GUIDING

PRINCIPLES
FOR COMPETENCY-BASED EDUCATION
AND ASSESSMENT
 GUIDING PRINCIPLES FOR COMPETENCY-BASED EDUCATION AND ASSESSMENT

AACN developed this resource to guide faculty engaged with transitioning to competency-based
curricula based on The Essentials: Core Competencies for Professional Nursing Education. The
following key components of competency-based education (CBE) provide a foundation for
implementing CBE: outcome competencies, sequenced progression, tailored learning experiences,
1
competency-focused instruction, and programmatic assessment. A shared understanding of the
components and approaches of CBE is needed for successful implementation while still allowing
for flexible program design. Comprehensive evaluation of program outcomes is important; however,
this document primarily focuses on guiding principles for competency assessment of individual
learners.

KEY POINTS
In an outcomes-based competency framework, curriculum, outcomes, and assessment
strategies are mapped to the 2021 Essentials.

Competencies are sequenced progressively and drive curriculum design. Effective sequencing
means:
Gradually increasing complexity of expectations,
Progressively building on foundational competencies,
Employing a systematic approach to map educational opportunities and assessments for
each competency across the curriculum.

Learner takes on authentic roles of graduates to attain and demonstrate competencies with
some flexibility for enrichment.

Teaching and assessment strategies are tailored to competencies and to the individual learner:
Faculty tailor learning experiences to competencies,
Learners actively guide their own learning,
Faculty ensure that each learner is an active participant in the assessment process, including
formative and summative assessments.
Faculty clearly delineate expectations of the learner, so the learner knows the
competencies they need to achieve and the behaviors expected.
Learners engage in gathering and reviewing performance evidence, including how to self-
assess and collaborate with faculty in generating their individualized learning plans to attain
competency.

Faculty are intentional about minimizing bias.

All assessments should be directly linked to the competencies delineated in the 2021 Essentials.

1
Van Melle, E., Frank, J.R., Holmboe, E.S., Dagnone, D., Stockley, D., & Sherbino, J. (2019). A core components framework for evaluating
implementation of competency-based medical education programs. Academic Medicine, 94(7), 1002-1009.

1
 GUIDING PRINCIPLES FOR COMPETENCY-BASED EDUCATION AND ASSESSMENT

CORE PRINCIPLES FOR ASSESSMENT OF LEARNERS IN CBE

Principle Implications for Implementation Examples

CBE Assessment: Multiple Points, Assessors, and Methods

Decisions about learner Create methods for data collection that Direct observation is important across
progress are based on match the competency or competencies the curriculum. However, different levels
assessments collected at being assessed. of supervision may be used as evidence is
multiple timepoints using a Gather multi-modal performance evidence documented regarding a student’s
variety of tools and methods of from multiple assessors in different progression. For example, assessing a
data collection. contexts about each learner for each student’s ability to perform a history and
competency or collection of associated physical exam by directly observing the
competencies. student versus listening to the student’s
Identify and conduct assessments in verbal presentation of the history and
clinical, lab/simulation, and didactic physical exam findings.
settings. Map the increasing level of competency
Approach assessment developmentally expected across courses related to
with multiple opportunities to physical assessment and identify points
demonstrate competency. for assessing.
Use different levels of Create a performance rubric for
supervision/oversight. assessors.
Use multiple assessors over time.

CBE Assessment: Active Learner Engagement

The learner must be an active Ensure each learner is an active participant Develop reflective assignments for
participant, and the process in the assessment and understands the students to assess their progress toward
must be dynamic. final decision process on competency achieving mastery for a given
Learner must be invested in attainment. competency.
his/her/their own learning. Provide clear expectations and stakes for
both the learner and assessor for each
point of assessment.
Engage the learner in gathering and
reviewing performance evidence.
Ensure each learner understands the
importance of his/her/their role in the
assessment process. Prepare learners to
self-assess under the guidance of a mentor
and generate their own individualized
learning plans to attain competency
achievement.

CBE Assessment: Methods Match Competency

Assessments use methods that Determine that the method being used is Example of a valid assessment measure
are valid and address the measuring what it is intended to measure. that is matched to the competency:
intended competencies. Student is observed for behaviors
Methods for assessment and demonstrating accountability,
data collection match the quality responsibility, advocacy, and social justice
of the competency being across four courses distributed
assessed. throughout the curriculum.

2
 GUIDING PRINCIPLES FOR COMPETENCY-BASED EDUCATION AND ASSESSMENT

Principle Implications for Implementation Examples

CBE Assessment: Direct Observation

Create assessment opportunities for direct Assessor uses observation of student
The primary emphasis should be observations of students by multiple performing health assessments during
on direct observation in the assessors and in diverse practice settings. multiple patient care experiences rather
practice environment. than, or in addition to, using the written
Assessments include multiple assessment reported on the patient care
opportunities for direct plan for multiple care plan assignments
observations in diverse practice across several courses.
settings.

CBE Assessment: Frequent Formative Feedback

Emphasis is on providing Train faculty, preceptors, and mentors in Providing one-on-one feedback by the
personalized, timely, and providing actionable, respectful feedback. faculty/preceptor immediately following
meaningful feedback. Follow each assessment with timely observing the learner in practice is
Assessment data provides feedback. essential to competency development.
learners with actionable Include debriefing, feedback, and time to This could be brief (10 minutes) but
feedback to guide their learning. allow student self-reflection with each should include recommendations for
Formative (low stakes) assessment opportunity. how or what the learner should be
assessments provide learners Establish a process and build in sufficient working on related to the competency as
with actionable data to guide time for remediation and additional well as learner self-reflection.
their progress toward learning and assessment opportunities to Example of formative assessment could
attainment of the competency increase successful competency include directly observing a student’s
and entrustment for achievement. engagement with a patient and/or family
unsupervised practice. in the clinic or simulation lab. The
Expected outcomes/behaviors assessor provides feedback immediately
are clearly defined. after the encounter including what the
Achieving competence is a learner did well and how they can
developmental process. improve with specifics of what to work
Competency expectations are on next.
leveled. Example: not
competent, approaching
competency, and competent.
Demonstration of competency
occurs by demonstrating the
sub-competencies for either
Level 1 or Level 2.
Sub-competencies and the
competencies themselves can be
assessed individually or together
in increasingly complex
contexts.

3
 GUIDING PRINCIPLES FOR COMPETENCY-BASED EDUCATION AND ASSESSMENT

Principle Implications for Implementation Examples

CBE Assessment: Collective Summative Assessments

At points across the curriculum, Explicitly measure the attribute of Example for collective summative
summative assessments are trustworthiness of the student by the assessments based on level of autonomy
performed to make collective assessor in addition to the knowledge, skills, allowed could include implementing an
formal decisions on and attitudes required for each competency. individualized plan of care using
competency attainment. Progression goes from total direct established protocols.
Progression includes supervision and observation to autonomous Early in the curriculum, students may
developing trust of the learner actions trusting that the student can implement person-centered care based
to demonstrate competency repeatedly provide specific care on their on instruction and with direct
reliably in increasingly complex own without input and prompting. supervision while in a capstone
situations and in different Assessments should be created to assess experience at the end of the program,
contexts/ competencies in situations that include students may implement person-
environments. increasing complexity, multiple factors, and centered care with the appropriate level
in different settings and environments. of supervision required by the facility
There may be activities that students are and/or program.
not allowed to do autonomously due to
institution/licensing regulations; the
preceptor/faculty and student need to
understand and be aware of limitations and
expectations.

CBE Assessment: Decision Making Process

Create and use robust, Include multiple, diverse professional Create an assessment rubric that includes:
validated system for decision judgments about competency attainment by
making regarding learner each learner. For the third-year students, expected
progression to and attainment Make decisions based on the body of behaviors to demonstrate achievement
of competency. evidence on assessments. of competencies for that level.
Create a process to render and maintain A fourth-year or capstone assessment
formal assessment decisions by a trained rubric that expects the student to
group (representing faculty and practice) demonstrate the ability to perform all
that reviews performance evidence for each competencies unsupervised prior to
student. graduation.
Develop a training plan focused on the Utilize a progression committee for
provision of feedback and coaching methods developing and implementing formalized
for faculty, preceptors, mentors, and others processes for all students and includes
who will be assessing learners. plans for students attaining “not
Consider the value of including competent” or “approaching
assessor/student relationships and formal competence” levels and therefore not
coaching opportunities in informing able to progress.
assessment decisions.

CBE Assessment: Data Management and Visualization

Create a longitudinal Create multiple data points. Faculty implement a competency
record/view of each learner’s Create a dashboard to document a learner’s tracking tool that adheres to the
performance, which includes competency development over time. principles of Self-Sovereign Identity and
aggregated performance Document multiple assessments and has the capability for students to retain
evidence as well as longitudinal associated assessors over time. ownership of their own data after
data on assessments, settings, Document setting and method of graduation.
context, assessor, and assessment. Competency tracking tools should allow
performance. Document outcome/performance of access for faculty, preceptors, and
learner. students with context-based views for
easy input and access to the right
information at the right time for the right
purpose.

4
 GUIDING PRINCIPLES FOR COMPETENCY-BASED EDUCATION AND ASSESSMENT

Principles Implications for Implementation Examples

CBE Assessment: Equity Assurance and Bias Mitigation

Design assessments for equity Embrace the philosophy that the intent is to Data that could indicate a problem with
assurance and bias mitigation. help all learners attain and demonstrate the bias is evaluated regularly, i.e., faculty
Understand the risk of expected competencies. assessment of students of color is
unconscious biases. Create an equity lens process that includes markedly different from students in
Document steps taken to multiple perspectives and focuses on general.
mitigate unconscious bias. uniqueness of the candidate’s perspective. A policy for interrater reliability among
Consider inherent bias and Include early and frequent assessments by faculty is developed by the program.
ensure alignment to mitigate multiple assessors with the goal to decrease
unconscious bias. biases.
Use a standardized rubric with Create an inter-rater reliability process in
exemplars to ensure the learner which faculty are evaluated for bias in
and assessor understands competency evaluation.
expectations for competency Consider replacing rankings such as
attainment. “honors,” “high pass,” “pass,” and “fail” with
Evaluate competency “not competent,” “approaching competent,”
attainment of diverse students and “competent.” This should decrease
i.e., students of color, indigenous competition and increase transparency and
students, and those with willingness to support others.
disabilities, to decrease
unintended consequences.

Forscher, P. S., Lai, C. K., Axt, J. R., Ebersole, C. R., Herman, M., Devine, P. G., & Nosek, B. A. (2019). A meta-analysis of procedures to change
implicit measures. Journal of Personality and Social Psychology, 117(3), 522–559. https://doi.org/10.1037/pspa0000160.

5
 GUIDING PRINCIPLES FOR COMPETENCY-BASED EDUCATION AND ASSESSMENT

GLOSSARY
Assessment:

Formative assessment is intended to enhance learning without consequences or to inform

progression decisions.

Summative assessment is intended for making a decision regarding attainment of the competency or
a key step towards competency demonstration, ability to perform the competency without or
limited supervision, or pass/fail.

Program Evaluation: The comprehensive evaluation of the overall outcomes of the program, which
would include aggregate attainment of competencies by the learners.

Self-Sovereign Identity: An approach to digital identity that gives individuals sole ownership of or ability
to control their personal data.

ASSESSMENT EXPERT WORKING GROUP

Bimbola F. Akintade, PhD, Dean, East Carolina University, Working Group Chair

Jonathan Amiel, MD, Senior Associate Dean for Innovation in Health Professions Education, Vagelos
College of Physicians and Surgeons, Columbia University

David Cella, PhD, Chair, Department of Medical Social Sciences, Northwestern University

Phil Dickison, PhD, Chief Operations & Examinations Officer, National Council of State Boards of Nursing

Carol Fowler Durham, EdD, Professor and Director, Education-Innovation-Simulation Learning

Environment, University of North Carolina at Chapel Hill

Robert Englander, MD, Associate Dean for Undergraduate Medical Education, University of Minnesota

Kara Hedvig Evans, MSN, Director of Nursing Professional Development, Atrium Health

Suzan Kardong-Edgren, PhD, Associate Professor, MGH Institute of Health Professions

Cynthia O'Neal, PhD, Associate Dean of Undergraduate Studies, University of Texas Health Science
Center at San Antonio

Margaret Rauschenberger, MSN, Dean Emerita, Alverno College

Janelle Sokolowich, PhD, Associate Provost, Social Mission, Chamberlain University

Susan Corbridge, PhD, Chief Essentials Program Officer, AACN, Staff Liaison

Joan Stanley, PhD, Chief Academic Officer, AACN, Staff Liaison

Updated December 2023 6

For more tools related to the AACN
Essentials, strategies for engaging
practice partners, and approaches to
moving to CBE, visit:

www.aacnnursing.org/Essentials