IAMSE Winter 2018 WAS Session 1 Highlights

In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Competency-Based Medical Education: Understanding the Principles
Presenter: Linda Snell, MD, MHPE, FRCPC, MACP
January 11, 12 PM EST

Goals of Webinar

  • To lay the foundation for future sessions in this series;
  • To outline reasons why we need to change our current education system, and how competency-based medical education (CBME) may address these
  • To define CBME and common terms that are used when discussing it;
  • To enumerate the 5 components of CBME
  • To describe models for implementing CBME across the continuum of medical education

Key terms:

  • Competency – the thing(s) they need to do.
  • Competent – can do all of the things.
  • Competence – does all of the things consistently, adapting to contextual and situational needs.

Why change our current education system?

  • Today’s medicine is changing in terms of the Profession, Patient and Public safety and access to care.
  • How can we as medical educators prepare physicians to be effective in this environment?
  • Competence drops over time and there are competency gaps.

Challenges of current education system

  • Modern Medical Education is based on time (fixed length of time) and not ability.
  • Trainees unprepared to move on
  • Tend to assess trainees outside of clinical setting.
  • Fail to fail
  • Overloaded or burden of faculty
  • Education not based on patient or society’s needs

Highlights of the Flexner Report

  • Need for fundamental redesign
  • Facts and concepts need to be taught, practiced and assessed in the context
  • Evaluation of learners must reach beyond knowledge to rigorously assess procedural skills, judgment
  • practice until an acceptable level of proficiency is attained
  • develop approaches to skills training that do not put our patients at risk in service to education

We need doctors who …

  • Are optimally prepared for practice
  • Can safely provide complex care
  • Can work and lead health care teams
  • Maintain / improve their competence in changing contexts
  • Possess skills and abilities beyond knowledge
  • Knowing > doing > being

We need medical education that …

  • Is based on explicit outcomes needed by graduates
  • Transparent to learners, teachers, assessors
  • Focuses on individual learner needs
  • Ensures physician competence increases over time
  • Teaches for competence, aims for excellence
  • Promotes life-long learning
  • Provides ‘right’ amount of time
  • Provides public accountability

“We believe that in the future, expertise rather than experience will underlie competency-based practice and…certification.”

Fundamental concepts of CBME

  • Education must be based on the health needs of the populations served
  • Primary focus of education & training should be desired outcomes for learners rather than structure and process of the system
  • The formation of a physician should be integrated across the continuum – UGME > PGME > practice

CBME principles

  1. Focus on outcomes: graduate abilities
  2. Ensure progression of competence
  3. Time is a resource, not framework
  4. Promote learner centeredness
  5. Greater transparency & utility

Milestones and EPAs


A defined, observable marker of an individual’s ability along a developmental continuum that expresses the stepwise progression of expertise; ‘significant point in development’

e.g. Respond to patients’ non-verbal communication; use appropriate non-verbal behaviors to enhance communication with patients

Milestones tend to be:

  • Applied to a person
  • More detailed than competencies
  • Clear descriptions, explicit statements
  • Expected level of ability
  • Observable – link to feedback

Issues Milestones Address

  1. Progression of Competence
  2. Authentic Assessment
  3. Comprehensive Curriculum
  4. Faculty guidance
  5. Learner transparency
  6. Failure to fail

Entrustable Professional Activity (EPA): 

A key task of a discipline (profession, specialty, or sub-specialty) that an individual can be trusted to perform without direct supervision in a given health care context, once sufficient competence has been demonstrated.

EPAs Describes a task

  • Links competency to clinical context
  • Reflects a collection of different competencies as applied to the work of the discipline

Linking EPAs and milestones

  • Assessing unstable patients, providing targeted treatment and consulting as needed
  • Recognize medical instability
  • Address primary priorities of resuscitation (ABCs)
  • Perform a focused clinical assessment
  • Develop a specific differential diagnosis
  • Develop and implement preliminary treatment strategies
  • Identify the necessity and urgency of consultation for advanced care
  • Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions
  • Communicate with the receiving physicians or health care professionals during transitions in care

Core Components of CBME

  1. Competencies required for practice are clearly articulated.
  2. Competencies are arranged progressively.
  3. Learning experiences facilitate the progressive development of competencies.
  4. Teaching practices promote the progressive development of competencies.
  5. Assessment practices support and document the progressive development of competencies.

Common competencies within the frameworks

  • (Clinical) expertise
  • Problem solving
  • Health advocacy / prevention
  • Communication skills
  • Teamwork / collaboration
  • Leadership and management
  • Teaching skills
  • Life-long learning
  • Critical appraisal
  • Professionalism

For more information on the next session or to register, please click here.