Interest in the competency-based education and training concept has grown in medicine over the last 10 years, catalyzed by a number of internal and external forces:
- Recognition among educators and policy-makers that substantial reforms in both undergraduate and graduate medical education were indicated, and
- The move to outcomes-based assessment and accreditation.
A key distinguishing feature of competency-based medical education (CBME) is that residents would progress through the educational process at different rates: the most capable and talented individuals should be able to make career transitions earlier, while others will require more time (up to a point) to attain a sufficient level of knowledge, skills and attitudes to enter independent practice.
ABIM has CBME pilot programs in:
- Gastroenterology - Transplant Hepatology
- Geriatrics - Palliative Medicine
- Internal Medicine - Cardiology
General CBME FAQs
- What is CBME?
CBME stands for Competency-Based Medical Education. As defined by Frank et al.*, competency-based medical education is “An outcomes-based approach to the design, implementation, assessment, and evaluation of medical education programs, using an organizing framework of competencies.”
- What is the purpose of the pilots?
Few experiments in residency redesign are investigating the feasibility and effectiveness of CBME. Furthermore, current beliefs and opinions about how training should be reformed lack an empiric evidence base to guide change. In light of this current situation, ABIM began to work with the educational community and a small number of willing Internal Medicine and fellowship training programs to pilot several different models of CBME. ABIM recognizes this will be a long evolution, with this first phase of work lasting 4-8 years, and that participating programs will need support from ABIM and the educational community to carry out these pilots.
- What are the requirements to propose a new pilot?
Currently, ABIM is not accepting pilot proposals. Below are the requirements for proposals when (and if) ABIM accepts additional proposals.
Proposals must be grounded in sound educational principles and theory, based on competency-based training, with a clear rationale for what the pilot program intends to accomplish from a patient, trainee, faculty, educational system and public perspective. In addition, pilot programs must meet the following requirements:
- Have a faculty lead
- Have departmental and institutional support as evidenced by the appropriate letters of support
- Define a study design and methodology that documents how the pilot will advance the assessment and evaluation of trainees in a competency-based education framework
- Must design the specific curriculum based on CBME principles for the pilot
- Define what the outcomes measures will be so as to demonstrate over time how the innovation improved competency-based medical education
- Must use some evidence-based assessment methods
- If a new assessment method or tool is utilized, the proposal must describe how the method or tool will be evaluated using the ACGME Assessment Review Group Criteria
- Utilize a competency or promotions committee to review assessment data and provide attestation regarding competency of trainees
- Provide a specific corrective action plan for trainees whose performance does not meet expected pilot outcomes
- Define how specific faculty development activities required to implement the innovation will be developed and how outcomes of the faculty training will be demonstrated
- If possible, should involve more than one institution/site to demonstrate the generalizability of the innovation
- Utilize the Internal Medicine Milestones and Narratives as part of the innovation
- Propose a strategy for incorporating data from the continuous MOC program to track the progress and performance of the pilot trainees post completion of the pilot program
- What specialties have been approved for the pilot?
Currently ABIM is working with the community on three CBME pilots: Gastroenterology-Transplant Hepatology, Geriatrics-Palliative Medicine and Internal Medicine-Cardiology statistics as of 2013.
Gastroenterology - Transplant Hepatology:
This program offers a combined curriculum of Gastroenterology and Transplant Hepatology. Successful fellows of this pilot will decrease expected program length from four years to three years. Before acceptance into this pilot, fellows need to demonstrate a trajectory of competency in gastroenterology before beginning the transplant hepatology portion.
Four fellows successfully completed and graduated from the pilot program in 2013. Three fellows are enrolled in the program and are expected to graduate in 2014.
Geriatrics - Palliative Medicine:
This program provides a combined curriculum of Geriatrics and Palliative Medicine. The pilot program will not decrease the length of training, but will allow for 16 months geriatrics-palliative medicine and eight months professional development. Residents are evaluated using competency-based measures, including direct observation and chart-stimulated recall.
Two residents have been enrolled in the pilot. One resident is expected to graduate in 2014. The second is expected to graduate in 2015.
Internal Medicine - Cardiology:
This program provides a “blended” third year of Internal Medicine training, during which components of cardiovascular disease training are incorporated into the resident's curriculum and are credited to both internal medicine and cardiology training requirements while remaining under the control of the Internal Medicine Residency. This pilot was approved in 2013 and will begin during the third year of the selected candidates' internal medicine training during the 2014-15 academic year.
- Did ACGME issue an official approval letter for the pilot?
Participation in the pilot programs is made possible through ABIM-granted individual exceptions to training. As individual exceptions to training, the IM RRC has agreed that participation in these pilots does not require IM RRC approval.
* Frank JR, et al. Competency-based medical education: theory to practice. Medical Teacher. 2010; 32(8): 638-45.