Faculty in many schools of nursing are engaged in implementing competency-based education (CBE). Competencies are observable abilities of the student.1,2 CBE is a means of enhancing readiness for practice and preparing nursing students with the knowledge, skills, and attitudes they need for entry into practice. The ultimate outcome of CBE should be alignment of the abilities of nursing graduates with the needs of patients and health care systems.

In a CBE model, teaching strategies are planned carefully for students to develop and refine competencies. Performance is systematically assessed with strategies that are also aligned with competencies.2 As faculty, we are used to planning teaching and assessment strategies to guide students in meeting course outcomes, but with CBE, this should be done across the curriculum. Most competencies are not developed in one course only or with one activity.

Any adoption of CBE has to include a well-developed evaluation plan, not only for assessing students' learning and performance in courses, units, and modules but importantly for the program as a whole. Program evaluation allows faculty, administrators, and other stakeholders to systematically collect data for making informed decisions rather than what we think will work best.3 With limited time in a nursing program, combined with the extensive knowledge and skills to be gained and the need for practice of competencies in various contexts, decisions about the curriculum, teaching, assignments, and resources should be based on data collected through evaluation. Program evaluation cannot be done only for accreditation-evaluation should be a continuous process built into the culture of the school. Then you can collect data to identify gaps in your teaching processes, curriculum, and extent of practice while students are in the program. If you are transitioning to CBE, the time to develop an evaluation plan is now-when you are getting started with adoption.

One question I have is whether the desired outcomes of CBE in nursing are being achieved. Outcomes are difficult to measure because there are so many variables that influence the education we provide to students and their learning and performance. As more programs implement CBE, we need to determine whether this model improves students' performance, readiness for practice, and confidence. Do new graduates have the competencies they need for practice? Does the adoption of CBE over time lead to improved patient care and health outcomes?

I have 3 recommendations for your program evaluation. First, start now. Develop a program evaluation plan that includes formative evaluation, done during the transition to CBE to address issues and areas needing further development, and summative evaluation, done to provide evidence of program quality and effectiveness.3

Second, develop a logic model to guide your evaluation. A logic model is a graphic that shows the relationships among: (1) inputs (resources including faculty, clinical educators, leadership, staff, financial, organizational, and others); (2) activities (teaching strategies, sequence of learning activities, and tools) for implementing CBE and achieving intended outcomes); (3) outputs (tangible products such as mapping of competencies with teaching strategies, learning activities, and assessment strategies; action plans); and (4) outcomes (changes in learner knowledge, skills, and attitudes).3,4 A logic model begins with the outcomes of the program (right-hand side) and then moves toward the left with the outputs or tangible products that are needed for these outcomes, activities to be done, and essential inputs or resources. The Supplemental Digital Content Figure (available at: http://links.lww.com/NE/B275) is an example of a logic model for evaluating a CBE program in nursing. It is not specific enough to guide a full program evaluation but is a good way to get started thinking about the connections between activities and outcomes.

My third recommendation is that once you develop a general logic model, I would produce logic models for the domains or groups of competencies to be evaluated, for example, informatics.1 These are your working models to focus on inputs and activities needed for development of specific competencies that relate to one another.

As part of your evaluation, you should ensure the fidelity of implementation of CBE. This includes how the competencies were taught, sequenced, practiced, and assessed. You need to know whether faculty, clinical nurse educators, facilitators in simulation, and others are using a CBE framework for their teaching and assessment. I recommend collecting descriptions of the competencies, teaching strategies, learning activities, assessments (with tools), context of implementation, and other details to determine whether the CBE model is being implemented as intended and to have this information available when interpreting the outcomes data.

Measuring the impact of CBE on students, faculty, clinical nurse educators, nursing programs, staff, and both patients and health care systems is not easy to do but is essential. Nurse educators are ready for the challenge.

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