CORE-HPE Reporting Guidelines: Standardizing Reporting for Competency-Based Health Professions Education Outcomes Research

Design and Development Process

A multi-phase, iterative consensus-development process was used to generate reporting recommendations for CBHPE outcomes studies. The reporting guideline process was submitted to EQUATOR (Enhancing the QUAlity and Transparency Of health Research) [42] before consensus and post-completion to support visibility, dissemination, and standardized use across journals and professional contexts. See Figure 1 for an overview of the process of development.

Figure 1

The consensus-development process for this reporting guideline was structured to emphasize transparency and reproducibility [43]. The development team used EQUATOR to support systematic processes for stakeholder engagement, iterative refinement, and usability testing [44]. In addition, checklist development was informed by published recommendations for Delphi reporting quality (CREDES) and broader consensus reporting guidance (ACCORD) to ensure that consensus processes were described in a complete and interpretable manner [45, 46]. The consensus process occurred in two primary stages: (1) development and refinement of draft reporting elements through structured writing group deliberations and broader stakeholder input; and (2) usability evaluation through pilot testing with non-expert users, followed by final revisions. Across development phases, checklist elements were refined to (1) prioritize reporting items that most strongly influence outcome interpretation, (2) reduce redundancy across items, and (3) improve decision clarity for commonly misunderstood constructs (e.g., minimum fidelity signals, implementation outcomes versus effectiveness outcomes, and outcomes over time (proximal, intermediate, and distal) [2, 36, 47, 48, 49].

Phase I: Need for Reporting Guidelines and Establishment of Steering Committee/Writing Group

The steering committee is a subcommittee of the International Competency-based Health Professions Educators Collaborative (ICBHPE), established in 2009. Approximately 90 scholars, leaders, implementers, and evaluators of CBHPE from six continents and diverse professions and backgrounds comprise ICBHPE. The aim of ICBHPE is to advance CBHPE through scholarship, implementation support, and international collaboration. The Collaborative has an extensive history of achieving these goals across activities such as journal supplements, world summits, and blog hosting.

In 2024, ICBHPE initiated a consensus process to prioritize emerging needs in the field. Consortium members first brainstormed a broad list of candidate issues and then voted to identify priority topics. Each of the 18 selected topics was then further elaborated by a small working group and approved by the consortium to be discussed at a formal consensus conference, hosted by Stanford University in February 2025. Over 50 participants attended the conference. During the conference, the topics were refined through structured workshops and large-group deliberation, and the view of CBHPE as defined by Van Melle’s Core Components [2] was debated and reaffirmed. The need for a reporting guideline was identified as a top priority.

The Writing Group consisted of 16 members across 4 continents, with 3 serving on the Steering Committee (AC, DR, JF). The writing group/steering committee brings extensive experience in CBHPE, assessment, and program evaluation across multiple health professions, including medicine, pharmacy, and veterinary medicine, and across undergraduate, graduate, and continuing professional education. Collectively, the authors hold leadership roles in academic institutions, accreditation-related activities, assessment and evaluation units, national and international medical and health professions education organizations, and editorial positions. Several authors have contributed to the conceptualization, implementation, evaluation, and scholarly study of CBME/CBHPE, including the development of core components, outcomes frameworks, and prior guidance on evaluation and reporting. These experiences shape our perspective and represent both a strength and a potential source of bias. As scholars and educators who view CBHPE as a promising and evolving response to limitations of traditional training models, we approach reporting with an explicit commitment to theory-informed design, transparency, and cumulative learning. At the same time, we recognize that our familiarity with CBHPE concepts, language, and infrastructure may influence assumptions about what should be reported or how reporting standards are interpreted. To mitigate this, we intentionally grounded these reporting guidelines in established implementation science, program theory, and evaluation frameworks; engaged in iterative, multidisciplinary dialogue across professions and international contexts; and focused on reporting elements intended to improve interpretability regardless of local models, stages of implementation, or outcomes observed.

Phase II. Drafting and Structured Discussions

During the 2025 Stanford conference, potential elements and frameworks for reporting guidelines were discussed in a 1.5-hour workshop. Post-conference ideas and notes were disseminated, and two structured virtual discussions were held to explore potential content for reporting guidelines. Following these virtual discussions, an outline was disseminated to elaborate the writing and consensus process and list reporting guideline elements, ensuring alignment with van Melle’s CBHPE core components [2] and program-theory constructs (e.g., outcomes, indicators, fidelity, context, adaptations, and equity considerations) [31]. The methodology for creating the guidelines was established through a consensus process [43, 44, 45, 46, 50].

Our author group focused on a recurring need identified through these discussions: greater clarity regarding the assumptions, mechanisms, and intended outcomes of contemporary CBHPE. We sought to translate the existing CBHPE literature and collective experience into practical guidance that could support program design, implementation, and evaluation. This produced a Theory of Change paper [31] that is part of the special series of articles in which this current paper is included [16, 17, 51, 52, 53, 54, 55, 56, 57, 58, 59] and the Reporting Guidelines contained in this present paper. The CBHPE Outcomes Theory of Change [31] was used to inform the Reporting Guidelines. In brief, the CBHPE Outcomes Theory of Change [31] is a conceptual framework describing how CBHPE initiatives are expected to produce implementation outputs and outcomes over time by situating CBHPE as a theory-informed program intervention in which core CBHPE components [2], stakeholder behaviors, and context interact to produce proximal outputs and longer-term outcomes. It is based on the definition of theory by Varpio [60] and is built on program theory as described by Funnell and Rogers [41]. Together, the Theory of Change and the Reporting Guidelines are complementary in nature. The former articulates the causal logic and expected pathways of CBHPE. At the same time, the Reporting Guidelines were designed to operationalize this logic into standardized reporting practices to improve transparency, interpretability, and comparability across CBHPE studies.

Post-conference, writing groups further developed the products. They presented them back to the consortium for member-checking with revisions informed by feedback to improve clarity, shared meaning of terminology, and usability across countries and professions.

Phases III and IV. Guideline Development, EQUATOR Registration, and Consensus-Building

Based on feedback, members of the Steering Committee (AC, DR) prepared another draft of the reporting guidelines, which were then circulated to all authors for iterative refinement. Two town hall meetings with the ICBHPE collaborative were conducted to further refine, build consensus, and finalize the guidelines. To support transparency and dissemination, the development team registered the reporting guidelines with the EQUATOR Network reporting guideline registry [42].

Town halls were held virtually in January 2026 with ICBHPE members. These served as structured mechanisms to gather feedback from the ICBHPE. Disseminating this to the ICBHPE membership enabled individuals representing the Global South and other health professions to provide feedback. Discussion prompts were used to solicit input on the clarity of checklist items, the perceived importance of each reporting element, the feasibility of reporting in real-world studies, and areas requiring additional guidance (e.g., definitions, examples, and decision rules). This process of incorporating broad stakeholder engagement aligned with recommended steps for developing health research reporting guidelines, including consultation with relevant end users to strengthen acceptability and real-world applicability [44].

Following each town hall, the members of the Steering Committee (AC, DR) synthesized stakeholder feedback and revised checklist items through iterative rounds of editing. Revisions informed by town halls included consolidating redundant checklist prompts, standardizing terminology across manuscript sections, and adding brief examples to guide interpretation of high-impact items (e.g., fidelity signals, adaptation reporting, and proximal versus distal outcome classification). These refinements were intended to reduce the reporting burden while preserving the elements most essential to the interpretability and transferability of CBHPE outcome findings. This iterative approach followed consensus-method guidance emphasizing transparent synthesis and structured refinement between feedback cycles [43]. Throughout the entire process, the Writing Group members provided feedback on the revisions.

A revised version of the checklist and accompanying explanations was circulated to the writing team members for final review. This stage focused on confirming completeness and clarity, identifying remaining ambiguities, and ensuring that the guidance was applicable across professions and across the educational continuum. Finalization decisions were made through group consensus following structured discussion of any unresolved issues, consistent with common approaches described in consensus methodology guidance [43, 44, 45, 46, 50]. The original list of items and the list prior to pilot testing can be found in Appendix II.

Organization and Structure of the Checklist

The checklist is organized to mirror how CBHPE outcomes studies are typically communicated in manuscripts and is presented across major sections of a scientific article (e.g., Title/Abstract, Introduction, Methods, Results, Discussion). Within each manuscript section, checklist items prompt reporting of information that directly impacts interpretability, including the CBHPE model being evaluated, implementation conditions, and outcome selection and measurement.

To support practical application, each checklist element includes a brief description and rationale (Appendix I). Where relevant, items encourage explicit differentiation between (1) proximal outputs (early indicators of implementation functioning) and (2) distal outcomes/impacts (educational, clinical, and societal outcomes). This distinction is essential for CBHPE evaluations, given that implementation and learning system maturation often precede measurable changes in downstream outcomes.

Core Reporting Domains Emphasized in the Guidelines

Across manuscript sections, the checklist (Table 1) highlights several core reporting domains that were consistently identified as essential for meaningful interpretation of CBHPE outcomes. To reduce terminology drift and support coherence across the CBHPE outcomes literature, the reporting guideline domains are organized to align with the CBHPE Outcomes Theory of Change Model [31]. The mapping between checklist items and Theory of Change components is made explicit in Appendix II. As an overview of the reporting guidelines, the core reporting domains are summarized below.

1. Clear specification of the CBHPE intervention and CBHPE core components

The checklist prompts authors to describe the CBHPE approach as a coherent system (rather than a single tool or isolated curricular change), including which CBHPE core components are present and how they function together. This includes specifying which elements are considered core versus adaptable, enabling readers to evaluate comparability across settings. For the purposes of reporting, CBHPE core elements are defined as those necessary for the initiative to function as a CBHPE model consistent with Van Melle’s CBHPE core components [2], whereas adaptable elements are locally selected design choices that may vary without altering the fundamental competency-based architecture (e.g., specific tools, assessment frequency, or local governance structures).

2. Program theory and intended causal logic

The guidelines emphasize explicit reporting of the CBHPE Theory of Change underlying the CBHPE model, including assumptions, mechanisms of action, and the intended causal pathway(s) linking implementation to outcomes. This program-theory orientation supports interpretation of whether outcomes plausibly reflect the intervention as designed [31, 41, 61]. As previously noted, the CBHPE Theory of Change was developed first, describing the linkages between implementation and outcomes. This then provided the underpinning for the development of the Reporting Guidelines.

3. Implementation fidelity and adaptations

Because CBHPE outcomes are highly sensitive to how consistently a model is enacted, checklist elements encourage reporting of implementation fidelity, including sufficient detail on what was implemented, the nature and extent of engagement, the quality of enactment, and differentiation from prior practices. The checklist also includes reporting of adaptations and evolution of the model over time, acknowledging that iteration is common and often necessary in CBHPE implementation. For studies focused entirely on CBHPE pre-implementation design, curricular implementation and innovation, or other areas that are not primarily assessment-focused, extra attention can be paid to this domain as the following one will not apply.

4. Assessment infrastructure and progression decision-making

The checklist emphasizes reporting on assessment design and interpretation processes if these processes are within its focus. The reporting guideline includes how assessment data are used to provide feedback and coaching to aid development, how they are triangulated, how progression decisions are made, and what governance structures support longitudinal assessment (e.g., competency committees or equivalent progression bodies). These elements were prioritized because CBHPE outcomes can be misinterpreted if readers cannot determine how assessment evidence was generated, synthesized, and used for decisions. It is important to note that a given study could focus on formative assessment, summative assessment, both, or neither (if the study focuses on CBHPE curricular implementation and innovation rather than assessment).

5. Measurement strategy and indicators

The checklist prompts reporting of outcomes and indicators at multiple levels, including specification of measurement tools, frequency, validity evidence when available, and analytic approaches. In addition, the guidelines encourage reporting of indicators used to monitor system functioning and continuous quality improvement, reflecting the expectation that CBHPE systems rely on ongoing monitoring and refinement.

6. Equity considerations and bias monitoring

Given known risks of differential opportunity, bias, and inequitable progression outcomes, the checklist prompts reporting of equity-oriented design features and equity monitoring processes. These elements aim to support responsible interpretation and dissemination of CBHPE outcomes research.

Intended Use and Scope

These reporting recommendations are intended for studies that evaluate CBHPE outcomes, broadly defined to include outcomes associated with curricula and curricular changes/innovations, learner progression and readiness, assessment and coaching systems, organizational implementation effects, and downstream impacts on practice or patient-oriented outcomes where applicable. The checklist is designed to be used prospectively (during study design and manuscript preparation) and retrospectively (during peer review and appraising the work as a reader of the published product) to support consistent reporting and reduce avoidable ambiguity and insufficient detail in interpreting findings.

Equally important with what these guidelines are, is what they are not. These reporting guidelines are intended to support and enhance, not constrain, CBHPE scholarly output. They are not a prescription but rather a flexible framework designed to enhance clarity, transparency, and interpretability of CBHPE research. We recognize that CBHPE is implemented across diverse contexts and uses a wide range of study designs and methodological approaches. As such, not all elements of these guidelines will be relevant to every study. Authors are encouraged to use the components that align with their work, indicate when items are not applicable, and prioritize reporting that best reflects the purpose, design, and context of their study. Importantly, adaptation is expected. When elements of CBHPE or aspects of study design are modified to fit local needs or constraints, we encourage authors to describe these adaptations explicitly, as they are critical to understanding implementation, context, and interpretation of findings. That is why we included this as a checklist item. We also acknowledge the value of existing and future scholarship that may not explicitly follow these guidelines. High-quality contributions to the field take many forms, and meaningful insights can emerge from a variety of approaches. These guidelines are intended to complement, not replace, diverse scholarship within CBHPE. Ultimately, we invite authors to engage with these guidelines as a resource to support more transparent reporting, enable clearer interpretation of findings, and contribute to a more coherent and cumulative body of CBHPE literature.

The checklist is not intended to serve as a quality appraisal tool for assessing the methodological rigor of CBHPE outcomes studies. Rather, its primary purpose is to improve reporting completeness and interpretability such that readers can understand what was implemented, how it was enacted, the conditions under which it occurred, and how outcomes were assessed and attributed. When applied consistently, the reporting guidelines are expected to strengthen the CBHPE evidence base by enabling more meaningful cross-study comparisons and more trustworthy synthesis of outcomes across settings, institutions, specialties, health professions, and countries. Authors are encouraged to cite this guideline when reporting CBHPE outcomes studies and to submit a completed checklist as an appendix or supplementary file where journal processes permit.

Box 1 provides a role-based roadmap for applying the guidelines across these stages and reinforces a central interpretive principle: CBHPE outcomes are most meaningful when the CBHPE system is sufficiently visible; that is, what was implemented, how it functioned in practice, and which outcomes are reasonable to interpret given implementation maturity and timeframe are clear and sufficiently detailed [44].

Box 1. Role-Based Application of the Cbhpe Outcomes Reporting Guidelines

The figure above provides a role-based entry point for applying the CBHPE Outcomes Reporting Guidelines and accompanying checklist (Table 1) to support transparent, interpretable, and transferable reporting of CBHPE outcomes studies. The central premise is that outcomes in CBHPE cannot be meaningfully interpreted when the CBHPE intervention is described only in terms of isolated tools or components (e.g., EPAs, milestones, assessment instruments), rather than as an integrated educational system. For outcomes to be interpretable, readers must be able to determine (1) what CBHPE model was implemented, (2) how it functioned in practice, and (3) which outcomes are reasonable to interpret given implementation maturity and evaluation timeframe.

Accordingly, the reporting guidelines and checklist are intended for use at multiple points across the CBHPE lifecycle. During implementation planning and evaluation design, Table 1 can be used to clarify core versus adaptable elements, align measures with program theory, and specify appropriate proximal and distal outcomes. During manuscript preparation, the checklist supports complete and consistent reporting of CBHPE system architecture, implementation conditions, and outcomes, with Appendix I providing item-level definitions and rationales to support consistent interpretation. During peer review and editorial decision-making, the checklist can be used to standardize expectations for reporting completeness and to identify missing information that limits interpretability, transferability, and synthesis.

Readers should use this figure as a navigation aid to identify their role, then apply the relevant sections of the checklist in Table 1, consulting Appendix I for additional guidance on reporting high-impact domains, including implementation fidelity, adaptations, governance of progression decisions, contextual influences, and equity considerations.

A practical way to apply the checklist (Table 1) is to use it in three steps:

1. Specify the CBHPE model being evaluated, including which core components are present and what is considered core versus adaptable (i.e., adaptable elements are locally selected design choices that may vary without changing the competency-based architecture, such as specific tools, assessment frequency, or local governance structures) [2].

2. Describe the theoretical framework or program theory (assumptions and mechanisms) linking implementation to the outcomes under evaluation [32].

3. Report the evaluation strategy, including how outcomes were selected, the level and timeline at which they were expected to manifest, and how progression decision-making was supported by assessment governance [36].

Limitations

This guideline should be interpreted in light of several limitations. First, while the checklist was developed using an iterative consensus-development process informed by established guidance, consensus processes inevitably reflect the perspectives and experiences of the contributors and stakeholders involved. Broader testing across additional professional groups and implementation contexts may identify opportunities to refine terminology, clarify feasibility expectations, or provide additional examples. The Collaborative and the author team for this paper have a heavy Global North representation, with less representation from the Global South. Therefore, while our Global North experiences inform our perspective, they also risk a Global North bias and an inability to fully understand how our work is best conceptualized for meaningful applicability to Global South contexts. This underscores that the checklist should continue to be refined over time, and that programs should be encouraged to report adaptations (as noted in the checklist) to address these limitations. Additionally, we welcome other perspectives, including those who have previously written about the limitations of CBHPE, to continue refining this checklist.

Second, the checklist is intended to improve reporting completeness and interpretability, but it is not designed as a tool to judge study quality or risk of bias. Reporting guidelines support transparency and reproducibility but do not guarantee methodological rigor; rather, they enable readers to evaluate rigor more accurately [44].

Third, the reporting burden remains a legitimate concern, particularly for programs with limited infrastructure or support staff. To mitigate burden, the checklist prioritizes elements that most strongly affect interpretation; however, journal word limits may require authors to use appendices or supplementary materials to document key implementation features fully. Representative examples of how review articles, manuscripts describing innovative CBHPE models, and CBHPE program implementation and evaluations use appendices and supplemental features are cited here for reference [19, 63, 64]. Further, as flexible guidelines rather than prescriptive standards, these guidelines may not be fully applicable to all studies. Their use should be adapted to context and design, with transparent reporting of modifications and acknowledgment of non-applicable elements.

Future Directions

Future work should include broad piloting of the CORE-HPE checklist across disciplines and across stages of the educational continuum to assess feasibility, usability, and contribution to reporting completeness. In addition, evaluation studies could examine whether adoption of the checklist improves interpretability and consistency of reporting over time, including the ability to synthesize findings across programs, thereby allowing necessary revisions to the guidelines. To support uptake, an Explanation and Elaboration (E&E) companion document with concrete examples and preferred reporting language would likely improve usability, particularly for authors who are new to CBHPE scholarship or evaluating hybrid or evolving models. Finally, dissemination strategies that include journal endorsement and alignment with broader reporting guideline infrastructures (e.g., EQUATOR [42]) could support standardization and normalization of reporting expectations in CBHPE outcomes research.