Yaich SL, McDonald FS. — American Board of Internal Medicine
Fix OK. — Swedish Medical Group
Leipzig R. — Icahn School of Medicine at Mount Sinai
Sivaram CA. — University of Oklahoma Health Sciences Center
Holmboe ES. — Accreditation Council for Graduate Medical Education
Iobst WF. — The Commonwealth Medical College
Presented: Accreditation Council for Graduate Medical Education: Educational Conference, February 2015
Competency-based medical education (CBME) is “an outcomes-based approach to the design, implementation, assessment, and evaluation of medical education programs, using an organizing framework of competencies” (Frank, Snell et al. 2010).
The Outcomes Project beginning in 1999 introduced the concept of competencies opening up the possibility of GME focused on competency-based outcomes. Yet there have been few experiments in the U.S. investigating the feasibility and effectiveness of shifting the balance of GME from predominately time-based to predominately competency-based systems.
Objective: To test feasibility of CBME in Internal Medicine residency and fellowship programs through graduate medical education (GME) pilots.
CBME pilots are required to:
- Have a national leader for the overall pilot.
- Have an oversight committee responsible for setting expectations and selecting trainees.
- Define outcomes to demonstrate how the innovation improved CBME.
- Involve more than one institution/site to demonstrate the generalizability of the innovation.
- Utilize the Internal Medicine Subspecialty Reporting Milestones and/or subspecialty EPAs.
- Define specific faculty development activities and demonstrate outcomes.
- Propose a strategy for incorporating data from the continuous Maintenance of Certification program to track the progress and performance of the pilot trainees post completion of the pilot program.
- Training must occur at the same institution for pilots involving two disciplines.
Programs with pilot fellows must:
- Have a faculty leader.
- Have departmental and institutional support.
- Design the specific curriculum based on CBME principles for the pilot.
- Use some evidence-based assessment methods.
- Utilize a competency committee to review assessment data and provide attestation regarding competency of trainees (pre-dated ACGME requirement).
- Provide a specific corrective action plan for trainees whose performance does not meet expected pilot outcomes.
Results: At the end of academic year 2014, all pilot fellows and faculty were surveyed about their experience. All reported the fellows were adequately trained and most faculty agreed that the pilots were a better way to train fellows in the subspecialty. All fellows were very satisfied/satisfied with the pilot. The survey identified a need for faculty development at the local and/or subspecialty level. Additional outcomes assessments are ongoing.
Significance/Implications/Relevance: Early indications suggest CBME can successfully shift the framework of GME from time-based to competency-based education. Limitations include relatively short timeframe and limited number of graduates. Future progress will be monitored for impact on educational and practice outcomes (e.g., pass rates after three years and at least 12 graduates) compared to standard training to assess if pilots achieve the goal of equivalent training and exceed the goal of increase proficiency with CBME compared to standard training.
Now that ACGME/ABIM milestones are being used by all programs, will CBME pilots be needed in the future?
For more information about this presentation, please contact Research@abim.org.