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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 143-149

Quantitative and qualitative evaluation of perception of medical faculty toward competency-based medical education for undergraduate curriculum


1 Department of Physiology, KAHER's J N Medical College, Belagavi, Karnataka, India
2 Department of Microbiology, KAHER's J N Medical College, Belagavi, Karnataka, India
3 Department of Anaesthesia, KAHER's J N Medical College, Belagavi, Karnataka, India

Date of Submission07-Oct-2020
Date of Decision02-Nov-2020
Date of Acceptance25-Nov-2020
Date of Web Publication19-Nov-2021

Correspondence Address:
Dr. Anita Teli
Department of Physiology, KAHER's J N Medical College, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_103_20

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  Abstract 


INTRODUCTION: Competency-based medical education (CBME) is an outcome-based education system. There is a big shift in roles and responsibilities of teachers, students, and teaching methods. This study was planned to evaluate the faculty perceptions and concepts toward the CBME and its implementation.
METHODOLOGY: This is a mixed-method study with elements of qualitative (free listing and pile sorting) and quantitative (three-point Likert scale) assessment of faculty perceptions on CBME designed through Google Forms, and the responses obtained were analyzed. Three hundred faculties were recruited for a quantitative study, out of which 125 responded. For qualitative analysis, the preclinical faculties (n = 20) were recruited. Percentages for the responses were calculated. Free-listing and pile-sorting exercise data were analyzed in Visual Anthropac 1.0 software.
RESULTS: The responses from participants showed encouraging analysis. A total of 128 faculty members responded that a response rate was 43%. Thirty-eight responses were obtained through interview pertaining to the concepts (qualitative study) of CBME. From the free-listed items or responses, the items were selected based on salience or ranking or investigator's judgment for pile sorting to understand clustering of responses.
CONCLUSION: Majority of the faculties had a positive perception about the implementation of CBME. Coordination between the Preclinical, paraclinical and clinical departments and proper lesson plan were the factors facilitating effective implementation. Inadequate faculty training and unanticipated holidays were the challenges for the implementation of CBME. Proper faculty training is the utmost important aspect in the effective implementation.

Keywords: Challenges, competency-based medical education, implementation, medical students, qualitative study, quantitative study


How to cite this article:
Teli A, Harakuni S, Kamat C. Quantitative and qualitative evaluation of perception of medical faculty toward competency-based medical education for undergraduate curriculum. BLDE Univ J Health Sci 2021;6:143-9

How to cite this URL:
Teli A, Harakuni S, Kamat C. Quantitative and qualitative evaluation of perception of medical faculty toward competency-based medical education for undergraduate curriculum. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 Jan 27];6:143-9. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/143/330765



The Medical Council of India (MCI) has brought a paradigm shift in medical education from traditional curriculum to competency-based medical education (CBME). CBME is the outcome-based education system. The traditional type was teacher lead learning, while CBME is learner paced, focusing mainly on assessment of skill development by an individual. Various medical colleges and universities across the world have already implemented the CBME.[1] According to Frank et al.,[2] CBME is an outcome-based approach to design, implement, assess, and evaluate a medical education program using an organized framework of competencies. CBME focuses also on clinical skills such as communication and professionalism beyond medical knowledge, thereby assuring holistic learning.[3] The failure of current educational approaches in achieving a competent undergraduate in terms of proficient and compassionate medical graduate has initiated the shift in the curriculum design.[4],[5] Ample of literature have been generated on CBME, its implementation, and related challenges in recent years.[6],[7],[8] There is a need for faculty to understand the ideology behind the CBME and its designed competencies for proper implementation. There is a considerable shift in teacher's role due to emphasis on outcome-based teaching/learning and assessment methods along with inclusion of attitude, ethics, and communication module (AETCOM). Therefore, faculty training forms the essential component of CBME.[9] It is essential to analyze the anticipated barriers for the implementation and rectify the process of implementation.[10] Thus, this study was intended to evaluate the faculty perception and concepts toward the CBME.


  Materials and Methods Top


This cross-sectional observational study was conducted after obtaining the institutional ethical committee approval. Written informed consent was obtained from all the teaching faculties of the institute. The duration of the study was from May to September 2019. This was a mixed-method study with elements of qualitative (free listing and pile sorting) and quantitative assessment of faculty perceptions on CBME through Google Forms. All faculties (n = 300) were recruited for a quantitative study. For qualitative analysis, year 1 faculties (n = 20), presently involved in implementation, were recruited. Any incomplete responses were excluded.

Parameter

For the quantitative data, prevalidated standard published questionnaire [Table 1] was used for assessing the perceptions on a three-point Likert scale (where 1 – disagree, 2 – neutral, and 3 – agree) and was distributed to all the staff members through Google Forms. The data collected from the questionnaire were analyzed using a Google Forms linked spreadsheet.
Table 1: Faculty perception regarding the competency-based medical education on a three-point Likert scale[11]

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For the qualitative data, the study tools used were:

  1. Free listing: The perception about the key aspects of CBME and the challenges involved in its implementation was identified using free-listing tool
  2. Pile sorting: The relationship between the identified key aspects and the salient challenges was recognized by pile-sorting tool.


Free listing

The following four stimulus research questions were used for the study:

  1. What are the challenges in the implementation of CBME according to you?
  2. Which aspect of CBME curriculum is beneficial for students according to you?
  3. What measures you can take to facilitate the implementation of CBME?
  4. What do you think of assessment in CBME?


The protocol was designed and the data were collected by one-on-one interview. The intention of the interview was briefed by the investigator to the participant. Investigator himself read all the research questions to the participant one after the other, and it was confirmed that they clearly understood each of the questions. Investigator wrote all the answers given by participants (in short sentences) in a book and verified that participants were clear about their answers once the responses were recorded. The responses obtained were analyzed by the Visual Anthropac software. The Smith's Salience Score was calculated, and depending on the elbow (cutoff) observed, salient variables were selected for the next step of pile sorting.

Pile sorting

Pile sorting was done to understand the similarities and differences among the responses obtained by the participants. The responses recorded were categorized into specific themes or groups. The pile-sorting method was also done on a one-to-one interaction. The responses obtained for the above questions were subjected to content analysis and based on agreement with respondent given generalized names or descriptions. Similar concepts or descriptions were compiled under a common name agreeable to all participants. From the free-listed items or responses, the items were selected for pile sorting to understand clustering of responses, by means of the salience score cutoff and also based on the investigator's judgment of the importance or relevance of items.

Statistical analysis

Quantitative data were processed using a Google Forms linked spreadsheet. The percentage of the responses was calculated. Free-listing and pile-sorting exercise data were entered and analyzed in Visual Anthropac 1.0 software.


  Results Top


Quantitative data

A prevalidated standard questionnaire[11] containing a total of 29 questions was asked to all the faculties (n = 300), out of which only 125 responded. Out of 125 responses, 25 responses were from preclinical, 38 responses were from paraclinical, and 62 responses were from clinical branches. The data were compiled and analyzed, as shown in [Table 1].

Qualitative data

Free-listing exercise involving responses by faculty participants of the study on the various aspects of newly introduced “competency-based medical education” (CBME) curriculum in India gave the following results.

What measures you can take to facilitate the implementation of competency-based medical education?

Nine variants of responses were observed in free listing, of which 8 items (lesson plan, coordination, time, innovative teaching, teaching aids, student feedback, training, and assessment plan) were selected for pile sorting.

What are the challenges in the implementation of competency-based medical education according to you?

Out of 49 items of free listing, 8 items (resources, time, assessment, coordination, outcomes, acceptance, holidays, and training) were selected for pile sorting.

Which aspect of competency-based medical education curriculum is beneficial for students according to you?

Twelve items were identified, of which 11 items (early clinical exposure [ECE], foundation course, AETCOM, self-directed learning, small group teaching, alignment, integration, assessment, sports and extracurricular activities, professionalism, and electives) were selected for pile sorting.

What do you think of assessment in competency-based medical education?

There were 14 items, of which 8 (frequency, difficulty, training, time, feasibility, feedback, genuineness, and resource) items were selected for pile sorting.

In free listing, the top items based on salience score and average ranking for the four questions on CBME were as follows and are shown in [Table 2], [Table 3] [Table 4], [Table 5].
Table 2: Free listing: Depicting the salience score and average ranking of top items for question 1

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Table 3: Free listing: Depicting the salience score and average ranking of top items for question 2

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Table 4: Free listing: Depicting the salience score and average ranking of top items for question 3

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Table 5: Free listing: Depicting the salience score and average ranking of top items for question 4

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The multidimensional scaling and cluster analysis of selected items for questions on CBME gave the following pictures:

What measures you can take to facilitate the implementation of competency-based medical education?

ID of pile-sort items: 1. Lesson plan, 2. Coordination, 3. Time management, 4. Innovative teaching, 5. Teaching aids, 6. Student feedback, 7. Training, and 8. Assessment plan [Figure 1].
Figure 1: Multidimensional scaling and cluster analysis of question 1

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Coordination and time management are piled together in cluster analysis which was consistent with manual piling by participants who stated that these are two related factors which are together responsible for effective implementation of CBME. Similarly, lesson plan, teaching aids, and innovative teaching methods were piled together because these were measures which will help to facilitate the CBME. Student feedback and faculty training will also go hand in hand because training of faculty will improve CBME and student feedback on CBME will help better training of faculty and improve implementation.

What are the challenges in the implementation of competency-based medical education according to you?

ID of pile-sort items: 1. Resources, 2. Time required, 3.Assessment, 4.Coordination, 5. Outcomes, 6. Acceptance, 7. Holidays, and 8. Training [Figure 2].
Figure 2: Multidimensional scaling and cluster analysis of question 2

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Acceptance of the CBME among students and faculty, abundance of holidays and need for additional training for faculty, etc., were considered as some independent issues which pose challenges to CBME but grouped together based on analysis, obviously showing high importance compared to others. Resources for planning and conducting CBME as per schedule, time required for it, and the need for timely assessment of each session were thought to be some challenges related to each other due to their effect on the critical steps of CBME.

Which aspect of competency-based medical education curriculum is beneficial for students according to you?

ID of pile-sort items: 1. ECE, 2. Foundation Course, 3. AETCOM, 4. Self-directed learning, 5. Small group teaching, 6. Alignment, 7. Integration, 8. Assessment, 9. Sports and Extracurricular activities, 10. Professionalism, and 11. Electives [Figure 3].
Figure 3: Multidimensional scaling and cluster analysis of question 3

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Items 1, 2, 3, 4, and 5 were clustered by software as partially by participants too, which might be due to the fact that these items were the novel things about CBME based on which the program aims to improve medical education. Alignment of curriculum with objectives and integrated session by various related departments are the aspects of CBME which are unique to it by which the CBME tries to bring a multidisciplinary holistic approach to health-care education.

What do you think of assessment in competency-based medical education?

ID of pile-sort items: 1. Frequency of assessments, 2. Difficulty of conducting, 3. Training of faculty, 4. Time required, 5. Feasibility issues, 6. Importance of feedback, 7. Genuineness of assessments, and 8. Importance of resource for assessments [Figure 4].
Figure 4: Multidimensional scaling and cluster analysis of question 4

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Items 1, 2, and 3 were clustered by software as well as participants too, indicating that the increased frequency of assessments poses difficulty in the conduct of assessment and needs appropriate training of the faculty. Items 4 and 5 were clustered separately indicating them as individual issues to be considered during assessment. Items 6, 7, and 8 were clustered because they were critical for planning and conducting assessment (resources for assessment, genuineness, and student feedback).


  Discussion Top


The aim of the study was to assess the faculty perception of the new CBME curriculum, recently introduced by MCI. Faculty perception about the implementation of CBME to the undergraduate curriculum was quantitatively and qualitatively evaluated. The perception of the faculty showed varied responses.

The implementation of CBME by Medical council of India has thrown the unparalleled challenges on the medical fraternity. Our study is an attempt to find the nature and extent of effect of the faculty academic activities in this scenario and is probably the first of its kind and unique in terms of evaluation of both quantitative and qualitative analysis of faculty perception of CBME.

The results illustrated that the majority of the faculties agree with various salient features of CBME. Faculties agree that CBME represents an important drift in current medical education intending to involve the integration of education along with the productive work within the learning process. CBME is planned to combine theory with practice, and the planning of students' activities is based on educational goals and objectives. CBME helps in the synthesis of clinical skills, knowledge, capabilities, and attitudes, and it trains students to work in a multidisciplinary team. Seventy-one of the faculties believed that the new curriculum intends to give the students a basic foundation toward health-care delivery by holistic approach,[12],[13] and it keeps the educational process or curriculum updated as well it improves the quality of health care. Our findings are consistent with the study,[11] in which majority of the issues related to CBME are agreed upon by participants of medical as well as dental college.

Students get equal opportunities to learn about the social, cultural, and ethnic aspects of medical practice through community and hospital-based education in CBME. The focus lies mainly on the health of the community, thereby contributing to equity in health-care delivery services. Implementation of CBME can be impeded by lack of financial support from health and academic institutions. These were some of the statements for which there were neutral responses by the faculty. These neutral responses may be due to lack of proper training and awareness of the faculty regarding CBME. Our findings are consistent with the study done by Mahrous.[11]

Eighty-two of the faculties disagreed that CBME is third-grade medical education producing third-grade graduates and “barefoot doctors.” Faculty disagreed that there is negligence for basic sciences in CBME and it has no scientific base. 78% of the faculties contradict that graduates from CBME programs are incompetent in dealing with patients, as most of the time is spent by them in the community. Sixty-six percent of the faculties did not agree that CBME may help strengthen the college financially and politically. Most of the findings of our study were in agreement with another study done on the quantitative perception of dental as well as medical faculty on CBME.[11]

The preclinical department faculties were chosen for qualitative analysis who were already sensitized in CBME. To understand the perspectives of the faculty regarding the program, the free-listing and pile-sorting methods were adopted. Many studies have adopted these methods in different settings.[14],[15]

The free listing and pile sorting employed showed proper coordination between the departments and within the departments along with proper time management in planning and conducting the classes were the measures responsible for implementation of CBME. Feedback to the student by teachers and faculty training may further support the effective implementation. Several earlier studies done have identified that giving feedback to students by teachers and taking reflection from students on teacher feedbacks are the two important aspects of effective implementation of CBME.[16],[17]

Student and staff acceptance of the new curriculum, unanticipated holidays, and inadequate training of the faculty were considered as some independent issues which pose challenges to CBME. Resources for planning and conducting CBME as per schedule, time required for it, and the need for timely assessment of each session were thought to be some other challenges. Several studies have similar findings as ours, and they also state that proper sensitization and training are the major challenges and can be overcome if effective measures taken. [18,[19],[20]

Alignment of curriculum with objectives and integrated session by various related departments were the beneficial aspects of CBME which are unique to it by which the CBME tries to bring a multidisciplinary holistic approach to health-care education. Similar suggestions are given in a study by Shah et al.[16]

Lack of proper guidelines for assessment, increased frequency of assessment, and resources are some of the hurdles faced by faculty for assessing students. The findings of our study are consistent with the study conducted by Shrivastava et al.[20]


  Conclusion Top


The majority of the responses by faculty being positive indicate that CBME is the need of the hour. The negative or neutral response obtained hint toward the challenges to be considered while implementing CBME. Free-listing and pile-sorting method applied among preclinical faculty found coordination and proper lesson plan were the important factors facilitating effective implementation. Inadequate training, unanticipated holidays, and inability to do timely assessment were the challenges for the implementation. ECE, self-directed learning, and foundation course were the novel things of CBME which help improve the medical education. Alignment and integration of various departments are the unique concepts of CBME which brings about a multidisciplinary holistic approach to health care. Increased frequency and feedback lead assessment help improve the quality of medical education among students in CBME. Proper training through workshops like curriculum implementation support program should be given to all staff to bring about its effective implementation of CBME.

Strength

The strengths of the study are that the faculty response rate was high, and the participants were adequately representative of various departments. The study was conducted, and responses were collected within months of CBME implementation, thus preventing recall bias amongst respondents and alterations of the factors. To the best of our knowledge, this is the first study which has assessed the qualitative perception of preclinical faculty in North Karnataka. Hence, the result of this study will help in overcoming the barriers in the implementation across the other phases.

Limitation

The study needs an extension of data collection over other institutions, so as to have faculty perceptions, in different settings. The duration of the study was limited to 4 months to achieve an on-ground snapshot. This might have been ineffectual as the situation is dynamic and newer trends might have emerged in the succeeding time period.

Acknowledgments

The present study was done as a part of the Advance Course in Medical Education under the guidance of faculty members of the J N Medical College Belagavi, Nodal Centre. Our heartfelt thanks to Dr. Shivayogi Teli, Professor and Head, Department of Physiology, SMV Medical College, and Dr. Praveen, Assistant Professor of Community Medicine from SMV Medical College, Pondicherry, for helping in the analysis of data using software.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Shrivastava SR, Shrivastava PS. Qualitative study to identify the perception and challenges faced by the faculty of community medicine in the implementation of competency-based medical education for postgraduate students. Fam Med Community Health 2019;7:e000043.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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