Navigating challenges in competency-based graduation: accelerating medical training while ensuring rigor and readiness for residency

PROBLEM: Accelerated pathway programs graduate students in three, rather than four, years. While these programs help address physician workforce shortage and student debt, they have not implemented rigorous assessment frameworks aligned with Competency-Based Medical Education (CBME) training to ensure students are ready to graduate one year early. This report describes an accelerated pathway program using a CBME framework to transition students into graduate medical education programs when they are deemed competent. APPROACH: Starting in 2018, the Virginia Commonwealth University School of Medicine (VCU-SOM), developed an accelerated and competency-based graduation (CBG) program focusing on competency as the standard for graduation. Students apply to the CBG program in their second year, with selection based on academic performance, program commitment, and mutual interest with the affiliated residency. Except for reduced post-clerkship elective time, students complete the same curriculum as non-CBG peers. Progress during the clinical year is evaluated by the CBG Clinical Competency Committee (CCC) to ensure students meet required milestones for advancement and eligibility for accelerated graduation. OUTCOMES: As of 2024, 20/33 (61%) CBG students graduated in 3 years, while the remainder (13/33; 39%) transitioned back to the standard program. CCC analysis showed increasing competency ratings, with nearly 100% achieving 'competent' or 'on track' in core domains. Some assessment areas showed lower competency, identifying targets for improvement. Program directors report that all CBG graduates are progressing appropriately through residency milestones, with no significant concerns about performance or burnout. NEXT STEPS: The CBG program offers a competency-based, time-variable pathway (CBTV) from medical school to residency, utilizing a CCC and designed to support both early and traditional progression based on achievement of competency. Future steps include adapting to the removal of Step 1 scores as a selection tool, ensuring adequate Entrustable Professional Activities (EPA) data for decision-making, and expanding participation across additional specialties.