The promise, perils, problems and progress of competency-based medical education

Touchie, Claire; Cate, Olle ten

doi:10.1111/medu.12839

Cited by 166 publications

(142 citation statements)

References 49 publications

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“…Critics caution that CBME may become reductionist if we do not appreciate the intricacies of clinical activities and how the clinical context influences physicians’ practice [27]. Our findings elaborate these concerns further.…”

Section: Discussionmentioning

confidence: 66%

Entrustment of the on-call senior medical resident role: implications for patient safety and collective care

2017

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BackgroundThe on-call responsibilities of a senior medicine resident (SMR) may include the admission transition of patient care on medical teaching teams (MTT), supervision of junior trainees, and ensuring patient safety. In many institutions, there is no standardised assessment of SMR competency prior to granting these on-call responsibilities in internal medicine. In order to fulfill competency based medical education requirements, training programs need to develop assessment approaches to make and defend such entrustment decisions.The purpose of this study is to understand the clinical activities and outcomes of the on-call SMR role and provide training programs with a rigorous model for entrustment decisions for this role.MethodsThis four phase study utilizes a constructivist grounded theory approach to collect and analyse the following data sets: case study, focus groups, literature synthesis of supervisory practices and return-of-findings focus groups.The study was conducted in two Academic Health Sciences Centres in Ontario, Canada. The case study included ten attending physicians, 13 SMRs, 19 first year residents and 14 medical students. The focus groups included 19 SMRs. The later, return-of-findings focus groups included ten SMRs.ResultsFive core on-call supervisory tasks (overseeing ongoing patient care, briefing, case review, documentation and preparing for handover) were identified, as well as a range of practices associated with these tasks. We also identified challenges that influenced the extent to which SMRs were able to effectively perform the core tasks. At times, these challenges led to omissions of the core tasks and potentially compromised patient safety and the admission transition of care.ConclusionBy identifying the core supervisory tasks and associated practices, we were able to identify the competencies for the on-call SMR role. Our findings can further be used by training programs for assessment and for making entrustment decisions.

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Section: Discussionmentioning

confidence: 66%

Entrustment of the on-call senior medical resident role: implications for patient safety and collective care

2017

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“…A responding paper quotes the previous text and replies by stating, the argument ‘resonates with others who experience the practice of competence‐based training as checking boxes on checklists rather than assessing the outcome of training in preparation for practice’. By distinguishing the practice of checking boxes from CBME, this quotation recasts the critiques of the former paper as an issue of poor implementation.…”

Section: Resultsmentioning

confidence: 98%

Competency-based medical education: the discourse of infallibility

et al. 2017

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In uncovering the discourse of infallibility, we explore how it can silence critical voices and hinder a rigorous examination of the competency-based approach. These discursive practices strengthen CBME by constructing it as infallible in the literature. We propose re-approaching the dialogue surrounding CBME as a starting point for empirical investigation, driven by the aim to broaden scholars' understanding of its design, development and implementation in medical education.

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“…EPAs are authentic and well-defined activities which are characteristic of the medical profession and which require different competences for being mastered [18]. Thus, performance of an EPA does not only require knowledge on diseases, symptoms and procedural aspects, defined skills and communication skills, but far beyond this, these facets of competence have to be combined in order to handle a specific clinical care situation [19]. A range of competences and facets of competence underlie each EPA [20].…”

Section: Introductionmentioning

confidence: 99%

Entrustable Professional Activities in final year undergraduate medical training – advancement of the final year training logbook in Germany

Berberat

Rotthoff

Baerwald

et al. 2019

GMS Journal for Medical Education; 36(6):Doc70

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The promise, perils, problems and progress of competency-based medical education

Abstract: The authors conclude with suggestions for the future and how using EPAs could lead us one step closer to the goals of not only competency-based medical education but also competency-based medical practice.

Cited by 166 publications

References 49 publications

Entrustment of the on-call senior medical resident role: implications for patient safety and collective care

Entrustment of the on-call senior medical resident role: implications for patient safety and collective care

Competency-based medical education: the discourse of infallibility

Entrustable Professional Activities in final year undergraduate medical training – advancement of the final year training logbook in Germany

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