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Millennials are quickly becoming the most prevalent generation of medical learners. These individuals have a unique outlook on education and have different preferences and expectations than their predecessors. As evidenced by its implementation by the Accreditation Council for Graduate Medical Education in the United States and the Royal College of Physicians and Surgeons in Canada, competency based medical education is rapidly gaining international acceptance. Characteristics of competency based medical education can be perfectly paired with Millennial educational needs in several dimensions including educational expectations, the educational process, attention to emotional quotient and professionalism, assessment, feedback, and intended outcomes. We propose that with its attention to transparency, personalized learning, and frequent formative assessment, competency based medical education is an ideal fit for the Millennial generation as it realigns education and assessment with the needs of these 21st century learners.

Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

Background In competency-based medical education emphasis has shifted towards outcomes, capabilities, and learner-centeredness. Together with a focus on sustained evidence of professional competence this calls for new methods of teaching and assessment. Recently, medical educators advocated the use of a holistic, programmatic approach towards assessment. Besides maximum facilitation of learning it should improve the validity and reliability of measurements and documentation of competence development. We explored how, in a competency-based curriculum, current theories on programmatic assessment interacted with educational practice. Methods In a development study including evaluation, we investigated the implementation of a theory-based programme of assessment. Between April 2011 and May 2012 quantitative evaluation data were collected and used to guide group interviews that explored the experiences of students and clinical supervisors with the assessment programme. We coded the transcripts and emerging topics were organised into a list of lessons learned. Results The programme mainly focuses on the integration of learning and assessment by motivating and supporting students to seek and accumulate feedback. The assessment instruments were aligned to cover predefined competencies to enable aggregation of information in a structured and meaningful way. Assessments that were designed as formative learning experiences were increasingly perceived as summative by students. Peer feedback was experienced as a valuable method for formative feedback. Social interaction and external guidance seemed to be of crucial importance to scaffold self-directed learning. Aggregating data from individual assessments into a holistic portfolio judgement required expertise and extensive training and supervision of judges. Conclusions A programme of assessment with low-stakes assessments providing simultaneously formative feedback and input for summative decisions proved not easy to implement. Careful preparation and guidance of the implementation process was crucial. Assessment for learning requires meaningful feedback with each assessment. Special attention should be paid to the quality of feedback at individual assessment moments. Comprehensive attention for faculty development and training for students is essential for the successful implementation of an assessment programme.

Abstract Over the last decade, strict duty hour policies, pressure for increased work related value units from faculty, and the apprenticeship model of education have coalesced to make opportunities for intraoperative teaching more challenging. Evidence is emerging that graduating residents are not exhibiting competence by failing to recognize major complications, and perform routine operations independently. In this pilot study, we combine Vygotsky's social learning theory with a modified version of the competency-based scale called TAGS to study 1 single operation, anterior cervical discectomy and fusion, with 3 individual residents taught by a single faculty member. In order for the 3 residents to achieve “Solo and Observe” in all 4 zones of proximal development, the number of cases required was 10 cases for postgraduate year (PGY)-3a, 19 cases for PGY 3b, and 22 cases for the PGY 2. In this pilot study, the time required to complete an independent 2-level anterior cervical discectomy and fusion by the residents correlated with the number of cases to reach competence. We demonstrate the Surgical Autonomy Program's ability to track neurosurgical resident's educational progress and the feasibility of using the Surgical Autonomy Program (SAP) to teach residents in the operating room and provide immediate formative feedback. Ultimately, the SAP represents a paradigm shift towards a modern, scalable competency-focused subspecialty teaching, evaluation and assessment tool that provides increases in resident's autonomy and metacognitive skills, as well as immediate formative feedback.

The Accreditation Council for Graduate Medical Education (ACGME) emphasizes the importance of medical trainees meeting specific performance benchmarks and demonstrating readiness for unsupervised practice. The aim of this study was to examine the readiness of Gastroenterology (GI) fellowship programs for competency-based evaluation in endoscopic procedural training. ACGME-accredited GI program directors (PDs) and GI trainees nationwide completed an online survey of domains relevant to endoscopy training and competency assessment. Participants were queried about current methods and perceived quality of endoscopy training and assessment of competence. Participants were also queried about factors deemed important in endoscopy competence assessment. Five-point Likert items were analyzed as continuous variables by an independent t-test and χ(2)-test was used for comparison of proportions. Survey response rate was 64% (94/148) for PDs and 47% (546/1,167) for trainees. Twenty-three percent of surveyed PDs reported that they do not have a formal endoscopy curriculum. PDs placed less importance (1—very important to 5—very unimportant) on endoscopy volume (1.57 vs. 1.18, P<0.001), adenoma detection rate (2.00 vs. 1.53, P<0.001), and withdrawal times (1.96 vs. 1.68, P=0.009) in determining endoscopy competence compared with trainees. A majority of PDs report that competence is assessed by procedure volume (85%) and teaching attending evaluations (96%). Only a minority of programs use skills assessment tools (30%) or specific quality metrics (28%). Specific competencies are mostly assessed by individual teaching attending feedback as opposed to official documentation or feedback from a PD. PDs rate the overall quality of their endoscopy training and assessment of competence as better than overall ratings by trainees. Although the majority of PDs and trainees nationwide believe that measuring specific metrics is important in determining endoscopy competence, most programs still rely on procedure volume and subjective attending evaluations to determine overall competence. As medical training transitions from an apprenticeship model to competency-based education, there is a need for improved endoscopy curricula which are better suited to demonstrate readiness for unsupervised practice.

Background Evaluation of competency-based medical curricula is still a challenge. Curriculum mapping comprises all learning objectives for the learning events which are (usually) mapped to a national framework. This study evaluates coherence within the learning spiral across two consecutive competency-based curricula by usage of curricular maps. Methods Curriculum mapping data of two undergraduate medical curricula (Bachelor and consecutive Master) from two different Swiss universities was used to evaluate a given topic (in our case cardiology) related to continuity and increasing complexity. In addition, coverage of the Swiss national framework (’PROFILES’) was assessed. Results A continuous exposure to cardiovascular content across the two programs as well as an increasing complexity was found. The analysis further showed that most parts of the national Swiss framework (‘PROFILES’) are covered to some extent and revealed missing coverage of some parts of the first chapter (‘General Objectives’) and second chapter (‘Entrustable Professional activities’). Conclusion The results support the implicit notion that the medical curriculum across two universities can be coherent and provide the necessary structure to enable a coordinated learning spiral. The approach can be used for any curriculum which has been mapped to a framework to evaluate the coherence and coordination of a learning spiral in each field. This approach can be very valuable especially for medical programs where students change from one institution to another.

Background: Competency-based nursing education necessitates effective instructional methods and assessment tools for evaluating students' knowledge, skills, and attitudes. Clinical simulation has emerged as a valuable approach, but creating well-crafted simulations traditionally requires substantial time and effort. The advent of artificial intelligence (AI), exemplified by ChatGPT (OpenAI), offers promising advancements in streamlining scenario creation. Method: This article explores the application of ChatGPT-3, version GPT-3, created by OpenAI in generating clinical simulation scenarios for nursing education. The focus is on the convenience, speed, and creativity provided by ChatGPT, enabling nurse educators to save time while developing intricate and thought-provoking scenarios. Results: ChatGPT generates intricate scenarios that stimulate critical thinking, significantly reducing the time required for nurse educators to create simulations. This AI tool's ability to produce clinical simulations quickly demonstrates its potential to enhance educational experiences in nursing. Conclusion: ChatGPT's convenience, speed, and innovative capabilities make it invaluable for constructing dynamic clinical simulations, opening new avenues for innovative instruction in nursing education. This article highlights the transformative role of AI in empowering educators and enhancing educational experiences, showcasing ChatGPT's potential to revolutionize nursing education despite ongoing discussions about its potential negative impacts. [J Nurs Educ. 2024;63(X):XXX–XXX.]

Given the complexity of the transition to competency-based medical education (CBME) and the diversity of systems and learning contexts, the literature has acknowledged the need for principled yet contextual approaches to implementation. There is a need for research that examines these adaptations and their consequences, both intended and unintended. We performed a constructivist grounded theory study to explore how the theory of CBME translated to practice in operative settings in a Canadian approach to CBME: Competence by Design (CBD). Program contexts both enabled and hindered how CBD translated into practice. The operative context was aligned with the principles of competency-focused instruction and allowed for frequent, direct observation and formative feedback. Time, personnel, and technology constraints unique to the patterns of practice in operative settings hindered programmatic assessment. Adaptations to CBME that are responsive to the context of programs can support the intended conceptual learning conditions of CBME.

Background Integrating digital technologies in clinical dentistry training is increasingly recognized as essential for modernizing competency-based education. However, structured frameworks for digital technology adoption in dental training are lacking, particularly in resource-limited settings such as Tanzania. This study assesses digital technology integration in clinical dentistry training and proposes a structured framework to enhance competency-based education. Methods A mixed-methods research design was employed, integrating quantitative and qualitative approaches. Data were collected from dental students, educators, graduates, and policymakers through structured questionnaires, semi-structured interviews, and focus group discussions. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were subjected to thematic analysis. Results The study found that while 57% of institutions had access to electronic health records (EHR) systems and 25% had digital imaging tools, advanced digital technologies such as AI-powered diagnostics and teledentistry platforms were absent. Significant digital competency gaps were identified, with only 27.5% of students and graduates rating their proficiency as “good” or “very good.” Faculty training remained limited, with only 20% of public institution faculty receiving digital training. Key barriers to digital integration included financial constraints, inadequate infrastructure, and lack of structured policies. Conclusions The study highlights the need for a structured digital integration framework in Tanzanian dental training institutions. The proposed framework emphasizes institutional readiness, faculty training, infrastructure development, and student competency enhancement. Implementing these measures will enhance digital literacy and ensure that graduates are equipped for modern dental practice. Clinical trial number Not applicable.

[...]the background of a simulation includes resources such as time and equipment, as well as how these resources will be allocated. [...]there is emerging literature about outcomes of simulation covering health outcomes of patients or care recipients whose caregivers were trained using simulation and organizational/system outcomes of simulation, including studies about cost-effectiveness and changes of practice.