1. Competency-based Curriculum - An Overview on Development, Implementation & Accreditation AAMC Annual Meeting – November 8, 2011

2. Current Directions in Competency Based Learning and Assessment Robert Englander, MD, MPH

3. “ “The best thing for being sad...is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins… you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds. There is only one thing for it then--to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the thing for you.” Merlyn from TH White’s The Once and Future King

4. Learning Objectives: 1. Briefly explore the rationale for the paradigm shift to CBME 2. Enumerate challenges in the transition to CBME 3. Discuss current AAMC efforts to advance CBME 4. Begin to envision and create the future!

5. Competency-Based Medical Education: Why switch?

6. Why Switch? 1980s-1990s-Increased pressure from public for physician ACCOUNTABILITY and QUALITY

7. Why Switch? IOM was addressing the public’s concerns through an evaluation of Quality in Health Care, resulting in:  To Err is Human (1999)  Crossing the Quality Chasm (2001)

8. Why Switch? Simultaneously and in response to the public outcries, the AAMC and ACGME focused on how we educate and evaluate physicians The MSOP and the ACGME Outcome Projects Shifted focus from input (curriculum and teacher-driven) to outcomes (learner-driven) Defined the medical professional through “domains” of competence

9. Why Switch? Thus, the focus on competency-based outcomes is the medical profession’s response to a public outcry Outcomes drive curriculum increased accountability

10. The Paradigm Shift VariableStructure/ Process Competency Based Driving Force for Curriculum Content & Knowledge Acquisition Outcomes & Knowledge application Driving Force for Process TeacherLearner (s) Path of LearningHierarchyNo Hierarchy Responsibility For Learning TeacherStudent and Teacher

11. Framework for Evaluation of Competence VariableStructure/ Process Competency -Based Typical Assessment Tool ProxyAuthentic Location of Assessment RemovedIn the trenches EvaluationNorm ReferencedCriterion Referenced

12. Framework for Evaluation of Competence VariableStructure/ Process Competency -Based Typical Evaluation Tool Subjective and Single Objective and Multiple Timing of Evaluation Emphasis on summative Emphasis on formative

13. Design Down Process Generation of exit outcomes Course outcomes Outcomes for individual learning experiences From Harden et al. An introduction to outcome-based education. Medical Teacher 200

14. Defining the Competencies Patient Care (PC) Medical Knowledge (MK) Practice-Based Learning and Improvement (PBLI) Interpersonal and Communication Skills (ICS) Professionalism (P) Systems-Based Practice (SBP)

15. Sub-Competencies: Patient Care Gather essential information Make informed diagnostic/therapeutic decisions Carry out management plans Counsel patients and families Provide health maintenance/anticipatory guidance Use information technology to optimize care

16. The Perfect Storm MSOP Outcome Project IOM reports MOC/MOL Carnegie Report -100 years after Flexner

17. Phase 1: July 2001 – June 2002 Phase 2: July 2002 – June 2006 Phase 3: July 2006 – June 2011 Phase 4: July 2011 and beyond Response to the Change in Requirements Focusing the Definitions and Assessments of the 6 Competencies Full Integration of Competency Assessment and Clinical Care Outcomes Expansion….. Develop and Share Models of Excellence Adapted from www.acgme.org

18. ACGME Core Competencies 2002 Programs were provided:  Little guidance  No tools for assessment  Little time for preparation

19. Challenge #1 Assessment of competencies, including defining and recognizing “competence” at key transition points, such as: Transition to clinical clerkships Transition to junior resident (primary caregiver with supervision) Transition to supervisory resident Transition to fellowship Transition to practice

20. Solutions The Milestones Project (ACGME and ABMS sponsored) Advanced stage for Pediatrics, Surgery and IM In process for Ob/Gyn, Urology Developing teams to work on Milestones for most other specialties

21. Solutions EPAC: Education in Pediatrics Across the Continuum (Debbie Powell leads with AAMC as key sponsor, partnering with ACGME, ABP)

22. Challenge #2 Reductionist vs Holistic Approach. Bringing Assessment into Real World Context

23. Solutions Entrustable Professional Activities 1-2 : EPAs EPAC seeks to use EPAs to define competence at the various transition points 1.ten Cate O. Entrustability of professional activities and competency- based training. Medical Education. 2005;39(12):1176-1177. 2.ten Cate O, Scheele F. Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine. Jun 2007;82(6):542-547.

24. Challenge #3 Completing the transition to competency-based education Seamless approach from pre-medical requirements through the span of a physician’s career Variable time, learner-centered education (moving away from one-size-fits-all)

25. Solutions EPAC Other specialties?

26. Challenge #4 Understanding, teaching, and assessing the new competencies :PBLI and SBP

27. Solutions Inter-professional Education Collaboration (IPEC)  Competencies defined  Pilot projects starting MedEdPortal: Over 150 curriculum focused on PBLI and SBP defined and linked to the competencies Aligning and Educating for Quality (AE4Q) Medical School Admissions Transformation

28. Challenge #5 Documenting performance levels in a manner that informs: Life-long learner-centered improvement Efficient documentation of competence for licensing, credentialing, and certification Programmatic opportunities for improvement (UME, GME, CME) Accountability to the public

29. Solutions eFolio Connector (eFC) Joint project of the NBME and AAMC

30. Challenge #6 Faculty development for all of the above!

31. Solution Teaching 4 Quality(Te4Q)

32. Thank you! Questions?

33. Competency-based medical education at UCSF Susan Masters, PhD Associate Dean, Curriculum Undergraduate Medical Education University of California, San Francisco

34. CBME is being integrated into existing UCSF curriculum 1 st year Foundations of Patient Care (FPC)FPC PrologueOrgans CVOrgans P/RM&NBMB 4 th year Advan Clerk Advan Clerk Advan Clerk Advan Clerk Advan Clerk Advan Clerk Advan Clerk Advan Clerk Coda Advan Clerk 2 nd year I-3Life Cycle FPC M-3 FPC Core Clerkship Block 1 CC 2 SeptNovJanMar May July Core Clerkship Block 4 Core Clerkship Block 3 Core Clerkship Block 5 Core Clerkship Block 6 Advan Clerk Advan Clerk Advan Clerk CC 2 3 rd year

35. CBME at UCSF has come a long way TEAM/ RESOURCES STAGES TARGET SUCCESS FACTORS True CBME All those things Bob said! 2005 2011 2007 2009 2010 Key curriculum committee charged re student assess- ment (COSA) Key portfolio committee charged Course and clerkship objectives linked to competency Focus on critical reflection curriculum 2 nd key curriculum committee (eCAMP) Key shift in competency advising (to faculty closer to students) Competency directors appointed Milestones for all 4 yrs MD Portfolio introduced for 1 st yrs More assess- ments reported in competency language Med Ed leadership Educational technology gp Educational research gp Course & clerk- ship directors Student ambassadors Thoughtful research Educator culture shift Meaningful to learners Confidence in measures

36. CBE Partnerships at UCSF CBME at UCSF, including milestones : http://medschool. http://medschool ucsf.edu/curriculum/competencies/ More information: UCSF’s MD Portfolio : http://medschool.ucsf.edu/curriculum/competencies/portfolio.aspx Co-curricular programs (MSTP, Pathways to Discovery) Interprofessional health education GME programs

37. Thank you! Questions?

38. Design a Comprehensive Assessment System in Preparation for Curricular Change Cynthia H Ledford, MD, FAAP, FACP Assistant Dean of Evaluation and Assessment Ohio State University College of Medicine

39. Why Now? Build on Past Successes Personalized Medical Education Deliberate Practice Horizontal and Vertical Integration of Learning Advanced Competencies Institutional tradition of innovation and continuous educational improvement and change Response to external indicators and forces calling for medical education reform

40. LeadServeInspire Curriculum Design Instruction Clinical Practice

41. LeadServeInspire Key Features Fully integrated Flexible learning Competency Based EFFICIENT and EFFECTIVE Allows students to explore and achieve more Key Benefits Personalized Medical Education Mentored Educational Portfolio Advanced Competencies Assured Competency Systematic Assessment of Progress Defined Levels of Competency

42. LeadServeInspire Longitudinal Projects Community Health Education Longitudinal Health Coach Interprofessional Systems Based Thinking Patient Safety 4 Years 18 months12 months18 months

44. LeadServeInspire Mentored Portfolio Clear Milestones Opportunitie s for More Keys to Success

45. LeadServeInspire Doing More Formalized deliberate career exploration during flexible times (Part 1 through 3) Longitudinal project work – make a real difference Specialty focused Advanced Clinical Tracks Advanced competencies

46. LeadServeInspire Challenges: In the setting of Personalized Medical Education (high degree of flexibility), what are the best methods for tracking and managing individual learning? Given the complexity of the Core Educational Objectives, what strategies can be used to assure every student meets every competency at each level of the curriculum? Are faculty prepared for this type of curriculum?

47. How do you want to learn this? Are you ready to be assessed? Do you know how this connects to learning before/after and your core educational objectives? Are you ready to move on? Let’s add this to your learning Portfolio For each Stepwise Learning Outcome

48. LeadServeInspire Faculty Development & Retention Task Force Role specific faculty development Sets them up for success in their roles Flexible delivery models Challenges: Faculty needs assessment Identify roles and essential skills Identifying and recruiting teaching experts Utilizing technology in the classroom and beyond Innovation grants to support mobile app development Technology showcases In-place technology training (department meetings)

49. LeadServeInspire Faculty Development Faculty Development for Medical Educators (FD4ME) Online modules Earn CME Scheduling and Tracking Database FD4ME.osu.edu

50. Thank you! Questions?