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REVIEW ARTICLE Table of Contents  
Ahead of print publication
Evaluation of the competency-based medical education curriculum


1 Department of Community Medicine, Medical Education Unit Coordinator and Member of the Institute Research Council, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

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Date of Submission20-Jul-2021
Date of Decision04-Aug-2021
Date of Acceptance10-Aug-2021
Date of Web Publication29-Sep-2021
 

  Abstract 


Competency-based medical education (CBME) is an approach to producing competent doctors by the adoption of a framework of competencies, which in turn are derived from the needs of the patients and the general population. A number of expected outcomes have been identified for different stakeholders and efforts should be taken to accomplish them. Evaluation is an important aspect of any initiative and the same stands true even in the case of CBME as it has been introduced across all the medical colleges in the nation and the future of thousands of students depend on the same. In general, any evaluation process has to evaluate the input, the process, the output, and the outcomes. To conclude, the CBME curriculum has been formulated and implemented to produce competent health-care physicians that can improve the health-care outcomes of the community. However, the success of the program has to be determined and there arises the need to periodically evaluate the program. The outcomes of the evaluation can be used to modify the program and thereby ensure better implementation.

Keywords: Competency, evaluation, medical education


How to cite this URL:
Shrivastava SR, Shrivastava PS. Evaluation of the competency-based medical education curriculum. Apollo Med [Epub ahead of print] [cited 2021 Nov 30]. Available from: https://www.apollomedicine.org/preprintarticle.asp?id=327152





  Introduction Top


Competency-based medical education (CBME) is an approach to producing competent doctors by the adoption of a framework of competencies, which in turn are derived from the needs of the patients and the general population.[1] In general, CBME is an outcome-based approach wherein the outcomes of the training have already been defined in advance and it is expected that by the time a medical student completes their training, they are competent enough to discharge their role under the five core competencies (viz., clinician, leader, communicator, lifelong learner, and professional).[1],[2] In the Indian settings, CBME has been adopted for the undergraduate courses from the academic year 2019–2020, and it was a much-awaited decision as the last educational regulations came in the year 1997.

CBME is a student-centric approach, wherein the students take the onus of their learning, plan accordingly, and aim to achieve the learning outcomes. The students should not only have the knowledge, but also the desired skills, attitude, and an ability to integrate them for the care of the patients and the community.[1],[2] CBME advocates formative assessment and all efforts have been taken to strengthen both informal and formal assessments. The curriculum has been divided into core and noncore competencies and significant emphasis has been given toward providing timely feedback to the students for improvement.[1],[2]


  Expected Outcomes in Competency-based Medical Education Top


A number of expected outcomes have been identified for different stakeholders and efforts should be taken to accomplish them.[1],[2] From the students' perspective, it is expected that the individual student becomes competent in the sub-competencies for each professional year, and are exposed to better supervision, mentoring, and guidance by means of daily informal and formal formative assessments. Considering that criterion-based assessment will be adopted, it will make it less stressful for the students as they would not be compared with their colleagues and can just focus on their own learning progression.[3],[4] Further, owing to the introduction of the foundation course, attitude, ethics and communication module, student–doctor mode of teaching, elective posting, etc., the students will get a number of opportunities to enhance their learning by means of the adoption of a flexible approach.[1],[2],[3],[4]

From the teachers' perspective, in CBME it is expected that teachers should just facilitate the learning process, and make students accountable for their own learning.[5] This will essentially require the adoption of a number of student-centered teaching-learning methods that encourage active student engagement. Further, the teachers have to limit their content to the predefined specific learning objectives and always include the component of how the taught knowledge can be applied by the students.[5],[6] Finally, from the patients' perspective, more emphasis has been given toward training the students on noncognitive attributes (viz., soft skills, professionalism, communication skills, leadership, empathy, altruism, ethics, etc.,). The rationale has been to improve not only the clinical outcomes of patients but even establish a sense of trust and satisfaction.[3],[4],[5]


  Evaluation of Competency-Based Medical Education Top


Evaluation is an important aspect of any initiative and the same stands true even in the case of CBME as it has been introduced across all the medical colleges in the nation and the future of thousands of students depend on the same.[2],[4] The outcomes that need to be evaluated in the case of CBME curriculum include the extent to which the curriculum is implemented as intended (considering the emergence of coronavirus disease-19 pandemic), the extent of temporal alignment, horizontal and vertical integration, the competencies that are covered in theory/practical or clinical sessions and the sequence of the same, the teaching-learning methods employed, the assessment methods employed, and adherence to the overall teaching schedule.[1],[2],[7]

In addition, each and every new initiative (like foundation course, early clinical exposure, integration, logbooks, electives, student–doctor method of training, etc.,) has to be evaluated to ascertain the effectiveness of the same and the extent to which it has helped the medical students. Further, we have to identify the potential facilitating and inhibiting factors that have influenced the overall planning and implementation of the CBME curriculum.[1],[8] Moreover, it will be quite essential to ascertain the specific competencies that have been acquired by the students over a period of time and in what ways it has helped the students to enhance their learning. In addition, it is also important to evaluate how the students are being prepared to meet the needs of the general population and for their clinical practice.[5],[7],[8]


  Components of Evaluation– Input, Process, Output, and Outcome Top


The proposed evaluation of the CBME program can occur at any stage starting from the preimplementation stage (to establish the need to introduce the program), design of the program (what are we implementing and the components of the same), midterm evaluation, short-term outcomes (are we accomplishing the intended outcomes like skill certification), and long-term outcomes (system-based results).[4],[5] In general, any evaluation process has to evaluate the input, the process, the output, and the outcomes.[7],[8] The inputs in the CBME curriculum include logistics, infrastructure, skill labs, patients, hospital, library, Internet, technology, etc., The process includes designing the schedule, formation of monthly timetable, involvement of different departments, faculty development programs, preparation of lesson plans, teaching-learning methods employed to impart training, incorporation of formative and summative assessments, skill certification, and obtaining feedback from students and teachers on curriculum.[9]

Furthermore, the process evaluation will also cover strategies adopted to ensure quality assurance, maintenance/assessment of logbook or portfolios, strategies employed to target both advanced and slow learners, documentation of the remedial measures, etc.[9],[10] In terms of output of the CBME program, the evaluation process can be directed toward measuring the number of faculty development programs organized, feedback obtained from the students, the completed logbooks/portfolios, change in the behavior of the students' posttraining, improvement in the clinical (viz., critical thinking, clinical reasoning, clinical skills, problem-solving, etc.,) and noncognitive domains (such as improvement in the communication skills, ability to work as a leader and a member of the health team, decision-making in ethical dilemmas, etc.).[2],[10]

The outcomes of CBME training can be measured either in terms of short-term or long-term outcomes. The short-term outcome comprises the number of students who demonstrate self-regulated learning, the number of students who are competent for their clinical practice upon completion of training, the number of students who have not attained the desired competencies, the expertise of the faculty members in giving constructive feedback to the students, validation of the assessment tools, the establishment of a structured and systematic network of programmatic assessment in the institution, etc.[2],[6],[7],[11] The long-term outcomes include improved patient care-related clinical outcomes, degree of alignment between the health needs of the population and the medical training delivered, implementation of continuing professional development activities, improvement in the health indices of the community, benefits to the society served by the medical students, etc.[1],[7],[8] The Kirkpatrick model of evaluation can be employed to evaluate different outcomes.


  Conclusion Top


To conclude, the CBME curriculum has been formulated and implemented to produce competent health-care physicians that can improve the health care outcomes of the community. However, the success of the program has to be determined and there arises the need to periodically evaluate the program. The outcomes of the evaluation can be used to modify the program and thereby ensure better implementation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sharma R, Bakshi H, Kumar P. Competency-based undergraduate curriculum: A critical view. Indian J Community Med 2019;44:77-80.  Back to cited text no. 1
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2.
Rajashree R, Chandrashekar DM. Competency-based medical education in India: A work in progress. Indian J Physiol Pharmacol 2020;64:S7-9.  Back to cited text no. 2
    
3.
Shrivastava SR, Shrivastava PS. Evaluation of medical education programs: Need, scope and tools. Curr Med Issues 2020;18:66-7.  Back to cited text no. 3
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4.
Oandasan I, Martin L, McGuire M, Zorzi R. Twelve tips for improvement-oriented evaluation of competency-based medical education. Med Teach 2020;42:272-7.  Back to cited text no. 4
    
5.
Vaižgėlienė E, Padaiga Ž, Rastenytė D, Tamelis A, Petrikonis K, Fluit C. Evaluation of clinical teaching quality in competency-based residency training in Lithuania. Medicina (Kaunas) 2017;53:339-47.  Back to cited text no. 5
    
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Shewade HD, Jeyashree K, Kalaiselvi S, Palanivel C, Panigrahi KC. Competency-based tool for evaluation of community-based training in undergraduate medical education in India – A Delphi approach. Adv Med Educ Pract 2017;8:277-86.  Back to cited text no. 6
    
7.
Shrivastava SR, Shrivastava PS. Employing a systematic approach to conduct program evaluation in medical education. CHRISMED J Health Res 2019;6:176-7.  Back to cited text no. 7
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8.
Poth CN, Searle M, Aquilina AM, Ge J, Elder A. Assessing competency-based evaluation course impacts: A mixed methods case study. Eval Program Plann 2020;79:101789.  Back to cited text no. 8
    
9.
Khan AM, Gupta P, Singh N, Dhaliwal U, Singh S. Evaluation of a faculty development workshop aimed at development and implementation of a competency-based curriculum for medical undergraduates. J Family Med Prim Care 2020;9:2226-31.  Back to cited text no. 9
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Hamza DM, Ross S, Oandasan I. Process and outcome evaluation of a CBME intervention guided by program theory. J Eval Clin Pract 2020;26:1096-104.  Back to cited text no. 10
    
11.
Moreau KA. Exploring the connections between programmatic assessment and program evaluation within competency-based medical education programs. Med Teach 2021;43:250-2.  Back to cited text no. 11
    

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Correspondence Address:
Saurabh RamBihariLal Shrivastava,
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_81_21





 

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