From Theory to Practice: Utilizing Competency-based Milestones to Assess Professional Growth and Development in the Foundational Science Blocks of a Pre-Clerkship Medical School Curriculum

Abstract

Physicians-in-training require skills and attitudes beyond medical knowledge in order to mature into successful clinicians. However, because assessments in pre-clerkship curricula historically have focused almost exclusively on medical knowledge, faculty contributions to early student development often have been limited. To address this challenge and enhance student progress, we re-designed our pre-clerkship curriculum to include settings in which diverse facets of student performance could be observed and fostered. Concurrently, we transitioned to an assessment strategy focused on competency-based milestones. The implementation of this strategy has allowed pre-clerkship science faculty to provide early-stage students with rich holistic feedback designed to stimulate their professional growth.

Keywords: Competency domains; Competency-based education; Milestones; Qualitative assessment.

Fig. 1

Milestones used to assess two individual competencies. Descriptors are shown for the medical knowledge: inquiry competency (top) and the practice-based learning and improvement: receptivity to feedback competency (bottom).

Fig. 2

Frequency and type of competency-based milestone assessments used for the foundational science blocks of the pre-clerkship Foundations of Medical Knowledge phase. The phase is comprised of five science blocks: Human Blueprint and Architecture (HBA) and Microbes and Immunity (M&I), which are each six-weeks in length, and Homeostasis; Endocrine, Digestion, and Reproduction (EDR); and Brain, Behavior, and Movement (BBM), which are each twelve-weeks in length. Arrows pointing up represent milestone assessments by students (red = self; green = peer). The red asterisk indicates that the self-assessment was part of the students’ review with their portfolio coaches. Students always receive assessments from a minimum of two of their peers. Arrows pointing down represent assessments by faculty facilitators (orange = comments and conferences; blue = milestone assessments, comments, and conferences). Three dissection team faculty conferences that included milestone assessments were held during the Homeostasis and EDR blocks.