The Transition to Competency

For students accustomed to the traditional rhythm of courses that conclude with a final grade, the transition to competency-based medical education (CBME) and assessment can be confusing. In the historical framework, students learned knowledge or skills specific to a course, were tested on those knowledge and skills, and the decision about whether or not a student passed or the grade they received was sometimes based on how well they performed compared to everyone else in the course. Exams and clinical experience still occur with CBME, but students no longer receive grades at the end of each course or module. Instead, evidence of student abilities in knowledge, skills, behaviors, and attitudes are gathered across modules, clerkships, or courses. This evidence is then reviewed by a team of trained experts to determine if the student has reached the needed level of ability to advance to the next phase of the curriculum or training. Critical to this process is the ability for students, coaches, and education leaders to monitor progress towards this decision. That means all of the evidence – exam scores, project evaluations, clinical performance rubrics – has to be collected, aggregated, and displayed in a way that everyone can decide if a student is on track or has done enough to advance.

Thanks to the combined efforts of the Office of Medical Student Education, Educational Technology Unit, and Assessment Team the competency portfolio was developed for just this need. Student outcomes were gathered from the exams and experiences in the Gateway Curriculum that contributed to the decision of competency and aggregated into a portfolio that displayed students’ progress, to date. Using an Excel workbook, information about each students’ performance was pulled from the assessments they had already completed and that would contribute to a decision of competency. Workbook pages were then created to provide the definitions of competency for each domain, review of each of the program objectives which were color-coded to represent the amount of evidence for each objective, and personalized pages depicting the student’s performance in each program objective and keyword. Tracking at this level is important to ensure students achieve competence in both the domain and the individual parts that make up each domain.

The first version of the portfolio was delivered to the Gateway coaches and students in mid-January 2021. This visual representation helped students, coaches, and those building our new curriculum understand which of our program objectives had been assessed and how often. This is important because of CBME’s longitudinal view of performance as compared to by each course as we historically did. The portfolio also helped students and coaches begin to identify areas of strengths and what might be an area of focus.

Many schools are working towards a competency-based program, and we are excited to be trailblazers in this important movement which aims to ensure all students reach their full potential through early recognition of areas of strength and areas that might require support.

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