“Prevention Is Better Than Cure”: A Plea to Emphasize the Learning Function of Competence Committees in Programmatic Assessment

Competency-based education (CBE), with an emphasis on learner-centeredness and recurring assessment to monitor students' performance, is widespread in health profession education (HPE) (1–5). CBE is based upon the proposition that an individual learner is able to follow his own unique learning trajectory for each aspect or competence domain. It aims to facilitate context-dependent performance development from novice to competent based on the learner's needs, unique talents, and ambitions. Assessment of clinical competence is a key issue in CBE (6). CBE in the health profession moves beyond the knowledge domain and typically involves multiple cognitive, psychomotor, and attitudinal/relational skills, and attributes. This requires a systematic approach to assessment as single-assessment methods cannot capture all these dimensions (7). Programmatic assessment (PA), as introduced by van der Vleuten et al. (8) in 2012, was recently described as one of five relevant components for evaluating the implementation of competency-based programs (9, 10) and was increasingly implemented worldwide (11–13). PA provides a framework founded on a set of empirical principles aimed at fostering learning in conjunction with robust high-stakes decision making (14–16). Recently, a consensus was reached on 12 theoretical principles of PA (15, 16) These principles can be grouped into three overarching themes (see Box 1) (16).