Competency-Based Education and Programmatic Assessment in Undergraduate Medical Education: Describing the Gateway...

Despite the calls for adoption of competency-based medical education (CBME) in undergraduate medical education, many programs have only demonstrated partial implementation. Although most medical schools have developed competencies and benchmarks, many continue to rely on traditional and course-based assessment methods rather than programmatic assessment as called for with CBME.

The transition of Washington University School of Medicine (WashU) to a comprehensive CBME program, focusing on the implementation of programmatic assessment, based on the principles of longitudinality, triangulation, and proportionality is described. Program design began in 2017. On graduating the first class in 2024, WashU successfully transitioned from a traditional 2-year preclinical, 2-year clinical instructional and assessment system to one aligning key principles of programmatic assessment and CBME. The new system uses competency committees to make formative and summative judgments of competency attainment to inform promotion and graduation recommendations and separates competency from promotion and graduation decisions between 2 committees to support regulatory requirements.

Internal program evaluations showed high student satisfaction with assessment alignment (70.5%), formative feedback (90.6% quality, 91% quantity), assessment fairness (92.5%), midrotation feedback (94% quality, 91.3% quantity), and coaching (93.4%). Graduation questionnaires demonstrated that students were confident that they were judged on abilities and not identity group (e.g., race or ethnicity, gender, other) (90% vs 68.4% nationally) and perceived the curriculum fostered and nurtured development as people and professionals (80.2% vs 73.5% nationally and 93.4% vs 92.8%, respectively).

Next steps include continuing to have conversations with faculty and students about the goals of the new program, differences between competency-based and traditional assessment, and reminders about how to optimize performance review; continuing to increase partnership with coaches and career advisors; continuing to provide feedback on specific competencies; and exploring additional outcomes.