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Review article: Biomedical intelligence

Vol. 150 No. 1516 (2020)

Nationwide introduction of a new competency framework for undergraduate medical curricula: a collaborative approach

DOI
https://doi.org/10.57187/smw.2020.20201
Cite this as:
Swiss Med Wkly. 2020;150:w20201
Published
15.04.2020

Abstract

Switzerland recently introduced PROFILES, a revised version of its national outcomes reference framework for the undergraduate medical curriculum. PROFILES is based on a set of competencies adapted from the CanMEDS framework and nine entrustable professional activities (EPAs) that students have to be able to perform autonomously in the context of a predefined list of clinical situations. The nationwide implementation of such a competency- and EPA-based approach to medical education is a complex process that represents an important change to the organisation of undergraduate training in the various medical schools. At the same time, the concepts underlying PROFILES also have to be reflected at the level of the Federal Licencing Examination (FLE) and the national accreditation process.

The vice-deans for education mandated a Swiss Working Group for PROFILES Implementation (SWGPI) to elaborate a guide presenting the principles and best practices based on the current scientific literature, to ensure the coherence between the future developments of the medical curricula and the evolution of the FLE, and to propose a coordinated research agenda to evaluate the implementation process.

On the basis of the literature and analysis of our national context, we determined the key elements important for a successful implementation. They can be grouped into several areas including curricular design and governance, the assessment system and entrustment process, faculty development and change management. We also identified two dimensions that will be of particular importance to create synergies and facilitate exchange between the medical schools: a systematic approach to curriculum mapping and the longitudinal integration of an e-portfolio to support the student learning process.

The nationwide collaborative approach to define strategies and conditions for the implementation of a new reference framework has allowed to develop a shared understanding of the implications of PROFILES, to promote the establishment of Swiss mapping and e-portfolio communities, and to establish the conditions necessary for ensuring the continuous alignment of the FLE with the evolving medical curricula.

References

  1. Carraccio CL, Englander R. From Flexner to competencies: reflections on a decade and the journey ahead. Acad Med. 2013;88(8):1067–73. doi:.https://doi.org/10.1097/ACM.0b013e318299396f DOI: https://doi.org/10.1097/ACM.0b013e318299396f
  2. Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach. 2010;32(8):631–7. doi:.https://doi.org/10.3109/0142159X.2010.500898 DOI: https://doi.org/10.3109/0142159X.2010.500898
  3. Royal College of Physicians and Surgeons of Canada [Internet]. CanMEDS Framework. [Cited 2019 June 30.] Available from: http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e
  4. Holmboe ES, Batalden P. Achieving the Desired Transformation: Thoughts on Next Steps for Outcomes-Based Medical Education. Acad Med. 2015;90(9):1215–23. doi:.https://doi.org/10.1097/ACM.0000000000000779 DOI: https://doi.org/10.1097/ACM.0000000000000779
  5. ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176–7. doi:.https://doi.org/10.1111/j.1365-2929.2005.02341.x DOI: https://doi.org/10.1111/j.1365-2929.2005.02341.x
  6. Holmboe ES. Competency-Based Medical Education and the Ghost of Kuhn: Reflections on the Messy and Meaningful Work of Transformation. Acad Med. 2018;93(3):350–3. doi:.https://doi.org/10.1097/ACM.0000000000001866 DOI: https://doi.org/10.1097/ACM.0000000000001866
  7. Carraccio C, Englander R, Van Melle E, Ten Cate O, Lockyer J, Chan MK, et al.; International Competency-Based Medical Education Collaborators. Advancing Competency-Based Medical Education: A Charter for Clinician-Educators. Acad Med. 2016;91(5):645–9. doi:.https://doi.org/10.1097/ACM.0000000000001048 DOI: https://doi.org/10.1097/ACM.0000000000001048
  8. Chen HC, van den Broek WE, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. Acad Med. 2015;90(4):431–6. doi:.https://doi.org/10.1097/ACM.0000000000000586 DOI: https://doi.org/10.1097/ACM.0000000000000586
  9. ten Cate O, Graafmans L, Posthumus I, Welink L, van Dijk M. The EPA-based Utrecht undergraduate clinical curriculum: Development and implementation. Med Teach. 2018;40(5):506–13. doi:.https://doi.org/10.1080/0142159X.2018.1435856 DOI: https://doi.org/10.1080/0142159X.2018.1435856
  10. Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, et al. Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency. Acad Med. 2016;91(10):1352–8. doi:.https://doi.org/10.1097/ACM.0000000000001204 DOI: https://doi.org/10.1097/ACM.0000000000001204
  11. https://afmc.ca/medical-education/entrustable-professional-activities-epas; accessed on 30.06.2019
  12. Lomis K, Amiel JM, Ryan MS, Esposito K, Green M, Stagnaro-Green A, et al.; AAMC Core EPAs for Entering Residency Pilot Team. Implementing an Entrustable Professional Activities Framework in Undergraduate Medical Education: Early Lessons From the AAMC Core Entrustable Professional Activities for Entering Residency Pilot. Acad Med. 2017;92(6):765–70. doi:.https://doi.org/10.1097/ACM.0000000000001543 DOI: https://doi.org/10.1097/ACM.0000000000001543
  13. Murray KE, Lane JL, Carraccio C, Glasgow T, Long M, West DC, et al.; Education in Pediatrics Across the Continuum (EPAC) Study Group. Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learners Are Ready for the Undergraduate-to-Graduate Transition. Acad Med. 2019;94(3):338–45. doi:.https://doi.org/10.1097/ACM.0000000000002535 DOI: https://doi.org/10.1097/ACM.0000000000002535
  14. Michaud PA, Jucker-Kupper P, The P ; The Profiles Working Group. The “Profiles” document: a modern revision of the objectives of undergraduate medical studies in Switzerland. Swiss Med Wkly. 2016;146:w14270. doi:.https://doi.org/10.4414/smw.2016.14270 DOI: https://doi.org/10.4414/smw.2016.14270
  15. Meyer EG, Chen HC, Uijtdehaage S, Durning SJ, Maggio LA. Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education. Acad Med. 2019;94(7):1040–9. doi:.https://doi.org/10.1097/ACM.0000000000002735 DOI: https://doi.org/10.1097/ACM.0000000000002735
  16. Casiro O, Regehr G. Enacting Pedagogy in Curricula: On the Vital Role of Governance in Medical Education. Acad Med. 2018;93(2):179–84. doi:.https://doi.org/10.1097/ACM.0000000000001774 DOI: https://doi.org/10.1097/ACM.0000000000001774
  17. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58. doi:.https://doi.org/10.1016/S0140-6736(10)61854-5 DOI: https://doi.org/10.1016/S0140-6736(10)61854-5
  18. Bordage G, Harris I. Making a difference in curriculum reform and decision-making processes. Med Educ. 2011;45(1):87–94. doi:.https://doi.org/10.1111/j.1365-2923.2010.03727.x DOI: https://doi.org/10.1111/j.1365-2923.2010.03727.x
  19. Swiss Working Group for PROFILES Implementation. An implementation guide for the Swiss medical schools. 2019 [cited 2019 November 28]. Available from: https://www.profilesmed.ch/sections/ressources
  20. Hays R. Integration in medical education: what do we mean? Educ Prim Care. 2013;24(3):151–2. doi:.https://doi.org/10.1080/14739879.2013.11494358 DOI: https://doi.org/10.1080/14739879.2013.11494358
  21. Merton RK. Some preliminaries to a sociology of medical education. In: Merton RK, Reader LG, Kendall PL, editors. The Student Physician: Introductory Studies in the Sociology of Medical Education. Cambridge, Mass: Harvard University Press; 1957: p. 3–79. DOI: https://doi.org/10.4159/harvard.9780674366831
  22. Stevens CD. Repeal and Replace? A Note of Caution for Medical School Curriculum Reformers. Acad Med. 2018;93(10):1425–7. doi:.https://doi.org/10.1097/ACM.0000000000002219 DOI: https://doi.org/10.1097/ACM.0000000000002219
  23. Harrison CJ, Könings KD, Dannefer EF, Schuwirth LW, Wass V, van der Vleuten CP. Factors influencing students’ receptivity to formative feedback emerging from different assessment cultures. Perspect Med Educ. 2016;5(5):276–84. doi:.https://doi.org/10.1007/s40037-016-0297-x DOI: https://doi.org/10.1007/s40037-016-0297-x
  24. van der Vleuten CP, Schuwirth LW, Driessen EW, Dijkstra J, Tigelaar D, Baartman LK, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34(3):205–14. doi:.https://doi.org/10.3109/0142159X.2012.652239 DOI: https://doi.org/10.3109/0142159X.2012.652239
  25. Frank JR, Mann K, Keely M. Portfolios and logbooks. In: Bandiera G, Sherbino J, Frank JR, editors. The CanMEDS assessment tools handbook. An introductory guide to assessment methods for the CanMEDS competencies. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2006: p. 32–5.
  26. Van Der Vleuten CPM, Schuwirth LWT, Driessen EW, Govaerts MJB, Heeneman S. Twelve Tips for programmatic assessment. Med Teach. 2015;37(7):641–6. doi:.https://doi.org/10.3109/0142159X.2014.973388 DOI: https://doi.org/10.3109/0142159X.2014.973388
  27. Mak-van der Vossen M. ‘Failure to fail’: the teacher’s dilemma revisited. Med Educ. 2019;53(2):108–10. DOI: https://doi.org/10.1111/medu.13772
  28. Yepes-Rios M, Dudek N, Duboyce R, Curtis J, Allard RJ, Varpio L. The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42. Med Teach. 2016;38(11):1092–9. doi:.https://doi.org/10.1080/0142159X.2016.1215414 DOI: https://doi.org/10.1080/0142159X.2016.1215414
  29. Dath D, Iobst W. The importance of faculty development in the transition to competency-based medical education. Med Teach. 2010;32(8):683–6. doi:.https://doi.org/10.3109/0142159X.2010.500710 DOI: https://doi.org/10.3109/0142159X.2010.500710
  30. Walsh A, Koppula S, Antao V, Bethune C, Cameron S, Cavett T, et al. Preparing teachers for competency-based medical education: Fundamental teaching activities. Med Teach. 2018;40(1):80–5. doi:.https://doi.org/10.1080/0142159X.2017.1394998 DOI: https://doi.org/10.1080/0142159X.2017.1394998
  31. Irby DM, O’Sullivan PS. Developing and rewarding teachers as educators and scholars: remarkable progress and daunting challenges. Med Educ. 2018;52(1):58–67. doi:.https://doi.org/10.1111/medu.13379 DOI: https://doi.org/10.1111/medu.13379
  32. Fritze O, Lammerding-Koeppel M, Boeker M, Narciss E, Wosnik A, Zipfel S, et al. Boosting competence-orientation in undergraduate medical education - A web-based tool linking curricular mapping and visual analytics. Med Teach. 2019;41(4):422–32. doi:.https://doi.org/10.1080/0142159X.2018.1487047 DOI: https://doi.org/10.1080/0142159X.2018.1487047
  33. Driessen E. Do portfolios have a future? Adv Health Sci Educ Theory Pract. 2017;22(1):221–8. doi:.https://doi.org/10.1007/s10459-016-9679-4 DOI: https://doi.org/10.1007/s10459-016-9679-4
  34. Sklar DP. Implementing Curriculum Change: Choosing Strategies, Overcoming Resistance, and Embracing Values. Acad Med. 2018;93(10):1417–9. doi:.https://doi.org/10.1097/ACM.0000000000002350 DOI: https://doi.org/10.1097/ACM.0000000000002350
  35. Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J ; International Competency-based Medical Education Collaborators. A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs. Acad Med. 2019;94(7):1002–9. doi:.https://doi.org/10.1097/ACM.0000000000002743 DOI: https://doi.org/10.1097/ACM.0000000000002743
  36. Guttormsen S, Beyeler C, Bonvin R, Feller S, Schirlo C, Schnabel K, et al. The new licencing examination for human medicine: from concept to implementation. Swiss Med Wkly. 2013;143:w13897. doi:.https://doi.org/10.4414/smw.2013.13897 DOI: https://doi.org/10.4414/smw.2013.13897
  37. Hrynchak P, Glover Takahashi S, Nayer M. Key-feature questions for assessment of clinical reasoning: a literature review. Med Educ. 2014;48(9):870–83. doi:.https://doi.org/10.1111/medu.12509 DOI: https://doi.org/10.1111/medu.12509
  38. Huwendiek S, Reichert F, Duncker C, de Leng BA, van der Vleuten CPM, Muijtjens AMM, et al. Electronic assessment of clinical reasoning in clerkships: A mixed-methods comparison of long-menu key-feature problems with context-rich single best answer questions. Med Teach. 2017;39(5):476–85. doi:.https://doi.org/10.1080/0142159X.2017.1297525 DOI: https://doi.org/10.1080/0142159X.2017.1297525
  39. Gilliland WR, La Rochelle J, Hawkins R, Dillon GF, Mechaber AJ, Dyrbye L, et al. Changes in clinical skills education resulting from the introduction of the USMLE step 2 clinical skills (CS) examination. Med Teach. 2008;30(3):325–7. doi:.https://doi.org/10.1080/01421590801953026 DOI: https://doi.org/10.1080/01421590801953026
  40. Hauer KE, Teherani A, Kerr KM, O’Sullivan PS, Irby DM. Impact of the United States Medical Licensing Examination Step 2 Clinical Skills exam on medical school clinical skills assessment. Acad Med. 2006;81(10, Suppl):S13–6. doi:.https://doi.org/10.1097/01.ACM.0000236531.32318.02 DOI: https://doi.org/10.1097/01.ACM.0000236531.32318.02
  41. Swanson DB, Roberts TE. Trends in national licensing examinations in medicine. Med Educ. 2016;50(1):101–14. doi:.https://doi.org/10.1111/medu.12810 DOI: https://doi.org/10.1111/medu.12810
  42. Melnick DE. Licensing examinations in North America: is external audit valuable? Med Teach. 2009;31(3):212–4. doi:.https://doi.org/10.1080/01421590902741163 DOI: https://doi.org/10.1080/01421590902741163
  43. Teunissen PW, Kogan JR, Ten Cate O, Gruppen LD, Lingard LA. Learning in Practice: A Valuation of Context in Time-Variable Medical Training. Acad Med. 2018;93(3S):S22–6. doi:.https://doi.org/10.1097/ACM.0000000000002070 DOI: https://doi.org/10.1097/ACM.0000000000002070

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