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Queen’s set to lead the country in transition to competency-based medical education

On this auspicious occasion of our CBME launch, I have invited Dr. Damon Dagnone to write a guest blog. I would like to thank Damon for his extraordinary efforts as Queen’s CBME Lead.

At the start of every summer, we welcome around 130 post-graduate medical students to Queen’s University to begin their residency programs. Orientation day, which kicks off this important chapter in their careers, is particularly exciting and a bit nerve-racking for the group. But this year, it might just be the PGME faculty and staff who are feeling that way. For them, July 1st represents a new beginning at Queen’s, and an opportunity to lead the rest of the country in transforming medical education.

As Canada celebrates its 150th anniversary, Queen’s will officially launch competency-based medical education (CBME) across all 29 of its specialty programs. To be fair, we are following the lead set by Family Medicine in successfully implementing their “Triple C” competency-based curriculum more than five years ago. But at Queen’s, we have embraced the Royal College of Physician & Surgeons of Canada’s (RCPSC) Competency by Design (CBD) Project wholeheartedly. While the rest of medical schools in Canada are implementing CBME over the next five years, we committed ourselves to an accelerated institutional path back in 2015, and are now in a remarkable position to be at the leading edge of the needed transformative changes in how we train doctors in Canada.

It might sound difficult to justify investing so much institutional time, energy, and resources to transforming all of our specialty programs into CBME curriculums given that we have trained excellent doctors for years. Yet a number of factors have shown us that a change was necessary: current systems of medical training cannot keep up with our rapidly changing world of technology; there is an ever-expanding body of medical knowledge; important and essential patient safety initiatives have been developed; there has been a reduction in duty hours and the renewed focus on trainee wellness; and our learners have a growing set of advanced needs.  The traditional blueprint for medical education, first introduced by the Flexner Report in 1910, needs urgent transformative change.

Leveraging the teaching and learning methods, tools, relationships, and passion we collectively share as learners and educators within our School of Medicine, we have spent the last two years designing a path for 29 programs at Queen’s. We have done this by supporting each other in this institutional change process, and in so doing, strengthened and expanded the community of education leaders that values principles such as a shared aspirational vision, co-production, responsive leadership, the diffusion of innovation, and a systems-based approach to transformative change.

From my point of view, as the CBME Faculty Lead for PGME, our readiness for launch on July 1st is thanks to many stakeholder groups. First and foremost, the vision, expertise, and strategic approach by the Faculty of Health Sciences decanal leadership cannot be understated. Next, the creation of a central CBME executive team, comprised of key leaders from within postgraduate medical education and the Faculty of Health Sciences, was essential to keeping us on track. The executive’s decision to take a systems approach for this institutional change has also been critical to our success in providing central support to all of our 29 programs.

At the program level, 29 program leadership teams have been created and they have done a fantastic job. Each team has had four fundamental tasks to complete over the last two years: perform a critical review and implement a reform of their curriculum; implement new concepts such as entrustable professional activities (EPAs), milestones, and competencies into their training programs; perform a critical review of their assessment methods that would result in the redesign of a comprehensive program of assessment; and identify education champions within their program to become academic advisors (“coaches”) to trainees and competence committee members, who will guide decisions for promotion.

There are many other stakeholder groups that have joined us on our journey, and we couldn’t have done this important work without their partnership. This includes our many CBME sub-committee members, our hospital partners in Kingston and at distributed sites, our frontline faculty, our current resident trainees, patient advisors and community members, and – last but certainly not least – the RCPSC executive leadership. Each group has been influential in the co-production and evolution of this transformative project. Moving forward, we will continue to nurture these ongoing partnerships to assist us in the implementation process. To them, and to all others that have assisted us thus far, I would like to say a very big “thank you”.

Looking ahead to July 1st, after over two years of preparation, we’re excited to be ready – but this is just the starting line. We are going to need a lot of ongoing communication and continued hard work to make sure our accelerated institutional path to CBME is a success.

As well, there are many questions to be answered as we start our CBME transformation. How will we know we’re implementing CBME as intended? How will we measure the benefits, risks, and unintended consequences of this innovation? And how will we adapt to unexpected challenges? It is imperative that we accumulate evidence of the impact of CBME and continue to approach implementation as an iterative process that’s committed to quality improvement, program evaluation, and improved outcomes for our trainees and the patients we provide care for.

Congratulations again to everyone for helping us get here. We’re ready to launch CBME across our 29 specialty programs at Queen’s and I’m excited for the next part of our journey together.

Signed (a proud Queen’s faculty member),

Damon Dagnone

CBME Faculty Lead, Special Assistant to the Associate Dean

Postgraduate Medical Education, Queen’s University

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