Jones & Bartlett Learning Health Blog

    What is This Thing Called Competency Based Education?

    Posted by sharonb on Oct 5, 2015 1:00:24 AM

    2014 Headshot_Short HairThe buzz in health care management education is all competencies, all the time. Your program, whether at the undergraduate or graduate level, must be anchored in a competency based framework. The framework selected must be based on your program’s mission, vision, and values, your target students and the outcomes, i.e., where do you expect these students to go. Every meeting you attend will touch upon competencies and the dreaded assessments. Some may ask, “Why the big push?” Others may say, “What was wrong with the old fashioned way?”

    Despite the fact that many of our current CEOs, COOs, and CFOs, came from the lecture, test, and pass the courses until you graduate model, these same employers grew to question the ability of graduates to take on the brave new world of health care. No longer was it appropriate to give good content and launch students across the graduation stage into the real world. The employers were not pleased with the quality and skills of the students coming to them, no matter how high the student’s GPA. Higher education, in general, and health care management education, in specific, continues to be called on the deficiencies in skills of their graduates.

    The fact that graduates struggle to find jobs combined with hard data on the declining traditional undergraduate student population (the baby bust, if you will), means higher education is fighting to maintain relevancy to employers and adult learners, alike. Enter competency based education (CBE), a notion that is based not on time to graduation, but on demonstration of the required knowledge skills and abilities. This means in some experimental sites the Department of Education (DOE) is watching to see how this new concept works out. The sticking point, as you can well imagine, is the definition of direct assessment required to demonstrate competencies.

    One federal definition says:

    “`direct assessment program'', an instructional program that uses or recognizes direct assessment of a student's learning in lieu of credit or clock hours.”

    The experiment sites guide states:

    “A direct assessment program is an instructional program that, in lieu of credit hours or clock hours as a measure of student learning, utilizes direct assessment of student learning, or recognizes the direct assessment of student learning by others. The assessment must be consistent with the accreditation of the institution or program utilizing the results of the assessment.”

    So what does this mean to healthcare management programs? I anticipate a growing number of potential students who are already working in the field, but who do not have degrees (a rather large number, by the way) will be searching for programs that offer opportunities for portfolio review (direct assessment of learning by others) and direct assessment of their competencies by experts at the institution or partner institutions. I also suspect this will take longer to come to fruition in healthcare management, given some of issues surrounding those universities that thought they’d be approved by the DOE, then weren’t. As of July, 2014, only two universities have had success in negotiating the complicated federal application and approval process.

    In the meantime, I recommend taking a good hard look at our own programs and asking some tough questions, some of which should include:

    • Do we have a mission, vision and value statement that drives a competency based curriculum?
    • Do we obtain input into the curriculum from all stakeholders, including employers, community partners, students, alumni, and advisory board members?
    • Do we use this input to adjust our competencies and curriculum?
    • Do we directly measure, i.e., assess, these competencies and address shortcomings in our program when students don’t perform well?
    • Do we have a strategic plan that incorporates environmental factors, such as CBE?
    • Are we relevant to the populations and communities we serve?
    • Do employers tell us they want more of our graduates?

    We cannot sit on the sidelines and wait for the brave new world of competency based education to go away quietly. It’s time to take a critical look at who we are and what we contribute to our students’ education and the field of health care management. If we don’t, we will be the architects of our own demise.

    Sharon B. Buchbinder, RN, PhD

    Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

    Here are some references if you are interested in this topic:
    Everhart, D., Sandeen, C., Seymour, D. & Yoshino, K. (n.d.) Clarifying competency based education terms. American Council on Education and Blackboard. Retrieved from

    Fain, P. (2014, July 23). Experimenting with aid. Retrieved from

    Fain, P. (2014, February 21). Taking the direct path. Retrieved from

    Federal Register. (2009, October 217). 34 CFR Parts 600 and 602: Institutional Eligibility Under the Higher Education Act of 1965, as Amended, and the Secretary's Recognition of Accrediting Agencies; Final Rule. Retrieved from

    Kamenetz, A. (2014, October 7). Competency-based education: No more semesters? Retrieved from

    U.S. Department of Education (2015, September). Introduction to competency based education. CBE experiment guide. Retrieved from

    Topics: Author, health administration, Health Administration, health care management, Sharon B. Buchbinder, Sharon Buchbinder Blog, competency based education

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