Era Of Competency-based Medical Education Research Articles

Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education

ABSTRACT Introduction Since 2022, all Canadian post-graduate medical programs have transitioned to a Competence by Design (CBD) model within a Competency-Based Medical Education (CBME) framework. The CBME model emphasized more frequent, formative assessment of residents to evaluate their progress towards predefined competencies in comparison to traditional medical education models. Faculty members therefore have increased responsibility for providing assessments to residents on a more regular basis, which has associated challenges. Our study explores faculty assessment behaviours within the CBD framework and assesses their openness to opportunities aimed at improving the quality of written feedback. Specifically, we explore faculty’s receptiveness to routine metric performance reports that offer comprehensive feedback on their assessment patterns. Methods Online surveys were distributed to all 28 radiology faculty at Queen’s University. Data were collected on demographics, feedback practices, motivations for improving the teacher-learner feedback exchange, and openness to metric performance reports and quality improvement measures. Following descriptive statistics, unpaired t-tests and one-way analysis of variance were conducted to compare groups based on experience and subspecialty. Results The response rate was 89% (25/28 faculty). 56% of faculty were likely to complete evaluations after working with a resident. Regarding the degree to which faculty felt written feedback is important, 62% found it at least moderately important. A majority (67%) believed that performance reports could influence their evaluation approach, with volume of written feedback being the most likely to change. Faculty expressed interest in feedback-focused development opportunities (67%), favouring Grand Rounds and workshops. Conclusion Assessment of preceptor perceptions reveals that faculty recognize the importance of offering high-quality written feedback to learners. Faculty openness to quality improvement interventions for curricular reform relies on having sufficient time, knowledge, and skills for effective assessments. This suggests that integrating routine performance metrics into faculty assessments could serve as a catalyst for enhancing future feedback quality.

Bridging the Gap: Inclusive Training for All Faculties in the Era of Competency-Based Medical Education

Bridging the Gap: Inclusive Training for All Faculties in the Era of Competency-Based Medical Education

Changing Roles of Medical Teachers in the Era of Competency-based Medical Education

Changing Roles of Medical Teachers in the Era of Competency-based Medical Education

PD30-06 A NOVEL SYSTEM FOR TEACHING INTRAOPERATIVE LAPAROSCOPIC SKILLS USING STANDARDIZED COMMUNICATION AND AN ENDOSCOPIC MONITOR FRAME OF REFERENCE TOOL

You have accessJournal of UrologyCME1 Apr 2023PD30-06 A NOVEL SYSTEM FOR TEACHING INTRAOPERATIVE LAPAROSCOPIC SKILLS USING STANDARDIZED COMMUNICATION AND AN ENDOSCOPIC MONITOR FRAME OF REFERENCE TOOL Kikachukwu Otiono, Jennifer Hoogenes, Kevin Kim, Bobby Shayegan, Anil Kapoor, Kevin Piercey, and Edward D. Matsumoto Kikachukwu OtionoKikachukwu Otiono More articles by this author , Jennifer HoogenesJennifer Hoogenes More articles by this author , Kevin KimKevin Kim More articles by this author , Bobby ShayeganBobby Shayegan More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Kevin PierceyKevin Piercey More articles by this author , and Edward D. MatsumotoEdward D. Matsumoto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003316.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Directional terminology in the operating room (OR) during laparoscopic surgery is a common source of confusion for trainees, as the spatial orientation of the on-screen operative field differs depending on the viewer’s perspective and frame of reference. We developed and evaluated the utility and feasibility of 2 endoscopic monitor screen overlays designed to standardize directional instruction. METHODS: For a baseline perspective on laparoscopic instruction, we video-recorded and qualitatively analyzed 20 teaching cases. We then designed and printed 2 transparent endoscopic monitor overlays: an alphanumeric grid (AG) and a clock. In a laparoscopic simulation lab, 63 medical students were randomized into 3 groups of 21: control, AG, and clock. AG and clock groups were given overlay-specific instructions. All groups completed 3 trials of 6 transfer tasks. Completion and error rates were recorded. We then trialed the overlays in 44 teaching cases in urology and general surgery (30 AG and 14 clock). All cases were video recorded, transcribed, and qualitatively analyzed. Participants completed follow-up experiential surveys with 6-point Likert scales of agreement and space for comments. RESULTS: In the baseline cases, instructors often used directional terms (e.g., screen left/right; up/down) and pointed to the screen during instruction. In the simulation study, the AG group demonstrated the lowest error rates which became significant by trial 3 (p=0.01). 6 instructors and 21 residents from urology (n=14) and general surgery (n=7) participated in the intraoperative evaluation of the overlays. Instructors rated the AG higher than the clock in improving efficiency and hand-eye coordination (p’s<0.001) and agreed that it should be used in the residency program. Trainees rated the AG higher in improving operative technique and confidence in the OR (p’s<0.001). Instructors were more likely to recommend use of the AG over the clock (p=0.004). CONCLUSIONS: We showed that an AG overlay used with standardized commands significantly improved instruction and learning during simulated and live laparoscopic cases. Further work will involve the evaluation of the economy of motion and errors while using the overlay. This could lead to the use of a heads-up display for laparoscopic and robotic training. Further exploration of instructor-trainee discourse is necessary when considering the development and implementation of new methods to improve intraoperative teaching in the era of competency-based medical education. Source of Funding: McMaster Surgical Associates, McMaster University, Hamilton, Ontario, Canada © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e833 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kikachukwu Otiono More articles by this author Jennifer Hoogenes More articles by this author Kevin Kim More articles by this author Bobby Shayegan More articles by this author Anil Kapoor More articles by this author Kevin Piercey More articles by this author Edward D. Matsumoto More articles by this author Expand All Advertisement PDF downloadLoading ...

An overview of Internal Medicine Point-of-Care Ultrasound rotations in Canada

BackgroundPoint-of-care ultrasound (POCUS) is a growing part of internal medicine training programs. Dedicated POCUS rotations are emerging as a particularly effective tool in POCUS training, allowing for longitudinal learning and emphasizing both psychomotor skills and the nuances of clinical integration. In this descriptive paper, we set out to review the state of POCUS rotations in Canadian Internal Medicine training programs.ResultsWe identify five programs currently offering a POCUS rotation. These rotations are offered over two to thirteen blocks each year, run over one to four weeks and support one to four learners. Across all programs, these rotations are set up as a consultative service that offers POCUS consultation to general internal medicine inpatients, with some extension of scope to the hospitalist service or surgical subspecialties. The funding model for the preceptors of these rotations is predominantly fee-for-service using consultation codes, in addition to concomitant clinical work to supplement income. All but one program has access to hospital-based archiving of POCUS exams. Preceptors dedicate ten to fifty hours to the rotation each week and ensure that all trainee exams are reviewed and documented in the patient’s medical records in the form of a consultation note. Two of the five programs also support a POCUS fellowship. Only two out of five programs have established learner policies. All programs rely on In-Training Evaluation Reports to provide trainee feedback on their performance during the rotation.ConclusionsWe describe the different elements of the POCUS rotations currently offered in Canadian Internal Medicine training programs. We share some lessons learned around the elements necessary for a sustainable rotation that meets high educational standards. We also identify areas for future growth, which include the expansion of learner policies, as well as the evolution of trainee assessment in the era of competency-based medical education. Our results will help educators that are endeavoring setting up POCUS rotations achieve success.

Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: an Institutional Implementation Pilot Study.

Canadian radiation oncology (RO) residency programs transitioned to a competency-based medical education (CBME) training model named Competence by Design (CBD) in July 2019. Prior to this, CBD was piloted in a single RO training program to characterize assessment completion and challenges of implementation. Six residents and seven staff participated in a mixed-methods study and were oriented to CBD. Four Entrustable Professional Activities were assessed over a 4-week-long block and documented using online assessment forms. Anonymized assessments were analyzed to characterize completion. Post-pilot surveys were completed by 4/6 residents and 5/7 staff. Semi-structured post-pilot focus groups were conducted with all residents. Assessments were requested and documented on a weekly basis. Narrative comments were found in 68.1% of assessments, of which 26.7% described specific examples of observed competence or recommendations for improvement. Three of five staff believed that assessments have a negative impact on clinical workflow. Three themes were identified: (1) direct observation is the most challenging aspect of CBD to implement; (2) feedback content can be improved; and (3) staff attitude, clinical workflow, and inaccessibility of assessment forms are the primary barriers to completing assessments. This study demonstrates that CBD assessments can be completed regularly in an outpatient radiation oncology setting and that implementation challenges include improving feedback quality, promoting direct observation, and continuing faculty development to improve perceptions of this assessment model. Further study is required to identify best practices and expectations for the discipline in the era of CBME.

Rationales for a Lottery Among the Qualified to Select Medical Trainees: Decades of Dutch Experience

Rationales for a Lottery Among the Qualified to Select Medical Trainees: Decades of Dutch Experience

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Experiences of Faculty Members Giving Corrective Feedback to Medical Trainees in a Clinical Setting.

Imperative to medical training is the observation and provision of feedback. In this era of competency-based medical education, feedback is one of the core components of this new model. A better understanding of the medical faculty's attitudes and experiences when providing feedback is essential. Currently, there are limited qualitative studies that have explored attitudes and experiences of faculty members when giving corrective feedback to medical trainees. To allow an in-depth exploration of this phenomenon, a hermeneutics phenomenology approach was used, by conducting semistructured interviews with 10 faculty members representing six disciplines and used thematic analysis to create data-driven codes and identify key themes through an iterative consensus-building process. Four themes were identified by the authors: (1) Elements of effective feedback, (2) Faculty members' perception of giving corrective feedback, (3) Challenges as it relates to the assessment culture of the institution, and (4) Providing effective corrective feedback as a mutual process focused on relationship building between learners and preceptors. By exploring faculty members' perceptions of providing perceived corrective feedback, we identified actionable recommendations based on the study participants' experiences, expectations, and challenges which could be addressed involving future faculty development with the focus on modifying concepts of feedback and institutional changes that will promote an attitudinal and a cultural shift.

Procedural skill needs for Canadian paediatricians: A national profile.

Procedural practice by paediatricians in Canada is evolving. Little empirical information is available on the procedural competencies required of general paediatricians. Accordingly, the aim of this study was to conduct a needs assessment of Canadian general paediatricians to identify procedural skills required for practice, with the goal of informing post-graduate and continuing medical education. A survey was sent to paediatricians through the Canadian Paediatric Surveillance Program (CPSP) (www.cpsp.cps.ca/surveillance). In addition to demographic information about practice type and location, participants were asked to indicate the frequency with which they performed each of 32 pre-selected procedures and whether each procedure was considered essential to their practice. The survey response rate was 33.2% (938/2,822). Data from participants who primarily practice general paediatrics were analyzed (n=481). Of these, 71.0% reported performing procedures. The most frequently performed procedures were: bag-valve-mask ventilation of an infant, lumbar puncture, and ear curettage, being performed monthly by 40.8%, 34.1%, and 27.7% of paediatricians, respectively. The procedures performed by most paediatricians were also those found most essential to practice, with a few exceptions. Respondents performed infant airway procedures with greater frequency and rated them more essential when compared to the same skill performed on children. We found a negative correlation between procedures being performed and difficulty maintaining proficiency in a skill. This report of experiences from Canadian general paediatricians suggests a wide variability in the frequency of procedural performance. It helps establish priorities for post-graduate and continuing professional medical education curricula in the era of competency-based medical education.

Workplace-based Assessment Data in Emergency Medicine: A Scoping Review of the Literature.

In the era of competency-based medical education (CBME), the collection of more and more trainee data is being mandated by accrediting bodies such as the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada. However, few efforts have been made to synthesize the literature around the current issues surrounding workplace-based assessment (WBA) data. This scoping review seeks to synthesize the landscape of literature on the topic of data collection and utilization for trainees' WBAs in emergency medicine (EM). The authors conducted a scoping review in the style of Arksey and O'Malley, seeking to synthesize and map literature on collecting, aggregating, and reporting WBA data. The authors extracted, mapped, and synthesized literature that describes, supports, and substantiates effective data collection and utilization in the context of the CBME movement within EM. Our literature search retrieved 189 potentially relevant references (after removing duplicates) that were screened to 29 abstracts and papers relevant to collecting, aggregating, and reporting WBAs. Our analysis shows that there is an increasing temporal trend toward contributions in these topics, with the majority of the papers (16/29) being published in the past 3years alone. There is increasing interest in the areas around data collection and utilization in the age of CBME. The field, however, is only beginning to emerge, leaving more work that can and should be done in this area.

Managing residents in difficulty within CBME residency educational systems: a scoping review

BackgroundBest practices in managing residents in difficulty (RID) in the era of competency-based medical education (CBME) are not well described. This scoping review aimed to inventory the current literature and identify major themes in the articles that address or employ CBME as part of the identification and remediation of residents in difficulty.MethodsArticles published between 2011 to 2017 were included if they were about postgraduate medical education, RID, and offered information to inform the structure and/or processes of CBME. All three reviewers performed a primary screening, followed by a secondary screening of abstracts of the chosen articles, and then a final comprehensive sub-analysis of the 11 articles identified as using a CBME framework.ResultsOf 165 articles initially identified, 92 qualified for secondary screening; the 63 remaining articles underwent full-text abstracting. Ten themes were identified from the content analysis with “identification of RID” (41%) and “defining and classifying deficiencies” (30%) being the most frequent. In the CBME article sub-analysis, the most frequent themes were: need to identify RID (64%), improving assessment tools (45%), and roles and responsibilities of players involved in remediation (27%). Almost half of the CBME articles were published in 2016–2017.ConclusionsAlthough CBME programs have been implemented for many years, articles have only recently begun specifically addressing RID within a competency framework. Much work is needed to describe the sequenced progression, tailored learning experiences, and competency-focused instruction. Finally, future research should focus on the outcomes of remediation in CBME programs.

Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic

The COVID-19 pandemic has disrupted healthcare systems around the world, impacting how we deliver medical education. The normal day-to-day routines have been altered for a number of reasons, including changes to scheduled training rotations, physical distancing requirements, trainee redeployment, and heightened level of concern. Medical educators will likely need to adapt their programs to maximize learning, maintain effective care delivery, and ensure competent graduates. Along with a continued focus on learner/faculty wellness, medical educators will have to optimize existing training experiences, adapt those that are no longer viable, employ new technologies, and be flexible when assessing competencies. These practical tips offer guidance on how to adapt medical education programs within the constraints of the pandemic landscape, stressing the need for communication, innovation, collaboration, flexibility, and planning within the era of competency-based medical education.

Should Wellness Be a Core Competency for Physicians?

There has been a recent rise in calls for action around wellness and physician health. In medical education, wellness has been proposed as a physician competency. In this article, the authors review the history of the "wellness as a competency" concept within U.S. and Canadian residency programs and medical schools. Drawing from literature on the discourses of wellness and competence in medical education, they argue that operationalizing wellness as a physician competency holds profound implications for curricula, admissions, evaluation, and licensure. While many definitions of "wellness" and "competency" are used within medical training environments, the authors argue that the definitions institutions ultimately use will have significant impacts for trainees who are considered "unwell." In particular, medical learners with disabilities-including those with mental health, chronic health, learning, sensory, and mobility disabilities-may not conform to dominant conceptions of "wellness," and there is a risk they will become further stigmatized or even be considered unsuitable to practice in the profession. The authors conclude that framing wellness as a competency has the potential to legitimize support-seeking and prioritize physician health, yet it may also have the potential unintended effect of excluding certain learners from the profession. They propose a universal design approach to understand wellness at a systems level and to remove barriers to wellness for all medical learners.

Aligning Requirements of Training and Assessment in Radiation Treatment Planning in the Era of Competency-Based Medical Education

Radiation treatment planning (RTP) is a unique skill that requires interdisciplinary collaboration among radiation oncologists (ROs), dosimetrists, and medical physicists (MP) to train and assess residents. With the adoption of competency-based medical education (CBME) in Canada, it is essential residency program curricula focuses on developing competencies in RTP to facilitate entrustment. Our study investigates how radiation oncology team members' perspectives on RTP education align with requirements of the CBME approach, and its implications for improving residency training. This qualitative research study took place in the Department of Oncology at a midsize academic institution. Through convenience sampling, focus groups were conducted with radiation oncologists (n = 11), dosimetrists (n = 7), medical physicists (n = 7), and residents (n = 7). Thematic design was adopted to analyze the transcripts through open coding resulting in 3 overarching themes. The results identified existing strengths and weaknesses of the residency program and future opportunities to redesign the curriculum and assessment process within a CBME model. Three overarching themes emerged from the analysis: (1) the strengths of RTP in the CBME environment; (2) challenges of RTP in CBME; and (3) opportunities for change. Stakeholders were optimistic CBME will help enrich resident learning with the increased frequency and quality of competency-based assessments. Participants suggested building a library of cases and developing computer-based learning resources to provide a safe environment to develop skills in contouring, dosimetry, and plan evaluation, in accordance with CBME training. This study identified future opportunities to redesign the RTP curriculum and assessment process within a CBME model. The need for innovative teaching and learning strategies, including case libraries, computer-based learning, and quality assessments, were highlighted in designing an innovative RTP planning curriculum.

A Matter of Trust

Trust is a fundamental tenet of the patient-physician relationship and is central to providing person-centered care. Because trust is profoundly relational and social, building trust requires navigation around issues of power, perceptions of competence, and the pervasive influence of unconscious bias-processes that are inherently complex and challenging for learners, even under the best of circumstances. The authors examine several of these challenges related to building trust in the patient-physician relationship. They also explore trust in the student-teacher relationship. In an era of competency-based medical education, a learner has the additional duty to be perceived as "entrustable" to 2 parties: the patient and the preceptor. Dialogue, a relational form of communication, can provide a framework for the development of trust. By engaging people as individuals in understanding each other's perspectives, values, and goals, dialogue ultimately strengthens the patient-physician relationship. In promoting a sense of agency in the learner, dialogue also strengthens the student-teacher relationship by fostering trust in oneself through development of a voice of one's own.

Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review.

Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.

Video-Based Assessment in Surgical Education: A Scoping Review

Video-based assessment of residents' surgical skills may offer several advantages over direct observations of clinical performance in terms of objectivity, time-efficiency, and feasibility. Although video-based assessment is becoming more common in surgical training, a broad understanding of its utility is lacking. This scoping review explores video-based assessment in surgical training and presents the evidence supporting its use. A literature search was conducted using the Web of Science database with key words related to video-based assessment and surgical training. Exclusion criteria included articles not published in English and articles on undergraduate medical education, continuing professional development, or non-surgical disciplines. Initially, 702 articles were identified; after title, abstract, and full-text screening by two independent reviewers (SM and VM), 199 articles remained. We present the benefits of video-based assessment, including the ability to capture clinical ability in the operating room without decreasing intraoperative efficiency, as well as the potential to improve formative assessment and feedback practices. We describe the validity, reliability, and challenges of video-based assessment, as well as the use of video-based methods in clinical and simulated settings. We conclude by discussing questions that remain to be addressed. Although further research and cost-benefit analyses are required, greater adoption of video-based assessment into surgical training may help meet increased assessment demands in an era of competency-based medical education.

159 Procedural Skills Needs for Canadian Paediatricians: A National Snapshot

Procedural practice by paediatricians in Canada is likely evolving. The availability of non- or minimally invasive technologies, practice type, geographical variation, and the expanding scope of multiprofessional providers are examples of factors that may contribute to such changes. There is, however, limited knowledge of the procedural competencies required of general paediatricians today. An accurate understanding of the skills required is vital for planning, preparing, and allocating limited educational resources both for current and future paediatricians. The primary objective of the study was to conduct a comprehensive analysis of the procedural practice of Canadian paediatricians, with the aim of building a needs assessment for independent general paediatric practice. A one-time survey was sent to paediatricians through the Canadian Paediatric Surveillance Program (CPSP) (www.cpsp.cps.ca/surveillance). In addition to demographic information about practice type and location, participants were asked to indicate the frequency with which they performed each of 32 pre-selected procedures. The procedure list was developed in consultation with CPSP members and a variety of paediatricians. Data was combined and summarized descriptively, with valid percentages calculated where appropriate. The survey response rate was 33% (938/2,822). Of the respondents, 589 (63%) participated either partly or entirely in general paediatrics practice, and 245 (42%) had practiced for > 20 years. All provinces were represented, and practice styles ranged from urban tertiary care to remote/rural. Of the respondents who practice general paediatrics, 71% reported performing procedures. Regularly performed procedures (at least monthly) included bag-mask ventilation for infants, lumbar puncture, ear curettage, peripheral intravenous line insertion and immunization (indicated by 54%, 48%, 39%, 27%, 25% of respondents, respectively). Rarely performed procedures (yearly or less) included chest compressions, intraosseous insertion, intubation, chest tube insertion and defibrillation (80%, 65%, 57%, 53%, 52%, respectively). Procedures reported as never performed included peripheral intravenous central catheter (PICC) line insertion, central venous line (CVL) insertion, arterial line insertion, tracheostomy tube change and thoracentesis (90%, 89%, 82%, 76%, 73%, respectively). This report of real-world experiences from Canadian general paediatricians suggests a wide variability in the frequency of procedural performance. It helps to establish priorities for continuing professional educational activities and postgraduate medical education curricula in the era of competency-based medical education. Additional investigation on importance and maintenance of proficiency of these procedures would be of added value to this needs assessment, and has been undertaken by the research group.

Addressing the opioid crisis in the era of competency-based medical education: recommendations for emergency department interventions.

Addressing the opioid crisis in the era of competency-based medical education: recommendations for emergency department interventions.