Acad Med. 2024 Jan 1;99(1):83-90. doi: 10.1097/ACM.0000000000005449. Epub 2023 Sep 12.
Competency-based medical education (CBME) represents a shift to a paradigm with shared definitions, explicit outcomes, and assessments of competence. The groundwork has been laid to ensure all learners achieve the desired outcomes along the medical education continuum using the principles of CBME. However, this continuum spans the major transition from undergraduate medical education (UME) to graduate medical education (GME) that is also evolving. This study explores the experiences of medical educators working to use CBME assessments in the context of the UME-GME transition and their perspectives on the existing challenges.
This study used a constructivist-oriented qualitative methodology. In-depth, semistructured interviews of UME and GME leaders in CBME were performed between February 2019 and January 2020 via Zoom. When possible, each interviewee was interviewed by 2 team members, one with UME and one with GME experience, which allowed follow-up questions to be pursued that reflected the perspectives of both UME and GME educators more fully. A multistep iterative process of thematic analysis was used to analyze the transcripts and identify patterns across interviews.
The 9 interviewees represented a broad swath of UME and GME leadership positions, though most had an internal medicine training background. Analysis identified 4 overarching themes: mistrust (a trust chasm exists between UME and GME); misaligned goals (the residency selection process is antithetical to CBME); inadequate communication (communication regarding competence is infrequent, often unidirectional, and lacks a shared language); and inflexible timeframes (current training timeframes do not account for individual learners' competency trajectories).
Despite the mutual desire and commitment to move to CBME across the continuum, mistrust, misaligned goals, inadequate communication, and inflexible timeframes confound such efforts of individual schools and programs. If current efforts to improve the UME-GME transition address the themes identified, educators may be more successful implementing CBME along the continuum.
以能力为基础的医学教育（CBME）代表了一种向具有共同定义、明确结果和能力评估的范式的转变。已经为确保所有学习者在使用 CBME 原则的医学教育连续体上实现预期结果奠定了基础。然而，这种连续体跨越了从本科医学教育（UME）到研究生医学教育（GME）的重大转变，而这一转变也在不断发展。本研究探讨了在 UME-GME 过渡背景下从事使用 CBME 评估的医学教育工作者的经验，以及他们对现有挑战的看法。
本研究采用了建构主义导向的定性方法。2019 年 2 月至 2020 年 1 月，通过 Zoom 对 UME 和 GME 中参与 CBME 的领导者进行了深入的半结构化访谈。在可能的情况下，每位受访者都由 2 位团队成员进行访谈，其中一位具有 UME 经验，另一位具有 GME 经验，这使得可以提出后续问题，更全面地反映 UME 和 GME 教育工作者的观点。采用多步骤迭代主题分析方法对转录本进行分析，并识别访谈中的模式。
9 位受访者代表了广泛的 UME 和 GME 领导职位，尽管大多数人都有内科培训背景。分析确定了 4 个总体主题：不信任（UME 和 GME 之间存在信任鸿沟）；目标不一致（住院医师选拔过程与 CBME 背道而驰）；沟通不足（关于能力的沟通不频繁，通常是单向的，缺乏共同语言）；和不灵活的时间框架（当前的培训时间框架没有考虑到个别学习者的能力轨迹）。
尽管整个连续体上都有向 CBME 过渡的共同愿望和承诺，但不信任、目标不一致、沟通不足和时间框架不灵活阻碍了个别学校和项目的努力。如果当前改善 UME-GME 过渡的努力解决了确定的主题，教育工作者可能会在连续体上更成功地实施 CBME。
