1. The NMC CBME Competency Framework
The National Medical Commission's Competency Based Medical Education framework defines 2,683 specific competencies that every MBBS student must achieve across 19 subjects. What makes CBME fundamentally different from the earlier MCI curriculum is not just the number of competencies — it is the level at which each competency must be achieved. The NMC assigns every competency one of four domain levels: K (Know), KH (Know-How), SH (Show-How), or P (Perform).
These four levels are adapted from George Miller's pyramid of clinical competence — one of the most influential frameworks in medical education globally. Miller described four levels: Knows, Knows How, Shows How, and Does. The NMC has adopted this framework as K, KH, SH, and P — and built the entire CBME curriculum around it. Understanding what each level means for teaching, assessment, and student certification is the foundation of CBME implementation.
NMC inspectors do not just check whether competencies are "covered" — they check whether the correct teaching method and assessment type were used for each domain level. A competency coded SH that was only taught by lecture and assessed by MCQ is not compliant, regardless of how many hours were spent on it.
2. K — Know Domain
Factual Knowledge — The Foundation
The K domain represents the base of Miller's pyramid — factual recall. A student at the K level can correctly state, define, enumerate, or describe a concept, fact, or clinical entity. They do not yet need to apply this knowledge clinically — knowing it accurately is the competency.
Most basic science competencies in Phase I (Anatomy, Physiology, Biochemistry) are coded K or KH. K-level competencies are the prerequisite knowledge on which clinical reasoning is built — but they are not sufficient for clinical practice on their own.
3. KH — Know-How Domain
Applied Knowledge — Clinical Reasoning
The KH domain moves from recall to application. A student at the KH level can apply their factual knowledge to a clinical scenario — they can interpret a clinical presentation, reason through a differential diagnosis, or select an appropriate investigation or management plan. They do not yet need to demonstrate or perform the skill, but they must show they can think clinically.
KH-level competencies are the dominant category in clinical Phase II and III subjects. Teaching KH requires active learning methods — not lectures alone. Small Group Discussions, problem-based learning, case presentations, and OSCE knowledge stations are the primary vehicles for developing the Know-How domain.
4. SH — Show-How Domain
Demonstrated Skill — Observed Performance
The SH domain is where clinical skills training becomes concrete. A student at the SH level must physically demonstrate the skill in a controlled, observed setting — in a simulation, an OSCE station, or a skills lab. The student can do it when observed; they may still need support or prompting in a real clinical environment.
SH-level competencies are primarily clinical and procedural — taking a structured history, performing an examination, interpreting an ECG, demonstrating a sterile technique, or performing a DOAP session task. These competencies cannot be achieved through lectures or even through case discussions — they require the student to physically demonstrate the skill to a faculty assessor.
5. P — Perform Domain
Independent Performance — Clinical Practice
The P domain is the apex of the competency framework — independent performance in real clinical practice. A student at the P level can perform the skill competently and independently in a real clinical environment, without prompting, in routine conditions. This is the level at which a competency can be certified as complete for graduation purposes.
P-level competencies are achieved through sustained clinical practice in the ward, OPD, or operation theatre — with faculty documentation of observed performance in the logbook. The logbook entry, with faculty sign-off, is the primary evidence of P-level achievement. Under NMC CBME, the number of P-level competencies a student must achieve before graduation is clearly defined per subject.
6. Teaching and Assessment Matrix
| Domain | What It Means | NMC-Approved Teaching | NMC-Approved Assessment |
|---|---|---|---|
| K — Know | Recall and state facts accurately | Lecture, tutorial, SDL | MCQ, SAQ, LAQ, true/false |
| KH — Know-How | Apply knowledge to clinical situations | SGD, case-based learning, PBL | Clinical MCQ, viva, OSCE knowledge station |
| SH — Show-How | Demonstrate skill when observed | DOAP, simulation, OSCE skills lab | OSCE skills station, DOPS, Mini-CEX |
| P — Perform | Perform independently in real practice | Supervised clinical practice, ward/OPD | Logbook sign-off, DOAP Perform certification |
7. Tracking All Four Domains with EdMedAI
EdMedAI's competency tracker shows each student's status across all 2,683 NMC competencies — colour-coded by domain and progress stage. At a glance, a student can see which competencies they have achieved at the K level, which need SH demonstration, and which are pending P-level logbook sign-off. Faculty see the same data per student, and HODs see it department-wide.
EdMedAI generates domain-level reports: "SH domain — 72% completion, 14 competencies pending" or "P domain — 56% certification, 8 competencies awaiting faculty sign-off." These reports can be filtered by student, subject, or phase — giving faculty and HODs the granular oversight that NMC inspectors look for.