The History of Medical Education in Europe and the United States, With Respect to Time and Proficiency.

In this article, the authors present a historic overview of the development of medical education in the United States and Europe (in particular the Netherlands), as it relates to the issues of time (duration of the course) and proficiency (performance requirements and examinations). This overview is necessarily limited and based largely on post hoc interpretation, as historic data on time frames are not well documented and the issue of competence has only recently been addressed.During times when there were few, if any, formal regulations, physicians were primarily "learned gentlemen" in command of few effective practical skills, and the duration of education and the competencies acquired by the end of a course simply did not appear to be issues of any interest to universities or state authorities. Though uniform criteria gradually developed for undergraduate medical education, postgraduate specialty training remained, before accreditation organizations set regulations, at the discretion of individual institutions and medical societies. This resulted in large variability in training time and acquired competencies between residency programs, which were often judged on the basis of opaque or questionable criteria. Considering the high costs of health care today and the increasing demand for patient safety and educational efficiency, continuing historic models of nonstandardized practices will no longer be feasible. Efforts to constrain, restructure, and individualize training time and licensing tracks to optimize training for safe care, both in the United States and Europe, are needed.

Competency-based education in anesthesiology: history and challenges.

The Accreditation Council for Graduate Medical Education is transitioning to a competency-based system with milestones to measure progress and define success of residents. The confines of the time-based residency will be relaxed. Curriculum must be redesigned and assessments will need to be precise and in-depth. Core anesthesiology faculty will be identified and will be the "trained observers" of the residents' progress. There will be logistic challenges requiring creative management by program directors. There may be residents who achieve "expert" status earlier than the required 36 months of clinical anesthesia education, whereas others may struggle to achieve acceptable status and will require additional education time. Faculty must accept both extremes without judgment. Innovative new educational opportunities will need to be created for fast learners. Finally, it will be important that residents embrace this change. This will require programs to clearly define the specific aims and measurement endpoints for advancement and success.

Outcome (competency) based education: an exploration of its origins, theoretical basis, and empirical evidence.

Outcome based or competency based education (OBE) is so firmly established in undergraduate medical education that it might not seem necessary to ask why it was included in recommendations for the future, like the Flexner centenary report. Uncritical acceptance may not, however, deliver its greatest benefits. Our aim was to explore the underpinnings of OBE: its historical origins, theoretical basis, and empirical evidence of its effects in order to answer the question: How can predetermined learning outcomes influence undergraduate medical education? This literature review had three components: A review of historical landmarks in the evolution of OBE; a review of conceptual frameworks and theories; and a systematic review of empirical publications from 1999 to 2010 that reported data concerning the effects of learning outcomes on undergraduate medical education. OBE had its origins in behaviourist theories of learning. It is tightly linked to the assessment and regulation of proficiency, but less clearly linked to teaching and learning activities. Over time, there have been cycles of advocacy for, then criticism of, OBE. A recurring critique concerns the place of complex personal and professional attributes as "competencies". OBE has been adopted by consensus in the face of weak empirical evidence. OBE, which has been advocated for over 50 years, can contribute usefully to defining requisite knowledge and skills, and blueprinting assessments. Its applicability to more complex aspects of clinical performance is not clear. OBE, we conclude, provides a valuable approach to some, but not all, important aspects of undergraduate medical education.

History and practice of competency-based assessment.

CONTEXT: In response to historical trends in expectations of doctors, the goals of medical education are increasingly framed in terms of global competencies. The language of these competencies has tended to adopt a prescriptive, rather than descriptive, approach. However, despite widespread agreement on the importance of competency-based education and more than two decades of study, this effort has not generated a dependable set of assessment tools. DISCUSSION: Because models of competency are legislated, rather than shaped by scholarly consideration of empirical data, it is unlikely that such models directly reflect actual human behaviour. Efforts to measure clinical behaviours could benefit from increased clarity in three related conceptual areas. Firstly, the language of educational constructs should be framed in terms of data-based hypotheses, rather than in terms of intuitively plausible abilities. Secondly, these constructs should be specified in terms of the situations to which they are relevant, rather than as global personal characteristics. Finally, the resources required to measure these constructs should be rigorously established because a common resource-based metric would allow for rational selection of assessment methods. Specific methods to establish each of these objectives are discussed. CONCLUSIONS: The political process of negotiating educational objectives should not be confused with the scientific work of establishing coherent and interpretable patterns of behaviour. Although the two activities can complement one another, each has its own distinct methods and style of discourse. It is thus critical to maintain boundaries between these two approaches to defining professional performance.

Adaptación del nuevo Grado en Medicina al Espacio Europeo de Educación Superior. ¿Cuál ha sido la aportación de Bolonia? / Adaptation of the new medical degree to the European Space for Higher Education. What has been the contribution of Bologna?

En los tres últimos años, el desarrollo de una profunda reordenación de las enseñanzas universitarias ha permitido cumplir con los compromisos de la Declaración de Bolonia y adaptar todas las enseñanzas para la nueva estructura de grado que se implantará en octubre del año 2010. En esta línea, (ORDEN ECI/332/2008) se han establecido los requisitos que deberán cumplir los títulos de grado que habiliten para el ejercicio de la profesión de médico. En los nuevos planes de estudio se prioriza la adquisición de competencias por parte de los estudiantes, y se hace énfasis en los métodos de aprendizaje de dichas competencias, así como en los procedimientos para evaluar su adquisición. Los créditos europeos (European Credit Transfer System [ECTS], entre 25 y 30h), constituyen la unidad de medida que refleja los resultados del aprendizaje. Además, se impulsa la adquisición de habilidades clínicas mediante la realización obligatoria de prácticas preprofesionales, en forma de un periodo de rotación clínico independiente y con una evaluación final de competencias, en los centros de salud, hospitales y otros centros asistenciales. En los próximos años se comprobará si esta modernización curricular de los planes de estudios mejora el ejercicio profesional de los nuevos médicos(AU)

In the last three years, the development of a profound reorganization of university teachings has made it possible to comply with the commitments of the Declaration of Bologna and to adapt all teaching to the new structure of the degree program that will be introduced in October 2010. Along these lines (Order ECI/332/2008), the requirements that must be fulfilled by the university degrees to be able to practice the medical profession have been established. In the new study plans, acquisition of skills by the students is given priority and emphasis is placed on the learning methods of these skills, and on the procedures to evaluate their acquisition. The European Credit Transfer System (ACTS), (between 25 and 30h), is the measurement unit that reflects the learning results. Furthermore, acquisition of clinical skills is promoted through the obligatory performance of pre-professional practices, in form of a period of independent clinical rotation and with a final evaluation of the skills, in health care centers, hospitals, and other care centers. In the upcoming years, it will be verified if this curriculum modernization of the study plans improves the professional practice of the new physicians(AU)

Competencias profesionales del psicólogo del Deporte / No disponible

A menudo nos preguntamos qué dewbe saber hacer un psicólogo para aplicar sus concocimientos en un área específica de intervención, éstas son las denominadas competencias profesionales. Para adquirir dichas competencias, se hace necesaria una adecuada formación en psicología y, en la época que vivimos, se hace imprescindible que dichos conocimientos sean equivalentes en todos los profesionales de Europa, dada la posibilidad del intercambio de profesionales dentro de nuestras fronteras europeas. En este trabajo analizaremos cuáles son y cómo deben adquirirse dichas competencias, analizándolas específicamente en el ámbito de aplicación de la Psicología del Deporte(AU)

Often we ask ourselves what dewbe a psychologist is able to do to apply his concocimientos in a specific area of intervention, these are the professional competitions called. To acquire the above mentioned competitions, a suitable formation becomes necessary in psychology and, in the epoch through that we live, it becomes indispensable that the above mentioned knowledge is equivalent in all the professionals of Europa, given the possibility of the professionals' exchange inside our European borders. In this work we will analyze which are and how the above mentioned competitions must be acquired, analyzing them specifically in the area of application of the Psychology of the Sport (AU)

Competency-based medical education: theory to practice.

Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership - the International CBME Collaborators - to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.

Percepções de competência: um estudo com crianças e adolescentes do ensino fundamental / Perceptions of competence: an study with children and adolescents from elementary school

Este estudo teve o objetivo de investigar como as crianças expressam suas percepções de competência nos diferentes domínios do comportamento humano. Foi utilizada a Escala de Percepção de Competência para Crianças com 96 crianças do ensino fundamental público. Os resultados sugerem que: a) crianças mais velhas apresentam níveis menores de percepção de competência; b) as percepções de competência de meninos e meninas nos diferentes domínios foram semelhantes; c) a percepção de competência escolar é mais baixa para as crianças mais velhas e repetentes; e, d) a menor competência escolar percebida, parece não afetar os níveis de competência nos demais domínios.

The objective of this study was to investigate how children perceived their competence in the different domains of human behavior. The Perceived Competence Scale was used with 96 children from elementary public school. The results suggested that: a) older children showed lower levels of perceived competence; b) boys and girls perceived competence in the different domains were similar; c) cognitive perceptions of competence were lower in older children as well as in children that repeated school year; e, d) the lower perceptions of cognitive competence appears have no effect in the perceptions of competence in the others domains.

El objetivo de este estudio fue investigar cómo niños expresan sus percepciones de competencia en los diferentes dominios del comportamiento humano. Se ha utilizado la Escala de Percepción de Competencia para Niños con 96 niños de la enseñanza fundamental pública. Los resultados sugieren que a) niños mayores presentan niveles de percepción de competencia más bajos; b) las percepciones de competencia de niños y niñas en los diferentes dominios han sido semejantes; c) la percepción de competencia escolar es inferior para los niños mayores y repitentes; y d) la menor competencia escolar percibida parece no afectar los niveles de competencia en los demás domínios.