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Harden's Blog > Harden's Blog - '2021'

September 2021 - Developments in Competency-Based Medical Education

In his latest blog Professor Harden discusses Developments in Competency-Based Medical Education, Remote working effectiveness, Exposure of residents to patients with COVID resulting in higher rates of burnout, and more.


Developments in Competency-Based Medical Education

I have argued that the move to competency-based medical education (CBME) has been the most significant development in medical education in the past two decades. Twelve articles in the July 2021 special issue of Medical Teacher, with Linda Snell and Jason Frank as guest editors, highlight key developments in relation to the implementation of Competency-Based Medical Education, including tips for learners engaged in a CBME programme.

Programmatic assessment is also on today’s agenda in medical education. An article in this special issue provides guidelines on implementing programmatic assessment in the CBME programme.

As noted by Frank et al. in an opening commentary, Hill Jason argued in 2007 "by making time a constant we make achievement a variable." The feature of CBME with standards fixed and time a variable has been the most difficult and controversial aspect to implement. As noted by Caretta-Weyer et al. many schools and programmes worldwide have managed to institute time-based progression to bolster the healthcare workforce and meet the unprecedented needs of society in confronting COVID-19. They argue, however, that regulatory bodies will need to work to align their certifying and licensing procedures with time-variable competency-based models to facilitate key transitions.

Remote working is less effective

Working at home became the new norm during the COVID-19 pandemic. Remote working, however, is less effective as confirmed by a study of Microsoft workers, in research carried out by the University of California and published in Nature Human Behaviour. Working from home was found to lead to worse communication and lower creativity among employees. Workers were also more likely to feel siloed and reluctant to communicate with other departments.

Remote learning, just like remote working, is also less effective. There is no doubt that during the COVID-19 pandemic online learning has had a valuable role to play and lessons were learned about how it could be managed effectively. There is a danger, however, that online learning will become what has been described as a "new norm" for education, replacing face-to-face teaching. In a feature in Times Higher Education (THE), 2nd September 2021 Brian Schmidt, Vice Chancellor of the Australian National University, argued that we will see universities making very poor long-term decisions in the heat of this short-term crisis. A future overreliance on online learning may be such a problem. Sir Anton Muscatelli, Vice Chancellor of the University of Glasgow, argues that the pandemic has made it clear that "active learning – which focuses on students interacting with their teachers and peers – must be even more central to education. Glasgow had begun prior to the pandemic to develop spaces on campus to encourage and enhance student interaction." The past 18 months, Muscatelli argues, have shown that active learning cannot be replaced by an online experience. Schmidt agrees, saying that undergraduate education at ANU will remain centred around on-campus learning.

Exposure of residents to patients with COVID results in burnout

A survey of 1420 trainees in the USA, China, Saudi Arabia, and Taiwan found that trainees who cared for a greater number of patients with COVID-19 were more likely to report burnout. Trainees were also concerned about the negative effects on training opportunities and professional development (Cravero, 2021).

Publishing controversial ideas

Just published is the first issue of the Journal of Controversial Ideas. The journal’s purpose is to provide a place for ideas that are finding it increasingly difficult to get an airing. The editors are happy to allow contributors to use pseudonyms if they wish. It is the anonymity that has provoked the most debate.

Previous AMEE Conferences have included a session where participants have the opportunity to present their points of view on what may be seen as a controversial subject. We hope to include this feature again at the AMEE 2022 Conference in Lyon.

Problems with assessment

Initial feedback from conference participants suggests that the AMEE 2021 Virtual Conference was successful. The rich programme was highly valued and the platform was found to be less technically challenging than the avatar programme at AMEE 2020. Some found the 15 hour day sessions challenging but recordings of different elements of the programme are available to be accessed at a convenient time. In the opening session I highlighted some of the many topics and issues addressed at the conference. These included:

Racism in medical education, The potential of IPE, Kinaesthetic learning, PG Trainees – Workforce or learners?, Stimulating motivation, Disentangling self-regulated learning, Micro-learning, Making game-based learning effective, Why Longitudinal Integrated Clerkships?, Measuring non-technical skills, Value of speed-mentoring, Need for process-orientation, Are today’s doctors dishonest?, Nurturing professional identity formation, Effectiveness of COVID-related changes, Understanding TBL, Bringing EPAs alive, Defining scholarship, Overcoming difficulties in international placements, Exploring uncertainty, Sequential testing, Influences on standard setting, Hybrid training programmes, Cultivating resilient learners, Can research improve medical education?, Education for sustainable healthcare, Why accreditation systems matter, Bringing about organisational change, Surgical underrepresentation in the curriculum, The muddy waters of CPD, Evaluation of the Flipped Classroom, Social accountability in practice, Using the ASPIRE Excellence Framework, Capitalising on e-Portfolios, Why curriculum transformation?, Identifying failure, Barriers facing female surgeons, Progress tests in athletic training, Promoting reflective practice, Research developments in CPD, Virtual Reality – A powerful tool, Open-book exams – A good alternative, Empathy, AV improves SJTs, Resident performance through the eyes of nurses, TED style micro-lectures.

The plenary session by Dylan William, a leading international authority on assessment, has been much acclaimed for his challenging views on the problems associated with assessment. His analysis of the problems and the action to be taken was much appreciated. The recording of the session is now available and is a valuable resource that should be viewed by everyone with an interest in health professions education.

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