|Year : 2022 | Volume
| Issue : 1 | Page : 147-150
Faculty perspectives on introduction of competency-based medical education curriculum
Savitri Sidddanagoudra1, Ashwini R Doyizode2, Shantala Shripad Herlekar3
1 Department of Physiology, KAHER's JGMM Medical College, Hubballi, Karnataka, India
2 Department of Physiology, SDM College of Medical Sciences and Hospital, A Constituent College of Shri Dharmasthala Manjunatheshwar University, Dharwad, Karnataka, India
3 Department of Physiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
|Date of Submission||25-Oct-2021|
|Date of Decision||12-Jan-2022|
|Date of Acceptance||11-Apr-2022|
|Date of Web Publication||27-Jun-2022|
Dr. Savitri Sidddanagoudra
Department of Physiology, JGMM Medical College, KLE Academy of Higher Education and Research, Hubballi, Karnataka
Source of Support: None, Conflict of Interest: None
CONTEXT: Global adoption of competency-based medical education (CBME) is a paradigm shift in India. Faculties play a key role in implementation by identifying and solving the challenges in CBME.
AIMS: Perspectives of the faculties were undertaken to known about CBME implementation.
SETTINGS AND DESIGN: Qualitative study design.
SUBJECTS AND METHODS: The study included 270 medical faculties who were trained in CBME from May to September 2019. A prevalidated, closed, quantitative questionnaire was administered to faculties. Likert's 3-point scale was used for rating.
STATISTICAL ANALYSIS USED: Data were analyzed based on percentage.
RESULTS: Ninety-seven percent of faculties perceived that CBME should be the current method of approach, 88% perceived the need of more resources, 61% were better prepared to face the challenges in implementation of CBME, 47% perceived that training in CBME reduced resistance to accept CBME, and 45% needed more clarification on self-directed learning (SDL), assessment, and certification of skills.
CONCLUSIONS: Implementation requires more resources and more clarity about SDL, assessment, and certification skill.
Keywords: Challenges, competency-based medical education, faculty perspectives
|How to cite this article:|
Sidddanagoudra S, Doyizode AR, Herlekar SS. Faculty perspectives on introduction of competency-based medical education curriculum. BLDE Univ J Health Sci 2022;7:147-50
|How to cite this URL:|
Sidddanagoudra S, Doyizode AR, Herlekar SS. Faculty perspectives on introduction of competency-based medical education curriculum. BLDE Univ J Health Sci [serial online] 2022 [cited 2022 Aug 16];7:147-50. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/1/147/348258
Competency-based medical education (CBME) was first introduced in the medical literature in the 1970s. Competency is an observable ability of a learner that includes multiple components including knowledge, skills, communication, and attitude values. CBME is an outcome-based model (knowledge application) of education and has triggered substantive changes across the world. CBME is an approach to prepare competent physicians for practice. Graduate Medical Education Regulations 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness so that he or she may serve effectively as a physician of first contact in the community while being globally relevant. A total of five core competencies have been identified in CBME by the Medical Council of India (MCI), namely clinician, communicator, leader, lifelong learner, professional, and a member of the health-care team recognizing “Health for all.”
The inadequacy of prevailing educational approaches in achieving the expected learner's outcome to be a competent practitioner, Importance of providing safe and compassionate patient care has led to a renewed focus on competencies and the CBME curricular approach. It deemphasizes time based training and promises greater accountability, flexibility, centeredness of learner and learners will work toward them until outcomes are achieved.
The competency-based model for medical education is not new outside the country. As this shift is only beginning, many faculties may not have experienced CBME in the country nor a solid foundation is found in the literature. Reviews have noted that implementation of CBME was delayed due to several challenges and barriers in health education, the main being faculty development in CBME. Especially medical teachers are key players in change, being responsible for putting concepts into practice., Acting as the bridge between planning and practical implication, teachers have to be familiar with different perspectives on the teaching and learning process. Other challenges include need for supportive administration, absence of a vision and a plan to bring about the reforms in curricular delivery, infrastructure, number of staff and learning resources, staff who are resistant to change, no proper guidelines from the regulatory bodies for the implementation, financial support, lack of coordination between the undergraduate and postgraduate curriculum, no comprehensive plan to streamline student assessment, and lack of guidelines to state universities and of support to and from Medical Education Unit.
Thus, faculty development is a “Vital element” for successful implementation of CBME is need of the hour. Considering CBME as a novel concept in India, acceptance/perception of stakeholders is necessary. The findings of the study will aid in better implementation of the program in the department, institution, and will be of value to society for health service challenges.
| Subjects and Methods|| |
This study was conducted from May to September 2019 before modification in the Curriculum Implementation Support Program (CISP1). Recently after CISP 1 training ,MCI has released written modules on student–doctor relationship, new assessment methods , skill training , skill certification, logbook (CISP2), Electives, Early clinical exposure and Foundation course. Hence, the study questionnaire mainly included the topics of CISP1.
- Study design: Descriptive qualitative study
- Study duration: 5 months
- Source: Medical faculties of respective college
- Sample size: 270
- Inclusion criteria: The study included medical faculties who had completed training in basics of CBME, that is, Revised Basic Course Workshop in Medical Education Training(RBCW), CISP1 training and who have completed in house one day faculty development program about CBME. These faculties were part of regular teaching–learning program in the institution.
After taking institutional ethical clearance and individual informed written consent, the study began. A set of qualitative questionnaire form was given to the participants, which were rated on Likert's 3-point scale. Agree, disagree, and undecided were the scale for each response. Prevalidation of administered questions was done by the pilot study. All 270 faculties completed questionnaire.
Statistical analysis was done by the assessment of the percentage by Microsoft excel data.
| Results|| |
Data were expressed as percentage of response to the questions. [Figure 1] and [Figure 2], respectively, depict the response to questionnaire.
| Discussion|| |
The present qualitative study was done in sensitized faculties. Ninety-seven percent of faculties perceived that CBME should be current method of approach in India. Eighty eight percent of faculties perceived, the need of more resources such as need of more number of faculties for small group teaching, Demonstrate Observe Assist Perform (DOAP) sessions, for assessing workplace based assessment(WPBA) sessions, conducting objective structured clinical examination( OSCE) sessions.Also they perceived the need of more demonstration rooms for small group discussion in infrastructure MCI criteria. Eighty-four percent expressed that foundation course is a welcoming model to teach professionalism and ethics, stress and time management, and other areas. However, duration would have been reduced to 2 weeks to provide more time to MBBS Phase I (13 months for teaching including three assessments, frequent formative assessments and vacations, and study period plus extracurricular activities). 61% of faculties were better prepared to face the challenges in the implementation of CBME, and 47% of faculties felt that training in CBME reduced resistance to accept CBME curriculum. After sensitization programs, faculties' apprehension was reduced to some extent. Faculty development is a key determinant of successful curricular implementation as noted by many educationists., Through RBCW and CISP, the MCI had been training thousands of medical teachers all over the country. In CBME curriculum, focus has shifted to adult learning principles, framing learning objectives, aligning objectives and teaching–learning methods to assessments, and various assessment methods. An author has expressed that CISP training without bare minimum sensitization to fundamentals of medical education training may become a futile exercise and completing CISP for all teaching faculty of the country before the proposed start of the new curriculum (August 2019) is a herculean task. 45% of faculties need more clarification on self directed learning (SDL), how to conduct, whether teacher has to monitor, and regarding taking the attendance has to be clarified. Faculties expressed that this SDL should be determined learning by a learner; hence, they have to be primed about CBME curriculum at the beginning itself so that the learners can acquire the desired outcomes to become IMG. Similar emphasis is given in a study to train the residents.,, In formative assessment, more details about clinical subjects which are learned for more than one phase were needed as to manage all term batches and patient care. Certification of many prescribed skills in CBME needs fully development skill laboratory with training of faculties. There are no more guidelines to what is a “remedial measures” and how it should be carried out. A study done in a postgraduate residency program indicated the same opinion that WPBA with giving constructive feedback was the crucial area of the CBME implementation program. Assessment has a great role in learning as it drives learning, so more emphasis should be given to assessment and its principles to ensure that what we produce are competent health care professionals. 70% of faculties perceived that introduction of electives is challenging in Phase III Part I MBBS as the duration for clinical major subjects along with allied subjects will be less. To plan and implement again need resources. Around 70% of faculties felt that early clinical exposure allotted duration is more. The basic sciences foundation has to be strong to be competent in surgery or medicine field. Already required applied aspects is taught in curriculum plus Learning ECE with human contact is a difficult for preclinical Faculties. It needs lot of cooperation from clinical side, and resources to implement this in alloted duration along with regular teaching schedule of other non MBBS courses. 60% of the faculties felt that integration is good move to take out redundancy and vertical integration gives a holistic approach to learning the topic.
Many senior faculties felt that MCI should involve the state universities first (before July 2019) and at least only few colleges would have implemented CBME first followed by blanket therapy. Then, challenges would have been minimized.
Strength of the study
The results of this study will be of great help for medical institutions to implement CBME in their settings. Further, this is the first study of its kind in which qualitative research methodology has been adopted to explore the perspectives of more number of faculty members who already have the experience to implement CBME.
| Conclusions|| |
Faculty development programs are essential to disseminate CBME curriculum and to reduce the resistance to accept the change in new curriculum.A growing hidden curriculum and implementation of CBME requires the proper planning ,to overcome the barriers. Further, the study will be carried to take perspectives after 1 year implementation of this CBME 2019–2020 batch from both learners and facilitators.
Authors thank Medical Education Unit, all participants, and supporting staff for their help to carry out the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shah N, Desai C, Jorwekar G, Badyal D, Singh T. Competency-based medical education: An overview and application in pharmacology. Indian J Pharmacol 2016;48:S5-9.
Snell LS, Frank JR. Competencies, the tea bag model, and the end of time. Med Teach 2010;32:629-30.
Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: A systematic review of published definitions. Med Teach 2010;32:631-7.
Bansal P, Supe A, Sahoop S, Vyas R. Faculty development for competency based medical education: Global, national and regional perspectives. NJIRM 2017;8:89-95.
Griewatz J, Simon M, Koeppel L. Competency-based teacher training: A systematic revision of a proven programme in medical didactics. GMS J Med Educ 2017;34:1-21.
Fazio SB, Ledford CH, Aronowitz PB, Chheda SG, Choe JH, Call SA, et al.
Competency-based medical education in the internal medicine clerkship: A report from the alliance for academic internal medicine undergraduate medical education task force. Acad Med 2018;93:421-7.
Mahrous MS. Faculty perceptions regarding community base medical education: The case of KSA. J Taibah Univ Med Sci 2017;13:22-33.
Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system – Rationale and benefits. N Engl J Med 2012;366:1051-6.
Basheer A. Competencybased medical education in India: Are we ready? J Curr Res Sci Med 2019;5:1-3. [Full text]
Johnston C. Residents prepare for switch to competency-based medical education. CMAJ 2013;185:1029.
Dankner R, Gabbay U, Leibovici L, Sadeh M, Sadetzki S. Implementation of a competency-based medical education approach in public health and epidemiology training of medical students. Isr J Health Policy Res 2018;7:13.
Schultz K, Griffiths J. Implementing competency-based medical education in a postgraduate family medicine residency training program: A stepwise approach, facilitating factors, and processes or steps that would have been helpful. Acad Med 2016;91:685-9.
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.
[Figure 1], [Figure 2]