Advancing competency-based medical education: A charter for clinician–educators.
Abstract
The International Competency-Based Medical Education (ICBME) Collaborators have been working since 2009 to promote understanding of competency-based medical education (CBME) and accelerate its uptake worldwide. This article presents a charter, supported by a literature-based rationale, which is meant to provide a shared mental model of CBME that will serve as a path forward in its widespread implementation.At a 2013 summit, the ICBME Collaborators laid the groundwork for this charter. Here, the fundamental principles of CBME and professional responsibilities of medical educators in its implementation process are described. The authors outline three fundamental principles: (1) Medical education must be based on the health needs of the populations served; (2) the primary focus of education and training should be the desired outcomes for learners rather than the structure and process of the educational system; and (3) the formation of a physician should be seamless across the continuum of education, training, and practice.Building on these principles, medical educators must demonstrate commitment to teaching, assessing, and role modeling the range of identified competencies. In the clinical setting, they must provide supervision that balances patient safety with the professional development of learners, being transparent with stakeholders about level of supervision needed. They must use effective and efficient assessment strategies and tools for basing transition decisions on competence rather than time in training, empowering learners to be active participants in their learning and assessment. Finally, advancing CBME requires program evaluation and research, faculty development, and a collaborative approach to realize its full potential.
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CBME and programmatic assessment have the potential to improve the practice of feedback by promoting frequent observation of learners, feedback conversations, and coaching for improvement.
“Two recently implemented initiatives in medical education, competencybased medical education (CBME) [9][10][11] and programmatic assessment of learners, 12 have the potential to improve the practice of feedback by promoting frequent observation of learners, feedback conversations, and coaching for improvement.”
From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [9]
Coaching is developmental and moves feedback away from its historic tie to assessment and closer to learning.
“Coaching is developmental, and philosophically it moves feedback away from its historic tie to assessment and moves it closer to learning.9,15,16”
From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [9]
The principles of programmatic assessment and CBME direct attention to actively engaging learners in their assessment, feedback, and development activities.
“Foundationally, the principles of programmatic assessment and CBME direct our attention to actively engaging learners in their assessment, feedback, and development activities.9,13,15”
From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [9]
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“Fulfilment of competencybased education in nursing involves the recognition of core competencies, drawing plans of curricula and teaching programs that clearly express the attributes underpinning each core competency, and developing evaluation tools that offer a valid and reliable instrument to assess these core compe…”
BackgroundThe COVID-19 Pandemic as an Imperative to Advance Medical Student Assessment: Three Areas for Change
Hauer, K. E., Lockspeiser, T. M., & Chen, H. C. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003764 · Cited by 31 · see citing works
Academic Primer Series: Key Papers About Competency-Based Medical Education
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Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment
Kinnear, B., Warm, E. J., Caretta‐Weyer, H. A., Holmboe, E. S., Turner, D. A., van der Vleuten, C. P. M., & Schumacher, D. J. (2021) · Academic Medicine · doi:10.1097/acm.0000000000004108 · Cited by 29 · see citing works
Ryan, M. S., Lomis, K. D., Deiorio, N. M., Cutrer, W. B., Pusic, M. V., & Caretta‐Weyer, H. A. (2023) · Academic Medicine · doi:10.1097/acm.0000000000005220 · Cited by 28 · see citing works
O'Brien, M. W., Shields, C. A., Crowell, S. J., Theou, O., McGrath, P. J., & Fowles, J. R. (2018) · Canadian Medical Education Journal · doi:10.36834/cmej.43098 · Cited by 28 · see citing works
Threshold concepts in medical education: A scoping review
Jones, H., & Hammond, L. E. (2022) · Medical Education · doi:10.1111/medu.14864 · Cited by 27 · see citing works
“In contrast, the conceptualisation of the TCF in this review aligns more closely with competency-based medical education (CBME), which is increasingly being applied in postgraduate medical education.(61) In CBME, progression of the learner is determined by achieving competencies related to practicing medicine instead…”
Stefan, A., Hall, J. N., Sherbino, J., & Chan, T. M. (2019) · Canadian Journal of Emergency Medicine · doi:10.1017/cem.2019.343 · Cited by 27 · see citing works
Castellanos-Ortega, Á., Broch, M. J., Palacios-Castañeda, D., Gómez-Tello, V., Valdivia, M., Vicent, C., Madrid, I., Martinez, N., Párraga, M. J., Sancho, E., et al. (2022) · Medicina Intensiva · doi:10.1016/j.medin.2022.01.011 · Cited by 27 · see citing works
Competency-based pharmacy education definition: What components need to be defined to implement it?
Daugherty, K. K., Chen, A. M. H., Churchwell, M. D., Jarrett, J. B., Kleppinger, E. L., Meyer, S. M., Nawarskas, J. J., Sibicky, S. L., Stowe, C. D., & Rhoney, D. H. (2023) · American Journal of Pharmaceutical Education · doi:10.1016/j.ajpe.2023.100624 · Cited by 27 · see citing works
Flexible competency based medical education: More time efficient, higher costs
van Rossum, T. R., Scheele, F., Sluiter, H. E., Bosman, P. J., Rijksen, L., & Heyligers, I. C. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1395404 · Cited by 27 · see citing works
“Competency-based medical education (CBME) can be used to redefine PGME programs in order to better prepare physicians for future practice (Carraccio et al. 2016).”
Key stakeholder opinions for a national learner education handover
Kassam, A., Ruetalo, M., Topps, M. H., Mountjoy, M. L., Walton, M., Edwards, S., & Nickell, L. A. (2019) · BMC Medical Education · doi:10.1186/s12909-019-1598-7 · Cited by 27 · see citing works
“CanMEDS is an educational framework that describes the abilities physicians require to effectively meet the health care needs of the people they serve [18, 30].”
BackgroundConsiderations that will determine if competency-based assessment is a sustainable innovation
Dauphinée, W. D., Boulet, J. R., & Norcini, J. J. (2018) · Advances in Health Sciences Education · doi:10.1007/s10459-018-9833-2 · Cited by 26 · see citing works
Jarrett, J. B., Goliak, K. L., Haines, S. T., Trolli, E., & Schwartz, A. (2021) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe8523 · Cited by 26 · see citing works
Leonardi, M., Ong, J., Espada, M., Stamatopoulos, N., Georgousopoulou, E. N., Hudelist, G., & Condous, G. S. (2020) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15337 · Cited by 26 · see citing works
“Unlike the conclusions of previous learning curve studies, we argue that a competency-based training model is more appropriate in this context and mirrors a global paradigm shift in medical education.(26,27)”
ResultDavis, D. A., Rayburn, W. F., & Smith, G. A. (2017) · Academic Medicine · doi:10.1097/acm.0000000000001777 · Cited by 25 · see citing works
Huang, S., Fang, S., Lee, S., Yu, P., Chen, C., & Lin, Y.-S. (2023) · Nurse Education in Practice · doi:10.1016/j.nepr.2023.103560 · Cited by 25 · see citing works
Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions
Jarrett, J. B., Elmes, A. T., Keller, E., Stowe, C. D., & Daugherty, K. K. (2024) · American Journal of Pharmaceutical Education · doi:10.1016/j.ajpe.2024.100709 · Cited by 25 · see citing works
Twelve tips for constructing a multiple mini-interview
Eva, K. W., Macala, C., & Fleming, B. (2018) · Medical Teacher · doi:10.1080/0142159x.2018.1429586 · Cited by 25 · see citing works
“On a more positive note, a school’s admissions processes are paramount because they can be used strategically to establish its culture and to demonstrate its social accountability (Cruess and Cruess 2014; Carraccio et al. 2016; Boelen 2018).”
BackgroundMilestone Learning Trajectories of Residents at Five Anesthesiology Residency Programs
Tanaka, P. P., Park, Y. S., Roby, J., Ahn, K. S., Kakazu, C. Z., Udani, A. D., & Macario, A. (2020) · Teaching and Learning in Medicine · doi:10.1080/10401334.2020.1842210 · Cited by 25 · see citing works
“Milestone ratings can also identify residents not progressing as expected.(17) Longitudinal analysis has advantages over previous cross-sectional studies because the purpose of the Milestones is to track individual progress over time; the NAS assessment framework was developed as a longitudinal model and not a cross-s…”
BackgroundClement, E., Oswald, A., Ghosh, S., & Hamza, D. M. (2024) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-23-00210.1 · Cited by 24 · see citing works
Mobilization of health professions students during the COVID-19 pandemic
Rupley, D. M., Grilo, S. A., Kondragunta, S., Amiel, J. M., Matseoane-Peterssen, D., Catallozzi, M., & Westhoff, C. L. (2020) · Seminars in Perinatology · doi:10.1016/j.semperi.2020.151276 · Cited by 24 · see citing works
Are they ready? Organizational readiness for change among clinical teaching teams
Bank, L., Jippes, M., Leppink, J., Scherpbier, A. J. J. A., den Rooyen, C., van Luijk, S. J., & Scheele, F. (2017) · Advances in Medical Education and Practice · doi:10.2147/amep.s146021 · Cited by 24 · see citing works
Kumar, N. L., Smith, B. N., Lee, L., & Sewell, J. L. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.05.023 · Cited by 24 · see citing works
Competency-based medical education for the clinician-educator: the coming of Milestones version 2
Torralba, K. D., Jose, D., & Katz, J. D. (2020) · Clinical Rheumatology · doi:10.1007/s10067-020-04942-7 · Cited by 22 · see citing works
Accessible and Adaptable Faculty Development to Support Curriculum Reform in Medical Education
van Schaik, S. M. (2021) · Academic Medicine · doi:10.1097/acm.0000000000003804 · Cited by 23 · see citing works
Resident and attending perceptions of direct observation in internal medicine: a qualitative study
Gauthier, S. R., Melvin, L., Mylopoulos, M., & Abdullah, N. (2018) · Medical Education · doi:10.1111/medu.13680 · Cited by 23 · see citing works
Trainee perception of cognitive load during observed faculty staff teaching of procedural skills
Sewell, J. L., Young, J. Q., Boscardin, C., ten Cate, O., & O’Sullivan, P. (2019) · Medical Education · doi:10.1111/medu.13914 · Cited by 23 · see citing works
Competency-based teacher training: A systematic revision of a proven programme in medical didactics
Griewatz, J., Simon, M., & Lammerding‐Koeppel, M. (2017) · PubMed Central · doi:10.3205/zma001121 · Cited by 23 · see citing works
“Die Umstellung der Curricula im Sinne einer kompetenzbasierten medizinischen Ausbildung (CMBE) stößt auf einige Herausforderungen und ist, wie internationale Untersuchungen zeigen [5], [6], [22], stark abhängig von der Bereitschaft der Fakultäten.”
BackgroundInfluentialCollaborative Development of Core Entrustable Professional Activities for Veterinary Education
Salisbury, S. K., Rush, B. R., Ilkiw, J. E., Matthew, S. M., Chaney, K. P., Molgaard, L. K., May, S. A., Bok, H. G. J., Hodgson, J., Frost, J. S., et al. (2020) · Journal of Veterinary Medical Education · doi:10.3138/jvme.2019-0090 · Cited by 22 · see citing works
Ryan, M. S., Blood, A. D., Park, Y. S., & Farnan, J. M. (2022) · Academic Medicine · doi:10.1097/acm.0000000000004912 · Cited by 22 · see citing works
“To ensure a common frame of reference, the coders first selected a state (Michigan) with a relatively small number of programs (6) but which represented a diverse range (private versus public, large versus small, new versus old).”
BackgroundIs It Time for Entrustable Professional Activities for Residency Program Directors?
Bing‐You, R. G., Holmboe, E. S., Varaklis, K., & Linder, J. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001503 · Cited by 22 · see citing works
Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study
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Entrepreneurship education from a Croatian medical student's perspective
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Mishra, S., Chung, A. D., Rogoza, C., Islam, O., Mussari, B., Wang, X., Dagnone, D., Cofie, N., Dalgarno, N., & Kwan, B. Y. M. (2021) · Canadian Association of Radiologists Journal · doi:10.1177/0846537121993058 · Cited by 21 · see citing works
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Haas, M., Triemstra, J. D., Tam, M., Neuendorf, K., Reckelhoff, K., Gottlieb‐Smith, R., Pedigo, R. A., McTaggart, S., Vasquez, J., Hundert, E. M., et al. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04155-x · Cited by 21 · see citing works
Teaching and assessing operative skills: From theory to practice
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“The long term goal of faculty-resident collaborations to develop trainee autonomy within the safety of residency programs is the culmination of many faculty entrustment decisions, across contexts and over time.(79) Graduated autonomy of residents bears the same”
BackgroundIdentifying essential competencies for medical students
Du, X., Kassab, S. E., Al-Moslih, A., Abu-Hijleh, M. F., Hamdy, H., & Cyprian, F. S. (2019) · Journal of Applied Research in Higher Education · doi:10.1108/jarhe-07-2018-0114 · Cited by 21 · see citing works
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Unheard Voices: A Qualitative Study of Resident Perspectives on Remediation
Krzyzaniak, S. M., Kaplan, B., Lucas, D., Bradley, E. B., & Wolf, S. J. (2021) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-20-01481.1 · Cited by 20 · see citing works
Developing a competency-based framework for resident-as-teacher
Liang, J.-F., Hsu, T., Chen, C., Yang, C., Jean, W.-H., Ou, L.-S., Cheng, H., Huang, C., Yang, Y., & Chen, C. (2022) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2022.01.027 · Cited by 20 · see citing works
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“In nursing and medicine for example, recent literature suggests that a focus on competencies will narrow the gap between education and practice and improve patient outcomes (Carraccio et al., 2016; Frank et al., 2010; Scott Tilley, 2008).”
BackgroundAn objective structured clinical exam to measure intrinsic CanMEDS roles
Kassam, A., Cowan, M., & Donnon, T. (2016) · Medical Education Online · doi:10.3402/meo.v21.31085 · Cited by 20 · see citing works
A Global View of Structures and Trends in Medical Education
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Leclair, R., Ho, J. S. S., Braund, H., Kouzmina, E., Bruzzese, S., Awad, S., Mann, S., & Zevin, B. (2023) · Journal of Medical Education and Curricular Development · doi:10.1177/23821205231175734 · Cited by 19 · see citing works
A Regional, Cost-Effective, Collaborative Model for Critical Care Fellows’ Ultrasonography Education
Patrawalla, P. S., Narasimhan, M., Eisen, L. A., Shiloh, A. L., Koenig, S., & Mayo, P. H. (2019) · Journal of Intensive Care Medicine · doi:10.1177/0885066619828951 · Cited by 19 · see citing works
“Any prior training, N (%) 223 (69) National course 23 (7) Didactics 56 (17) Journal club 7 (2) Simulation or other formal hands-on 77 (24) Informal hands-on 156 (48) Self-directed learning 92 (28) Content of prior training, N (%) Vascular guidance 215 (66) Pleural 147 (45) Lung 140 (43) DVT 83 (26) Abdomen 86 (27) Bas…”
BackgroundCompetency-Based Medical Education and its Competency Frameworks
ten Cate, O. (2016) · Technical and vocational education and training · doi:10.1007/978-3-319-41713-4_42 · Cited by 19 · see citing works
Evolution in Parental Leave Policies: Plastic Surgery and Obstetrics/Gynecology Lead the Way
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- Authors
- Carraccio, C., Englander, R., Van Melle, E., ten Cate, O., Lockyer, J., Chan, M.-K., Frank, J. R., & Snell, L. S.
- Affiliations
- C. Carracciois vice president, Competency-Based Assessment, American Board of Pediatrics, Chapel Hill, North Carolina.
- Association of American Medical Colleges (US)
- E. Van Melleis education researcher, Queen’s University, Kingston, Ontario, Canada, and education scientist, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.
- O. ten Cateis professor of medical education and director, Center for Research and Development of Education, University Medical Center, Utrecht, the Netherlands.
- University of Calgary (CA)
- University of Manitoba (CA)
- University of Ottawa (CA)
- McGill University (CA)
- Corresponding author
- Carraccio, Carol
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-05
- Volume
- 91
- Issue
- 5
- Pages
- 645-649
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W2332143888
- Cited by
- 372
- References
- 36
- Citations by year
- 2026: 33 · 2025: 31 · 2024: 39 · 2023: 33 · 2022: 39 · 2021: 42 · 2020: 42 · 2019: 43 · 2018: 33 · 2017: 21 · 2016: 13 · 2015: 2 · 2012: 1
- FWCI
- 24.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Health Professions › General Health Professions › Health and Medical Education
- Social Sciences › Psychology › Social Psychology › Competency Development and Evaluation
- Keywords
- competency-based medical education, medical faculty, professional responsibility, clinical supervision, competency assessment, faculty development, program evaluation
- MeSH terms
- Clinical Competence, Competency-Based Education, Education, Medical, Undergraduate, Faculty, Medical, Humans, Staff Development, United States, Models, Educational
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