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Competency-based Medical Education: The Perceptions of Faculty

Article in Journal of Medical Academics · June 2019

DOI: 10.5005/jp-journals-10070-0034

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EDITORIAL (ORIGINAL RESEARCH)

Competency-based Medical Education: The Perceptions of

Faculty
Shaifaly M Rustagi1, Charu Mohan2, Niket Verma3, Bindu T Nair4

A b s t r ac t
Introduction: Competency-based medical education (CBME) is being implemented across India in medical colleges from the 2019 batch. The
new aspects of this curriculum are introduction of a foundation course (FC); early clinical exposure; longitudinal program on attitudes, ethics,
and communication; electives; emphasis on small group learning methods; assessment changes; and most importantly, a horizontally aligned
and vertically integrated method of teaching–learning. The faculty members of medical colleges are the prime movers for implementing the
CBME. The Medical Council of India (MCI) is imparting training about the new curriculum to the faculties of all medical colleges across India.
All faculty members have not been able to get the requisite training in the latest changes as required for the new curriculum. This study is an
attempt to analyze the awareness and perceptions of the faculty and the challenges envisaged in the implementation of CBME.
Materials and methods: All faculty members of our college were e-mailed a self-structured, prevalidated Google questionnaire. The results
were analyzed by the inbuilt available Google statistical software.
Results: A total of 58 faculty members responded to the questionnaire. Of the 58 faculty members, 87.9% were aware about the CBME but
only 51.7% felt that better doctors would be produced as a result of its implementation. Eighty-one percent were aware that small group
teaching needs to be two-thirds of the total teaching hours in a particular subject but the small group teaching methods only few could enlist.
Around 86.2% agreed that students should have early clinical exposure. Around 41.4% were not aware of the changes in internal assessment
as proposed by CBME.
Conclusion: The faculty lacked uniformity in awareness and there was ambiguity on various aspects and constituents of CBME as proposed
by the MCI. The proper implementation of CBME would require more clarity and continuous efforts by Medical Education Units (MEU) under
guidance of the MCI to update their faculty in the form of Curriculum Implementation Support Programs (CISPs), Revised Basic Course Workshops
(RBCWs), and advanced courses in medical education.
Keywords: Challenges of CBME, Competence based medical education, Faculty awareness, Faculty perspectives, Medical education.
Journal of Medical Academics (2019): 10.5005/jp-journals-10070-0034

Introduction 1–4
​Department of Anatomy, Army College of Medical Sciences, New
Delhi, India
The medical education in India is going through a radical change 2,3
this year with the implementation of competency-based medical Department of Medicine, Army College of Medical Sciences, New
education (CBME) curriculum. The CBME is an outcome-based Delhi, India
4
approach where the emphasis is on producing a competent Indian Department of Paediatrics, Army College of Medical Sciences, New
Medical Graduate (IMG).1​The salient features of the new CBME Delhi, India
are the “competencies” that are the main focus of the curriculum. Corresponding Author: Charu Mohan, Department of Medicine, Army
A competency can be defined as “the habitual and judicious use College of Medical Sciences, New Delhi, India, Phone: +91 9810946939,
of communication, knowledge, technical skills, clinical reasoning, e-mail: [email protected]
emotions, values, and reflection in daily practice for the benefit of How to cite this article: Rustagi SM, Mohan C, Verma N, et al.​
the individual and community being served.”2​ Competency-based Medical Education: The Perceptions of Faculty.
J Med Acad 2019;2(1):1–5.
The IMG is expected to be a physician of first contact who has
to essay the roles of a clinician, leader, professional, communicator, Source of support:​The Dean and ethical committee for consent and
and lifelong learner. The new Graduate Medical Education faculty of ACMS for giving their valuable responses to the Google
questionnaire
Regulations (GMER) states that the learning process should include
living experiences, problem-oriented approach, case studies, and Conflict of interest:​ None
community health care activities. Hence, CBME is learner-centric
with the teaching–learning activities concentrating on skill communication process. The development of ethical values and
acquisition and clinical experiences with the didactic lectures not overall professional growth as an integral part of the curriculum
exceeding one-third of the schedule. Therefore, the majority of shall be implemented through a structured longitudinal and
teaching schedule would include interactive sessions, practical dedicated program on professional development and ethics called
sessions, and small group discussions. Attitude Ethics and Communication (AETCOM). It will be delivered
The present curriculum is not aligned with societal needs by well-defined modules, role plays, project work, field trips,
and lays more emphasis on knowledge than skill acquisition with medical camps, and voluntary services.1​
no formal training on attitudes. The new CBME curriculum gives One of the biggest challenges in implementing CBME would
priority to the doctor–patient relationship, ethical values, and the be the horizontal alignment between different subjects in a single

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
 CBME: The Perceptions of Faculty

phase and vertical integration across phases. This new curriculum of faculty were not even aware that CBME is being implemented
as a system-based approach focuses on competencies that would from the 2019 batch. Of the 51 faculty members who were aware
need more efforts and dedication on the part of the faculty to make of the new curriculum, only 25 (43.1%) members felt that its
it a success. The faculty would no longer be givers of knowledge but implementation would lead to better doctors in future.
will become facilitators in the students’ acquisition of knowledge. The numbers of faculty who attended the RBCW, AETCOM, and
To sensitize and train the faculty about CBME, the Curriculum CISP workshops are given in Table 1.
Implementation Support Program (CISP) workshops are being held
Regarding the newly introduced FC, 81% of faculty were
in various colleges across India. The aim of this study was to assess
aware that such a course of 1 month was being introduced
the attitude, awareness, and perception of faculty about CBME and
the challenges likely to be faced in its implementation. at the beginning of the new curriculum. Around 70.7% of the
faculty had also seen the uploaded timetable of the FC in the
M at e r ia l s and Methods college website.
This study was carried out in our college as a cross-sectional Competency-based medical education has incorporated a
questionnaire-based study. The consent of the dean and new module of ECE, which is being introduced as a teaching tool
ethics committee approval were taken. The questionnaire was in classroom, hospital-based, and community settings. Around
administered online in the form of a Google form. All faculties were 89.7% of faculty were aware that the new curriculum mandates ECE
sent the form through e-mail. Consenting faculty filled the form for undergraduate students. Suggestions were asked from faculty
online. Responses were received from 58 faculties members. The members about the cases that were more important for ECE for the
questionnaire included both open- and closed-ended questions. It fresher students. The suggestions are listed in Table 2.
comprised of seven sections. The first part focused on the awareness The perceptions of faculty on lectures and small group
and training of faculty in form of Revised Basic Course Workshops teaching–learning methods are listed in Table 3. Majority of the
(RBCWs), AETCOM sensitization workshops, and CISP workshops. The
faculty were aware that the new curriculum limits “lectures” to
subsequent parts had questions pertaining to awareness of faculty
only one-third of the total teaching hours allotted to a particular
on FC, early clinical exposure (ECE), electives, teaching–learning
methods, and assessment changes. The last section had open-ended subject and that “small group” teaching–learning methods
questions to know about the likely challenges in implementation would now account for two-third of the total teaching hours
and their suggestions to make it successful. The responses were (Table 4).
analyzed by an inbuilt Google Statistics available with Google forms. Electives have been a new addition in the CBME curriculum.
The new curriculum mandates 2 months of elective postings for
R e s u lts undergraduate students between 3rd prof part-1 and part-2 was
Of the 70 faculty members, 58 faculty members responded. Of known to 67.2% of the faculty. The topics suggested by our faculty
the 58 faculty members who answered the questionnaire, 12.9% for electives are given in Table 5.

Table 1: Number of faculty members who attended the RBCW, AETCOM, and CISP workshops
Topic Attended (n​) Not attended (n​)
Revised Basic Course Workshop (RBCW) 32 (44.8%) 26 (55.2%)
Attitude Ethics and Communication (AETCOM) Workshop 44 (24.1%) 14 (75.9%)
Curriculum Implementation and Support Programme (CISP) Workshop 35 (39.7%) 23 (60.3%)

Table 2: Topics suggested by faculty for ECE (in random order)

Topics suggested
Acute abdomen Chest pain Inguinal hernia
Jaundice Anaphylaxis Varicose veins
Myocardial infarction General fever case Pulmonary tuberculosis
Water-borne and food-borne disease Hospital-acquired and community-acquired Communicable and noncommunicable (lifestyle)
pneumonia disorders
Anemia Thyroid disorders (hyper or hypothyroidism) Chronic renal failure
Diabetes mellitus Hypertension and anemia in pregnancy Bell’s palsy
Hypertension A case of ascites Notifiable diseases under Integrated Disease
Surveillance Program (IDSP)
Malnutrition Malaria Weight loss
Congenital heart disease Spinal nerve injuries Cranial nerve injuries
Immunization clinic Pain abdomen Poison ingestion
Dehydration Dialysis center Insect bites
Dengue Tuberculosis Seizure disorder
Gastroenteritis Stroke Prostate hypertrophy
First aid in trauma and emergency care Pleural effusion Paraplegia
Blunt injury case Chronic liver disease Respiratory distress

2 Journal of Medical Academics, Volume 2 Issue 1 (January–June 2019)

 CBME: The Perceptions of Faculty

Table 3: Faculty responses on lectures/small group learning methods

S. no. Question asked Aware Unaware
1 Are you aware that the new curriculum limits “lectures” (as a teaching–learning 46 (79.3%) 12 (20.7%)
method) to only one-third of the total teaching hours allotted to a particular subject?
2 Are you aware that the new curriculum mandates “small group” teaching–learning 47 (81%) 11 (19%)
methods for two-third of the total teaching hours allotted to a particular subject?
3 Do you know of any “small group” teaching learning methods? 42 (72.4%) 16 (27.6%)

Table 4: Small group learning methods suggested by the faculty

Methods suggested
Seminar Tutorials Focused group discussion
Fish bowl Think pair share Problem-based learning
Snow ball Case-based discussion Flipped classroom
E-Learning Jigsaw Role-playing
Buzz groups Simulation Bedside teaching

Table 5: Topics suggested for electives by faculty in random order

General elective Clinical elective
Statistics/biostatistics Emergency medicine
Research methodology Dialysis unit
Molecular techniques in diagnostics Transfusion medicine
Sports/exercise physiology Cosmetic dermatology
Dietetics Psychological evaluation in pediatrics
Computer skills Critical care
Organ donation and transplant units Oncopathology
Genetics Lab medicine
Hospital management Toxicology lab
Assisted reproductive technology unit Rehabilitative medicine
Immunology unit Neonatology
Regenerative medicine Palliative care
Community projects Rheumatology

Table 6: Faculty awareness about assessment changes

S. no. Yes No
1 Are you aware that the MCI mandates regular formative assessment 44 14
under CBME? 75.9% 24.1%
2 Are you aware of the changes in weightage of internal assessment in 34 24
the final result? (58.6%) (41.4%)

Table 7: Innovative assessment methods for formative assessment

Daily feedback Muddiest point Log book with reflection writing
Objective structured practical examination (OSPE) One minute perceptor Objective structured clinical examination (OSPE)
Mini clinical evaluation exercise (Mini-CEX) Class quiz series 360 degree evaluation
Work place based assessment (WPBA) Portfolio Mock case presentation
MCQ Clinical encounter card Chart simulated recall

The assessment methods have been modified from the previous Discussion
curriculum. The responses of the awareness of the changes have
The introduction of CBME has led to a paradigm shift in medical
been tabulated in Table 6.
education across India. However, it is yet to be seen whether the
The faculty suggestions for formative assessment included the promises of CBME will be able to prepare the next generation of
following “Innovative Assessment Methods” (Table 7). doctors effectively to meet the health needs of the country. Faculty
In the last section of the questionnaire, the faculty members members across various medical colleges in India are putting in
were also asked to give their views on the challenges faced by their whole-hearted efforts to make this successful. The timetable
them. Thematic analysis of qualitative responses is given below of first-year MBBS has been uploaded on the websites of respective
(Table 8). medical colleges.

Journal of Medical Academics, Volume 2 Issue 1 (January–June 2019) 3

 CBME: The Perceptions of Faculty

Table 8: Thematic analysis of qualitative responses of faculty about likely challenges in CBME implementation
Inadequate number of faculty members to Logistics-related issues
implement CBME
Shortage of faculty members for small group teach- Required new setups in UG lab due to addition of new practicals
ing would be a major challenge
Gross mismatch between MCI-stated faculty Lack of clinical forensic medicine cases and unpreparedness of the clinicians to share
requirements in departments and actual requirement situations of medicolegal relevance and significance
to implement small group teaching and formative
assessment
Faculty to take out time from busy schedule to do the First-time exposure to a new teaching method will create hurdles
small group teaching everyday especially faculty in
clinical departments
Lack of faculty would lead to improper Horizontal and vertical integration of different departments
implementation, conduct, and assessment
A dedicated faculty will be required to devote time Difficulty in the integration of all topics with other departments as the contents
for these students length differ in different departments
A dedicated faculty will be required to devote time Training and sensitizing all faculty for the same
for these students
Ratio of faculty and students is very less There should be enough cooperation between the faculty members
Logistics of conducting small groups in clinical settings in wards
Assessment and feedback for each and every activity
Piecemeal coverage of topics
Faculty to be made aware of proper guidelines
Implementation of new TL activity
As I am from FMT, and now we have to teach for 2 years and its assessment will be in
the end of the course. I think they will not take seriously in first of the forensic class
Faculty to take out time from busy schedule to do the small group teaching everyday,
three batches of students across three semesters with different topics going on for
each semester
The teething problems of having a curriculum that fits every parallel department
It would take a lot of careful planning and execution initially but it would be fruitful in
the end
Development of objective skill assessment and feedback
Procurement issues Time-related issues
New instruments and new kits Time management issues
Required new setups in UG lab due to addition of Syllabus completion could be a problem
new practicals
Will require better time management
Time management in imparting skills necessary
Managing teaching hours balancing already previous curriculum batches
The faculty will have to put in more number of hours to plan small group activities;
for example, for case-based learning they need to draft cases for common clinical
problems, so they will have to be motivated and kept free of other duties to do justice
to CBME

The awareness and knowledge about the salient features and module, field visit to community health center, and professional
new aspects of CBME was not uniform across faculty members. development including ethics, language, and communication
Although majority of them were aware of the changes, around skills. The students admitted to the MBBS course being from
10% were unaware. The new pool of faculty members joining every diverse backgrounds need training in local language to be able to
year have been trained in the previous curriculum and would not communicate effectively with patients. Imparting basic computer
be aware of the finer aspects of the new curriculum. This requires skills training is also a component of FC. Eighty-one percent of
that all medical institutions to keep up with the continuous efforts our faculty were aware of the one-month FC, and 70.7% of faculty
of updating their faculty members in form of CISPs, RBCWs, and members knew about the above-mentioned components of FC.
advanced courses in medical education supported by MEU units Early clinical exposure has been introduced in CBME to impart
under guidance of the MCI.3​ clinical relevance to the basic sciences. This is also expected to
The FC as proposed by GMER has recently been concluded in engrain empathy and compassion toward patients. Early clinical
most medical colleges across India.4 The FC is a 175-hours module exposure can be in the form of case scenarios, paper cases, lab
covered in 25 days, which includes the following components: skills reports, ECG, photographs, and “actual patients.” This can be

4 Journal of Medical Academics, Volume 2 Issue 1 (January–June 2019)

 CBME: The Perceptions of Faculty

imparted in the classroom setting, hospital setting, and community So far, CBME has been experimented in India only in few
visits.1 Around 89.7% of the faculty members were aware that the medical colleges for postgraduate education with good results but
new curriculum mandated ECE, and majority of the faculty (86.2%) the outcome for undergraduates is awaited.7​Systematic planning
members were in agreement with the concept of exposing the needs to be done, and the approach to medical education needs
first-year students to ECE. to be a given a new direction.8​
Electives are another new introduction in the CBME curriculum. As faculty members are the forebearers to this new change,
They are brief courses available to the learners to explore their our study is an attempt to analyze the perceptions of the faculty
interests in different medical fields consisting of one general and the likely challenges to be faced about the new curriculum.
elective and one clinical elective. They are being introduced for This knowledge can be used for proper implementation, conduct,
the first time to sensitize the students to various career options that and assessment of CBME.
are available after completing their graduation by having direct
experiences in diverse areas. It is mandatory that all students take
up any two elective topics for 2-month duration after completion
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Journal of Medical Academics, Volume 2 Issue 1 (January–June 2019) 5

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