Shift from Content-Based to Competency-Based Nursing Education
The 2020 American College of Cardiology Clinical Competencies document explicitly describes the ongoing shift in nursing education from content-focused curricula to competency-based training, incorporating major advances in both content and structure toward competency-based models. 1
Key Documents Addressing This Educational Shift
Primary Guideline Documents
The 2020 ACC Clinical Competencies for Nurse Practitioners and Physician Assistants in Adult Cardiovascular Medicine published in the Journal of the American College of Cardiology directly addresses this transition. 1 This document states that subsequent updates to cardiovascular training have "incorporated major advances and revisions—both in content and structure—including a further move toward competency-based training." 1
The ACC document specifically describes the adoption of the 6-domain competency structure promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties, endorsed by the American Board of Internal Medicine. 1 This structure is now used for:
- Defining competencies for cardiovascular specialists across the entire career spectrum 1
- Describing lifelong learning competencies for practicing cardiologists 1
- Medical staff privileging and peer-review professional competence assessments in hospital systems 1
Contemporary Nursing Education Literature
The 2024 umbrella review "Educating Nursing Students for Sustainable Future Rural Health-Care Services" published in the International Journal of Nursing Studies emphasizes that curricula should be specifically designed to educate nursing students to be "fit for practice" with necessary competencies rather than simply covering content. 1
This document highlights that curriculum developers must align nursing education to 21st century competencies and skills, moving beyond traditional content delivery to competency development that addresses:
- Broader generalist competencies needed for rural nursing practice 1
- Flexible nursing roles requiring complex assessments 1
- Leadership in technology adoption based on patient needs and values 1
Rationale for the Shift
Outcome-Based Evaluation Systems
A key feature of competency-based training is an outcome-based evaluation system that assesses achievement of individual components of competency rather than mere content knowledge. 1 The ACC competency statements include specific tools for assessing competency achievement, representing a fundamental departure from content-focused assessment. 1
Addressing Educational Gaps
The shift addresses critical gaps in traditional content-based education, particularly the lack of formal postgraduate training programs where most knowledge and skills were previously learned through unstructured practice experience. 1 Competency-based frameworks provide:
- Nationally-recognized core competencies for standardized expectations 1
- Clear delineation of competencies relevant to actual services provided 1
- Structured pathways for competency development rather than passive content absorption 2
Practice Readiness Focus
Recent literature emphasizes that competency-based education focuses on individual students' development and demonstrated performance of role-specific aspects, rather than simply covering curriculum content. 2 This approach prioritizes:
- Application of clinical knowledge, skills, and abilities as building blocks of professional expertise 2
- Developmental pathways involving appropriate training and substantial practice 2
- Integration of situated knowledge into competency understanding 2
Implementation Across Nursing Education
The 2021 American Association of Colleges of Nursing (AACN) Essentials represents the standardization of this shift across all nursing education levels, articulating competency-based standards for baccalaureate and graduate nursing education in the 21st century. 3, 4, 5 Academic institutions are actively working to quantify student learning outcomes based on AACN Essentials domains, competencies, and sub-competencies. 3
This transformation involves academic-practice partnerships redefining entry- and advanced-level nursing education, including new approaches to clinical experiences and competency assessment that clarify what new nurses are prepared to do while enhancing practice readiness. 4