. Based on one author's (CC) experience, there are many reasons for career choice changes, including but not limited to, misalignment between family expectations and individual choices, increasing debt burden, and inability to meet performance expectations.…”

A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees

“…which readiness is not required prior to advancing/promoting/ graduating an individual. 34 As described above, trustworthiness entails more than simply clinical competence (ability). Several components of trustworthiness serve to mitigate risk (which is inherent to PEDM) when learners are promoted or graduated into unknown or novel real-world future contexts (also inherent to PEDM).…”