Competency-based medical education: The spark to ignite healthcare’s escape fire

Abstract

High-value care is what patients deserve and what healthcare professionals should deliver. However, it is not what happens much of the time. Quality improvement master Dr. Don Berwick argued more than two decades ago that American healthcare needs an escape fire, which is a new way of seeing and acting in a crisis situation. While coined in the U.S. context, the analogy applies in other Western healthcare contexts as well. Therefore, in this paper, the authors revisit Berwick’s analogy, arguing that medical education can, and should, provide the spark for such an escape fire across the globe. They assert that medical education can achieve this by fully embracing competency-based medical education (CBME) as a way to place medicine’s focus on the patient. CBME targets training outcomes that prepare graduates to optimize patient care. The authors use the escape fire analogy to argue that medical educators must drop long-held approaches and tools; treat CBME implementation as an adaptive challenge rather than a technical fix; demand genuine, rich discussions and engagement about the path forward; and, above all, center the patient in all they do.

Keywords:

• Competency-based medical education
• quality care
• trainee assessment

Disclosure statement

The authors have no declarations of interest to report.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Daniel J. Schumacher

Daniel J. Schumacher, MD, PhD, MEd, is tenured professor of pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.

Benjamin Kinnear

Benjamin Kinnear, MD, MEd, is associate professor of pediatrics and internal medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.

Carol Carraccio

Carol Carraccio, MD, MA, is now retired but spent her career as a clinician educator and medical education researcher.

Eric Holmboe

Eric Holmboe, MD, is chief research, milestones development and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

Jamiu O. Busari

Jamiu O. Busari, MD, PhD, MHPE, is associate professor of medical education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Cees van der Vleuten

Cees van der Vleuten, PhD, is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.

Lorelei Lingard

Lorelei Lingard, PhD, is professor and scientist, Department of Medicine, and Center for Education Research & Innovation, Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada.