A call to action: The controversy of and rationale for competency-based medical education

Abstract

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.

Disclosure statement

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

Eric Holmboe is employed by the ACGME and receives royalties for a textbook on assessment from Mosby-Elsevier. Resources and secretariat support for this project was provided by the Royal College of Physicians and Surgeons of Canada.

Glossary

Competency-based medical education: An outcomes-based approach to the design, implementation, assessment, and evaluation of medical education programs, using an organizing framework of competencies. (Frank et al. 2010b)

Notes on contributors

Eric S. Holmboe, MD, is a Senior Vice President for Milestone Development and Evaluation, Accreditation Council for Graduate Medical Education, USA.

Jonathan Sherbino, MD, is an Associate Professor in the Department of Medicine, McMaster University, and an Assistant Dean with Program for Education Research and Development, McMaster University, Canada.

Robert Englander, MD, is an Associate Dean for Undergraduate Medical Education, University of Minnesota School of Medicine, USA.

Linda Snell, MD, is a Professor of Medicine and Core Faculty member, Centre for Medical and Department of General Internal Medicine, McGill University, and a Senior Clinician Educator, Royal College of Physicians and Surgeons of Canada, Canada.

Jason R. Frank, MD, is the Director, Specialty Education, Strategy and Standards in the Office of Specialty Education at the Royal College of Physicians and Surgeons of Canada, and the Director of Educational Research & Development in the Department of Emergency Medicine, University of Ottawa, Canada.