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Physician competencies have increasingly been a focus of medical education at all levels. This article gives a brief overview of how a competency-based curriculum differs from other approaches and then describes the issues that need to be considered in the design and implementation of such a curriculum. In order to achieve success, a competency-based curriculum requires careful planning, preparation and a long-term commitment from everyone involved in the educational process. Building a competency-based curriculum is really about maintaining quality control and relinquishing control to those who care the most about medical education, our students. In the face of the many challenges that are facing undergraduate medical education UME , including declining availability of teaching patients and over-burdened faculty, instituting quality control and relinquishing control will be necessary to maintain high quality. This is a preview of subscription content, log in via an institution to check access. Rent this article via DeepDyve. Institutional subscriptions. Accessed November 29, Albanese, M. Defining characteristics of educational competencies. Medical Education, 42 , — Article Google Scholar. Brown, T. A competency-based educational approach to reproductive biology. American Journal of Obstetrics and Gynecology, , — Google Scholar. Buckendahl, C. A comparison of Angoff and bookmark standard setting methods. Journal of Educational Measurements, 39 3 , — Burg, F. A method for defining competency in pediatrics. Journal of Medical Education, 51 , — Cooke, M. American medical education years after the Flexner report. The New England Journal of Medicine, , — Engel, G. Are medical schools neglecting clinical skills? JAMA, , — Hansen, W. Expected proficiencies for undergraduate economics majors. The Journal of Economic Education, 32 , — Horowitz, S. Board certification and physician quality. Medical Education, 38 1 , — Howsam, R. Change and challenge. Howsam Eds. Chicago: Science Research Associates. Jaeger, R. Minimum competency achievement testing: Motives, models, measures, and consequences. Livingston, S. Passing scores. May, B. Evaluation in a competency-based educational system. Physical Therapy, 57 , 28— McGaghie, W. Competency-based curriculum development in medical education: An introduction. Geneva: World Health Organization. Merenstein, J. A residency curriculum for the future. Family Medicine, 22 , — Nedelsky, L. Absolute grading standards for objective tests. Educational and Psychological Measurement, 14 , 3— Quinlan, T. The Rockford experience: Competency-based medical curriculum. American Journal of Pharmaceutical Education, 39 4 , — Seegel, D. Smith, S. AMEE guide No. Medical Teacher, 21 1 , 15— Talbot, M. Monkey see, monkey do: A critique of the competence model in graduate medical education. Medical Education, 38 , — Weinstein, H. Competency-based psychiatric education. American Journal of Psychiatry, , — Download references. This article is based upon a presentation the first author gave as the Jack L. The authors wish to thank the selection committee for providing the impetus for the genesis of this article. You can also search for this author in PubMed Google Scholar. Correspondence to Mark A. The Indiana University School of Medicine IUSM experience provides an example of faculty buy-in and faculty development being critical to the success of a competency-based curriculum. After adoption, there was substantial resistance from faculty who taught all four UME years. Thus buy-in was essential. These workshops emphasized that people normally evaluate each other on the basis of their interpersonal and communications skills as well as professionalism in their daily lives. Thus evaluating medical students on these competencies was a natural extension of this normal process. An important part of the workshop was to have basic science faculty reflect on past classes to remember the student s whom they felt lacked the interpersonal skills to become a competent physician yet had the knowledge base required to pass discipline and USMLE exams. Discussion centered on contrasting how this type of student would have been dealt with in a competency based curriculum. Next, faculty were asked whether they would prefer to be treated or have a family member treated by a physician who was judged competent in nine competency areas versus one not competent in one or more of these nine competencies. This further reinforced the general usefulness of the competency-based curriculum in the basic science years. The next part of the workshop was designed to assure basic science faculty that they could teach and assess competencies, emphasizing that each basic science course need not address all competencies, but should do several of them. The assessment form to be used in all courses contained multiple descriptors emphasizing behaviors and attitudes that were assessed on a three-point scale: 1 below attainment, 2 average attainment, and 3 exemplary attainment. It was pointed out that the goal was to identify outliers, and that these outliers would be remediated before being allowed to progress to the clinical years. Emphasis was placed on multiple observations of each competency, not a single assessment. Several examples were given of exercises in basic science that could be used to teach and assess particular competencies, and faculty were urged to come up with other examples in their courses. Workshops for faculty in years 3 and 4 followed the same general structure but emphasized that many of the competencies were best taught and assessed in the clinical years of UME. Each clerkship was originally asked to embrace only one competency to minimize the impact on overburdened clinical faculty. Over the years, many of the clerkships have adopted multiple competencies as part of their program. This has especially been true for student remediation upon non-attainment of competencies. Reprints and permissions. Building a competency-based curriculum: the agony and the ecstasy. Adv in Health Sci Educ 15 , — Download citation. Received : 02 January Accepted : 09 April Published : 15 May Issue Date : August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Home Advances in Health Sciences Education Article Building a competency-based curriculum: the agony and the ecstasy Reflections Published: 15 May Volume 15 , pages —, Cite this article. Abstract Physician competencies have increasingly been a focus of medical education at all levels. Access this article Log in via an institution. Competency-based medical education for the clinician-educator: the coming of Milestones version 2 Article 13 February Article Google Scholar Brown, T. Google Scholar Buckendahl, C. Article Google Scholar Burg, F. Google Scholar Cooke, M. Article Google Scholar Engel, G. Article Google Scholar Hansen, W. Google Scholar Horowitz, S. Article Google Scholar Howsam, R. Google Scholar Jaeger, R. Google Scholar Livingston, S. Google Scholar May, B. Google Scholar McGaghie, W. Google Scholar Merenstein, J. Google Scholar Nedelsky, L. Article Google Scholar Quinlan, T. Google Scholar Seegel, D. Google Scholar Smith, S. Article Google Scholar Talbot, M. Article Google Scholar Weinstein, H. Google Scholar Download references. Acknowledgements This article is based upon a presentation the first author gave as the Jack L. Albanese View author publications. View author publications. Rights and permissions Reprints and permissions. About this article Cite this article Albanese, M. Copy to clipboard. 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