Review article: Biomedical intelligence
Vol. 150 No. 1516 (2020)
Nationwide introduction of a new competency framework for undergraduate medical curricula: a collaborative approach
- Marc Sohrmann
- Christoph Berendonk
- Mathieu Nendaz
- Raphaël Bonvin
- the Swiss Working Group for PROFILES Implementation
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Cite this as:
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Swiss Med Wkly. 2020;150:w20201
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Published
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15.04.2020
Summary
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- https://afmc.ca/medical-education/entrustable-professional-activities-epas; accessed on 30.06.2019
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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.
- 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
- Mak-van der Vossen M. ‘Failure to fail’: the teacher’s dilemma revisited. Med Educ. 2019;53(2):108–10.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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