Competency-based time-variable training internationally: Ensuring practical next steps in the wake of the COVID-19 pandemic

Abstract

Competency-based medical education has been advocated as the future of medical education for nearly a half-century. Inherent to this is the promise that advancement and transitions in training would be defined by readiness to practice rather than by time. Of the logistical problems facing competency-based, time-variable (CBTV) training, enacting time variability may be the largest hurdle to clear. Although it is true that an ‘all or nothing’ approach to CBTV training would require massive overhauls of both medical education and health care systems, the authors propose that training institutions should gradually evolve within their current environments to incrementally move toward the best version of CBTV training for learners, supervisors, and patients. In support of this evolution, the authors seek to demonstrate the feasibility of advancing toward the goal of realistic CBTV training by detailing examples of successful CBTV training and describing key features of initial steps toward CBTV training implementation.

Keywords:

• clinical assessment
• outcomes-based
• undergraduate education
• postgraduate education

Acknowledgments

The concept for this article originated during a two-day forum meeting of the International Competency-Based Medical Education (ICBME) Collaborators in Ottawa, Canada, July 2019.

Ethical approval

N/A

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Transition in place: Giving an individual more responsibility or training opportunities above and beyond those considered to be core (i.e. they are allowed to transition from traditional residency training experiences) while they are still within the residency program and institution (i.e. this transition is ‘in place’). This transition in place opportunity allows the resident to tailor their subsequent training experiences to pursuing future career interests, advancing their clinical skills, pursuing self-directed learning, and supervising and teaching junior colleagues.

Additional information

Notes on contributors

Daniel J. Schumacher

Dr. Daniel J. Schumacher, MD, PhD, is an associate professor of pediatrics at Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Holly Caretta-Weyer

Dr. Holly Caretta-Weyer, MD, is a clinical assistant professor of emergency medicine at Stanford University, Palo Alto, California, USA.

Jamiu Busari

Dr. Jamiu Busari, MD, PhD, MHPE, is an associate professor of medical education at Maastricht University and a consultant pediatrician and dean at Horacio Oduber Hospital, Aruba.

Carol Carraccio

Dr. Carol Carraccio, MD, MA, now retired, was vice-president for competency-based medical education at the American Board of Pediatrics, Chapel Hill, North Carolina, USA, at the time this article was written.

Arvin Damodaran

Dr. Arvin Damodaran, FRACP, MMedEd, is a rheumatologist and director of medical education at Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia.

Larry D. Gruppen

Dr. Larry D. Gruppen, PhD, is a professor of learning health sciences at the University of Michigan Medical School, Ann Arbor, Michigan, USA.

Andrew K. Hall

Dr. Andrew K. Hall, MD, MMEd, is an associate professor in the Department of Emergency Medicine at Queen’s University, Kingston, Ontario, Canada, and a clinician educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.

Benjamin Kinnear

Dr. Benjamin Kinnear, MD, MEd, is an associate professor of internal medicine and pediatrics at Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Eric Warm

Dr. Eric Warm, MD, is a professor of medicine at the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Olle Ten Cate

Dr. Olle ten Cate, PhD, is professor of medical education and a senior scientist at the Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands.