Sören Huwendiek

The concurrent uptake of both artificial intelligence (AI) and competency-based health professions education (CBHPE) represents a watershed opportunity to improve and streamline educational processes and enhance educational effectiveness. Members of the International Competency-based Health Professions Educators Collaborative (ICBHPE) explored the potential of AI to strengthen CBHPE implementation by addressing persistent challenges in meeting its five core components: defined outcome competencies; progressive sequencing; tailored learning experiences; competency-focused instruction; and programmatic assessment. Effective integration of AI tools can be guided by socio-technical systems theory (STST), which highlights the significant interdependence of technical systems and social systems. Successful application of AI in HPE will hinge on addressing the complex interactions among people and roles; goals and incentives; workflows and processes; technology; infrastructure; and organizational culture. Health professions educators should enhance their fundamental knowledge of how AI tools are developed and deployed to understand both its potential and its limitations. The HPE community must rigorously evaluate AI applications to ensure responsible and equitable integration that complements human relationships and judgment.

Competency-based education is widely endorsed in health professions education (CBHPE) as an outcomes-focused approach to ensuring that all graduates demonstrate the competencies needed to improve patient and population health. Despite adoption of outcomes frameworks, accreditation requirements, and CBHPE tactics, interventions remain siloed within programs and training levels rather than spanning the education to practice continuum. Consequently, learners and teachers experience fragmented educational journeys that can fall short of addressing each learner’s needs for continuous learning and growth. To advance efforts toward a CBHPE continuum, this systems-informed conceptual analysis uses a systems thinking perspective to analyze leverage points, places within complex systems where small, strategic interventions can cause large-scale, lasting changes. Drawing on Meadows’ framework for understanding leverage points in complex systems, we examined barriers and opportunities to achieve a continuum and present five theoretically informed, literature-based, and expert-derived recommendations for transformation. Our analysis revealed that strategic intervention points, including paradigm shifts from ‘time-served’ to ‘competence-demonstrated’ readiness, structural changes through cross-continuum governance alignment, and process modifications via shared competency language and data systems, enable meaningful transformation beyond surface-level adjustments. Key recommendations include: (1) restructuring system architecture to enable seamless learner progression through competency committees and joint governance bodies; (2) shifting mental models to normalize time-variable progression and reconceptualize assessment as growth-supporting; (3) implementing high-impact approaches to assessment with longitudinal learner analytics; (4) changing rules and incentives to reward competency achievement; and (5) establishing continuous data-driven feedback systems. Understanding these leverage points informs targeted approaches, enabling a cohesive, coordinated, learner-centered CBHPE continuum.

Assessments serve several purposes in competency-based medical education (CBME) and competency-based health professions education (CBHPE) programs. These purposes are commonly termed ‘assessment for learning’ and ‘assessment of 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.

Background: 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. Objective: To develop structured reporting guidelines for CBHPE outcomes studies to improve transparency, interpretability, and transferability across educational contexts and professions. Methods: 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. Results: 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. Conclusions: 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.

Competency-Based Health Professions Education (CBHPE) has transformed health professions training by emphasizing demonstrated competence over time-based progression. Yet the clinical learning environment (CLE), the social, cultural, and organizational ecosystem in which learning occurs, has not evolved in parallel. Persistent hierarchies, workload pressures, and inadequate faculty development limit CBHPE’s full potential. Thus, the authors sought to identify priorities for CLE reform. A structured consensus process was conducted at the International Competency-Based Education Collaborators Summit in February 2025, where interdisciplinary health professions educators identified CLE reform priorities. Findings were refined through virtual meetings over three months. Five interdependent priorities were identified as essential for transforming the CLE:Psychological safety: enabling vulnerability, feedback, coaching, and growth through faculty and learner developmentTeaching environment: prioritizing faculty well-being, recognition, and sustainable teaching capacityDesirable difficulty and productive struggle: balancing challenge and safety to promote adaptive expertise and resilienceInterdependence and collectivism: reframing education from individual performance to team-based competence and shared accountabilityPartner alignment: integrating educational and healthcare system goals to advance patient care and workforce well-beingTogether, these domains outline the CLE as both a developmental and operational engine for CBHPE. Realizing the promise of CBHPE depends on transforming the CLE into a psychologically safe, appropriately challenging, interdependent, and system-aligned ecosystem. Reform demands cultural change that values coaching, feedback, vulnerability, and collective responsibility as professional imperatives. By aligning structures and empowering adaptive educators, the CLE can evolve from a passive setting to an active driver of successful competency-based transformation.

Introduction: Competency-Based Health Professions Education (CBHPE) is an outcomes-based approach to planning and conceptualizing the training of health professionals to serve population needs. Despite its uptake, ongoing debate persists regarding the assumptions underpinning CBHPE, its intended purposes, and how success should be defined and evaluated. This contributes to variable implementation and difficulty aligning core features with meaningful outcomes. To date, no published theory of change has articulated how CBHPE’s core components provide a framework for later evaluation of intended outcomes.Methods: Using Funnell and Rogers’ purposeful program theory, the authors, all members of the International Competency-based Education Health Professions Educators Collaborative (ICBHPE), developed a model theory of change. The authors conducted a broad review of CBHPE literature, supplemented by CBE frameworks from adjacent educational contexts to strengthen underdeveloped constructs in implementation and evaluation. Findings were iteratively synthesized into a program theory and refined through repeated cycles of large-group feedback, consensus building, and member checking within ICBHPE.Results: The authors developed a CBHPE Outcomes Theory of Change that articulates key assumptions, mechanisms of impact, and expected outcomes associated with CBHPE implementation. The framework specifies how van Melle’s CBHPE core components are theorized to function across phases of implementation and identifies proximal and distal outcomes that can reasonably be expected, based on intentional, deliberate program evaluation at each implementation and evaluation stage.Discussion: The CBHPE Outcomes Theory of Change offers scholars and implementers a practical guide to enhance the quality and fidelity of implementation, evaluation, and research efforts related to CBHPE worldwide. Using this guide as a framework, programs can plan, implement, and then examine whether the intended outcomes of CBHPE have been realized.

Aim: Written assessment methods are widely used to assess clinical reasoning in undergraduate health professions education, yet little is known about the specific approaches used and educators’ needs. Although automatic question generation, especially AI-based, offers promising efficiency gains, the extent of its application in clinical reasoning assessment remains unclear. The aim of this study is to determine the needs for written clinical reasoning assessment methods and automatic question generation in undergraduate health professions education. Methods: An international web-based survey was conducted between February and June 2024. Participants were health professions educators knowledgeable about written assessment methods in their programs. The survey covered current practices, perceived importance, barriers, and needs related to written clinical reasoning assessment methods and automatic question generation. Parametric and non-parametric statistical tests were used for the analysis. Results: 51 programs from 33 countries participated. Multiple-choice questions (MCQs) were the most widely used method (100% of programs). Short-answer questions were perceived as most important for both formative and summative assessment. Main barriers in using the written assessment methods were lack of know-how (81.6%) and insufficient time (79.6%). “Differential diagnosis” and “management and treatment” were the most commonly assessed clinical reasoning components, while ethical aspects, patient perspective, and interprofessional collaboration were the least assessed. Only 58.1% of programs provide feedback on MCQ results to students, with varying levels of detail. Awareness and use of automatic question generation methods were low, both for template-based and non-template-based (artificial intelligence) methods. Educators showed willingness to participate in training on assessment methods and automatic question generation. Conclusion: While MCQs are ubiquitous, there is recognition of the importance of other methods such as short-answer questions. Significant barriers exist in benefiting from various assessment methods. There is a clear need for faculty development and greater awareness of innovative solutions, such as automatic question generation to enhance efficiency of assessment practices in medical schools.

Near-peer teaching (NPT) is widely used to substitute faculty in undergraduate clinical skills training. However, little is known about which educational design choices are made when incorporating NPT, prompting the following research questions: What were course directors' design choices when incorporating near-peers into clinical skills courses? And, what were the reasons for these design choices? This descriptive qualitative study carried out 25 semi-structured interviews with course directors from 12 countries who had recently published on NPT, complemented by other, recognized NPT experts. Reflexive thematic analysis of the transcribed interviews combined inductive and deductive approaches. Cognitive Apprenticeship informed the deductive analysis. Course directors appointed near-peers to teach standardisable skills to small groups of beginners in courses without patients - complemented by faculty supervision. Some directors involved near-peers in co-designing education, co-assessments, or co-facilitating transition to clinical practice. Course directors justified their choices based on near-peers' limited content expertise, but also their adherence to teaching scripts, cognitive congruence with students, social proximity, digital/technical literacy and low costs. Course directors' design choices were mainly inspired by working around near-peers' limitations. Some courses capitalised on near-peers' unique perspectives, extending near-peer roles to co-designing education and co-facilitating transitions to practice.

Purpose: Negotiating the balance between clinical residents’ roles as health care practitioners and learners is a struggle in postgraduate medical education. Although ad hoc entrustment has been studied in this context, little is known about residents’ perceptions of ad hoc over- and underentrustment, the need for supervision, and their coping strategies. Therefore, this study explored residents’ perspectives concerning these topics. Method: The authors conducted semistructured, in-depth interviews with 12 purposively sampled residents in the graduate medical educational phase of residency who were involved in geriatric psychiatry rotations from different training sites and settings in Switzerland. The interviews were conducted between January and March 2022. Researchers used a thematic analysis to explore and interpret the data within a constructivist research paradigm. Results: Four overarching themes were identified: ad hoc and default entrustment in the workplace, perceptions of supervision, applied coping strategies to over- and underentrustment, and suggestions for improvement. Residents described entrustment decisions in the workplace as a default, often covert process and as an explicit, ad hoc delegation of clinical tasks. Perceived optimal supervision entailed sufficient time, frequency, and availability of the supervision, supervisors referring to scientific evidence in their reasoning, trustworthiness, and a psychologically safe learning environment. Residents described suboptimal supervision as lacking appropriate feedback timing, having little or nonexistent time in general, using an ambivalent communication style, and clinical decision-making by the supervisor that is not explicit. Residents applied instrumental, appraisal-focused, and emotion-focused coping strategies. Their suggestions for improvement included instructional design of the workplace-based curriculum, supervision, teaching content, and contextual factors. Conclusions: Within postgraduate training, addressing the organizational and contextual factors of entrustment and resident supervision is essential. Default entrustment decisions need to be explored and explicitly addressed to prevent overentrustment, meet residents’ need for supervision, and effectively coach residents to maintain their well-being.