37 slide presentation involving learning objectives, introduction, components of CBME, teaching-learning-assessment-challenges in CBME, MCI UG curriculum and its future implicability

1. COMPETENCY BASED
MEDICAL EDUCATION
Presented by:- Dr. PRADEEP KUMAR DEWANGAN
( PG Scholar)

2. The illiterates of the twenty first century
will not be those who can not read and
write but rather those who can not
learn, unlearn….. . and relearn.
Alvin Toffler

3. CONTENTS
1. Learning objectives
2. Introduction
3. CBME and its rationale
4. Its Components
5. Teaching learning method in CBME
6. Assessment of CBME
7. Implementation & Challenges of CBME
8. Competencies in UG curriculum
9. SWOT analysis and Future of CBME

4. LEARNING OBJECTIVES
At the end of presentation you will be able to
understand
Difference between conventional and competency
based learning.
Components of competency based medical
education.
Different models of competencies.
Expected competencies of Medical council of India.
Pros and cons of CBME.

5. INTRODUCTION
Competency based medical education(CBME) is an
outcomes-based approach to the design, implementation
and evaluation of a medical education program using an
organizing framework of competencies.(2) where
competency is defined as “the ability to do something
successfully and efficiently,”

6. INTRODUCTION…….
It is an approach to ensure the development of
competencies required to fulfill the patient’s needs in the
society.
Discourages time based training.
Promises greater accountability, flexibility, and learner-
centeredness.
It continues till the desired competency is achieved.
Assessments would be frequent and formative in nature,
and feedback would be inbuilt in the process of training.

7. Traditional Vs Competency based Medical Education
S.N Traditional Medical Education Competency Based Medical
Education
1 Subject centered Learner centered
2 Emphasizes Time based learning De-emphasizes Time based learning
3 Summative assessment Formative assessment
4 Little opportunity for feedback Feedback is process of training
5 Teaching – learning focuses on
knowledge
Teaching – learning focuses on attitude
and skill
6 Assesses via written and viva-
voce
Assesses for defined desired
competency

9. THE COMPONENTS OF CBME
Three components of competency based medical
educations are :
1) Competency
2) Entrustable Professional Activity
3) Milestones

10. COMPETENCCY
 Is the ability of health professional.
 Is application of competencies in real setting.
 Encompasses knowledge, skills, values and attitude.
 It is predetermined in the curriculum.
 Are contextual to the environment in which one
eventually will work

11. Competency
Patient
Care
Medical
Knowledge
Practice
based
learning
Communi-
cation
Skill
Professio-
nalism
System
Based
Practice
Accreditation council of Graduate Medical Education USA

12. Competency
Scholar
ResearcherPractitioner
For Medical Graduate in UK

13. Competencies expected of an Indian Medical Graduate
MCI
Competency
Clinician
Leader &
Member
Commu
-nicator
Life
long
Learner
Professio-
nalism

15. The Medical Council of India has also suggested Competencies for Indian
Medical Graduate
SN Competency Description
1. Clinician Who understands and provides preventive,
promotive, curative , palliative & holistic care with
2. Leader & member
of the health-
system
With capabilities to collect analyze, synthesize and
communicate health data appropriately
3. Communicator With patients, families, colleagues and community
4. Life long learner Committed to continuous improvement of skills
and knowledge
5. Professional Excellence is ethical, responsive, accountable to
patients, community and profession

16. ENTRUSTABLE PROFESSIONAL ACTIVITY
 Are the descriptors of work that defines a profession.
 EPA bridges the gap between theory and practice of
CBME.
 Process and outcome are observable and measurable.
 It requires multiple competencies in integrative and
holistic manner.
 Requires definite set of knowledge, skill and attitude

17. ENTRUSTABLE PROFESSIONAL ACTIVITY
While looking after a disease one should competent of
Knowledge: Clinical presentation, required investigation
and treatment protocol.
Skill: Clinical interviewing, general and systemic
examination and interpretation of
investigation.
Attitude: Communication with empathy, inviting
questions and offering appropriate guidance
and advice

18. MILESTONES
Milestones are the step-by-step achievement of competencies.
Famous Dreyfus model is paradigm for milestones, it has five
levels.
1) Novice
2) Advanced beginner
3) Competent
4) Proficient
5) Expert

19. MILESTONES
Novice Advanced
beginner
Competent Proficient Expert

20. MILESTONES
oLevel 1:- Students only observe the EPA.
oLevel 2:- Student performs the EPA with direct,
proactive supervision.
oLevel 3:- Student performs the EPA with indirect
supervision.
oLevel 4:- Students is ready for independent,
unsupervised practice and is given the
“statement of awarded responsibility.
oLevel 5:- When the student is ready to assist other
learners in performing EPA

21. TEACHING-LEARNING METHODS IN CBME
CBME is learner-centered, offers flexibility in time and focuses
on cognitive, psychomotor and affective learning domains.
It should be more skill based, involving more clinical, hands-on
experience.
“Being a life-long learner” is one of the competency expected of
an IMG by the MCI.
The teacher’s role would be to facilitate the student’s progress,
to provide ample opportunities for self directed learning and to
make them incorporate them inbuilt behavior of feedback

22. NEWER TEACHING TECHNIQUE
Problem based learning
Case based learning
Community based research
Information communication technology
Flipped classroom
Team based learning

23. PBL CBL
Methods Open Inquiry Guided Inquiry
Pre-reading Material Not provided Provided
Role of Facilitator Passive
Don't guide question
Active
Uses guided question
Interaction with faculty More Less
Skill learned Problem solving Clinical
Conclusion May be false correct
Post session work More Less
Self directed learning and
listening skill
More Less
Difference between Problem based learning/Case based learning

24. Team Based Learning
Phase
1
• Pre-class study
Phase
2
• Individual readiness assurance test (iRAT)
• Team readiness assurance Test(tRAT)
• Team appeals and feedback
Phase
3
• Team application exercises(in classes and online)

25. ASSESSMENT OF CBME
The international collaborators of CBME have enlisted six key
features of effective assessment, these are :-
1) Continuous and frequent formative assessment.
2) It must be criterion based.
3) Work-based assessment needs to be done.
4) Assessment tools meet minimum standard of quality.
5) More qualitative approach in the form of judgments and
feedback.
6) There should be active involvement of Trainees

26. IMPLEMENTATION OF CBME IN THE INSTITUTES
Broadly three steps of curriculum planning and
strategies in Indian context.
 Identification of competencies and contents.
 Program organization and assessment planning.
 Program evaluation.
 Curriculum map as a tool can be used to ensure that
the competencies, the teaching-learning methods and
assessment methods are constructively aligned

27. CHALLENGES IN THE IMPLEMENTATION OF
CBME
1) Sensitization and training of stakeholders and faculties.
2) Uniform implementation throughout Indian Medical
Schools.
3) Comprehending what competency, EPA and milestones ?
4) Bringing about the paradigm shift is difficult task.
5) Procuring additional resources man, money and material.
6) Keeping equal pace in all learner is difficult.
7) Achieving a competent graduate is another challenge.
8) Reluctance and apprehension in learner and teacher as well
as administrator.

28. TOPICS AND OUTCOME IN PRE AND PARA-
CLINICAL SUBJET
S.N. Subjects Topic/
Outcome
1 Medicine 26/506
2 Anatomy 82/409
3 Pediatrics 35/406
4 Pathology 36/182
5 FMT 14/162
6 Surgery 30/155
7 Physiology 11/137

29. TOPICS AND OUTCOME IN PRE AND PARA-
CLINICAL SUBJET
S.N. Subjects Topic/Outcome
8 Obstetrics and Gynecology 38/126
9 Psychiatry 19/117
10 Community Medicine 20/107
11 Biochemistry 11/89
12 Pharmacology 05/85
13 ENT 04/76
14 Skin 18/73
15 Ophthalmology 09/60

30. TOPICS AND OUTCOME IN PRE AND PARA-
CLINICAL SUBJET
S.N. Subjects Topic/Outcome
16 Microbiology 08/54
17 Respiratory Medicine 02/47
18 Anesthesiology 10/46
19 Physical Medicine & Rehabilitation 9/43
20 Orthopedics 14/39
21 Dentistry 05/23
22 Radio diagnosis 01/13
23 Radiotherapy 05/16

31. TOPICS AND OUTCOME IN COMMUNITY
MEDICINE
S.N. Topics No. of Competency
1 Concept of health & diseases 10
2 Epidemiology 09
3 Reproductive maternal and child health 09
4 Environmental Health Problems 08
5 Nutrition 08
6 Epidemiology of communicable and non-
communicable diseases
07
7 Demography and vital statistics 07

32. TOPICS AND OUTCOME IN COMMUNITY
MEDICINE
S.N. Topics No. of Competency
8 Occupational Health 05
9 Health Care of Community 05
10 Occupational Health 05
11 Geriatric services 04
12 Disaster Management 04
13 Basic Statistics and its application 04
14 Health planning and Management 04

33. TOPICS AND OUTCOME IN COMMUNITY
MEDICINE
S.N. Topics No. of Competency
15 Recent advances in Community Medicine 04
16 Hospital waste management 03
17 Mental Health 03
18 Essential Medicine 03
19 Principles of health promotion & Education 03
20 International Health 02
Community Medicine 107

34. SWOT ANALYSIS OF COMPETENCY BASED
MEDICAL EDUCATION
STRENGTH
1)Learns as a art of Medicine
2)Capable in communication & ethics
3)Promises greater accountability
4)Learn Real life situation skills
5)Focuses on outcomes
WEAKNESS
1)Should not be considered as panacea
2)Lacking time bound/teacher driven
3)May produce chaotic situation
4)Slow learner may encounter anxiety
5)Not suited for higher level skills
OPPORTUNITIES
1)Expected to produce competent Drs.
2)Excellent Indian medical graduates
3)Uniqueness in professional practices
4)To prove better than conventional
5)Refreshment for faculty & admin
THREATS
1)Difficult for teachers & trainers
2)Uncritical and unworthy adoption
3)Additional resources required
4)Big ? Mark in defining competency
5)May loss the essence of tradition

35. THE FUTURE OF COMPETENCY BASED MEDICAL
EDUCATION
MCI Vision 2015 document is intending to gently
move towards competency based curriculum.
Hybrid approach has been suggested by MCI
wherein CBME should be inbuilt in the tenets of the
conventional curriculum in its initial phase followed
by gradual replacement so that expected benefits can
be measured and analyzed.
Principles of CBME if implemented as per regional
context and circumstances we may reap the fruits.

36. COMPETENCY BASED LEARNING:
ITS NOT ABOUT TIME, ITS ABOUT OUTCOME
Thank-you

37. REFERENCES
1. Competency-based medical education: An overview and application in
pharmacologyNilima Shah, Chetna Desai,1 Gokul Jorwekar,2 Dinesh
Badyal,3 and Tejinder Singh42
2. The International CBME Collaborators Frank et al. Med Teach, 2010
3. Competency based undergraduate curriculum for the indian medical graduate
2018
4.International Journal of Community Medicine and Public Health Shunmugam J et
al. Int J Community Med Public Health. 2016 Jan;3(1):99-103
http://www.ijcmph.com