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Competency-Based Medical Education (CBME)

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Medical education is changing to meet the demands of our evolving health care system. One of these changes is the development and implementation of competency-based medical education (CBME).

CBME is an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. The goal of CBME is to ensure that all learners achieve the desired patient-centered outcomes during their training.

The AAMC has been a leader in CBME for more than two decades and continues to support the development and implementation of new competencies. Below, you will find resources from the AAMC and other organizations toward the design and use of CBME.

Foundational Competencies

The AAMC, the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) are developing a new initiative to create a common set of foundational competencies for use in undergraduate medical education programs in the United States. This initiative aligns with recommendations outlined in the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC) and is part of a comprehensive effort to improve the transition to residency. The initiative will engage thought leaders from across academic medicine, beginning with a series of listening sessions planned for later in 2022.

AAMC New and Emerging Areas in Medicine Competency Series

The AAMC New and Emerging Areas in Medicine competency series was developed by leaders from across the medical education and clinical practice communities. These competencies are intended to add depth to key emerging areas to guide curricular and professional development, formative performance assessment, cross-continuum collaborations, and, ultimately, improvements in health care services and outcomes.

New AAMC diversity, equity, and inclusion (DEI) competencies for medical educators

At the nexus of education and clinical care, academic medicine has a responsibility to confront the factors that drive racism, hate, and bias in health care and to prepare culturally responsive physicians to address these issues. The AAMC, with input from a broad range of education stakeholders, has developed DEI competencies (PDF) for use across the continuum of undergraduate medical education, graduate medical education, and continuing medical education. Please direct any questions or comments to DEIcompetencies@aamc.org.

Telehealth and Virtual Care

Telehealth, defined as the use of technology to deliver health care at a distance, has become an increasingly important and commonly used tool for delivering care to patients. The Telehealth Competencies Across the Learning Continuum report provides background, a glossary, and context (including curricular models) for integrating and improving telehealth curricula in medical education. Please direct any questions or comments to telehealth@aamc.org.

Quality Improvement and Patient Safety (QIPS)

The Quality Improvement and Patient Safety Competencies Across the Learning Continuum report presents a road map for curricular and professional development, performance assessment, and the improvement of health care services and outcomes across the continuum of medical education. Please direct any questions or comments to QIPS@aamc.org.

Diversity, Equity, and Inclusion (DEI)

At the nexus of education and clinical care, academic medicine has a responsibility to confront the factors that drive racism, hate, and bias in health care and to prepare culturally responsive physicians to address these issues. A set of DEI competencies is in development and will be released in early 2022. These competencies will align with the AAMC Framework for Addressing and Eliminating Racism at the AAMC, in Academic Medicine, and Beyond, which will help guide internal AAMC efforts as well as amplify and support efforts at medical schools and teaching hospitals. Please direct any questions or comments to DEIcompetencies@aamc.org.

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Other Contemporary Consensus Competencies, Priorities, and Guidance Resources

Below are several examples of additional resources available to educators across the health professions to inform and guide curricular efforts. These resources are not specialty-specific and have been developed nationally through systematic and inclusive consensus building processes.

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Opportunities for Engagement and Professional Development

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Highlights From the Development of CBME

Highlights From the Development of CBME

1996 – CanMEDS is released. This framework aims to improve patient care by enhancing physician training through defining the necessary competencies for all areas of medical practice and providing a comprehensive foundation for medical education and practice in Canada. It is formally adopted by the Royal College of Physicians and Surgeons of Canada in 1996 and refreshed in 2005 and 2015.

1998 – The Medical School Objectives Project begins. This initiative is designed to reach a consensus within the medical education community on the skills, attitudes, and knowledge that graduating medical students should possess. From 1998 to 2008, the AAMC also convenes expert consultants and panels to address special topics in medicine and offer their findings on learning objectives and educational strategies for all medical students in a series of Contemporary Issues in Medicine reports.

1999 – The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties endorse a set of six core competencies that define the foundational skills every practicing physician should possess. The competencies are used to shape and evaluate the education of residents.

2009 – The Education in Pediatrics Across the Continuum project is established to build a model for true CBME, with progression through training based on the achievement of competencies rather than the passage of time. Four schools test the feasibility of using a time-variable, outcomes-based model in pediatrics training. In 2021, this project expands to focus on time-variable progression and educational programming at the graduate medical education level.

2011 – The Interprofessional Education Collaborative (IPEC), consisting of six founding organizations including the AAMC, releases its initial core competencies for interprofessional collaborative practice. Since its inception, IPEC has become more inclusive, and it updates its core competencies in 2016. IPEC is currently updating its core competencies again in preparation for a 2023 release.

2012 – The ACGME launches the Next Accreditation System, which incorporates milestones into the core competency framework. Milestones use stages of professional development and provide descriptive, longitudinal narratives for the six core competencies.

2013 – The Physician Competency Reference Set (PCRS) is released. This reference list is designed to move toward a common taxonomy of competencies. The PCRS is used by the AAMC Curriculum Inventory and by many medical schools in the design of their program objectives and assessments.

2014 – A set of 13 Core Entrustable Professional Activities (EPAs) for Entering Residency is developed by a drafting panel convened by the AAMC. The Core EPAs are made up of the activities that a resident could be expected to perform with indirect supervision on the first day of residency. Also in 2014, the AAMC begins a 10-school pilot to assess the feasibility of implementing the Core EPAs in undergraduate medical education. The pilot activities are completed in 2021.

2017 – The AAMC begins its AAMC New and Emerging Areas in Medicine competency series. This series includes competencies focused on QIPS (released in 2019), telehealth (released in 2020), and DEI (scheduled to be released in early 2022).

2018 – The ACGME Milestones 2.0 work begins. It includes expert development groups convened to develop cross-specialty “harmonized” milestones for Interpersonal and Communication Skills, Problem-Based Learning and Improvement, Professionalism, and Systems-Based Practice.

2020 – Action Plan 1 of the AAMC Strategic Plan is announced. This action plan focuses on strengthening the medical education continuum to transform the health care and learning environments. CBME is a key theme for the projects and activities supporting this action plan.

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