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Year : 2019  |  Volume : 51  |  Issue : 3  |  Page : 212--213

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

Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2,  
1 Vice-Principal Curriculum, Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Kancheepuram, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Kancheepuram, Tamil Nadu, India

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Associate Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet Taluk, Kancheepuram 603 108, Tamil Nadu
India

Abstract

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.



How to cite this article:
Shrivastava SR, Shrivastava PS. Whether introduction of competency-based medical education should be advocated in India?.Indian J Pharmacol 2019;51:212-213


How to cite this URL:
Shrivastava SR, Shrivastava PS. Whether introduction of competency-based medical education should be advocated in India?. Indian J Pharmacol [serial online] 2019 [cited 2021 Dec 5 ];51:212-213
Available from: https://www.ijp-online.com/text.asp?2019/51/3/212/262459


Full Text



 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.[1],[2] 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.[1],[2],[3] 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.[1],[2],[3] 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).[1],[2]

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.[2],[3] 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?[1],[4] This is because of the various challenges which have been identified in the planning and implementation phase of the program.[4],[5],[6] 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.[1],[5],[6] The successful implementation of CBME program essentially depends on the sensitization programs for all the faculty members and dedicated faculty members.[4],[5],[6]

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.[5],[6] 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.[5],[6] 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.[1],[5],[6]

 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.

References

1Shah N, Desai C, Jorwekar G, Badyal D, Singh T. Competency-based medical education: An overview and application in pharmacology. Indian J Pharmacol 2016;48:S5-9.
2Ferguson PC, Caverzagie KJ, Nousiainen MT, Snell L. ICBME Collaborators. Changing the culture of medical training: An important step toward the implementation of competency-based medical education. Med Teach 2017;39:599-602.
3Kiguli-Malwadde E, Olapade-Olaopa EO, Kiguli S, Chen C, Sewankambo NK, Ogunniyi AO, et al. Competency-based medical education in two Sub-Saharan African medical schools. Adv Med Educ Pract 2014;5:483-9.
4Shrivastava SR, Shrivastava PS, Ramasamy J. Development of a module to successfully implement competency based medical education program in an institute. Muller J Med Sci Res 2018;9:27-9.
5Caverzagie KJ, Nousiainen MT, Ferguson PC, Ten Cate O, Ross S, Harris KA, et al. Overarching challenges to the implementation of competency-based medical education. Med Teach 2017;39:588-93.
6Hawkins RE, Welcher CM, Holmboe ES, Kirk LM, Norcini JJ, Simons KB, et al. Implementation of competency-based medical education: Are we addressing the concerns and challenges? Med Educ 2015;49:1086-102.