Toward a Glossary of Competency-Based Medical Education Terms

摘要

Competency-based medical education (CBME) is now the standard for physician education, highlighted by the implementation of competency-based Milestones1 at the graduate medical education level for all specialties by July 1, 2014. However, transitioning to CBME has been both difficult and bewildering, particularly as a student seeking assurance that my medical school education is preparing me to succeed in a competency-focused residency program. Even understanding CBME literature is difficult for a newcomer to the education field. Terms, such as competence and competency-based medical education are frequently used, but lack consistent definitions.2,3 What is really meant when my attending tells me I am competent or even, dyscompetent or starts talking about Milestones? Scholars also recognize this problem—individual authors and collaborators have worked to review term usage and promote universal definitions.4–6 However, those definitions have not been widely adopted, as evidenced by the continued reframing of terms in subsequent articles. To address this issue, we first identified “key elements” of commonly used CBME terms and used those elements to create a succinct definition for each term.;Methods We used a 2-step approach: (1) we conducted a literature search for terms and associated definitions within CBME manuscripts, and (2) we identified frequently cited articles, key term elements, and associated definitions. Step 1: Survey and Search Strategy for CBME Terms A preliminary literature review on CBME using the terms competency and competency-based education yielded a set of repeatedly used terms. Those terms were used to frame our formal literature search. The period searched for each term depended on the presence of review articles containing compiled definitions from the preceding literature: competency and competency-based medical education4,5 were searched starting from January 1, 2010, with the search frame ending for all terms on December 31, 2012. Each term was searched individually (table?1) in the following databases: CINAHL with Full Text, MEDLINE, Health Source: Nursing/Academic Edition, Academic Search Premier, Education Research Complete, Educational Administration Abstracts, ERIC, and MasterFILE Premier.3,4 Use of Boolean phrases narrowed the search to the field of medical education. Four article inclusion criteria were selected to create a feasible review strategy given the explosion of literature in CBME: (1) published in a peer-reviewed, English-language journal; (2) retrievable without cost (eg, medical college library, interlibrary access); (3) set in the continuum of medical education (undergraduate, graduate, or continuing); and (4) included the definition of the term under consideration (whether original or citing another source). Relevant articles from the literature on nursing and physician assistant education retrieved during the literature search were also included. View larger version (21K) TABLE 1Competency-Based Medical Education (CBME) Search Terms Presented by Number of Articles Meeting Inclusion Criteria and Unique Definitions;Results Eight CBME terms consistently appeared in the literature: competency, competency-based medical education, dyscompetence, enabling competency, entrustable professional activities, facet of competency, meta-competency, and Milestone (table?1). Although multiple articles were retrieved for each term, only a few contained definitions (inclusion criteria No.?4). Four terms had definitions that drew on previous literature: competency-based medical education, entrustable professional activities, meta-competency, and Milestone. For example, the search for the term Milestone returned 32 articles without duplication, 5 of which fit the inclusion criteria (eg, had definitions). Although 3 of those 5 articles (60%) drew on a single reference7 to define Milestone, more typically authors defined terms without reference to previous work. We identified 7 frequently cited arti