Implementation of competency‐based medical education: are we addressing the concerns and challenges?
Abstract
Context: Competency‐based medical education (CBME) has emerged as a core strategy to educate and assess the next generation of physicians. Advantages of CBME include: a focus on outcomes and learner achievement; requirements for multifaceted assessment that embraces formative and summative approaches; support of a flexible, time‐independent trajectory through the curriculum; and increased accountability to stakeholders with a shared set of expectations and a common language for education, assessment and regulation. Objectives: Despite the advantages of CBME, numerous concerns and challenges to the implementation of CBME frameworks have been described, including: increased administrative requirements; the need for faculty development; the lack of models for flexible curricula, and inconsistencies in terms and definitions. Additionally, there are concerns about reductionist approaches to assessment in CBME, lack of good assessments for some competencies, and whether CBME frameworks include domains of current importance. This study will outline these issues and discuss the responses of the medical education community. Methods: The concerns and challenges expressed are primarily categorised as: (i) those related to practical, administrative and logistical challenges in implementing CBME frameworks, and (ii) those with more conceptual or theoretical bases. The responses of the education community to these issues are then summarised. Conclusions: The education community has begun to address the challenges involved in implementing CBME. Models and guidance exist to inform implementation strategies across the continuum of education, and focus on the more efficient use of resources and technology, and the use of milestones and entrustable professional activities‐based frameworks. Inconsistencies in CBME definitions and frameworks remain a significant obstacle. Evolution in assessment approaches from in vitro task‐based methods to in vivo integrated approaches is responsive to many of the theoretical and conceptual concerns about CBME, but much work remains to be done to bring rigour and quality to work‐based assessment.
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These activities are best achieved through longitudinal relationships with faculty who assimilate various sources of information and provide customized appraisal and feedback.
“Collectively, these activities are best achieved through longitudinal relationships with faculty who assimilate various sources of information (e.g., direct observation, multisource feedback) and provide customized appraisal and feedback, facilitating an exploration to identify improvement areas [13–20].”
Graduate medical education programs struggle to operationalize these activities and frequently lack sufficient infrastructure to support longitudinal relationships between trainees and faculty.
“However, graduate medical education (GME) programs struggle to operationalize these activities, and frequently lack sufficient infrastructure to support longitudinal relationships between trainees and faculty [13,22,23].”
This requires significant changes, such as designing GME programs that link residents with faculty over longer time periods, faculty development in coaching skills, reconsidering clinical faculty roles, and examining the balance between clinical service and education requirements.
“This requires significant changes, such as designing GME programs that link residents with faculty over longer time periods, faculty development in coaching skills, reconsidering clinical faculty roles, and examining the balance between clinical service and education requirements [13,46,52].”
The transition from less granular, 'time-based' assessments to CBME and entrustment requires more direct workplace-based observations of trainees, provision of high-quality feedback, and use of highly reliable assessment tools, all of which require transformation in processes, resources, and faculty expectations.
“The transition from less granular, ‘time-based’ assessments to Competency-Based Medical Education (CBME) and entrustment requires more direct workplace-based observations of trainees, provision of high-quality feedback, and use of highly reliable assessment tools, all of which require transformation in processes, resources, and faculty expectations [13,46–48].”
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- Authors
- Hawkins, R. E., Welcher, C. M., Holmboe, E. S., Kirk, L. M., Norcini, J. J., Simons, K. B., & Skochelak, S. E.
- Affiliations
- American Medical Association (US)
- Accreditation Council for Graduate Medical Education (US)
- The University of Texas Southwestern Medical Center (US)
- Foundation for Advancement of International Medical Education and Research (US)
- Medical College of Wisconsin (US)
- Corresponding author
- Hawkins, Richard E
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2015-10-22
- Volume
- 49
- Issue
- 11
- Pages
- 1086-1102
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W2105590394
- Cited by
- 409
- References
- 119
- Citations by year
- 2026: 34 · 2025: 39 · 2024: 39 · 2023: 37 · 2022: 47 · 2021: 46 · 2020: 41 · 2019: 40 · 2018: 33 · 2017: 36 · 2016: 17
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Medical Association Foundation
- 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, implementation barriers, medical curriculum development, formative and summative assessment, faculty development, entrustable professional activities, milestones, workplace-based assessment, task-based assessment, administrative burden
- MeSH terms
- Competency-Based Education, Curriculum, Education, Medical, Undergraduate, Faculty, Medical, Humans, Learning, Staff Development, Models, Educational
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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