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Wendy is a second year internal medicine resident currently struggling to feel “competent” as an outpatient primary care provider. Over the course of her internship year, her competence and confidence with inpatient care grew. However, her outpatient clinics were infrequent in comparison, and she feels like she hasn’t learned to be a “good primary care doctor.” She shares her frustrations with her mentor—in part fueled by the breadth of skills required, the lack of benchmarks to measure her progress, and the lack of validated assessment tools. Her mentor attempts to help Wendy develop an individualized learning plan with formative assessments.
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Medical education has recently undergone a transformation from process-oriented measures of success to more outcomes-oriented assessments that gauge what a learner can actually do and not only to what they have been exposed. Although the notion of competencies is not new, more recent conceptualizations move far beyond simple listings of skills and include multidimensional, dynamic, contextual, and developmental elements. This movement has been particularly transformative in the realm of graduate medical education (GME) with the advent of the Accreditation Council for Graduate Medical Education (ACGME) competencies and has become increasingly common as medical schools begin to embrace competency-based medical education (CBME) and translate the GME competencies for medical students “further upstream.” Learning objectives and related competencies are now more frequently articulated and tend to be more commonly linked to specific assessment tools that measure achievement of that specific competency. However, the practice of medicine is inherently complex and often requires subtle, nuanced skills that are both difficult to teach and challenging to quantify. In particular, competencies that fall within the realm of the Behavioral and Social Sciences (BSS) have proven particularly difficult to articulate, teach, and assess.
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This chapter will first provide a brief overview of CBME that articulates common advantages and limitations of this approach. We then offer a summary of BSS curricular thinking within medical education, including the work of the Association of American Medical Colleges (AAMC) BSS Expert Panel, the BSS Curriculum Consortium (funded by National Institutes of Health [NIH]), and the behavioral science subcommittee of the MCAT 5th Revision (MR5) Committee. This chapter presents a careful melding of the concepts and processes of CBME with the content of BSS by offering a synthesis of the innovative work emerging on both undergraduate medical education (UME) and GME levels. Specific assessment methods and evaluation tools for BSS competencies are described in Chapter 45.
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PEDAGOGICAL BUILDING BLOCKS FOR CBME
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The International Competency-based Medical Education (ICBME) consortium defined CBME as “an outcomes-based approach to the design, implementation, assessment and evaluation of an education program using an organizing framework of competencies.” CBME is intended to focus on outcomes, emphasize abilities, de-emphasize time-based training, and promote greater learner-centeredness. Epstein defines professional competence as “the habitual and ...