Competency-based medical education in India: A work in progress

THE BENEFITS OF CBME

CBME will help today’s learners to become better physicians of tomorrow by providing a comprehensive educational experience. Evolutionary educational thinking and new medical program accreditation process in India provided an opportunity to reconsider existing approaches to medical education.^[3] Many authors have made an effort to categorise and discuss various advantages of CBME to its beneficiaries.^[4]

CHALLENGES TO BE ADDRESSED

Operationalisation of CBME is a herculean task. Advantages of CBME are many, yet it is not a complete foolproof system. CBME though provides a seamless linkage between all stages of lifelong learning; its implementation poses numerous challenges.^[5] These challenges if not addressed properly will have negative implications on students’ learning environment. Challenges to various domains are as follows.

FACULTY DEVELOPMENT PROGRAMS: A MISSING MAJOR LINKAGE

Echoing the words of John Dewey; ‘if we teach today’s students as we taught yesterday’s, we rob them of tomorrow,’ we are pointing at importance of faculty development programs (FDP) by policy makers. Faculty play a key role in successful implementation of CBME. FDPs are fundamental to the effective transition of traditional teaching to CBME.^[8]

However, there are many questions yet to be resolved especially in Indian scenario; are the faculty well acquainted with CBME? Have they prepared adequately to teach and assess? If not, how, where and when will they be given sufficient training? Is it not essential to train them sufficiently before expecting them to take a plunge into the unfamiliar, vast ocean of CBME? These queries need to be addressed. Although curriculum implementation support programs are being conducted by nodal centres, many of the faculty are still skeptical and unconvinced. Faculty needs much more elaborative FDPs to meet the demands of CBME than just passively attending few days’ workshop. Frequent and constant hands-on workshops are required to bring much needed awareness. Moreover, in many of the institutions, medical education unit (MEU) is in its infancy, with untrained junior faculty being the head and members of the MEU which has, in turn, hampered effective delivery of FDPs. Current faculty in India are not well prepared and trained for the CBME task in imparting newer competencies of medical knowledge, clinical skills, professionalism, evidence-based practice, interdisciplinary teamwork and systems. The implication of these observations is that the MCI urgently needs a nationwide initiative of faculty development in CBME teaching and assessment.

CBME: THE ROAD AHEAD

Despite the broad endorsement of CBME as a core strategy to educate and assess the next generation of physicians, major concern is about reductionist approaches in CBME, lack of good universal timetable and assessments. Granularity of competency-focused curriculum may result in ‘missing the forest for the trees.’ The concerns and challenges can be categorised as: (i) Those related to practical, administrative and logistical challenges in implementing CBME and (ii) those which are conceptual or theoretical in nature. Inconsistencies in CBME conceptual frameworks and guidelines remain a significant obstacle.^[9] The critical insights into the operationalisation of CBME are warranted. Hall et al. relate implementation of the practical components of CBME as a sprint, while realising the principles of CBME and changing culture as a marathon denoting sustained effort in the form of frequent program evaluation and continuous FDPs.^[10] With all these pros and cons, CBME still stands out as a better approach to meet the needs of patients, providers and other stakeholders in the health-care system. Hope everyone will soon join hands in the smooth and successful transition to CBME, to promote better transparency, accountability, fiscal responsibility and patient safety. CBME should not be viewed as a fixed doctrine, but rather as a set of evolving concepts, principles, tools and approaches that can enable important reforms in medical education that, in turn, enable the best outcomes for patients.^[11] In overcoming these challenges, one can use conceptual framework, designed using Mento’s^[12] step change management process for effective and sustainable implementation of CBME.^[12]

CONCLUSION

CBME remains the best possible solution for most of the problems inherent to conventional system of medical education in India. Hence, a systemic collaborative approach and dedicated involvement of all the stakeholders; medical educators, students and policy makers will ensure successful implementation of CBME.