The Transformational Path Ahead: Competency-Based Medical Education in Family Medicine

Abstract

Competency-based medical education (CBME) is an outcomes-based approach that has taken root in residency training nationally and internationally. CBME explicitly places the patient, family, and community at the center of training with the primary goals of concomitantly improving both educational and clinical outcomes. Family medicine, as the foundational primary care discipline, has always embraced the importance of linking training with health system needs and performance since its inception. While CBME is no longer a new concept, full implementation of this outcomes-based approach has been daunting and challenging. Gaps in the effectiveness, safety, equity, efficiency, timeliness, and patient/family centeredness of health and health care in the United States continue to be persistent and pernicious. These gaps summon family medicine and the entire graduate medical education system to take stock of its current state and to examine how more fully embracing an outcomes-based educational approach can help to close these gaps. This article provides a brief history of the CBME movement, and more importantly, its key underlying educational principles and science. I will explore the key inflection points of progress, including identifying core CBME components, introduction of competency Milestones, experimental pilots of time variable training, advancements in mastery-based learning, and advances in work-based assessment, within the context of family medicine. I will conclude with suggestions for accelerating the adoption and implementation of CBME within family medicine residency training.

Using the Five Core Components of Competency-Based Medical Education to Support Implementation of CBVE

“…There are inherent challenges associated with adoption of a new model of education, especially when faculty are comfortable in the perceived “stability” of the current system ( 15 ). As the movement toward outcomes-based education is initiated within a program, it is important ensure all faculty understand the curricular changes are based on evidence-informed approaches utilizing lessons learned from multiple research disciplines and fields ( 3 , 7 , 16 ).…”

“…However, although this terminology infers rigidity or strictness in the rules of this model of education, it is important to recognize that CBME is a collection of pedagogical principles and approaches that are constantly evolving to meet the primary aim of achieving better outcomes for patients and learners ( 6 ). Furthermore, it is recognized there is a need for the experience, wisdom and expertise of local healthcare faculty to guide meaningful standardization where appropriate, while incorporating the flexibility and adaptability to meet the local needs of educational programs ( 7 ).…”

Racial Concordance, Rather Than Cultural Competency Training, Can Change Outcomes

“…9,10 While a holistic approach is often described in terms of medical school and residency admissions, we endorse a broader approach to assessing knowledge, combining the breadth and flexibility of the ITE with specific assessments of knowledge while precepting, on hospital rounds or in labor and delivery. This is the promise of competency-based assessment, 11 and the ITE is an important component of this assessment strategy. Finally, and importantly, the exams (ITE and FMCE) are not intended as a measure of clinical skills, communication, professionalism, problem-based learning, or systems-based practices-the other ACGME core competencies, which residencies evaluate and track using the ACGME milestones.…”

The Promise of Aire

“…It is important to recognize that CBME is much more than developing thoughtful goals and objectives and a curricular map. 5 Applications should include systematic attention to the Van Melle framework 6 which is now the gold standard for competency curriculum redesign. CBME begins with explicit attention to the community needs the residency program is addressing and is grounded in a system of outcomes-based assessment.…”