From Competence by Time to Competence by Design: Lessons From A National Transformation Initiative
Bibliographic record
Abstract
Competency based medical education (CBME) is a global movement to reform health professions education (HPE).In contrast to the traditional time-based training, it is an educational design approach that emphasizes necessary learner abilities, greater learner-centeredness, and better alignment with public's needs for healthcare providers.Unlike numerous previous HPE innovations, CBME is framed as a complex transformational change with multiple proposed elements [1].Training programs employing a competency-based approach can have five core components to operationalize their implementation with fidelity: outcome competencies, progressive sequencing, tailored learning experiences, competency-focused instruction, and programmatic assessment [2].Health professions education institutions, disciplines, and programs across the globe have been implementing CBME at an ever-increasing rate.The CBME movement began with early innovations such as the CanMEDS framework [3-7], the ACGME Outcomes Project [8-10], entrustable professional activities [11,12], the Dutch CBME curriculum [13,14], the Cincinnati observable practice activities [15], the College of Family Physicians of Canada Triple C Curriculum [15-17], and the University of Toronto Orthopedic program [18].CBME has now spread worldwide with implementations in, for example, Switzerland, Taiwan, Australian Orthopedic training [19], Finland, South Africa, Brazil, and many more countries.Competency based education is now a part of many health professions beyond medicine, including nursing [20] and veterinary medicine [21].Despite the global implementation effort, the current discourse around CBME is still largely focused on theoretical underpinnings and potential [22,23] and countered with skeptical criticisms [24,25].There are early efforts to evaluate and clarify the outcomes of these CBME curricula [26,27].However, what is needed at this stage of the diffusion of these innovations is sharing CBME praxis: examples of the application of the CBME approach to real-life HPE systems and the lessons learned for others who follow.In this special issue of Perspectives on Medical Education, a team of educators has come together to describe a unique Canadian configuration of CBME implementation called Competence by Design (CBD).Worldwide, the majority of CBME innovations have focused on implementing
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".