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Research Article

Competency-based medical education: theory to practice

Jason R. Frank Royal College of Physicians and Surgeons of Canada and University of Ottawa, Canada; JASON R. FRANK, MD, MA(Ed), FRCPC, is the Associate Director of the Office of Education, Royal College of Physicians and Surgeons of Canada, and the Director of Education in the Department of Emergency Medicine, University of Ottawa.Correspondence[email protected]

Linda S. Snell McGill University and Royal College of Physicians and Surgeons of Canada,; LINDA S. SNELL, MD, MHPE, FRCPC, FACP, is Professor of Medicine, Vice-Chair (Education), Department of Medicine, and a member of the Centre for Medical Education, McGill University, Montréal. She is also Senior Clinician Educator at the Royal College of Physicians and Surgeons of Canada, Ottawa, Canada.

Olle Ten Cate Center for Research and Development of Education, University Medical Center, Utrecht, the Netherlands; OLLE TEN CATE, PhD, is Professor of Medical Education and Director of the Center for Research and Development of Education at University Medical Center, Utrecht, the Netherlands.

Eric S. Holmboe American Board of Internal Medicine, USA; ERIC HOLMBOE, MD, is Senior Vice President and Chief Medical Officer at the American Board of Internal Medicine and American Board of Internal Medicine Foundation. He is also Professor Adjunct of Medicine at Yale University, and Adjunct Professor at the Uniformed Services University of the Health Sciences.

Carol Carraccio Department of Pediatrics, University of Maryland, BaltimoreUSA; CAROL CARRACCIO, MD, MA, is Professor of Pediatrics and Associate Chair for Education at the University of Maryland, Baltimore, MD, USA.

Susan R. Swing Accreditation Council for Graduate Medical Education, USA; SUSAN R. SWING, PhD, is Vice President of Outcome Assessment at the Accreditation Council for Graduate Medical Education. Dr. Swing is a co-developer of the ACGME/ABMS Toolbox of Assessment Methods and is working on collaborative projects to evaluate the quality of assessment tools and develop performance milestones for residents.

Peter Harris University of New South Wales, Australia; PETER HARRIS, MB BS, FRACGP, is a Senior Lecturer in the Medical Education and Student Office of the Medical Faculty, University of New South Wales, Sydney, Australia, where he co-ordinates the Medical Faculty's Assessment Working Party and has been involved in undergraduate and specialty training curriculum design.

Nicholas J. Glasgow Australian National University, Canberra, Australia; NICHOLAS J. GLASGOW, BHB, MBChB, MD, FRNZCGP, FRACGP, FAChPM, is Dean of Medicine and Health Sciences and Dean of the Medical School at the Australian National University, Canberra, Australia.

Craig Campbell Royal College of Physicians and Surgeons of Canada and University of Ottawa, Canada; CRAIG CAMPBELL, MD, FRCPC, is a specialist in Internal Medicine, Associate Professor of Medicine at the University of Ottawa, and is the Director, Professional Affairs, at the Royal College of Physicians and Surgeons of Canada. He directs the Centre for Learning in Practice; a CPD research and development unit at the Royal College focusing on physician lifelong learning.

Deepak Dath McMaster University and Royal College of Physicians and Surgeons of Canada,; DEEPAK DATH, MD, MEd, FRCSC, FACS, is Associate Professor of Surgery at McMaster University, Hamilton, Ont., and a Clinician Educator with the Royal College of Physicians and Surgeons of Canada.

Ronald M. Harden University of Dundee, Scotland; RONALD M. HARDEN MD was formally Professor of Medical Education and Director of the Centre for Medical Education, Teaching Dean and Postgraduate Dean at the University of Dundee, Scotland. He is currently General Secretary of the Association for Medical Education in Europe (AMEE) and is the Editor of Medical Teacher.

William Iobst American Board of Internal Medicine, USA; WILLIAM IOBST, MD, is Vice President of Academic Affairs at the American Board of Internal Medicine. He is also an Associate Professor of Clinical Medicine at the Pennsylvania State University College of Medicine.

Donlin M. Long Johns Hopkins University, Baltimore, USA; DONLIN M. LONG, MD, PhD, is Distinguished Service Professor, The Johns Hopkins University School of Medicine, Baltimore, Md., USA.

Rani Mungroo Canadian Association of Internes and Residents,; RANI MUNGROO, MPA, is Manager, Education & Professionalism at the Canadian Association of Internes and Residents, Ottawa, Ontario.

Denyse L. Richardson University of Toronto and Royal College of Physicians and Surgeons of Canada,; DENYSE RICHARDSON, MD, MEd, FRCPC, is a Clinician Educator at the University of Toronto. She is the Lead for Faculty Development in the Division of Physiatry. She is also a Clinician Educator at the Royal College of Physicians and Surgeons of Canada, Ottawa, Canada.

Jonathan Sherbino McMaster University, Hamilton, and Royal College of Physicians and Surgeons of Canada,; JONATHAN SHERBINO, MD, MEd, FRCPC, is the Director of Continuing Professional Education, Division of Emergency Medicine, McMaster University, Hamilton, Ont., and a Clinician Educator with the Royal College of Physicians and Surgeons of Canada.

Ivan Silver University of Toronto,; IVAN SILVER, MD, MEd, FRCPC, is Professor of Psychiatry and Vice-Dean of Continuing Education and Professional Development in the Faculty of Medicine, University of Toronto.

Sarah Taber Royal College of Physicians and Surgeons of Canada,; SARAH TABER, MHA, is the Manager of Educational Strategy, Innovations and Development at the Royal College of Physicians and Surgeons of Canada, where she oversees strategic initiatives and major projects related to key policy issues in postgraduate medical education.

Martin Talbot University of Sheffield, England; MARTIN TALBOT, MAEd, MEd, FRCP Lond, F Acad M Ed, is a Consultant Physician in Genitourinary Medicine/HIV and Honorary University Reader in Medical Education at the University of Sheffield, England. He is a Senior Fellow of the United Kingdom's Higher Education Academy, an Associate of the Institute of Education, London University, Fellow of the Academy of Medical Educators, and Policy Lead of the Association for the Study of Medical Education, Edinburgh, Scotland. (The views expressed here are not the official views of the ASME.)

Kenneth A. Harris Royal College of Physicians and Surgeons of Canada, University of Ottawa and University of Western Ontario, Canada; KENNETH A. HARRIS, MD, FRSCS is Director of Education at the Royal College of Physicians and Surgeons of Canada, has an adjunct appointment with the University of Ottawa, and is Professor Emeritus at the University of Western Ontario.

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Abstract

Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership – the International CBME Collaborators – to examine conceptual issues and current debates in CBME.

We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals.

In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education.

We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.

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Competency-based medical education: theory to practice

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