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What is Competency-Based Medical Education?
Competency-based medical education (CBME) focuses on the development of actionable abilities and skills required for clinical medical practice, not just the acquisition of knowledge. This concept, initially developed in the late 1970s,1 arose from a call for greater accountability of health profession graduates to the public.2 Patients and their families deserve to know that graduates are actually qualified to do the job; that they have not only answered the multiple choice test questions correctly, but that they have demonstrated the ability to apply their knowledge in the practical, tangible ways required for clinical practice.
The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) specifies that a program’s curriculum must align with the program’s competencies (B1.01b).3 They also require a summative evaluation be given within 4 months of program completion to demonstrate that each student meets those program competencies (B4.03).3 As such the curriculum must support the competencies to be in compliance with ARC-PA requirements, prepare students to successfully pass the summative exam and be eligible for graduation, and be equipped to enter clinical practice. Physician Assistant (PA) programs can help ensure they are providing students with the knowledge and skills to meet the competency expectations upon graduation by aligning the curriculum to the competencies.
References:
1. Holmboe E. The transformational path ahead: competency-based medical education in family medicine. Fam Med. 2021;53(7):583-589. doi:10.22454/FamMed.2021.296914
3. Standards-5th-Ed-March-2023.pdf. Accessed July 9, 2023. https://www.arc-pa.org/wp-content/uploads/2023/04/Standards-5th-Ed-March-2023.pdf
What are our Competencies?
Our program has 18 competencies reflective of the abilities and skills we believe graduates require to function as a physician assistant. Each competency is matched back to one or more of 6 overarching domains. This information is posted on our program’s website.
All courses, didactic and clinical, have been mapped to the competencies that they fulfill and assess. That information is included in each course syllabus. Ultimately the summative exam provides a final assessment of all 18 competencies through various stations and modalities.
Domains
Medical Knowledge (MK)- possess the knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as apply this knowledge to patient care
Patient Care and Procedural Skills (PC/PS)- provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
Practice-based Learning and Improvement (PBLI)- investigate and evaluate the care of patients, appraise, and assimilate scientific evidence, and continuously improve patient care based on constant self-evaluation and life-long learning
Systems-based Practice (SBP)- an awareness of and responsiveness to the larger context and system of health care and the ability to call on system resources effectively to provide care that is of optimal value
Interpersonal and Communicatin Skills (ICS)- effective exchange of information and collaboration with patients, their families, and health professionals
Professionalism (P)- a commitment to carrying out professional responsibilities and an adherence to ethical principles
Competencies (Program Learning Outcomes)
1) Integrate and apply knowledge of pathophysiologic principles of injury and disease and how it alters the anatomical structure and physiologic functioning of the human body recognizing associations of disease conditions and complications through application of scientific concepts. (MK, PC/PS)
2) Elicit and interpret medical history (chief complaint, history of present illness, past medical history, social history, surgical history, allergies, family history, prior diagnostic workup and interventions, risk factors, and review of systems) that is relevant and accurate. (MK, ICS, PC/PS, P)
3) Recognize and interpret patient information across the lifespan and appropriate to the health care setting while demonstrating responsive, empathetic, and active listening that establishes rapport with patients and caregivers. Accurately recognize and respond to non-verbal forms of communication during interactions. (MK, ICS, PC/PS, P)
4) Identify and interpret the signs of disease through visual, auditory, tactile, and/or olfactory means as manifested throughout the head to toe physical examination of the patient. (MK, PC/PS)
5) Select appropriate clinical laboratory tests and interpret normal and abnormal results related to patient management (MK, PC/PS, PBLI)
6) Select appropriate diagnostic imaging tests and interpret normal and abnormal results related to patient management. (MK, PC/PS, PBLI)
7) Analyze patient information/data requiring clinical reasoning and problem solving skills to develop a differential diagnosis and problem list. (MK, PC/PS, PBLI)
8) Determine appropriate and responsible therapeutic management plans for common medical conditions utilizing pharmacologic, non-pharmacologic, surgical, preventive, and rehabilitative modalities with consideration of informed consent and ethical practice. (MK, PC/PS, PBLI, SBP)
9) Document and present patient data, including interpretive recommendations and therapeutic plans, in a manner meaningful to the healthcare team. (PC/PS, PBLI, SBP, ICS, P)
10) Communicate information (oral and/or written) in a succinct yet comprehensive manner to patients, caregivers and other members of the health care team while ensuring appropriate confidentiality. (PC/PS, SBP, ICS, P)
11) Perform physical examinations, diagnostic and clinical procedures meeting accepted standards of care while optimizing the safety of themselves and others including the use of universal precautions and sterile technique. (MK, PC/PS, ICS, P)
12) Determine appropriate counseling for patients regarding physical and mental health, including nutrition, exercise, disease management and prevention, normal growth and development, reproductive health, compliance, and adherence. (MK, ICS, P)
13) Assess the severity of, and respond to, common potentially life-threatening emergencies. (MK, PC/PS, SBP)
14) Appropriately refer patients to meet the needs of diverse patients and families considering social, emotional, spiritual, cultural, economic, and/or environmental factors. (PC/PS, ICS, SBP)
15) Function as a responsible member of the interprofessional healthcare team who identifies within their scope of practice the limits of their own ability, requests assistance when necessary, and maintains socially acceptable, respectful, and professional relationships with patients, caregivers and other members of the team. (ICS, P)
16) Accept and respond to constructive criticism and resolve conflicts in a socially acceptable and professional manner while providing care with honesty and integrity. (ICS, P)
17) Critically evaluate and utilize evidence-based protocols and clinical algorithms in providing patient care. (MK, SBP, PBLI)
18) Navigate the health care system to advocate for optimal patient care and safety while limiting risk. (PC/PS, SBP, P)
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