1 of 26

Competency-Based Education: Simulation is the Perfect Tool to Measure Competencies

July 2025

Tammy Pleasant, MSN, RN, CNE

2 of 26

Objectives for this Session

Understand the Fundamentals of Competency-Based Education (CBE).

1

Explore the Role of Simulation in Enhancing Learning Outcomes.

2

Identify Best Practices and Future Trends in CBE and Simulation Integration.

3

3 of 26

Types of Nursing Curricula

Blocked Content Curricula

Typically structured around clinical specialty areas, patient populations, pathological conditions, or physical systems

Concept-Based Curricula

Use core concepts to help learners understand how these concepts explain health conditions and situations. Students increase knowledge and understanding of concepts as they progress in the curriculum

Competency-Based Education

Focused on the abilities of graduates; it’s a way to show achievement in a program as opposed to being the curriculum itself

WHEN WE TALK CBE, WE ARE NOT ONLY TALKING ABOUT THE ESSENTIALS
CURRICULUM IS WHAT YOU’RE TEACHING, WHERE IT’S TAUGHT, AND HOW THAT ALL WORKS TOGETHER.
IT’S THE CONTENT, THE COURSES, AND THE SEQUENCING OF THE INFORMATION INCLUDED IN A PROGRAM.

THERE ARE DIFFERENT NURSING CURRICULAR STRUCTURES MODELS FOR SURE.
MOST COMMONLY IS A TRADITIONAL CURRICULUM AND A CONCEPT BASED CURRICULUM.
THAT TRADITIONAL MODEL, OR WHAT WE SOMETIMES CALL A BLOCKED CONTENT CURRICULUM, HAS STANDARD COURSES WITH CONTENT STRUCTURED AROUND CLINICAL SPECIALTY AREAS, PATIENT POPULATIONS, OR SPECIFIC CONDITIONS OR BODY SYSTEMS.

CONCEPT BASED CURRICULA OR CBC IS ORGANIZED AROUND CORE CONCEPTS TO HELP LEARNERS UNDERSTAND HOW THESE CONCEPTS EXPLAIN HEALTH CONDITIONS AND SITUATIONS.
STUDENTS INCREASE KNOWLEDGE AND UNDERSTANDING OF CONCEPTS AS THEY PROGRESS THROUGH IN THE CURRICULUM.
YOU MAY BE FAMILIAR OF CBC BECAUSE OF GIDDENS .

BUT COMPETENCY BASED EDUCATION OR CBE IS NOT A CURRICULAR MODEL.
IT’S NOT THE CONTENT OF THE COURSE, THE COURSES, OR THE SEQUENCING OF THOSE COURSES.
IT’S A WAY OF SHOWING ACHIEVEMENT WITHIN A PROGRAM AS OPPOSED TO BEING THE CURRICULUM ITSELF.
YOU CAN FIND NURSING PROGRAMS WITH A MORE TRADITIONAL CONTENT CURRICULUM OR A CONCEPT-BASED CURRICULUM USING COMPETENCIES.
SPECIFICALLY, PROGRAMS THAT HAVE CCNE ACCREDITATION HAVE A NEW SET OF ESSENTIAL DOMAINS, COMPETENCIES AND SUB-COMPETENCIES IN WHICH THEY MUST SHOW STUDENT PROGRESSION AND ACHIEVEMENT.
THAT IS, THE 2021 AACN ESSENTIALS.

4 of 26

TIME FOR AN ACTIVITY………

4

5 of 26

Shift from what learners are expected to know versus what they are expected to do!

Competency-Based Education

AACN defines competency-based education as “a system of instruction, assessment, feedback, self-reflection, and academic reporting based on students demonstrating that they have learned the knowledge, attitudes, motivations, self-perceptions, and skills expected of them as they progress through their education” (AACN, 2023).

SO LET’S DIG DEEPER INTO COMPETENCY BASED EDUCATION ITSELF.

e NLN Vision Statement: Integrating Competency-Based Education (CBE) in the Nursing Curriculum by providing context for educators to strategically close gaps in WHAT LEARNERS ARE EXPECTED TO KNOW VERSUS WHAT THEY ARE EXPECTED TO DO.

. THERE ARE SEVERAL CHARACTERISTICS OF COMPETENCY-BASED EDUCATION:

IT ALLOWS STUDENTS TO LEARN AT THEIR OWN PACE;
IT EMPHASIZES LEARNING OUTCOMES AND ASSESSMENT;
IT TARGETS COMPETENCIES THAT ARE ALIGNED DIRECTLY WITH WORKPLACE TASKS;
IT ACKNOWLEDGES LEARNING OUTSIDE THE CLASSROOM;
IT PROMOTES EQUITY AND EMPOWERS STUDENTS THROUGH INDIVIDUALIZED INSTRUCTION (BOUCHER, 2021);
IT CONNECTS LEARNING PATHWAYS TO SUPPORT LEARNER PROGRESSION THROUGH NURSING CAREER ROLES. 1

6 of 26

Competency-Based Education is…..

“a system of instruction, assessment, feedback, self-reflection, and academic reporting based on students demonstrating that they have learned the knowledge, attitudes, motivations, self-perceptions, and skills expected of them as they progress through their education” (AACN, 2023).

7 of 26

Competency-Based Education

Shift from what learners are expected to know versus what they are expected to do!

Educator focuses on guiding and assessing application of knowledge vs. delivering knowledge.

Students must take ownership of their learning process and understand the expectations in a CBE

8 of 26

Characteristics of Competencies

Focused on outcomes
Reflect what is learned
Expressed in terms of measurable behavior
The standard for judging competence independent of any other person’s performance
Inform learners and other stakeholders what is expected of them
Covert, et al, 2019

First – what are competencies?

Competencies typically have the following characteristics:��1. OBSERVABLE AND MEASURABLE: COMPETENCIES SHOULD BE DEFINED IN TERMS OF OBSERVABLE BEHAVIORS, SKILLS, OR KNOWLEDGE THAT CAN BE ASSESSED AND MEASURED.��2. JOB-RELEVANT: COMPETENCIES SHOULD BE DIRECTLY RELATED TO THE TASKS, RESPONSIBILITIES, AND REQUIREMENTS OF A SPECIFIC JOB OR ROLE.��3. COMPREHENSIVE: COMPETENCIES SHOULD COVER THE FULL RANGE OF KNOWLEDGE, SKILLS, ABILITIES, AND OTHER ATTRIBUTES NECESSARY FOR EFFECTIVE JOB PERFORMANCE.��4. CLEARLY DEFINED: COMPETENCIES SHOULD BE CLEARLY DEFINED AND DESCRIBED, LEAVING NO ROOM FOR AMBIGUITY OR MISINTERPRETATION.��5. DEVELOPABLE: COMPETENCIES SHOULD BE LEARNABLE AND IMPROVABLE THROUGH TRAINING, EDUCATION, AND EXPERIENCE.��6. TRANSFERABLE: COMPETENCIES SHOULD BE APPLICABLE ACROSS DIFFERENT CONTEXTS OR SITUATIONS WITHIN NURSING. ��7. ALIGNED WITH ORGANIZATIONAL GOALS: COMPETENCIES SHOULD SUPPORT AND ALIGN WITH THE OVERALL GOALS, VALUES, AND STRATEGIC OBJECTIVES OF THE ORGANIZATION.��8. CONTINUOUSLY UPDATED: COMPETENCIES SHOULD BE REGULARLY REVIEWED AND UPDATED TO REFLECT CHANGES IN JOB REQUIREMENTS, INDUSTRY STANDARDS, OR BEST PRACTICES.��THESE CHARACTERISTICS ENSURE THAT COMPETENCIES ARE PRACTICAL, RELEVANT, AND EFFECTIVE IN GUIDING THE DEVELOPMENT, ASSESSMENT, AND EVALUATION OF INDIVIDUALS IN THEIR RESPECTIVE ROLES OR PROFESSIONS.

9 of 26

Miller’s Pyramid

KNOWS

KNOWS HOW

SHOWS

HOW

DOES

This level represents knowledge and understanding. nursing students should possess the theoretical knowledge necessary for nursing practice.

At this level, students should be able to apply their knowledge in practical scenarios. this includes understanding the basic principles of patient care and clinical procedures.

Demonstrating skills and competencies in real clinical situations aligns with this level. nursing students must showcase their ability to perform tasks, such as administering medications or conducting assessments.

The highest level of miller's pyramid signifies that students can independently perform clinical activities. in nursing, this equates to students being able to demonstrate competence in a real-world context.

Over 30 years ago, George Miller acknowledged that no single assessment method could provide all the data required for complex measures, such as professional competency, and He developed a framework for assessment (Miller, 1990). While Miller's Pyramid was initially designed for physicians, it provides a beneficial theoretical base for other health professional education, including nursing (Hampton et al., 2024). Miller's Pyramid outlines four levels of behaviors related to clinical skill performance: ‘knows,’ ‘knows how,’ ‘shows how,’ and ‘does’ (Miller, 1990). Miller's Pyramid underscores the importance of distinguishing levels in assessment, allowing learners to meet assessment criteria over a period of time, ensuring assessment drives learning and facilitates iterative competence development throughout their ed

KNOWS: THIS LEVEL REPRESENTS KNOWLEDGE AND UNDERSTANDING. NURSING STUDENTS SHOULD POSSESS THE THEORETICAL KNOWLEDGE NECESSARY FOR NURSING PRACTICE.
KNOWS HOW: AT THIS LEVEL, STUDENTS SHOULD BE ABLE TO APPLY THEIR KNOWLEDGE IN PRACTICAL SCENARIOS. THIS INCLUDES UNDERSTANDING THE BASIC PRINCIPLES OF PATIENT CARE AND CLINICAL PROCEDURES.
SHOWS HOW: DEMONSTRATING SKILLS AND COMPETENCIES IN REAL CLINICAL SITUATIONS ALIGNS WITH THIS LEVEL. NURSING STUDENTS MUST SHOWCASE THEIR ABILITY TO PERFORM TASKS, SUCH AS ADMINISTERING MEDICATIONS OR CONDUCTING ASSESSMENTS.
DOES: THE HIGHEST LEVEL OF MILLER'S PYRAMID SIGNIFIES THAT STUDENTS CAN INDEPENDENTLY PERFORM CLINICAL ACTIVITIES. IN NURSING, THIS EQUATES TO STUDENTS BEING ABLE TO DEMONSTRATE COMPETENCE IN A REAL-WORLD CONTEXT (MILLER, 1990).

10 of 26

The Intersection of CBE and Simulation-Based Education (SBE)

Focus on Mastery
Application of Knowledge
Assessment and Accountability
Regulatory and Accreditation Requirements
Professional Readiness
Personalized Learning
Real-world Relevance
Continuous Improvement
Adaptability to Changes in Health Care
Interprofessional Collaboration

SBE translates well into CBE
SBE is a perfect tool for CBE to facilitate formative education and assessment
SBE is well-aligned with the “shows how” aspect of Miller’s Pyramid
SBE allows students to practice competencies in a safe environment, giving them the opportunity to build on mastery of their competencies.

Simulation-based education (SBE) offers valuable principles, strategies, and standards that translate well into CBE.

While simulation-based and competency-based education share overlapping principles, they are not precisely synonymous.

Simulation-based education often serves as a tool within competency-based education frameworks to facilitate formative education and assessment THINK BACK TO SOME OF THE PRINCIPLES OF CBE

. COMPREHENSIVE: COMPETENCIES SHOULD COVER THE FULL RANGE OF KNOWLEDGE, SKILLS, ABILITIES, AND OTHER ATTRIBUTES NECESSARY FOR EFFECTIVE JOB PERFORMANCE.��4. CLEARLY DEFINED: COMPETENCIES SHOULD BE CLEARLY DEFINED AND DESCRIBED, LEAVING NO ROOM FOR AMBIGUITY OR MISINTERPRETATION.��5. DEVELOPABLE: COMPETENCIES SHOULD BE LEARNABLE AND IMPROVABLE THROUGH TRAINING, EDUCATION, AND EXPERIENCE.��6. TRANSFERABLE: COMPETENCIES SHOULD BE APPLICABLE ACROSS DIFFERENT CONTEXTS OR SITUATIONS WITHIN NURSING. ��7. ALIGNED WITH ORGANIZATIONAL GOALS: COMPETENCIES SHOULD SUPPORT AND ALIGN WITH THE OVERALL GOALS, VALUES, AND STRATEGIC OBJECTIVES OF THE ORGANIZATION.��8. CONTINUOUSLY UPDATED: COMPETENCIES SHOULD BE REGULARLY REVIEWED AND UPDATED TO REFLECT CHANGES IN JOB REQUIREMENTS, INDUSTRY STANDARDS, OR BEST PRACTICES.

11 of 26

Focus on Mastery

Mastering essential skills
Ensuring learners are proficient in providing safe patient care with effective clinical judgment

12 of 26

Application of Knowledge

Application of Knowledge
Real-world context
Bridge the gap between theory and practice
Giving skills check-offs some contexts by making them mini-simulations
Advancing to complex simulations and multi patient simulations to reflect actual practice and opportunities to practice clinical judgment skills

13 of 26

Assessment and Accountability

CBE provides clear metrics for assessing learners’ competence

SBE allows students to be evaluated on specific competencies in a real-world patient experience

SBE promotes reflection, allowing students to focus on their learning strengths and needs

Giving students accountability and allowing them to be actively engaged in learning and developing those lifelong learning skills

14 of 26

Regulatory and Accreditation Requirements

Of course, accreditation is a key component of nursing programs
CBE helps programs meet these criteria
SBE provides a standardized approach to competency assessment with consistency and reliability

15 of 26

Professional Readiness

CBE’s goal is to enhance professional readiness
SBE provides immersive, experiential learning opportunities to develop and demonstrate the essential competencies
SBE aligns with the goal of CBE to enhance professional readiness

16 of 26

Personalized Learning

CBE emphasizes personalized learning pathways tailored to each learner's needs and abilities
This allows students to progress through their education as they demonstrate mastery of concepts
SBE can be adapted to meet individualized learning styles and pace

17 of 26

Real-world Relevance

CBE promotes application of knowledge and skills to meet competencies needed to practice safe patient care
What better way to replicate “real-world” than in the Sim lab!

Credit: Herzing University

18 of 26

Continuous Improvement

CBE emphasizes detailed feedback and assessment that is measurable

This allows continuous improvement in teaching strategies and student experiences

Simulations can be constantly improved based on performance data and evolving healthcare standards

19 of 26

Adaptability to Changes in Healthcare

CBE's focus on competencies allows for the curriculum to be quickly updated to reflect changes in health care due to technological advancements, changing patient demographics, and emerging health challenges

Ensuring that SBE is mapped to the curriculum and regular curriculum review allows Simulations to be adapted to the changing world of healtcare

20 of 26

Interprofessional Collaboration

Collaboration with multidisciplinary teams is a key competency for nursing practice

Many nursing programs include interprofessional SBE, giving students a safe place to practice and achieve this competency

21 of 26

Best Practices for SBE

Professional Development

Prebriefing

Simulation Design

Facilitation

Debriefing Process

Operations

Outcomes and Objectives (Competencies included)

Professional Integrity

Sim-Enhanced IPE

Evaluation of Learning and Performance

Simulation Glossary

22 of 26

TIME FOR AN ACTIVITY………

22

23 of 26

De Gagne, J. C., & Oermann, M. H. (2025). *Teaching in nursing and role of the educator* (4th ed.). Springer Publishing Company. Page 261

24 of 26

Future Trends in CBE and SBE

AI! The sky’s the limit with responsible AI in education

Build simulation activities and competency assessments

Future advancements in Simulation modalities and equipment

Increased body of Literature on CBE and SBE

25 of 26

26 of 26

References

 American Association of Colleges of Nursing. (2021). The essentials of baccalaureate education for professional nursing practice. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf 
Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9), S63–S67. https://doi.org/10.1097/00001888-199009000- 00045
Giddens, J.F. (2024) Mastering Concept-based Teaching and competency Assessment: A Guide for Nurse Educators (3^rd ed.). Elsevier.
Marie Gilbert, Kristen M. Brown, Penni Watts, The intersections between competency-based education and simulation-based education: Integration in nursing education. Journal of Professional Nursing, Volume 54, 2024, https://doi.org/10.1016/j.profnurs.2024.08.010. (https://www.sciencedirect.com/science/article/pii/S8755722324001376)
De Gagne, J. C., & Oermann, M. H. (2025). *Teaching in nursing and role of the educator* (4th ed.). Springer Publishing Company. Chapter 13