Competencies and Entrustable Professional Activities: new models for elaboration of a Curriculum Framework for Family and Community Medicine Residency
DOI:
https://doi.org/10.5712/rbmfc13(40)1632Keywords:
Internship and Residency, Curriculum, Family PracticeAbstract
Objective: The purpose is to carry out a literature review on Competency Based Curriculum that could support the elaboration of a matrix for the Residency Program in Family and Community Medicine of Fortaleza, Ceará. Methods: A literature review was made on the theoretical reference of competency-based education, selecting articles, guidelines, documents and curricula models of medical schools and national and international entities involved with medical education. Results: The literature review evidenced two main curriculum models repeatedly mentioned in the references: ACGME (Accreditation Council for Graduate Medical Education) Milestones and CanMEDS (Canadian Medical Education Directions for Specialists) Framework. Competency-Based Curriculum emphasizes student-centered teaching and uses a results-based approach to the design, implementation, and evaluation of medical education programs. It is organized as a framework of competencies mapped to entrustable professional activities in the form of a matrix. The evaluation is based on performance through milestones. For creating its own curricular Matrix, the CanMEDS 2015 was adopted as a model because it was approved by 12 Canadian medical organizations and it is currently used as reference in dozens of countries, being the most widely applied model in the world. Conclusion: We expect that this review would serve as a tool for other Medical Schools and their Residency Programs to develop their own Competency-Based Curricula.
Downloads
Metrics
References
Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: from Flexner to competencies. Acad Med [Internet]. 2002 [acesso 2017 Set 15];77(5):361-7. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/12010689 DOI: http://dx.doi.org/10.1097/00001888-200205000-00003 DOI: https://doi.org/10.1097/00001888-200205000-00003
Spady WG. Competency Based Education: A Bandwagon in Search of a Definition. Educ Res [Internet]. 1977 [acesso 2017 Set 15];6(1):9-14. Disponível em: http://journals.sagepub.com/doi/abs/10.3102/0013189X006001009 DOI: http://dx.doi.org/10.3102/0013189X006001009 DOI: https://doi.org/10.3102/0013189X006001009
Merenstein JH, Schulte JJ. A residency curriculum for the future. The STFM Task Force on Residency Curriculum for the Future. Fam Med [Internet]. 1990 [acesso 2017 Set 15];22(6):467-73. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/2262110
Fernandes CR, Farias Filho A, Gomes JMA, Pinto Filho WA, da Cunha GKF, Maia FL. Currículo baseado em competências na residência médica. Rev Bras Educ Med [Internet]. 2012 [acesso 2017 Set 15];36(1):129-36. DOI: http://dx.doi.org/10.1590/S0100-55022012000100018 DOI: https://doi.org/10.1590/S0100-55022012000100018
Albanese MA, Mejicano G, Mullan P, Kokotailo P, Gruppen L. Defining characteristics of educational competencies. Med Educ [Internet]. 2008 [acesso 2017 Set 15];42(3):248-55. DOI: http://dx.doi.org/10.1111/j.1365-2923.2007.02996.x DOI: https://doi.org/10.1111/j.1365-2923.2007.02996.x
Santos WS. Organização curricular baseada em competência na educação médica. Rev Bras Educ Med [Internet]. 2011 [acesso 2017 Set 15];35(51):86-92. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-55022011000100012 DOI: http://dx.doi.org/10.1590/S0100-55022011000100012 DOI: https://doi.org/10.1590/S0100-55022011000100012
Epstein RM, Hundert EM. Defining and assessing profesional competence. JAMA [Internet]. 2002 [acesso 2017 Set 15];287(2):226-35. DOI: http://dx.doi.org/10.1001/jama.287.2.226 DOI: https://doi.org/10.1001/jama.287.2.226
World Federation for Medical Education. Postgraduate Medical Education: WFME Global Standards for Quality Improvement (The 2015 Revision) [Internet]. Copenhagen: WFME; 2015 [acesso 2017 Set 15]. Disponível em: http://wfme.org/standards/pgme/
WONCA. WONCA Global Standards on Postgraduate Family Medicine Education [Internet]. 2013 Jun [acesso 2017 Set 15]. 17 p. Disponível em: http://www.globalfamilydoctor.com/site/DefaultSite/filesystem/documents/Groups/Education/WONCA ME stds_edit for web_250714.pdf
Frank JR, Snell LS, Ten Cate O, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: theory to practice. Med Teach [Internet]. 2010 [acesso 2017 Set 15];32(8):638-45. Disponível em: http://www.tandfonline.com/doi/full/10.3109/0142159X.2010.501190 DOI: http://dx.doi.org/10.3109/0142159X.2010.501190 DOI: https://doi.org/10.3109/0142159X.2010.501190
Araújo D. Noção de Competência e Organização Curricular. Rev Baiana Saúde Pública. 2007;31(Supl.1):32-43.
Long DM. Competency-based residency training: the next advance in graduate medical education. Acad Med [Internet]. 2000 Dec [acesso 2017 Set 15];75(12):1178-83. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/11112714 DOI: http://dx.doi.org/10.1097/00001888-200012000-00009 DOI: https://doi.org/10.1097/00001888-200012000-00009
Ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med [Internet]. 2007 Jun [acesso 2017 Set 15];82(6):542-7. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/17525536 DOI: https://doi.org/10.1097/ACM.0b013e31805559c7
Miller GE. The assessment of clinical skills/competence/performance. Acad Med [Internet]. 1990 [acesso 2017 Set 15];65(9):S63-7. DOI: http://dx.doi.org/10.1097/00001888-199009000-00045 DOI: https://doi.org/10.1097/00001888-199009000-00045
McCloskey CB, Domen RE, Conran RM, Hoffman RD, Post MD, Brissette MD, et al. Entrustable Professional Activities for Pathology. Acad Pathol [Internet]. 2017 [acesso 2017 Set 15];4. Disponível em: http://journals.sagepub.com/doi/10.1177/2374289517714283 DOI: http://dx.doi.org/10.1177/2374289517714283 DOI: https://doi.org/10.1177/2374289517714283
Ten Cate O. Entrustability of professional activities and competency-based training. Med Educ [Internet]. 2005 [acesso 2017 Set 15];39(12):1176-7. DOI: http://dx.doi.org/10.1111/j.1365-2929.2005.02341.x DOI: https://doi.org/10.1111/j.1365-2929.2005.02341.x
Ten Cate O. Competency-based education, entrustable professional activities, and the power of language. J Grad Med Educ [Internet]. 2013 [acesso 2017 Set 15];5(1):6-7. Disponível em: http://www.jgme.org/doi/full/10.4300/JGME-D-12-00381.1 DOI: http://dx.doi.org/10.4300/JGME-D-12-00381.1 DOI: https://doi.org/10.4300/JGME-D-12-00381.1
Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Med Teach [Internet]. 2015 [acesso 2017 Set 15];37(11):983-1002. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/26172347 DOI: http://dx.doi.org/10.3109/0142159X.2015.1060308 DOI: https://doi.org/10.3109/0142159X.2015.1060308
Shaughnessy AF, Sparks J, Cohen-Osher M, Goodell KH, Sawin GL, Gravel J Jr. Entrustable professional activities in family medicine. J Grad Med Educ [Internet]. Accreditation Council for Graduate Medical Education; 2013 Mar [acesso 2017 Maio 29];5(1):112-8. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/24404237 DOI: http://dx.doi.org/10.4300/JGME-D-12-00034.1 DOI: https://doi.org/10.4300/JGME-D-12-00034.1
Griffiths J, Schultz K. Developing EPAs (Entrustable Professional Activities) for Family Medicine [Internet]. 2013 [acesso 2018 Jan 19]. Disponível em: http://docplayer.net/8296592-Developing-epas-entrustable-professional-activities-for-family-medicine.html
Aguilera Campos CE. Os princípios da Medicina de Família e Comunidade. Rev APS [Internet]. 2005 [acesso 2018 Jan 19]; 8(21):181-90. Disponível em: http://www.ufjf.br/nates/files/2009/12/principios.pdf
Brasil. Ministério da Educação. Secretaria de Educação Superior. Resolução no 1, de 25 de maio de 2015. Regulamenta os requisitos mínimos dos programas de residência médica em Medicina Geral de Família e Comunidade [Internet]. Brasília: Ministério da Educação; 2015 [acesso 2018 Jan 19]. Disponível em: http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=17661-res01-25052015-sesu-residencia-medica&category_slug=junho-2015-pdf&Itemid=30192
Anderson MIP, Rodrigues RD. Formação de especialistas em Medicina de Família e Comunidade no Brasil: dilemas e perspectivas. Rev Bras Med Fam Comunidade [Internet]. 2011 [acesso 2017 Set 15];6(18):19-20. Disponível em: http://www.rbmfc.org.br/rbmfc/article/view/246 DOI: https://doi.org/10.5712/rbmfc6(18)246
Demarzo MMP, Marin A, Padula Anderson MI, De Castro Filho ED, Kidd M. Desarrollo de estándares para la educación y formación en medicina familiar y comunitaria - contribuciones de la WONCA IberoAmérica (CIMF). Aten Prim [Internet]. 2011 [acesso 2017 Set 15];43(2):100-3. DOI: http://dx.doi.org/10.1016/j.aprim.2010.04.013 DOI: https://doi.org/10.1016/j.aprim.2010.04.013
Anderson MIP, Castro Filho ED, Rodrigues RD, Dala MDB, Bourget MMM. Bases para expansão e desenvolvimento adequados de programas de Residência em Medicina de Família e Comunidade. Rev Bras Med Fam Comunidade [Internet]. 2007 [acesso 2018 Jan 19];3(11):180-98. Disponível em: https://www.rbmfc.org.br/rbmfc/article/view/336/225 DOI: http://dx.doi.org/10.5712/rbmfc3(11)337 DOI: https://doi.org/10.5712/rbmfc3(11)337
de Oliveira VG, Queiroz FN, Araujo BP, Silva CMM, Silva FD. Medicina de Família e Comunidade: breve histórico, desafios e perspectivas na visão de discentes de graduação. Rev Bras Med Fam Comunidade [Internet]. 2014 [acesso 2017 Set 15];9(30):85-8. DOI: http://dx.doi.org/10.5712/rbmfc9(30)850 DOI: https://doi.org/10.5712/rbmfc9(30)850
Castro Filho ED, Gusso GDF, Demarzo MMP, Stein A, Schneider JC, Dala MDB, et al. A especialização em MFC e o desafio da qualificação médica para a Estratégia Saúde da FamIília: proposta de especialização, em larga escala, via educação à distância. Rev Bras Med Fam Comunidade [Internet]. 2007 [acesso 2018 Jan 19];3(11):199-209. DOI: http://dx.doi.org/10.5712/rbmfc3(9)338 DOI: https://doi.org/10.5712/rbmfc3(9)338
Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet [Internet]. 2010 [acesso 2017 Set 15];376(9756):1923-58. DOI: http://dx.doi.org/10.1016/S0140-6736(10)61854-5 DOI: https://doi.org/10.1016/S0140-6736(10)61854-5
Quintero GA. Medical education and the healthcare system - why does the curriculum need to be reformed? BMC Med [Internet]. 2014 [acesso 2017 Set 15];12(1):213. Disponível em: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0213-3 DOI: http://dx.doi.org/10.1186/s12916-014-0213-3 DOI: https://doi.org/10.1186/s12916-014-0213-3
Gruppen LD, Mangrulkar RS, Kolars JC. The promise of competency-based education in the health professions for improving global health. Hum Resour Health [Internet]. 2012 [acesso 2017 Set 15];10(1):43. Disponível em: http://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-10-43 DOI: http://dx.doi.org/10.1186/1478-4491-10-43 DOI: https://doi.org/10.1186/1478-4491-10-43
Walsh A, Pettigrew LM. A global perspective on education for primary care: a WONCA special edition. Educ Prim Care [Internet]. 2016 [acesso 2017 Set 15];27(5):341-2. Disponível em: http://www.tandfonline.com/doi/full/10.1080/14739879.2016.1224984
Michael Kidd A. Challenges for healthcare in the 21 st century: How family medicine can help. J Fam Med Prim Care [Internet]. 2013 [acesso 2017 Set 15];2(3):211-4. Disponível em: http://www.jfmpc.com/text.asp?2013/2/3/211/120712 DOI: http://dx.doi.org/10.4103/2249-4863.120712 DOI: https://doi.org/10.4103/2249-4863.120712
Ben AJ, Lopes JMC, Daudt CVG, Pinto MEB, de Oliveira MMC. Rumo à educação baseada em competências: construindo a matriz do internato em Medicina de Família e Comunidade. Rev Bras Med Fam Comunidade [Internet]. 2017 May 22 [acesso 2017 Set 16];12(39):1354. Disponível em: https://www.rbmfc.org.br/rbmfc/article/view/1354 DOI: http://dx.doi.org/10.5712/rbmfc12(39)1354 DOI: https://doi.org/10.5712/rbmfc12(39)1354
Accreditation Council for Graduate Medical Education (ACGME). Accreditation Council for Graduate Medical Education (ACGME) - About Us [Internet]. [acesso 2017 Set 30]. Disponível em: http://www.acgme.org/About-Us/Overview
Frank JR, Snell L, Sherbino JE, eds. CanMEDs 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada [Internet]. 2015 [acesso 2017 Set 16]. 30 p. Disponível em: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications
Swing SR. The ACGME outcome project: retrospective and prospective. Med Teach [Internet]. 2007 [acesso 2017 Set 16];29(7):648-54. DOI: http://dx.doi.org/10.1080/01421590701392903 DOI: https://doi.org/10.1080/01421590701392903
ACGME. The Family Medicine Milestone Project. J Grad Med Educ Suppl [Internet]. 2014 [acesso 2018 Jan 19];6(1 Suppl 1):74-86. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966595/ DOI: https://doi.org/10.4300/JGME-06-01s1-05
Hobgood CD, Riviello RJ, Jouriles N, Hamilton G. Assessment of Communication and Interpersonal Skills Competencies [Internet]. Acad Emerg Med. 2002 Nov [acesso 2018 Jan 19];9(11):1257-69. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/12414480 DOI: http://dx.doi.org/10.1111/j.1553-2712.2002.tb01586.x DOI: https://doi.org/10.1111/j.1553-2712.2002.tb01586.x
Frank JR, ed. The CanMEDS 2005 Physician Competency Framework. Better standards. Better physicians. Better care. [Internet]. Ottawa: The Royal College of Physicians and Surgeons of Canada [acesso 2018 Jan 19]; 2005. Disponível em: http://www.ub.edu/medicina_unitateducaciomedica/documentos/CanMeds.pdf
Tannenbaum D, Konkin J, Parsons E, Saucier D, Shaw L, et al; Working Group on Curriculum Review. CanMEDS- ¬Family Medicine [Internet]. 2009 [acesso 2017 Set 16]. Disponível em: http://www.cfpc.ca/uploadedFiles/Education/CanMeds FM Eng.pdf
Bomfim ALB. Macrocompetências para o currículo dos programas de residência em medicina de família e comunidade de Fortaleza/CE [Dissertação]. Universidade Federal do Ceará [Internet]; 2014 [acesso 2017 Set 16]. Disponível em: https://renasf.fiocruz.br/sites/renasf.fiocruz.br/files/disseracoes/2014_UFC_Andr%C3%A9%20Lu%C3%ADs%20Benevides%20Bomfim_0.pdf
Tannenbaum D, Kerr J, Konkin J, Organek A, Parsons E, Saucier D, et al. Triple C competency-based curriculum. Report of the Working Group on Postgraduate Curriculum Review – Part 1. Ottawa: The College of Family Physicians of Canada 2011 [Internet]. [acesso 2018 Jan 19]. Disponível em: http://www.cfpc.ca/uploadedFiles/Education/_PDFs/WGCR_TripleC_Report_English_Final_18Mar11.pdf
McWhinney IR, Freeman T. Manual de medicina de família e comunidade. 3 ed. Porto Alegre: Artmed; 2010.
Heyrman J, ed. EURACT Educational Agenda. Leuven: European Academy of Teachers in General Practice EURACT; 2005.
Flum E, Berger S, Szecsenyi J, Marquard S, Steinhaeuser J. Training standards statements of family medicine postgraduate training - A review of existing documents worldwide. PLoS One [Internet]. 2016 [acesso 2017 Set 16];11(7):e0159906. DOI: http://dx.doi.org/10.1371/journal.pone.0159906 DOI: https://doi.org/10.1371/journal.pone.0159906
Schuwirth LWT, Southgate L, Page GG, Paget NS, Lescop JMJ, Lew SR, et al. When enough is enough: a conceptual basis for fair and defensible practice performance assessment. Med Educ [Internet]. 2002 [acesso 2017 Set 16];36(10):925-30. DOI: http://dx.doi.org/10.1046/j.1365-2923.2002.01313.x DOI: https://doi.org/10.1046/j.1365-2923.2002.01313.x
Van Der Vleuten CPM, Schuwirth LWT. Assessing professional competence: from methods to programmes. Med Educ [Internet]. 2005 [acesso 2017 Set 16];39(3):309-17. DOI: http://dx.doi.org/10.1111/j.1365-2929.2005.02094.x DOI: https://doi.org/10.1111/j.1365-2929.2005.02094.x
Van Der Vleuten CPM. The assessment of professional competence: Developments, research and practical implications. Adv Heal Sci Educ [Internet]. 1996 [acesso 2017 Set 16];1(1):41-67. Disponível em: http://link.springer.com/article/10.1007/BF00596229 DOI: http://dx.doi.org/10.1007/BF00596229 DOI: https://doi.org/10.1007/BF00596229
McCoubrie P. Metrics in Medical Education. Ulster Med J [Internet]. 2010 [acesso 2018 Jan 19];79(2):52-6. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993142/
Murray PM, Valdivia JH, Berquist MR. A metric to evaluate the comparative performance of an institution’s graduate medical education program. Acad Med [Internet]. 2009 [acesso 2017 Set 16];84(2):212-
Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/19174668 DOI: http://dx.doi.org/10.1097/ACM.0b013e3181939705 DOI: https://doi.org/10.1097/ACM.0b013e3181939705
Asch DA, Nicholson S, Srinivas S, Herrin J, Epstein AJ. Evaluating Obstetrical Residency Programs Using Patient Outcomes. JAMA [Internet]. 2009 Sep 23 [acesso 2017 Mar 18];302(12):1277. Disponível em: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2009.1356 DOI: https://doi.org/10.1001/jama.2009.1356
Klessig JM, Wolfsthal SD, Levine MA, Stickley W. A Pilot Survey Study to Define Quality in Residency Education. Acad Med [Internet]. 2000 [acesso 2018 Jan 19];75(1):71-3. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/10667880 DOI: http://dx.doi.org/10.1097/00001888-200001000-00018 DOI: https://doi.org/10.1097/00001888-200001000-00018
Dijkstra J, van der Vleuten CPM, Schuwirth LWT. A new framework for designing programmes of assessment. Adv Heal Sci Educ [Internet]. 2010 [acesso 2018 Jan 19];15(3):379-93. DOI: http://dx.doi.org/10.1007/s10459-009-9205-z DOI: https://doi.org/10.1007/s10459-009-9205-z
Hawkins RE, Welcher CM, Holmboe ES, Kirk LM, Norcini JJ, Simons KB, et al. Implementation of competency-based medical education: are we addressing the concerns and challenges? Med Educ [Internet]. 2015 [acesso 2017 Set 16];49(11):1086-102. DOI: http://dx.doi.org/10.1111/medu.12831 DOI: https://doi.org/10.1111/medu.12831
Ten Cate O. Entrustment as Assessment: Recognizing the Ability, the Right and the Duty to Act. J Grad Med Educ [Internet]. 2016 [acesso 2017 Set 16];8(2):261-2. DOI: http://dx.doi.org/10.4300/JGME-D-16-00097.1 DOI: https://doi.org/10.4300/JGME-D-16-00097.1
Ribeiro MTAM. Avaliação da implantação de Programa de Residência em Medicina de Família e Comunidade de larga escala em Capital do Nordeste [Dissertação]. Fortaleza: Universidade Federal do Ceará [Internet]; 2009 [acesso 2017 Set 16]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/7044
de Castro VS, Nóbrega-Therrien SM. Residência de Medicina de Família e Comunidade: uma estratégia de qualificação. Rev Bras Educ Med [Internet]. 2009 [acesso 2017 Set 16];33(2):211-20. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-55022009000200008&lng=pt&nrm=iso&tlng=pt. DOI: http://dx.doi.org/10.1590/S0100-55022009000200008 DOI: https://doi.org/10.1590/S0100-55022009000200008
Brasil. Lei no. 12871, de 22 de out. de 2013. Institui o Programa Mais Médicos, altera as Leis no 8.745, de 9 de dezembro de 1993, e no 6.932, de 7 de julho de 1981, e dá outras providências. Brasília: Presidência da República [Internet]; 2013 [acesso 2017 Set 16]. Disponível em: http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2013/lei/l12871.htm
Leung FH, Herold J, Iglar K. Family Medicine Mandatory Assessment of Progress. Can Fam Physician [Internet]. 2016 [acesso 2018 Jan 19];62(5):e263-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865355/
Lima VV. Espiral construtivista: Uma metodologia ativa de ensino-aprendizagem. Interface [Internet]. 2017 [acesso 2017 Set 16];21(61):421-34. DOI: http://dx.doi.org/10.1590/1807-57622016.0316 DOI: https://doi.org/10.1590/1807-57622016.0316
Hernández F, Ventura M. A Organização do Currículo por Projetos de Trabalho: O Conhecimento é Um Caleidoscópio. Porto Alegre: Pensa [Internet]; 2017 [acesso 2017 Set 16]. Disponível em: https://books.google.com.br/books?id=PkVXDgAAQBAJ
Downloads
Published
How to Cite
Issue
Section
License
By submitting a manuscript to the RBMFC, authors retain ownership of the copyright in the article, and authorize RBMFC to publish that manuscript under the Creative Commons Attribution 4.0 license and identify itself as the vehicle of its original publication.