Use of the Competency-Based Achievement System (CBAS) assessment can improve the identification of medical residents who are experiencing difficulties, in turn helping medical education programs achieve the goal of increased competence among residents, according to a study published in JAMA Network Open.

Competency-based medical education is an established part of medical training. Yet despite widespread use of this approach, no evidence exists to demonstrate that this approach results in safer or more competent clinicians than non-competency-based educational approaches. CBAS was designed to assess clinician learning and provide regular feedback to residents.

In this retrospective observational cohort, Shelley Ross, PhD, of the Department of Family Medicine at the University of Alberta in Edmonton, Alberta, Canada, and colleagues used a secondary analysis of data originally collected as part of the assessment process in the 2-year family medicine residency program at the University of Alberta to evaluate competency-based assessment and determine its association with changes in identifying residents in difficulty compared with traditional assessment.

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The investigators reviewed files from 458 residents (pre-CBAS n=163, 49.7% women; post-CBAS n=295, 48.8% women). They observed a significant reduction in the proportion of residents who received at least 1 flag during training after the implementation of CBAS (0.38; 95% CI, 0.377-0.383). Additionally, there was a significant reduction in the number of rotations during which residents received flags on assessments (0.24; 95% CI, 0.238-0.243). The number of residents in difficulty after CBAS decreased as well (from 0.13 to 0.17; 95% CI 0.128-0.132 and 95% CI, 0.168-0.172, respectively), and documentation of discussion of flags with residents and support for residents increased significantly.

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The authors noted that the study was limited by its inclusion of only 1 medical education program. They admitted that factors other than CBAS may have been involved in the improvements observed. As the study assessed only residents in the family medicine program and there was increased competition for residency programs in this specialty during the study period, this may have affected outcomes.

“Changing the focus of assessment to an emphasis on direct observation, increased documentation, and assessment for learning may be associated with improved identification of learners who are deficient in 1 or more competency and with how those deficiencies are addressed,” they concluded.


Ross S, Binczyk NM, Hamza DM, et al. Association of a competency-based assessment system with identification of and support for medical residents in difficulty. JAMA Netw Open. 2018;1(7):e184581.