Overarching challenges to the implementation of competency-based medical education

Abstract

Medical education is under increasing pressure to more effectively prepare physicians to meet the needs of patients and populations. With its emphasis on individual, programmatic, and institutional outcomes, competency-based medical education (CBME) has the potential to realign medical education with this societal expectation. Implementing CBME, however, comes with significant challenges. This manuscript describes four overarching challenges that must be confronted by medical educators worldwide in the implementation of CBME: (1) the need to align all regulatory stakeholders in order to facilitate the optimization of training programs and learning environments so that they support competency-based progression; (2) the purposeful integration of efforts to redesign both medical education and the delivery of clinical care; (3) the need to establish expected outcomes for individuals, programs, training institutions, and health care systems so that performance can be measured; and (4) the need to establish a culture of mutual accountability for the achievement of these defined outcomes. In overcoming these challenges, medical educators, leaders, and policy-makers will need to seek collaborative approaches to common problems and to learn from innovators who have already successfully made the transition to CBME.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.. Resources and secretariat support for this project was provided by the Royal College of Physicians and Surgeons of Canada.

Notes on contributors

Kelly J. Caverzagie, MD, is Associate Dean for Educational Strategy, College of Medicine, University of Nebraska Medical Center and Vice-President for Education, Nebraska Medicine, USA.

Markku T. Nousiainen, MD, is Associate Professor, Department of Surgery, University of Toronto, and Program Director, Division of Orthopaedic Surgery, University of Toronto, Canada.

Peter C. Ferguson, MD, is Associate Professor, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Canada.

Olle ten Cate, PhD, is Professor of Medical Education and Director of the Centre for Research and Development of Education, University Medical Center Utrecht, The Netherlands.

Shelley Ross, PhD, is Associate Professor and Director of Research and Innovation, Competency-Based Achievement System Program, in the Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Canada.

Kenneth A. Harris, MD, is Executive Director, Office of Specialty Education, at the Royal College of Physicians and Surgeons of Canada, Canada.

Jamiu Busari, MD PhD, is Program Director of the Department of Pediatrics, Zuyderland Medical Center and Associate Professor of Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.

M. Dylan Bould, MB ChB, is Associate Professor, Department of Innovation in Medical Education, University of Ottawa and Associate Professor of Anesthesiology, Department of Pediatric Anesthesia, Children’s Hospital of Eastern Ontario, Canada.

Jacques Bouchard, MD, is Clinical Professor, Department of Surgery, Department of Clinical Neurosciences, University of Calgary, Canada.

William F. Iobst, MD, is Vice President, Academic and Clinical Affairs and Vice Dean at The Commonwealth Medical College, Scranton, PA, USA.

Carol Carraccio, MD, is Vice President, Competency-Based Assessment, American Board of Pediatrics, USA.

Jason R. Frank, MD, is 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.