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Assessing competencies using milestones along the way.

Ara Tekian1, Brian D Hodges, Trudie E Roberts

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This study explores global perspectives on using milestones for competency assessment in medical education. It highlights challenges and calls for new conceptualizations of competence beyond simple time-based progression.

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Area of Science:

  • Medical Education
  • Competency-Based Education
  • Assessment

Background:

  • Outcomes-based medical education emphasizes competency assessment.
  • Milestones are a key tool in assessing medical student progression.
  • Global approaches to milestone implementation vary significantly.

Purpose of the Study:

  • To present diverse global perspectives on milestone use in medical education.
  • To discuss controversies and challenges in implementing milestone-based competency assessment.
  • To explore the rationale behind different international approaches to milestones.

Main Methods:

  • Comparative analysis of milestone implementation in Canada, Europe, and the United States.
  • Review of current literature and expert perspectives on competency assessment.
  • Discussion of conceptual frameworks for milestones in medical education.

Main Results:

  • Canada is moving towards competency demonstration, requiring complex milestones.
  • Europe views time as crucial for achieving competence and milestones.
  • The US uses sampling for milestones, but this may not guarantee overall competence.

Conclusions:

  • Implementing outcomes-based medical education with milestones presents emerging challenges.
  • Complex, narrative-based milestones may be necessary for accurate competency assessment.
  • New conceptualizations of competence are needed to address limitations of current milestone systems.