Strategic choices in curriculum design to facilitate knowledge and competency development

Strategic choices in the alignment between learning outcomes, teaching formats and assessment is paramount for the success any curriculum. Competency-based education is mainly concerned with the competencies students need to develop. How we should support and assess this development requires clarification. This thesis aims to solve part of the puzzle. We described the design of a competency-based undergraduate curriculum and compared the performance of its students to that of students from the preceding curriculum. At the end of the curriculum, we found hardly any differences with regard to medical knowledge, clinical performance and how well students felt prepared for practice. This implies that the specific attention for competency development did not affect other important educational outcomes. Additionally, we investigated the feasibility of longer clerkship rotations, which support students’ competency development. We found it to be feasible as a decrease in the number of disciplines visited during clerkships would not negatively affect the development of specific competencies or discipline-specific knowledge. Finally, we investigated cumulative assessment, a specific type of repeated testing. Cumulative assessment was shown to be very effective in stimulating students to spend time studying. Initially poor-performing students were able to repair this throughout a module. Furthermore, students in a cumulative assessment program spent 50% more time on self-study and procrastinated significantly less than students with only a test at the end of the module. In summary, this thesis offers insight in the feasibility and consequences of competency-based education and possibilities to support knowledge and competency development in competency-based curricula.