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1.
Asia Pac Psychiatry ; 13(4): e12491, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1556034

ABSTRACT

Medical education in India is undergoing a landmark transformation under the National Medical Commission implementing competency-based medical education (CBME). The CBME approach intends to ensure that medical graduates acquire the competencies needed to fulfill the health needs of the patient and society. This outcome-based approach shifts the focus from the traditional knowledge-based training to skill-based training valued on attitude, ethics, and communication (AETCOM) competencies. CBME thus aims to create medical professionals capable of providing holistic care with compassion and excellence embracing the global trends. The opportunity posed by the CBME should be utilized to sensitize and create interest among the learners about the science and scope of psychiatry. However, there are many challenges in the successful implementation of CBME, which have to be identified and addressed on time for serving the purpose. A basic tenet in CBME is to continue training until the desired competencies are achieved; in other words, to de-emphasize time-based learning. Moreover, the current COVID 19 pandemic is posing a significant influence on the execution of CBME implemented in August 2019. Online platforms could have several advantages in assisting the implementation of CBME; they provide an alternative to continue teaching-learning and assessment during these times and allow learners with the flexibility to learn at their own pace. In this article, we discuss the opportunities, including digital platforms and challenges to be overcame as well as the need for training the faculty toward assimilating the curriculum in the undergraduate psychiatric training.


Subject(s)
COVID-19 , Education, Medical , Competency-Based Education , Curriculum , Humans , SARS-CoV-2
2.
Acad Med ; 97(3S): S90-S97, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1532559

ABSTRACT

Advancement toward competency-based medical education (CBME) has been hindered by inertia and a myriad of implementation challenges, including those associated with assessment of competency, accreditation/regulation, and logistical considerations. The COVID-19 pandemic disrupted medical education at every level. Time-in-training sometimes was shortened or significantly altered and there were reductions in the number and variety of clinical exposures. These and other unanticipated changes to existing models highlighted the need to advance the core principles of CBME. This manuscript describes the impact of COVID-19 on the ongoing transition to CBME, including the effects on training, curricular, and assessment processes for medical school and graduate medical education programs. The authors outline consequences of the COVID-19 disruption on learner training and assessment of competency, such as conversion to virtual learning modalities in medical school, redeployment of residents within health systems, and early graduation of trainees based on achievement of competency. Finally, the authors reflect on what the COVID-19 pandemic taught them about realization of CBME as the medical education community looks forward to a postpandemic future.


Subject(s)
COVID-19 , Competency-Based Education/trends , Education, Medical/trends , SARS-CoV-2 , Forecasting , Humans , Pandemics , United States
4.
Educ Prim Care ; 33(2): 69-76, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1366928

ABSTRACT

INTRODUCTION: Entrustable Professional Activities (EPAs) are developed to support the practical application of competency frameworks in postgraduate medical education (PGME) programmes. EPAs are used for the assessment of the trainees' competence development, which takes place by means of an entrustment decision, aiming to stimulate learning and independent practice in trainees. In this pilot study, we explore the feasibility and validity of EPA-based assessment in a General Practice (GP) training programme. METHODS: We used questionnaires to evaluate trainers' and trainees' experiences with the use of six EPAs for trainee learning, assessment and independent practice at the Out-of-Hours GP Center. Data were analysed quantitatively and qualitatively. Additionally, we examined the inter-item correlation between scores on EPA-based assessment and competency-based assessment using Spearman's Rho. RESULTS: EPA-based assessment provided opportunities for giving concrete feedback and substantiating competency-based assessment. No consistent correlation between EPA-based assessment and competency-based assessment could be detected. Only later in the course of the training programme a correlation was found between the EPA scores and the degree of independence of trainees. DISCUSSION: Results of this pilot study confirm the theories behind EPAs, as well as earlier research on EPAs in the workplace regarding trainee learning, assessment and independent practice. An important limitation of this study was the COVID-19 pandemic, as it influenced the results through reduced inclusion and follow-up, and through the impact on the workplace and trainee learning possibilities. Further research is needed to determine how EPAs support independent practice of trainees, as well as the assessment of trainee competency development.


Subject(s)
COVID-19 , General Practice , Internship and Residency , Clinical Competence , Competency-Based Education/methods , Feasibility Studies , Humans , Pandemics , Pilot Projects
5.
Acad Med ; 96(7S): S6-S8, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1286597

ABSTRACT

The COVID-19 pandemic of 2020 exposed the reactive nature of the medical education community in response to a disruption that, at one time, may have seemed preposterous. In this article, the author reflected on the impact of an unpredictable plight on a system of medical education that (1) is continuous but doesn't function as a continuum and (2) requires adaptation but is steeped in a fixed mindset and structure that resists change. As a result, innovations which were previously considered impossible, such as time variable education and training, were forced into being. Inspired by the changes brought about by the pandemic, the ensuing decade is explored through a lens of possible futures to envision a path forward based on resilience rather than reactivity.


Subject(s)
COVID-19 , Competency-Based Education/organization & administration , Education, Medical/organization & administration , Models, Educational , Organizational Innovation , Competency-Based Education/methods , Creativity , Education, Medical/methods , Humans , Resilience, Psychological , Systems Analysis , United States
6.
Med Educ Online ; 26(1): 1940765, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1269454

ABSTRACT

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students' learning and mental wellbeing. During a period of ongoing comprehensive social distancing measures in Germany, we translated a competency-based curriculum including obstetrics, paediatrics, and human genetics to an e-learning course based on online patient and teacher encounters. In our qualitative study on students' and teachers' views, we identify potential enablers and drivers as well as barriers and challenges to undergraduate medical education under lockdown. In summer 2020, we conducted six focus group interviews to investigate medical students' and teachers' perspectives, experiences and attitudes. All focus groups were videotaped, transcribed verbatim and coded. To guide our deductive and inductive analysis, we applied the theoretical framework of Regmi and Jones. Content analysis was performed in a multi-perspective group. We identified five major themes contributing to a successful use of clinical competency-based e-learning under lockdown: Communication (with teachers, students, and patients), Mental wellbeing, Structure and self-organization, Technical issues, and Learning and commitment. We discuss enablers and potential barriers within all themes and their overlap and link them in an explanatory model. In our setting, students and teachers find e-learning holds strong potential and especially in times of COVID-19 it is greatly appreciated. We broaden the understanding of the impact of distant learning on acquiring competencies, on attitudes, and on mental wellbeing. Our model may serve for a thoughtful, necessary transition to future e-learning and hybrid programs for a competency-based medical education with ongoing social distancing measures.


Subject(s)
COVID-19/epidemiology , Clinical Competence/standards , Education, Distance , Education, Medical, Undergraduate/organization & administration , Adult , Competency-Based Education/organization & administration , Curriculum , Education, Medical, Undergraduate/standards , Faculty, Medical , Focus Groups , Germany , Humans , Male , Pandemics , Qualitative Research , SARS-CoV-2 , Students, Medical
7.
Med Teach ; 43(7): 817-823, 2021 07.
Article in English | MEDLINE | ID: covidwho-1246484

ABSTRACT

The COVID-19 pandemic has disrupted many societal institutions, including health care and education. Although the pandemic's impact was initially assumed to be temporary, there is growing conviction that medical education might change more permanently. The International Competency-based Medical Education (ICBME) collaborators, scholars devoted to improving physician training, deliberated how the pandemic raises questions about medical competence. We formulated 12 broad-reaching issues for discussion, grouped into micro-, meso-, and macro-level questions. At the individual micro level, we ask questions about adaptability, coping with uncertainty, and the value and limitations of clinical courage. At the institutional meso level, we question whether curricula could include more than core entrustable professional activities (EPAs) and focus on individualized, dynamic, and adaptable portfolios of EPAs that, at any moment, reflect current competence and preparedness for disasters. At the regulatory and societal macro level, should conditions for licensing be reconsidered? Should rules of liability be adapted to match the need for rapid redeployment? We do not propose a blueprint for the future of medical training but rather aim to provoke discussions needed to build a workforce that is competent to cope with future health care crises.


Subject(s)
COVID-19 , Education, Medical , Internship and Residency , Clinical Competence , Competency-Based Education , Curriculum , Goals , Humans , Pandemics , SARS-CoV-2
8.
Med Teach ; 43(7): 810-816, 2021 07.
Article in English | MEDLINE | ID: covidwho-1243349

ABSTRACT

Competency-based medical education has been advocated as the future of medical education for nearly a half-century. Inherent to this is the promise that advancement and transitions in training would be defined by readiness to practice rather than by time. Of the logistical problems facing competency-based, time-variable (CBTV) training, enacting time variability may be the largest hurdle to clear. Although it is true that an 'all or nothing' approach to CBTV training would require massive overhauls of both medical education and health care systems, the authors propose that training institutions should gradually evolve within their current environments to incrementally move toward the best version of CBTV training for learners, supervisors, and patients. In support of this evolution, the authors seek to demonstrate the feasibility of advancing toward the goal of realistic CBTV training by detailing examples of successful CBTV training and describing key features of initial steps toward CBTV training implementation.


Subject(s)
COVID-19 , Pandemics , Clinical Competence , Competency-Based Education , Humans , SARS-CoV-2
9.
Med Teach ; 43(7): 774-779, 2021 07.
Article in English | MEDLINE | ID: covidwho-1240814

ABSTRACT

The COVID-19 pandemic has exposed a paradox in historical models of medical education: organizations responsible for applying consistent standards for progression have needed to adapt to training environments marked by inconsistency and change. Although some institutions have maintained their traditional requirements, others have accelerated their programs to rush nearly graduated trainees to the front lines. One interpretation of the unplanned shortening of the duration of training programs during a crisis is that standards have been lowered. But it is also possible that these trainees were examined according to the same standards as usual and were judged to have already met them. This paper discusses the impacts of the COVID-19 pandemic on the current workforce, provides an analysis of how competency-based medical education (CBME) in the context of the pandemic might have mitigated wide-scale disruption, and identifies structural barriers to achieving an ideal state. The paper further calls upon universities, health centres, governments, certifying bodies, regulatory authorities, and health care professionals to work collectively on a truly time-variable model of CBME. The pandemic has made clear that time variability in medical education already exists and should be adopted widely and formally. If our systems today had used a framework of outcome competencies, sequenced progression, tailored learning, focused instruction, and programmatic assessment, we may have been even more nimble in changing our systems to care for our patients with COVID-19.


Subject(s)
COVID-19 , Education, Medical , Competency-Based Education , Curriculum , Humans , Pandemics , SARS-CoV-2
10.
Acad Med ; 96(11): 1529-1533, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1226568

ABSTRACT

The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/psychology , Delivery of Health Care/trends , Students, Medical/psychology , Academic Medical Centers/economics , Biomedical Technology/instrumentation , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Competency-Based Education/methods , Creativity , Education, Distance/methods , Education, Medical, Graduate/economics , Humans , Leadership , Policy Making , SARS-CoV-2/genetics , Telemedicine
16.
J Postgrad Med ; 67(1): 18-23, 2021.
Article in English | MEDLINE | ID: covidwho-1061064

ABSTRACT

The uncertainty in all spheres of higher education due to the COVID-19 pandemic has had an unprecedented impact on teaching-learning and assessments in medical colleges across the globe. The conventional ways of assessment are now neither possible nor practical for certifying medical graduates. This has necessitated thoughtful considerations in making adjustments to the assessment system, with most institutions transitioning to online assessments that so far have remained underutilized. Programmatic assessment encourages the deliberate and longitudinal use of diverse assessment methods to maximize learning and assessment and at present can be utilized optimally as it ensures the collection of multiple low-stake assessment data which can be aggregated for high-stake pass/fail decisions by making use of every opportunity for formative feedback to improve performance. Though efforts have been made to introduce programmatic assessment in the competency-based undergraduate curriculum, transitioning to online assessment can be a potential opportunity if the basic tenets of programmatic assessment, choice of online assessment tools, strategies, good practices of online assessments and challenges are understood and explored explicitly for designing and implementing online assessments. This paper explores the possibility of introducing online assessment with face-to-face assessment and structuring a blended programmatic assessment in competency-based medical education.


Subject(s)
Competency-Based Education/methods , Curriculum , Education, Distance/methods , Education, Medical/methods , Educational Measurement/methods , Humans , India
19.
Int J Environ Res Public Health ; 17(21)2020 10 27.
Article in English | MEDLINE | ID: covidwho-895363

ABSTRACT

Due to the coronavirus disease (COVID-19) pandemic, there are many restrictions in effect in clinical nursing practice. Since effective educational strategies are required to enhance nursing students' competency in clinical practice, this study sought to evaluate the effectiveness of simulation problem-based learning (S-PBL). A quasi-experimental control group pretest-post-test design was used. Nursing students were allocated randomly to the control group (n = 31) and the experimental group (n = 47). Students in the control group participated in a traditional maternity clinical practicum for a week, while students in the experimental group participated S-PBL for a week. The students in the experimental group were trained in small groups using a childbirth patient simulator (Gaumard® Noelle® S554.100, Miami, USA) based on a standardized scenario related to obstetric care. The students' learning attitude, metacognition, and critical thinking were then measured via a self-reported questionnaire. Compared with the control group, the pre-post difference in learning attitude and critical thinking increased significantly (p < 0.01) in the experimental group. S-PBL was found to be an effective strategy for improving nursing students' learning transfer. Thus, S-PBL that reflects various clinical situations is recommended to improve the training in maternal health nursing.


Subject(s)
Competency-Based Education/methods , Metacognition , Problem-Based Learning/methods , Simulation Training/methods , Students, Nursing/psychology , Thinking , Betacoronavirus , COVID-19 , Clinical Competence , Coronavirus Infections/epidemiology , Education, Nursing, Baccalaureate/methods , Educational Measurement , Female , Humans , Pandemics , Pneumonia, Viral/epidemiology , Preceptorship , Pregnancy , SARS-CoV-2
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