Realizing medical education is on the brink of a major paradigm shift from structure- and process-based to competency-based education and measurement of outcomes, the authors reviewed the existing medical literature to provide practical insight into how to accomplish full implementation and evaluation of this new paradigm. They searched Medline and the Educational Resource Information Clearinghouse from the 1960s until the present, reviewed the titles and abstracts of the 469 articles the search produced, and chose 68 relevant articles for full review.
The authors found that in the 1970s and 1980s much attention was given to the need for and the development of professional competencies for many medical disciplines. Little attention, however, was devoted to defining the benchmarks of specific competencies, how to attain them, or the evaluation of competence. Lack of evaluation strategies was likely one of the forces responsible for the three-decade lag between initiation of the movement and wide-spread adoption. Lessons learned from past experiences include the importance of strategic planning and faculty and learner buy-in for defining competencies. In addition, the benchmarks for defining competency and the thresholds for attaining competence must be clearly delineated. The development of appropriate assessment tools to measure competence remains the challenge of this decade, and educators must be responsible for studying the impact of this paradigm shift to determine whether its ultimate effect is the production of more competent physicians.
Dr. Carraccio is professor and associate chair for education, Department of Pediatrics, Dr. Wolfsthal is associate professor and associate chair for education, Department of Medicine, and Dr. Ferentz is associate professor of family medicine and residency program director, Department of Family Medicine, all at the University of Maryland, Baltimore. Dr. Englander is assistant professor and associate program director, Department of Pediatrics, University of Connecticut, Hartford (held same titles at the University of Maryland, Baltimore, at the time the work was done). Dr. Martin is assistant professor and medical educator, Department of Medicine, University of Maryland (was professor of biology, Ursuline College, Pepper Pike, Ohio, at the time the work was done).
Correspondence should be addressed to Dr. Carraccio, Department of Pediatrics, Rm. N5W56, 22 South Greene Street, Baltimore, MD 21201; telephone: 410-328-5213; fax: 410-328-0646; e-mail: 〈firstname.lastname@example.org〉. Reprints are not available.
The authors thank Mary Alice Parsons, executive director, Residency Review Committee for Pediatrics and Family Medicine, for her critical review of the manuscript. This work was funded in part through a grant from the Health Resources and Services Administration, Bureau of Health Professions.