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).

1. CBME(Competency Based Medical
Education): Methodologies and challenges
in assessment
Dr Mohit Kher
Senior Resident
Pharmacology, LHMC

2. OUTLINE
• CBME
• Difference between old and new curriculum
• Components
• Teaching methods
• Competencies
• Challenges

3. Introduction
• Competency‐based medical education (CBME), originally introduced in 1978, has regained
momentum over the past decade.
• Competency – It is defined as “ the ability to do something successfully and efficiently”.
• According to international CBME Collaborators, 2009: An observable ability of a health
professional, integrating multiple components such as knowledge, skills, values and attitudes.
• Measurable
• Descriptors of physicians

4. International CBME Collaborators
• ICBME have been working since 2009 to promote the application of CBME in different medical
institutions worldwide.
• Principles outlined by ICBME in 2013 summit:
1. Based on the health needs of the population
2. Primary focus is desired outcomes for learners
3. Formation of the physician should be seamless

6. CBME: Key Features
• Outcome based
• Learner centric
• Focusses on three domain of learning (K/S/A): Knowledge, Skill and
attitude
• Evaluation integrates all domains
• Self directed learning
• Time independent
• Learning is individualized

13. CBME: Components
1. Competencies
2. Entrustable professional activity (EPA)
3. Milestones
These are used as tools for assessment

14. Competencies expected of an Indian medical
graduate (IMG)
COMPETENCY DESCRIPTION
Clinician Who understands and provides preventive, promotive,
curative, palliative and holistic care with compassion
Leader and member of the health care team and
system
With capabilities to collect, analyze, synthesize and
communicate health data appropriately
Communicator With patients, families, colleagues and community
Life longer learner Committed to continuous improvement of skills and
knowledge
Professional Who is committed to excellence is ethical, responsive and
accountable to patients, community and profession

18. Entrustable Professional Activity (EPA)
• EPA means the work that defines a profession.
• For a medical student, EPA includes the role of clinician,
communicator and professional.

20. Milestones in CBME
• Milestones in CBME refers to a significant point in development
where competencies are achieved gradually step by step.
• Milestones gives information on individual’s trajectory of competency
acquisition.
• Guides self assessment by learner.

23. Different teaching learning methods in CBME
• Teacher centric/Passive learning: Lecture cum demonstration,
Seminars and audio/video recordings
• Learner centric/Cognitive learning: Self directed learning/E-
learning, Roleplay and simulation/real life patient.
• Learner centric with deeper discussion: Case study, small group
discussions, DOAP and workshops.

24. Challenges
• Novice faculty/poor acceptance for CBME
• Duration of second professional reduced by 6 months
• Increased administrative requirements
• Need for faculty development
• Lack of models for flexible curriculum
• Inconsistencies in terms and definitions
• Lack of good assessments for some competencies
• Absence of a vision and a plan to bring about the reforms in curricular
delivery

25. • Infrastructure, learning resources and financial support
• Reluctant teaching staff and resistance to change
• No guidelines from the regulatory body for the mandatory
implementation
• Poor coordination between the undergraduate and postgraduate
curriculum
• No comprehensive plan and periodicity to streamline student
assessment
• Lack of clarity about CBME among Postgraduates (no sensitization)

28. CONCLUSION

29. REFERENCES
• Shrivastava, Saurabh Rambiharilal, and Prateek Saurabh Shrivastava. “Qualitative study to identify
the perception and challenges faced by the faculty of community medicine in the implementation
of competency-based medical education for postgraduate students.” Family medicine and
community health vol. 7,1 e000043. 24 Jan. 2019, doi:10.1136/fmch-2018-000043
• Ramanathan R, Shanmugam J, Sridhar MG, Palanisamy K, Narayanan S. Exploring faculty
perspectives on competency-based medical education: A report from India. J Educ Health Promot.
2021;10:402. Published 2021 Oct 29. doi:10.4103/jehp.jehp_1264_20
• Shah N, Desai C, Jorwekar G, Badyal D, Singh T. Competency-based medical education: An
overview and application in pharmacology. Indian J Pharmacol. 2016;48(Suppl 1):S5-S9.
doi:10.4103/0253-7613.193312
• Hamza DM, Ross S, Oandasan I. Process and outcome evaluation of a CBME intervention guided
by program theory. J Eval Clin Pract. 2020;26(4):1096-1104. doi:10.1111/jep.13344

34. What should be done
• Curtailing the duration of foundation course
• Sensitization of all medical teachers through faculty development
programs
• Better synchronized vertical integration
• Increasing the strength of faculty in each department
• Adequate infrastructure for skills laboratory