Comparability of outcome frameworks in medical education: Implications for framework development

Abstract

Background: Given the increasing mobility of medical students and practitioners, there is a growing need for harmonization of medical education and qualifications. Although several initiatives have sought to compare national outcome frameworks, this task has proven a challenge. Drawing on an analysis of existing outcome frameworks, we identify factors that hinder comparability and suggest ways of facilitating comparability during framework development and revisions.

Methods: We searched MedLine, EmBase and the Internet for outcome frameworks in medical education published by national or governmental organizations. We analyzed these frameworks for differences and similarities that influence comparability.

Results: Of 1816 search results, 13 outcome frameworks met our inclusion criteria. These frameworks differ in five core features: history and origins, formal structure, medical education system, target audience and key terms. Many frameworks reference other frameworks without acknowledging these differences. Importantly, the level of detail of the outcomes specified differs both within and between frameworks.

Conclusion: The differences identified explain some of the challenges involved in comparing outcome frameworks and medical qualifications. We propose a two-level model distinguishing between “core” competencies and culture-specific “secondary” competencies. This approach could strike a balance between local specifics and cross-national comparability of outcome frameworks and medical education.

Acknowledgments

We thank Claudia Kiessling for revising the manuscript. We also thank Anne-Katrin Reinsch for her help during data collection and data extraction.

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the article. S.H. and W.H. contributed equally. Berlin Senate Department of Education, Youth and Science in the context of the Berliner Qualitätsoffensive für die Lehre 2012 bis 2016.

Notes

1. There are various definitions for terms as competence and outcome. To have a common understanding of the terms, we share the following definitions: Competence: “The array of abilities [knowledge, skills, and attitudes or KSA] across multiple domains or aspects of performance in a certain context. Statements about competence require descriptive qualifiers to define the relevant abilities, context and stage of training. Competence is multi-dimensional and dynamic. It changes with time, experience and setting.” (Frank et al. 2010). Outcome: “All possible demonstrable results that stem from casual factors or activities. In medical education, outcome refers to a new skill, knowledge or stimulus to improve the quality of patient care. Setting outcomes can be very useful for developing a framework of various results expected from various educational activities […].” (MedEdWorld 2014).