If we could turn back time: Imagining time-variable, competency-based medical education in the context of COVID-19

Abstract

The COVID-19 pandemic has exposed a paradox in historical models of medical education: organizations responsible for applying consistent standards for progression have needed to adapt to training environments marked by inconsistency and change. Although some institutions have maintained their traditional requirements, others have accelerated their programs to rush nearly graduated trainees to the front lines. One interpretation of the unplanned shortening of the duration of training programs during a crisis is that standards have been lowered. But it is also possible that these trainees were examined according to the same standards as usual and were judged to have already met them. This paper discusses the impacts of the COVID-19 pandemic on the current workforce, provides an analysis of how competency-based medical education (CBME) in the context of the pandemic might have mitigated wide-scale disruption, and identifies structural barriers to achieving an ideal state. The paper further calls upon universities, health centres, governments, certifying bodies, regulatory authorities, and health care professionals to work collectively on a truly time-variable model of CBME. The pandemic has made clear that time variability in medical education already exists and should be adopted widely and formally. If our systems today had used a framework of outcome competencies, sequenced progression, tailored learning, focused instruction, and programmatic assessment, we may have been even more nimble in changing our systems to care for our patients with COVID-19.

Keywords:

• Assessment
• outcome-based
• timetabling/rotations
• institutional accreditation
• curriculum infrastructure

Disclosure statement

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

Additional information

Notes on contributors

Holly A. Caretta-Weyer

Holly A. Caretta-Weyer, MD, MHPE, is associate residency program director and director of evaluation and assessment in the Department of Emergency Medicine at Stanford University, Palo Alto, California, United States.

Teresa Chan

Teresa Chan, MD, MHPE, is assistant dean for faculty development, Faculty of Health Sciences, and associate professor of emergency medicine in the Department of Medicine at McMaster University and adjunct scientist in the McMaster Program for Education Research, Innovation, and Theory (MERIT), Hamilton, Ontario, Canada.

Blair L. Bigham

Blair Bigham, MD, MSc, DTMH, is a resident physician in the Division of Emergency Medicine, Department of Medicine at McMaster University, Hamilton, Ontario, Canada.

Benjamin Kinnear

Benjamin Kinnear, MD, Med, is associate professor in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center and in the Department of Pediatrics at the University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.

Sören Huwendiek

Sören Huwendiek, MD, PhD, MME, is professor in the Department for Assessment and Evaluation at the Institute for Medical Education at the University of Bern, Bern, Switzerland.

Daniel J. Schumacher

Daniel Schumacher, MD, PhD, is associate professor in the Division of Emergency Medicine at Cincinnati Children’s Hospital and in the Department of Pediatrics at the University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.

On behalf of the ICBME Collaborators.