Implementation of United Arab Emirates competency framework for medical education in undergraduate medical curriculum

Abstract

Background

The dynamic and evolving demands of modern healthcare systems necessitate advancements in medical education. Competency-Based Medical Education (CBME) is an outcomes-driven approach that prioritizes measurable competencies over traditional time-based training. The United Arab Emirates Competency Framework for Medical Education (UCFME) was developed to standardize and elevate the quality of medical education across the UAE, aligning with global standards while addressing local healthcare needs. This study documents the implementation process of UCFME in undergraduate medical curricula (eventhough the outcomes are yet to be established), focusing on strategies, challenges, and lessons learned.

Methods

The UCFME was developed collaboratively by the Ministry of Education, the National Institute for Health Specialties, and academic stakeholders. A mixed-methods approach was employed, involving literature reviews, surveys, Delphi consensus, focus groups, and workshops. Key thematic roles and competencies were identified. The framework was mapped to international standards, including CanMEDS and ACGME, and integrated into the curriculum using Kotter’s 8-Step Change Model. To operationalize UCFME, a structured four-step model was employed for gradual integration, emphasizing milestones, supervisory levels, and diverse assessment methods to track learner progression. Milestones were defined using the Dreyfus model. After curriculum mapping and constructive alignment, competencies were mapped to the Qualifications Framework-Emirates to align with national educational benchmarks. Faculty were trained in CBME principles, and assessment methods were redesigned to include Entrustable Professional Activities (EPAs) and milestone-based evaluations. Pilot implementation and feedback guided refinements in each step.

Results

The RAK College of Medical Sciences successfully integrated UCFME’s 9 thematic roles, 9 core competencies, 85 enabling competencies and 14 EPAs into the undergraduate curriculum. Pilot studies demonstrated improvements in curriculum alignment, faculty engagement, and assessment reliability. Challenges included resistance to change, faculty training needs, cultural considerations and resource disparities. Faculty workshops and simulation-based training enhanced instructional capabilities. Enablers such as government support, technological infrastructure, and collaborative networks facilitated implementation. Students demonstrated progression in competence, with targeted EPAs achieved through formative and summative assessments.

Conclusions

The UCFME implementation represents a transformative step in undergraduate medical education, aligning national curricula with international best practices. Its strategic implementation underscores the importance of structured change management, faculty engagement, and competency-based assessment. This framework provides a replicable model for other institutions aiming to adopt CBME, fostering a competent and adaptable healthcare workforce.

Background

The rapid evolution of healthcare systems necessitates corresponding advancements in medical education to prepare graduates for the dynamic and complex demands of modern clinical practice. Competency-based medical education (CBME) has emerged as a transformative approach to aligning medical training with healthcare needs by emphasizing measurable outcomes and learner-centered methodologies [1, 2]. CBME is an outcomes-based approach to the design, implementation, assessment, and evaluation of medical education programs using an organizing framework of competencies [2, 3]. In contrast, a competency-based framework is a basic conceptual structure that includes pertinent physician duties and obligations around which core competencies can be built [4,5,6,7]. One of the most important advancement in medical education during the past three decades is outcome-based education, which is seen as a paradigm shift. Numerous factors contributed to the development of this novel method of teaching medicine. The change from a teacher-centered to a student-centered approach is the most notable of these. Another justification for CBME is to shift the focus from time-based training to outcomes. Whereas CBME focuses on the learning achieved, time-based training emphasizes the amount of time a student spends on an instructional unit. In medical education programs, this would entail switching from set time and flexible standards to fixed standards and flexible time [1,2,3,4,5,6].

The UAE healthcare landscape presents unique challenges characterized by a high prevalence of chronic diseases, notably diabetes and cardiovascular disorders, reflecting lifestyle factors, rapid urbanization, and demographic shifts. Additionally, the UAE hosts a multicultural and multilingual population, necessitating culturally competent care and tailored communication skills among healthcare providers [2, 6]. Furthermore, the rapid growth in the population and corresponding healthcare infrastructure expansion underline the pressing need for a standardized competency-based medical education system that can reliably produce a workforce adept at handling diverse clinical scenarios. The alignment of the United Arab Emirates Competency Framework for Medical Education (UCFME) with national strategic initiatives such as UAE Vision 2030, which emphasizes the enhancement of healthcare quality and educational excellence, reinforces the necessity of this transformative educational reform. Thus, the implementation of UCFME holds significant importance beyond merely elevating educational standards, as it directly addresses specific healthcare needs and strategic priorities within the UAE.

Rooted in a CBME model, the framework is designed to align medical training with the specific needs of the UAE healthcare system while adhering to international standards [6]. Within this paradigm, Entrustable Professional Activities (EPAs) have gained prominence as a practical method for assessing competencies. EPAs represent specific tasks or responsibilities that trainees must perform independently once sufficient competence has been demonstrated [7]. EPAs are units of professional work that can be entrusted to a trainee once sufficient competence has been demonstrated. EPAs represent tasks or responsibilities that are essential to daily clinical practice and require integration of multiple competencies (knowledge, skills, and attitudes). While competencies describe the attributes of the learner (e.g., communication skills, medical knowledge), EPAs are more task-oriented and context-specific, focusing on what the trainee can be trusted to do in real-life clinical settings [6, 7]. In essence, competencies are descriptors of the person, whereas EPAs are descriptors of the work that can be safely delegated based on those competencies. This distinction allows for more holistic, performance-based assessment in medical education. Early implementation of EPAs in undergraduate and postgraduate medical education, such as the Association of American Medical Colleges (AAMC) Core EPA framework in the United States, has provided valuable insights into the challenges and opportunities of this model [8]. This article explores the ongoing implementation process of the UCFME, focusing on strategies employed, challenges encountered, and lessons learned eventhough the outcomes are yet to be established. It aims to serve as a resource for educators and policymakers undertaking similar initiatives in CBME.

Methods

Development of UCFME

The development of the UCFME involved a collaborative and multi-phase process led by the Ministry of Education, the National Institute for Health Specialties (NIHS), and key academic and clinical stakeholders [6]. The framework's foundation is built on EPAs that define the essential clinical and professional responsibilities expected of medical graduates. These EPAs were shaped by global best practices and localized to meet the UAE's unique healthcare challenges and cultural context. Each of the nine thematic roles that make up the suggested Framework's Core competences is further broken into enabling competences. These thematic responsibilities and the supporting abilities that go along with them are especially designed to meet the UAE's long-term goals and future requirements. Additionally, particular attention was paid to the region's and the country's distinct demographics, healthcare requirements, and rapid information growth. The Qualifications Framework for the Emirates (QF-E), the Canadian Physician Competency Framework (CanMEDS), the Association of American Medical Colleges—Physician Competencies Reference Set (AAMC-PCRS), SaudiMEDs for Kingdom of Saudi Arabia and the Accreditation Council for Graduate Medical Education (ACGME) are all in accordance with the suggested list of thematic roles [9,10,11,12,13]. These 9 roles include Medical Expert, Evidence-based Practitioner and Scholar; Patient Care Provider and Health Advocate; Communicator; Collaborator, Innovator and Leader; Professional; Health System Proponent; Self and Profession Enhancer and Socially Accountable ensuring a holistic approach to medical education [6].

The development of UCFME methodology encompassed six key approaches [6]:

• 1. Literature Review: Comprehensive analysis of existing competency frameworks and CBME literature.

• 2. Quantitative Surveys: Web-based surveys to gather insights from stakeholders.

• 3. Qualitative Approaches: Delphi techniques, focus groups, and interviews for consensus building.

• 4. Workshops: Interactive workshops for faculty development and framework review.

• 5. Committee Meetings: Regular meetings of EmiratesMEDs Scientific Committee and taskforce committees (representatives of academic stakeholders) for iterative development.

• 6. External Validation: Review by an expert panel and alignment with international accreditation standards. The framework underwent rigorous external validation by expert panels and was systematically aligned with international accreditation standards, including CanMEDS, AAMC-PCRS, SaudiMEDs, and ACGME competencies. This structured validation assured educational robustness.

The taskforce, formed in February 2021, included representatives from medical schools, regulatory bodies, and healthcare authorities [6, 14]. It was divided into two sub-taskforces:

• Competency Sub-taskforce: Focused on thematic roles, competencies, and enabling competencies.

• EPAs and Clinical Skills Sub-taskforce: Prioritized EPAs and mapped them to assessment methods.

The framework was developed in four phases [6]:

• Phase I: Needs analysis and preliminary competency and EPA drafts.

• Phase II: Alignment of competencies with EPAs and review by international experts.

• Phase III: Mapping assessment methods to competencies and EPAs.

• Phase IV: External validation and approval by the Commission for Academic Accreditation (CAA) and Ministry of Education.

Milestones for competency attainment were categorized into three levels: behaviors requiring corrective response, developing behaviors, and required behaviors at graduation [6]. The CAA website provides access to the comprehensive UCFME document created by EmiratesMED's scientific committee [6].

Process of implementation of UCFME into undergraduate curriculum

The implementation of the UCFME into undergraduate medical education followed a systematic, evidence-based approach using Kotter’s 8-Step Model for Change Management [15]. This framework ensured a structured progression from planning to institutionalizing the competency-based approach. The first step was to establish the need for change by creating a sense of urgency among stakeholders. The stakeholders supported the change when they understood the relevance of UCFME. A committee on Competency Framework for Medical education was formed consisting of the Dean, curriculum leaders, experienced faculty and course coordinators. They conducted several meetings, and orientation sessions, thus, helping stakeholders recognize the importance of adopting a competency-based approach. As change initiatives required strong leadership, a guiding coalition was essential for successful implementation of the framework. Key responsibilities of the committee included setting goals and timelines for the integration process; advocating for the framework within the program and addressing resistance. A clear and compelling vision was critical for guiding implementation efforts. The vision for integrating the UCFME focused on how to align the UCFME with RAK College of Medical Sciences (RAKCOMS) Doctor of Medicine (MD) undergraduate curriculum. Previously RAKCOMS curriculum was a traditional integrated program (2 years basic sciences + 3 years clinical clerkships) without a formal competency framework. From the year 2023, RAKCOMS offers a six-year undergraduate MD program (twelve semesters); thus, ‘MD Year 2’ denotes the second year of study in the MD curriculum. The UCFME was introduced to map and enhance this existing curriculum where the goal is to integrate competencies and EPAs into the curriculum and assessments using a staged implementation model. This contextualizes the transformation from the old format to the new CBME-aligned format. The strategy outlined specific steps for embedding competencies into the curriculum, including curriculum mapping, aligning teaching methods with competency themes, faculty development, and assessment redesign.

Effective communication was essential for gaining buy-in from faculty, students, and other stakeholders. For faculty, emphasis was given on “how the framework supports better educational outcomes and aligns with accreditation requirements” [16]. Regular updates through newsletters, emails, and institutional websites were provided. Empowering faculty with faculty development workshops on competencies application, providing resources such as competency-based teaching guides and encouraging innovation by allowing faculty to take part in interprofessional education were essential [16,17,18]. Short-term wins build credibility and sustain momentum. So, pilot programs offered an evidence-based approach to demonstrating the feasibility and benefits of the UCFME. The framework was implemented in two courses (clinical rotations) initially. Objective metrics, such as student performance on OSCEs and student feedback surveys were used to showcase success. Basing on these successful pilots, broader curriculum integration was planned. Refinement of teaching methods, assessments, and faculty training based on feedback and data followed next. Institutionalizing policies that support competency-based education, such as standardized assessment rubrics and competency tracking systems were introduced. Faculty and student perceptions were critically examined through structured surveys, focus groups, and interactive workshops conducted during the pilot implementation phase of the UCFME. These methodologies aligned with contemporary educational research methods emphasizing stakeholder engagement to drive curricular innovations. Continuous monitoring and quality improvement (CQI) are in process to sustain and scale educational reforms. Strategies to anchor change included aligning institutional mission and vision statements with the framework, embedding competencies in accreditation standards and evaluation criteria and conducting regular reviews to ensure the framework remains responsive to evolving healthcare needs [5, 6, 17, 18].

A systematic process was employed to align curriculum design, learner progression, and assessment strategies with the UCFME framework. A comprehensive master chart served as a reference tool to track learner progression across milestones, competence stages, supervisory levels, and assessment methods. Milestones represented critical developmental checkpoints for learners, organized to reflect a logical progression of knowledge, skills, and attitudes. Then a structured four-step learning model was developed as described below.

• Pre-clerkship preparation: Focused on foundational knowledge and skills through didactic sessions, workshops, and self-directed learning.

• Simulated formative learning: Provided a controlled environment for practice using simulations, standardized patients, and virtual cases to develop confidence.

• Formative learning during clerkship: Allowed learners to apply skills in real clinical settings under supervision, emphasizing workplace-based learning and entrustment decisions.

• Summative end-clerkship assessment: Rigorous assessments evaluated readiness for progression to advanced training phases.

UCFME thematic roles were systematically mapped to the QF-E, ensuring alignment with national educational benchmarks. Fourteen EPAs were categorized into Essential (E), Important (I), and Relevant (R), facilitating efficient allocation of time and resources in curriculum design. These EPAs were incrementally introduced across MD years, progressing from foundational skills in Year 2 to near-independent proficiency by the final year. A diverse range of assessment tools including Objective Structured Clinical Examinations (OSCEs), Mini Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedural Skills (DOPS), portfolios, and reflective logs, ensured reliable evaluation of cognitive, psychomotor, and affective domains. Assessment mapping highlighted alignment with course-level outcomes (CLOs) and program-level outcomes (PLOs), identifying gaps for continuous improvement. Tools like the Evaluation Priority Index and EPA-Competency Domain Evaluation Matrix were used to prioritize critical EPAs and allocate weightage to assessments based on impact and learner milestones (Please refer to Table No-9 and 10). This approach streamlined resource allocation and assessment planning, ensuring focused development in essential areas. Schematic diagrams and charts were employed to represent alignment of UCFME themes with PLOs, CLOs, and EPA achievements. These visual aids provided clarity on curriculum coherence and learner progression.

This comprehensive and structured approach ensured effective integration of the UCFME into the RAKCOMS MD curriculum, fostering the development of competent medical professionals prepared to meet the demands of modern healthcare.

Early adopters of the competency framework, have demonstrated its potential to drive transformative change in undergraduate medical education [8, 14]. Their experiences underscore the importance of faculty development, robust assessment tools, and curriculum realignment in successful implementation. The integration of OSCEs and milestone-based evaluations has been particularly instrumental in ensuring reliable and valid assessments of student competencies [1].

As medical schools in the UAE continue to implement the UCFME, their efforts are expected to contribute to a highly skilled and adaptable healthcare workforce. This initiative not only aligns the UAE’s medical education system with international best practices but also positions it as a leader in CBME in the region.

Implementation steps

The UCFME themes, core competencies, enabling competencies, EPAs, clinical skills and presentations are shown in the Figure 1 [6].

Fig. 1

UCFME themes, core competencies, enabling competencies, EPAs, Clinical Skills and presentations

A master chart was then conceptualized and developed to serve as a comprehensive reference tool, enabling a systematic approach to tracking and supporting learner progression. The goal was to integrate key elements of competency-based education consisting of milestones (steps in learner’s progress), stages of learner’s competence, instructor level of supervision (Entrustment scale), assessment methods for each level and description of trainee at different stages of competence, so as to serve as a dynamic reference that harmonizes multiple dimensions of learner assessment and supervision (Table 1) [19,20,21,22,23].

Table 1 Master chart with steps in the learner’s progress including milestones, stages of competence, entrustment scale, assessment methods and trainee description

It facilitates goal-directed learning, ensures alignment between learning outcomes and assessment, and supports the EPA framework. Milestones (Steps in Learner’s Progress) represent critical developmental checkpoints in a learner's journey. These were identified and sequenced based on the expected progression of skills, knowledge, and attitudes. The milestones help instructors and learners understand where the learner stands and what comes next. Stages of Learner’s Competence were defined using frameworks such as the Dreyfus Model (novice to expert) [24]. Each stage corresponds to specific behaviors, skillsets, and decision-making capabilities demonstrated by the learner. A variety of assessment methods were mapped to each stage of competence, ensuring that evaluations are reliable, valid, and tailored to the complexity of the task. Examples include: DOPS for practical tasks, Mini-CEX for clinical reasoning, OSCEs for structured skill and knowledge assessment, Portfolios and reflective logs for ongoing professional development etc. [23, 25, 26]. Detailed descriptions were provided to characterize the expected performance, behaviors, and decision-making processes of trainees at each stage. These descriptions guide both learners and instructors, ensuring consistent expectations and feedback. As RAKCOMS MD curriculum is an undergraduate curriculum, a student is expected to reach upto Level-3/Competent stage.

Instructor’s Level of Supervision (Entrustment Scale) defines the level of supervision required for each milestone or stage of competence. It helps to determine when a learner can perform independently, ensuring patient safety and educational rigor. There are 5 levels of supervision identified (Table 2) [22, 23, 25].

Table 2 Levels of Supervision defined for each milestone or stage of competence

The four-step approach provides a logical progression for developing and assessing competencies through a blend of preparatory learning, simulation, real-world application, and summative evaluation. This structured methodology ensures that learners are adequately prepared and assessed at each stage, promoting the attainment of EPAs within the UCFME. The resulting model, illustrated in Figure 2, provides a structured pathway that integrates pre clerkship preparation, Simulated formative learning, Formative learning during clerkship and Summative end clerkship assessment).

Fig. 2

Four step structured model that integrates pre clerkship preparation, Simulated formative learning, Formative learning during clerkship and Summative end clerkship assessment

Pre-Clerkship preparation focuses on equipping learners with foundational knowledge and skills before they enter clinical environments. Activities in this phase include didactic sessions, foundational skill workshops, and self-directed learning. This ensures that students have the baseline competence necessary for effective participation in subsequent steps. In Simulated formative learning phase, learners engage in simulation-based activities to practice clinical skills in a controlled, low-stakes environment. Simulations, such as standardized patient encounters, virtual cases, and procedural skill labs, allow learners to gain confidence and refine their skills while receiving immediate feedback. The emphasis is on iterative improvement through active practice and formative assessment.In Formative learning during clerkship phase, learners transition to real clinical settings. They apply their knowledge and skills under the supervision of instructors. This step emphasizes workplace-based learning, where students gain practical experience through patient care while receiving formative feedback. Entrustment decisions and real-time guidance help students progress from dependent learners to semi-independent practitioners [27,28,29]. In the final step of Summative end-clerkship assessment, learners'competencies are evaluated through rigorous summative assessments. This step ensures that learners are ready for progression to the next phase of their training, depending on the context.

Results and discussion

To ensure consistency with national educational standards, the UCFME thematic roles were systematically mapped to the QF-E. This ensures that the development of medical professionals adheres to educational benchmarks established for various qualification levels within the UAE. This mapping, illustrated in Table 3, bridges the competencies outlined in UCFME with the levels, descriptors, and outcomes specified in the QF-E [21, 30].

Table 3 Mapping of UCFME thematic roles with QF-E knowledge, skills and aspects of competence

The mapping of PLOs and CLOs with UCFME themes, illustrated in Figure 3, demonstrates how the RAKCOMS MD Program achieves constructive alignment. The schematic flow diagram visually represents the interconnectedness of UCFME themes, PLOs, and CLOs within the RAKCOMS MD Program. It highlights the logical progression from the UCFME framework to program-level outcomes, course-level outcomes, and instructional design. The diagram serves as a blueprint for curriculum developers and faculty to maintain alignment and coherence in the educational process [21].

Fig. 3

Schematic diagram demonstrating RAKCOMS MD PLO-CLO mapping with UCFME themes and competencies

The mapping of RAKCOMS MD Program Learning Outcomes (PLOs) with the UCFME themes, as shown in Table No-4, ensures that the program's educational goals align with the competencies required for professional medical practice, identifies gaps or redundancies in the curriculum and facilitates alignment between learning outcomes, teaching strategies, and assessment methods [21, 26, 30].

Table 4 Mapping of RAKCOMS MD PLOs knowledge, skills and aspects of competence with UCFME themes

Mapping of UCFME Themes, core competencies, enabling competencies and EPAs are done for each course according to the format table shown below (Table No-5).

Table 5 Format for Mapping of UCFME Themes, core competencies, enabling competencies, EPAs for each course

The EPAs are designed to encapsulate the practical application of competencies in real-world clinical settings. To streamline curriculum design and ensure targeted learning, the EPAs are categorized as follows:

• Essential (E): These EPAs are critical and foundational for all medical graduates. They represent tasks and responsibilities that every graduate, regardless of future specialization, must be proficient in to ensure safe and effective patient care.

• Important (I): These EPAs are highly significant but may not be universally required in all clinical contexts. Proficiency in these activities may depend on the specific career path or clinical environment a graduate chooses.

• Relevant (R): These EPAs are context-dependent and may not be directly applicable to every graduate's practice. They are still included in the curriculum to provide a broader understanding of the professional roles and responsibilities, allowing learners to adapt to diverse medical scenarios.

Table 6 provides a detailed breakdown of the 14 EPAs into these three categories. This classification helps in Curriculum design where educators can allocate time and resources efficiently by focusing primarily on the Essential and Important EPAs while ensuring exposure to Relevant ones [22]. Also formative and summative assessments are planned based on the priority level of EPAs. It also assists students in understanding the expectations for their training and prioritizing their learning efforts accordingly.

Table 6 Categorization of EPAs and domains into essential, important or relevant

The EPAs are integrated into the medical curriculum with incremental complexity starting from MD Year 2. This approach ensures a gradual progression in students'skills, knowledge, and responsibilities. Table 7 visually outlines how each EPA is distributed across the curriculum. RAKCOMS MD Years 1 (semester-I & II) and 2 (semester-III & IV) are called as “pre-medical” years. MD Years 3 (semester-V & VI) and 4 (semester- VII) are the “pre-clinical” years. MD Years 4 (semester-VIII), 5 (semester-IX & X) and 6 (semester-XI & XII) are designated as “clinical” years. In MD Year 2, students are introduced to the basic components of EPAs. Activities focus on foundational skills such as history taking, physical examinations, and simple clinical reasoning under close supervision. Emphasis is placed on developing a strong knowledge base and building confidence in performing routine tasks. During intermediate complexity in MD Years 3 and 4, students progress to more complex tasks that require integration of multiple skills, such as formulating differential diagnoses, interpreting diagnostic tests, and participating in patient management. Supervision levels are adjusted based on student competence, fostering independence while maintaining patient safety. Opportunities are provided for students to take on greater responsibility in clinical settings. In advanced complexity in Final Year, students are expected to demonstrate near-independent proficiency in all core EPAs. Activities may include managing acute care scenarios, performing specific procedures, or coordinating interprofessional care. The focus shifts to emphasizing decision-making, leadership, and adaptability in diverse clinical contexts.

Table 7 The EPAs are integrated into the MD curriculum with incremental complexity starting from MD Year 2

Figure 4 serves as a visual and comprehensive summary of intended EPA achievements for each graduate by the end of the MD program. It reflects how students have progressed in each EPA, their competency milestone stages at which critical competencies will be achieved and alignment with Program Goals. The figure visually demonstrates the gradual development of EPA competencies across different MD years, showing incremental complexity and increasing levels of independence [22, 31]. It highlights how foundational skills in earlier years evolve into advanced, integrated competencies in later years.

Fig. 4

Summary of intended EPA achievements for each graduate by the end of the MD program

Assessment in the medical curriculum is a critical component of ensuring that students acquire the necessary knowledge, skills, and attitudes to become competent medical professionals. To achieve this, the RAKCOMS MD Curriculum employs a variety of assessment tools and instruments tailored to measure different domains of learning (cognitive, psychomotor, and affective). These tools are systematically illustrated in Table No-8. By this mapping, educators and students can easily understand how each domain of learning is assessed, ensuring alignment with CLOs. The use of diverse tools also ensures that all aspects of a student’s development (knowledge, skills, attitude and professionalism) are thoroughly evaluated [32,33,34]. Mapping tools to curriculum objectives helps identify any gaps or redundancies in the assessment process, allowing continuous improvement [35,36,37].

Table 8 Mapping of Assessment tools/instruments used in RAKCOMS MD Curriculum for UCFME thematic roles

EPA Observation Checklist is a tool used to document and assess the performance of medical students or other trainees in specific professional activities. The checklist serves as a structured way to observe and evaluate these activities in real-time during clinical encounters, providing valuable feedback for both students and instructors. The checklist includes specific EPAs where each EPA is clearly defined (e.g., taking a patient history, performing a physical exam, or managing a clinical situation) so that students know what is expected of them. It also includes specific behaviors and performance indicators that need to be observed to assess the student’s competency in performing the activity. The checklist also includes different levels of supervision, from direct observation to independent practice, depending on the student's progress and there is a feedback section to provide feedback, highlighting strengths, areas for improvement, and specific suggestions for development (Figure 5) [35, 37].

Fig. 5

EPA Observation checklist to document and assess the performance of medical students or other trainees in specific professional activities

The “Priority Index” in evaluation is a framework used to prioritize which EPAs should be evaluated with more focus during a student's training [38]. This helps in identifying key areas where students may need more attention and guidance, ensuring that assessments are aligned with the most critical learning objectives at a given stage of their education. In Table No-9, the Evaluation Priority Index is visually represented to show how different EPAs can be ranked according to their significance at each stage of training. In Table No-10, the EPA-Competency Domain Evaluation Matrix visually organizes how each EPA is given a relative weightage with respect to the impact (EPA importance) and learner progress (milestones) for assessment. The EPA evaluation weightage is shown as radar chart in Figure No-6.

Fig. 6

EPA evaluation weightage radar chart

Table 9 Priority index in evaluation showing how different EPAs can be ranked according to their significance at each stage of training

Table 10 EPA-competency domain evaluation matrix showing how each EPA is given a relative weightage with respect to the impact [EPA importance] and learner progress [milestones] for assessment

Challenges and enablers

The UCFME represents a significant step in advancing medical education in the UAE. It aligns with international standards while addressing the unique healthcare challenges and cultural context of the region. Implementing this framework, however, involves navigating various challenges and leveraging enablers to ensure its success.

Collaborative integration among medical schools required strategic coordination and alignment, initially met with logistical and cultural barriers due to institutional autonomy, varying infrastructural capacities, and differences in faculty familiarity with competency-based education principles. While faculty generally supported the initiative, resistance was evident among some educators, stemming primarily from uncertainties regarding competency-based assessment methodologies and apprehensions about increased workload and responsibilities.

Challenges in implementation

Institutional readiness- Many medical institutions may lack the infrastructure, resources, or expertise to adopt UCFME effectively. Resistance to change from faculty and administrative staff further complicates the transition [4]. In the UAE, disparities in resource allocation among institutions exacerbate this issue [40].

Faculty development- Faculty members often require training to understand and apply UCFME principles. Limited access to professional development opportunities and insufficient training in modern pedagogical methods can hinder this process [41, 42]. Research underscores the importance of faculty development in successful competency based education implementation [43, 44].

Assessment challenges- Designing and implementing competency-based assessments require significant resources and expertise. Ensuring reliability and validity while accommodating diverse learner needs poses additional challenges [34, 39, 45,46,47].

Cultural considerations The UAE’s multicultural environment necessitates a framework that respects cultural diversity while maintaining global standards. Balancing these aspects can be challenging [48].

Policy and regulatory barriers- Fragmented policies and inconsistent regulatory support can delay implementation. Coordination among stakeholders, including government bodies, accreditation agencies, and institutions, is essential [49, 50].

Enablers of implementation

Government support- The UAE government’s commitment to advancing healthcare and education serves as a strong enabler. Investments in medical education and healthcare infrastructure create a conducive environment for the framework’s implementation. Government initiatives, such as the UAE Vision 2030, emphasize education and healthcare as national priorities [51].

Existing educational excellence- Many UAE medical institutions already adhere to international accreditation standards, providing a solid foundation for integrating the UCFME [40, 52].

Technological advancements- The UAE’s investment in digital infrastructure facilitates the integration of technology-enhanced learning and assessment tools, which are essential for UCFME [40, 53].

Collaborative networks Partnerships among institutions, government bodies, and international organizations foster knowledge sharing and resource pooling [6, 40, 54].

Mitigation strategies

To enhancing institutional readiness, comprehensive needs assessments is warranted to identify gaps in infrastructure and resources. Funding and support from government and private sectors can be secured to address resource disparities which facilitates successful implementation of UCFME. It represents a unique advantage within the UAE context. Substantial financial and infrastructural support is explicitly driven by the UAE government’s strategic commitment to elevating national healthcare standards and aligning medical education with international benchmarks. However, recognizing the variability in global contexts, alternative funding strategies are recommended, including international collaborative partnerships, grants from educational foundations, and public–private collaborations, which could be viable for regions without equivalent governmental support. For faculty development, continuous professional development programs needs to be implemented focusing on CBME principles. Culturally adapted faculty development workshops are integral in overcoming initial resistance and enhancing educator competencies, addressing cultural sensitivities, language barriers, and differing pedagogical traditions effectively. These targeted interventions not only bolster faculty confidence but also strengthen stakeholder engagement, facilitating a smoother transition towards competency-based medical education. Mentorship programs to support faculty during the transition are recommended. The “Train-the-Trainer” (TTT) initiative in Canada’s CBME implementation provides a model for faculty development [4, 41, 42]. The primary difference is one of context and scale: Canada’s TTT was implemented alongside a nationwide CBME rollout in residency, whereas our effort is in undergraduate education and will be tailored to UAE’s local needs and resources. Thus, the principles (peer-led faculty development, cascade training) can be adopted with customizing the content and delivery to our environment.

In order to improve assessment strategies, standardized guidelines for competency-based assessments needs to be implemented. Investments in assessment technologies, such as e-portfolios and simulation-based evaluations are required. The use of OSCEs has been successful in competency-based assessment globally [37,38,39,40]. To address cultural considerations, diverse stakeholders in framework development need to be engaged to ensure cultural relevance. Cultural competence training for both educators and learners can be incorporated [48]. To streamline policies and regulations, fostering collaboration among regulatory bodies to create unified policies and establishing a national task force to oversee and coordinate implementation efforts are required. The ACGME model in the US demonstrates the importance of centralized oversight [50].

Conclusion

Implementing the United Arab Emirates Competency Framework for Medical Education in Undergraduate Medical Curriculum requires a structured and evidence-based approach. Kotter’s 8-Step Model provides a practical roadmap for managing this complex change process. By creating urgency, building coalitions, communicating a clear vision, and empowering stakeholders, medical institutions can ensure successful integration of the framework. Generating short-term wins, consolidating gains, and anchoring changes in institutional culture will sustain the impact of this initiative. The implementation of the UCFME in UAE presents both challenges and opportunities. Addressing institutional readiness, faculty development, assessment design, cultural considerations, and policy alignment is essential for success. Leveraging government support, technological advancements, and collaborative networks can act as significant enablers. The next phase involves scaling the UCFME across other institutions in the UAE, under the guidance of national bodies (MoE, CAA, NIHS). The establishment of the national task force committee to oversee UCFME implementation across all colleges, ensures consistency. Through targeted mitigation strategies, the UAE can ensure the effective adoption of this framework. We strongly believe that this model of RAKCOMS will be useful for other institutions adopting the new competency frame work into their curriculum.