title: Competency-based education: programme design and challenges to implementation.
abstract: BACKGROUND
  Competency-based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time-based training, and promotion of learner centredness. Each of these features has implications and potential challenges for implementing CBE.
  
  
  METHODS
  As an experiment in CBE programme design and implementation, the University of Michigan Master of Health Professions Education (UM-MHPE) degree programme was examined for lessons to be learned when putting CBE into practice. The UM-MHPE identifies 12 educational competencies and 20 educational entrustable professional activities (EPAs) that serve as the vehicle for both learning and assessment. The programme also defines distinct roles of faculty members as assessors, mentors and subject-matter experts focused on highly individualised learning plans adapted to each learner.
  
  
  CONCLUSIONS
  Early experience with implementing the UM-MHPE indicates that EPAs and competencies can provide a viable alternative to traditional courses and a vehicle for rigorous assessment. A high level of individualisation is feasible but carries with it significant costs and makes intentional community building essential. Most significantly, abandoning a time-based framework is a difficult innovation to implement in a university structure that is predicated on time-based education.
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Gruppen
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Burkhardt
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Ann Arbor VA Geriatrics Research, Education and Clinical Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Fitzgerald
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Funnell
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Haftel
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Lypson
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Mullan
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Santen
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Kent J
authors.initials: KJ
authors.lastname: Sheets
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.|Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Caren M
authors.initials: CM
authors.lastname: Stalburg
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Vasquez
mesh_terms: D003162:Competency-Based Education / Q000379:methods* / Q000458:organization & administration; D004501:Education, Medical / Q000379:methods* / Q000458:organization & administration; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D008824:Michigan; D016730:Program Development