Feedback and formative assessment in Competency by Design: The experience of residents and supervisors within a urology training program

Abstract

Introduction: Competency by Design (CBD) is a form of competency-based medical education implemented in Canadian urology programs since 2018. Regular, multimethod assessments and formative feedback via Entrustable Professional Activities (EPAs) are the cornerstones of CBD. Increased personalized and regular feedback are the top perceived benefits of CBD by both residents and supervisors; however, evidence shows that in practice, constant feedback-seeking is burdensome, and increased quantity of feedback does not equal increased quality. The experience of CBD implementation has not yet been studied in surgical programs. Our aim was to examine how supervisors and residents have experienced the integration of formative assessment and feedback since the implementation of CBD in a surgical training program. Methods: Using data from focus groups, a qualitative phenomenological analysis based on the experiences of the residents and supervisors in a urology residency program was performed. Results: Residents and supervisors felt that CBD allowed for better tracking of resident performance and increased quantity of feedback; however, increased workload, delayed completion of EPA assessments, lack of direct observation in non-surgical activities, variable supervisor guidance, and lack of understanding of CBD were cited as barriers to providing proper feedback and formative assessment. Conclusions: The participants experienced a lukewarm transition in feedback and formative assessment practices with CBD. As with every process of change, these growing pains may eventually result in meaningful practice improvements and incorporation of a CBD culture into everyday learning activities.

Clinical supervisors’ experience of a first-time application of entrustable professional activities in clinical supervision of medical students: findings from a Swedish pilot study

“…Clinical supervisors described that EPAs required the supervisors to give more frequent feedback to the students. This is in line with previous research showing that the introduction of EPAs increased the frequency and quality of feedback, and motivated the students to request more feedback [19,20]. However, the concern, expressed by some respondents, that some of the feedback tend be too vague to be useful for the students, is also supported by experience from others, reporting that a proportion of the written feedback on EPAs was deemed without guidance or actionable steps [21].…”

“…The challenge to adapt the clinical workplace, primarily focused on providing safe healthcare, to accommodate clinical supervision is well known [33,[48][49][50]. Lack of time to teach is frequently seen as a barrier to effective clinical supervision [19,33,34,[51][52][53].…”

Making Competence by Design work is a shared responsibility

“…A s I read through the report by Aubé-Peterkin et al, 1 on urology resident and faculty experiences during the early years of Competence by Design (CBD), I found myself nodding in recognition of a familiar story -there have been several speed bumps and unintended negative consequences during the rollout of CBD across residency training in Canada. And, although this qualitative study was performed using focus groups of residents and faculty at a single urology residency program, I think the findings can likely be generalized across all urology residency programs (and probably residency programs in all disciplines) in Canada.…”