Introduction

Evaluation and assessment of medical trainees has evolved over time. Many graduate medical education (GME) programs now use criteria and competency-based methods evaluation. While the AAMC has defined Entrustable Professional Activities for graduating medical students1, overall the implementation of competency-based medical education (CBME) into undergraduate medical education (UME) has been slow. This review aimed to assess the literature surrounding CBME employed in the UME core clerkships.

Methods

A preliminary search did not yield any reviews on this topic. We developed key words based on “criteria” and “clerkship”. We then searched the PubMed database with the following search strategy: (Criteria[ti] OR Competency[MeSH] OR Competenc*[ti] OR Clinical competence[MeSH]) AND (Clerkship*[ti] OR Clinical Clerkship[MeSH] OR Rotation*[ti] OR Apprenticeship*[ti]). This yielded 2101 results. We then refined the search to (Criteria[ti] OR Competency[MeSH] OR Competenc*[ti] ) AND (Clerkship*[ti] OR Clinical Clerkship[MeSH] OR Rotation*[ti] OR Apprenticeship*[ti]). The 219 resulting articles were evaluated based on titles and abstracts. Articles that were not written in English or did not discuss CBME were excluded. The full text of the remaining 31 these articles was evaluated, leaving 6 relevant articles.

Results

Five articles were identified that discussed the utility of CBME in UME2,3,4,5,6. Additionally, there are two examples of articles investigating the implementation of CBME into clerkships. The Alliance for Academic Internal Medicine Undergraduate Medical Education Task Force crafted Entrustable Professional Activities (EPAs) for the internal medicine core clerkship7. At one institution, the family medicine department implemented Educational Activities (EAs), their version of EPAs8.

Conclusion

Competency-based evaluation has been considered for undergraduate medical training. There is some guidance and discussion surrounding constructing and implementing CBME-based curricula and evaluation. However, there has been minimal implementation of the CBME methodology into clerkships. One family medicine clerkship did show that the EPA/EA framework was accepted by learners and evaluators. There is further work to be done in crafting CBME undergraduate medical training curricula and EPA schemas for all of the core clerkships.

References

  1. The Core Entrustable Professional Activities (EPAs) for Entering Residency. AAMC. https://www.aamc.org/about-us/mission-areas/medical-education/cbme/core-epas

  2. Chen HC, van den Broek WE, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. Acad Med. 2015;90(4):431-436. doi:10.1097/ACM.0000000000000586

  3. Harris P, Snell L, Talbot M, Harden RM. Competency-based medical education: implications for undergraduate programs. Med Teach. 2010;32(8):646-650. doi:10.3109/0142159X.2010.500703

  4. Hauer KE, Boscardin C, Fulton TB, Lucey C, Oza S, Teherani A. Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Ass

  5. Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676-682. doi:10.3109/0142159X.2010.500704

  6. ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice?. Acad Med. 2007;82(6):542-547. doi:10.1097/ACM.0b013e31805559c7

  7. Fazio SB, Ledford CH, Aronowitz PB, et al. Competency-Based Medical Education in the Internal Medicine Clerkship: A Report From the Alliance for Academic Internal Medicine Undergraduate Medical Education Task Force. Acad Med. 2018;93(3):421-427. doi:10.1097/ACM.0000000000001896

  8. Schneider B, Biagioli FE, Palmer R, O'Neill P, Robinson SC, Cantone RE. Design and Implementation of a Competency-Based Family Medicine Clerkship Curriculum. Fam Med. 2019;51(3):234-240. doi:10.22454/FamMed.2019.539833