In traditional education the central aim of the teaching-learning process is to convey content; the teacher is the centre of the process, the one who possesses and transmits knowledge, and the student plays a passive role, as a mere receiver. With CBE, in contrast, students are the centre of the teaching–learning process, and the aim is for them to learn how to learn, to solve problems and to adapt to changes in their environment. Its objective is to achieve learning that combines knowledge, skills (know-how), attitude and behaviour. These sets of knowledge are called competencies.

This approach is regarded as one of the most important changes in education in the twenty-first century. Its importance lies in promoting the active participation of students in their own learning, making them aware of their progress and development, helping them to manage their knowledge and to acquire the necessary competencies that will make it easier for them to adapt to a changing and unpredictable environment. It also enables training programmes to be developed more flexibly, so that students learn at their own pace, and it emphasises formative assessment.1

In CBE, those responsible for training play the role of guides to learning, and to achieve this they must design educational experiences that engage students and make them participate actively.

The defining features of CBE are2:

• •

  Competencies have to be clearly identified, verified and familiar to all those involved in the education process.

• •

  Every training action must be geared towards achieving specific learning outcomes and accompanied by its corresponding assessment.

• •

  Assessment must not be based exclusively on evaluating knowledge, but on evidence of learning, such as attitudes and performance. In addition, it must be qualitative (“students are competent or are not yet competent”) and personalised (students are compared with themselves, not with their peers).

• •

  Efforts must be made to ensure that the teaching is individualised and tailored to the rate of progress of each participant.

• •

  The students must play a part in developing the learning and assessment strategies, which require continuous feedback.

Identifying the competencies needed for professional practice is an essential component of this approach to teaching. They include those required by the official training programme, as well as others that arise in day-to-day practice, as a result of changes in the healthcare environment or of new knowledge or advances in technology. Other sources of information are assessments of training actions and studies carried out to ascertain their real impact. All this provides the system with feedback, expands knowledge of training needs and gradually identifies the set of real competencies.

Competency-Based Education makes it possible to establish a direct relationship between competencies and the contents of training programmes, which are structured in training modules.2 Thus a competency may be developed in more than one training module, and a module, in turn, may address several competencies. Modules in CBE are the learning units that enable objectives, contents and activities to be structured around a problem in professional practice and the competencies we are seeking to develop. The modules may or may not be hierarchically related and go from the general to the specific.2

Any CBE programme must be constructed on the basis of knowledge of the competencies required, developing training actions that make use of all the resources available and conducting assessment processes on their performance, to provide feedback and optimise learning.

As we have seen, all available learning opportunities must be utilised. Distance learning, with the aid of new technologies, is an efficient method of achieving this, which can be adapted to the student's needs (timetable, pace of work, place of residence, financial means, etc.). Adoption of the principles of CBE has given rise to Continuum, the distance learning platform of the Spanish Association of Paediatrics. It offers training activities designed to cover the competencies (knowledge and skills) that paediatricians need to acquire and maintain in their day-to-day practice. The available content is structured in various types of activity (training courses, new publications, images of the week, interactive clinical cases, knowledge pills, tools) which function as training modules, designed to cover a set of predefined competencies. For this purpose we have developed a competence matrix, which constitutes the teaching structure of Continuum.

The matrix is based on the Global Pediatric Education Consortium3 (GPEC) training programme. This body is made up of leaders of national and regional organisations devoted to education, qualification and accreditation, whose mission is to establish relevant criteria for training and practice in paediatrics at an individual level and to assess their efficacy for ensuring the quality of paediatric learning and care throughout the world. The GPEC curriculum is designed for general paediatric training, in both primary and hospital care, and although it addresses competencies pertaining to specific training areas, with a greater or lesser degree of development, it is not currently intended as a benchmark for training in such areas. Nevertheless, since it is by its nature an open-ended document, it can be supplemented with whatever contributions and improvements professionals in the various training areas consider necessary for their speciality.

The matrix has a hierarchical structure, with 2 generic sections: one for basic abilities and behaviour and another in which the various areas of paediatric knowledge are deployed (Table 1). In the latter, specific, successively subordinated contents are developed, and in each one there are subgroups of competencies related to history, physical, diagnosis and management. The programme has been adapted into Spanish from the original version in English, and as new training actions arise, with teaching aims that are not included in the matrix, modifications are introduced or new competencies are created.

To facilitate locating items in the matrix, each competency is assigned a hierarchically structured code (see Tables 2 and 3). This means that when students perform an activity, they can find out what results they can achieve with it.

In addition, the matrix enables students to locate the competencies they are interested in and to look up the activities that the platform offers for acquiring them (www.bit.ly/continuumcompt). They thereby obtain a personalised view of their training curriculum or virtual portfolio (once they have registered and identified themselves), showing the competencies they have covered in each area and those they have yet to attain.

Competencies can be searched for in the matrix in 2 ways, either by expanding the various sections of which it is composed (see Figs. 1–3) or by entering the keyword in the search box (Fig. 4).

Figure 1.

Competency matrix in Continuum (www.bit.ly/continuumcompt). Partially expanded view of the competency matrix.

(0.4MB).

Figure 2.

Partially expanded view of the competency matrix (www.bit.ly/continuumcompt). Further expansion of competencies, showing the headings and a specific competency. Each heading has an icon on the right through which the user can access training activities in which that issue is developed in Continuum.

(0.41MB).

Figure 3.

Competencies in the area of rate and rhythm disorders, with an expanded window of related activities. By clicking on the icon students can select the activities available in Continuum for them to perform, which will enable them to acquire a given competency.

(0.39MB).

Figure 4.

Competency search using the search engine. With this search option the user enters a key term in the box located at the top left of the screen, and the available teaching related to the chosen competency is displayed.

(0.44MB).

From a teaching point of view, the array of competencies offered by the matrix is essential for those designing and scheduling training activities, since it enables them to tailor their training programmes to the requirements. This same idea was expressed by Le Boterf, the founding father of CBE,4 when he commented that “one has to have a reference framework of the competencies required in order to identify the need for them”.

On an independent basis, as well, trainee professionals and paediatricians that consult the virtual portfolio will be able to find out what knowledge and skills they have to acquire in order to develop and improve their training.

Finally, another way in which it may be useful is by offering members of the Spanish Association of Paediatrics the option of combining the educational and professional spheres and obtaining credits for in-service training that can be presented to any institution as evidence of their professional development and periodically certify their qualification in the future.

In conclusion, the Continuum competency matrix offers the following educational opportunities and innovations:

• -

  It formulates a CBE programme, underpinned by a curriculum developed and accepted by internationally recognised experts in paediatrics.

• -

  It allows students to manage their own learning according to their needs.

• -

  It sets out the road map that tutors and trainee paediatricians can follow to develop their training plan.

• -

  It helps users to produce a personalised training portfolio, which can be used as the basis for future recertification.

The education of competent paediatricians must move forward from an exclusively curriculum-based form of training to one focusing on competencies, thus responding to the needs of the current Health System. Acquiring and maintaining professional qualification requires excellent initial training, ongoing professional development and continuous application of learning based on innovation and improvement. To achieve this, the Spanish Association of Paediatrics has made the Continuum platform available to its members, in order to attain the highest level of qualification for the whole professional community and provide the Spanish child and adolescent population with the best possible care.

Carlos Ochoa Sangrador and Carmen Villaizán Pérez are Continuum Competency Matrix coordinators; Javier González de Dios and Francisco Hijano Bandera are joint directors of Continuum.