Delivering on the promise of competency based medical education – an institutional approach

Dagnone, Damon; Stockley, Denise; Flynn, Leslie; Egan, Rylan; Wylick, Richard van; McEwan, Laura; Walker, Robert V.; Reznick, Richard

doi:10.36834/cmej.43303

Cited by 27 publications

(25 citation statements)

References 6 publications

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“…7) This challenge was also identified in the present study, in which residents who were not CC members often had the impression that CCs were a ‘black box’ in terms of their decision‐making processes. Given the importance of stakeholder engagement in ensuring the successful implementation of CBME, 40 it is important that programmes liaise with residents to explain how CCs make decisions and ensure that residents understand the expectations they must fulfil as learners. In addition to improving engagement, this may also help to increase the amount of data available to CCs, as many programmes reported that residents were not initiating assessments as often as required.…”

Section: Discussionmentioning

confidence: 99%

Competence committees: The steep climb from concept to implementation

et al. 2021

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Introduction Competence committees (CCs) are groups of educators tasked with reviewing resident progress throughout their training, making decisions regarding the achievement of Entrustable Professional Activities and recommendations regarding promotion and remediation. CCs have been mandated as part of competency‐based medical education programmes worldwide; however, there has yet to be a thorough examination of the implementation challenges they face and how this impacts their functioning and decision‐making processes. This study examined CC implementation at a Canadian institution, documenting the shared and unique challenges that CCs faced and overcame over a 3‐year period. Methods This study consisted of three phases, which were conceptually and analytically linked using Moran‐Ellis and colleagues’ notion of ‘following a thread.’ Phase 1 examined the early perceptions and experiences of 30 key informants using a survey and semi‐structured interviews. Phase 2 provided insight into CCs’ operations through a survey sent to 35 CC chairs 1‐year post‐implementation. Phase 3 invited 20 CC members to participate in semi‐structured interviews to follow up on initial themes 2 years post‐implementation. Detailed observation notes from 16 CC meetings across nine disciplines were used to corroborate the findings from each phase. Results Response rates in each phase were 83% (n = 25), 43% (n = 15) and 60% (n = 12), respectively. Despite the high degree of support for CCs among faculty and resident members, several ongoing challenges were highlighted: adapting to programme size, optimising membership, engaging residents, maintaining capacity among members, sharing and aggregating data and developing a clear mandate. Discussion Findings of this study reinforce the importance of resident engagement and information sharing between disciplines. Challenges faced by CCs are discussed in relation to the existing literature to inform a better understanding of group decision‐making processes in medical education. Future research could compare implementation practices across sites and explore which adaptations lead to better or worse decision‐making outcomes.

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Section: Discussionmentioning

confidence: 99%

Competence committees: The steep climb from concept to implementation

et al. 2021

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“…Indeed, the initial experience at Queen's University, one of the earlier centres to adopt widespread postgraduate implementation, has highlighted the critical importance of the creation of leadership roles in both faculty, educational leaders and residents to optimize effective implementation by actively co-engaging all stakeholders in the process. 26,32 In the theme value of feedback for residents, study participants reported that they valued specific and actionable feedback. Recent studies reported that qualitative narrative, actionable and specific feedback was of great value and facilitated a conversation with more credibility, allowing the learner to be more at ease.…”

Section: Discussionmentioning

confidence: 99%

Exploring resident perceptions of initial competency based medical education implementation

et al. 2021

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Background: Competence by design (CBD) is a nationally developed hybrid competency based medical education (CBME) curricular model that focuses on residents’ abilities to promote successful practice and better meet societal needs. CBD is based on a commonly used framework of five core components of CBME: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction and programmatic assessment. There is limited literature concerning residents’ perceptions of implementation of CBME. Objective: We explored resident perceptions of this transformation and their views as they relate to the intended framework. Methods: We recruited residents enrolled in current CBME implementation between August 2018 and January 2019. We interviewed residents representing eight disciplines from the initial two CBME implementation cohorts. Inductive thematic analysis was used to analyse the data through iterative consensus building until saturation. Results: We identified five themes: 1) Value of feedback for residents; 2) Resident strategies for successful Entrustable Professional Activity observation completion; 3) Residents experience challenges; 4) Resident concerns regarding CBME; and 5) Resident recommendations to improve existing challenges. We found that while there was clear alignment with residents’ perceptions of the programmatic assessment core CBME component, alignment was not as clear for other components. Conclusions: Residents perceived aspects of this transformation as helpful but overall had mixed perceptions and variable understanding of the intended underlying framework. Understanding and disseminating successes and challenges from the resident lens may assist programs at different stages of CBME implementation.

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“…Assuming that competency is met after a specific number of procedures is very unlikely to capture those who need additional training before commencing independent practice. Competency-based learning, on the other hand, relies on the notion that trainees must demonstrate well-defined educational goals before progressing to the next step of their training [23, 24]. The advantage of competency-based learning is that all trainees will meet the same educational goals, and the only variable that differs between trainees is the time to achieve these goals.…”

Section: Discussionmentioning

confidence: 99%

Consensus on Training and Assessment of Competence in Performing Chorionic Villus Sampling and Amniocentesis: An International Delphi Survey

Johnsson¹,

Tolsgaard²,

Hyett³

et al. 2021

Fetal Diagn Ther

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Introduction: The aim of this study was to obtain expert consensus on the content of a curriculum for learning chorionic villus sampling (CVS) and amniocentesis (AC) and the items of an assessment tool to evaluate CVS and AC competence. Methods: We used a 3-round iterative Delphi process. A steering committee supervised all processes. Seven international collaborators were identified to expand the breadth of the study internationally. The collaborators invited fetal medicine experts to participate as panelists. In the first round, the panelists suggested content for a CVS/AC curriculum and an assessment tool. The steering committee organized and condensed the suggested items and presented them to the panelists in round 2. In the second round, the panelists rated and commented on the suggested items. The results were processed by the steering committee and presented to the panelists in the third round, where final consensus was obtained. Consensus was defined as support by more than 80% of the panelists for an item. Results: Eighty-six experts agreed to participate in the study. The panelists represented 16 countries across 4 continents. The final list of curricular content included 12 theoretical and practical items. The final assessment tool included 11 items, systematically divided into 5 categories: pre-procedure, procedure, post-procedure, nontechnical skills, and overall performance. These items were provided with behavioral scale anchors to rate performance, and an entrustment scale was used for the final overall assessment. Conclusion: We established consensus among international fetal medicine experts on content to be included in a CVS/AC curriculum and on an assessment tool to evaluate CVS/AC skills. These results are important to help transition current training and assessment methods from a time- and volume-based approach to a competency-based approach which is a key step in improving patient safety and outcomes for the 2 most common invasive procedures in fetal medicine.

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Delivering on the promise of competency based medical education – an institutional approach

Cited by 27 publications

References 6 publications

Competence committees: The steep climb from concept to implementation

Competence committees: The steep climb from concept to implementation

Exploring resident perceptions of initial competency based medical education implementation

Consensus on Training and Assessment of Competence in Performing Chorionic Villus Sampling and Amniocentesis: An International Delphi Survey

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