Table 1.

Van Melle Framework6 for Competency-Based Medical Education

ComponentDescription
An outcomes-based competency framework
  • Desired outcomes of training are identified based on societal needs.

  • Outcomes are paramount so that the graduate functions as an effective health professional.

Progressive sequencing of competencies
  • In competency-based medical education (CBME), competencies and their developmental markers must be explicitly sequenced to support learner progression from novice to master clinicians.

  • Sequencing must consider that some competencies form building blocks for the development of further competence.

  • Progressions is not always a smooth, predictable curve.

Learning experiences tailored to competencies in CBME
  • Time is a resource, not a driver or criterion.

  • Learning experiences should be sequenced in a way that supports the progression of competence.

  • There must be flexibility to accommodate variation in individual learner progression.

  • Learning experiences should resemble the practice environment.

  • Learning experiences should be carefully selected to enable acquisition of one or many abilities.

  • Most learning experiences should be tied to an essential graduate ability.

Teaching tailored to competencies
  • Clinical teaching emphasizes learning through experience and application, not just knowledge acquisition.

  • Teachers use coaching techniques to diagnose a learner in clinical situations and give actionable feedback.

  • Teaching is responsive to individual learner needs.

  • Learners are actively engaged in determining their learning needs.

  • Teachers and learners coproduce learning.

Programmatic assessment (ie, program of assessment)
  • There are multiple points and methods for data collection.

  • Methods for data collection match the quality of the competency being assessed.

  • Emphasis is on workplace-based assessment.

  • Emphasis is on providing personalized, timely, meaningful feedback.

  • Progression is based on entrustment.

  • There is a robust system for decision making.

  • Good assessment requires attention to issues of implicit and explicit bias that can adversely affect the assessment process.