Challenges and Opportunities: Innovative Credentials in the Medical Education SpaceLarry Gruppen | Chair of Medical Education at the School of Medicine, University of Michigan
Competency-based education has been gaining momentum across the American higher education landscape over the past five years, but in the medical education field competencies have been king since 2000. That said, some main campuses are still wary of the competency-based approach to credentialing and management tools, for the most part, are lagging behind in helping institutions to support these students. In this interview, Larry Gruppen discusses competency-based programming through the medical education lens, reflects on some of the reasons why he and his colleagues launched their Master’s of Professional Health Education program and discusses some of the challenges of managing this program in the current postsecondary climate.
The EvoLLLution (Evo): Why did you and your colleagues decide that it was important to introduce a competency-based degree model in the medical education space?
Larry Gruppen (LG): In many ways, medical education has been doing competency-based education for at least 15 years. Back in 2000, one of the accrediting agencies for graduate medical education stipulated that all residency programs needed to document that their graduates were competent in six very broad domains that covered just about all the medical practice. That was really the beginning of what you would call a competency-based perspective in medical education. Our efforts to translate that into a master’s degree program really built on a reasonably well-established history of recognition and acceptance of competency-based education, at least as a philosophical model if not always a practical implementation.
Evo: In the early stages when you were proposing a competency-based model for a degree program, did people recognize this legacy that existed in medical education or did they see it as a response to industry hype?
LG: Within the medical school, they understood the language. They thought it was an interesting idea, innovative in the sense that nobody had done it where education was the content area as opposed to medicine. They saw the relevance and they thought it was appropriate.
However, we had much greater difficulty communicating this to the university as a whole. When we proposed the degree to our School of Graduate Studies and emphasized that this wasn’t going to have traditional courses, it wasn’t time-based and we would accept evidence of competence from prior work, they suggested that we launch the program out of the medical school rather than the graduate school. This was far too radical a transition from their traditional focus on foundation programs.
Evo: In your opinion, how innovative—or comfortable with change—is the medical education space as compared to the rest of higher education?
LG: In some ways, medicine is very pragmatic. They are not going to be tied to any theory because they have built their career on it. They’re very concerned about the outcomes. If there’s a better way to come to the same outcomes or to make the outcomes better, they’re all for it. In many ways, they are more flexible in looking at educational ideas. On the other hand, some faculty cannot accept change, but overall there is probably more flexibility in the medical space then there is in many areas of higher education.
Evo: What are a few of the most significant differences between this program and other, similar programs that don’t use the competency-based model?
LG: The key difference is traditional education focuses on time—time is fixed and the outcomes are variable. In competency-based education, we argue that the outcomes are fixed but the time is variable. Here you define what constitutes competency and those remain fixed for everybody, whether that takes place in one year or five years.
Evo: What were some of the major roadblocks you and your team had to overcome in launching the competency-based Master’s of Professional Health Education program?
LG: Directly related to time is money. The university is built around a tuition model that is based on semesters so you pay certain tuition for a certain number of credit hours and that translates into a three-year master’s program. If you’re going to break free of time, you’ve got to figure out a different way to charge tuition. The university wasn’t resistant to it but they had never had to deal with that problem before so they didn’t have anything to suggest.
The fact that the federal government only really recognized competency-based programs for financial aid, was also a hurdle that we had to jump over recently. That has been cleared up now. It’s becoming more accepted and understood gradually.
Evo: Did you have to change the way you register and enroll students so that they could be supported by the university in this competency-based framework as opposed to a traditional time-based framework?
LG: That was another situation in which the university’s traditional tracking mechanisms just weren’t working. Most of the bureaucracy in the university has not been able to accommodate the competency-based framework. As a small program with a target of 40-60 people, we were given the responsibility to track our own students.
Evo: How have students responded to the new approach to delivering the program?
LG: The feedback we’ve gotten is that the competency-based perspective makes a lot of sense to people in health professions. They know what it is to be competent and they know that it takes different rates of time. They are all coming into this role as educators in addition to being a nurse or physician or pharmacist. Being an educator is something many of them have been doing for years. They already have a lot of experience and they recognize that they’re competent in many ways so the idea of having to go back and start from scratch in the traditional time-based program wasn’t very attractive.
The other part that we do in our program is not specifically competency-based but we do all of our instruction and assessment through work-based learning, so they can learn about these educational principals and practices by performing the educational roles that they already have with the guidance of our faculty of how to do better, how to use these activities like building a curriculum, assessing learners’ performance as evidence for competence. We build the learning into their daily practice; they don’t have to take time out of their schedule. That’s been a selling point for many of the learners in our program.
Evo: What are some of the other features you’ve had to bake into the program to make sure you’re providing these adult students with the customer experience as well as the student experience they’ve come to expect?
LG: One of the consequences that we hadn’t fully appreciated when we started competency-based education is if you assume that people are going to become competent at different rates, it means they are pursuing a very individualized program. They are learning the skills and competencies that they want in what sequence they want but they also come in with more or less experience. One of the challenges we’ve had is how to give them the valuable community experience through their peers but still maintain a very individualized curricular plan. We are trying to do more work to bring the students together into cohorts so that they can learn from each other.
The other part we need to do because it’s so individualized is to give them a faculty mentor who helps guide them through the program and ensures they’re making good choices about their activities and staying on track. In this kind of program, you have all kinds of day-to-day urgencies that get in the way of your studies.
Evo: What is the most important piece of advice you would share with other medical education leaders looking to introduce competency-based programs of their own?
LG: The biggest lesson I’ve learned is that higher education is education for the faculty by the faculty. Learners come and go and the faculty get into a perspective of designing the educational experience to make it convenient for them. A competency-based framework really flips that around. The focus is on learning, not teaching and if you take that seriously, that has a lot of implications. My advice to people looking at doing something similar is if you’re going to be serious about being learner- centered, you may have to give up a lot of the comfortable structures, practices and policies that we’ve become so used to.
The other lesson I have learned is that you don’t need to reinvent the wheel. All of the master’s programs—certainly for Professional Health Education—we’re all trying to teach the same competencies. There’s not a lot of differences in terms of what we would consider a good health professions educator. There’s a lot more opportunity for sharing resources, ideas and structures and even sharing faculty.
Evo: With similarities between medical education programs, the outcomes that you’re trying to achieve and the capacity to share human and intellectual resources, what are some of the differentiators that could lead a student to study at the University of Michigan rather than any of its competitors?
LG: If we all agree on the same competencies and if the focus is on learning, students can get there in lots of different ways. Students continue to look for the fact that they are learning from the faculty. It’s not the structure as much as the qualifications, the reputation. For us at Michigan we have close to 18 faculty in the program, which is larger than many other programs at similar medical schools, and we have a faculty that have produced over 1000 peer-reviewed publications. For us, it’s the reputation of the University of Michigan, the environment and the community of scholarship that we’re offering among the faculty that then translates into the learner experience. The competencies are the same. You can get them in a lot of different places, but the environment in which you do that has a lot of additional benefits that aren’t necessarily reflected in the curriculum itself.