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Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 44-45

Overarching challenges to be addressed before implementing competency-based medical education in India

Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. V Dinesh Kumar
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjhs.bjhs_5_19

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How to cite this article:
Kumar V D, Rajasekhar S S. Overarching challenges to be addressed before implementing competency-based medical education in India. BLDE Univ J Health Sci 2019;4:44-5

How to cite this URL:
Kumar V D, Rajasekhar S S. Overarching challenges to be addressed before implementing competency-based medical education in India. BLDE Univ J Health Sci [serial online] 2019 [cited 2020 Jul 2];4:44-5. Available from: http://www.bldeujournalhs.in/text.asp?2019/4/1/44/260740


We have read the Editorial by Vallabha[1] on the move toward competency-based medical education (CBME) in Indian Medical Academia with great enthusiasm. We would like to add to the discussion by highlighting certain pertinent issues that could potentially influence the impact of large-scale change. Following the MCI's proposal, there was a buzz among the academic faculty in various academic and social media platforms where many opined the need for a sensitization/orientation program on CBME before its implementation. Even though the intension of CBME is great and attractive, it is difficult for any academic community to accept the paradigm shift like a “gospel” and without subjecting it to a critical review. Salim and White[2] used the metaphor of swimming in a tsunami to describe this transformative stage because an adequate preparation is quintessential in achieving the desired goal, i.e. attaining a defined level of proficiency in the context of specified local needs. Otherwise, there is chance that it could become yet another educational reform that would be “lost in translation,” akin to the famous parable of blind men and elephant. Viewing under the “optimistic” lens, we would like to highlight four predominant challenges from the faculty's perspective that would develop a shared understanding among various stakeholders of medical academia.

First, since CBME involves complete revamping of teaching and assessment methodologies, there is a felt need for faculty development programs. We would like to point out that these programs should start from the very basics including the standard language required for operationalizing it.[3] Second, according to the Dreyfus[4] model of competence, the medical trainees acquire competency in the form of a continuum, at their “own pace.” Hence, the modules framed for CBME should be designed in a flexible manner. It becomes all the more difficult to implement in colleges who have traditional training schemes and are already burdened by a low faculty: student ratio. Furthermore, as the time available for covering a mammoth syllabus is getting shortened over the years, it is difficult to test the degrees of attainment of each competency at an individual level. The main intension behind the assessment is to verify the ability to entrust the vital professional activities to learners. Hence, the learning environments should be appropriately fortified to facilitate a regular and continuous observation of the performance of students and to provide real-time feedback.

Third, the entire change process mandates the faculty to don new roles that are in stark contrast to the traditional training schemes that are in practice until now.[5] Any radical curricular reform would make a fraction of executors feel skeptical or apprehensive as it warrants a change in their traditional skill set. For example, the practical assessment is required to be made more accurate in the form of a continuum, which is taxing when compared to the cross-sectional assessments followed until now. We wish to reiterate that Indian Medical Academia is still primitive in terms of differentiating the “decision moments” such as pass/fail from the “assessment moments”[6] even in postgraduate examinations. In the same context, most of the examiners do not try to collectively judge the candidate by adhering to basic principles of competency-based assessments. Moreover, we need to learn lessons from the previous medical educational reforms such as problem-based learning (PBL), which rarely got past the level of documents. On critical analysis, we feel that it is the lack of trained tutors, with adequate training and expertise in the theories of learning, that lead to the failure of PBL, even before it took off. Hence, it is wise to have a guarded approach by implementing the CBME in a phased manner starting from preclinical and paraclinical subjects. After the evaluation of the results from preliminary implementation, there will be room for appropriate modifications before implementation of CBME module in the clinical departments.

Moving any curricular reform from paper to classroom is a herculean task that requires a continuous effort, visionary leadership, and shared accountability among various stakeholders. Taking lessons from the short life spans of the previous reforms, we believe that the above-mentioned pitfalls can be circumvented by the strategic augmentation of workforce and meticulous efforts for effective adoption. Pragmatism and constructive debate on the issue at hand will lead us to the green pastures of intended outcome in the CBME.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Vallabha T. Moving toward competency-based medical education. BLDE Univ J Health Sci 2018; 3:67-8.  Back to cited text no. 1
  [Full text]  
Salim SY, White J. Swimming in a tsunami of change. Adv Health Sci Educ Theory Pract 2018;23:407-11.  Back to cited text no. 2
Carraccio CL, Englander R. From flexner to competencies: Reflections on a decade and the journey ahead. Acad Med 2013;88:1067-73.  Back to cited text no. 3
Dreyfus S. The five-stage model of adult skill acquisition. Bull Sci Technol Soc 2004;24:177-81. Available from: http://www.bumc.bu.edu/facdev-medicine/files/2012/03/Dreyfus-skilllevel.pdf. [Last accessed on 2019 Jan 10].  Back to cited text no. 4
Tsouroufli M, Payne H. Consultant medical trainers, modernising medical careers (MMC) and the European time directive (EWTD): Tensions and challenges in a changing medical education context. BMC Med Educ 2008;8:31.  Back to cited text no. 5
Schuwirth L, Ash J. Assessing tomorrow's learners: In competency-based education only a radically different holistic method of assessment will work. Six things we could forget. Med Teach 2013;35:555-9.  Back to cited text no. 6


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