Department of Pediatrics & Institute of Health Sciences Education, McGill University, Montreal, Quebec, CA.
Mid-West Intern Network, University of Limerick, Limerick, IE.
Perspect Med Educ. 2023 Nov 6;12(1):507-516. doi: 10.5334/pme.1027. eCollection 2023.
The widespread adoption of Competency-Based Medical Education (CBME) has resulted in a more explicit focus on learners' abilities to effectively demonstrate achievement of the competencies required for safe and unsupervised practice. While CBME implementation has yielded many benefits, by focusing explicitly on what learners are doing, curricula may be unintentionally overlooking who learners are becoming (i.e., the formation of their professional identities). Integrating professional identity formation (PIF) into curricula has the potential to positively influence professionalism, well-being, and inclusivity; however, issues related to the definition, assessment, and operationalization of PIF have made it difficult to embed this curricular imperative into CBME. This paper aims to outline a path towards the reconciliation of PIF and CBME to better support the development of physicians that are best suited to meet the needs of society. To begin to reconcile CBME and PIF, this paper defines three contradictions that must and can be resolved, namely: (1) CBME attends to behavioral outcomes whereas PIF attends to developmental processes; (2) CBME emphasizes standardization whereas PIF emphasizes individualization; (3) CBME organizes assessment around observed competence whereas the assessment of PIF is inherently more holistic. Subsequently, the authors identify curricular opportunities to address these contradictions, such as incorporating process-based outcomes into curricula, recognizing the individualized and contextualized nature of competence, and incorporating guided self-assessment into coaching and mentorship programs. In addition, the authors highlight future research directions related to each contradiction with the goal of reconciling 'doing' and 'being' in medical education.
基于能力的医学教育（CBME）的广泛采用导致了更明确地关注学习者有效展示安全和无人监督实践所需能力的能力。虽然 CBME 的实施带来了许多好处，但通过明确关注学习者正在做什么，课程可能会无意中忽略学习者正在成为什么（即，他们的专业身份的形成）。将专业身份形成（PIF）纳入课程具有积极影响专业精神、幸福感和包容性的潜力；然而，与 PIF 的定义、评估和实施相关的问题使得将这一课程要求纳入 CBME 变得困难。本文旨在概述一条使 PIF 和 CBME 协调一致的道路，以更好地支持培养最适合满足社会需求的医生。为了开始协调 CBME 和 PIF，本文定义了必须且可以解决的三个矛盾，即：（1）CBME 关注行为结果，而 PIF 关注发展过程；（2）CBME 强调标准化，而 PIF 强调个性化；（3）CBME 围绕观察到的能力组织评估，而 PIF 的评估本质上更全面。随后，作者确定了课程机会来解决这些矛盾，例如将基于过程的结果纳入课程，认识到能力的个性化和情境化性质，以及将引导性自我评估纳入辅导和指导计划。此外，作者强调了与每个矛盾相关的未来研究方向，旨在协调医学教育中的“做”和“是”。
