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CBE and the Missing ‘E’: Making Competency-Based Education an Equitable Framework for Global Health Professions Education Cover

CBE and the Missing ‘E’: Making Competency-Based Education an Equitable Framework for Global Health Professions Education

Open Access
|Sep 2026

References

  1. Fremont D, Buh A, Hoar-Stephens C, Biyani N, Mahbub S, Singla R, et al. Equity, Diversity, and Inclusion Programs in Health Care Institutions: A Systematic Review and Meta-Analysis. 2026(2574–3805 (Electronic)). DOI: 10.1001/jamanetworkopen.2025.55896
  2. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383–392. DOI: 10.1016/j.jnma.2019.01.006
  3. Kakara Anderson H, Govaerts M, Abdulla L, Balmer D, Busari J, West D. Clarifying and expanding equity in assessment by considering three orientations: Fairness, inclusion and justice. Med Educ. 2025;59(5)(1365–2923 (Electronic)):494–502. DOI: 10.1111/medu.15534
  4. Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs. Academic medicine: journal of the Association of American Medical Colleges. 2019;94(7):1002–1009. DOI: 10.1097/ACM.0000000000002743
  5. Riaz Q, Khan MR, Ahmed M. Competency-based postgraduate medical education as an institutional initiative in a low- middle-income country: program directors’ perceptions of early implementation. BMC medical education. 2025;25(1):912. DOI: 10.1186/s12909-025-07065-2
  6. Gilliam CA, Lurie B, Winn AS, Barber A, Jackson D, Weisgerber M, et al. The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments. Current Problems in Pediatric and Adolescent Health Care. 2024;54(9):101641. DOI: 10.1016/j.cppeds.2024.101641
  7. Williams SM. Diversity, Equity, Inclusion, and Belonging in Veterinary Education. Veterinary Clinics of North America: Small Animal Practice. 2024;54(5):777–784. DOI: 10.1016/j.cvsm.2024.06.002
  8. Barnabe C, Osei-Tutu K, Maniate JM, Razack S, Wong BM, Thoma B, et al. Equity, diversity, inclusion, and social justice in CanMEDS 2025. Can Med Educ J. 2023;14(1):27–32. DOI: 10.36834/cmej.75845
  9. Unaka NI, Winn A, Spinks-Franklin A, Poitevien P, Trimm F, Nuncio Lujano BJ, et al. An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities. Pediatrics. 2022;149(2). DOI: 10.1542/peds.2021-054604
  10. Andrade BB, Sasaki KCM, Menezes RC, Luzardo Filho RL, Avena KM. From framework to fitness for the 21st century: How Brazil’s 2025 National Curricular Guidelines recast priorities for training physicians. 2026(2296–858X (Print)). DOI: 10.3389/fmed.2025.1730625
  11. Jayaram A, Pawlak N, Kahanu A, Fallah P, Chung H, Valencia-Rojas N, et al. Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach. 2021(1095–8673 (Electronic)).
  12. Rustagi SM, Mohan C, Verma N, Nair BT. Competency-based Medical Education: The Perceptions of Faculty. Journal of Medical Academics. 2019;2(1):1–5. DOI: 10.5005/jp-journals-10070-0034
  13. Nagar NS, Nagar SS. Qualitative assessment of faculty’s perspectives regarding effective implementation of competency-based medical education. Indian Journal of Community and Family Medicine. 2025;11(1):69–73. DOI: 10.4103/ijcfm.ijcfm_13_24
  14. Gupta S, Menon V. Psychiatry training for medical students: A global perspective and implications for India’s competency-based medical education curriculum. 2022(0019–5545 (Print)). DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_187_22
  15. Kiguli-Malwadde E, Olapade-Olaopa EO, Kiguli S, Chen C, Sewankambo NK, Ogunniyi AO, et al. Competency-based medical education in two Sub-Saharan African medical schools. 2014(1179–7258 (Print)). DOI: 10.2147/AMEP.S68480
  16. Matsuyama YA-O, Nomura OA-O, Oikawa S, Kikukawa M, Shimizu I, Gomi H. Competency-based medical education guidelines are context-based: Lessons from national guidelines in five countries. Medical teacher. 2024;46(1466–187X (Electronic)):S11–S20. DOI: 10.1080/0142159X.2024.2351215
  17. Urushibara-Miyachi Y, Matsushita K, Nishigori H. Development of a competency-based national model core curriculum in Japan: A case study. Medical teacher. 2024;46(sup1):S11–S20. DOI: 10.1080/0142159X.2024.2388906
  18. Aiken LH, Sloane DM, Bruyneel L, Griffiths P, Sermeus W. Staffing and education of nurses and hospital mortality in Europe-Authors’ reply. Lancet. 2014;384(9946):851–852. DOI: 10.1016/S0140-6736(14)61482-3
  19. Africa HPCoS. (Core Competencies for Undergraduate Students in Clinical Associate, Dentistry and Medical Teaching and Learning Programmes in South Africa. 2014. Available from: https://www.hpcsa-blogs.co.za/wp-content/uploads/2017/04/MDB-Core-Competencies-ENGLISH-FINAL-2014.pdf.
  20. Yilmaz Y, Chan M-K, Richardson D, Atkinson A, Bassilious E, Snell L, et al. Defining new roles and competencies for administrative staff and faculty in the age of competency-based medical education. Medical teacher. 2023;45(4):395–403. DOI: 10.1080/0142159X.2022.2136517
  21. Nel D, McNamee L, Wright M, Alseidi AA, Cairncross L, Jonas E, et al. Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context. Journal of Surgical Education. 2023;80 (10)(1878–7452 (Electronic)). DOI: 10.1016/j.jsurg.2023.06.027
  22. Frank JR, Karpinski J, Sherbino J, Snell LS, Atkinson A, Oswald A, et al. Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education. Perspectives on medical education. 2024;13(1):201–223. DOI: 10.5334/pme.1096
  23. Frank JR, Snell L, Englander R, Holmboe ES, Collaborators I. Implementing competency-based medical education: Moving forward. Medical teacher. 2017;39(6):568–573. DOI: 10.1080/0142159X.2017.1315069
  24. ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176–1177. DOI: 10.1111/j.1365-2929.2005.02341.x
  25. Bhattacharya S. Competency-based medical education: An overview. Annals of Medical Science & Research. 2023;2(3). DOI: 10.4103/amsr.amsr_27_23
  26. Lee GB, Chiu AM. Assessment and feedback methods in competency-based medical education. Ann Allergy Asthma Immunol. 2022;128(3)(1534–4436 (Electronic)):256–262. DOI: 10.1016/j.anai.2021.12.010
  27. Schuwirth LWT, Van der Vleuten CPM. Programmatic assessment: From assessment of learning to assessment for learning. Medical teacher. 2011;33(6):478–485. DOI: 10.3109/0142159X.2011.565828
  28. van der Vleuten CP, Schuwirth LW, Driessen EW, Dijkstra J, Tigelaar D, Baartman LK, et al. A model for programmatic assessment fit for purpose. Medical teacher. 2012;34(3):205–214. DOI: 10.3109/0142159X.2012.652239
  29. Driessen EW, Muijtjens AMM, van Tartwijk J, van der Vleuten CPM. Web- or paper-based portfolios: Is there a difference? Med Educ. 2007a;41:1067–1073. DOI: 10.1111/j.1365-2923.2007.02859.x
  30. Greenfield J, Qua K, Prayson RA, Bierer SB. “It Changed How I Think”-Impact of Programmatic Assessment Upon Practicing Physicians: A Qualitative Study. Med Sci Educ. 2023;33(4):963–974. DOI: 10.1007/s40670-023-01829-5
  31. Holmboe EA-O, Kogan JR. Will Any Road Get You There? Examining Warranted and Unwarranted Variation in Medical Education. Acad Med. 2022;97(8(1938–808X (Electronic)):1128–1136. DOI: 10.1097/ACM.0000000000004667
  32. Embo M, Grave HD, Stighelen SVD, Valcke M, Tengera O, Muhayimana A, et al. Can ePortfolios Scaffold Competency-based Workplace Learning in Low-income Countries? Lessons Learnt from a Qualitative Pilot Study in Midwifery Education in Rwanda. Proceedings of the International Conference on Medical Education (ICME 2021). 2021. DOI: 10.2991/assehr.k.210930.042
  33. Busari J, Diffey L, Hauer K, Lomis K, Amiel J, Barone M, et al. Advancing anti-oppression and social justice in healthcare through competency-based medical education (CBME). Medical teacher. 2024;46(9)(1466–187X (Electronic)). DOI: 10.1080/0142159X.2023.2298763
  34. Van Schalkwyk SC, Couper ID, Blitz J, De Villiers MR. A framework for distributed health professions training: using participatory action research to build consensus. BMC medical education. 2020;20(1):154. DOI: 10.1186/s12909-020-02046-z
  35. Busari JO, Verhagen EA, Muskiet FD. The influence of the cultural climate of the training environment on physicians’ self-perception of competence and preparedness for practice. BMC medical education. 2008;8:51. DOI: 10.1186/1472-6920-8-51
  36. Solchanyk DA-OX, Ekeh O, Saffran L, Burnett-Zeigler IE, Doobay-Persaud A. Integrating Cultural Humility into the Medical Education Curriculum: Strategies for Educators. Teach Learn Med. 2021;33(5)(1532–8015 (Electronic)):554–560. DOI: 10.1080/10401334.2021.1877711
  37. Avant ND, Gillespie GL. Pushing for health equity through structural competency and implicit bias education: A qualitative evaluation of a racial/ethnic health disparities elective course for pharmacy learners. Curr Pharm Teach Learn. 2019;11(4)(1877–1300 (Electronic)):382–393. DOI: 10.1016/j.cptl.2019.01.013
  38. WHO. WHO Guidelines Approved by the Guidelines Review Committee. Transforming and Scaling Up Health Professionals’ Education and Training: World Health Organization Guidelines 2013. Geneva: World Health Organization Copyright © World Health Organization 2013. 2013.
  39. McKenzie-White J, Mubuuke AG, Westergaard S, Munabi IG, Bollinger RC, Opoka R, et al. Evaluation of a competency based medical curriculum in a Sub-Saharan African medical school. BMC Med Educ. 2022;22(1)(1472–6920 (Electronic)). DOI: 10.1186/s12909-022-03781-1
  40. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–1958. DOI: 10.1016/S0140-6736(10)61854-5
  41. Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Medical teacher. 2010;32(8):631–637. DOI: 10.3109/0142159X.2010.500898
  42. Bleakley A, Bligh J, Browne J. Medical education for the future: Identity, power and location: Springer Science & Business Media; 2011. DOI: 10.1007/978-90-481-9692-0
  43. Hohmann E, Tetsworth KA-O. Fellowship exit examination in orthopaedic surgery in the commonwealth countries of Australia, UK, South Africa and Canada. Are they comparable and equivalent? A perspective on the requirements for medical migration. 2018(1087–2981 (Electronic)). DOI: 10.1080/10872981.2018.1537429
  44. Naidu T. Coloniality lives on through medical education. 2023(1756–1833 (Electronic)). DOI: 10.1136/bmj.p2294
  45. Eichbaum Q. Acquired and Participatory Competencies in Health Professions Education: Definition and Assessment in Global Health. Acad Med. 2017;92(4)(1938–808X (Electronic)):468–474. DOI: 10.1097/ACM.0000000000001382
  46. Ray K, Choudhari S, Roy H. Challenges and perceived solutions in implementing competency-based undergraduate curriculum: A qualitative study. Indian Journal of Health Sciences and Biomedical Research kleu. 2024;17(3). DOI: 10.4103/kleuhsj.kleuhsj_225_24
  47. Bakunda L, Crooks R, Johnson N, Osei-Tutu K, Bharwani A, Gye E, et al. Redefining professionalism to improve health equity in competency based medical education (CBME): A qualitative study. MedEdPublish (2016). 2024;14 (237)(2312–7996 (Electronic)). DOI: 10.12688/mep.20489.1
  48. Hodges B, Lingard L. Introduction. In The Question of Competence: Reconsidering Medical Education in the Twenty-First Century. In: Brian David H, Lorelei L, editors. The Question of Competence: Reconsidering Medical Education in the Twenty-First Century. Ithaca, NY: Cornell University Press; 2012. pp. 1–13. DOI: 10.7591/9780801465802-004
  49. Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Academic medicine. 2009;84(6):782–787. DOI: 10.1097/ACM.0b013e3181a42398
  50. Fricker M. Epistemic injustice: Power and the ethics of knowing: Oxford university press; 2007. DOI: 10.1093/acprof:oso/9780198237907.001.0001
  51. Feldacker C, Pintye J, Jacob S, Chung MH, Middleton L, Iliffe J, et al. Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation. PloS one. 2017;12(10):e0186074. DOI: 10.1371/journal.pone.0186074
  52. Qasem F, Al Areibi A. Adapting Canada’s CBME Model in Kuwait: Challenges, Strategies, and Lessons Learned in Postgraduate Medical Education. Journal of graduate medical education. 2025;17(6):701–704. DOI: 10.4300/JGME-D-25-00517.1
  53. Holmboe ES, Sherbino J, Englander R, Snell L, Frank JR, Collaborators I. A call to action: The controversy of and rationale for competency-based medical education. Medical teacher. 2017;39(6):574–581. DOI: 10.1080/0142159X.2017.1315067
  54. Ten Cate O. Competency-Based Postgraduate Medical Education: Past, Present and Future. GMS Journal for Medical Education. 2017;34(5)(2366–5017 (Electronic)).
  55. Hodges BD. A tea-steeping or i-Doc model for medical education? Acad Med. 2010;85 (9)(1938–808X (Electronic)). DOI: 10.1097/ACM.0b013e3181f12f32
  56. Norman G, Norcini J, Bordage G. Competency-based education: milestones or millstones? J Grad Med Educ. 2014;6(1)(1949–8349 (Print)):1–6. DOI: 10.4300/JGME-D-13-00445.1
  57. Ellaway R, Masters K. AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Med Teach. 2008;30(5)(1466–187X (Electronic)):455–473. DOI: 10.1080/01421590802108331
  58. Steinert Y, Mann K, Anderson B, Barnett BM, Centeno A, Naismith L, et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40. Med Teach. 2016;38(8)(1466–187X (Electronic)):769–786. DOI: 10.1080/0142159X.2016.1181851
  59. ten Cate O, Snell L, Carraccio C. Medical competence: the interplay between individual ability and the health care environment. Med Teach. 2010;32(8)(1466–187X (Electronic)):669–675. DOI: 10.3109/0142159X.2010.500897
  60. WHO. Transforming and Scaling Up Health Professionals’ Education and Training: World Health Organization Guidelines. Geneva: World Health Organization; 2013.
  61. Woolf K, Potts HWW, McManus IC. Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. BMJ. 2011;342:d901. DOI: 10.1136/bmj.d901
  62. Sultan MA, Miller E, Tikkanen RS, Singh S, Kullu A, Cometto G, et al. Competency-based education and training for Community Health Workers: a scoping review. BMC Health Serv Res. 2025;25(1):263. DOI: 10.1186/s12913-025-12217-7
  63. Müller J, Reardon C, Coetzee F, Bester J, Dube K, Hanekom S, et al. Transformative learning through participation: experiences at a rural clinical training site in South Africa. BMC medical education. 2022;22(1):183. DOI: 10.1186/s12909-022-03233-w
  64. Schuwirth L, van der Vleuten C. A history of assessment in medical education. Adv Health Sci Educ Theory Pract. 2020;25(5)(1573–1677 (Electronic)):1045–1056. DOI: 10.1007/s10459-020-10003-0
  65. Naidu T. Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship. Lancet Glob Health. 2021;9(9):e1332–e1335. DOI: 10.1016/S2214-109X(21)00198-4
  66. Busari JO, Chan M-K. Healthcare leadership and the path to social justice through academic publishing. BMJ Leader. 2023;7(Suppl 2):e000878. DOI: 10.1136/leader-2023-000878
  67. Martin-Booran Mirraboopa K. Ways of knowing, being and doing: A theoretical framework and methods for indigenous and indigenist re-search. Journal of Australian Studies. 2003;27(76):203–214. DOI: 10.1080/14443050309387838
  68. Sciences RFoH. Disruption of all forms of racism Winnipeg: University of Manitoba; 2023. Available from: https://umanitoba.ca/health-sciences/office-anti-racism.
  69. Society CP. Antiracism in pediatric health care. Canadian Paediatric Society; 2021.
  70. Stanford FC. The Importance of Diversity and Inclusion in the Healthcare Workforce. 2020(1943–4693 (Electronic)).
  71. AAMC. Medical Pathways & Enrichment Opportunities. Association of American Medical Colleges; 2026.
  72. Boatright D, Edje L, Gruppen LD, Hauer KE, Humphrey HJ, Marcotte K. Ensuring Fairness in Medical Education Assessment. Acad Med. 2023;98(1938–808X (Electronic)):S1–S2. DOI: 10.1097/ACM.0000000000005244
  73. Meurer LN, Young SA, Meurer JR, Johnson SL, Gilbert IA, Diehr S. The urban and community health pathway: preparing socially responsive physicians through community-engaged learning. American journal of preventive medicine. 2011;41(4 Suppl 3):S228–S236. DOI: 10.1016/j.amepre.2011.06.005
  74. Evanson TA, Zust BL. The Meaning of Participation in an International Service Experience Among Baccalaureate Nursing Students. International Journal of Nursing Education Scholarship. 2004;1(1). DOI: 10.2202/1548-923X.1070
  75. Zaccagnini M, Cameron E, Strasser R, Razack S, Molinaro M, Dubé T. Unpacking educational approaches for social accountability in health professions education: a scoping review. Advances in Health Sciences Education. 2025. DOI: 10.1007/s10459-025-10494-9
  76. Ashwell G, Russell AM, Williamson AE, Pope LM. Learning about Inclusion Health in undergraduate medical education: a scoping review. BMJ Open. 2025;15(4):e092420. DOI: 10.1136/bmjopen-2024-092420
  77. Do V, Lewis M, Goldstein C, Sonnenberg LK. Fostering a Health-Promoting Learning Environment in Medical Education: Adapting the Okanagan Charter for Administrators and Medical Educators. Academic medicine: journal of the Association of American Medical Colleges. 2023;98(6):672–679. DOI: 10.1097/ACM.0000000000005159
  78. Do V, Lewis M, Flynn L, Sonnenberg LK. Sick by design? Why medical education needs health promoting learning environments. Can Med Educ J. 2025;16(1):123–124. DOI: 10.36834/cmej.80471
  79. Mangalindan KE, Wyatt TR, Brown KR, Shapiro M, Maggio LA. Investigating the Road to Equity: A Scoping Review of Solutions to Mitigate Implicit Bias in Assessment within Medical Education. Perspectives on medical education. 2025;14(1):92–106. DOI: 10.5334/pme.1716
  80. Isik U, Wouters A, Verdonk P, Croiset G, Kusurkar RA. “As an ethnic minority, you just have to work twice as hard.” Experiences and motivation of ethnic minority students in medical education. Perspectives on medical education. 2021;10(5):272–278. DOI: 10.1007/S40037-021-00679-4
  81. Klasson CL, Shibli-Rahhal A, Ortiz E, Raghuram A, Behel J, Gregory A, et al. Restorative Justice Practices as a Foundation for Medical Education Innovation. Clin Teach. 2025;22(1):e13852. DOI: 10.1111/tct.13852
  82. Sawin G, Klasson CL, Kaplan S, Larson Sawin J, Brown A, Thadaney Israni S, et al. Scoping Review of Restorative Justice in Academics and Medicine: A Powerful Tool for Justice Equity Diversity and Inclusion. Health Equity. 2023;7(1):663–675. DOI: 10.1089/heq.2023.0071
  83. Kassam A, de Vries I, Zabar S, Durning SJ, Holmboe E, Hodges B, et al. The Next Era of Assessment Within Medical Education: Exploring Intersections of Context and Implementation. Perspectives on medical education. 2024;13(1):496–506. DOI: 10.5334/pme.1128
  84. Duchesne A, Shaw A, Sawyer K, Barata P, Radtke L. Advancing a plural, reflexive, and inclusive psychology through feminist mentoring. Feminism & Psychology. 2026;36(1):3–14. DOI: 10.1177/09593535251404121
DOI: https://doi.org/10.5334/pme.2551 | Journal eISSN: 2212-277X
Language: English
Page range: 880 - 893
Submitted on: Mar 8, 2026
Accepted on: Aug 26, 2026
Published on: Sep 29, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services

© 2026 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, Members of the International Competency-Based Health Professions Educators Collaborative, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.