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

THIS MONTH’S HEADLINES


A new era of partnership and co-creation for CBD

Andrew Padmos, BA, MD, FRCPC, FACP shares his thoughts on the new direction for Competence by Design (CBD).


Creating the conditions for engagement

We’ve recently adjusted the format of the internal CBD Implementation (Core) Team to create more avenues for dialogue and discussion with our stakeholders and support increased collaboration.


CBD Progress: November 2015 to February 2016

Here are some of the highlights of the discussions we’ve had and the work we’ve completed together.


What’s Next

Find out what’s coming next


Emergency Medicine begins their CBD journey: Videos

We spoke to several Emergency Medicine physicians to get their candid thoughts on Competence by Design (CBD). Here’s what they had to say.


Expanding the CBME approach

In January, Queen’s University announced that it will be adopting competency-based medical education (CBME) across all of its 29 post-graduate medical programs starting in 2017 for incoming residents. Learn more.


Paving the way for better care by integrating CanMEDS 2015

The changes introduced as part of CanMEDS 2015 will lead to better trained physicians and improved patient care. For this reason, it is important to incorporate the new CanMEDS changes into training and practice as rapidly as possible, but in a way that is efficient and mindful of the other systems changes underway.


Continuing the conversation

In order to create a competency-based medical education system which is usable and practical at every university in Canada, we need your help. Take part in the CBD conversations.


Tools and resources

Get the most up-to-date material on Competence by Design (CBD).




Vol. 1, No. 3 — March 2016


 

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A new era of partnership and co-creation for CBD

A new era of partnership and co-creation for CBD

Dear colleagues,

In the last issue of the CBD Community Touchpoint, I committed to a responsive and adaptive approach to CBD implementation. In this issue, I stand by this commitment, and I’d like to share with you how we are putting this approach into practice. 

Over the past few months we’ve received feedback from our medical school partners expressing logistical, technology and resource concerns with the CBD implementation model and timeline. We were pleased to hear that many faculties want to be more fully engaged in developing the CBD implementation strategy. 

Sometimes feedback can be difficult to hear, but we stopped, listened and realized we needed to make some changes to our approach. And in December 2015, respecting the needs of our partners, we made the decision to slow down the full-scale launch of CBD for Cohort One disciplines – Medical Oncology and Otolaryngology– Head and Neck Surgery – originally scheduled for July 2016.

We remain fully committed to implementing CBD across the country – enhancing patient care by better aligning medical education and lifelong learning with evolving patient needs. We now simply have more time to listen and work with you to truly iterate, test and co-create a competency-based model that meets the needs of the medical education system. 

In January we began creating a new era of partnership by holding the first of several bimonthly teleconferences scheduled with the Post Graduate Deans (PG Dean). This meeting was very positive, and together we have agreed to the following steps:


Along with these activities, we are continuing to work with Medical Oncology and Otolaryngology – Head and Neck Surgery – including developing the above mentioned roadmap, a glossary of CBD/CBME terms, messaging and FAQs focused on the CBD rationale and more information about competency-based assessment practices. In 2016, we anticipate that some programs in both disciplines, and potentially programs in Cohort Two disciplines, will begin to field test various aspects of CBD, such as: the formation/role of a competence committee; the flow of new assessment processes; the trial of EPAs to focus teaching and assessment; and the use of faculty development resources. These testing activities will allow us to improve our model and check for any unintended consequences. The lessons learned from each testing experience will be shared with our partners and will allow us to co-create and adjust implementation activities moving forward.

We are also continuing to collaborate with the disciplines scheduled in the remaining Cohorts to prepare and fine-tune CBD adoption. Working together we are seeing the excitement grow as CBD becomes real and competency-based practices become concrete and usable.

We knew at the start of the CBD journey that there would be bumps along the way. This is common in all change initiatives and why we committed to an iterative approach. By shifting the CBD timeline, we are holding true to our principles and creating the time and space to listen and adapt to the needs of our partners. I have no doubt that this shift will allow us to learn and work together and – ultimately – develop a medical education system which aligns with the care needs of today’s patients.

As we move forward with CBD activities, I will continue to provide you with progress updates. I encourage you to take part in CBD co-creation by


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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Creating the conditions for engagement

Creating the conditions for engagement

When Competence by Design (CBD) was first launched in 2013, the Royal College created an internal CBD Implementation (Core) Team – made up of senior leaders, subject matter experts and education professionals  –  to guide CBD implementation.

We’ve recently adjusted the format of the Core Team to create more avenues for dialogue and discussion with our stakeholders and support increased collaboration.

Dr. Kenneth A. Harris, Executive Director, Office of Specialty Education and Deputy CEO continues in his role as CBD Executive Lead. Moving forward, Ken will partner with Dr. Andrew Padmos, the Royal College’s CEO and Michel Cavallin, Chief Operating Officer to provide executive leadership and oversight to CBD.

Overall CBD implementation will be co-led by Dr. Jason Frank, Director of Specialty Education, Strategy and Standards – who will provide subject matter expertise – and Jane Fulford, Chief Information Officer, Director of eSolutions and Associate Director of Planning – who will focus on operational planning activities. 

Together, Jason and Jane will work with executive leadership, members of the Core Team and our partners and stakeholders to integrate all aspects of CBD and further develop, test and implement competency-based practices. As we continue along our CBD journey, we will connect with each university to ensure that individual context, challenges and opportunities are reflected in implementation activities.

“The changes to the CBD leadership structure reflect our renewed focus on field testing and co-creation, says Dr. Ken Harris. “We now have the structure in place to increase our outreach activities and engage our partners in meaningful conversations.” 

 

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CBD progress: November 2015 to February 2016

CBD progress: November 2015 to February 2016

Over the past few months, we’ve spoken to a number of our partners in medical education and health care about Competence by Design (CBD).

The meaningful feedback and insight generated by these conversations have helped CBD continue to move from theory to reality. Here are some of the highlights of the discussions we’ve had, the work we’ve completed together and a look at our next steps.


Engagement, Outreach and Key Meetings


Documents, Tools and Products

 

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Competence by Design (CBD) What’s Next

Competence by Design (CBD) What’s Next

 

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Emergency Medicine begins their CBD journey

Emergency Medicine begins their CBD journey

“I’m excited about the changes [CBD] is going to bring to the program in general and for the evaluations – the much richer evaluations – that we’re going to get for the residents. We’ll be getting information on the residents much earlier if they’re in trouble, as compared to now where they’re R4s and R5s before you find out that your resident may be in trouble.”

Carine Haggar MD, FRCPC
Program Director, Emergency Medicine, McGill University

Over the last few months, a number of disciplines have begun preparing for Competence by Design (CBD). In February, members of the Emergency Medicine Specialty Committee, several Program Directors and volunteers partnered with Royal College staff to begin the iterative process of creating specialty specific milestones, Entrustable Professional Activities (EPAs), new training standards and competency-based assessment models.

We spoke to several Emergency Medicine workshop attendees to get their candid thoughts on CBD. Here’s what they had to say.


Carolyn Snider, MD, FRCPC

 

“I was a bit anxious actually, coming in and thinking about how [CBD] would affect me as an emergency physician, affect my teaching at the bedside and affect emergency flow. I really did expect this change to take a lot of time [out of my teaching and daily work], but now I’m starting to realize that it’s not going to take as much time. It’s actually going to be better for teaching, and it’s going to be much more beneficial for our residents and myself as a teacher.”

Carolyn Snider, MD, FRCPC
Clinician-scientist, Department of Emergency Medicine, University of Manitoba

 

Glen Bandiera, MD, FRCPC

 

“I’m excited about the way CBD is going to empower faculty to give honest feedback to the residents that rooted in competencies and rooted in entrustable professional activities [EPAs]. I think the idea of multiple sampling over the course of many experiences will lessen the stakes for a given assessment but will create a lot more confidence and validity in the final assessment.”

Glen Bandiera, MD, FRCPC
Associate Dean, Postgraduate Medical Education, University of Toronto

 

Stephen Choi MD, FRCPC

 

“The key thing with CBD, to me, is that we now use competence as the benchmark for a resident’s training experience as they learn to become practising specialists in my field which is emergency medicine. The historical model of just using time, we recognize, is not enough. And the thing that is going to benefit patients the most is that we use competence as the benchmark. And that to me is exciting because it’s so incredibly logical.”

Stephen Choi MD, FRCPC
Program Director, Emergency Medicine, University of Ottawa



Candid thoughts about CBD


 

Kirk Magee, MD, MSc, FRCPC

Site Research Director, Associate Professor,
Department of Emergency Medicine, Dalhousie University

 
 

Brian James Chung, MD, FRCPC

Clinical Assistant Professor- Program Director, Postgraduate Education, Emergency Medicine,
Faculty of Medicine University of British Columbia

 
 

Sandy Dong MD, MSc, FRCPC, DABEM

Associate Clinical Professor, RCPS Residency Program Director,
Department of Emergency Medicine, University of Alberta



Have your say

Attended a CBD workshop and have comments to share? Or have input and guidance on CBD overall? We want to hear from you.


Let us know what you think of the process by sending an email to cbd@royalcollege.ca or commenting on Twitter, Facebook and/or LinkedIn.

 

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Expanding the CBME approach

Expanding the CBME approach

In January, Queen’s University announced that it will be adopting competency-based medical education (CBME) across all of its 29 post-graduate medical programs starting in 2017 for incoming residents.

Guided by the Royal College, all disciplines in Canada will adopt CBME gradually over the next few years as they implement Competence by Design (CBD). With our support, Queen’s is jumping ahead of this schedule and adopting competency-based practices wholesale as an institution.

“One of the pillars of our strategic plan is to advance new ways of training. As such, the opportunity to help lead in a fundamental transformation of how we prepare the specialists of the future, is not only exciting, but exactly what we said we would do as part of our planning process,” says Richard Reznick, Dean of Health Sciences at Queen’s.

“Rather than just time, we are demanding a higher standard. It’s more accountable,” said Damon Dagnone, an assistant professor in emergency medicine who is Queen’s CBME lead.

This is an exciting opportunity, and we welcome the chance to learn and share with our partners at Queen’s as they grow and expand the approach to CBME.  As Queen’s moves forward, the Royal College will provide guidance and advice and leverage the lessons learned to inform CBD implementation. And as each specialty and subspecialty adopts CBD, (as per the Cohort schedule) Queen’s will adjust its CBME-based programs to fully align with CBD practices.

For more information about Queen’s shift to CBME, please see Designing Competency at Queen’s.

 

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Paving the way for better care by integrating CanMEDS 2015

Paving the way for better care by integrating CanMEDS 2015

After years of partnership, consensus-building and consultation with Fellows and key partners across Canada, the Royal College launched the revitalized CanMEDS 2015 Physician Competency Framework and its associated competency milestones in October of 2015.  Now that the updates are complete, our focus is on helping each discipline implement CanMEDS in a smooth and efficient manner.

The changes introduced as part of CanMEDS 2015 will lead to better trained physicians and improved patient care. For this reason, it is important to incorporate the new CanMEDSchanges into training and practice as rapidly as possible, but in a way that is efficient and mindful of the other systems changes underway.


Multiple paths to integrating CanMEDS 2015 into specialty and subspecialty programs

The implementation of the CanMEDS 2015 is occurring as part of the Royal College’s Competence by Design (CBD) initiative. CBD is being implemented through multiple cohorts and over an extended period of time. The final cohort of disciplines shifting to CBD is expected to happen no earlier than 2022. One of the main reasons for this extended transition is because CBD involves major systems changes that require careful planning and ongoing consultation.


Special CanMEDS OTR Addendum to come into effect on July 1

Rather than waiting for the each discipline to adopt CanMEDS 2015 as they gradually implement CBD or asking them to separately modify their specialty document suite, we’ve introduced  a practical approach – the  CanMEDS 2015 Special Objectives of Training Requirements (OTR) addendum. The addendum, which comes into effect on July 1, 2016,  will help ensure that the highlights of CanMEDS 2015 are incorporated efficiently into training programs in a timely manner, without over-burdening stakeholders.


What Specialty Committee members and PGME offices need to know

The CanMEDS 2015 Special OTR Addendum is a generic document that will supplement the Objectives of Training for the 58 disciplines transitioning to CBD in cohorts 3 or later.

Key details of the OTR addendum are as follows:


Supporting Implementation

The Royal College is committed to helping with the implementation of CanMEDS and CBD. We are developing tools, resources and programs to help all disciplines learn, share, teach and implement CanMEDS. For example, the following resources are already available:


Note: The Royal College is holding webinars in April on the CanMEDS 2015 Special OTR Addendum; further details will be available shortly.

We’re here to help!  Contact canmeds@royalcollege.ca with any questions or concerns.

To learn more, including what cohort your specialty falls into, please visit the OTR Addendum webpages.

 

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Continuing the Conversation

Continuing the Conversation

Competence by Design (CBD) is about transforming specialty medical education so every learning activity, every service rotation, focuses on patient needs and patient care.

Improving care is a goal we share with all our colleagues in medical education and the healthcare community across Canada.

In order to meet this goal and create a system which is usable and practical at every university in Canada, we need your help.


Take part in the CBD conversation

 

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Tools and Resources

Tools and Resources

Find the most up-to-date material on Competence by Design (CBD) on the CBD Resources page.


Check out the:

If the available material doesn’t meet your needs, contact cbd@royalcollege.ca and we’ll work with you to assemble content that fits your context.

 

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