Correspondence Address:
Anita Herur
Department of Physiology, S. Nijalingappa Medical College, Bagalkot, Karnataka
India

Full Text

Dear Sir,

Medical educators all over the world and also in India strongly emphasize the need for competency in medical graduates. The current medical education system is a "Tea bag model of medical education," in which a fixed time is spent by students in a particular context that ensures readiness of the student to serve the community, ignoring whether the students actually learn or not, whether the student is competent enough or not. How do we then, ensure that all of our graduates are competent enough to serve the community? To address this challenge, many jurisdictions around the globe have adopted "competency frameworks" for medical education the result being a movement from the existing structure and process-based models to competency-based medical education (CBME) which is an outcome-based model. [1]

The need for CBME has been recognized by Medical Council of India (MCI). According to the vision document put forth by MCI, the undergraduate medical education program is designed with a goal to create an Indian Medical Graduate (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness, so that he or she may function appropriately and effectively as a "physician of first contact" of the community while being globally relevant too. To fulfill this goal, the IMG must be able to function in the following ROLES effectively: (MCI, regulations on graduate medical education, 2012). [2]

Clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassionLeader and member of the health care team and system with capabilities to collect analyze, synthesize, and communicate health data appropriatelyCommunicator with patients, families, colleagues, and communityLifelong learner committed to continuous improvement of skills and knowledgeProfessional, who is committed to excellence, is ethical, responsive and accountable to patients, community, and profession.

Competency-based medical education is defined as an outcomes-based approach to the design, implementation, assessment, and evaluation of medical education programs, using an organizing framework of competencies. [3],[4]

Competency is an observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. The concept of competence is ever-changing and contextual. The idea of "progression of competence" speaks to this conception of competence as dynamic, developing or receding over time, and as grounded in the environment of practice or learning. [3],[4]

Competencies and objectives may be shown to be related as under: [5],[6]

Mission → goals → Competencies → learning objectives

Competencies are general statements that are broad in scope and are typically written at the program/course level to reflect what is expected of a graduate at that point of time. On the other hand, objectives are specific, observable, and measurable learning outcomes written for individual units of study.

A competency-based curriculum, therefore, begins with outcomes in mind, on the basis of which it defines the abilities needed by graduates and then develops milestones, instructional methods, and assessment tools to facilitate their acquisition by learners.

The rationale for competency-based medical education: four themes can be discussed in favor of competency-based medical education [3],[4]

Focusing on outcomes

In an era of greater public accountability, medical curricula must ensure that all graduates are competent in all essential domains. At present, not all current curricula assess or ensure that graduates have acquired all of the necessary abilities. In the health professions, assessment scores should not be compensatory from one domain to another (i.e., excellent knowledge does not compensate for poor communication skills). Medical education must emphasize on outcomes (e.g., student's performance) rather than process issues (e.g., instructional methods). Medical education must prepare trainees for practice.

Emphasizing abilities

Medical curricula must emphasize the abilities to be acquired. There is too much emphasis on knowledge, and not enough on skills, attitudes, and their synthesis into observable competencies. An emphasis on the abilities of learners should be derived from the societal needs.

De-emphasizing time-based training

Medical education can shift from a focus on the time a learner spends on an educational unit to a focus on the learning actually attained. Learners may progress at different rates, and may achieve threshold competencies faster or slower than the average peer. Greater flexibility may make some curricula more efficient and engaging.

Promoting greater learner-centerdness

Medical education can promote greater learner engagement in training. A roadmap of milestones provides a transparent path to achieve the competencies. An individual learner can adjust their own learning using the milestones.

Differences between traditional and competency-based education [5],[6]

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A move from traditional teaching to competency-based education will be faced by several challenges that we need to be overcome before the start of implementation.

Some of the challenges in implementation that we may encounter are [3],[5]

Inadequate strength of faculty, lack of motivation, fear of transition, time constraints, noncooperation from facultyNew educational roles of the teacher as facilitator, planner, manager, performance assessor may be hinderingInfrastructure for process and skills trainingLack of curriculum directors and experts with the knowledge of CBME, within and outside the university.

Some solutions suggested to overcome the above challenges

Increasing the number faculty required to implement CBME by MCIUndertaking faculty development programs to train the faculty in CBMEOrient faculty and management toward the advantages of CBMEConvincing the university and management about the funds emphasizing that the investment is for better health care and in turn, a healthy societyAwareness has to be created, and the need for a shift toward CBME has to be emphasized to all the stakeholders with the support of best evidence from the literature.

With this basic knowledge of CBME and its implications, we understand that although CBME is excellent to produce competent doctors to serve the society, we are nowhere near the beginning too. Instead of waiting for a drastic change to occur from the higher level, each one of us can do our little bit:

We can create awareness about CBME in students and other facultyWe can define milestones to achieve competencies at the beginning of the year, and convey the same to the studentsWe can design teaching-learning methods to support CBME, i.e., to make the student competent in a particular skill in a specified timeWe can also include CBME templates in all the formative assessments.

These little changes can make the medical students more competent and definitely would give us (mentors and facilitators) more satisfaction of having contributed to the health care of the society, for we are responsible citizens of our country.

Acknowledgments

I would like to thank the faculty and Participants of Fellowship in Medical Education (FIME) 2015 A and B batches at JNMC, Belagavi, Karnataka, for their contributions to the understanding of CBME, which has helped in drafting this manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References