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      Setting Objectives for a Competency-based Undergraduate Obstetrics and Gynecology Curriculum

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          Abstract

          Introduction:

          Little emphasis on standardization, less stringent outcome measurement and resource constrains can result in deteriorating competencies among medical graduates in a country with rapidly increasing number of medical institutions like India. A competency-based curriculum is where we carefully design curricular experiences to achieve pre-identified outcomes. In this study, we aimed to define the outcome objectives of a competency-based undergraduate Obstetrics and Gynaecology curriculum which is comprehensive, and is based on the present day need of our society. These objectives can serve as the basis for designing a suitable curriculum with aligned teaching learning and assessment methods.

          Methods:

          This is an observational study in which a Delphi technique was used to identify the outcome objectives representing competencies specific to the subject of obstetrics and gynaecology at graduate level. The six core competencies identified by Accreditation Council for Graduate Medical Council formed the framework to identify these competencies. Then, a cross-sectional countrywide survey was conducted among purposively sampled teachers and clinical experts through a postal questionnaire to know the relative importance of the identified outcome measures and need for their inclusion in a contemporary outcome-based curriculum.

          Result:

          Ninety four medical teachers and clinical experts, belonging to institutes across the county, with demonstrable interest and expertise in the field of medical education identified 38 outcome objectives for the curriculum. There were twenty one “vital”, fourteen “essential”, two “desirable” and one “optional” outcome objectives identified. There were eighteen outcome objectives for “patient care” domain, nine for “medical knowledge”, four for “Practice based learning and improvement”, three for “professionalism”, two for “system based practice”, and two for “interpersonal and communication skills”.

          Conclusion:

          The outcome objectives for a competency-based obstetrics and gynaecology curriculum in an Indian context were defined.

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          Most cited references18

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          Evaluating obstetrical residency programs using patient outcomes.

          Patient outcomes have been used to assess the performance of hospitals and physicians; in contrast, residency programs have been compared based on nonclinical measures. To assess whether obstetrics and gynecology residency programs can be evaluated by the quality of care their alumni deliver. A retrospective analysis of all Florida and New York obstetrical hospital discharges between 1992 and 2007, representing 4 906 169 deliveries performed by 4124 obstetricians from 107 US residency programs. Nine measures of maternal complications from vaginal and cesarean births reflecting laceration, hemorrhage, and all other complications after vaginal delivery; hemorrhage, infection, and all other complications after cesarean delivery; and composites for vaginal and cesarean deliveries and for all deliveries regardless of mode. Obstetricians' residency program was associated with substantial variation in maternal complication rates. Women treated by obstetricians trained in residency programs in the bottom quintile for risk-standardized major maternal complication rates had an adjusted complication rate of 13.6%, approximately one-third higher than the 10.3% adjusted rate for women treated by obstetricians from programs in the top quintile (absolute difference, 3.3%; 95% confidence interval, 2.8%-3.8%). The rankings of residency programs based on each of the 9 measures were similar. Adjustment for medical licensure examination scores did not substantially alter the program ranking. Obstetrics and gynecology training programs can be ranked by the maternal complication rates of their graduates' patients. These rankings are stable across individual types of complications and are not associated with residents' licensing examination scores.
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            Competency-based medical education: An overview and application in pharmacology

            Competency-based medical education (CBME) is gaining momentum across the globe. The Medical Council of India has described the basic competencies required of an Indian Medical Graduate and designed a competency-based module on attitudes and communication. Widespread adoption of a competency-based approach would mean a paradigm shift in the current approach to medical education. CBME, hence, needs to be reviewed for its usefulness and limitations in the Indian context. This article describes the rationale of CBME and provides an overview of its components, i.e., competency, entrustable professional activity, and milestones. It elaborates how CBME could be implemented in an institute, in the context of basic sciences in general and pharmacology in particular. The promises and perils of CBME that need to be kept in mind to maximize its gains are described.
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              How do you deliver a good obstetrician? Outcome-based evaluation of medical education.

              The goal of medical education is the production of a workforce capable of improving the health and health care of patients and populations, but it is hard to use a goal that lofty, that broad, and that distant as a standard against which to judge the success of schools or training programs or particular elements within them. For that reason, the evaluation of medical education often focuses on elements of its structure and process, or on the assessment of competencies that could be considered intermediate outcomes. These measures are more practical because they are easier to collect, and they are valuable when they reflect activities in important positions along the pathway to clinical outcomes. But they are all substitutes for measuring whether educational efforts produce doctors who take good care of patients.The authors argue that the evaluation of medical education can become more closely tethered to the clinical outcomes medical education aims to achieve. They focus on a specific clinical outcome-maternal complications of obstetrical delivery-and show how examining various observable elements of physicians' training and experience helps reveal which of those elements lead to better outcomes. Does it matter where obstetricians trained? Does it matter how much experience they have? Does it matter how good they were to start? Each of these questions reflects a component of the production of a good obstetrician and, most important, defines a good obstetrician as one whose patients in the end do well.
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                Author and article information

                Journal
                J Adv Med Educ Prof
                J Adv Med Educ Prof
                Journal of Advances in Medical Education & Professionalism
                Journal of Advances in Medical Education & Professionalism (Iran )
                2322-2220
                2322-3561
                October 2018
                : 6
                : 4
                : 147-154
                Affiliations
                [1 ]Department of Obstrtrics and Gynecology, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India;
                [2 ] Department of Community Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India;
                [3 ]Department of Anatomy, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
                Author notes
                Correspondence:Ajay Halder, Room no27, First Floor, Hospital Building, AIIMS, Saket Nagar, Bhopal 262020, India
                Article
                JAMP-6-4
                6191833
                355d8d35-9691-4f37-b024-09c2bd9fc084
                Copyright: © Journal of Advances in Medical Education & Professionalism

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 September 2018
                : 18 February 2018
                Categories
                Original Article

                outcome , objectives , competency , obstetrics , gynecology , curriculum

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