CONTEXT Competency-based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing edu- cational programmes that reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time- based training, and promotion of learner cen- tredness. Each of these features has implica- tions and potential challenges for implementing CBE. METHODS As an experiment in CBE pro- gramme design and implementation, the University of Michigan Master of Health Profes- sions Education (UM-MHPE) degree pro- gramme was examined for lessons to be learned when putting CBE into practice. The UM-MHPE identifies 12 educational competen- cies and 20 educational entrustable profes- sional activities (EPAs) that serve as the vehicle for both learning and assessment. The pro- gramme also defines distinct roles of faculty members as assessors, mentors and subject-mat- ter experts focused on highly individualised learning plans adapted to each learner. CONCLUSIONS Early experience with imple- menting the UM-MHPE indicates that EPAs and competencies can provide a viable alterna- tive to traditional courses and a vehicle for rigorous assessment. A high level of individual- isation is feasible but carries with it significant costs and makes intentional community build- ing essential. Most significantly, abandoning a time-based framework is a difficult innovation to implement in a university structure that is predicated on time-based education.
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