scholarly journals LO72: Spotting potential opportunities for teachable moments

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S33-S34
Author(s):  
H. Alrimawi ◽  
MB BCh ◽  
S. Sample ◽  
T. Chan
Keyword(s):  
Emergency Medicine ◽  
Post Intervention ◽  
Historical Cohort ◽  
Competency Based Medical Education ◽  
Professional Activities ◽  
Significant Difference ◽  
Local Program ◽  
Competency Based ◽  
Student’S T ◽  
Case Based

Introduction: With the transition of Emergency Medicine into competency based medical education (CBME), entrustable professional activities (EPAs) are used to evaluate residents on performed clinical duties. This study aimed to determine if implementing a case-based orientation, designed to increase recognition of available EPAs, into CBME orientation would help residents increase the number of EPAs completed. Methods: We designed an intervention consisting of clinical cases that were reviewed by national EPA experts who identified which EPAs could be assessed from each case. A case-based session was incorporated into the 2019 CBME orientation for The McMaster Emergency Medicine Program. Postgraduate Year (PGY)1 residents read the cases and discussed which EPAs could be obtained with PGY2/faculty facilitators. The number of EPAs completed in the first two blocks of PGY1 was determined from local program data and Student's t-test was used to compare averages between cohorts. Results: We analyzed data from 22 trainees (7 in 2017, 8 in 2018, and 7 in 2019). In the first two blocks of PGY1, the intervention cohort (2019) had a significantly higher average number of EPAs completed per trainee (47.4 [SD 11.8]) than the historical cohort (25.3 [SD 6.7]) (p < 0.001) (Cohen's d = 2.3). No significant difference existed in the number EPAs obtained between the 2017/2018 cohorts, with averages of 24.3 [SD 6.8] and 26.1 [SD 7.0] per trainee respectively (p = 0.6). Conclusion: Implementation of a case-based orientation led by CBME-experienced facilitators nearly doubled the EPA acquisition rate of our PGY1s. The consistent EPA acquisition by the 2017/2018 cohorts suggest that the post-intervention increase was not solely due to developed familiarity with the CBME curriculum.

The competency-based medical education evolution of Canadian emergency medicine specialist training

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Jonathan Sherbino ◽  
Glen Bandiera ◽  
Ken Doyle ◽  
Jason R. Frank ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Residency Education ◽  
Multiple Sources ◽  
High Stakes ◽  
Competency Based Medical Education ◽  
Professional Activities ◽  
Local Resources ◽  
Education Design ◽  
Competency Based

ABSTRACTCanadian specialist emergency medicine (EM) residency training is undergoing the most significant transformation in its history. This article describes the rationale, process, and redesign of EM competency-based medical education. The rationale for this evolution in residency education includes 1) improved public trust by increasing transparency of the quality and rigour of residency education, 2) improved fiscal accountability to government and institutions regarding specialist EM training, 3) improved assessment systems to replace poor functioning end-of-rotation assessment reports and overemphasis on high-stakes, end-of-training examinations, and 4) and tailored learning for residents to address individualized needs. A working group with geographic and stakeholder representation convened over a 2-year period. A consensus process for decision-making was used. Four key design features of the new residency education design include 1) specialty EM-specific outcomes to be achieved in residency; 2) designation of four progressive stages of training, linked to required learning experiences and entrustable professional activities to be achieved at each stage; 3) tailored learning that provides residency programs and learner flexibility to adapt to local resources and learner needs; and 4) programmatic assessment that emphasizes systematic, longitudinal assessments from multiple sources, and sampling sentinel abilities. Required future study includes a program evaluation of this complex education intervention to ensure that intended outcomes are achieved and unintended outcomes are identified.

Faculty development in the age of competency-based medical education: A needs assessment of Canadian emergency medicine faculty and senior trainees

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 527-534 ◽  
Author(s):  
Alexandra Stefan ◽  
Justin N. Hall ◽  
Jonathan Sherbino ◽  
Teresa M. Chan
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Faculty Development ◽  
Patient Care ◽  
Needs Assessment ◽  
Direct Observation ◽  
Senior Resident ◽  
Cross Sectional ◽  
Competency Based Medical Education ◽  
Competency Based

ABSTRACTObjectivesThe Royal College of Physicians and Surgeons of Canada (RCPSC) emergency medicine (EM) programs transitioned to the Competence by Design training framework in July 2018. Prior to this transition, a nation-wide survey was conducted to gain a better understanding of EM faculty and senior resident attitudes towards the implementation of this new program of assessment.MethodsA multi-site, cross-sectional needs assessment survey was conducted. We aimed to document perceptions about competency-based medical education, attitudes towards implementation, perceived/prompted/unperceived faculty development needs. EM faculty and senior residents were nominated by program directors across RCPSC EM programs. Simple descriptive statistics were used to analyse the data.ResultsBetween February and April 2018, 47 participants completed the survey (58.8% response rate). Most respondents (89.4%) thought learners should receive feedback during every shift; 55.3% felt that they provided adequate feedback. Many respondents (78.7%) felt that the ED would allow for direct observation, and most (91.5%) participants were confident that they could incorporate workplace-based assessments (WBAs). Although a fair number of respondents (44.7%) felt that Competence by Design would not impact patient care, some (17.0%) were worried that it may negatively impact it. Perceived faculty development priorities included feedback delivery, completing WBAs, and resident promotion decisions.ConclusionsRCPSC EM faculty have positive attitudes towards competency-based medical education-relevant concepts such as feedback and opportunities for direct observation via WBAs. Perceived threats to Competence by Design implementation included concerns that patient care and trainee education might be negatively impacted. Faculty development should concentrate on further developing supervisors’ teaching skills, focusing on feedback using WBAs.

scholarly journals Delivering on the promise of competency based medical education – an institutional approach

2019 ◽  
Vol 10 (1) ◽  
pp. e28-38 ◽  
Author(s):  
Damon Dagnone ◽  
Denise Stockley ◽  
Leslie Flynn ◽  
Rylan Egan ◽  
Richard Van Wylick ◽  
...  
Keyword(s):  
Medical Education ◽  
Diffusion Of Innovation ◽  
Training Model ◽  
Residency Education ◽  
Transformative Change ◽  
Competency Based Medical Education ◽  
Professional Activities ◽  
Competency Based ◽  
Institutional Vision ◽  
Proactive Measures

The Royal College of Physicians and Surgeons of Canada (RCPSC) adopted a plan to transform, over a seven-year horizon (2014-2021), residency education across all specialties to competency-based medical education (CBME) curriculum models. The RCPSC plan recommended implementing a more responsive and accountable training model with four discrete stages of training, explicit, specialty specific entrustable professional activities, with associated milestones, and a programmatic approach to assessment across residency education. Embracing this vision, the leadership at Queen’s University (in Kingston, Ontario, Canada) applied for and was granted special permission by the RCPSC to embark on an accelerated institutional path. Over a three-year period, Queen’s took CBME from concept to reality through the development and implementation of acomprehensive strategic plan. This perspective paper describes Queen’s University’s approach of creating a shared institutional vision, outlines the process of developing a centralized CBME executive team and twenty-nine CBME program teams, and summarizes proactive measures to ensure program readiness for launch. In so doing, Queen’s created a community of support and CBME expertise that reinforces shared values including fostering co-production, cultivating responsive leadership, emphasizing diffusion of innovation, and adopting a systems-based approach to transformative change. 

scholarly journals Analyzing the Administrative Burden of Competency Based Medical Education

2021 ◽  
pp. 084653712110389
Author(s):  
Kevin Cheung ◽  
Christina Rogoza ◽  
Andrew D. Chung ◽  
Benjamin Yin Ming Kwan
Keyword(s):  
Medical Education ◽  
Postgraduate Medical Education ◽  
Assessment Process ◽  
Full Time ◽  
Equal Distribution ◽  
Competency Based Medical Education ◽  
Quantitative Evidence ◽  
Administrative Burden ◽  
Professional Activities ◽  
Competency Based

Purpose: Postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) system. Within this system, resident performance is documented through frequent assessments that provide continual feedback and guidance for resident progression. An area of concern is the perception by faculty of added administrative burden imposed by the frequent evaluations. This study investigated the time spent in the documentation and submission of required assessment forms through analysis of quantitative data from the Queen’s University Diagnostic Radiology program. Methods and Materials: Data regarding time taken to complete Entrustable Professional Activities (EPA) assessments was collected from 24 full-time and part-time radiologists over a period of 18 months. This data was analyzed using SPSS to determine mean time of completion by individuals, departments, and by experience with the assessment process. Results: The average time taken to complete an EPA assessment form was 3 minutes and 6 seconds. Assuming 3 completed EPA assessment forms per week for each resident (n = 12) and equal distribution among all staff, this averaged out to an additional 18 minutes of administrative burden per staff member over a 4 week block. Conclusions: This study investigated the perception by faculty of additional administrative burden for assessment in the CBME framework. The data provided quantitative evidence of administrative burden for the documentation and submission of assessments. The data indicated that the added administrative burden may be reasonable given mandate for CBME implementation and the advantages of adoption for postgraduate medical education.

scholarly journals An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Ndidi I. Unaka ◽  
Ariel Winn ◽  
Adiaha Spinks-Franklin ◽  
Patricia Poitevien ◽  
Franklin Trimm ◽  
...  
Keyword(s):  
Medical Education ◽  
Health Care Systems ◽  
Health Inequities ◽  
Professional Activity ◽  
Competency Based Medical Education ◽  
Pediatric Health ◽  
Professional Activities ◽  
Care Systems ◽  
Competency Based ◽  
Pediatric Populations

Racism and discrimination are the root of many pediatric health inequities and are well described in the literature. Despite the pervasiveness of pediatric health inequities, we have failed to adequately educate and prepare general pediatricians and pediatric subspecialists to address them. Deficiencies within education across the entire continuum and in our health care systems as a whole contribute to health inequities in unacceptable ways. To address these deficiencies, the field of pediatrics, along with other specialties, has been on a journey toward a more competency-based approach to education and assessment, and the framework created for the future is built on entrustable professional activities (EPAs). Competency-based medical education is one approach to addressing the deficiencies within graduate medical education and across the continuum by allowing educators to focus on the desired equitable patient outcomes and then develop an approach to teaching and assessing the tasks, knowledge, skills, and attitudes needed to achieve the goal of optimal, equitable patient care. To that end, we describe the development and content of a revised EPA entitled: Use of Population Health Strategies and Quality Improvement Methods to Promote Health and Address Racism, Discrimination, and Other Contributors to Inequities Among Pediatric Populations. We also highlight the ways in which this EPA can be used to inform curricula, assessments, professional development, organizational systems, and culture change.

Assessment of Entrustable Professional Activities Using an Online Simulation Platform During Transition to Emergency Medicine Residency: A Mixed Methods Pilot Study (Preprint)

2021 ◽  
Author(s):  
Cynthia R Peng ◽  
Kimberly A Schertzer ◽  
Holly A Caretta-Weyer ◽  
Stefanie S Sebok-Syer ◽  
William Lu ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Pilot Study ◽  
Final Diagnosis ◽  
Diagnostic Assessment ◽  
Entrustable Professional Activities ◽  
Simulation Platform ◽  
Professional Activities ◽  
Clinical Encounters ◽  
Critical Action ◽  
Competency Based

BACKGROUND The 13 Core Entrustable Professional Activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education. Five of these EPAs (EPA2: prioritizing differential, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for online assessment. OBJECTIVE For this pilot study, we created a web-based simulation platform for diagnostic assessment of these EPAs and examined its feasibility and acceptability. METHODS Four simulation cases underwent three rounds of consensus panels and pilot testing. Incoming emergency medicine interns (n=15) completed all cases, and up to 4 “look for” statements, which encompassed specific EPAs, were generated for each participant: 1) performing harmful or missing actions, 2) narrow differential or wrong final diagnosis, 3) having errors in documentation, and 4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. RESULTS All participants had at least 1 missing critical action and 40% participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of assessments (53%). Other errors included choosing the incorrect documentation (40%) and indiscriminately applying oxygen (60%). The themes to the interviews included: psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. CONCLUSIONS This study demonstrates the feasibility and acceptability of this platform for diagnostic assessment of specific EPAs. This approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides this feedback in a manner appreciated by residency leadership, and informs individualized learning plans.

scholarly journals P101: The development of entrustable professional activity reference cards to support the implementation of Competence by Design in emergency medicine

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S100
Author(s):  
E. Stoneham ◽  
L. Witt ◽  
Q. Paterson ◽  
L. Martin ◽  
B. Thoma
Keyword(s):  
Emergency Medicine ◽  
Low Cost ◽  
Intervention Mapping ◽  
Assessment System ◽  
Professional Activity ◽  
Residency Programs ◽  
Professional Activities ◽  
Competency Based ◽  
Curriculum Map ◽  
User Friendly

Innovation Concept: Competence by Design (CBD) was implemented nationally for Emergency Medicine (EM) residents beginning training in 2018. One challenge is the need to introduce residents to Entrustable Professional Activities (EPAs) that are assessed across numerous clinical rotations. The Royal College's resources detail these requirements, but do not map them to specific rotations or present them in a succinct format. This is problematic as trainees are less likely to succeed when expectations are unclear. We identified a need to create practical resources that residents can use at the bedside. Methods: We followed an intervention mapping framework to design two practical, user-friendly, low-cost, aesthetically pleasing resources that could be used by residents and observers at the bedside to facilitate competency-based assessment. Curriculum, Tool or Material: First, we designed a set of rotation- and stage-specific EPA reference cards for the use of residents and observers at the bedside. These cards list EPAs and clinical presentations likely to be encountered during various stages of training and on certain rotations. Second, we developed a curriculum board to organize the EPA reference cards by stage based upon our program's curriculum map. The curriculum board allows residents to view the program's curriculum map and the EPAs associated with each clinical rotation at a glance. It also contains hooks to hang and store extra cards in an organized manner. Conclusion: We believe that these practical and inexpensive tools facilitated our residency program's transition to competency-based EPA assessments. Anecdotally, the residents are using the cards and completing the suggested rotation-specific EPAs. We hope that the reference cards and curriculum board will be successfully incorporated into other residency programs to facilitate the introduction of their EPA-based CBD assessment system.

scholarly journals Examining Academic Leader’s work in implementing Competency-based Medical Education using Organizational Learning Theory

2018 ◽  
Author(s):  
Nicolas Fernandez ◽  
Nicole Leduc ◽  
Nathalie Caire Fon ◽  
Louis-Georges Ste-Marie ◽  
Dat Nguyen-Dinh ◽  
...  
Keyword(s):  
Medical Education ◽  
Organizational Learning ◽  
Learning Theory ◽  
Structured Interviews ◽  
Academic Leaders ◽  
Competency Based Medical Education ◽  
Organizational Learning Theory ◽  
Professional Activities ◽  
Competency Based ◽  
Implementation Progress

ContextCompetency-based medical education (CBME) implementation is being carried out in many medical schools worldwide. Academic Leadership is a strategy where selected Faculty act to influence peers to adopt change. The Université de Montréal medical school, has adopted this strategy to implement CBME.PurposeThis paper aims to describe the work of Academic Leaders in the process of CBME implementation and to explore relevance of the Nonaka and Toyama organizational learning theory to map implementation progress.MethodBecause knowledge creation model focuses on the relationships between leaders and social structures, embedded case study was selected. Diverse sampling method was used to select three departments: internal medicine, surgery and psychiatry, based on the number of CBME training activities. Data collection was at two intervals, two years apart. Semi-structured interviews (individual and group) were conducted with Department Heads and Academic Leaders. Thematic analysis was conducted on the 15 interview transcriptions.ResultsAs implementation begins, Leaders critically revisit accepted teaching routines and develop a common conception of CBME. This enables leaders to communicate with a wider audience and work within existing committees and working groups where they “break down” CBME into practical concepts. This practical understanding, disseminated through Entrustable Professional Activities, enables observable change.ConclusionLeaders’ roles evolved from an “expert” that disseminates knowledge about CBME through lectures, to a responsive and pragmatic supporting role by developing and writing practical tools in collaboration with peers and program directors.

scholarly journals Challenges in implementation of Competency Based Medical Education – A Cross Sectional survey among medical faculty in India

2021 ◽  
Author(s):  
sangeetha kandasamy ◽  
A.Precilla Catherine ◽  
Shivkumar Gopalakrishnan
Keyword(s):  
Medical Education ◽  
Development Program ◽  
Medical Faculty ◽  
Faculty Development Program ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Competency Based Medical Education ◽  
Significant Difference ◽  
Competency Based ◽  
Teaching Faculty

Abstract Background. In India, Competency Based Medical Education (CBME) is gaining foothold to transform the medical student into a doctor fulfilling community and societal needs. With that end in view the teaching faculty are getting sensitized and trained by the National Faculty Development Program (FDP). Objectives. To assess the awareness about FDP among teaching faculty in medical colleges. To study the attitude & perceived barriers to implementation of CBME. Methods. This questionnaire based multicentric cross sectional study was conducted among teaching faculties in Indian medical institutes. Electronic media [Google forms] was used to disseminate the questionaire. Attitudinal and perceptional differences were internally compared among the faculties.Results. Among 251 participants 90.2% faculties from private institutes had undergone FDP significantly more than those from Government sector (p=0.008). We observed that 92.4% were aware, 80.2 % had undergone Curriculum Implementation Support Program (CISP) and 95.2% did agree that CBME will improve the medical education system.Major challenges perceived were high student to faculty ratio (67.7%), ill developed infrastructure (41.4%) and difficulties in assessment (41.1%). The popular solutions suggested were to increase faculty strength (73.7%), improve infrastructure (69.3%), extra remuneration (35.9 %) and increase administrative support (30.7%). There were significant difference of opinions between teaching faculty of government and private sector (p=0.017).Conclusion. Most of the medical faculty are aware of the need and have acquired a positive attitude to enforcement of CBME. However significant barriers do exist in the form of manpower and resources which need to be addressed.

scholarly journals Assessment of emergency medicine residents: a systematic review

2017 ◽  
Vol 8 (1) ◽  
pp. e106-122 ◽  
Author(s):  
Isabelle N Colmers-Gray ◽  
Kieran Walsh ◽  
Teresa M Chan
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Direct Observation ◽  
Full Text ◽  
Assessment Tools ◽  
Competency Based Medical Education ◽  
Mesh Terms ◽  
Competency Based ◽  
Resident Assessment ◽  
Assessment Frequency

Background: Competency-based medical education is becoming the new standard for residency programs, including Emergency Medicine (EM). To inform programmatic restructuring, guide resources and identify gaps in publication, we reviewed the published literature on types and frequency of resident assessment.Methods: We searched MEDLINE, EMBASE, PsycInfo and ERIC from Jan 2005 - June 2014. MeSH terms included “assessment,” “residency,” and “emergency medicine.” We included studies on EM residents reporting either of two primary outcomes: 1) assessment type and 2) assessment frequency per resident. Two reviewers screened abstracts, reviewed full text studies, and abstracted data. Reporting of assessment-related costs was a secondary outcome.Results: The search returned 879 articles; 137 articles were full-text reviewed; 73 met inclusion criteria. Half of the studies (54.8%) were pilot projects and one-quarter (26.0%) described fully implemented assessment tools/programs. Assessment tools (n=111) comprised 12 categories, most commonly: simulation-based assessments (28.8%), written exams (28.8%), and direct observation (26.0%). Median assessment frequency (n=39 studies) was twice per month/rotation (range: daily to once in residency). No studies thoroughly reported costs.Conclusion: EM resident assessment commonly uses simulation or direct observation, done once-per-rotation. Implemented assessment systems and assessment-associated costs are poorly reported. Moving forward, routine publication will facilitate transitioning to competency-based medical education.

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