Evaluating the Paradigm Shift from Time-Based Toward Competency-Based Medical Education: Implications for Curriculum and Assessment

Abstract

In the early twentieth century, most curricula were based on a concept of fixed time. Students who successfully completed a program were judged to be competent. However, a paradigm shift toward competency-based education occurred at the end of the twentieth century, allowing only students who are judged “competent” to move forward in a professional school curriculum. There are significant implications to this paradigm shift, particularly for curricular design, performance assessment, faculty development, and resources. Educators may find challenges addressing individual learning differences—some students are able to progress easily in some subject areas, while some may continue to struggle. Learners can also progress at different rates in competency-based education programs. While it is relatively easy to develop competencies in areas of knowledge and skill, it is more difficult to define milestone assessments in areas such as reasoning and judgment, and to assess complex professional behaviors. The promise in competency-based education is to graduate professionals who are better adapted for the needs of complex and rapidly changing systems. Yet, implementing competency-based curricula raise important questions not only in instruction, but also in the assessment of competencies and outcomes. This chapter synthesizes the existing literature and perspectives that support and critique competency-based education, identifies pressing challenges for educators, and speculates on the future of this still emerging paradigm.