Making sense of competency-based medical education (CBME) literary conversations: A BEME scoping review: BEME Guide No. 78

Competency-based medical education (CBME) received increased attention in the early 2000s by educators, clinicians, and policy makers as a way to address concerns about physician preparedness and patient safety in a rapidly changing healthcare environment. Opinions and perspectives around this shift in medical education vary and, to date, a systematic search and synthesis of the literature has yet to be undertaken. The aim of this scoping review is to present a comprehensive map of the literary conversations surrounding CBME. Twelve different databases were searched from database inception up until 29 April 2020. Literary conversations were extracted into the following categories: perceived advantages, perceived disadvantages, challenges/uncertainties/skepticism, and recommendations related to CBME. Of the 5757 identified records, 387 were included in this review. Through thematic analysis, eight themes were identified in the literary conversations about CBME: credibility, application, community influence, learner impact, assessment, educational developments, organizational structures, and societal impacts of CBME. Content analysis supported the development of a heat map that provides a visual illustration of the frequency of these literary conversations over time. This review serves two purposes for the medical education research community. First, this review acts as a comprehensive historical record of the shifting perceptions of CBME as the construct was introduced and adopted by many groups in the medical education global community over time. Second, this review consolidates the many literary conversations about CBME that followed the initial proposal for this approach. These findings can facilitate understanding of CBME for multiple audiences both within and outside of the medical education research community.

基于胜任力的医学教育（Competency-based medical education, 以下简称CBME）在21世纪初受到教育工作者、临床医师与政策制定者的日益关注，该模式旨在应对快速变革的医疗环境中，医师执业准备度与患者安全领域存在的诸多顾虑。围绕这一医学教育转型的观点与看法存在分歧，且截至目前，学界尚未开展针对相关文献的系统性检索与综合分析工作。本次范围综述（scoping review）旨在全面梳理围绕CBME的文献研讨脉络。研究检索了12个不同数据库自建库至2020年4月29日的全部相关文献，相关文献研讨内容被划分为以下类别：感知优势、感知劣势、挑战/不确定性与质疑声，以及与CBME相关的建议。在检索得到的5757条文献记录中，最终有387条被纳入本次综述。通过主题分析，本次综述从围绕CBME的文献研讨中识别出8个核心主题：公信力、应用落地、社群影响力、学习者影响、评估体系、教育发展、组织结构，以及CBME的社会影响。内容分析支持构建了热图（heat map），可直观展示这些文献研讨内容随时间推移的出现频次。本综述可为医学教育研究领域达成两大目标：其一，本综述可作为一份全面的历史记录，展现随着全球医学教育界诸多群体逐步引入并采纳这一框架，学界对CBME的认知如何随时间演变；其二，本综述整合了自该模式首次提出以来，各类围绕CBME的文献研讨内容。本研究结果可帮助医学教育研究领域内外的多类受众更好地理解CBME。