scholarly journals Black Ice: ways to get a grip on resident co-production within medical education change

2020 ◽  
Author(s):  
Jeffery D. Dagnone ◽  
Samantha Buttemer ◽  
Jena Hall ◽  
Liora Berger ◽  
Kristen Weersink
Keyword(s):  
Medical Education ◽  
Postgraduate Training ◽  
Postgraduate Medical Education ◽  
Change Leadership ◽  
Successful Implementation ◽  
Competency Based Medical Education ◽  
Education Change ◽  
Competency Based ◽  
Queen's University ◽  
National Approach

The Royal College of Physicians and Surgeons of Canada (RCPSC) is transforming its national approach to postgraduate medical education by transitioning all specialty programs to competency based medical education (CBME) curriculums over a seven-year period. Queen’s University, with special permission from the RCPSC, launched CBME curricula for all incoming residents across its 29 specialty programs in July 2017. Resident engagement, empowerment, and co-production through this transition has been instrumental in successful implementation of CBME at Queen’s University. This article aims to use our own experience at Queen’s in the context of current literature and rooted in change leadership theory, to provide a guide for educators, learners, and institutions on how to leverage the interest and enthusiasm of trainees in the transition to CBME in postgraduate training. The following ten tips provides a model for avoiding the “black ice” type pitfalls that can arise with learner involvement, and ensure a smoother transition for other institutions moving forward with CBME implementation.

Resident evaluations in the age of competency-based medical education: faculty perspectives on minimizing burdens

2020 ◽  
pp. 1-6
Author(s):  
Jessica E. Rabski ◽  
Ashirbani Saha ◽  
Michael D. Cusimano
Keyword(s):  
Medical Education ◽  
Mobile Application ◽  
Postgraduate Medical Education ◽  
Professional Activity ◽  
Successful Implementation ◽  
Neurosurgical Training ◽  
Complete Evaluation ◽  
Competency Based Medical Education ◽  
Main Challenge ◽  
Competency Based

OBJECTIVECompetency-based medical education (CBME), an outcomes-based approach to medical education, continues to be implemented across many postgraduate medical education programs worldwide, including a recent introduction into Canadian neurosurgical training programs (July 2019). The success of this educational paradigm shift requires frequent faculty observation and evaluation of residents performing defined tasks of the specialty. A main challenge involves providing residents with frequent performance evaluations and feedback that are feasible for faculty to complete. This study aims to define what is currently happening and what changes are needed to make CBME successful for the certification of neurosurgeons’ competence.METHODSA 55-item questionnaire was emailed nationwide to survey Canadian neurosurgical faculty.RESULTSFifty-two complete responses were received and achieved a distribution highly correlated with the number of faculty neurosurgeons practicing in each Canadian province (Pearson’s r = 0.94). Two-thirds (35/52) of faculty reported currently taking a median of 10 minutes to complete evaluation forms at the end of a resident’s rotation block. Regardless of the faculty’s province of practice (p = 0.50) or years of experience (p = 0.06), they reported 3 minutes (minimum 1 minute, maximum 10 minutes, interquartile range [IQR] 3 minutes) as a feasible amount of time to spend completing an evaluation form following an observation of a resident’s performance of an entrustable professional activity (EPA). If evaluation forms took 3 minutes to complete, 85% of respondents (44/52) would complete EPA evaluations weekly or daily. The faculty recommended 5 minutes as a feasible amount of time to provide oral feedback (minimum 1 minute, maximum 20 minutes, IQR 3.25 minutes), which was significantly higher (p = 0.00099) than their recommended amount of time for completing evaluation forms. The majority of faculty (71%) stated they would prefer to access resident evaluation forms through a mobile application compared to a paper form (12%), an evaluation website (8%), or through a URL link sent via email (10%; p = 0.0032).CONCLUSIONSTo facilitate the successful implementation of CBME into a neurosurgical training curriculum, resident EPA assessment forms should take 3 minutes or less to complete and be accessible through a mobile application.

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

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.

Competency-based medical education in postgraduate medical education

2010 ◽  
Vol 32 (8) ◽  
pp. 651-656 ◽  
Author(s):  
William F. Iobst ◽  
Jonathan Sherbino ◽  
Olle Ten Cate ◽  
Denyse L. Richardson ◽  
Deepak Dath ◽  
...  
Keyword(s):  
Medical Education ◽  
Postgraduate Medical Education ◽  
Competency Based Medical Education ◽  
Competency Based

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 Towards a shared mental model of progressive competence in postgraduate medical education

2018 ◽  
Vol 9 (3) ◽  
pp. e115-118
Author(s):  
Eric Prost
Keyword(s):  
Medical Education ◽  
Mental Model ◽  
Postgraduate Medical Education ◽  
Competency Based Medical Education ◽  
Shared Mental Model ◽  
Competency Based ◽  
The Military ◽  
Postgraduate Medicine

Many professions have hierarchies and a promotion structure. Postgraduate medicine has a tradition of promoting residents based on time spent in a certain specialty. The military, too, may promote its personnel based on factors other than just merit. Both professions have been criticized for divorcing competence from promotion. While Competency-Based Medical Education (CBME) partly solves this problem in medicine, many models of CBME, including the Canadian one, retain distinct stages of training. We urgently need a shared mental model of what a learner in each stage looks like. Some models have been proposed but fall short.

scholarly journals Challenges of implementing competency-based medical education postgraduate training programs: the issue of context

2021 ◽  
Vol 46 (4) ◽  
Author(s):  
Marcio Gomes ◽  
Linda Snell
Keyword(s):  
Medical Education ◽  
Curriculum Development ◽  
Professional Training ◽  
Postgraduate Training ◽  
Local Context ◽  
Dynamic Nature ◽  
Competency Based Medical Education ◽  
Research Curriculum ◽  
Core Components ◽  
Competency Based

Introduction: Competency-based medical education (CBME) is being adopted worldwide. The aim of this paper is to discuss the evolution of CBME and address some perceived challenges in CBME curriculum development and implementation in postgraduate (residency) medical education. Methods: This is an opinion paper based on lived experiences and personal beliefs. The authors have professional training in medical education and are actively involved in CBME research, curriculum development and implementation around the world. Results: The issue of local and system-wide context seems to be of particular importance to individuals, programs, institutions, governing bodies and other stakeholders involved in the development and implementation of CBME programs. CBME has evolved differently at different places, and there are concerns regarding the fidelity of implementation. Stakeholders have been dealing with challenging questions in their CBME journeys, which reflect the varied, complex and dynamic nature of health and education systems. Recently, scholars have established core components of any CBME program. Discussion and conclusions: CBME design should benefit from ground-up strategies that consider the local context. It is essential to approach implementation with a quality improvement lens and pay special attention to the fidelity and integrity of the core CBME components.

scholarly journals From prescription to guidance: a European framework for generic competencies

2019 ◽  
Vol 25 (1) ◽  
pp. 173-187 ◽  
Author(s):  
Jessica E. van der Aa ◽  
Anna J. M. Aabakke ◽  
Betina Ristorp Andersen ◽  
Annette Settnes ◽  
Peter Hornnes ◽  
...  
Keyword(s):  
Medical Education ◽  
Change Management ◽  
Postgraduate Medical Education ◽  
Competency Framework ◽  
Competency Based Medical Education ◽  
Generic Competencies ◽  
Obstetrics And Gynaecology ◽  
Competency Based ◽  
Hospital Boards ◽  
Management Theories

Abstract In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: ‘Patient-centred care’, ‘Teamwork’, ‘System-based practice’ and ‘Personal and professional development’. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.

Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen’s Fundamental Innovations in Residency Education)—Part 1: Transition to Discipline and Foundation of Discipline Stages

2020 ◽  
pp. 084653711989472 ◽  
Author(s):  
Benjamin Yin Ming Kwan ◽  
Achire Mbanwi ◽  
Nicholas Cofie ◽  
Christina Rogoza ◽  
Omar Islam ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Training ◽  
Residency Education ◽  
Diagnostic Radiology ◽  
Radiology Department ◽  
Competency Based Medical Education ◽  
Postgraduate Medical Training ◽  
Radiology Residency ◽  
Competency Based ◽  
Queen's University

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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