Review of Challenges to the Implementation of Competence by Design in Post-Graduate Medical Education: What Can Diagnostic Radiology Learn from the Experience of Other Specialty Disciplines?

The Surgical Education Checklist: A Novel Tool to Improve the Use of Entrustable Professional Activities in Operative Training in Competence by Design

OBJECTIVE

Surgical residents face significant challenges in meeting Entrustable Professional Activity (EPA) assessment requirements under the Competence By Design (CBD) framework, potentially impacting their surgical training and readiness for practice. This study seeks to assess the effectiveness of the Surgical Education Checklist (SEC) in increasing the proportion of completed EPA assessments within the Division of General Surgery.

DESIGN

This prospective cohort study implemented the SEC between January 1, 2023, and June 30, 2023. A pre and postchecklist survey collected experiences with the SEC and overall CBD framework. The primary outcome was the proportion of completed EPA assessments. Descriptive statistics were reported and subgroup analyses were performed based on resident postgraduate year (PGY).

SETTING

About 5 tertiary academic-affiliated teaching hospitals with McMaster University (Hamilton, Ontario) PARTICIPANTS: All general surgery residents and staff faculty were invited to utilize the survey, with an approximate sample size of 71 participants. The overall response rate was 34 (47.9%) for the prechecklist survey and 11 (15.5%) for the postchecklist survey.

RESULTS

The number of EPA assessments triggered increased from 485 to 639, with a significant increase in the absolute number of EPA assessments completed (400 vs 477, p < 0.01). There was an increase in the proportion of expired assessments (85 [17.5%] vs 162 [25.4%], p < 0.01) after the implementation of the SEC. In the subgroup analysis based on resident PGY, PGY1 to 3 general surgery residents triggered significantly more EPA assessments after the implementation of the SEC.

CONCLUSIONS

The SEC demonstrated its effectiveness as a perioperative prompt for triggering EPA assessments, particularly amongst junior general surgery residents, indicating its potential to facilitate early engagement with essential surgical training tasks. However, there remains gaps in follow-through and completion of triggered EPA assessments.

Could entrustable professional activities support assessment in optometric clinical education in Australia and New Zealand?

Entrustable professional activities (EPAs) are increasingly being adopted as an assessment tool by medicine and other health professions in a bid to enhance competency-based health professional education. EPAs are well-defined professional activities that can be entrusted to students to perform with varying levels of supervision. They were introduced to overcome some of the limitations of traditional assessment methods of competency such as individual skills assessment or Direct Observation of Procedures and Objective Structured Clinical Examinations. Could EPAs be beneficial in Australian and New Zealand optometric clinical education for advanced skills training and accreditation including the credentialing assessment of overseas educated practitioners? This paper discusses the historical context of how competencies were introduced and assessed in Australian optometry, the evolution of the concept of EPAs in medicine and other health professions, their design and implementation worldwide and whether EPAs could be adopted into optometric training and assessment in Australia and New Zealand.

Competency-Based Cardiology Training: A Simple Approach to Improve Supervisor Completion of Entrustable Professional Activities

Background

Adult cardiology residency programs formally transitioned to Competency by Design (CBD) in July 2021. CBD was designed to establish clear learning expectations and increase opportunities for coaching; however, cited challenges include inconsistent participation by staff, and variable timelines for receiving feedback. This project was designed to implement a simple intervention to improve expiry rates and completion timelines of entrustable professional activities (EPAs).

Methods

EPAs triggered by cardiology residents at Dalhousie University between July 1, 2020 and February 28, 2023 were reviewed. The intervention consisted of performance reviews, including a grand rounds presentation, along with a personalized data set distributed to each staff supervisor, with individual statistics compared to group averages. Outcomes include EPAs completed per resident-months, time to completion, and percentage of expired EPAs.

Results

At 12 months postintervention, the percentage of expired EPAs decreased from 35.0% to 21.5% (odds ratio 0.51, CI 0.33-0.79; P = 0.03), and the time to completion decreased from 7.3 ± 5.99 days to 5.0 ± 5.78 days (difference -2.31, CI -3.55 to -1.07; P < 0.001). The number of EPAs completed per resident-months increased from 3.10 to 4.29 (rate difference 1.18; CI 0.64-1.72; P < 0.001), and the percentage of EPAs completed within the target time of 48 hours increased from 54.4% to 71.5% (OR 2.11, CI 1.27-3.50; P = 0.004).

Conclusions

Performance reviews in the form of a group presentation, along with the distribution of personalized data sets to supervisors, positively impacted EPA expiry rates, completion timelines, and completion rates, which helped facilitate the transition to CBD.

Standardizing clinician training and patient care in the neonatal neurocritical care: A step-by-step guide

Neonatal neurocritical care (NNCC) has emerged as an important specialty to address neurological conditions affecting newborns including a wide spectrum of brain injuries and developmental impairment. Despite the discipline's growth, variability in NNCC service delivery, patient care, and clinical training poses significant challenges and potentially adversely impacts patient outcomes. Variations in neuroprotective strategies, postnatal care, and training methodologies highlight the urgent need for a unified approach to optimize both short- and long-term neurodevelopmental outcomes for these vulnerable population. This paper presents strategic blueprints for establishing standardized NNCC clinical care and training programs focusing on collaborative effort across medical and allied health professions. By addressing these inconsistencies, the paper proposes that standardizing NNCC practices can significantly enhance the quality of care, streamline healthcare resource utilization, and improve neurodevelopmental outcome, thus paving the way for a new era of neonatal neurological care.

Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program

Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.

Evaluating Competence by Design as a Large System Change Initiative: Readiness, Fidelity, and Outcomes

Program evaluation is an essential, but often neglected, activity in any transformational educational change. Competence by Design was a large-scale change initiative to implement a competency-based time-variable educational system in Canadian postgraduate medical education. A program evaluation strategy was an integral part of the build and implementation plan for CBD from the beginning, providing insights into implementation progress, challenges, unexpected outcomes, and impact. The Competence by Design program evaluation strategy was built upon a logic model and three pillars of evaluation: readiness to implement, fidelity and integrity of implementation, and outcomes of implementation. The program evaluation strategy harvested from both internally driven studies and those performed by partners and invested others. A dashboard for the program evaluation strategy was created to transparently display a real-time view of Competence by Design implementation and facilitate continuous adaptation and improvement. The findings of the program evaluation for Competence by Design drove changes to all aspects of the Competence by Design implementation, aided engagement of partners, supported change management, and deepened our understanding of the journey required for transformational educational change in a complex national postgraduate medical education system. The program evaluation strategy for Competence by Design provides a framework for program evaluation for any large-scale change in health professions education.

National Core and Advanced Cardiac Imaging Curricula: A Framework From the Canadian Society of Thoracic Radiology Education Committee

RATIONALE

Well-defined curriculum with goals and objectives is an inherent part of every radiology residency program.

MATERIALS AND METHODS

Following a needs assessment, the Canadian Society of Thoracic Radiology education committee developed a cardiac imaging curriculum using a mixed method collaborative approach.

RESULTS

The Cardiovascular Imaging Curricula consist each of two separate yet complimentary granular parts: a Core Curriculum, aimed at residents in-training, with the main goal of building a strong foundational knowledge and an Advanced Curriculum, designed to build upon the core knowledge and guide a more in-depth fellowship subspecialty training.

CONCLUSION

The curricular frameworks aim to enhance the educational experience of trainees (residents and fellows) and provide an educational framework for clinical supervisors and residency and fellowship program directors.

SUMMARY STATEMENT

The Canadian Society of Thoracic Radiology (CSTR) championed the creation of Cardiovascular and Thoracic Imaging curricula encompassing clinical knowledge and technical, communication, and decision-making skills with the goal of providing direction to a strong foundational knowledge for residents and to guide specialty training for fellowship programs.