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      Competency-Based Postgraduate Medical Education: Past, Present and Future Translated title: Kompetenzbasierte postgraduale medizinische Weiterbildung: Vergangenheit, Gegenwart und Zukunft

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          Abstract

          Since the turn of the twenty-first century, competency-based medical education (CBME) has become a dominant approach to postgraduate medical education in many countries. CBME has a history dating back half a century and is rooted in general educational approaches such as outcome-based education and mastery learning. Despite controversies around the terminology and the CBME approach, important national medical regulatory bodies in Canada, the United States, and other countries have embraced CBME. CBME can be characterized as having two distinct features: a focus on specific domains of competence, and a relative independence of time in training, making it an individualized approach that is particularly applicable in workplace training. It is not the length of training that determines a person’s readiness for unsupervised practice, but the attained competence or competencies. This shift in focus makes CBME different from traditional training. In this contribution, definitions of CBME and related concepts are detailed.

          Zusammenfassung

          Seit Beginn des 21. Jahrhunderts ist die kompetenzbasierte medizinische Weiterbildung (Competency-Based Medical Education, CBME) zum dominanten pädagogischen Ansatz in der medizinischen Ausbildung vieler Länder geworden. Mit einer Geschichte, die ein halbes Jahrhundert zurückgeht, ist die CBME in pädagogischen Ansätzen wie ergebnisorientierter Ausbildung und „Mastery Learning“ verwurzelt. Trotz der Kontroversen um die Terminologie und den CBME-Ansatz haben wichtige nationale medizinische Aufsichtsbehörden in Kanada, den Vereinigten Staaten und in anderen Ländern eine Bereitschaft für CBME gezeigt. CBME kann durch zwei deutliche Merkmale charakterisiert werden: durch einen Fokus auf spezifische Kompetenzbereiche und durch eine relative Unabhängigkeit vom Zeitpunkt innerhalb der Ausbildung; so wird CBME zu einem individualisierten Ansatz, der besonders beim Lernen am Arbeitsplatz anwendbar ist. Es ist nicht die Länge der Ausbildung, die das Bereitsein des Einzelnen für nicht supervidierte Praxis bestimmt, sondern die gewonnene Kompetenz oder die gewonnenen Kompetenzen. Diese Schwerpunktverlagerung unterscheidet CBME von der traditionellen Ausbildung. In diesem Beitrag werden Definitionen von CBME und verwandten Konzepten ausgeführt.

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          Entrustability of professional activities and competency-based training.

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            Toward a common taxonomy of competency domains for the health professions and competencies for physicians.

            Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions' competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges' (AAMC's) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites. The authors used the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties six domains of competence and 36 competencies delineated by the ACGME as their foundational reference list. They added two domains described by other groups after the original six domains were introduced: Interprofessional Collaboration (4 competencies) and Personal and Professional Development (8 competencies). They compared the expanded reference list (48 competencies within eight domains) with 153 competency lists from across the medical education continuum, physician specialties and subspecialties, countries, and health care professions. Comparison analysis led them to add 13 "new" competencies and to conflate 6 competencies into 3 to eliminate redundancy. The AAMC will use the resulting "Reference List of General Physician Competencies" (58 competencies in eight domains) to categorize resources for MedEdPORTAL and CIR. The authors hope that researchers and educators within medicine and other health professions will consider using this reference list when applicable to move toward a common taxonomy of competencies.
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              From the educational bench to the clinical bedside: translating the Dreyfus developmental model to the learning of clinical skills.

              The Accreditation Council for Graduate Medical Education Outcome Project has shifted the focus of residents' education to competency-based outcomes of learning. The challenge of meaningful assessment of learner competence has stimulated interest in the Dreyfus and Dreyfus Model, a framework for assessing skill acquisition that describes developmental stages beginning with novice and progressing through advanced beginner, competent, proficient, expert, and master. Many educators have adopted this model, but no consensus about its adaptation to clinical medicine has been documented. In this article, the authors seek to integrate generally accepted knowledge and beliefs about how one learns to practice clinical medicine into a coherent developmental framework using the Dreyfus and Dreyfus model of skill acquisition. Using the general domain of patient care, the characteristics and skills of learners at each stage of development are translated into typical behaviors. A tangible picture of this model in real-world practice is provided through snapshots of typical learner performance at discrete moments in time along the developmental continuum. The Dreyfus and Dreyfus model is discussed in the context of other developmental models of assessment of learner competence. The limitations of the model, in particular the controversy around the behaviors of "experts," are discussed in light of other interpretations of expertise in the literature. Support for descriptive developmental models of assessment is presented in the context of a discussion of the deconstructing versus reconstructing of competencies.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 November 2017
                2017
                : 34
                : 5 , Postgraduate education/Weiterbildung
                Affiliations
                [1 ]University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, The Netherlands
                Author notes
                *To whom correspondence should be addressed: Olle ten Cate, University Medical Center Utrecht, Center for Research and Development of Education, P.O. Box # 85500, NL-3508 GA Utrecht, The Netherlands, Phone: +31.88.75.57010, Fax: +31.88.75.53409, E-mail: t.j.tencate@ 123456umcutrecht.nl
                Article
                zma001146 Doc69 urn:nbn:de:0183-zma0011469
                10.3205/zma001146
                5704607
                9e004c3c-2cdf-4eed-a642-827eac2dcf4b
                Copyright © 2017 ten Cate

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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