Goals, Roles & Competencies:
CBME*
.
Learning Objectives
Define CBME
Differentiate between CBME & traditional
curriculum
Define goals , competencies and objectives and
explain the relationship with each other
Developing competencies for all domains
What is curriculum?
What is curriculum?
Curriculum
A series of planned activities and educational
experiences provided to a learner by an institution to
achieve an objective
Curriculum is a formal plan of educational experiences
and activities offered to a learner under the guidance
of an educational institute .
Curriculum Planning
Who are the planners?
MCI
University
Institution
Department
Curriculum Planning is NOT a job of
an individual
but
Joint Enterprise
of
educationists, psychologists, planners,
administrators, teachers, politicians and
Social thinkers
Curriculum has to be
Co- operative
Continuous
Comprehensive
Concrete
Steps involved in Traditional Curriculum
Planning
1) Problem Identification and General Needs Assessment
2) Needs assessment for targeted learners
3) Goals and objectives
4) Educational Strategies
5) Implementation
6) Evaluation and Feedback
Six step approach –curriculum
Miller’s – For Assessment
Goal
•Goal: A projected state of affairs that a person or system
plans to achieve
•Where do you want to go? or What do you want to
become?
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The Goal of Residency Training
“To develop professional competence to the
level of a physician ready to begin practice
in the speciality of Family Medicine.”
Objective
•Objective: Statement of what a learner should be able to do
at the end of a specific learning experience
•What the Indian Medical Graduate should know, do, or
behave? (Specific)
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Competency
Competency: The habitual and judicious use of
communication, knowledge, technical skills, clinical
reasoning, emotions, values, and reflection in daily practice
for the benefit of the individual and community being served
• What should you be able to do? or
• What should have changed in KSAC?
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Inter Relationship - Objectives, Competencies,
Role & Goal
17
Goal
Role
Competency
Objective Objective Objective Objective
“If you are not certain where you are going, you
may very well end up somewhere else. (and not
even know it!!!)”
- Mager
Planning of CBME
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Goal
Role
Competency
Objective Objective Objective Objective
Competency Based Medical Education
(CBME)
Task-oriented or ―Activity based’.
Community based medical education,
Competencies derived from an analysis of needs of society and patient
as per our future graduates concerned.
Spady (1994:8) states:’ what and whether students learn successfully is
more important than when and how they learn something....
It is a curricular concept designed to provide skills clinician need
rather than solely a large, prefabricated collection of knowledge.
Competency based medical education is of variable length but defined
outcomes.
Need for CBME
Time bound
traditional
model
Ration
Knowledge
al for Lack of
driven
CBME professionalism
Lack of
Communication
and
interpersonal
relationship
“The mind is not a vessel to be
filled but a fire to be kindled.”
(Plutarch)
ROLES of IMG
1. Clinician who understands and provides preventive, promotive,
curative, palliative and holistic care with compassion.
2. Leader and member of the health care team and system with
capabilities to collect analyze, synthesize and communicate health
data appropriately.
3. Communicator with patients, families, colleagues and community.
4. Lifelong learner committed to continuous improvement of skills
and knowledge.
5. Professional, who is committed to excellence, is ethical,
responsive and accountable to patients, community and
profession.
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I - Effective Communication
II - Basic Clinical Skills
III - Using Science to Guide Diagnosis,
Management, Therapeutics, and Prevention
IV - Lifelong Learning
V - Self-Awareness, Self-Care, and Personal Growth
VI - The Social and Community Contexts of Health
Care
Advantages
Competency-based education is results-driven
Can respond to the needs of society
Learner focused
Works naturally with independent study
Instructor in the role of facilitator
Skip learning modules entirely
Advantages
Criteria based
Time flexibility
Takes care of individual variability amongst students and
reduce the achievement gaps
Produce competent professionals
Limitations
Time required is more
Facilitators required are more
Frequent assessments are required
Facilitators must be competent
More effort on the part of facilitators is required
Highly individualized so difficult to implement
Variable Traditional education Competency Based
Driving force of curricula Content Outcome
Goal of education Knowledge acquisition Knowledge application.
encounter
Central theme What do learners need to What abilities are needed of
know or How shall we teach graduates
our learners
Type of assessment tool Single subjective measure Multiple objective measure
Setting Remote Direct observation
Focus of assessment Non referenced Criterion referenced
Assessment Emphasis on summative Formative
Program completion Fixed time Variable time
Steps in planning CBME curricula
1. Agreement on Competencies
2. Gap analysis-Current to Desired
3. Defining educational objectives, instructional and assessment
methods.
4. Define milestones along a developmental path for the competent.
5. Assessment of Milestones achieved.
6. Analysis of the outcome and accordingly updating the
competencies
Competency
Core - A competency that is necessary in order to
complete the requirements of the subject (traditional
must know)
Non core - A competency that is optional in order to
complete the requirements of the subject. (traditional
nice know/ desirable to know)
Competence
Doing the right thing at the right time in
the right way in complex situations
Observable Competencies
• “An observable ability of a health
professional, integrating multiple
components such as knowledge,
skills, values and attitudes.
• Since competencies are
observable, they can be measured
and assessed to ensure their
acquisition.”
Driving a Car
Gear, Clutch,
Accelerator, Steering
Traffic rules
Driving Judgment
Enough practice
student should be
able to drive a car
independently Fix the tyre in case of
puncture
Domains of Competency
K Knowledge
S Skill
A Attitude
C Communication
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Learning Domains
Bloom, B (1956) Taxonomy of Educational Objectives
Depiction of Competency design-
The competency design and charting can be done as
follows-
Domain Core
Sr no Competency Highest Level
K/S/A/C Y/N
Domain : K – Knowledge S – Skills A – Attitude C – Communication
Highest level (in the miller’s pyramid) K – knows KH – Knows how
Shows how P – Performs independently (EPA)
Core – is this part of the core curriculum (yes or No)
Exit Competency : A medical graduate should be able to perform CPR on a
roadside accident victim independently.
Level wise or subject wise Competency for a I MBBS student.
Knowledge: a student must have knowledge of anatomy and physiology of
RS and CVS in relation to CPR.
He must be able to list indications and contraindications of CPR.
Skills : a student of I MBBS must be able to demonstrate all steps of CPR on
a mannequin independently.
And this competency must be assessed before he is promoted to II MBBS.
Name of Topic: SHOCK Number of competencies: ( 3 )
Number of procedures that require certification :
Prerequisite knowledge for topic from previous phases: Physiology of circulation.
Competency Domain Highest Core
K/S/A Level Yes / No
K/KH/SH/P
Describe Patho physiology of shock. K KH Y
Types of shock. Principles of resuscitation including fluid
replacement and monitoring.
Describe the clinical features of shock and its appropriate K KH Y
treatment.
Perform Cardiopulmonary Resuscitation in simulated S SH Y
environment
DREAM is not what u see in your sleep,
DREAM is the thing that does not allow you to
sleep.
Dr APJ Abdul Kalam
References-
1. Danielle Saucier, Elizabeth Shaw, Jonathan Kerr. Competency based curriculum
for family medicine. Canadian Family Physician June 2012 vol. 58 no. 6 707-
708
2. Competency based training in medical education. Australian Medical
Association. 2010
3. WaiChing Leung. Competency based medical training: review. BMJ. Sep 28,
2002; 325(7366): 693–696.
4. Carol Carraccio, Susan D. Wolfsthal, Robert Englander, Kevin Ferentz, and
Christine Martin. Shifting Paradigms: From Flexner to Competencies. Acad.
Med. 2002;77:361–367.
5. William McGaghie et al. competency based curriculum development in medical
education. WHO
6. Frank et al. Competency based medical education: theory to practice. Medical teacher.
2010;32:638-645.
7. The competency or outcomes based curriculum model. Recipe for Success. Maureen
Sroczynski
8. Kiguli Malwadde et al. Competency based medical education in two Sub-Saharan African
medical schools. AMEP;2014(5):483-489.
9. Harden RM, Crosby JR, Davies MH, Freidman M. AMEE Guide No. 14: Outcome-based
education: Part 5-From competency to meta-competency: a model for the specification of
learning outcomes. Medical Teacher. 1999; 21( 6):546-552.
10. Wouter Kerdijk, Jos W Snoek, Elisabeth A van Hell and Janke CohenSchotanus. The
effect of implementing undergraduate competency based medical education on students’
knowledge acquisition, clinical performance and perceived preparedness for practice: a
comparative study. BMC Medical Education 2013, 13:76
Principle of Education
48
When you are clear what you have to achieve at the
end of the learning period, your performance
improves
