CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

THIS MONTH’S HEADLINES


Royal College CEO commits to an iterative and collaborative approach to CBD

As we get closer to July 2016 (when our first adopting disciplines will go live), and Competence by Design (CBD) becomes increasingly “real”, I want to reiterate our commitment to the foundational principles of CBD implementation.


Ensuring quality patient care through programmatic assessment

How will CBD change assessment to bring us closer to our goal of improving excellence in medical training and practice and enhancing patient care? Find out.


Answering your assessment questions: Video

Dr. Farhan Bhanji, MHPE, FRCPC explains assessment within a CBD world.


First steps towards refining the residency accreditation system

Recognizing the opportunity to improve the system, and responding to calls for transformation, the Royal College, the College of Family Physicians of Canada and the Collège des médecins du Québec partnered to develop a proposal to re-engineer residency accreditation.


Seeing CanMEDS differently – learn how it fits into your practice: Video

Dr. Kevin Imrie, FRCPC, FACP, President of the Royal College reflects on the importance of the CanMEDS Framework and shares how he uses CanMEDS as an educator and as a practicing physician.


CBD progress and what’s next

Here’s a look at some of the work we’ve done and an idea of the steps we’re about to take.



Share your experiences: Online poll

CBD aims to embed authentic assessment practices into day-to-day training. But we want to learn from your experiences. What’s the most valuable feedback or assessment you have ever received?


Continuing the conversation

Over the past two years, we’ve reached out to a number of organizations and individuals to begin CBD discussions. These conversations were just the beginning.


Tools and resources

Looking for tools and resources? Check out our updated CBD Resources page for a variety of informational documents and videos.


Want the latest information on Competence by Design (CBD)?
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CBD Community Touchpoint – for printing



Vol. 1, No. 2 — October 2015


 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Making sure we’re on the right track

Dear colleagues,

Andrew Padmos, BA, MD, FRCPC, FACP, Chief Executive Officer

When work on Competence by Design (CBD) first began, the Royal College committed to a number of foundational principles for implementation. These include:

As we get closer to July 2016 (when our first CBD adopting disciplines will go live), and CBD becomes increasingly “real”, I want to reiterate this commitment.

There is no “one size fits all” approach to CBD implementation. We understand that each program and faculty has its own unique challenges, opportunities and timeframe. CBD is an iterative and adaptive process. And as we approach July 2016, we will continue to work with our early adopters and you, our partners, to validate our implementation approach, ensure it works for each specific context – and adjust and refine as needed.

The shift to competency-based medical education is a learning experience for us all. By working and learning together we can improve our implementation process and develop a truly responsive and flexible education system which works across the country. I encourage you to help us hold true to our principles by proving regular information on our implementation process.

If you have any questions or you would like to discuss any aspect of CBD, please contact me at cbd@royalcollege.ca.

Yours Sincerely,

Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Ensuring quality patient care through programmatic assessment

John Wu, MD, FRCPC, at the B.C. Children's Hospital in Vancouver, B.C.

Canada is respected the world over for the quality of its specialty medical education. The excellence of our physicians is an accomplishment that all health care partners can share in and celebrate.

Patients trust us to train competent doctors and maintain those standards throughout physicians’ careers. The better we educate residents and support practising physicians in maintaining their competence, the more we support our overarching goal of providing better health for Canadians.

Assessment is a key element in our success. It touches all aspects of training and practice – from the accreditation of medical universities and the training of residents in specialty programs, to the continuing education of practising physicians, who are responsible for maintaining their competence throughout their careers.

By enhancing assessment practices through building a whole program of assessment, we can increase the amount and authenticity of the feedback given to residents and better support their performance improvements. We can also give residents the self-assessment skills that will benefit them and their patients throughout their careers. And finally, responding to the trust placed in us by the public, we can create a system which more openly demonstrates the excellent education standards of our physicians.

The question, then, is: How will CBD change assessment to bring us closer to our goal of improving excellence in medical training and practice and enhancing patient care?


Workplace-based assessment in residency to build lifelong competence

CBD will help physicians demonstrate their competence and the quality of care that they provide to patients by integrating a programmatic model of workplace-based assessment into residency. This means that, rather than our current approach of focusing predominantly on a resident’s results and competence at the end of training, CBD will embed continuous assessment into each program. It will do this by integrating competency milestones and Entrustable Professional Activities (EPAs) into each stage of training and assessment.


Milestones (M)

Competency milestones are observable markers of an individual’s ability.

Entrustable Professional Activities (EPAs)

EPAs are clinical tasks that a resident’s supervisor delegates once the physician has demonstrated sufficient competency. Typically, each EPA encompasses a number of milestones.


As they adopt CBD, the Specialty Committee members, program directors and other trusted peers of the discipline will develop discipline-specific EPAs and milestones for each stage of training. Residents will progress to the next stage of training when they successfully demonstrate they have achieved the various EPAs within their current stage. Supervisors will use the EPAs to perform regular, discrete assessments throughout each stage. The targeted-nature of the EPAs will foster the delivery of authentic and concrete feedback and the regularity of the assessment will also allow educators to support struggling residents earlier and support all trainees by giving them the feedback they need to improve their performance

Taken together, milestones and EPAs will layout a clear learning plan for residents and clear teaching and assessment goals for educators. Overall, this approach will increase the number of assessments within residency; however, it will also increase the amount of valuable, practical and demonstrable data we can use to evaluate the competence of our learners and ensure they are delivering quality patient care.


A shifting focus for the exam

The continuous cycle of in-training assessment shifts the focus of the exam slightly by requiring programs to involve a greater amount of in-training assessment. The purpose of this change is not to devalue the examination; rather, it is to place a greater emphasis on clinical performance as a valuable learning and assessment opportunity.

“Competency-based medical education will make our evaluation better. It’s going to make it easier to identify and have conversations with residents around their performance…[It] is going to take away the personal, subjective aspect of evaluation and make it more objective.”

Erin D. Wright, MDCM, MEd, FRCSC, member of the Royal College Specialty Committee in Otolaryngology – Head and Neck Surgery and professor, Department of Surgery, University of Alberta

Under CBD, the exam will continue to be a major program milestone. As residents move closer to the exam date, a cycle of continuous feedback and input will be embedded into their program to ensure they are well prepared.

However, the timing of the exam will move to earlier in a resident’s training – most likely at the end of the Core of Discipline stage. This will ensure trainees are not solely focused on textbooks in their final year. Instead, the program will place a greater emphasis on increasingly independent work and skills, enabling residents to use their final year to hone their skills in anticipation of independent practice.

As CBD moves forward, we will work with our partners to test and refine the assessment practices. Together, we will develop a model of assessment which produces confident and competent graduates without overwhelming the system or the faculty.

To learn more about assessment within CBD, watch the Q&A videos with Dr. Farhan Bhanji, MHPE, FRCPC.

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Answering your assessment questions: Video

Dr. Farhan Bhanji, MHPE, FRCPC explains assessment within a CBD world.

Did we miss a question? Let us know at cbd@royalcollege.ca.

How will assessment work in Competence by Design?

Watch 'How will assessment work in Competence by Design?' by Dr. Farhan Bhanji, MHPE, FRCPC

 

What is workplace-based assessment?

Watch 'What is workplace-based assessment?' by Dr. Farhan Bhanji, MHPE, FRCPC

 

What does this mean for the Program Directors?

Watch 'What does this mean for the Program Directors?' by Dr. Farhan Bhanji, MHPE, FRCPC

 

What does this mean for patients?

Watch 'What does this mean for patients?' by Dr. Farhan Bhanji, MHPE, FRCPC

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

First steps towards refining the residency accreditation system

Colin Pearce, MD, FRCPC, at the Royal University Hospital in Saskatoon, Sask.

In 2013, the Royal College, the College of Family Physicians of Canada and the Collège des médecins du Québec partnered to undertake the first redesign of Canada’s residency education accreditation system in 20 years.

This review, along with other activities, built upon strengths in the current system and aimed to address a number of challenges. The challenges include standards that would benefit from greater clarity and emphasis on outcomes, labour-intensive processes that are still paper-based, and opportunities to improve consistency and reproducibility of decision-making from program to program, to name a few.

Recognizing the opportunity to improve the system, and responding to calls for transformation, the three colleges have developed a proposal to redesign residency accreditation. The aim is to align accreditation with 21st century care needs and support the shift to a competency-based model of education delivery.


A proposal based on feedback

Since then, the three colleges have worked together to explore opportunities and new directions in the development of new conjoint standards and processes for residency education that reflect a rigorous, balanced accreditation system.

The proposal preserves the strengths of the current system, in particular an adherence to national standards across all programs and universities to ensure competent graduates ready to enter independent practice and promote excellence in care delivery through lifelong learning throughout practice.

In particular, the new accreditation system will feature:


Planned and iterative implementation

In response to feedback from stakeholders and recognizing the challenges that are inherent in transiting to a new accreditation system, the three colleges are developing an implementation plan that emphasizes phasing-in of the new system over multiple years, with opportunities for testing and refinement prior to large scale implementation. Accordingly, the three colleges will ensure all schools and programs have the time they need to review, understand, prepare for and integrate the new standards and practices before they are expected to demonstrate compliance.

None of the proposed changes will affect accreditation visits taking place in 2015 or 2016. The earliest possible testing phases for the proposed changes would be 2017.


A continuing conversation

The Royal College, along with their partners at the Collège des médecins du Québec (CMQ) and the College of Family Physicians of Canada (CFPC) are crafting a detailed implementation plan for phasing in the new standards and processes over a realistic timeframe. Work to develop and finalize the implementation plan will entail opportunities for discussion with and input from postgraduate deans, specialty committees, program directors and program administrators, as well as volunteer surveyors.

As this work continues, we will share this plan and work to ensure all stakeholders have the opportunity to shape and refine an accreditation system that is usable, practical and relevant.

For more information about the proposed changes, visit the Residency Accreditation in the 21st Century Information Sheet.

If you’d like to share your thoughts or ask questions about the upcoming changes to accreditation, please contact us at cbd@royalcollege.ca.

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Seeing CanMEDS differently – learn how it fits into your practice

Dr. Kevin Imrie, FRCPC, FACP, President of the Royal College reflects on the importance of the CanMEDS Framework and shares how he uses CanMEDS as an educator and as a practicing physician.

Watch Dr. Kevin Imrie's video on 'Seeing CanMEDS differently'.

Read more from Dr. Imrie as he challenges your perspective on CanMEDS: Why Fellows should take a closer look at CanMEDS 2015

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

CBD progress: June to October 2015

CBD progress: June to October 2015

In the first issue of CBD Community Touchpoint, we shared a few milestones of our early journey in implementing CBD.

Since then, we’ve continued to engage and collaborate with our partners and have made good progress toward implementing CBD. Here’s a look at some of the work we’ve done and an idea of the steps we’re about to take.


New faculty development and support tools launched at ICRE

In October 2015, the Royal College introduced a number of faculty support and development tools that will help program directors prepare for the transition to CBD.

Additional resources, including slide decks, info sheets and webinars are available in the CBD Resources section of the Royal College website.


Supporting your CBD adoption

Many of our partners have asked for more information about the steps involved in adopting CBD. We’ve also heard from several disciplines interested in getting a head start on implementing CBD. To assist, we’ve created the following faculty support products.


What’s Next

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Share your experiences: Online poll

Rashpal Basran, MD, FRCPC, at the Royal University Hospital in Saskatoon, Sask.

It’s no secret that assessment drives both learning and performance. Concrete assessments help learners locate and respond to weakness while building on and enhancing strengths.

CBD aims to embed authentic assessment practices into day-to-day training. But we want to learn from your experiences.

What’s the most valuable feedback or assessment you have ever received?




 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Continuing the conversation

Continuing the conversation

Over the past two years, we’ve reached out to a number of organizations and individuals to begin CBD discussions. These conversations were just the beginning.

In order to create a practical and usable competency-based education system we need to hear from you. We’re open and we’re listening.


To tell us how we can make CBD work for you

 

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CBD Community Touchpoint: Improving patient care through a lifelong competency-based medical education (CBME) model

Looking for tools and resources?

Looking for tools and resources?

Check out our updated CBD Resources page for a variety of informational documents and videos:

Or, send your questions and comments to cbd@royalcollege.ca. Questions of a broad nature could be the focus of a future item in an upcoming issue of Dialogue.

 

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