Reconciling Competency-based and Precision medical education

We have all heard the challenges associated with US medical education.  They include the need for greater flexibility;  the modern student (medical or otherwise) wants to be able to customize their learning experience so that it fits in and around their other life pursuits and obligations. Reduction of cost is another challenge. As costs rise and resources dwindle, the considerable financial burden of schooling is landing on students – and with all the known short- and long-term implications of student debt. Finally, reformers want educators to close the competency gap between undergraduate medical education (UME) and graduate medical education (GME) while also making sure students leave school with the skills they need for the workforce, including but not limited to communication, collaboration, self-regulation, and lifelong learning skills.  Traditionally, medical education does not respond well to external mandates, non-medical expertise, or change. However, for reasons that are not completely known to me, it has taken to competency-based education as a potential solution for its issues related to inclusivity, cost, and efficacy.

According to a 2014 EDUCAUSE article, “competency-based education awards academic credit based on mastery of clearly defined competencies,”  or observable learner outcomes representing the integration of knowledge, skills, and attitudes. (See Competency-based medical education: The basics for additional definitions and background). Competency-based education has its critics, who tend to cite it as encouraging a checklist mentality as detrimental to critical thinking, deeper understanding, and connected learning.  Nevertheless, it has gained traction in the field to the point that the UME programs known for pedagogical innovation consider it a foregone conclusion. While it remains a buzzword to add to the webpage description, competency-based education is no longer something they advertise as new or cutting edge.

In the last year, a new buzzword emerged among perennial innovators such as Stanford, Johns Hopkins, and National Universities. Precision education (styled after the 2015 Obama Administration’s Precision Medicine Initiative) promises customizable curriculum and multiple learning pathways.  It is a semantic variation of personalized learning, which is found on medical school webpages nationwide, including those of Vanderbilt, Michigan State, and Oregon Health and Science Universities.  Precision or personalized learning (I’ll use precision education for the remainder of this post) focuses on customizability and the ways in which students can make a program their own.

Given the recent rise of precision education- in a time where medical schools are just accepting competency-based education –  I want to explore the relationship between the two concepts. Is it an and/or situation?  Do they overlap?  Or are they the same concept but with different names?

In this post, I will show how competency-based and precision education are both facets of the same general educational movement towards student-centered, active, and authentic learning.  When educators think and speak in terms of competency-based education, they are focusing on the educational design.  When they think and speak in terms of precision education, they are focusing on the student experience.  Which the school opts to emphasize (compare Vanderbilt’s Curriculum 2.0 vs. Oregon Health and Science University’s YourMD) have much to do with school culture and branding.

Competency-Based and Precision education.jpg

featured image: Gaelle Marcel on Unsplash


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