Competency-based medical education and Milestones
In response to the global trend of CBME development, the core competency framework commonly adopted in Taiwan is based on the guidelines issued by the Accreditation Council for Graduate Medical Education (ACGME) in the United States. In 1998, ACGME advocated the Outcome Project, an outcome-based system [1], to replace the previous process-oriented evaluation method and defined six core competencies (patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning, and systems-based practice) as the foundation for the development of the clinical training system (Fig. 1).
Figure 1: Six core competencies
Since 2001, the ACGME has required that all training programs in all specialties incorporate the six-core competency framework, later in 2009, it has been incorporated into the accreditation system [2]. The next challenge is to further strengthen the competency framework more delicately and validating [3]. To establish a time schedule and standardized assessment for core competencies, ACGME CEO Dr. Thomas Nasca, proposed the concept of milestones in May 2008, announcing the development of core competency milestones for each specialty [4] and the establishment of a corresponding assessment system [1]. In 2009, ACGME and the American Board of Medical Specialties (ABMS) jointly proposed the "Milestones Project", to assist clinical educators in assessing the effectiveness of training on learners, enabling learners to understand their strengths and weaknesses in response to the concept of competency-based medical education [4].
In July 2013, the ACGME released a next-generation accreditation system - the Next Accreditation System (NAS with three major goals: (1) to strengthen education and training for residencies through an open and transparent accreditation mechanism; (2) to implement learning-outcome-oriented assessment in institutions; and (3) to reduce the proportion of the current process-oriented assessment [6].
The purpose of promoting the next evaluation system is to hope that each specialist training can implement the ability oriented medical education, improve the quality of resident training, and evaluate the progress of students' ability in the way of milestones every six months as a framework for concretizing and standardizing clinical competency training. [7]. Therefore, the next focus of medical institutions is to develop a core competency framework and milestones based on the six core competencies in all specialties. The specific objectives include: (1) clearly and concisely describing each core competency; (2) developing the knowledge, attitudes, and skills of the sub-core competencies according to the characteristics of each specialty; and (3) describing in detail the stages of the residency training process and adopting specific proficiency in core competencies as the training objective.
Evidently, setting learning milestones in every specialty is a crucial target for the next phase of medical education reform, acting as the essential basis for CBME implementation.
Taiwan Medical Radiation Therapy Learning Milestones
In August 2019, the Division of Medical Education and Radiation Oncology of National Taiwan University Hospital jointly held a national consensus conference on learning milestones in medical radiotherapy. We invited the Joint Commission of Taiwan and Taiwanese specialists in radiotherapy to collaborate and establish learning milestones by using stringent consensus-based approach to enhance the professional identity of RTTs [8]. Nominal Group Technique (NGT) and the Modified Delphi Method (MDM) were being used as the stringent consensus-based approach throughout this article, which are also commonly used in health care applications [9, 10] and [11].
The first version of medical radiation therapy learning milestones were defined after the conference, including the five core competencies (patient care, knowledge of medical imaging and radiology, doctor-patient relationship and team communication skills, professionalism, and enhancement of job skills) and the descriptions of 115 learning milestones in Levels 1–5 of the 13 sub-core competencies (Table 1).
Table 1
Core and sub-competencies of medical radiation therapy
| Core competencies | Sub-competencies |
|---|
| Patient care | 1–1 | Radiotherapy technology |
| 1–2 | Simulation technology |
| 1–3 | Management of instrument error and malfunction |
| 1–4 | Patient safety |
| 1–5 | Task handover |
| 1–6 | Interprofessional teamwork |
| Knowledge of medical imaging and radiological science | 2 − 1 | Knowledge and abilities in relation to image-guidance |
| 2–2 | Instrument quality control and radiation safety |
| Provider-patient relationship and team communication skills | 3 − 1 | Effective communication with other professions |
| 3 − 2 | Optimal communication with patients |
| Continuous improvement of professional skills | 4 − 1 | Continuous improvement of professional skills |
| Professionalism | 5 − 1 | Professional values |
| 5 − 2 | Accountability |
The development of Taiwan Medical Radiation Therapy Learning Milestones is crucial for the advancement of CBME implementation in Taiwan, with meaningful values for non-physician medical personnel [12]. On October 31, 2019, the full-scale learning milestones of radiotherapy were shared by Joint Commission of Taiwan for nationwide clinical educators when teaching and assessing future medical radiotherapy trainees.
Table 1
Core and Sub-competencies
By analyzing the results of self-assessments on trainees and clinical educators at each stage, this study aims to understand the current learning situation in the nationwide core competency training courses before the full-scale promotion of learning milestones for future application and training planning.