Competency Based Medical Education at Queen’s: Change FOR us, BY Us
Guest blog by Dr. Jena Hall, PGY 2/CIP Obstetrics and Gynecology, on behalf of the CBME Resident Subcommittee
For some time, there has been a buzz around Competency Based Medical Education (CBME) at Queen’s – that it’s coming soon, it means more assessment, and potentially shorter residencies? … Let’s look at the facts.
CBME will be implemented across Canada by 2021 on slightly differing schedules depending on specialties. The Royal College (RC) granted Queen’s a ‘fast track’ implementation (i.e. all of our programs are implementing CBME at the same time). On July 1 2017, all incoming Queen’s residents will begin their residencies in CBME curricula. Although current Queen’s residents will remain in standard curricular models, we can contribute to CBME related changes and take advantage of improved assessment practices as they roll out.
CBME does not mean residencies will be shorter, as the RC version of CBME is a hybrid model using competency and time. However, residents who excel in CBME models may have opportunity to pursue more electives. Alternatively, residents requiring more time in one area will be identified earlier and enhanced learning plans will be tailored to meet their learning needs, with the goal of avoiding formal remediation.
So why can we not just change the way we assess residents without such an overhaul? The reason is, CBME is more than just better assessment. CBME is an entire paradigm shift to rethink the way we teach and learn modern medicine. It moves the focus of residency curricula away from short term, rotation based objectives and towards long term residency outcomes. This reform stems from a societal need for increased accountability and quality improvement in medicine; a need to redesign residency training to meet the standards of modern health care systems.
For residents, incoming and current, there are a number of perks that come with CBME. First, clinical rotations and formal teaching sessions (academic half day, grand rounds, etc.) will have clear and specific objectives, with actionable steps for improvement in performance along a continuum towards achieving the ‘competent’ or ‘entrustable’ level. You may be asking, “What is wrong with the objectives we have now?”. Nothing… except that they are often vague, reflect only the highest level of performance, and provide no information about how to improve.
For example, performance of a caesarean section may be a procedural objective for both a junior and senior obstetrics (OB) rotation. A junior OB resident will not perform a C-section at the same performance level as a senior resident. They will likely need more support and only do certain portions of that procedure. Does this mean that the junior resident ‘fails’ to achieve that objective? Or, does it mean that they are successfully performing the activity for their level of development, but ‘not yet achieving’ competence? CBME helps make that transition from ‘failure’ to ‘not yet achieved’ while providing specific descriptions of observable behaviours at each performance level. These descriptions provide concrete stepping-stones for residents to strive towards.
Second, with increased direct observation, comes more specific and timely feedback. How often has resident feedback read, “no concerns”, “read more”, or “solid resident”? It is not easy to give specific, helpful feedback, particularly since most physicians get little, if any, training in how to do so. Those qualitative performance stepping-stones I described above will also help here. They will provide supervising physicians with better descriptions of performance at different levels, and help cue more specific feedback.
With all of this said, there will be challenges that come with this change. As assessment practices change, adjustments will be required. As training objectives change, rotations will require modification, and the results of all of this are yet unknown. It will take time to adjust to this paradigm shift involving more direct observation, more frequent and specific assessment, and learning driven by residents and faculty together. This will all take time, calculated trials, and open-mindedness. But, while it is new in practice, CBME is supported by substantial literature grounded in educational theory, unlike our current model for residency education.
I am excited to be a resident entering this era of educational reform. I am also realistically aware that with change come many challenges, which residents, faculty, and administrators will have to work together to overcome. The accelerated CBME integration at Queen’s means that we, as residents, now more than ever, have an incredible opportunity to be involved in the improvement of Canadian and international residency education. This is change for us, by us.
Join the discussion!
CBME Town Hall
Dr. Richard Reznick and the CBME Executive Team invite you to share your perspective and ask questions regarding CBME transition at Queen’s via an open-dialogue format
November 14th, 4:30pm to 5:30pm, SOM Lecture Hall 132A
Everyone welcome to attend.