Dr. Anderson is a Northern Ontario School of Medicine (NOSM) Associate Professor, the Postgraduate Site Director of Family Practice and FRCP Anesthesia at NOSM, and Program Director, Anesthesiology. He has been involved in the development of CBD at NOSM for four years, and has given many lectures on the details of development and implementation of CBD, including how to develop effective EPAs. We talked recently with Dr. Anderson about his experiences and challenges championing CBD for Anesthesiology, which is one of two cohorts scheduled to launch CBD July 1, 2017.
We know you’ve had a lot of success developing CBD for anesthesiology, but what have been some of the specific challenges?
The biggest difficulty has been managing uncertainty. CBD is a major change. We think we’re doing a pretty good job training residents right now and the Royal College is saying that CBD will be much better than what we currently have. I believe that to be true and I see the evidence around me. But in truth, we’re at the forefront of the biggest medical education experiment in the last 100 years. So, a major challenge is in convincing people that we need this change. I’m confident that people will be convinced once they see CBD in action.
As for specific challenges, scheduling has been a bit difficult. Anesthesiology relies on internal medicine, emergency, pediatrics and many others to determine scheduling. There are numerous scheduling pressures, including providing clinical service for patients, working with off-service rotations to get appropriate and timely training experiences and using different scheduling frameworks than other programs. While this is challenging for other programs and postgraduate departments, it is an opportunity for them to explore better ways to do things when they transition to CBD in the future.
Mainly it’s been challenging because our department is the first through the door with CBD, so we don’t have others to turn to for advice.
What are the benefits for residents learning in a CBD program?
CBD will help us better support learners who are either struggling or way ahead. For struggling learners, we’ll be able to identify their challenges more swiftly and give them a customized learning plan to overcome their issues.
But an even greater benefit will be for the rock stars who in the past we’ve thought didn’t need interventions from us. They’ve always been treated as if they’re okay and we just let them sail through the process. But CBD’s process and portfolio reviews at the competency committee level ensure that every resident gets a personalized learning plan. It’s not just about pass/fail. It’s about how can we improve your performance today. So, if a resident gets all their EPAs in the first few months, they can continue to learn and improve instead of just moving toward graduation with minimal supervision. CBD is about raising the bar for everyone.
I also see great benefits for residents in the system now who will take the competency-based approach into their professional development. We’re training our residents to learn in this new environment, so it’s all they know. My hope is that, when they graduate, the practice environment will include more authentic, real feedback for faculty members. The culture will hopefully translate through to a continuum of improved practice, and that will translate to better patient care.
What advice do you have for future cohorts going through this process, or just starting the process?
A couple things. First, at a high level, the main thing is to remain optimistic and positive about this experience. Those following you will be looking to you for that. Those who may not be as supportive are looking for any evidence that this isn’t working, which can make it hard to stay positive. But don’t give in to negativity.
Also, I think some really important advice – especially for those who may still be many months from their workshops – is to try not to drink the ocean. Go for some easy wins that will be helpful for your specialty, such as picking a couple everyday procedures that you trust your residents to do with minimal supervision. For us in anesthesiology, labour epidurals were that kind of procedure. Build an assessment around something simple and you’ll get a feel for the work. One challenge is that we want to make sure we don’t miss anything when we build our EPAs, but you need to choose just for now and get used to it.
Next, you can start to figure out how what you’re doing will fit within CBD without creating a lot of extra work. Because CBD isn’t more work, it’s better work. If there are steps in your current process that you can delete, then do that. We found we were able to protect the great things we already did – such as our excellent and very active core program – and fit it within the new paradigm of CBD. The idea is to let CBD replace what you’re already doing with something better – and preserve what you’re already doing that you find valuable.
You also need to identify champions early and get them educated in the process. Think about recruiting young educators who are motivated and looking for a home academically, such as a medical education research plan or a scholarship program. CBD is an amazing opportunity for them to get involved and help shape what people do locally.
Do you think CBD is the right move for Canada?
Competency-based medical education is absolutely the right move for Canada. As for CBD, it’s new and not perfect, but it is already better than what we are doing. We’re already seeing that. Our department implemented competency-based assessments and progression four years ago and today the approach is highly valued by residents and faculty. The process makes sense and enables us to give residents valuable feedback.
A new process is bound to be challenging at the outset and it will take 10 years to make CBD seamless. But it will happen. To get a culture shift, it takes a complete redesign – and CBD is a complete redesign. It’s like we’re cleaning out our basement that has lots of things we like and lots of things we don’t like. When we set it back up, we can’t include everything – only the things that work.