Accelerating Change in Medical Education

Medical education explores competency-based assessment

More medical schools are moving their learning models toward competency-based assessment, requiring greater collaboration and information-sharing in this relatively new area.

Competency-based medical education “focuses on the skills and progression of learning of an individual, promoting greater learner-centeredness and potentially allowing greater flexibility in the time required for training,” according to a report  by the AMA Council on Medical Education. Taking a learner-centered approach could allow physicians to acquire competencies in new specialty areas.

Competency education redesign allows students to progress at their own rates of knowledge and skills achievements.  For example, some of the newer three-year “fast track” programs are using competency-based education to assess students’ progress and readiness for residency. A few schools participating in the AMA Accelerating Change in Medical Education initiative are investigating such models, including New York University School of Medicine, which uses an electronic patient portfolio and a virtual patient panel, in addition to core clinical work with patients,  to teach and track skills within competency domains for students in the three-year program.

Vanderbilt University School of Medicine’s Curriculum 2.0 also is based on competency assessment, built on the idea that an inflexible, classroom- and clerkship-based curriculum should be replaced by one that focuses on lifelong learning. Assessing competency throughout a physician’s learning continuum—from medical school to practice—is a major component of the work by the AMA-led consortium of 11 schools.

Shifting from time- to competency-based curricula isn’t without challenges. Assessing student competencies requires valid and reliable assessment tools, and faculty must consistently interpret their observations and evaluations of learners, requiring increased investment in faculty development. Plus, competencies are necessarily complex, requiring assessment of learners throughout the physician continuum.

Schools participating in the AMA’s consortium and moving to competency-based assessment also are figuring out how to resolve issues related to data management and administrative flexibility.

In an effort to build bridges across the phases of physician training, the AMA House of Delegates in June passed policy based on the AMA Council on Medical Education report to create consistency through pre-medical education and into a physician’s lifelong learning stage. The new policy calls on the AMA to continue studying the challenges and opportunities for achieving a competency-based curriculum across the medical education continuum.

The AMA also will contribute to work that establishes a framework of consistent vocabulary and definitions across health sciences education that will facilitate competency-based curriculum, adult learning and assessment implementation. The Association of American Medical Colleges already is compiling and comparing various competency frameworks, taking the first step in establishing a common taxonomy of competencies.

As consortium schools continue to implement solutions, schools will share materials, tools and ideas with one another. Once refined as best practices, the consortium will disseminate these solutions to medical schools across the country.