What is competency-based education (CBE)?
Competency-based education (CBE) is an educational model that starts with the expected outcomes in mind. For that reason, it is considered a backward curriculum design, starting by the end and making its way to relevant streams and courses within a curriculum. The driving force behind the adoption of this model is the requirement to prepare students to fulfil their societal role for the benefit of enhanced patient care and safety in an ever-advancing healthcare landscape. Pierre wrote a detailed justification of CBE below, as a kind of white paper on the topic. There are several definitions of competency-based education. The one that was found best suited was coined by Hodges in 2012 (see quote).
Competence is the ability to carry out a job or task at an expected level (standard), and competencies (singular: competency) are the building blocks of competence. Competencies are composed of knowledge, skills and attitudes (KSA), and expressed as actual behaviours which can be observed, measured and assessed. They are usually presented as a framework that encompasses all the expected behaviours of a newly graduated professional.
CBE Definition
“education that derives a curriculum from an analysis of a prospective or actual role in modern society and attempts to certify students’ progress on the basis of demonstrated performance in some or all aspects of that role.”
Why transition to competency-based education (CBE)?
- A white paper -
The Lancet Commission was launched to take a critical look at health education, 100 years after the Flexner report, which shaped education for a century. One of the problems identified by the Commission was a mismatch of competencies to patient and population needs. In other words, there is a gap between education and practice. They suggest that any instructional reforms should adopt, amongst others, competency-driven approaches to instructional design, and adapt these competencies to rapidly changing local conditions [1]. Competency-Based education is defined as: “Education that derives a curriculum from an analysis of a prospective or actual role in modern society and attempts to certify students’ progress on the basis of demonstrated performance in some or all aspects of that role” [2]. This means that a competent graduate needs to be able to perform the tasks expected from society, and not just get the foundation (knowledge, skills and attitude (KSA)) without putting it to use. A better curriculum is not one that will compress more KSA, but one that provides space to apply them to relevant professional activities (contextualized problem solving for deeper learning). As stressed by Schuwirth and Van Der Vleuten, “Striking differences between experts and novices is not per se the possession of more explicit knowledge but the superior organization of knowledge in his/her brain and pairing it with multiple real experiences, enabling not only better problem solving but also more efficient problem solving.” [3].
“Health professional education has not kept pace with the challenges of health care in the 21st century, largely because of fragmented, outdated and static curricula that produce ill-equipped graduates”
The World Health Organization (WHO) also recently suggested that health education move towards competency-based education for a work-ready workforce [4]. This was recently echoed by the International Pharmaceutical Federation (FIP) in their report on key priorities in education and training from 21 countries, in which competency development and competency-based education emerged as one of the key findings [5]. For too long, we have been trying to keep a more traditional approach to teaching and learning and not addressing the issues and flaws with this approach, especially now that information is available at our fingertips. As emphasized by Noble et al. “the curriculum (should) aims to develop pharmacists who are a ‘‘certain kind of person,’’ a person who will think, act, and do things in a way that shows they are truly patient-centered pharmacists. Perhaps then we can stop tinkering with knowledge and skills and truly transform the pharmacy curriculum” [6]. Indeed, the value of lectures in higher education is much debated and the limitations of this approach as a key teaching format are well known [7]. Active learning or “flipped classroom” modalities are changing the way students learn and improve their success [8]. To a point that in a Nature paper titled “The science of teaching science” [9], it was mentioned: “At this point it is unethical to teach in any other way”.
“The action-oriented principles of CBE are associated with better preparedness for practice, learner engagement and health worker performance, with the potential to improve health outcomes of the populations that health workers serve.”
Assessment is another aspect that needs to be reconsidered [3]. As stated by Fielding and Regehr [10], the assessment must be integrated within the curriculum design and not be an afterthought. Assessment of learning (AoL) has been our main objective, but it evaluates students at the end of their learning journey, when it is too late to remediate. Assessment for learning (AfL) allows a better evaluation of student progression and a finer diagnostic of the problems that students experience before it is too late for them to improve. As the authors emphasize: “To be successful, AfL needs a learning environment that is deliberately engineered to involve students in the learning tasks. The design features of an AfL environment include, amongst others: clear learning intentions and shared criteria for success, enabling classroom discussions and classroom activities that provide evidence of learning, and feedback delivered in a manner that assists learning progression”. By allowing students to learn from misconceptions and mistakes, AfL and feedback are indeed the cornerstone of improving student engagement and performance, and have to occur at the program level [11].
In their recent 246 page white paper, the AACP competency-based education joint education task force recommended (# 4) that “AACP should commit to competency-based education as the learning model that meets the needs of society and patients, the health care system and workforce, academic institutions, and pharmacy learners across the career lifespan” [12]. This is powerful endorsement from a leading country in pharmacy education.
In conclusion, the driving force behind adoption of this model is the requirement to prepare students to fulfil their societal role for the benefit of enhanced patient care and safety in an ever-advancing healthcare landscape [13]. It is indeed time to really consider a major curricular reform that will be both current and adaptable to the future, as the professional roles (and expected competencies) evolve over the years. The 10-step framework developed and implemented by Prof. Pierre Moreau takes all these crucial elements into consideration.
References
Frenk J et al. 2010. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 376 (9756): 1923–1958.
Hodges BD & Lingard L. 2012. The Question of Competence: Reconsidering Medical Education in the Twenty-First Century. Ithaca: ILR Press.
Schuwirth LWT & Van Der Vleuten CPM. 2011. General overview of the theories used in assessment: AMEE Guide No. 57. Medical Teacher, 33:10, 783-797
Global Competency and Outcomes Framework for Universal Health Coverage. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. (accessed 01/10/2023)
International Pharmaceutical Federation (FIP). Key priorities in education and training for pharmacy professionals across 21 countries. The Hague: International Pharmaceutical Federation; 2023
Noble C et al. 2011. Curriculum for Uncertainty: Certainty May Not Be the Answer. Am J Pharma Educ, 75, 1–2.
Davis D et al. 1999. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 282:867–874.
Freeman S et al. 2014. Active learning increases student performance in science, engineering, and mathematics. Proc National Acad Sci, 111, 8410–8415.
Mitchell Waldrop M. 2015. The science of teaching science. Nature, 523: 272-274.
Fielding DW & Regehr G. 2017. A call for an integrated program of assessment. Am J Pharm Educ, 81; Article 77.
Jessop T. Student agency and engagement: Transforming assessment and feedback in higher education. Routledge, London 2024. (DOI)
Rhoney D. et al. 2021-2022 American Association of Colleges of Pharmacy (AACP) competency-based education joint task force white paper. (Access)
Miller, B. M., Moore, D. E., Stead, W. W. & Balser, J. R. Beyond Flexner: A New Model for Continuous Learning in the Health Professions. Academic Medicine. 85: 2; 266–272 (2010).