Perspectives on Medical Education最新文献

{"title":"CORE-HPE Reporting Guidelines: Standardizing Reporting for Competency-Based Health Professions Education Outcomes Research.","authors":"Aleda M H Chen, Denise H Rhoney, Susan Humphrey-Murto, Mary Ellen J Goldhamer, Linda Snell, Holly Caretta-Weyer, Daniel J Schumacher, Soeren Huwendiek, Arvin Damodaran, Andrew K Hall, Robert Englander, Laura Molgaard, Anna Oswald, Pedro Tanaka, Fremen Chihchen Chou, Jason R Frank","doi":"10.5334/pme.2554","DOIUrl":"https://doi.org/10.5334/pme.2554","url":null,"abstract":"<p><strong>Background: </strong>Competency-Based Health Professions Education (CBHPE) is increasingly implemented; however, CBHPE outcomes research remains difficult to interpret and synthesize when studies incompletely report the CBHPE model and other elements.</p><p><strong>Objective: </strong>To develop structured reporting guidelines for CBHPE outcomes studies to improve transparency, interpretability, and transferability across educational contexts and professions.</p><p><strong>Methods: </strong>A multi-phase, iterative consensus-development process was used to create a CBHPE outcomes reporting checklist aligned with a CBHPE Outcomes Theory of Change. Draft reporting elements were generated and refined through structured writing-group deliberations, broad stakeholder feedback gathered through interactive town hall sessions within the ICBHPE Collaborative, and iterative revision cycles. The checklist was then pilot-tested with non-expert users to assess clarity, feasibility, and usability, and revisions were made to reduce redundancy, harmonize terminology, and strengthen guidance for high-impact reporting domains.</p><p><strong>Results: </strong>The final product is a structured reporting checklist, organized by manuscript section, accompanied by brief item descriptions and rationales, and registered with EQUATOR. The guidelines prioritize reporting elements that support causal interpretability in CBHPE outcomes research, including specification of the CBHPE intervention architecture and core components, program theory and intended mechanisms, implementation fidelity and adaptations, assessment system design and governance for progression decisions, multi-level outcomes and indicators across developmental timeframes, contextual enablers and constraints, and equity considerations.</p><p><strong>Conclusions: </strong>These CBHPE outcomes reporting recommendations provide a practical tool and guideline for authors, reviewers, and editors to strengthen the completeness and consistency of CBHPE outcomes reporting and should be considered before beginning a study. Adoption of this checklist may improve interpretability and evidence synthesis across programs and accelerate actionable learning about what works in CBHPE, for whom, in what contexts, and why.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"894-915"},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity in the Era of Competency-Based Health Professions Education: Tensions and Potential Solutions.","authors":"Michael S Ryan, Claire Touchie, Jason R Frank, H Carrie Chen, Benjamin Kinnear","doi":"10.5334/pme.2593","DOIUrl":"https://doi.org/10.5334/pme.2593","url":null,"abstract":"<p><p>Assessment in health professions education has evolved dramatically in the past hundred years. The way in which we conceptualize validity has also required evolution, particularly in the era of competency-based health professions education (CBHPE). The CBHPE approach compels us to reexamine a historical focus on objectivity, individual assessments, and standards of achievement alone. In this manuscript, the authors explore the implications CBHPE places on validity, highlighting three tension points: the paradigm of assessment, levels of validation, and the reference for competence. The authors examine health profession education's historical orientation toward the post-positivist paradigm including an emphasis on standardization, reliability, and truth-seeking. This is contrasted with two alternative paradigms, constructivism and pragmatism, which prioritize different data sources to build validity arguments. In the section on levels of validation, the authors explore tensions between validity arguments that are holistic (considers the entire picture of performance) and those which use a decomposition approach (distilling competence into individual components). Finally, the authors consider the value in measuring learner competence using norm-referenced standards, criterion-reference approaches, or the measurement of growth throughout (and beyond) their training. Ultimately, the authors propose a balanced approach to address each tension, considering the strengths and weaknesses of traditional methods with the modern needs of CBHPE.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"959-969"},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Wicked Problem of Selection and Competency-Based Education: Applying TRIZ Inversion to the Graduate Medical Education Selection Process.","authors":"Holly A Caretta-Weyer, Ming-Ka Chan, Mary Ellen J Goldhamer, Alan Schwartz, Teresa M Chan, Lalena M Yarris, Ian W Incoll, Arvin Damodaran, H Carrie Chen","doi":"10.5334/pme.2596","DOIUrl":"https://doi.org/10.5334/pme.2596","url":null,"abstract":"<p><strong>Introduction: </strong>Graduate medical education (GME) selection processes may pose significant barriers to implementing competency-based health professions education (CBHPE). Current selection metrics are largely nonpredictive of future success, and the removal of clerkship grades has given rise to a shadow economy of effort focused on publications, research hours, and other activities that detract from clinical training. This misalignment between selection practices and CBHPE principles constitutes a wicked problem that requires innovative approaches to develop new solutions.</p><p><strong>Methods: </strong>We conducted a TRIZ (Theory of Inventive Problem Solving) exercise, a Liberating Structure that challenges assumptions by asking what would make a process fail spectacularly. Eight participants representing three countries, two continents, and four medical specialties convened via video conference in October 2025. Participants served as proxies for key stakeholder groups (students, program directors, medical school leadership, and patients/society), identified elements of the worst-possible selection system, compared them to current practices, and proposed solutions.</p><p><strong>Results: </strong>Participants identified numerous elements characterizing suboptimal selection systems, including inequitable and biased processes, arbitrary decision-making, gaming of metrics, resource-intensive processes that fail to differentiate candidates, misinformation from training sites, and prioritization of self-interest over patient needs. Many of these elements were recognized as present in current GME selection systems worldwide.</p><p><strong>Discussion: </strong>Recommendations to align selection with CBHPE included embedding social accountability throughout selection, leveraging coproduced competency frameworks, prioritizing workforce diversity, ensuring equity in assessment and selection, incentivizing a growth mindset through a transparent learner handover, and implementing structural innovations, including preference signaling or potentially lottery systems, to better align CBHPE and selection.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"970-985"},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competency-Based Health Professions Education in Evolution: Challenges and Adaptations After Implementation.","authors":"Robert Englander, Mary Ellen Goldhamer, Aleda M H Chen, Anna Oswald, Adelle Atkinson, Holly Caretta-Weyer, Teresa M Chan, Fremen Chihchen Chou, Timothy R Dalseg, Reshma G Kini, Roberta I Ladenheim, Leila Niemi-Murola, David A Turner, Linda Snell, Andrew K Hall","doi":"10.5334/pme.2580","DOIUrl":"https://doi.org/10.5334/pme.2580","url":null,"abstract":"<p><p>Health professions education is experiencing a paradigm shift, from a focus on the structures and processes of education to a focus on the outcomes health professionals must demonstrate to meet the healthcare needs of the public served. The Competency-based Health Professions Education (CBHPE) movement now has two decades of implementation experience in some contexts. Educators across health professions working on the design, planning, implementation, or maintenance of competency-based systems can benefit from the lessons learned through implementation efforts to date. In this manuscript, the authors capitalize on the experiences of the International Competency-based Health Professions Educators Collaborative (ICBHPE), a multinational and interprofessional group of educators, to summarize some of the common challenges faced and adaptations made after implementation. The lens of post-implementation challenges allows a view of CBHPE programs as they have matured. The challenges are organized by the five core components of CBHPE: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. For each component, the authors review those challenges that are most common and provide examples of adaptations that have been successful. The challenges and their adaptations are synthesized through \"lessons learned\" to provide practical insights for designing, planning, implementing, and maintaining CBHPE programs to continue driving the evolution of CBHPE globally.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"930-945"},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CBE and the Missing 'E': Making Competency-Based Education an Equitable Framework for Global Health Professions Education.","authors":"Jamiu O Busari, Ming-Ka Chan, Arvin Damodaran, Alan Schwartz, Roberta Ladenheim, Ben Jones, Marjan Khajehei, David A Turner, Liknaw Zeleke, Holly A Caretta-Weyer","doi":"10.5334/pme.2551","DOIUrl":"https://doi.org/10.5334/pme.2551","url":null,"abstract":"<p><p>It is generally assumed that competency-based health professions education (CBHPE) is a positive and ongoing educational reform. However, the assumption that CBHPE naturally leads to more equitable outcomes has not been thoroughly examined. This 'Eye Opener' identifies global challenges in implementing equitable CBHPE, with particular attention to majority-world (low- and middle-income) contexts. These tensions include: 1) variable approaches to adoption that limit transferability, 2) uneven infrastructure for implementation and innovation, 3) export of predeveloped conceptual frameworks that may not be locally fit for purpose or implemented alongside collaborative knowledge exchange, and 4) pressures for fidelity in implementation that impede flexibility and compromise effectiveness in local contexts. In each area of tension, the authors outline challenges to equity and suggest potential ways forward. From their analysis, the authors propose that equity must be deliberately embedded in CBHPE at multiple levels, and the proposed solutions include addressing equity on three levels - the micro level of individual learner access and assessment; the meso level of curricula, faculty development, and program learning culture; and the macro level of national accreditation standards and education policies. Examples of opportunities at each level and for each of the five core components of CBHPE are also provided. The authors argue for a shift in perspective-from \"outside-in,\" in which Western nations export CBHPE to the majority world, to \"outside-in, inside-out and all around,\" in which CBHPE frameworks are co-created to leverage contributions from both Western and majority-world education systems. They believe that more thoughtful adaptation and embracing Global South ways of knowing, doing, and being, rather than simple replication, alongside the continuous application of a social justice lens, are needed to ensure that CBHPE serves all communities and contributes to equitable, high-quality learning and healthcare without discrimination.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"880-893"},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment Fit for (More Than One) Purpose? Reconciling the Dual Purposes of Assessments in Competency-Based Health Professions Education.","authors":"Michael S Ryan, Aleda M H Chen, Heather Nichol, Sören Huwendiek, Denyse Richardson, Benjamin Kinnear, Warren J Cheung, Claire Touchie, Fremen Chihchen Chou, David A Turner, Anna Oswald","doi":"10.5334/pme.2592","DOIUrl":"https://doi.org/10.5334/pme.2592","url":null,"abstract":"<p><p>Assessments serve several purposes in competency-based medical education (CBME) and competency-based health professions education (CBHPE) programs. These purposes are commonly termed 'assessment <i>for</i> learning' and 'assessment <i>of</i> learning.' Historically, educational scholars have advised against using an assessment for multiple purposes, arguing that doing so undermines its primary purpose. However, at times, such an approach may be required from a pragmatic standpoint. In this Eye Opener, the authors consider the competing purposes of assessment in CBHPE programs from a practical lens. They propose specific strategies to maximize benefits and minimize risks of dual-purposing when such an approach is necessary. First, the authors describe the importance of setting the stage for dual-purposing by creating a culture of trust, which requires clear institutional commitment to learner orientation and faculty development, infrastructure, and appropriate channels of communication with all constituents. Second, data considerations are discussed. The authors focus on adoption of programmatic assessment principles, opportunities for frequent formative observations, and strategies for leveraging available technology. Finally, the focus turns to the learner, highlighting their essential function as a key agent in driving their own growth and development. Balancing learner- and supervisor-initiated assessments, implementing longitudinal coaching programs, and considering \"ultra-low-stakes\" assessments are identified as mechanisms to support learner agency and development. Taken together, these specific design conditions may be used to promote learner growth and acquisition of competence when practical constraints require assessment data to serve a dual purpose.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"946-958"},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching Slow Clinical Observation Through Art: A Museum-Based Innovation in Undergraduate Nursing Education.","authors":"Álvaro Carmona Pestaña, Jenifer Santos García, Patricia Ferrero Sereno","doi":"10.5334/pme.2891","DOIUrl":"10.5334/pme.2891","url":null,"abstract":"<p><strong>Background & need for innovation: </strong>Health professions education needs learning experiences that help students practise careful observation, evidence-based description, interpretive reasoning and attention to the human dimensions of illness. Undergraduate nursing education still needs clearly described, theory-informed and transferable museum-based models that move beyond cultural enrichment.</p><p><strong>Goal of innovation: </strong>We designed a curriculum-embedded museum-based innovation for first-year nursing students. Its central contribution is a transferable sequence for slow, deliberate and dialogic observation: preparation, slow looking, evidence-based description, facilitated interpretation, humanistic reflection and clinical transfer.</p><p><strong>Steps taken for development and implementation of innovation: </strong>The activity was delivered at the Museo Nacional del Prado across two academic years and was informed by visual thinking approaches, experiential learning and reflective practice. Students engaged with selected artworks as complex visual and human situations rather than diagnostic riddles.</p><p><strong>Evaluation of innovation: </strong>We used anonymous pre- and post-activity questionnaires across two cohorts, supported by open-ended responses, faculty field notes and voluntary student reflections. A total of 874 valid questionnaires were analysed as unmatched group-level responses. Students reported higher post-activity scores in perceived knowledge, observational skills and educational value, with smaller differences in empathy. Descriptive qualitative content analysis suggested that students valued close looking, art-medicine integration and clinical relevance.</p><p><strong>Critical reflection on your process: </strong>The evaluation supports feasibility, acceptability and implementation stability, not objective improvement in clinical performance. Key lessons concern how to design and facilitate museum-based learning: preserve the slow observation sequence, avoid reducing artworks to diagnoses, and pair humanistic reflection with transfer to nursing practice.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"871-879"},"PeriodicalIF":3.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Controlling Teaching Persists in Medical Education: A Self-Determination Theory Perspective.","authors":"Adam Neufeld","doi":"10.5334/pme.2417","DOIUrl":"10.5334/pme.2417","url":null,"abstract":"<p><p>Autonomy-supportive teaching is widely promoted in medical education for its benefits to learner motivation and well-being. Yet many learners continue to experience clinical education as controlling, even in environments that explicitly endorse learner-centred values. This persistent gap suggests that barriers to autonomy-supportive practice extend beyond lack of knowledge or skill. This paper offers a theory-informed analysis of why psychologically controlling teaching persists in high-stakes clinical learning environments. Using Self-Determination Theory (SDT) as its organizing framework and drawing on complementary perspectives from psychological reactance, stress and coping, motivating styles, and medical education systems, the paper advances four interconnected arguments. Controlling teaching may emerge when educators experience pressure, threatened agency, responsibility, and uncertainty; be reinforced when authority and instructional structure are mistaken for psychological control; be legitimized through professional norms that associate control with competence; and be reproduced through assessment, administrative, and curricular systems. Its persistence is understandable because controlling approaches often produce the immediate outcomes educators seek-compliance, efficiency, predictability, and reduced uncertainty-even while carrying longer-term motivational costs. Control is therefore conceptualized not simply as an individual pedagogical failure, but as a downstream behavioural expression of pressure travelling through educational systems. By making these mechanisms visible, the paper provides a conceptual foundation for developing autonomy-supportive practices that remain viable under pressure and offers practical implications for educators, faculty development, and educational systems.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"861-870"},"PeriodicalIF":3.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taking Fun Seriously: A Scoping Review of Frameworks, Outcomes, and Definitions of Fun in Education.","authors":"Stephen K Stacey, Kurt B Angstman, Lauren P Baker, Parivash Badar, Sara S Oberhelman-Eaton, Rachel S Wasson, Carol Goulet, Joshua P Scheil, Heather N Jett, David A Cook","doi":"10.5334/pme.3030","DOIUrl":"10.5334/pme.3030","url":null,"abstract":"<p><strong>Introduction: </strong>Researchers studying the concept of <i>fun</i> in education encounter challenges because frameworks, covariates, outcomes, and definitions vary across studies and fields. The authors conducted a scoping review to map the field of fun in education, identify key psychological associations, and synthesize a working definition of fun.</p><p><strong>Methods: </strong>The authors searched multiple databases in April 2024 for peer-reviewed articles focusing on fun in education and adjacent disciplines. Articles targeting any age group, topic, and educational or workplace setting were included. The authors extracted data on outcomes of fun, conceptual frameworks related to fun, features of fun activities, and definitions related to fun.</p><p><strong>Results: </strong>Of 1,073 articles screened, 40 were included. The psychological construct of fun was commonly associated with positive emotions experienced in relation to an enjoyable activity. The authors identified 120 distinct features of fun and grouped these into seven categories: safety, novelty, autonomy, playfulness, purpose, immersion, and social connection. Synthesizing findings from all included articles, the authors propose the following definition of fun: \"Fun is a positive emotional experience arising from active engagement in enjoyable activities or experiences, often of a playful or amusing nature, that naturally fosters a desire to sustain or revisit the activity.\"</p><p><strong>Discussion: </strong>These findings suggest a theory-informed conceptual framework of fun in learning that may provide a foundation for guiding future research into fun as an educational tool. This synthesized working definition of fun addresses gaps in prior research by incorporating recurring themes that are adaptable across diverse contexts, including health professions education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"845-860"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing Validity: How Values Shape Assessment in Postgraduate Medical Education.","authors":"Sandra Monteiro, Matthew Sibbald, Matthew Lineberry, Teresa M Chan","doi":"10.5334/pme.2818","DOIUrl":"10.5334/pme.2818","url":null,"abstract":"<p><strong>Introduction: </strong>Values (value judgments, beliefs, etc.) have implications for clinician educators' conceptualization of postgraduate education, as well as their interpretation and application of assessment data. Seeking clarity around individual, program, and systems values within a competency based medical education (CBME) program, the authors sought evidence of distinct values reflected in the CBME assessment literature.</p><p><strong>Methods: </strong>The authors conducted an exploratory critical review study in two phases aligned with Kahlke's method. In phase one (from September 2020 to December 2022) the authors worked towards five interconnected goals: focus, generate data, appraise, sample, and analyze. In phase two (October 2022), the authors invited peer review of the process and findings.</p><p><strong>Results: </strong>Three values and related assessment goals were distilled from the literature on competency-based assessment: 1) Safety: Assessment protects patient safety, ensuring that only clinicians who demonstrate safe practice are advanced; 2) Development: Assessment supports the development of learners' competence, rather than ranking or differentiating between individuals; and 3) Agility: Assessment evolves in response to context and should be adapted to better support learners and faculty. The authors linked the values within assessment programs to practical consequences for measuring clinical competence.</p><p><strong>Discussion: </strong>The authors articulated how values within academic medicine directly shape the interpretation and judgement of competence. Deliberately balancing the values of patient safety, learner development, and systems agility can prevent harm when any single value dominates. Preparing faculty to recognize and navigate these value tensions is essential for fair, transparent, and defensible assessment decisions in CBME.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"15 1","pages":"830-844"},"PeriodicalIF":3.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}