Changing the culture of medical training: An important step toward the implementation of competency-based medical education

Purpose: The Royal College of Physicians and Surgeons of Canada (RCPSC) has mandated the transition of postgraduate medical training in Canada to a competency-based medical education (CBME) model divided into 4 stages of training. As part of the Queen’s University Fundamental Innovations in Residency Education proposal, Queen’s University in Canada is the first institution to transition all of its residency programs simultaneously to this model, including Diagnostic Radiology. The objective of this report is to describe the Queen’s Diagnostic Radiology Residency Program’s implementation of a CBME curriculum. Methods: At Queen’s University, the novel curriculum was developed using the RCPSC’s competency continuum and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones. In addition, new committees and assessment strategies were established. As of July 2015, 3 cohorts of residents (n = 9) have been enrolled in this new curriculum. Results: EPAs, milestones, and methods of evaluation for the Transition to Discipline and Foundations of Discipline stages, as well as the opportunities and challenges associated with the implementation of a competency-based curriculum in a Diagnostic Radiology Residency Program, are described. Challenges include the increased frequency of resident assessments, establishing stage-specific learner expectations, and the creation of volumetric guidelines for case reporting and procedures. Conclusions: Development of a novel CBME curriculum requires significant resources and dedicated administrative time within an academic Radiology department. This article highlights challenges and provides guidance for this process.

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Assessing competency using simulation: the SimZones approach

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2019-000480 ◽

2019 ◽

Vol 6 (5) ◽

pp. 262-267

Author(s):

Christopher Roussin ◽

Taylor Sawyer ◽

Peter Weinstock

Keyword(s):

Medical Education ◽

Medical Training ◽

System Development ◽

Real Life ◽

Competency Assessment ◽

Competency Based Medical Education ◽

Simulation Based ◽

Competency Based ◽

The Many ◽

Structured Approach

IntroductionCompetency-based medical education (CBME) is a system of medical training that focuses on a structured approach to developing the clinical abilities of medical education graduates and practicing physicians. CBME requires a robust and multifaceted system of assessment in order to both measure and guide the progress of learners toward pre-established goals. Simulation has been proposed as one method for assessing competency in healthcare workers. However, a longitudinal framework for assessing competency using simulation has not been developed.MethodsConjecture mapping methodology was used to map Miller’s framework for competency assessment—‘knows’, ‘knows how’, ‘shows how’, and ‘does’—to the five SimZones described by Roussin and Weinstock. The SimZones describe a system of organising the development and delivery of simulation-based education and offer a foundation for both guiding and organising assessment in a simulation context.ResultsA conceptualised alignment of the SimZones with Miller’s pyramid of assessment was developed, as well as a detailed conjecture map. SimZone 0 (auto-feedback) and SimZone 1 (foundational instruction) mapped to ‘knows’ and ‘knows how’. SimZone 2 (acute care instruction) mapped to ‘shows how’. SimZone 3 (team and system development) mapped to ‘shows how’. SimZone 4 (real-life debriefing and development) mapped to ‘does’.ConclusionThe SimZones system of competency assessment offers a robust, flexible, and multifaceted system to guide both formative and summative assessment in CBME. The SimZones approach adds to the many methods of competency assessment available to educators. Adding SimZones to the vocabulary of CBME may be helpful for the full deployment of CBME.

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Ten ways to get a grip on designing and implementing a competency-based medical education training program

Canadian Medical Education Journal ◽

10.36834/cmej.70723 ◽

2021 ◽

Author(s):

Tina Hsu ◽

Flavia De Angelis ◽

Sohaib Al-asaaed ◽

Sanraj K. Basi ◽

Anna Tomiak ◽

...

Keyword(s):

Medical Education ◽

Medical Training ◽

Training System ◽

Successful Implementation ◽

Competency Based Medical Education ◽

Design Elements ◽

Program Administrator ◽

Professional Activities ◽

Key Stakeholders ◽

Competency Based

Background: Globally there is a move to adopt competency-based medical education (CBME) at all levels of the medical training system. Implementation of a complex intervention such as CBME represents a marked paradigm shift involving multiple stakeholders. Methods: This article aims to share tips, based on review of the available literature and the authors’ experiences, that may help educators implementing CBME to more easily navigate this major undertaking and avoid “black ice” pitfalls that educators may encounter. Results: Careful planning prior to, during and post implementation will help programs transition successfully to CBME. Involvement of key stakeholders, such as trainees, teaching faculty, residency training committee members, and the program administrator, prior to and throughout implementation of CBME is critical. Careful and selective choice of key design elements including Entrustable Professional Activities, assessments and appropriate use of direct observation will enhance successful uptake of CBME. Pilot testing may help engage faculty and learners and identify logistical issues that may hinder implementation. Academic advisors, use of curriculum maps, and identifying and leveraging local resources may help facilitate implementation. Planned evaluation of CBME is important to ensure choices made during the design and implementation of CBME result in the desired outcomes. Conclusion: Although the transition to CBME is challenging, successful implementation can be facilitated by careful design and strategic planning.

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Competency based medical education in gastrointestinal motility

Neurogastroenterology & Motility ◽

10.1111/nmo.12835 ◽

2016 ◽

Vol 28 (10) ◽

pp. 1460-1464 ◽

Cited By ~ 14

Author(s):

R. Yadlapati ◽

R. N. Keswani ◽

J. E. Pandolfino

Keyword(s):

Medical Education ◽

Gastrointestinal Motility ◽

Competency Based Medical Education ◽

Competency Based

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Competency on Call: Resident Driven Learning Objectives for Competency-Based Medical Education

Academic Psychiatry ◽

10.1007/s40596-019-01178-9 ◽

2020 ◽

Vol 44 (6) ◽

pp. 812-813 ◽

Cited By ~ 1

Author(s):

Bruce Fage ◽

Tracy Alldred ◽

Sarah Levitt ◽

Amanda Abate ◽

Mark Fefergrad

Keyword(s):

Medical Education ◽

Learning Objectives ◽

Competency Based Medical Education ◽

Competency Based

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Implementing competency-based medical education: Moving forward

Medical Teacher ◽

10.1080/0142159x.2017.1315069 ◽

2017 ◽

Vol 39 (6) ◽

pp. 568-573 ◽

Cited By ~ 49

Author(s):

Jason R. Frank ◽

Linda Snell ◽

Robert Englander ◽

Eric S. Holmboe ◽

Keyword(s):

Medical Education ◽

Competency Based Medical Education ◽

Competency Based

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Blueprint for summative theory assessment in pharmacology - A tool to increase the validity as per the new competency based medical education

National Journal of Physiology Pharmacy and Pharmacology ◽

10.5455/njppp.2021.11.06170202107072021 ◽

2021 ◽

pp. 1

Author(s):

Meenu Pichholiya ◽

Arvind Yadav ◽

Sangita Gupta ◽

Sandeep Kamlekar ◽

Sakshi Singh

Keyword(s):

Medical Education ◽

Competency Based Medical Education ◽

Competency Based

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Postgraduate medical education: The history and development of competency-based training program in Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i1.36243 ◽

2021 ◽

Vol 8 (1) ◽

pp. 102-112

Author(s):

Jay Narayan Shah ◽

Jenifei Shah ◽

Jesifei Shah ◽

Ashis Shrestha ◽

Nabees Man Singh Pradhan

Keyword(s):

Medical Education ◽

Healthcare System ◽

Postgraduate Training ◽

Core Competencies ◽

Health Sciences ◽

Medical Council ◽

Competency Based Medical Education ◽

Surgical Workforce ◽

Competency Based ◽

Medical Colleges

Nepal is a small, lower-middle-income country; with a population of around 30 million. As per WHO, Nepal has a low doctor-patient ratio (0.7/1000) and even lower specialists (e.g., surgical) workforce (0.003/1000); additionally, data from Nepal Medical Council show the number of postgraduate specialists is 1/3rd of the total registered doctors. The mismatch in the doctor-patient ratio is further aggravated by the overwhelming number of doctors in urban areas; when 80% of the population are in rural Nepal. This inequitable discrepancy in the healthcare system requires: proper training of competent medical graduates, a fair distribution across the country, and effective changes in the healthcare system. Competency-based medical education plays an important role in: standardizing education, training competent doctors, and deploying them where they are needed the most. The Government of Nepal has recently established Medical Education Commission-which plans to oversee the entrance exams; and expand the postgraduate training to be conducted by private hospitals, previously not affiliated with any medical colleges or universities. Historically, Civil Medical School started training compounders and dressers in Nepal in 1934. A big milestone was achieved with the establishment of the Institute of Medicine under Tribhuvan University in 1972, which has continued to train all categories of health manpower needed in the country. In 2006 Nepal Medical Council developed “Regulations for Post-graduate Medical education”. Thereafter, several institutions started providing postgraduate training, for example: the BP Koirala Institute of Health Sciences, Kathmandu University, National Academy of Medical Sciences, and Patan Academy of Health Sciences (PAHS). The PAHS conducts PG programs and post-PG fellowships in line with competency-based medical education. In addition to formative assessments, research thesis, and a publishable article; PAHS requires its trainees to be certified in a pre-set of entrustable professional activities (EPAs) and to master eight Core Competencies domains in: Professionalism, Patient-centered care, Procedural skills, Clinical Reasoning, Communication, Scholarship, Leadership, Community orientation. The number of medical colleges in Nepal has since expanded to 24 (medical 21 and dental colleges 3). Private medical colleges make up about 3/4th of the total medical colleges in Nepal. This makes the inclusion and regulation of more components of the competency-based curriculum in postgraduate training programs, and its monitoring, somewhat of a challenge.

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