Solutions · By vertical · Health sciences and CBME

What did the learner do, who saw it, and where is the evidence?

Clinical education has to show more than a mark: what a learner can do, how consistently, how much supervision they still need, and the evidence behind every academic decision. Creatrix Campus connects the whole chain, from curriculum and competencies through clinical placement, assessment opportunity, evidence, feedback and portfolio, to a progression decision a committee can defend.

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Why it goes wrong

CBME did not fail. It got implemented as forms.

Most programmes have already adopted the vocabulary. There are EPAs, there are entrustment levels, there are short forms for Mini-CEX, DOPS and case-based discussion. What is missing is the join. The form is completed on a ward and filed in one place, the placement plan sits in another, the competency framework lives in a document, and the portfolio is assembled at the end of the year out of all three.

So the committee that decides whether a learner progresses is handed a folder rather than a picture. Nobody sees which EPAs carry no evidence until it is too late in the year to collect any, and a supervisor's careful judgement about how much oversight a learner still needs becomes a tick on a page nobody reads again.

The problem: clinical evidence collected everywhere, joined nowhere.
Six broken joins Each one is ordinary practice, and each one shows up as a gap at the committee.
  • Requirements are agreed, then remembered Assessment policy lives in a handbook, not in a learner's list
    What is due, and by when, is somebody's memory
  • The schedule and the assessment do not know each other Placements planned in one place, forms filled in another
    No link between where a learner is and what to collect
  • Forms are filed, not tagged A completed discussion with no EPA or competency against it
    The evidence exists and proves nothing in particular
  • Feedback is written and never closed No acknowledgement, no reflection, no follow-up
    One-off scores instead of a record of growth
  • Gaps surface at the end Missing EPAs found when the portfolio is compiled
    The rotation that could have covered it has passed
  • The committee reviews a folder Evidence assembled by hand for each learner discussed
    A defensible decision rests on whatever arrived in time

Six habits, one consequence: the programme documents CBME instead of running it.

Before a learner reaches the ward

Four things defined up front, and the fourth is the one that changes everything.

Most programmes have a framework, an environment and a set of tools. What separates a running CBME programme from a documented one is whether assessment expectations exist before the clinical experience does.

One

The framework

What is being judged, and against what scale.

HoldsCompetency domains, competencies, milestones and the EPA master.
Owned byThe curriculum and CBME committee.
Institution-definedYour domains, your milestones, your standards. Nothing is fixed by the software.
Without itEntrustment is a word rather than a scale two people can apply the same way.
Two

The environment

Where clinical learning actually takes place.

HoldsHospitals, hubs, sites, departments, clinical services, clerkships and rotations.
Owned byRotation coordinators and academic administrators.
Institution-definedYour own clinical activities: rounds, clinics, theatre, simulation, handovers, on-call.
Without itAn observation has no location, so exposure cannot be compared across sites.
Three

The mapping

The joins between the first two.

HoldsEPA to clerkship, competency, assessment tool, eligible assessor role and target level.
Owned byThe CBME lead, defined once and versioned after.
Institution-definedWhich faculty roles may assess which activity, and where it can be demonstrated.
Without itYou have lists rather than a curriculum, and evidence that aggregates to nothing.
Four

The blueprint

Policy, turned into each learner's actual list.

HoldsWhat must be assessed, with which tool, how often, by when, under which scoring model.
Owned byAcademic leadership, reviewed and published.
On publicationGenerates learner-specific requirements, tracked pending, in progress, completed or overdue.
Without itExpectations are set after the fact, and completion depends on ad hoc record keeping.
Blueprints can be scoped by programme, clerkship, rotation, block, week or site, so policy is stated once and applied where it belongs.

How it is done

Six moves, and the rotation is where five of them land.

The framework and the blueprint are set before the placement begins. Everything else happens during the rotation, which is the only window in which the evidence can actually be collected.

Not visible Chased afterwards On the record Acted on in time
  1. 01

    Define the framework, then map it

    Competency domains, competencies, milestones and EPAs are registered, then joined: each EPA to its clerkships, its competencies, the tools that can evidence it, the faculty roles permitted to assess it and the target level expected.

    EPA · Competency · Target
  2. 02

    Configure the clinical environment

    Hospitals, hubs, sites, departments, clinical services, clerkships and rotations are held as structure rather than a spreadsheet, so every observation has a real location and an eligible supervisor behind it.

    Hub · Site · Service
  3. 03

    Assign the rotation, then schedule the week

    These are two different jobs. The assignment planner decides which cohort goes to which clerkship, hub, site and block against real capacity. The weekly planner then sets the day-to-day: service, clinical team, time and allocated learners.

    Blocks · Slots · Teams
  4. 04

    Publish the blueprint, let it generate the list

    A published blueprint turns assessment policy into learner-specific requirements with tools, counts, windows and scoring models attached, each one tracked as pending, in progress, completed or overdue.

    Blueprint · Requirements
  5. 05

    Observe, tag, and close the loop

    Faculty start an assessment from a planned clinical activity, so the learner, setting and requirement are already known. The form captures context, EPA and competency tags, rubric scores and narrative feedback. The learner acknowledges it and reflects, which is what makes it evidence of growth rather than a score.

    Mini-CEX · DOPS · CBD
  6. 06

    Decide from an evidence pack

    The committee is handed assembled longitudinal evidence rather than a folder: assessments, EPA progression, structured-exam outcomes, feedback and requirement status. It records the decision, the rationale and any remediation plan, with an audit trail behind every override.

    Committee · Rationale · Audit

At the committee

Six questions about one learner, and where the answer comes from.

These are the questions that decide whether someone moves on. Each should be a lookup, not a discussion about what the paperwork might have meant.

Has this learner reached the required level for this EPA?
FromEPA progression read against the target level, in rotation context, so nobody is marked behind for a clerkship they have not started.
What is still outstanding?
FromThe requirements registry, where every blueprint-generated requirement sits as pending, in progress, completed or overdue.
Who observed this, and where?
FromThe clinical activity behind the assessment: the service, the site, the hub, the team, and the assessor eligible to complete it.
Did the learner respond to the feedback?
FromThe acknowledgement and reflection attached to the assessment, which is what turns a score into a record of growth.
Is the judgement the assessor's, or the software's?
FromThe assessment record. AI assists with drafting and station design; scoring, entrustment and progression stay with faculty and the committee.
What was the rationale for this decision?
FromThe committee record: the evidence reviewed, the decision taken, its rationale, the remediation plan and the audit trail behind any override.

Go deeper

CBME is an assessment problem wearing a scheduling problem's clothes.

Entrustment depends on getting the right learner in front of the right supervisor, then capturing what happened. These are the pages behind both halves.

Lifecycle Assessment & Outcomes Assessment design, moderation and attainment: the machinery workplace-based assessment plugs into. See the lifecycle → Lifecycle Academic Operations Calendars, offerings and scheduling: where blocks, weeks and clinical slots come from. See the lifecycle → Product Outcomes & Attainment The outcome engine behind competency domain trends and the roll-up from evidence to claim. See the product → Lifecycle Quality & Accreditation Turning portfolios, entrustment records and coverage into evidence a medical accreditor can read. See the lifecycle → By need Accreditation readiness Evidence captured as work happens, so a programme review is a query rather than a rescue mission. See the need → In practice Institutions already doing this Universities and colleges across Europe, the Middle East, Southeast Asia and Oceania, and the frameworks they report against. Meet our customers →

What it runs on

The products behind the clinical record.

The CBME layer sits on the same academic record as the rest of the institution, which is why a clerkship, a preceptor and a transcript do not need three systems.

Competency
Outcomes & Attainment →

Competency domains and trends computed from the evidence, so a domain reading is derived rather than assigned.

DomainsMilestonesRoll-up
 Curriculum
Curriculum & Catalog →

Clerkships, phases and the versioned mapping between EPAs, competencies and the programme that owns them.

ClerkshipsVersionsMapping
 Rotations
Class Scheduling →

Blocks, weeks and clinical slots against real capacity, with teams staffed and learners allocated.

BlocksSlotsCapacity
 Structured
Examination Management →

OSCE and OSPE circuits: station banks, examiner allocation, live scoring, finalisation and audit trail.

OSCEStationsModeration
 Assessors
Faculty Management →

Consultants, residents, nurse educators, preceptors and examiners, with eligibility, load and sign-off history on the record.

RolesEligibilityWorkload
 Evidence
Accreditation & Evidence →

Portfolios, EPA coverage and committee decisions mapped to the criteria a medical accreditor asks about.

StandardsCoverageExports
Start with one clerkship. The structure it needs is the structure the institution already has.

Frequently asked

Plain answers about CBME.

What is an EPA, and how is it different from a competency?

An Entrustable Professional Activity is a professional task a learner can be trusted to perform once they have shown sufficient competence: taking a focused history and examining a patient, presenting a case, forming a differential and management plan, performing a procedure under appropriate supervision, communicating with families, recognising a deteriorating patient.

A competency is the underlying ability behind that work. Each EPA is mapped to one or more clerkships, domains, milestones and tools, so evidence gathered against the activity also reports against the competencies.

Which assessment tools are supported?

The tool catalogue is configurable. It covers Mini-CEX, DOPS, case-based discussion, direct clinical observation, mid-rotation and final rotation reviews, simulation-based assessment, professionalism assessment, chart and documentation review, procedure sign-off with supervisor attestation, and presentation review.

Multi-source 360 degree feedback is also supported, gathering views from doctors, nurses, patients and administrative staff on communication, teamwork and professional behaviour.

Does AI make the entrustment or progression decision?

No. AI assists the academic workflow: drafting narrative from the encounter details so a supervisor is not typing at the end of a clinical day, and suggesting OSCE stations from your own station bank and blueprint.

Academic users review every suggestion, and scoring, entrustment and progression remain decisions made by faculty and the authorised committee.

Do we have to go fully competency-based?

No. Alongside entrustment scoring, the platform supports rating scales, percentage scores, pass or fail decisions and checklists.

That lets a programme run a full CBME model, or a hybrid that combines competency evidence with the academic requirements it already has.

How are OSCE and OSPE examinations handled?

Each has its own workflow, because a station bank, circuit, examiner allocation, live scoring and result finalisation follow a different lifecycle from ward scheduling. Absences, flags and incident notes are recorded, and results are finalised and published with an audit trail.

Both stay connected to the assessment blueprint and the learner portfolio, and outcomes appear in requirement monitoring once released.

Will learners be flagged for EPAs in clerkships they have not started?

No. Readiness indicators take the learner's actual rotation context into account.

An EPA belonging to a clerkship the learner has not yet reached does not count against them, so the at-risk signal means something when it appears.

GET STARTED

Tell us your EPA list and the clerkships you run.

Send us your EPA master and your clerkship structure. We will map the two and show you the blueprint it implies, clerkship by clerkship, and where each activity's evidence would come from.

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