The faces of CBD
Early insights: implementing CBD
Dr. Brian W Rotenberg MD MPH FRCSC
Residency Program Director
Department of Otolaryngology - Head & Neck Surgery
“One of the most surprising realities has been the sheer excitement and positivity that many of the staff have displayed toward CBD and its processes.”
With the first two disciplines launching their Competence by Design (CBD) programs on July 1, 2017, we are pleased to offer a glimpse into the first few months of the CBD experience. In this edition, we profile Residency Program Director, Brian Rotenberg to discuss how things are going with the implementation of CBD in the Otolaryngology – Head & Neck Surgery (OTO-HNS) Department at Western University.
Program directors are involved in every step of designing the new CBD program for their discipline, in addition to working with colleagues at their home faculties to prepare for implementation. Dr. Rotenberg is an enthusiastic supporter of a competency-based medical education (CBME) approach to residency education.
After only a few months with CBD in place, we asked him to reflect on learnings so far regarding implementing CBD.
What do you see as the real advantage of CBD for the modern physician?
“By nature, we doctors are empirical people and this bodes well when you introduce a system that responds directly to the needs of the changing times and changing learners too. Under CBD, we can address specific issues in a real-time way and add detail to the way the learner acquires strength in one area of specialty.
There’s much more conversation about learning happening under CBD, which targets areas of improvement and identifies areas of strength very specifically. This efficiency makes CBD a natural evolution for time-crunched physicians today.”
Describe the role of the Program Director (PD) in implementing CBD.
”The PD has a role to play in making sure CBD unfolds as planned. PDs have significant conversations with their staff about CBD. We play a persuading role and while there is sometimes resistance from staff, they need to be able to align everyone in one direction. Ultimately CBD is the way to go, so if anyone has a fundamental problem with it, it does fall on the PD to make tough decisions about who should be on the educational team. PDs also create enthusiasm, generate interest and harness positive contributions from all participants. This is critical. In the end, the single most important factor to the success of CBD will have been communications.
PDs are hands on, they watch and they are the symbol that residents emulate. Under CBD, the role of the PD has in fact never been more important. With the introduction of EPAs and other measurable achievement milestones, the frequency and regularity of exchanges between mentor and mentee has increased exponentially, improving overall learning.”
"With Competence by Design, the job of Program Director is like that of an Orchestra Conductor. All the parts of the ensemble have to come together in harmony for the symphony to work. Brian brings those acute management tools to the table, and exemplifies the drive and passion that is needed to truly affect change.”
What unexpected challenges did you encounter?
“One of the challenges has been making this smooth within a team that is not familiar with CBD. In particular, when OTO-HNS students rotate into a non-CBME specialty, there is often a lot of questions asked by the supervisors from those specialties as how to evaluate the OTO-HNS trainees, as they have no knowledge of CBD. This makes for an awkward reality in the field. Currently there is no bridge built that provides an easy solution for this reality.”
“One of the most surprising realities has been the sheer excitement and positivity that many of the staff have displayed toward CBD and its processes. When asked to be guinea pigs for a new program, they put their hands up and said “sign me up coach!” It’s very pleasant to see young, bright people come out and say that they like the frequency and quality of the exchanges with their mentor which has contributed to a general happiness among the staff. Junior staff have also brought forward many amazing suggestions to make CBD even better at our school. We have communicated these to the Royal College and have always been well received."
What is important to keep in mind about the CBD implementation process?
Dr. Rotenberg cautions anyone who thinks CBD will look exactly as predicted in the end. CBD affects everyone in the medical education continuum, from residents, to Program Administrators, to PDs, the Royal College and so on.
“Given the sheer variety of people impacted by CBD and the different points of views that come with it, it would be unreasonable to assume the CBD program will look exactly as predicted 10 years down the line.”
If you could tell a program director in another medical specialty one thing about preparing to implement CBD, what would that be?
“Don’t underestimate the amount of organization involved in rolling out CBD in your program. While the College will provide guidelines, milestones and all other blueprint materials, you, the program director, will need to put this into practice and this is no small feat. One of the most underestimated criteria in selecting a program director is the need to have someone who is organized and can lead a project. Having someone who is not organized or inclined to plan can be a huge detriment to the success of CBD in your program.”
“Remember, the Royal College provides the blueprints, but programs build the house.”