scholarly journals P.179 An International Comparison of Neurosurgical Competence by Design Curriculum

2021 ◽  
Vol 48 (s3) ◽  
pp. S71-S71
Author(s):  
J Rabski ◽  
G Moodie
Keyword(s):  
Medical Training ◽  
Postgraduate Medical Education ◽  
The United States ◽  
Professional Activities ◽  
The United Kingdom ◽  
Competency Frameworks ◽  
Future Challenges ◽  
Regulatory Bodies ◽  
General Program ◽  
Competency Based

Background: Prior to its recent introduction into Canadian neurosurgical curriculum, Competence by Design (CBD) principles have been implemented across many international neurosurgical training programs for several years. As such, comparing other international competency-based educational frameworks and curricula can help anticipate, avoid or mitigate potential future challenges for Canadian neurosurgical trainees. Methods: A comparative web-based analysis of neurosurgical postgraduate medical education documents and resources provided by medical accreditation and regulatory bodies of Canada, the United States, the United Kingdom and Australasia, was performed. Results: All four countries varied considerably across four major curriculum-based themes: 1) general program structure; 2) overarching foundational competency frameworks; 3) types and numbers of performance assessments required and; 4) curricular learning outcomes. In particular, the expected progression and degree of competence required of neurosurgical residents when performing entrustable professional activities (EPAs) or defined tasks of neurosurgical practice, varied across all countries. Differences in types of neurosurgical EPAs and number of required assessments demonstrating a trainee’s competence achievement were also appreciated. Conclusions: This study revealed variations across competency-based neurosurgical curricula proposed by four international medical training regulatory bodies. Differences in types of EPAs and their required degree of competence achievement suggests potential disconnects between neurosurgical educational outcomes and actual medical practice.

scholarly journals Analyzing the Administrative Burden of Competency Based Medical Education

2021 ◽  
pp. 084653712110389
Author(s):  
Kevin Cheung ◽  
Christina Rogoza ◽  
Andrew D. Chung ◽  
Benjamin Yin Ming Kwan
Keyword(s):  
Medical Education ◽  
Postgraduate Medical Education ◽  
Assessment Process ◽  
Full Time ◽  
Equal Distribution ◽  
Competency Based Medical Education ◽  
Quantitative Evidence ◽  
Administrative Burden ◽  
Professional Activities ◽  
Competency Based

Purpose: Postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) system. Within this system, resident performance is documented through frequent assessments that provide continual feedback and guidance for resident progression. An area of concern is the perception by faculty of added administrative burden imposed by the frequent evaluations. This study investigated the time spent in the documentation and submission of required assessment forms through analysis of quantitative data from the Queen’s University Diagnostic Radiology program. Methods and Materials: Data regarding time taken to complete Entrustable Professional Activities (EPA) assessments was collected from 24 full-time and part-time radiologists over a period of 18 months. This data was analyzed using SPSS to determine mean time of completion by individuals, departments, and by experience with the assessment process. Results: The average time taken to complete an EPA assessment form was 3 minutes and 6 seconds. Assuming 3 completed EPA assessment forms per week for each resident (n = 12) and equal distribution among all staff, this averaged out to an additional 18 minutes of administrative burden per staff member over a 4 week block. Conclusions: This study investigated the perception by faculty of additional administrative burden for assessment in the CBME framework. The data provided quantitative evidence of administrative burden for the documentation and submission of assessments. The data indicated that the added administrative burden may be reasonable given mandate for CBME implementation and the advantages of adoption for postgraduate medical education.

scholarly journals Development of an integrated competency framework for postgraduate paediatric training: a Delphi study

2021 ◽  
Author(s):  
Marieke Robbrecht ◽  
Koen Norga ◽  
Myriam Van Winckel ◽  
Martin Valcke ◽  
Mieke Embo
Keyword(s):  
Delphi Study ◽  
Medical Training ◽  
Graduate Training ◽  
Postgraduate Education ◽  
Curriculum Planning ◽  
Working Environment ◽  
Competency Framework ◽  
Competency Based Education ◽  
Competency Frameworks ◽  
Competency Based

AbstractCompetency-based education (CBE) has transformed medical training during the last decades. In Flanders (Belgium), multiple competency frameworks are being used concurrently guiding paediatric postgraduate CBE. This study aimed to merge these frameworks into an integrated competency framework for postgraduate paediatric training. In a first phase, these frameworks were scrutinized and merged into one using the Canadian Medical Education Directives for Specialists (CanMEDS) framework as a comprehensive basis. Thereafter, the resulting unified competency framework was validated using a Delphi study with three consecutive rounds. All competencies (n = 95) were scored as relevant in the first round, and twelve competencies were adjusted in the second round. After the third round, all competencies were validated for inclusion. Nevertheless, differences in the setting in which a paediatrician may work make it difficult to apply a general framework, as not all competencies are equally relevant, applicable, or suitable for evaluation in every clinical setting. These challenges call for a clear description of the competencies to guide curriculum planning, and to provide a fitting workplace context and learning opportunities.Conclusion: A competency framework for paediatric post-graduate training was developed by combining three existing frameworks, and was validated through a Delphi study. This competency framework can be used in setting the goals for workplace learning during paediatric training. What is Known:•Benefits of competency-based education and its underlying competency frameworks have been described in the literature.•A single and comprehensive competency framework can facilitate training, assessment, and certification. What is New:•Three existing frameworks were merged into one integrated framework for paediatric postgraduate education, which was then adjusted and approved by an expert panel.•Differences in the working environment might explain how relevant a competency is perceived.

scholarly journals POSTGRADUATE MEDICAL EDUCATION IN UKRAINE

2020 ◽  
Vol 62 (2) ◽  
Author(s):  
George Kuzycz ◽  
Keyword(s):  
Medical Education ◽  
Medical Training ◽  
Postgraduate Medical Education ◽  
The United States ◽  
The State ◽  
Hospital Administrators ◽  
Postgraduate Medical Training ◽  
Fulbright Scholar ◽  
Informal Discussion

Discussion of observations and interviews as to the state of postgraduate medical education in Ukraine during an informal discussion of author’s time as a U.S. Fulbright Scholar for the 2018-2019 academic years for the project titled Postgraduate Medical Education In Ukraine. The interviews with interns (85); attendings, program directors, hospital administrators (75), several medical students and others were recorded during numerous author’s visits and observations (50) to various Ukrainian hospitals. The conclusions made herein are my own and serve to report my observations on the state and quality of postgraduate medical training in Ukraine, reference to that in the United States and the author’s over 45-year practice as a surgeon in Illinois. This mainly concerns internships in the surgical specialties and subspecialties. Some suggestions as to how to change the system are presented.

scholarly journals Could Entrustable Professional Activities mediate teaching-care integration services in the community?

2020 ◽  
Vol 69 (2) ◽  
Author(s):  
Ieda Francischetti ◽  
José Bitu Moreno ◽  
Harm Peters
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Primary Health Care ◽  
Medical Training ◽  
Entrustable Professional Activities ◽  
Professional Activities ◽  
Care Integration ◽  
Primary Health ◽  
Teaching Community ◽  
Competency Based

Currently, competency-based medical education (CBME) is the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transposition of the competency-based curriculum into physicians’ professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors’ experience in teaching community-based healthcare integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections made here allow suggesting that, although it is a challenging process, the adoption of EPA in undergraduate medical training is appropriate to achieve a better provision of primary health care to individuals, families, and communities in general.

scholarly journals National competency frameworks for medical graduates: Is it time for the “SudanMeds”?

2020 ◽  
pp. 20-34
Author(s):  
Ahmad AbdulAzeem Abdullah
Keyword(s):  
Medical Education ◽  
Medical Schools ◽  
Education Programs ◽  
Competency Based Medical Education ◽  
Medical Graduates ◽  
Competency Frameworks ◽  
Regulatory Bodies ◽  
Competency Based ◽  
Basic Medical Education ◽  
Basic Medical

Competency-based medical education has emerged recently as a novel model of medical training driven by its ability to reconcile the desired attributes in future physicians and address the overarching and demanding issues of the discipline in this century. The rising concerns of social accountability, patient safety, and cost effectiveness of medical education programs have contributed significantly to the popularity of this paradigm worldwide. This is translated in turn to the evolution of national competency frameworks for medical graduates that are increasingly implemented in different jurisdictions to standardize and ensure equivalent outcomes of medical curricula and readiness of their graduates to better serve their communities. Medical education in Sudan is deeply rooted in the history of the nation and the continent and is tinged with remarkable success and achievements. It is challenged nowadays with unprecedented expansion in basic medical education which may hinder the quality of medical schools’ programs and their graduates. This article explores the feasibility of one such framework in Sudan: the “SudanMeds” to ensure minimum standards and comparability of medical schools’ curricula and their outcomes across the Country. The framework would also arm the regulatory bodies with a tool for accreditation and recognition of basic medical education programs in Sudan and reflect quality assurance in their settings. Once this approach is deemed feasible, the contribution of all stakeholders from the highest top to the bottom – the government, the regulatory bodies, the public and civil organizations, and the medical schools’ community – is required to allow for creation, implementation, and follow-up of the “SudanMeds” framework. Keywords: Sudan, competency-based medical education, national competency frameworks, medical schools, basic medical education

scholarly journals An Updated Primer on Entrustable Professional Activities (EPAs)

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 712-720
Author(s):  
Olle ten Cate
Keyword(s):  
Undergraduate Students ◽  
Medical Training ◽  
Specific Activity ◽  
Two Dimensions ◽  
Entrustable Professional Activities ◽  
Turn Of The Millennium ◽  
Professional Activities ◽  
Competency Based ◽  
Almost All ◽  
Indirect Supervision

ABSTRACT Since the turn of the millennium, competency-based medical education (CBME) has become a new standard for medical training in many countries. CBME has been operationalized in detailed frameworks of competencies that every physician should demonstrate at graduation, and similar frameworks have been created for specialties. However, the competencies, describing qualities that physicians should possess, do not directly translate into everyday activities of physicians. For that reason, the Entrustable Professional Activities (EPAs) were introduced. EPAs are units of professional practice that may be entrusted to undergraduate students, once they show the competencies needed to perform them without supervision. EPAs have become a popular topic within CBME programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the strengths and weaknesses of EPAs. After a brief historical overview, the reason why EPAs are a bridge between a competency framework and daily clinical practice is explained. While competencies are qualities of individuals, EPAs are units of work. The two can be seen as two dimensions of a matrix, showing that almost all activities in health care are based on multiple competencies, such as communication skill, collaboration, professional behavior, content knowledge. Next, entrustment decision-making as a form of assessment is created and a framework of levels of supervision is presented. Entrustment decisions focus on the level of supervision a student requires for a specific activity, divided into five levels (1: allowed to observe; 2; allowed to perform under direct supervision; 3: allowed to perform under indirect supervision; 4: allowed to perform the activity unsupervised; 5: allowed to supervise the activity performed by more junior learners). For readers interested in applying the concept to practice, a stepwise approach to the curriculum development is proposed. The paper concludes with an overview of the state-of-the-art of working with EPAs across disciplines, professions and countries.

scholarly journals Identifying Entrustable Professional Activities in Internal Medicine Training

2013 ◽  
Vol 5 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Karen E. Hauer ◽  
Jeffrey Kohlwes ◽  
Patricia Cornett ◽  
Harry Hollander ◽  
Olle ten Cate ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Content Validity ◽  
Medical Training ◽  
Entrustable Professional Activities ◽  
Internal Medicine Training ◽  
Professional Activities ◽  
Delphi Approach ◽  
Validity Indices ◽  
Competency Based ◽  
Competency Based Assessment

Abstract Background Entrustable professional activities (EPAs) can form the foundation of competency-based assessment in medical training, focused on performance of discipline-specific core clinical activities. Objective To identify EPAs for the Internal Medicine (IM) Educational Milestones to operationalize competency-based assessment of residents using EPAs. Methods We used a modified Delphi approach to conduct a 2-step cross-sectional survey of IM educators at a 3-hospital IM residency program; residents also completed a survey. Participants rated the importance and appropriate year of training to reach competence for 30 proposed IM EPAs. Content validity indices identified essential EPAs. We conducted independent sample t tests to determine IM educator-resident agreement and calculated effect sizes. Finally, we determined the effect of different physician roles on ratings. Results Thirty-six IM educators participated; 22 completed both surveys. Twelve residents participated. Seventeen EPAs had a content validity index of 100%; 10 additional EPAs exceeded 80%. Educators and residents rated the importance of 27 of 30 EPAs similarly. Residents felt that 10 EPAs could be met at least 1 year earlier than educators had specified. Conclusions Internal medicine educators had a stable opinion of EPAs developed through this study, and residents generally agreed. Using this approach, programs could identify EPAs for resident evaluation, building on the initial list created via our study.

scholarly journals Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027577
Author(s):  
Nader Al-Shakarchi ◽  
Lucy Obolensky ◽  
Sarah Walpole ◽  
Harry Hemingway ◽  
Amitava Banerjee
Keyword(s):  
Content Analysis ◽  
Global Health ◽  
Scoping Review ◽  
Medical Training ◽  
Postgraduate Medical Education ◽  
Core Competencies ◽  
Competency Framework ◽  
Postgraduate Medical Training ◽  
Curricular Content ◽  
Competency Frameworks

ObjectiveTo assess global health (GH) training in all postgraduate medical education in the UK.DesignMixed methodology: scoping review and curricular content analysis using two GH competency frameworks.Setting and participantsA scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded.OutcomesThe scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded.ResultsUsing the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum.ConclusionsEquity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.

An Environmental Scan of the National and Provincial Diagnostic Reference Levels in Canada for Common Adult Computed Tomography Scans

2019 ◽  
Vol 70 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Michelle Linda Ferderbar ◽  
Thomas E. Doyle ◽  
Reza Samavi ◽  
David Koff
Keyword(s):  
Computed Tomography ◽  
Threshold Model ◽  
The United States ◽  
Reference Level ◽  
Low Dose Radiation ◽  
The United Kingdom ◽  
Dose Monitoring ◽  
Course Of Action ◽  
Regulatory Bodies ◽  
Dose Radiation

Several regulatory bodies have agreed that low-dose radiation used in medical imaging is a weak carcinogen that follows a linear, non-threshold model of cancer risk. While avoiding radiation is the best course of action to mitigate risk, computed tomography (CT) scans are often critical for diagnosis. In addition to the as low as reasonably achievable principle, a more concrete method of dose reduction for common CT imaging exams is the use of a diagnostic reference level (DRL). This paper examines Canada's national DRL values from the recent CT survey and compares it to published provincial DRLs as well as the DRLs in the United Kingdom and the United States of America for the 3 most common CT exams: head, chest, and abdomen/pelvis. Canada compares well on the international scale, but it should consider using more electronic dose monitoring solutions to create a culture of dose optimization.

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