Abim Cbe The Basics
Abim Cbe The Basics
Abim Cbe The Basics
Education
The Basics
! CBME basics!
Definitions!
! Frameworks and outcomes!
Where we are/where we need to be!
! The role of milestones and entrustment in
the assessment and evaluation of
competence!
Learning Objectives
! Understand the basics of Competency-Based
Medical Education (CBME)!
! Understand the benefits of a clearly defined
framework assessing competency-based
training outcomes!
Recognize the value of a milestones framework for
defining outcomes of training!
Identify Entrustable Professional Activity (EPA) and
entrustment as a strategy for generating meaningful
and manageable work-based assessments of
performance!
5
Competency
!!
!
An observable ability of a health professional,
integrating multiple components such as
knowledge, skills, values and attitudes.!
Competency&Based&
Knowledge&applica?on&
Mul?ple&objec?ve&measures&
Criterion&referenced&
Evalua?on&seDng:&DO&
Variable&length,&dened&outcome&
Emphasis&on&forma?ve&
Caraccio'et'al'2002'
Competency-Based Medical Education
! Medical knowledge!
! Patient care and procedural skills!
! Interpersonal and communication skills!
! Practice-based learning and improvement!
! Systems-based practice!
! Professionalism!
What is the outcome and who
determines it?
The Profession?!
The Public?!
Policy Makers?!
! The Profession?!
The core of medicine?!
Competence in the ACGME general
competencies?!
Safe and effective patient care?!
! The Public?!
Trust that a doctor is competent to do what he
or she does? !
! Policy Makers?!
Meeting the needs of the complex and aging
population?!
!
!
The Outcome
Exemplary
Teaching
Hospitals
Fully Competent
A A B
C
!
Internal Medicine Milestones
32
Emergency Medicine Milestones
33
Neurosurgery Milestones
34
Narratives and Judgments!
! Pangaro (1999) matching students to a
synthetic descriptive framework (RIME) reliable
and valid across multiple clerkships!
! Regehr (2007) Matching students to a
standardized set of holistic, realistic vignettes
improved discrimination of student performance!
! Regehr (2012) Faculty created narrative
profiles (16 in all) found to produce consistent
rankings of excellent, competent and
problematic performance.!
Assessment/Evaluation Challenges
Expert/
Master
Proficient
Competent
Advanced Beginner
Novice
PGY2
MS4
Fellow
Fellow PGY3 Expert/
PGY2 Master
PGY1 Proficient
MS4
MS4 Competent
MS3
Advanced Beginner
Novice
Fellow
PGY3 Expert/
Master
PGY1 Proficient
MS4 Competent
MS3
Advanced Beginner
Novice
Putting it Together
!
!
!
!
Next
Curriculum Entrustments Milestones Accreditation
(K/S/A) And EPAs
System
Attesting to (competence)
Clinical
Competency
49
Committee
Wisdom of the Crowd!
! Hemmer (2001) Group conversations more
likely to uncover deficiencies in professionalism !
! Schwind, Acad. Med. (2004) 18% of resident
deficiencies requiring active remediation only
became apparent through group discussion.!
Average discussion 5 minutes/resident
(range 1 30 minutes)!
! Thomas (2011) Group assessment
improved inter-rater reliability and reduced
range restriction in multiple domains in an
internal medicine residency!
Competencies, Milestones and EPAs
COMPETENCIES!
MILESTONES! EPAs!