Whether introduction of competency-based medical education should be advocated in India?

BACKGROUND: The healthcare needs of the general population are on the rise and to meet these demands, the healthcare professionals, especially doctors have to acquire a large number of skills. In the Indian settings, as of now, conventional system of education is being followed in medical colleges and this is despite the fact that it has many flaws associated with it. AIMS AND
OBJECTIVES: The objective of the article is to explore the utility and the need of Competency Based Medical Education (CBME) in Indian settings.
MATERIALS AND METHODS: It is a brief review of pertaining to the transition of delivery of medical education in India and is well-supported by the studies from different nations.
RESULTS: CBME is a thoughtful approach to develop physicians in their future practice and encourages better accountability and flexibility. However, if so many things are good with CBME, then the question arises why it has not been implemented yet across all the medical colleges in India? This is because of the various challenges which have been identified in the planning and implementation phase of the program.
CONCLUSION: In conclusion, CBME remains the ultimate solution for the problems persisting in the conventional system of medical education. However, a systemic plan and better involvement of the stakeholders in the preparedness phase will significantly enhance the chances of the success of the program.

Introduction

The healthcare needs of the general population are on the rise and to meet these demands, the healthcare professionals, especially doctors have to acquire a large number of skills.[12] In the current set-up, the responsibility to improve the quality of the doctors depends on the type of education offered in medical colleges.[2] The ultimate aim of the medical education in India is to produce a doctor, who remains the first contact physician, but then at the same time be globally relevant.[123] In other words, we want our graduate students to be more socially responsive and well-equipped for their clinical practice.[1]

Shortcomings in the conventional system of medical education

In the Indian settings, as of now, conventional system of education is being followed in medical colleges, and this is despite the fact that it has many flaws associated with it.[1] To start with, it is a teacher-driven curriculum, where the responsibility for the content and the learning lies with the teacher.[2] This is not right, as onus has to be with the learner as they have to become doctor and treat patients in the future.[2] If we further go in depth, in the conventional system, the main force for learning is to acquire the knowledge, instead of the practical application of the same, which is the need of the hour.[1]

In addition, the assessment process is predominantly summative and norm-referenced test.[1] This is again a big problem, as summative assessments do not give any chance for the learners to improve.[1] In contrast, competency-based medical education (CBME) emphasizes on formative assessment, multiple assessments and removes subjectivity through the adoption of the rubrics of milestones during the assessment. In addition, as the assessment in CBME is criterion-referenced test and not norm-referenced test, it does not compare the performance of one learner with another.[123] Moreover, the assessment tools employed in the conventional system cannot be used in authentic settings.[1] Finally, the duration of the course is fixed in conventional curriculum (unlike in CBME which is relative independence of time in training), which is not right as each learner may differ from other and expecting them to master within the specified time does not suit with different category of learners (advocated in CBME).[12]

Prospects of Competency Based Medical Education and Challenges

CBME is a very thoughtful approach to develop physicians in their future practice and encourages better accountability and flexibility.[23] However, if so many things are good with CBME; then, the question arises why it has not been implemented yet across all the medical colleges in India?[14] This is because of the various challenges which have been identified in the planning and implementation phase of the program.[456] The success of CBME depends on the presence of a supportive administration/management, resources and requires proper planning, and supervision of the implementation process to ensure that intended objectives are met.[156] The successful implementation of CBME program essentially depends on the sensitization programs for all the faculty members and dedicated faculty members.[456]

At the same time, it is feared that the introduction of CBME will overcomplicate medical training, as competencies are divided into key competencies, which are then further divided into milestones.[56] As a whole, it becomes quite exhaustive and impractical, as the process of setting descriptors, designing of rubrics, doing internal and external validation for each of the subject-specific evolutionary program-induction algorithms is difficult.[56] Moreover, the practical difficulties to assess competencies such as professionalism or lifelong learner can also not be ignored.[6] Even though the idea of negating the issue of total duration of the course (keeping it variable) looks okay, but in reality, already the medicine course is quite long and making it even more longer might not go well with many of the learners as well as administrators.[156]

Conclusion

In conclusion, CBME remains the ultimate solution for the problems persisting in the conventional system of medical education. However, a systemic plan and better involvement of the stakeholders in the preparedness phase will significantly enhance the chances of the success of the program.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.