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

  • Jonathan Sherbino (a1), Glen Bandiera (a2), Ken Doyle (a3), Jason R. Frank (a4), Brian R. Holroyd (a5), Gord Jones (a6), Joanne Norum (a5), Carolyn Snider (a7) and Kirk Magee (a8)...

Abstract

Canadian 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.

La formation des spécialistes au niveau de la résidence en médecine d'urgence (MU) au Canada est actuellement en voie de connaître la transformation la plus importante de son histoire. Il sera question, dans l'article, de la justification, du processus et de la nouvelle conception de la formation médicale axée sur les compétences en MU. Au nombre des raisons sous-tendant l’évolution de la formation au niveau de la résidence figurent : 1) une plus grande confiance du public à l’égard de cette spécialité grâce à une transparence accrue de la qualité et de la rigueur de la formation; 2) une meilleure reddition de compte fiscale au gouvernement et aux établissements en ce qui concerne la formation des spécialistes en MU; 3) l’établissement de meilleurs systèmes d’évaluation visant à remplacer le fonctionnement inadéquat des rapports d’évaluation en fin de stage et à mettre fin à l'importance exagérée accordée aux examens en fin de formation; 4) un apprentissage adapté aux besoins individuels des résidents. Un groupe de travail, composé de membres provenant de différentes régions et représentant différentes parties, s'est réuni un certain nombre de fois, sur une période de deux ans, et a convenu d'un processus de consensus pour les prises de décision. Le nouveau programme de formation au niveau de la résidence comprend quatre éléments clés : 1) l'atteinte de résultats précis en MU, en tant que spécialité, au cours de la résidence; 2) l’élaboration de quatre stages progressifs de formation, en lien avec les expériences nécessaires d'apprentissage et les activités professionnelles confiables quant aux compétences à acquérir à chaque stage; 3) un apprentissage personnalisé, fondé sur la flexibilité des programmes de résidence et la souplesse des apprenants, afin de s'adapter aux ressources locales et aux besoins des stagiaires; 4) une évaluation « programmatique » qui met l'accent sur les évaluations systématiques et longitudinales provenant de différentes sources, et sur les capacités sentinelles. Enfin, il faudra procéder ultérieurement, dans le cadre d'une étude, à une évaluation du programme afin de s'assurer de l'atteinte des objectifs visés et de relever l’émergence de résultats collatéraux non recherchés.

Copyright

Corresponding author

Correspondence to: Dr. Jonathan Sherbino, DBHSC Room 5003, 1280 Main St. West, Hamilton, ON L8P 1H6; Email: sherbino@mcmaster.ca

References

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1.Elyas, R. The birth of a new specialty: The history of emergency medicine in Canada. In: The Proceedings of the 16th Annual History of Medicine Days (ed. Stapleton, M). Calgary: University of Calgary; 2007, 277–86.
2.Royal College of Physicians and Surgeons of Canada. Competence by Design (CBD): moving towards competency-based medical education; 2015. Available at: http://www.royalcollege.ca/portal/page/portal/rc/resources/cbme (accessed March 4, 2019).
3.Carraccio, CL, Englander, R. From Flexner to competencies. Acad Med 2013;88(8):1067–73.
4.Frenk, J, Chen, L, Bhutta, ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010;376(9756):1923–58.
5.Frank, JR, Snell, LS, Cate, OT, et al. Competency-based medical education: theory to practice. Med Teach 2010;32(8):638–45.
6.Holmboe, ES, Sherbino, J, Englander, R, Snell, L, Frank, JR. A call to action: the controversy of and rationale for competency-based medical education. Med Teach 2017;39(6):574–81.
7.Colin, L. With college and hospital actions soaring, the CMPA recalibrates. Med Post 2017. Revised April 18, 2017. Available at: http://www.canadianhealthcarenetwork.ca/physicians/news/with-college-and-hospital-actions-soaring-the-cmpa-recalibrates-49438 (accessed March 12, 2019).
8.Collaborative Working Group on the Future of Emergency Medicine in Canada. Final Report of the Collaborative Working Group on the Future of Emergency Medicine in Canada; 2016. Available at: http://caep.ca/sites/caep.ca/files/caep/cwg0001_cwg-em_report_-_august_-_final_web.pdf (accessed March 4, 2019).
9.Nousiainen, MT, Mironova, P, Hynes, M, et al. Eight-year outcomes of a competency-based residency training program in orthopedic surgery. Med Teach 2018;40(10):1042–54.
10.Iobst, WF, Sherbino, J, Ten, Cate O, et al. Competency-based medical education in postgraduate medical education. Med Teach 2010;32(8):651–6.
11.Chan, TM, Sherbino, J, Mercuri, M. Nuance and noise: lessons learned from longitudinal aggregated assessment data. J Grad Med Educ 2017;9(6):724–9.
12.Hall, AK, Rich, J, Dagnone, J, et al. P061: implementing CBME in emergency medicine: lessons learned from the first 6 months of transition at Queen's University. CJEM 2018;20(S1):S78.
13.Van Melle, E, Frank, JR, Holmboe, ES, Stockley, D, Sherbino, J. A core components framework for evaluating implementation of competency-based medical education programs. Acad Med 2019;epub.
14.Frank, JR, Snell, L, Sherbino, J, eds. CanMEDS 2015 Physician Competency Framework. Royal College of Physicians and Surgeons of Canada; 2015. Available at: http://canmeds.royalcollege.ca/uploads/en/framework/CanMEDS2015Framework_EN_Reduced.pdf (accessed March 4, 2019).
15.Personal Correspondence. C. Abbot. Manager of CanMEDS, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada. Contacted February 15, 2019.
16.Dreyfus, HL, Dreyfus, SE. Mind over machine. New York: Simon & Schuster; 1986.
17.Ericsson, KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med 2008;15(11):988–94.
18.Chan, T, Sebok-Syer, S, Thoma, B, et al. Learning analytics in medical education assessment: the past, the present, and the future. AEM Educ Train 2018;2(2):178–87.
19.Harris, P, Bhanji, F, Topps, M, et al. Evolving concepts of assessment in a competency-based world. Med Teach 2017;39(6):603–8.
20.Sherbino, J, Bandiera, G, Frank, JR. Assessing competence in emergency medicine trainees: an overview of effective methodologies. CJEM 2008;10(4):365–71.
21.Chan, T, Sherbino, J, McMAP Collaborators. The McMaster Modular Assessment Program (McMAP). Acad Med 2015;90(7):900–5.
22.Englander, R, Frank, JR, Carraccio, C, et al. Toward a shared language for competency-based medical education. Med Teach 2017;39(6):582–7.
23.Acai, A, Li, S-A, Sherbino, J, Chan, TM. Attending emergency physicians’ perceptions of a programmatic workplace-based assessment system: the McMaster Modular Assessment Program (McMAP). Teach Learn Med 2019;epub:1–11.
24.Li, S-A, Sherbino, J, Chan, TM. McMaster Modular Assessment Program (McMAP) through the years: residents’ experience with an evolving feedback culture over a 3-year period. AEM Educ Train 2017;1(1):514.
25.Hauer, KE, Chesluk, B, Iobst, W, et al. Reviewing residents’ competence. Acad Med 2015;90(8):1084–92.
26.Hauer, KE, Cate, O Ten, Boscardin, CK, et al. Ensuring resident competence: a narrative review of the literature on group decision making to inform the work of clinical competency committees. J Grad Med Educ 2016;8(2):156–64.
27.Cooney, R, Chan, T, Gottlieb, M, et al. Academic Primer Series: key papers about competency-based medical education. West J Emerg Med 2017;18(4):713–20.
28.Norman, G, Norcini, J, Bordage, G. Competency-based education: milestones or millstones? J Grad Med Educ 2014;6(1):16.
29.Van Melle, E, Gruppen, L, Holmboe, ES, et al. Using contribution analysis to evaluate competency-based medical education programs: it's all about rigor in thinking. Acad Med 2017;92(6):752–8.
30.Royal College of Physicians and Surgeons of Canada. Emergency medicine competencies; 2018. Available at: http://www.royalcollege.ca/rcsite/ibd-search-e?N=10000033+10000034+4294967050 (accessed March 4, 2019).
31.Gofton, WT, Dudek, NL, Wood, TJ, Balaa, F, HAmstra, SJ. The Ottawa surgical competency operating room evaluation ()-SCORE): a tool to assess surgical competence. Acad Med 2012;87(10):1401–7.

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

  • Jonathan Sherbino (a1), Glen Bandiera (a2), Ken Doyle (a3), Jason R. Frank (a4), Brian R. Holroyd (a5), Gord Jones (a6), Joanne Norum (a5), Carolyn Snider (a7) and Kirk Magee (a8)...

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