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Entrustable professional activities (EPAs) have seen widespread adoption in medical education and other health professions education. EPAs aim to provide a bridge between competency-based education and clinical practice by translating competencies into fundamental profession-specific tasks associated with clinical practice. Despite the extensive use of EPAs in health professions education, EPAs have yet to be introduced into chiropractic education. The purpose of this paper is to describe the development and introduction of EPAs as part of 2 community-based chiropractic student preceptorship education programs in the United States. EPAs were developed and introduced at 2 community-based chiropractic preceptorship sites in 5 distinct steps: (1) differentiating EPAs from competencies, learning objectives, and knowledge, skills, and attitudes; (2) identifying EPAs; (3) mapping EPAs to competencies and necessary experience, knowledge, and skills; (4) designing EPA assessment strategies; and (5) implementing the use of EPAs. A total of 13 individual EPAs were developed and mapped to Council on Chiropractic Education meta-competency outcomes and underlying experience, knowledge, and skills. Three assessment tools were created to evaluate student entrustability for EPAs and enhance student self-assessment. The EPAs and assessment tools were integrated into chiropractic student preceptorships at each site. This paper describes the development and introduction of EPAs at 2 community-based chiropractic preceptorship sites. Future research is needed to develop and standardize EPA use and assessment, and to evaluate outcomes associated with EPA use. [ABSTRACT FROM AUTHOR]

Competency‐based medical education (CBME) is an outcomes‐focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty‐specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence‐based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system. [ABSTRACT FROM AUTHOR]

Objective: Entrustable Professional Activities (EPAs) are increasingly being used in competency-based medical education approaches. A general lack of time in clinical settings, however, prevents supervisors from providing their trainees with adequate feedback. With a willingness for more administrative tasks being low in both trainees and educators, the authors developed a radical user-friendly mobile application based on the EPA concept called "Surg-prEPAred". Design: Surg-prEPAred is designed to collect micro-assessment data for building competency profiles for surgical residents according to their curriculum. The goal of Surg-prEPAred is to facilitate the performance and documentation of workplace-based assessments. Through aggregated data the app generates a personalized competency profile for every trainee. During a pilot run of 4 months, followed by ongoing usage of the application with a total duration of 9 months (August 2019 to April 2020), 32 residents and 33 consultants made daily use of the application as a rating tool. Every rating included knowledge, skills and professional attitudes of the trainees. Before the initiation of the App and after the 9-month trial period trainees and supervisors where both sent questionnaires to evaluate the user friendliness and effectiveness of the App. Results: Five hundred ten App based assessments were generated. Out of 40 pre-defined EPAs, 36 were assessed. 15 trainees and 16 supervisors returned the questionnaires and stated the surg-prEPAred App as very valuable, effective and feasible to evaluate trainees in a clinical setting providing residents with an individual competence portfolio to receive precision medical education. Conclusions: The authors expectation is that the Surg-prEPAred App will contribute to an improvement of quality of medical education and thus to the quality of patient care and safety. In the future the goal is to have the App become an integral part of the official Swiss surgical curriculum accepted by the Swiss professional surgical society. [ABSTRACT FROM AUTHOR]

As competency-based curricula get increasing attention in postgraduate medical education, Entrustable Professional Activities (EPAs) are gaining in popularity. The aim of this survey was to determine the use of EPAs in anesthesiology training programs across Europe and North America. A survey was developed and distributed to anesthesiology residency training program directors in Switzerland, Germany, Austria, Netherlands, USA and Canada. A convergent design mixed-methods approach was used to analyze both quantitative and qualitative data. The survey response rate was 38% (108 of 284). Seven percent of respondents used EPAs for making entrustment decisions. Fifty-three percent of institutions have not implemented any specific system to make such decisions. The majority of respondents agree that EPAs should become an integral part of the training of residents in anesthesiology as they are universal and easy to use. Although recommended by several national societies, EPAs are used in few anesthesiology training programs. Over half of responding programs have no specific system for making entrustment decisions. Although several countries are adopting or planning to adopt EPAs and national societies are recommending the use of EPAs as a framework in their competency-based programs, few are yet using these to make "competence" decisions. [ABSTRACT FROM AUTHOR]

Health care revolves around trust. Patients are often in a position that gives them no other choice than to trust the people taking care of them. Educational programs thus have the responsibility to develop physicians who can be trusted to deliver safe and effective care, ultimately making a final decision to entrust trainees to graduate to unsupervised practice. Such entrustment decisions deserve to be scrutinized for their validity. This end-of-training entrustment decision is arguably the most important one, although earlier entrustment decisions, for smaller units of professional practice, should also be scrutinized for their validity. Validity of entrustment decisions implies a defensible argument that can be analyzed in components that together support the decision. According to Kane, building a validity argument is a process designed to support inferences of scoring, generalization across observations, extrapolation to new instances, and implications of the decision. A lack of validity can be caused by inadequate evidence in terms of, according to Messick, content, response process, internal structure (coherence) and relationship to other variables, and in misinterpreted consequences. These two leading frameworks (Kane and Messick) in educational and psychological testing can be well applied to summative entrustment decision-making. The authors elaborate the types of questions that need to be answered to arrive at defensible, well-argued summative decisions regarding performance to provide a grounding for high-quality safe patient care. [ABSTRACT FROM AUTHOR]

Medical education is situated within health care and educational organizations that frequently lag in their use of data to learn, develop, and improve performance. How might we leverage competency-based medical education (CBME) assessment data at the individual, program, and system levels, with the goal of redefining CBME from an initiative that supports the development of physicians to one that also fosters the development of the faculty, administrators, and programs within our organizations? In this paper we review the Deliberately Developmental Organization (DDO) framework proposed by Robert Kegan and Lisa Lahey, a theoretical framework that explains how organizations can foster the development of their people. We then describe the DDO's conceptual alignment with CBME and outline how CBME assessment data could be used to spur the transformation of health care and educational organizations into digitally integrated DDOs. A DDO-oriented use of CBME assessment data will require intentional investment into both the digitalization of assessment data and the development of the people within our organizations. By reframing CBME in this light, we hope that educational and health care leaders will see their investments in CBME as an opportunity to spur the evolution of a developmental culture. [ABSTRACT FROM AUTHOR]

Tensions have always existed between innovation and standardization in family medicine, due to the need for rapid responses to changing health issues while ensuring proficiency. For innovation in residency training to be successful, standardization of milestones and frameworks as well as outcomes of residency education are needed and must be clear and rely on measurable effectiveness standards. Standardization without innovation can cause educational stasis, failure to adapt to change, and/or lack of evidence-guided education. Here, we examine possible options for creating the right balance, review what the evidence shows, and make recommendations for the future, including (1) adoption and study of clear, actionable entrustable professional activities (EPAs) as educational standards for residency graduates; (2) core faculty be required to engage in faculty development that includes competency-based medical education using the EPA framework, advanced curriculum development, program evaluation, objective learner assessments aligned with individualized learning plans, and increased opportunities for program directors to gain additional training in the educational sciences; (3) 30% of protected time for core faculty to design, administer, and assess the educational program; (4) required participation in educational collaboratives that rigorously study innovation; (5) required scholarly work that supports program development both clinically and educationally. Taken together, these recommendations represent a vital interplay between cutting-edge innovation and thoughtful standardization using collaboration to graduate residents ready to provide optimal care in their communities, both now and into the future. All stakeholders in the discipline must undertake strategic and deliberate planning designed to adjust direct and indirect costs of residency training to support these recommendations. [ABSTRACT FROM AUTHOR]

Background: Competency-based education has been shown to enhance clinical skills, improve patient care, and reduce number of complications resulting in a better return on investments. Residents constitute an important workforce at many hospitals. Yet, the effect of training on residents' contribution to production in patient care is scarcely studied. This study evaluated the effects of early competency-based procedural training on residents' contribution to patient care in central venous catheterization and spinal and epidural anesthesia. Methods: The design was a non-randomized cohort study of first-year anesthesiology residents. The intervention group received additional early focused skills training while three control groups received traditional competency-based education. The residents' contributions to patient care were compared between the intervention group (n = 20), a historical control group (n = 19), and between a contemporary control group (n = 7) and a historical control group (n = 7) from different departments. The residents' vs specialists' procedural production share was compared between years within each study group. We calculated specialist time saved compared to the time spent providing additional skills training in the intervention group. Results: We found statistically significant increases in residents' vs specialists' share of total production after the intervention for epidural anesthesia: 2015: 0.51 (0.23, 0.70) to 2017: 0.94 (0.78, 1.05), p = 0.011 and central venous catheterization: 2015: 0.30 (0.23, 0.36) to 2016: 0.46 (0.35, 0.55), p =.008; and to 2017: 0.64 (0.50, 0.79), p = 0.008. Comparison between residents and specialists on production of the three procedures before and after the intervention showed a surplus of 21 h of freed specialist time per year. Conclusions: Early procedural training results in more productive residents and freed specialist time for additional supervision, other clinical tasks or research. This provides empirical support for a positive correlation between early focused training and increased independent production among residents. [ABSTRACT FROM AUTHOR]

Issue: Entrustable Professional Activities (EPAs) describe the core tasks health professionals must be competent performing prior to promotion and/or moving into unsupervised practice. When used for learner assessment, they serve as gateways to increased responsibility and autonomy. It follows that identifying and describing EPAs is a high-stakes form of work analysis aiming to describe the core work of a profession. However, hasty creation and adoption of EPAs without rigorous attention to content threatens the quality of judgments subsequently made from using EPA-based assessment tools. There is a clear need for approaches to identify validity evidence for EPAs themselves prior to their deployment in workplace-based assessment. Evidence: For EPAs to realize their potential in health professions education, they must first be constructed to reflect accurately the work of that profession or specialty. If the EPAs fail to do so, they cannot predict a graduate's readiness for or future performance in professional practice. Evaluating the methods used for identification, description, and adoption of EPAs through a construct validity lens helps give leaders and stakeholders of EPA development confidence that the EPAs constructed are, in fact, an accurate representation of the profession's work. Implications: Application of a construct validity lens to EPA development impacts all five commonly followed steps in EPA development: selection of experts; identification of candidate EPAs; iterative revisions; evaluation of proposed EPAs; and formal adoption of EPAs into curricula. It allows curricular developers to avoid pitfalls, bias, and common mistakes. Further, construct validity evidence for EPA development provides assurance that the EPAs adopted are appropriate for use in workplace-based assessment and entrustment decision-making. [ABSTRACT FROM AUTHOR]

Entrustment decision-making has become a topic of interest in workplace-based assessment in the health professions and is germane to the use of entrustable professional activities. Entrustment decisions stem from judgments of a trainee's competence and include the permission to act with a higher level of responsibility or autonomy and a lower level of supervision. Making entrustment decisions differs from regular assessment of trainees, which usually has no consequences beyond marking trainee progress. Studies show that clinicians generally weigh more factors in making an entrustment decision than when merely assessing trainee competence or performance without direct consequences for patient care. To synthesize the varying factors reported in literature, the authors performed a thematic analysis of key qualitative studies that investigated trainee features clinical supervisors find important when making entrustment decisions. Five themes emerged from the 13 publications: Capability (specific knowledge, skills, experience, situational awareness), Integrity (truthful, benevolent, patient-centered), Reliability (conscientious, predictable, accountable, responsible), Humility (recognizes limits, asks for help, receptive to feedback), Agency (proactive toward work, team, safety, personal development). Thoughtful entrustment decisions, made either by individual clinical supervisors or by clinical competency committees, may be enriched by taking into account these five features. [ABSTRACT FROM AUTHOR]

Progress testing aligns well with competency-based medical education (CBME) frameworks, which stress the importance of continuous improvement. Entrustment is a useful assessment concept in CBME models. The purpose of this study was to explore the use of an entrustability rating scale within the context of an objective structured clinical examination (OSCE) Progress Test. A 9-case OSCE Progress Test was administered to Internal Medicine residents (PGYs 1–4). Residents were assessed using a checklist (CL), global rating scale (GRS), training level rating scale (TLRS), and entrustability scale (ENT). Reliability was calculated using Cronbach's alpha. Differences in performance by training year were explored using ANOVA and effect sizes were calculated using partial eta-squared. Examiners completed a post-examination survey. Ninety one residents and forty two examiners participated in the OSCE. Inter-station reliability was high for all instruments. There was an overall effect of training level for all instruments (p < 0.001). Effect sizes were large. 88% of examiners completed the survey. Most (62%) indicated feeling comfortable in making entrustment decisions during the OSCE. An entrustability scale can be used in an OSCE Progress Test to generate highly reliable ratings that discriminate between learners at different levels of training. [ABSTRACT FROM AUTHOR]

With the introduction of competency-based undergraduate curriculum in India, a paradigm shift in the assessment methods and tools will be the need of the hour. Competencies are complex combinations of various attributes, many of which being not assessable by objective methods. Assessment of affective and communication domains has always been neglected for want of objective methods. Areas like professionalism, ethics, altruism, and communication—so vital for being an Indian Medical Graduate, can be assessed longitudinally applying subjective means only. Though subjectivity has often been questioned as being biased, it has been proven time and again that a subjective assessment in expert hands gives comparable results as that of any objective assessment. By insisting on objectivity, we may compromise the validity of the assessment and deprive the students of enriched subjective feedback and judgement also. This review highlights the importance of subjective assessment in competency-based assessment and ways and means of improving the rigor of subjective assessment, with particular emphasis on the development and use of rubrics. [ABSTRACT FROM AUTHOR]

Assessment in competency-based dental education continues to be a recognized area for growth and development within dental programs around the world. At the joint American Dental Education Association (ADEA) and the Association for Dental Education in Europe (ADEE) 2019 conference, Shaping the Future of Dental Education III, the workshop on assessment was designed to continue the discussion started in 2017 at the ADEA-ADEE Shaping the Future of Dental Education II.1 The focus of the 2019 conference involved examining the potential of entrustable professional activities (EPAs) and current thinking about workplace-based assessment (WBA) within competency-based education in the 21st century. Approximately 30 years ago, George Miller wrote about the assessment of competence in medical education and challenged faculty to reach for higher levels of assessment than knowledge or skill.2 Acknowledging that no one assessment method can result in a valid assessment of competence, Miller proposed a four-level framework for assessment. The lowest level involves measuring what students know ("knows"), followed by assessment of the skill with which knowledge is applied in relevant tasks or problems ("knows how"). Next is an assessment of task performance in standardized settings ("shows how"), and finally, the highest level assesses the student's performance in the unstandardized clinical workplace ("does"). The 2019 assessment workshop focused on advances in the assessment of learners in the unstandardized workplace-the highest level of Miller's assessment pyramid ("does"). Research has shown that dental education has struggled to implement assessment strategies that meet this level.3 The workshop brought together individuals from around the world, with an interest in assessment in dental education, to consider how assessment in the "does" level, specifically EPAs and WBA, factors into competence assessment in dentistry/dental education. [ABSTRACT FROM AUTHOR]

Background: Competency‐based medical education (CBME) is becoming widely implemented in medical education. Trainees' perceptions of CBME are important factors in the implementation and acceptance of CBME. Online discussion groups allow unique insight into trainees' perceptions of CBME during residency training. Methods: We analysed 867 posts from 20 discussion threads in Premed 101 (Canadian) and 2756 posts from 50 threads in Student Doctor Network (SDN) (American) using NVivo 11. Inductive content analysis was used to develop a data‐driven coding scheme that evolved throughout the analysis. Measures were taken to ensure the trustworthiness of findings, including co‐coding of a subsample of 600 posts, peer debriefing, consensus‐based analytical decision making and the maintenance of an audit trial. Results: Medical residents and students participating in the discussion forums emphasised select themes regarding the implementation of CBME in residency training. Concerns about CBME in Canada primarily involved its implications for the length of residency and post‐residency opportunities. Posts on the American forum had a prominent focus on differing areas, such as the subjectivity in the assessment of core competencies and the role of CBME in termination of a resident's position. Conclusions: Online discussion groups have the potential to provide unique insight into perceptions of CBME. The presented concerns may have implications for refining the model of CBME and illustrate the importance of providing clarification for trainees regarding length of training and evaluation structures from those involved in designing of CBME programmes. To facilitate the further development of CBME practices, the authors analyze student discussion forums, highlighting their potential to serve as useful continuous quality improvement tools. [ABSTRACT FROM AUTHOR]

Background Over the last two decades, competency-based frameworks have been internationally adopted as the primary educational approach in medicine. Yet competency-based medical education ( CBME) remains contested in the academic literature. We look broadly at the nature of this debate to explore how it may shape scholars' understanding of CBME, and its implications for medical education research and practice. In doing so, we deconstruct unarticulated discourses and assumptions embedded in the CBME literature. Methods We assembled an archive of literature focused on CBME. The archive dates from 1996, the publication year of the first Can MEDS Physician Competency Framework. We then conducted a Foucauldian critical discourse analysis ( CDA) to delineate the dominant discourses underpinning the literature. CDA examines the intersections of language, social practices, knowledge and power relations to highlight how entrenched ways of thinking influence what can or cannot be said about a topic. Findings Detractors of CBME have advanced an array of conceptual critiques. Proponents have often responded with a recurring discursive strategy that minimises these critiques and deflects attention from the underlying concept of the competency-based approach. As part of this process, conceptual concerns are reframed as two practical problems: implementation and interpretation. Yet the assertion that these are the construct's primary concerns was often unsupported by empirical evidence. These practices contribute to a discourse of infallibility of CBME. Discussion In uncovering the discourse of infallibility, we explore how it can silence critical voices and hinder a rigorous examination of the competency-based approach. These discursive practices strengthen CBME by constructing it as infallible in the literature. We propose re-approaching the dialogue surrounding CBME as a starting point for empirical investigation, driven by the aim to broaden scholars' understanding of its design, development and implementation in medical education. [ABSTRACT FROM AUTHOR]

Although medical education has enjoyed many successes over the last century, there is a recognition that health care is too often unsafe and of poor quality. Errors in diagnosis and treatment, communication breakdowns, poor care coordination, inappropriate use of tests and procedures, and dysfunctional collaboration harm patients and families around the world. These issues reflect on our current model of medical education and raise the question: Are physicians being adequately prepared for twenty-first century practice? Multiple reports have concluded the answer is “no.” Concurrent with this concern is an increasing interest in competency-based medical education (CBME) as an approach to help reform medical education. The principles of CBME are grounded in providing better and safer care. As interest in CBME has increased, so have criticisms of the movement. This article summarizes and addresses objections and challenges related to CBME. These can provide valuable feedback to improve CBME implementation and avoid pitfalls. We strongly believe medical education reform should not be reduced to an “either/or” approach, but should blend theories and approaches to suit the needs and resources of the populations served. The incorporation of milestones and entrustable professional activities within existing competency frameworks speaks to the dynamic evolution of CBME, which should not be viewed as a fixed doctrine, but rather as a set of evolving concepts, principles, tools, and approaches that can enable important reforms in medical education that, in turn, enable the best outcomes for patients. [ABSTRACT FROM PUBLISHER]

Competency-based medical education (CBME) is both an educational philosophy and an approach to educational design. CBME has already had a broad impact on medical schools, residency programs, and continuing professional development in health professions around the world. As the CBME movement evolves and CBME programs are implemented, a wide range of emerging research questions will warrant scholarly examination. In this paper, we describe a proposed CBME research agenda developed by the International CBME Collaborators. The resulting framework includes questions about the meaning of key concepts of CBME and their implications for learners, faculty members, and institutional structures. Other research questions relate to the learning process, the meaning of entrustment decisions, fundamental measurement issues, and the nature and definition of standards. The exploration of these questions will help to solidify the theoretical foundation of CBME, but many issues related to implementation also need to be addressed. These pertain to, among other things, nurturing independent learning, assembling and using assessment results to make decisions about competence, structuring feedback, supporting remediation, and how best to evaluate the longer-term outcomes of CBME. High-quality research on these questions will require rigorous outcome measures with strong validity evidence. The complexity of CBME necessitates theoretical and methodological diversity. It also requires multi-institutional studies that examine effects at multiple levels, from the learner to the team, the institution, and the health care system. Such a framework of research questions can guide and facilitate scholarly discourse on the theoretical and practical body of knowledge related to competency-based health professions education. [ABSTRACT FROM PUBLISHER]

Background Given the complexity of competency frameworks, associated skills and abilities, and contexts in which they are to be assessed in competency-based education ( CBE), there is an increased reliance on rater judgements when considering trainee performance. This increased dependence on rater-based assessment has led to the emergence of rater cognition as a field of research in health professions education. The topic, however, is often conceptualised and ultimately investigated using many different perspectives and theoretical frameworks. Critically analysing how researchers think about, study and discuss rater cognition or the judgement processes in assessment frameworks may provide meaningful and efficient directions in how the field continues to explore the topic. Methods We conducted a critical and integrative review of the literature to explore common conceptualisations and unified terminology associated with rater cognition research. We identified 1045 articles on rater-based assessment in health professions education using Scorpus, Medline and ERIC and 78 articles were included in our review. Results We propose a three-phase framework of observation, processing and integration. We situate nine specific mechanisms and sub-mechanisms described across the literature within these phases: (i) generating automatic impressions about the person; (ii) formulating high-level inferences; (iii) focusing on different dimensions of competencies; (iv) categorising through well-developed schemata based on (a) personal concept of competence, (b) comparison with various exemplars and (c) task and context specificity; (v) weighting and synthesising information differently, (vi) producing narrative judgements; and (vii) translating narrative judgements into scales. Conclusion Our review has allowed us to identify common underlying conceptualisations of observed rater mechanisms and subsequently propose a comprehensive, although complex, framework for the dynamic and contextual nature of the rating process. This framework could help bridge the gap between researchers adopting different perspectives when studying rater cognition and enable the interpretation of contradictory findings of raters' performance by determining which mechanism is enabled or disabled in any given context [ABSTRACT FROM AUTHOR]

Introduction:This study presents a web-based method and its interface ensuring alignment of all parts of a curriculum map including competencies, objectives, teaching and assessment methods, workload and patient availability. Needs, acceptance and effectiveness are shown through a nine-year study. Methods:After a comprehensive needs assessment, the curriculum map and a web-based interface “Learning Opportunities, Objectives and Outcome Platform” (LOOOP) were developed according to Harden’s conceptual framework of 10-steps for curriculum mapping. The outcome was measured by surveys and results of interdisciplinary MCQ-assessments. The usage rates and functionalities were analysed. Results:The implementation of LOOOP was significantly associated with improved perception of the curriculum structure by teachers and students, quality of defined objectives and their alignment with teaching and assessment, usage by students to prepare examinations and their scores in interdisciplinary MCQ-assessment. Additionally, LOOOP improved the curriculum coordination by faculty, and assisted departments for identifying patient availability for clinical training. Conclusion:LOOOP is well accepted among students and teachers, has positive effect on curriculum development, facilitates effective utilisation of educational resources and improves student’s outcomes. Currently, LOOOP is used in five undergraduate medical curricula including 85,000 mapped learning opportunities (lectures, seminars), 5000 registered users (students, teachers) and 380,000 yearly page-visits. [ABSTRACT FROM AUTHOR]

The author shares her thoughts on the present state of interprofessional education (IPE) from her perspective on evaluation and what has to be done to ensure sustainability of initiatives in the future. She suggests taking into account standards of national accreditation bodies for each health profession at pre-certification level and use these to help define outcomes. She cites the need for educators and clinical academics to build high quality evaluation and research in their courses.

Objectives:The current study focused on validating a protocol for training and auditing the resident’s practice-based learning and improvement (PBLI) and quality improvement (QI) competencies for primary care.Methods:Twelve second-year (R2), 12 first-year (R1) and 12 postgraduate year-1 residents were enrolled into group A, B and C, respectively, as trainees. After three training protocols had been completed, a writing test, self-assessed questionnaire and mini-OSTE and end-of-rotation assessment were used in auditing the PBLI competency, performance and teaching ability of trainees.Results:Baseline expert-assessed PBLI and QI knowledge application tool writing scores were low for the R1and R2residents. After three training protocols, PBLI and QI proficiencies, performance and teaching abilities were improved to similar levels cross the three training levels of residents based on the expert-assessed writing test-audited assessments and on the faculty and standardized clerk-assessed end-of-rotation-/mini-OSTE-audited assessments.Conclusion:The different four-level hierarchical protocols used to teach group A, B and C were equally beneficial and fitted their needs; namely the different levels of the trainees. Specifically, each level was able to augment their PBLI and QI proficiency. This educational intervention helps medical institutions to train residents as PBLI instructors. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable - in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation of the project's genesis and focus of the study are highlighted. A summary of key definitions related to competency-based education and training frameworks and competency-based career frameworks are provided to further readers' commonality of understanding. The nature of the problem to be solved is explored and the potential value-add for the Australian health workforce and its key constituents proposed. The paper concludes by discussing relevance and feasibility issues within Australia's current and changing healthcare context along with the essential steps and implementation realities that would need to be considered and actioned if whole-of-workforce frameworks were to be developed and implemented. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the facets of competence (FOC) that are utilized by physician educators in entrusting responsibilities to medical trainees the Netherlands,

Background Despite the movement toward competency-based assessment by accrediting bodies in recent years, there is no consensus on how to best assess medical competence. Direct observation is a useful tool. At the same time, a comprehensive assessment system based on direct observation has been difficult to develop. Intervention We developed a system that translates data obtained from checklists of observed behaviors completed during educational activities, including direct observation of clinical care, into a graphic tool (the "radar graph") usable for both formative and summative assessment. Using unique, observable behaviors to evaluate levels of competency on the Dreyfus scale, we assessed resident performance in 6 learning sites within our residency. Data are represented on a radar graph, which residents and faculty used to recognize both strengths and areas for growth to guide educational planning for the individual learner. Results Initial data show that the radar graphs have construct validity because the development process accurately reflects the desired construct, assessors were adequately trained, and the radar graphs demonstrated resident growth over time. A form completion rate of 90% for .1500 disseminated assessments suggests the feasibility of our process. Conclusions The radar graph is a promising tool for use in resident feedback and competency assessment. Further research is needed to determine the full utility of the radar graphs, including a better understanding of the tool's reliability and construct validity. [ABSTRACT FROM AUTHOR]

Competency-based education in the health care professions has become a prominent approach to postgraduate training in Canada, the Netherlands, the United Kingdom, the United States, and many other countries. Competency frameworks devised at national and international levels have been well received, and in many cases mandated, by governing bodies. However, the teaching and assessment of competencies pose questions of practicality, validity, and reliability. In this article we propose that competence and competencies be approached in the context of the particular clinical environment, such that the assessment of competence is tied to a trainee's performance of essential clinical activities that define the profession. Competence is implicit in the eventual entrustment of trainees to perform these professional activities. Competencies and “entrustable professional activities” (EPAs) relate to each other as two dimensions of a grid in which each EPA can be mapped back to a number of competencies. This backward visioning from EPAs to competencies is proposed as a guide to curriculum planning and assessment. The authors discuss experiences with this conceptual model in research, curriculum development and learner assessment. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread implementation of competency-based education, evidence of ensuing enhanced patient care and cost-benefit remains scarce. This narrative review uses the Kirkpatrick/Phillips model to investigate the patient-related and organizational effects of graduate competency-based medical education for five basic anesthetic procedures. Methods: The MEDLINE, ERIC, CINAHL, and Embase databases were searched for papers reporting results in Kirkpatrick/Phillips levels 3–5 from graduate competency-based education for five basic anesthetic procedures. A gray literature search was conducted by reference search in Google Scholar. Results: In all, 38 studies were included, predominantly concerning central venous catheterization. Three studies reported significant cost-effectiveness by reducing infection rates for central venous catheterization. Furthermore, the procedural competency, retention of skills and patient care as evaluated by fewer complications improved in 20 of the reported studies. Conclusion: Evidence suggests that competency-based education with procedural central venous catheterization courses have positive effects on patient care and are both cost-effective. However, more rigorously controlled and reproducible studies are needed. Specifically, future studies could focus on organizational effects and the possibility of transferability to other medical specialties and the broader healthcare system. [ABSTRACT FROM AUTHOR]