Implementing the 5 Core Components of Competency-Based Medical Education in US Emergency Medicine Residency Programs

Background As graduate medical education programs implement competency-based medical education (CBME) approaches, many specialties struggle to adopt this paradigm in a way that successfully incorporates the 5 core components of CBME. Objective To develop and implement the 5 core components of CBME within 8 US emergency medicine (EM) residency programs and assess acceptability and feasibility. Methods We designed an intervention to implement the 5 core components of CBME: (1) an outcomes framework; (2) developmental progression; (3) tailored learning experiences; (4) competency-focused instruction or coaching; and (5) programmatic assessment. A consensus process to develop the framework and developmental trajectory was followed and included the development and deployment of programmatic assessment, coaching programs, and individualized learning plans using a shared model for implementation. We implemented the intervention beginning in August 2021. We surveyed site implementation leads about its feasibility and acceptability. Results The survey response rate was 100% (8 of 8). Estimated time required for the project intervention was 2 to 15 hours per month and 4 to 21.4 hours per month for the program coordinator and program leadership, respectively, with no additional salary provided. Residents and faculty received brief training about the CBME program (0.25 to 1 hours for residents and 0.5 to 1 hour for faculty), with periodic reminders afterward. Site leads perceived mixed acceptability from residents and faculty. Perceived challenges to implementation included resistance to change, time limitations, faculty discomfort with providing written assessment data, and difficulties navigating institutional barriers to technology-enhanced data collection. Conclusions CBME was estimated to require manageable time for program staff and leadership, with mixed acceptability from residents and faculty.