E. Van Melle is senior education scientist, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. J.R. Frank is director of specialty education, strategy and standards, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. D. Dagnone is competency-based medical education faculty lead and associate professor, Department of Emergency Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada. D. Stockley is professor and scholar in higher education, Office of the Vice-Provost (Teaching and Learning), Queen's University, Kingston, Ontario, Canada. J. Sherbino is assistant dean, Program for Education Research and Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Acad Med. 2019 Jul;94(7):1002-1009. doi: 10.1097/ACM.0000000000002743.
The rapid adoption of competency-based medical education (CBME) provides an unprecedented opportunity to study implementation. Examining "fidelity of implementation"-that is, whether CBME is being implemented as intended-is hampered, however, by the lack of a common framework. This article details the development of such a framework.
A two-step method was used. First, a perspective indicating how CBME is intended to bring about change was described. Accordingly, core components were identified. Drawing from the literature, the core components were organized into a draft framework. Using a modified Delphi approach, the second step examined consensus amongst an international group of experts in CBME.
Two different viewpoints describing how a CBME program can bring about change were found: production and reform. Because the reform model was most consistent with the characterization of CBME as a transformative innovation, this perspective was used to create a draft framework. Following the Delphi process, five core components of CBME curricula were identified: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. With some modification in wording, consensus emerged amongst the panel of international experts.
Typically, implementation evaluation relies on the creation of a specific checklist of practices. Given the ongoing evolution and complexity of CBME, this work, however, focused on identifying core components. Consistent with recent developments in program evaluation, where implementation is described as a developmental trajectory toward fidelity, identifying core components is presented as a fundamental first step toward gaining a more sophisticated understanding of implementation.
基于能力的医学教育（CBME）的快速采用为研究实施提供了一个前所未有的机会。然而，由于缺乏通用框架，检查“实施保真度”——即 CBME 是否按照预期实施——受到了阻碍。本文详细介绍了这样一个框架的开发。
采用两步法。首先，描述了 CBME 旨在带来变革的观点。相应地，确定了核心组件。从文献中汲取灵感，将核心组件组织成一个草案框架。使用改良的 Delphi 方法，第二步检查了 CBME 领域的一组国际专家对该框架的共识。
发现了两种描述 CBME 计划如何带来变革的不同观点：生产和改革。由于改革模型与 CBME 作为变革性创新的特征最为一致，因此采用这种观点来创建草案框架。在 Delphi 流程之后，确定了 CBME 课程的五个核心组件：结果能力、有序进展、量身定制的学习体验、以能力为重点的教学和课程评估。在措辞上进行了一些修改，国际专家小组达成了共识。
通常，实施评估依赖于创建具体的实践检查表。然而，鉴于 CBME 的不断发展和复杂性，这项工作侧重于确定核心组件。与 CBME 作为一个发展轨迹向保真度描述的实施的最新发展一致，确定核心组件被提出作为更深入理解实施的基本第一步。
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