Comprehensive educational performance improvement (CEPI): an innovative competency-based assessment tool

The focus of competency-based training is on outcomes, specifically well-trained residents. Our goal is to help move resident assessment away from content- and process-based factors and towards measures of mastery of practice. Doing so requires reorganizing and reprioritizing elements of the training program. We describe our attempt to shift the priorities of our program (the primary care internal medicine residency of the Mount Sinai School of Medicine [Elmhurst] Program) towards the desired outcomes of the medical resident, faculty, institution, and program as a whole. These outcomes are based on the six core competencies of graduate medical education (medical knowledge, patient care, interpersonal and communication skills, professionalism, systems-based practice, and practice-based learning and improvement). We call this process "comprehensive educational performance improvement" (CEPI).

We began by identifying each individual learning element of the program and classifying it into a clinical, didactic or evaluative "domain." We thus identified 40 clinical learning elements (specific outpatient and inpatient clinical settings), 25 didactic learning elements (specific lecture formats, workshops, conferences, etc.), and 11 evaluative elements (evaluation formats and contexts). Then we developed a set of questions intended to define and evaluate each element. Finally, we established criteria for prioritizing these questions, by asking relevant faculty, staff, and residents to assign priority scores for each.

By this process, we generated 2-6 questions for each learning element, resulting in a total of 301 questions. This constituted a comprehensive plan for the assessment of both the program and the competency of the medical residents who have completed the program. Examples of the application of this process are described.

The CEPI process has a number of strengths. It allows for the concurrent assessment of each learning element with its intended outcomes, enabling us to simultaneously assess its outcome and its programmatic value. It effectively integrates the cognitive aspects of a program element with its clinical aspects, along with the input of evaluators at various levels. Finally, it helps train faculty members in an evidence-based approach to the curriculum.