Figure 1
Dimensions of the Educational Alliance in Competency-Based Education. The figure depicts three interrelated layers: (center) the relational foundation of mutual trust and respect; (middle) shared goals and tasks that structure the collaborative educational process; and (outside) the contextual environment - including programmatic assessment systems, psychological safety and institutional culture - that shapes and is shaped by the alliance. The three layers of the figure symbolize reciprocal influence and feedback loops representing dialogue, reflection, and adaptive calibration across the layers.
Table 1
Key features of the educational alliance, alignment with the five core components of competency-based education, and the responsibilities of trainees and supervisors to promote a successful alliance for learning.
| FEATURE OF THE EDUCATIONAL ALLIANCE | EXPLANATION IN COMPETENCY-BASED EDUCATION PROGRAM, TIED TO CORE COMPONENTS [7] | TRAINEE RESPONSIBILITY/ACTION | SUPERVISOR RESPONSIBILITY/ACTION |
|---|---|---|---|
| Interpersonal Relationship | |||
| Mutual respect | Tailored learning experiences that facilitate the developmental acquisition of competency | Contribute to a culture that encourages supervisors to provide honest and actionable feedback, and trainees to engage in feedback dialogues Trust in formative feedback that is intended to enhance learning and skill building | Create a culture of trust and psychological safety Foster cultural humility Attention to professional identity formation |
| Goals of engagement | |||
| Shared purpose and goals | Outcome competencies | Co-production of learning goals aligned with the outcome competencies | |
| Shared agreement on how trainees and supervisors will interact | Tailored learning experiences that facilitate the developmental acquisition of competency | Shared agreement between supervisor and trainee to dedicate time for goal setting, direct observation, feedback, coaching | |
| Mutual accountability for learning outcomes | Outcome Competencies | Collaborative goal setting to include iterative updates to individualized learning plans and a realistic timeline for achievement of competencies | |
| Commitment to honest feedback and continuous improvement | Competency focused instruction to promote developmental acquisition of competency | Engage in self-reflective practice, seek and accept feedback, embrace a growth mindset rather than a performance mindset | Coaching methods to promote feedback, dialogue, and growth (R2C2 coaching [48]) Engage in relevant faculty development including coaching theory and methods Encourage trainee to adopt a growth mindset, avoidance of a false growth mindset |
| Task orientation (how to pursue agreed-upon goals) | |||
| Shared identification of learning needs and opportunities | Outcome Competencies | Co-produce learning goals and individualized learning plans that include an action plan | |
| Shared focus on feedback | Competency focused instruction to promote developmental acquisition of competency | Recognize the value in self-reflective practice, seek and accept feedback, embrace a growth mindset rather than performance mindset | Coaching methods to promote feedback, dialogue, and growth (R2C2 coaching) Seek peer feedback and faculty development opportunities to grow as a supervisor |
| Alignment on assessment methods and criteria | Programmatic Assessment | Seek to understand the formative and summative criteria and assessments that inform competency-based advancement | Ensure trainee understands the formative and summative criteria and assessments that inform competency-based advancement |
| Engagement in reflection | Tailored learning experiences to facilitate the developmental acquisition of competency | Recognize the value of self-assessment informed by feedback and multi-source work-place based assessments | Reflect on the supervisor role in facilitating trainee self-assessment to promote growth Encourage trainee to incorporate feedback and multi-source evaluations in their self-assessment along with reflective practice |
| Cultivation of trainee’s agency for self-direction | Competency-focused instruction informs teaching practices that promote the developmental acquisition of competency | Compare self-assessment with supervisor feedback Iteratively update learning goals and individualized learning plan | Encourage trainee self-assessment with structured feedback conversations to inform progress |
Chart
An Educational Agreement to foster the educational alliance between trainee and supervisor. This shared Agreement is centered on the three key features of the educational alliance: interpersonal relationship building, goals of engagement, and task orientation to achieve goals. Suggested goals are coupled with actionable “sentence starters” to facilitate trainee and supervisor dyads as they develop and strengthen their relationship through collaborative goal setting. This Agreement is a shared responsibility of both the educator and the learner. It is intended to be adapted to meet local needs and contexts. Trainees are defined as students, residents, fellows, or other learner(s) and supervisors are teachers, clinical teachers, faculty, or equivalent roles.
Supplemental File 1: Appendix
Types of Educational Alliances within a Competency-Based Health Professions Education Program across relevant contexts, roles, and settings.
| TRAINEE – SUPERVISOR RELATIONSHIP | CONTEXT | PURPOSE OF INTERACTIONS |
|---|---|---|
| Trainee and direct clinical supervisor | Regular (i.e., daily, weekly monthly) contact for finite period of clinical training assignment |
|
| Trainee and longitudinal coach, mentor, advisor | Often an assigned relationship that may last throughout the entire program |
|
| Trainee and program director | Oversight over trainees within the training program |
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| Trainee and clinical competency committee | Periodic, scheduled review of progress toward program competencies and milestones |
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