Three-Year Experience with an Innovative, Modular Competency-Based Curriculum for Orthopaedic Training

Ferguson, Peter C.; Kraemer, William J.; Nousiainen, Markku; Safir, Oleg; Sonnadara, Ranil; Alman, Benjamin A.; Reznick, Richard

doi:10.2106/jbjs.m.00314

Cited by 99 publications

(72 citation statements)

References 8 publications

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“…To determine the financial costs of simulation in the competency-based curriculum [1,6], both before and after the implementation of the pilot to the University of Toronto training program, all invoices that were submitted to the division's administrative office for simulation training were reviewed for each academic year. For reference, the academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum.…”

Section: Methodsmentioning

confidence: 99%

“…For the past 5 years at the University of Toronto, a novel competency-based curriculum has been implemented as a pilot, functioning as a parallel stream of training for residents in the Division of Orthopaedic Surgery [1,6]. In each of the first 3 years of the pilot program, three of 12 residents who matched to the residency program at the University of Toronto were selected into the competency-based curriculum stream.…”

Section: Introductionmentioning

confidence: 99%

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Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Nousiainen

McQueen

Ferguson

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time. Questions/purposes This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program. Methods All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally among the competencybased curriculum and regular stream residents for teaching 123 Clin Orthop Relat Res (2016) 474:935-944 DOI 10.1007/s11999-015-4512-6 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® (60 residents)and among 14 competency-based curriculum residents and 21 regular stream residents for assessment. Results The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012-2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competencybased curriculum (academic year 2008-2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase. Conclusions Although the financial costs and time demands on faculty in running the simulation program in...

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Nousiainen

McQueen

Ferguson

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…[1][2][3][4] Moreover, opportunities for residents to practice independently have suffered in this milieu. 5 The concept of competency-based medical education (CBME) arose from this crucible, and various medical licensing bodies champion the initiative, including such education leaders as the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Accreditation Council for Graduate Medical Education (ACGME) 6 in the United States. The influence of the CBME movement has been so notable that it has been compared with the impact of the Flexner report.…”

Section: Résumémentioning

confidence: 99%

“…The first program was launched in the Department of Orthopedic Surgery at the University of Toronto in 2009. Since then, the program has enjoyed considerable success and is particularly recognized for its accomplishments in improving technical skill performance in early training 5,[22][23][24][25] and reducing the length of training for most residents. 24 Although the increased use of simulation-based skills training in this program has led to some largely front-end loaded increases in cost, 5,25 a shortened duration of specialty training could potentially reduce training costs by up to $100,000 for each personyear of residency that is eliminated.…”

Section: Competency-based Medical Education: What Already Exists?mentioning

confidence: 99%

Curriculum reform for residency training: competence, change, and opportunities for leadership

Fraser

Stodel

Chaput

2016

Can J Anesth/J Can Anesth

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Purpose Certain pressures stemming from within the medical community and from society in general, such as the need for increased accountability in resident training and restricted resident duty hours, have prompted a re-examination of methods for training physicians. Leaders in medical education in North America and around the world champion competency-based medical education (CBME) as a solution. The Department of Anesthesiology at the University of Ottawa launched Canada's first CBME program for anesthesiology residents on July 1, 2015. In this paper, we discuss the opportunities and challenges associated with CBME and delineate the elements of the new CBME program at the University of Ottawa. Source Review of the current literature. Principal findings Competency-based medical education addresses some of the challenges associated with physician training, such as ensuring that specialists are competent in all key areas and reducing training costs. In principle, competency-based medical education can better meet the needs of patients, providers, and other stakeholders in the healthcare system, but its success will depend on support from all involved. As CBME is implemented, anesthesiologists have the opportunity to become leaders in innovation and medical education. The University of Ottawa has implemented a CBME program with a twofold purpose, namely, to focus learning opportunities on the development of the specific competencies required of practicing anesthesiologists and to test the effectiveness of a reduction in the length of training. Conclusion Canadian anesthesia residency programs will soon transition to CBME in order to promote better transparency, accountability, fairness, fiscal responsibility, and patient safety. Competency-based medical education offers significant potential advantages for healthcare stakeholders. RésuméObjectif Certaines pressions provenant de la communauté médicale et de la société en général, telles que la nécessité d'une imputabilité accrue lors de la résidence et des heures réduites pour les résidents, ont motivé un réexamen des méthodes de formation des médecins. Les chefs de file de la formation médicale en Amérique du Nord et de par le monde prô nent la formation médicale fondée sur les compétences (FMFC) comme solution. Le département d'anesthésiologie de l'Université d'Ottawa a lancé le premier programme canadien de FMFC destiné aux résidents en anesthésiologie le 1 er juillet 2015. Dans cet article, nous présentons les occasions et les défis associés à la FMFC et décrivons les éléments du nouveau programme de FMFC de l'Université d'Ottawa. Source Revue de la littérature actuelle. Constatations principales La formation médicale fondée sur les compétences relève certains des défis associés à la formation des médecins, tels que de garantir que les

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“…A trial competency-based medical education program was initiated at the University of Toronto in 2009, and as of July 2013, all first-year residents (postgraduate year [PGY]-1) have been automatically enrolled in the competency-based medical education program as part of their medical education and training [17]. Using a process of consensus, our faculty created a list of the top 10 entrustable professional activities for the program (Table 1) from a previously established list of competencies [39].…”

Section: Introductionmentioning

confidence: 99%

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

Dwyer

Wadey

Archibald

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background An entrustable professional activity describes a professional task that postgraduate residents must master during their training. The use of simulation to assess performance of entrustable professional activities requires further investigation. Questions/purposes (1) Is simulation-based assessment of resident performance of entrustable professional activities reliable? (2) Is there evidence of important differences between Postgraduate Year (PGY)-1 and PGY-4 residents when performing simulated entrustable professional activities? Methods Three entrustable professional activities were chosen from a list of competencies: management of the patient for total knee arthroplasty (TKA); management of the patient with an intertrochanteric hip fracture; and management of the patient with an ankle fracture. Each assessment of entrustable professional activity was 40 minutes long with three components: preoperative management of a patient (history-taking, examination, image interpretation); performance of a technical procedure on a sawbones model; and postoperative management of a patient (postoperative orders, management of complications). Residents were assessed by six faculty members who used checklists based on a modified Delphi technique, an overall global rating scale as well as a previously validated global rating scale for the technical procedure component of each activity. Nine PGY-1 and nine PGY-4 residents participated in our simulated assessment. We assessed reliability by calculating the internal consistency of the mean global rating for each activity as well as the interrater reliability between the faculty assessment and The institution of one or more of the authors (TD, MN) has received, during the study period, funding from a Core Competency Innovation Grant from the OMeGA Medical Grants Association. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and informed consent for participation in the study was obtained. This work was performed at the University of Toronto, Toronto, Ontario, Canada. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® blinded review of videotaped encounters. We sought evidence of a difference in performance between PGY-1 and PGY-4 residents on the overall global rating scale for each station of each entrustable professional activity. Results The reliability (Cronbach's a) for the hip fracture activity was 0.88, it was 0.89 for the ankle fracture activity, and it was 0.84 for the TKA activity. A strong correlation was seen between blinded observer video review and faculty scores (mean 0.87 [0.07], p \ 0.001). For the hip fracture entrustable professional activity, the PGY-4 group had a hi...

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Three-Year Experience with an Innovative, Modular Competency-Based Curriculum for Orthopaedic Training

Cited by 99 publications

References 8 publications

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Curriculum reform for residency training: competence, change, and opportunities for leadership

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

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