Toward Competency Based Medical Education in India

Anoop Amrith Lal

Department of Community Medicine, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India*

Published on 26th June, 2015

There is a joke about engineering profession, in which an airplane full of engineering college professors is going on a trip. Before takeoff the pilot announces that the plane was built by their students. Immediately everybody runs to get out of the plane except the oldest professor. When asked why, he says he was absolutely confident that the plane won’t make it to the runway.

This joke would not sound so funny if it is on the medical profession. How many of us medical college teachers are willing to be treated by our own students, if we are taken ill? How many of us are willing to entrust the health and lives of our dear ones in the hands of our students? Is medical education as a system producing doctors, who can be entrusted with the health and lives of our citizens?1 If not, is the system doing justice to the nation?2

Indian Medical Graduates (IMGs) are not welcome to practice medicine in developed countries unless they undergo a series of eligibility examinations and special trainings. This is because those countries do not consider IMGs competent enough to treat their citizens. Even the best of our graduates qualify only after prolonged and relentless effort.

This situation is all bound to change if the medical council of India has its way. From academic year 2016-2017 onward, MCI is planning to introduce Competency Based Medical Education (CBME) in India, which is a system of teaching medicine which has been very successfully implemented in many developed and developing countries around the world. CBME is a paradigm shift from the traditional way of discipline based imparting of skills and knowledge.3

Competence is what the society expects out of a doctor. Competencies are a set of attributes that makes a doctor competent of meeting societal expectations. The whole idea is to shift the focus of medical education from imparting specific knowledge and skills which may or may not be useful, to creating doctors who are competent enough to address the healthcare needs and expectations of the society. The strategy is to identify well defined areas of competence in healthcare and train the graduates in the direction of achieving them. The patients coming to a doctor with a set of symptoms do not care if the doctor knows the physiology, pathology, or pharmacological of the disease. What they care about is the behavior of the doctor toward them, the compassion and reassurance shown and the ability to diagnose and treat the condition with reasonably favorable outcome.

The most important merit of CBME is that its starts by focusing on the attitude aspect of learning, which if achieved, can be easily transformed to knowledge and skills. It makes the IMG capable of facing the real world; to go out there and do what is expected of him/her with utmost confidence. It takes the pressure away from learning, by being less time and exam oriented and by being a more outcome-oriented. The learner, not the teacher, becomes the driving force in the learning process, thereby becoming responsible for achieving competence goals. Integrated learning between specialties avoids unnecessary fragmentation of knowledge right from the beginning. CBME also ensures that only those students who have achieved the required competencies at each phase of medical education move on to the next phases. Thus, CBME will to a great extent help to regain the trust of the society in the medical profession.

There are also limits and challenges in the full-fledged implementation of CBME.4 CBME is resource intense. It will need more teachers, learning resources and time. The entire medical curriculum needs to be reworked to implement CBME.5 The teachers themselves will need to be trained to ensure that they are competent enough to implement CBME. There is also the risk that many of the knowledge domain content might get left behind if the focus is only on competencies. Some student may not at all attain all the required competencies. Support systems like eLearning and Skills lab will be needed for the implementation of CBME.

Assessment in CBME is the most daunting challenge. CBME to a great extent blurs the line between formative and summative assessment because ensuring objectivity is a great challenge. Very often a significant improvement in formative performances will need to be taken as summative. For this, performance criteria need to be defined and minimum acceptable norms need to be established for summative performance. Workplace Based Assessment seems to be the most suitable methods for assessing competencies.

Thus, even though CBME seems to be the way forward for medical education in India, there are a number of challenges to be faced and met before we can have it rolled out nationwide.

End Note

Author Information

Anoop Amrith Lal, Department of Community Medicine, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India


Conflicts of Interest



1. Vision 2015Medical Council of India 2011

2. Rangan S, Uplekar M, Community health awareness among recent medical graduates of BombayNatl Med J India 1993; 6: 60-4. [PubMed]

3. Modi JN, Gupta P, Singh T, Competency-based medical education, entrustment and assessmentIndian Pediatr 2015; 52: 413-20. [CrossRef] [PubMed]

4. Chacko T, Moving toward competency-based education: Challenges and the way forwardArch Med Health Sci 2014; 2: 247. [CrossRef]

5. Kern DE, Thomas PA, Hughes MT, Curriculum Development for Medical Education: A Six-Step Approach 2010; Baltimore: JHU Press 269

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