Design and Implementation of Competency Based Postgraduate Medical Education in Otorhinolaryngology: The Pilot Experience in India

Abstract

The worldwide call for a shift towards competency based postgraduate medical education has until recently gone largely unheeded in India, despite the Medical Council of India enshrining the principle in its regulations for postgraduate institutions. This paper details the first concrete attempt at establishing a CBME curriculum in Otorhinolaryngology in India. The design and implementation of the CBME curriculum was carried out in four phases, in a time-bound manner over a period of 6 months. Phase I consisted of an extensive literature review and a clarification of the major objectives of the program. Phase II involved the listing out of 20–30 entrustable professional activities (EPAs) for each specialty and the 13 core EPAs common to all incoming residents and the subsequent mapping of these EPAs to their respective domains of competence and year-wise levels of competence. This was followed by the development of milestones for each EPA and appropriate clinical vignettes. Phase III focused on development of 360° assessment strategies, including the in-house development of an e-portfolio. Phase IV was dedicated to the implementation of the CBME curriculum, and involved various sensitization and orientation programs for faculty and the new residents. This exercise in designing and implementing a CBME program showed the important role that intra-departmental and inter-institutional cross-communication and exchange of ideas vies-a-vie workshops and personal communication play in bridging the lapses in knowledge in this emerging area, reaching consensus to achieve project goals and for finding relevant solutions to common problems. Medical education in India presents its own peculiar set of logistical and cultural challenges. Keeping in line with the recommendations of the Medical Council of India regarding Postgraduate Medical Education, it is essential that medical colleges in India not fall behind the international paradigm shift towards CBME.

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