Caretta-Weyer Holly A, Schnapp Benjamin H, Brown Charles A, Fant Abra, Gisondi Michael A, Kropf Charles W, Magda Matthew, Pirotte Matthew, Scott Kevin R, Yarris Lalena M
is Clinical Associate Professor, Department of Emergency Medicine, and Associate Dean of Admissions and Assessment, Stanford University School of Medicine, Palo Alto, California, USA.
is an Associate Professor (CHS) and Director of Residency Evaluation and Assessment, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
J Grad Med Educ. 2025 May;17(2 Suppl):57-63. doi: 10.4300/JGME-D-24-00639.1. Epub 2025 May 15.
As graduate medical education programs implement competency-based medical education (CBME) approaches, many specialties struggle to adopt this paradigm in a way that successfully incorporates the 5 core components of CBME. To develop and implement the 5 core components of CBME within 8 US emergency medicine (EM) residency programs and assess acceptability and feasibility. We designed an intervention to implement the 5 core components of CBME: (1) an outcomes framework; (2) developmental progression; (3) tailored learning experiences; (4) competency-focused instruction or coaching; and (5) programmatic assessment. A consensus process to develop the framework and developmental trajectory was followed and included the development and deployment of programmatic assessment, coaching programs, and individualized learning plans using a shared model for implementation. We implemented the intervention beginning in August 2021. We surveyed site implementation leads about its feasibility and acceptability. The survey response rate was 100% (8 of 8). Estimated time required for the project intervention was 2 to 15 hours per month and 4 to 21.4 hours per month for the program coordinator and program leadership, respectively, with no additional salary provided. Residents and faculty received brief training about the CBME program (0.25 to 1 hours for residents and 0.5 to 1 hour for faculty), with periodic reminders afterward. Site leads perceived mixed acceptability from residents and faculty. Perceived challenges to implementation included resistance to change, time limitations, faculty discomfort with providing written assessment data, and difficulties navigating institutional barriers to technology-enhanced data collection. CBME was estimated to require manageable time for program staff and leadership, with mixed acceptability from residents and faculty.
随着毕业后医学教育项目实施基于胜任力的医学教育（CBME）方法，许多专业在以成功纳入CBME五个核心组成部分的方式采用这种范式时面临困难。在美国的8个急诊医学（EM）住院医师培训项目中开发并实施CBME的5个核心组成部分，并评估其可接受性和可行性。我们设计了一项干预措施来实施CBME的5个核心组成部分：（1）结果框架；（2）发展进程；（3）量身定制的学习体验；（4）以胜任力为重点的指导或辅导；（5）项目评估。遵循了一个共识过程来制定框架和发展轨迹，包括使用共享的实施模型开发和部署项目评估、辅导项目和个性化学习计划。我们于2021年8月开始实施干预措施。我们就其可行性和可接受性对各站点的实施负责人进行了调查。调查回复率为100%（8/8）。项目干预估计每月所需时间分别为项目协调员2至15小时、项目负责人4至21.4小时，且未提供额外薪资。住院医师和教员接受了关于CBME项目的简短培训（住院医师0.25至1小时，教员0.5至1小时），之后会定期提醒。各站点负责人认为住院医师和教员的接受程度不一。实施过程中察觉到的挑战包括对变革的抵触、时间限制、教员对提供书面评估数据的不适，以及在克服技术增强型数据收集的机构障碍方面存在困难。据估计，CBME对项目工作人员和负责人来说所需时间可控，住院医师和教员的接受程度不一。
