EQual rubric scores reliably measured alignment of EPAs with literature-described standards. Further, its application accurately identified EPAs requiring major revisions.

Background: Residency training programs in Canada are undergoing a mandated transition to competency-based medical education (CBME).  There is limited literature regarding resident perspectives on CBME.  As upper year residents act as mentors and assessors for incoming cohorts, and are themselves key stakeholders in this educational transition, it is important to understand how they view CBME.  We examined how residents who are not currently enrolled in a competency-based program view that method of training, and what they perceive as potential advantages, disadvantages, and considerations regarding its implementation. Methods: Sixteen residents volunteered to participate in individual semi-structured interviews, with questions focussing on participants’ knowledge of CBME and its implementation.  We used a grounded theory approach to develop explanations of how residents perceive CBME. Results: Residents anticipated improved assessment and feedback, earlier identification of residents experiencing difficulties in training, and greater flexibility to pursue self-identified educational needs.  Disadvantages included logistical issues surrounding CBME implementation, ability of attending physicians to deliver CBME-appropriate feedback, and the possibility of assessment fatigue.  Clear, detailed communication and channels for resident feedback were key considerations regarding implementation. Conclusions: Resident views align with educational experts regarding the practical challenges of implementation.  Expectations of improved assessment and feedback highlight the need for both residents and attending physicians to be equipped in these domains.  Consequently, faculty development and clear communication will be crucial aspects of successful transitioning to CBME.

Construct: Competence Based Medical Education (CBME) is designed to use workplace-based assessment (WBA) tools to provide observed assessment and feedback on resident competence. Moreover, WBAs are expected to provide evidence beyond that of more traditional mid- or end-of-rotation assessments [e.g., In Training Evaluation Records (ITERs)]. In this study we investigate competence in General Internal Medicine (GIM), by contrasting WBA and ITER assessment tools.Background: WBAs are hypothesized to improve and differentiate written and numerical feedback to support the development and documentation of competence. In this study we investigate residents’ and faculty members’ perceptions of WBA validity, usability, and reliability and the extent to which WBAs differentiate residents’ performance when compared to ITERs.   Approach: We used a mixed methods approach over a three-year period, including perspectives gathered from focus groups, interviews, along with numerical and narrative comparisons between WBA and ITERs in one GIM program.Results: Residents indicated that the narrative component of feedback was more constructive and effective than numerical scores. They perceived the focus on specific workplace-based feedback was more effective than ITERs. However, quantitative analysis showed that overall rates of actionable feedback, including both ITERs and WBAs, were low (26%), with only 9% providing an improvement strategy. The provision of quality feedback was not statistically significantly different between tools; although WBAs provided more actionable feedback, ITERs provided more strategies. Statistical analyses showed that more than half of all assessments came from 11 core faculty.Conclusions: Participants in this study viewed narrative, actionable and specific feedback as essential, and an overall preference was found for written feedback over numerical assessments. However, quantitative analyses showed that specific actionable feedback was rarely documented, despite qualitative emphasis from both groups of its importance for developing competency. Neither formative WBAs or summative ITERs clearly provided better feedback, and both may still have a role in overall resident evaluation. Participant views differed in roles and responsibilities, with residents stating that faculty should be responsible for initiating assessments and vice-versa. These results reveal a disconnect between resident and faculty perceptions and practice around giving feedback and emphasize opportunities for programs adopting and implementing CBME to address how best to support residents and frontline clinical teachers.

The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.

Pain is a characteristic of many medical conditions. In developing countries, pain is poorly managed due to scarce health resources, limited access to training and cultural attitudes. In this article, a focus group comprising anesthesia residents in Kigali, Rwanda, was conducted to determine how challenges to implementing pain management strategies are perceived, and to offer suggestions to overcoming these barriers.

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The Royal College of Physicians and Surgeons of Canada (RCPSC) adopted a plan to transform, over a seven-year horizon (2014-2021), residency education across all specialties to competency-based medical education (CBME) curriculum models. The RCPSC plan recommended implementing a more responsive and accountable training model with four discrete stages of training, explicit, specialty specific entrustable professional activities, with associated milestones, and a programmatic approach to assessment across residency education. Embracing this vision, the leadership at Queen’s University (in Kingston, Ontario, Canada) applied for and was granted special permission by the RCPSC to embark on an accelerated institutional path. Over a three-year period, Queen’s took CBME from concept to reality through the development and implementation of acomprehensive strategic plan. This perspective paper describes Queen’s University’s approach of creating a shared institutional vision, outlines the process of developing a centralized CBME executive team and twenty-nine CBME program teams, and summarizes proactive measures to ensure program readiness for launch. In so doing, Queen’s created a community of support and CBME expertise that reinforces shared values including fostering co-production, cultivating responsive leadership, emphasizing diffusion of innovation, and adopting a systems-based approach to transformative change.