Competency-Based Medical Education: Considering Its Past, Present, and a Post-COVID-19 Era

Confidence Among Graduating Dental Students on Their Competencies During the COVID-19 Pandemic

OBJECTIVE

To assess the confidence of graduating dental students affected by the COVID-19 pandemic's clinic closure and restrictions and again after their first year of practice.

METHODS

Previously validated online surveys were sent to the University of Toronto classes of 2021 (n = 118, "21S") and 2022 (n = 120, "22S") at graduation and after 1 year of practice as dentists ("21D," "22D"), asking about their confidence in performing competencies of the Association of Canadian Faculties of Dentistry. Analyses included demographics, mean values of Likert scale responses, independent samples t-tests for comparison between groups, one-way ANOVA for comparison between multiple groups, followed by post hoc pairwise comparison using Tukey's tests using statistical significance of p < 0.05.

RESULTS

Response rates were 43% (21S), 44% (22S), 30.5% (21D), and 17.5% (22D). Students (21S) were more confident than 22S (x̄21S = 3.67, x̄22S = 3.25, p < 0.01). Dentists were statistically more confident "practicing general dentistry" than when they were students (x̄22D = 3.71, x̄22S = 3.25, p < 0.05). There were no statistical differences between dentist groups "practicing general dentistry" (x̄21D = 3.83, x̄22D = 3.71) in this study. Within students (22S), males were more confident than females for "prosthodontic competencies" (p < 0.05) and "practicing general dentistry" (p < 0.01), and as dentists, they were more confident in performing surgeries (p < 0.05). For prosthodontics, students (22S) were less confident than 2021 (21S) (p < 0.05); however, after a year in practice, there were no significant differences between groups.

CONCLUSION

These graduates demonstrated a lower confidence in the competencies expected of a new Canadian dentist and after 1 year, there were no differences in confidence in "practicing general dentistry" between groups.

Five years of competency-based medical education in Canadian urology A national survey of senior resident and faculty satisfaction and perspectives

INTRODUCTION

In 2018, competency-based medical education (CBME) was introduced to Canadian urology residency training. We examined learner and faculty experiences with CBME five years post-implementation.

METHODS

Two online surveys were developed from a scoping review of CBME literature and expert consultation. They covered aspects including unintended consequences, satisfaction, and challenges. They were distributed to Canadian urology residency program directors, faculty, and senior residents from January to June 2023. Respondents rated agreement/satisfaction using a five-point Likert scale. Descriptive analyses considered scores of 4-5 as agreement/satisfaction and 1-2 as disagreement/dissatisfaction.

RESULTS

Twenty-nine faculty members (including 10/13 [77%] program directors) and 33/63 (53%) senior residents responded. Overall, 69% of respondents are unsatisfied with CBME, 19% are neutral, and 11% are satisfied. Anxiety and/or fatigue with CBME are reported by 76% of faculty and 66% of residents. CBME is seen as burdensome: 61% of residents frequently trigger assessment requests, while 66% of faculty feel overwhelmed by the volume of requested assessments. Faculty members (83%) and residents (73%) find CBME time-consuming. Over 50% of respondents believe CBME failed to de-emphasize time-based learning, individualize progression, rapidly identify struggling residents, or improve feedback quality. Over 60% agree that CBME has clarified learning expectations and training stages.

CONCLUSIONS

There is prevailing dissatisfaction with CBME within Canadian urology training programs, impacting the well-being of both faculty and residents while falling short of delivering personalized training; however, CBME has provided a structured and transparent framework for trainee advancement. Improvements to CBME are needed beyond its initial five years.

Satisfaction and learning experience of students using online learning platforms for medical education

BACKGROUND

Advancement in medical education has led to the adoption of online learning platforms in the development and execution of learning modules. Online learning platforms are appraised and accessed regarding their capability of ensuring a seamless experience and enhancing satisfaction in users, especially students. In this study, the satisfaction and learning experience of medical students were studied with emphasis on their sociodemographic features.

METHOD

Data were collected using a structured questionnaires distributed to a group of medical students in a medical college in Eastern Nigeria. 300 undergraduate students from Enugu State University of Science and Technology participated in this survey from four departments: anatomy, medical laboratory, nursing, and medicine. The questionnaires included closed-ended questions divided into sociodemographic information, learning experience, and satisfaction with online learning.

RESULT

Results from the survey indicate that sociodemographic factors like the course of study and sex of respondents show a noticeable relationship to the learning experience and satisfaction with online learning platforms while other factors have no impact. The majority of respondents (63.1%) strong agreed that online learning platform effectively delivers medical course content with a mean value of user learning experience of online learning platform as 4.15.

CONCLUSION

Feature perception, learning experience, and satisfaction level of medical students were dependent on their course of study and sex, thus independent course curriculum was relevant in determining satisfaction of students. The findings of this study add to the empirical and practical understanding of students' satisfaction with using online learning platforms as a success in medical education and its use is recommended by other medical institutions.

Trainee Perceptions of a Competency-Based Mid-Career Fellowship in Hospice And Palliative Medicine

Context: The time-variable, competency-based mid-career fellowship in Hospice and Palliative Medicine (HPM) is a multicenter pilot program for physicians who want to train in HPM part-time. Objectives: This study describes the experience of the early cohort of mid-career fellows. Methods: Fellows at the seven sites were surveyed about their perceptions of the program and their confidence in subspecialty skills. Results: Surveys were sent to 13 fellows and completed by 8. All reported positive experiences with curricula, direct observation, feedback, and cross-site case reviews. Most responses were positive regarding individualized learning plans and case-stimulated reviews. Respondents reported high confidence in 9 of the 13 specialty-specific skills, including communication, caring for dying patients, and pain management. They reported less confidence with psychological and non-pain symptoms, spirituality, and prognostication. Fewer than half indicated that the process for graduation was clear. Conclusion: Physicians in the competency-based HPM fellowship report a positive experience and high confidence in subspecialty skills.

Challenges in Implementing Competency-based Medical Education in India - Stakeholders' Perspective: A Mixed-method Analysis

Introduction

Competency-based Medical Education (CBME) was introduced in the year 2019 in India. It has brought about major changes in medical education. The curriculum is learner centric, outcome based, focuses on the development of core competencies and professionalism. However, many institutions have faced challenges during the implementation of the CBME curriculum. This study was aimed at assessing the challenges faced by all the stakeholders (students, faculty, and administrators) of various medical institutions and gather their insights on proposed solutions.

Methodology

This cross-sectional study was conducted over a period of 3 months, from October 1, 2023, to December 31, 2023. The study was conducted in 32 medical colleges across India. A total of 60 faculty of various disciplines, 32 administrators of the institutes, and 580 undergraduate medical students were included in the study. Perception of students and faculty was collected using a validated survey form. One-on-one interview was done for all the 32 administrators using a facilitator guide. A mixed-methods approach was used for quantitative and qualitative data collection and analysis.

Results

Around 40 (66.6%) faculty opined that that deficiency of trained faculty was a significant challenge in implanting CBME curriculum. Twenty (33.3%) of the faculty felt that there is a lack of adequate infrastructure required for the implementation of CBME curriculum. Among the administrators surveyed, 12 (37.5%) felt that dwindling student attendance was a major challenge, whereas 10 (31.5%) felt that there was the lack of collaboration between universities, colleges, and regulatory authorities. Four hundred and twenty-five (73.2%) of students opined that simulation-based training and 435 (75%) students opined that electives were very good initiatives by CBME curriculum. The students found the inclusion of integrated teaching, Attitude, Ethics, and Communication Module, early clinical exposure, and Family Adoption Programme in the CBME curriculum helpful.

Conclusion

CBME curriculum was largely accepted across all the medical colleges. The training of faculty and administrators was considered an important challenge which needs to be considered. Students opined that the newer curricular reforms enhanced their learning.

Challenges faced by medical faculty in implementation of competency-based medical education and lessons learned

BACKGROUND

Regulations on Graduate Medical Education (Amendment), 2019 (GME) introduced competency-based medical education (CMBE) for undergraduate medical students and were implemented in the 2019 entrance batch in medical colleges all over India. This study aimed to find out the challenges faced by medical teachers in CBME implementation, lessons learned, and the level of preparedness for upcoming batches.

MATERIAL AND METHODS

A cross-sectional, multi-centric descriptive study was conducted from November 2021 to February 2022 including first-year faculty of medical colleges. A self-administered questionnaire was provided through electronic media, about challenges faced during CBME implementation and suggestions for improvement. Responses were analyzed as descriptive statistics, and content analysis was conducted for open-ended questions.

RESULTS

A total of 50 responses were analyzed. About 46% believed that the foundation course (FC) could satisfy the GME Regulation's goal to only some extent. About 60% believed that integration was not optimum, and 40% had not taken any integrated session. About 36% had not taken any attitude, ethics and communication (AETCOM) session, and 30% considered that they were not sufficiently competent. About 68% believed that early clinical exposure (ECE) given is insufficient. "Skills" (50%) and "attitude-communication" (34%) could not be satisfactorily assessed. About 72% believed that the coronavirus disease 2019 (COVID-19) pandemic significantly affected academics, 20% are still confused about the complexities of CBME, and 58% believed they are better prepared for the future. The COVID-19 pandemic (78%), lack of proper training (70%), and adequate faculty (60%) were common difficulties. Frequent hands-on workshops (68%) and better inter-departmental coordination (68%) were suggested.

CONCLUSION

First professional-year faculties are slowly getting accustomed to the transition from a traditional to a competency-based curriculum. These reforms are complex, and the challenges need to be addressed sincerely and timely.

Integrating behavioral assessment in instructional design for competency-based medical education

As institutions continuously strive to align with the standards set forth within competency-based medical education, there is an increased need to produce evidence of learner achievement in the form of observable behaviors. However, the complexity of healthcare education and clinical environments make it challenging to generate valid and reliable behavioral assessments. In this article, we utilize our interdisciplinary knowledge from the perspectives of experts in medical education, assessment, and academic administration to provide tips to successfully incorporate behavioral assessments into instructional designs. These include tips for identifying the best assessment methods fit for purpose, guiding instructors in establishing boundaries of assessment, managing instructors, selecting raters, generating behavioral assessment guides, training raters, ensuring logistics support assessment strategies, and fostering capacity for iteration. These can be used by institutions to improve planning and implementation for longitudinal behavioral assessments.

Pilot Evaluation of Silicone Surrogates for Oral Mucosa Simulation in Craniofacial Surgical Training

Surgical simulators are crucial in early craniofacial and plastic surgical training, necessitating synthetic materials that accurately replicate tissue properties. Recent critiques of our lab's currently deployed silicone surrogate have highlighted numerous areas for improvement. To further refine our models, our group's objective is to find a composition of materials that is closest in fidelity to native oral mucosa during surgical rehearsal by expert craniofacial surgeons. Fifteen platinum silicone-based surrogate samples were constructed with variable hardness and slacker percentages. These samples underwent evaluation of tactile sensation, hardness, needle puncture, cut resistance, suture retention, defect repair, and tensile elasticity. Expert craniofacial surgeon evaluators provided focused qualitative feedback on selected top-performing samples for further assessment and statistical comparisons. An evaluation revealed surrogate characteristics that were satisfactory and exhibited good performance. Sample 977 exhibited the highest performance, and comparison with the original surrogate (sample 810) demonstrated significant improvements in critical areas, emphasizing the efficacy of the refined composition. The study identified a silicone composition that directly addresses the feedback received by our team's original silicone surrogate. The study underscores the delicate balance between biofidelity and practicality in surgical simulation. The need for ongoing refinement in surrogate materials is evident to optimize training experiences for early surgical learners.

Implementation status of the nationally harmonized competency-based, integrated, modular medical curriculum in Ethiopia: opportunities and challenges

BACKGROUND

Well-designed curriculums are crucial for quality education. This study aimed to assess the implementation status of a harmonized competency-based medical curriculum (CBMC) in Ethiopia, as well as identify the associated challenges and benefits.

METHODS

A mixed-method approach was used. Data collection took place from September 1, 2023, to October 15, 2023. Eleven medical schools were randomly selected from a list of 28 public medical schools in Ethiopia. Participants were purposively chosen from selected medical schools using a controlled sampling method. A total of 121 participants took part in the survey. Interviews and focus group discussions were conducted with key informants to complement the quantitative findings. Descriptive statistics, such as frequencies and percentages, were used to summarize the quantitative survey responses. Thematic content analysis was used to analyze the qualitative data.

RESULTS

The implementation of a CBMC in Ethiopian public universities faces various challenges and provides opportunities. Around 22% of respondents mentioned that the whole group session (WGS) had never been implemented in their school. Regarding community-based learning (CBL), 64.6% of respondents noted that it was intermittently implemented in their institution. Only 32% of respondents considered students' clinical exposure during preclerkship years to be reasonable. Interestingly, approximately 73% of respondents stated that problem-based learning (PBL) activities were regularly conducted in their school. Around 68% of respondents believed that competency-based assessment methods were moderately utilized. While many participants perceive the curriculum as having positive content alignment and structure with intended learning outcomes, challenges related to practical sessions, resource limitations, and uneven access to training opportunities persist. Resource constraints are a prominent challenge. The opportunities identified include early clinical exposure and enhanced communication skills.

CONCLUSIONS

This survey highlights the need for ongoing curriculum evaluation and fine-tuning to ensure its success.

The Perceived Impact of COVID-19 on Graduate Medical Education and Recommendations for Bridging the Educational Gap

INTRODUCTION

COVID-19 generated a system-wide shock causing an unbalanced equilibrium between producing adequately trained physicians and meeting extraordinary operational needs. Previous studies report the experience of surgical residents during COVID-19 at a regional level. This study measures the learning losses related with the redeployment of highly specialized medical professionals to the care of COVID-19 patients, while we systematically investigate proposed remedial strategies.

METHODS

We administered an online cross-sectional survey in 67 countries capturing training inputs (i.e., surgeries and seminars residents participated in) before and during the pandemic and retrieved residents' expected learning outputs, career prospects and recommended remedial measures for learning losses. We compared responses of residents working in (treatment group) and out (control group) of hospitals with COVID-19 patients.

RESULTS

The analysis included 432 plastic surgery residents who were in training during the pandemic. Most of the learning losses were found in COVID-19 hospitals with 37% and 16% loss of surgeries and seminars, respectively, per week. Moreover, 74%, 44%, and 55% of residents expected their surgical skill, scientific knowledge, and overall competence, respectively, to be lower than those of residents who graduated before COVID. Residents in COVID-19 hospitals reported participating in significantly (P < 0.001) fewer surgeries and having significantly (P < 0.001) lower surgical skill relative to those not in COVID-19 hospitals.

CONCLUSIONS

The perceived lower competence and the fall-off in surgical skill and scientific knowledge among future surgeons suggest that health-care systems globally may have limited capacity to perform specialized and costly procedures in the future.

Development of entrustable professional activities for emergency medicine medical education fellowships: A modified Delphi study

Background

It is essential that medical education (MedEd) fellows achieve desired outcomes prior to graduation. Despite the increase in postgraduate MedEd fellowships in emergency medicine (EM), there is no consistently applied competency framework. We sought to develop entrustable professional activities (EPAs) for EM MedEd fellows.

Methods

From 2021 to 2022, we used a modified Delphi method to achieve consensus for EPAs. EM education experts generated an initial list of 173 EPAs after literature review. In each Delphi round, panelists were asked to make a binary choice of whether to include the EPA. We determined an inclusion threshold of 70% agreement a priori. After the first round, given the large number of EPAs meeting inclusion threshold, panelists were instructed to vote whether each EPA should be included in the "20 most important" EPAs for a MedEd fellowship. Modifications were made between rounds based on expert feedback. We calculated descriptive statistics.

Results

Seventeen experts completed four Delphi rounds each with 100% response. After Round 1, 87 EPAs were eliminated and two were combined. Following Round 2, 46 EPAs were eliminated, seven were combined, and three were included in the final list. After the third round, one EPA was eliminated and 13 were included. After the fourth round, 11 EPAs were eliminated. The final list consisted of 16 EPAs in domains of career development, education theory and methods, research and scholarship, and educational program administration.

Conclusions

We developed a list of 16 EPAs for EM MedEd fellowships, the first step in implementing competency-based MedEd.

Impact and assessment of training models in interventional endoscopic ultrasound

Interventional endoscopic ultrasound (IEUS) has gained significant popularity in recent years because of its diagnostic and therapeutic capabilities. The proper training of endoscopists is critical to ensure safe and effective procedures. This review study aims to assess the impact of different training models on the competence of trainees performing IEUS. Eight studies that evaluated simulators for IEUS were identified in the medical literature. Various training models have been used, including the EASIE-R, Mumbai EUS, EUS Magic Box, EndoSim, Thai Association for Gastrointestinal Endoscopy model, and an ex vivo porcine model (HiFi SAM). The trainees underwent traditional didactic lectures, hands-on training using simulators, and direct supervision by experienced endoscopists. The effectiveness of these models has been evaluated based on objective and subjective parameters such as technical proficiency, operative time, diagnostic success, and participant feedback. As expected, the majority of skills were improved after the training sessions concluded, although the risk of bias is high in the absence of external validation. It is difficult to determine the ideal simulator among the existing ones because of the wide variation between them in terms of costs, reusability, design, fidelity of anatomical structures and feedback, and types of procedures performed. There is a need for a standardized approach for the evaluation of IEUS simulators and the ways skills are acquired by trainees, as well as a clearer definition of the key personal attributes necessary for developing a physician into a skilled endoscopist capable of performing basic and advanced therapeutic EUS interventions.

Power/knowledge: A sociomaterial perspective on a new accreditation process during COVID-19

INTRODUCTION

The COVID-19 pandemic had significant impacts on many aspects of health care and education, including the accreditation of medical education programmes. As a community of international educators, it is important that we study changes that resulted from the pandemic to help us understand educational processes more broadly. As COVID-19 unfolded in Canada, a revised format of undergraduate medical accreditation was implemented, including a shift to virtual site visits, a two-stage visit schedule, a focused approach to reviewing standards and the addition of a field secretary to the visit team. Our case study research aimed to evaluate the sociomaterial implications of these changes in format on the process of accreditation at two schools.

METHODS

We interviewed key informants to understand the impacts, strengths and limitations of changes made to the accreditation format. We used an abductive approach to analyse transcripts and applied a sociomaterial lens in looking for interconnections between the material and social changes that were experienced within the accreditation system.

RESULTS

Stakeholders within the accreditation system did not anticipate that changes to the accreditation format would have significant impacts on how accreditation functioned or on its overall outcomes. However, key informants described how the revised format of accreditation reconstructed how power was distributed and how knowledge was produced. The revised format contributed to changes in who held power within each of the programmes, within each of the visiting teams and between site members and visiting team members. As power shifted across stakeholders in response to material changes to the accreditation format, key informants described changes in how knowledge was produced.

CONCLUSIONS

Our findings suggest that the most powerful knowledge about any given programme might best be obtained through individualised tools, technologies and voices that are most meaningful to the unique context of each programme. Deliberate attention to how knowledge and power are influenced by the interactions between material and social processes within accreditation may help educators and leaders see the effects of change.

A Program of Assessment Model for Point-of-Care Ultrasound Training for Pediatric Critical Care Providers: A Comprehensive Approach to Enhance Competency-Based Point-of-Care Ultrasound Training

Point-of-care ultrasound (POCUS) is increasingly accepted in pediatric critical care medicine as a tool for guiding the evaluation and treatment of patients. POCUS is a complex skill that requires user competency to ensure accuracy, reliability, and patient safety. A robust competency-based medical education (CBME) program ensures user competency and mitigates patient safety concerns. A programmatic assessment model provides a longitudinal, holistic, and multimodal approach to teaching, assessing, and evaluating learners. The authors propose a fit-for-purpose and modifiable CBME model that is adaptable for different institutions' resources and needs for any intended competency level. This educational model drives and supports learning, ensures competency attainment, and creates a clear pathway for POCUS education while enhancing patient care and safety.

Advantages and pitfalls in utilizing artificial intelligence for crafting medical examinations: a medical education pilot study with GPT-4

BACKGROUND

The task of writing multiple choice question examinations for medical students is complex, timely and requires significant efforts from clinical staff and faculty. Applying artificial intelligence algorithms in this field of medical education may be advisable.

METHODS

During March to April 2023, we utilized GPT-4, an OpenAI application, to write a 210 multi choice questions-MCQs examination based on an existing exam template and thoroughly investigated the output by specialist physicians who were blinded to the source of the questions. Algorithm mistakes and inaccuracies, as identified by specialists were classified as stemming from age, gender or geographical insensitivities.

RESULTS

After inputting a detailed prompt, GPT-4 produced the test rapidly and effectively. Only 1 question (0.5%) was defined as false; 15% of questions necessitated revisions. Errors in the AI-generated questions included: the use of outdated or inaccurate terminology, age-sensitive inaccuracies, gender-sensitive inaccuracies, and geographically sensitive inaccuracies. Questions that were disqualified due to flawed methodology basis included elimination-based questions and questions that did not include elements of integrating knowledge with clinical reasoning.

CONCLUSION

GPT-4 can be used as an adjunctive tool in creating multi-choice question medical examinations yet rigorous inspection by specialist physicians remains pivotal.

The Association of "First 1000 Days of Life" Training Program on Communication Skill and Empathy of Undergraduate Medical Students: A Cross-Sectional Study

Introduction

1000 First Days of Life (1000FDL) training program is carried out for 2 years from the 3rd to 6th semester; in this program, students are asked to accompany pregnant women until their children are 2 years old. This study aimed to analyse undergraduate medical students' communication skills and empathy levels and determine the association between communication skills and empathy after the training program.

Methods

This is a cross-sectional study in which 176 undergraduate medical students in Hasanuddin University participated; they were enrolled in 1000FDL training program and selected using purposive sampling. Data were collected using Modified Arabic Version of the ABIM's Patient Assessment (MAV-ABIM) and Jefferson Scale of Empathy - Student Version (JSE-S) questionnaires to assess their level of communication skills and empathy. In this study, demographic data were obtained using a semi-open-ended questionnaire. Data were analysed using descriptive statistics, Chi-Square, and Spearman tests.

Results

Communication skill was very good (83.5%), good (15.9%), and inadequate (0.6%), while the empathy level was high (9.1%), medium (25%), and low (65.9%). There was no significant difference between the level of communication skills (p-value 0.168) and empathy (p=0.145) based on gender, but there was a significant difference between <12 or >12 times interaction with the empathy level (p<0.001). The association between the level of communication showed that the level of empathy was significant (p<0.001, r=0.399).

Conclusion

Undergraduate medical students had very good communication skills but low empathy levels. There was a positive association between communication skills and empathy level after the training program. The students' empathy level can be improved by increasing the frequency of interaction with patients in experiential learning through training programs.

Trainee Evaluations of Preparedness for Clinical Trials in Medical Oncology-A National Questionnaire

BACKGROUND

A standardized approach to the education of clinical trial investigators across Canadian medical oncology (MO) subspecialty training does not exist. With training programs transitioning to competency-based medical education (CBME), studies assessing education practices and competence are paramount to enhancing trainee education. This study aimed to determine whether current education practices in MO subspecialty training programs in Canada prepare trainees for participating in clinical trials as an investigator.

METHODS

From November 2021 to February 2022 a national, bilingual, online questionnaire to understand trainee experiences with self-perceived competence, preparedness, and willingness to participate in clinical trials as investigators was conducted. MO trainees, fellows, and new-to-practice physicians who completed an MO subspecialty training program in Canada were included.

RESULTS

A total of 41 responses were received (response rate: 15%). Formal training in how to participate in clinical trials as an investigator was reported by 73% of respondents. At the end of training, 65% of respondents rated competence in clinical trials as fair/poor and 74% rated preparedness in conducting clinical trials as fair/poor. Correlation analysis determined that in-clinic teaching in clinical trials trended toward improved self-evaluations of competence and preparedness (p > 0.05).

CONCLUSION

This is the first study in Canada to assess competencies in any residency training program since the establishment of CBME. Training in conducting clinical trials is highly variable across MO programs in Canada, with most trainees finding current practices not translating into self-perceived competence and preparedness. Further assessment into how to produce competent clinical trial investigators is warranted.

Outcome-Based Medical Education Implication and Opportunities for Competency-Based Medical Education in Undergraduate Pathology

Introduction Outcome-Based Education (OBE) is an education model for students that assist the teachers to outline the cause and evaluation with goals in mind to achieve results such as Program Outcome (PO) and Course Outcome (CO) which forms the basis for evaluating student performance. Materials and methods This study was conducted with the participants to discuss the hardships faced while implementing Competency-Based Medical Education (CBME). Need-gap analysis based on CBME guidelines was performed. Detailed discussion was done with department faculty to plan. Results Internal and final evaluations were done for all the students. When compared with conventional didactic lectures remarkable improvement in academic results of the students were noted which were statistically significant with p value less than 0.001. Conclusion CBME is not just adding capabilities but also achieving and strengthening these capabilities with a proper educational approach and efficacious evaluation methods.

Competency-based medical education in the United States: What the otolaryngologist needs to know

Competency-based medical education (CBME) is an outcomes-focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty-specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence-based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system.

Lessons for Medical and Health Education Learned from the COVID-19 Pandemic

Our paper analyzes lessons for medical education and health education stemming from the experience gained in the course of the COVID-19 pandemic. Moreover, it tackles the issue of the social health and psychological wellbeing of medical students involved in online education during the COVID-19 pandemic. The paper systematizes up-to-date data on how medical schools and universities have adapted to the conditions of the COVID-19 pandemic and implemented novel effective solutions for the learning process, such as transitioning from traditional in-person classes to online learning, incorporating virtual simulations and telemedicine experiences for clinical training, and collaborating with health authorities to provide support in testing and contact tracing efforts. The paper contains an analysis of various aspects of medical education, such as the changes in practical classes, the impact of the pandemic on the formation of communication skills, methods for assessing students' knowledge and skills, and many others. It also considers case studies related to the implementation of educational programs, methodologies, and novel digital technologies in a pandemic. Additionally, the paper features an empirical study that is based on the results of our own survey that was carried out with the help of a snowball convenient sampling that involved 710 medical students between 19 and 25 years of age (56% females and 44% males) from 4 Russian regions (Moscow, Krasnodar, Kazan, and Saint Petersburg). We applied the correlation between stress scores, anxiety scores, factors of stress, and strategies for coping with stress and various economic and demographic variables (age, environment, and gender) that were analyzed using the chi-square test. Our results demonstrate that over 85% of the students in our sample yielded an above-average vulnerability to stress due to the COVID-19 restrictions. At the same time, around 61% of the students experienced severe anxiety during online education in the COVID-19 pandemic. The important factors leading to stress and anxiety were the fear of getting infected and social distancing, and the best strategy to deal with stress and increase wellbeing was self-control. Through a comprehensive review of the literature and empirical estimations, our paper identifies key areas of improvement, including curriculum adaptation, technology integration, faculty development, student support, and interprofessional collaboration. The proposed recommendations aim at strengthening medical education systems and preparing healthcare professionals to effectively navigate future pandemics.

A Practical Introduction to Growth Mindsets in Surgical Training

This Viewpoint summarizes the research behind psychological mindsets and their possible applications to surgical training and introduces some practical recommendations to harness growth mindsets for optimizing the learning of otolaryngology residents.

Nurses' clinical competency and its correlates: before and during the COVID-19 outbreak

BACKGROUND

Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic.

METHODS

We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered.

RESULTS

The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic.

CONCLUSION

The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses.

Four- and three-year emergency medicine residency graduates perform similarly in their first year of practice compared to experienced physicians

INTRODUCTION

United States emergency medicine (EM) post-graduate training programs vary in training length, either 4 or 3 years. However, it is unknown if clinical care by graduates from the two curricula differs in the early post-residency period.

METHODS

We performed a retrospective observational study comparing measures of clinical care and practice patterns between new graduates from 4- and 3-year EM programs with experienced new physician hires as a reference group. We included emergency department (ED) encounters from a national EM group (2016-19) between newly hired physicians from 4- and 3- year programs and experienced new hires (>2 years' experience) during their first year of practice with the group. Primary outcomes were at the physician-shift level (patients per hour and relative value units [RVUs] per hour) and encounter-level (72-h return visits with admission/transfer and discharge length of stay [LOS]). Secondary outcomes included discharge opioid prescription rates, test ordering, computer tomography (CT) use, and admission/transfer rate. We compared outcomes using multivariable linear regression models that included patient, shift, and facility-day characteristics, and a facility fixed effect. We hypothesized that experienced new hires would be most efficient, followed by new 4-year graduates and then new 3-year graduates.

RESULTS

We included 1,084,085 ED encounters by 4-year graduates (n = 39), 3-year graduates (n = 70), and experienced new hires (n = 476). There were no differences in physician-level and encounter-level primary outcomes except discharge LOS was 10.60 min (2.551, 18.554) longer for 4-year graduates compared to experienced new hires. Secondary outcomes were similar among the three groups except 4- and 3-year new graduates were less likely to prescribe opioids to discharged patients, -3.70% (-5.768, -1.624) and - 3.38% (-5.136, -1.617) compared to experienced new hires.

CONCLUSIONS

In this sample, measures of clinical care and practice patterns related to efficiency, safety, and flow were largely similar between the physician groups; however, experienced new hires were more likely to prescribe opioids than new graduates. These results do not support recommending a specific length of residency training in EM.

Health Sciences before, during and after the COVID-19 Pandemic

The COVID-19 pandemic has heavily influenced the teaching and practical training required for students enrolled in health sciences courses globally both at undergraduate, graduate and postgraduate levels [...].

Competency-Based Medical Education (CBME): an Overview and Relevance to the Education of Future Surgical Oncologists

In the next two decades, the global cancer burden is expected to rise by 47%, and the demand for global cancer surgery will increase by 52%. At present, only 25% of the estimated 80% of patients needing surgical intervention have access to timely surgical care. The shortage of a trained workforce of surgical oncologists is one of the main barriers to providing the optimal surgical intervention needed for cancer patients. Some of the contributing factors to the shortage of trained surgical oncologists are variations in the current global educational platforms, long training programs, and physician burnout. Therefore, the availability of a credible training framework and a sustainable certification pipeline for future surgical oncologists is critical to meet the global demand for an adequate healthcare workforce. The current surgical oncology educational program is a time-based construct that trains surgeons to function seamlessly in the multidisciplinary care of cancer patients. However, there is a lack of flexibility in the training framework and timeline despite differences in trainees' abilities. Developing a globally acceptable standard curriculum for surgical oncology training based on the competency-based medical education (CBME) framework and tailoring it to local needs can increase the surgical oncology workforce ready to tackle the rising cancer burden. However, successful implementation of the global CBME-based surgical oncology training curriculum requires an innovative approach to ensure that this framework produces a competent surgical oncologist that meets the local needs.

Health Research and Education during and after the COVID-19 Pandemic: An Australian Clinician and Researcher Perspective

Introduction: The COVID-19 pandemic had an unprecedented global effect on teaching and education. This review discusses research, education and diagnostics from the perspectives of four academic clinicians and researchers across different facilities in Australia. Materials and methods: The study adopted a literature review and an Australian researcher's perspective on the impact of the COVID-19 pandemic on health education, research and diagnostics. Results: At the start of the pandemic, medical facilities had to adhere urgently to major work restrictions, including social distancing, mask-wearing rules and/or the closure of facilities to protect staff, students and patients from the risk of COVID-19 infection. Telemedicine and telehealth services were rapidly implemented and adapted to meet the needs of medical education, the teaching of students, trainee doctors, nursing and allied health staff and became a widely accepted norm. The impact on clinical research and education saw the closure of clinical trials and the implementation of new methods in the conducting of trials, including electronic consents, remote patient assessments and the ability to commence fully virtual clinical trials. Academic teaching adapted augmented reality and competency-based teaching to become important new modes of education delivery. Diagnostic services also required new policies and procedures to ensure the safety of personnel. Conclusions: As a by-product of the COVID-19 pandemic, traditional, face-to-face learning and clinical research were converted into online formats. An hybrid environment of traditional methods and novel technological tools has emerged in readiness for future pandemics that allows for virtual learning with concurrent recognition of the need to provide for interpersonal interactions.

An online case-based teaching and assessment program on clinical history-taking skills and reasoning using simulated patients in response to the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has created unprecedented challenges for medical students and educators worldwide. Groups 1, 2 and 3 of year 3, semester 2 medical students at the Royal College of Surgeons in Ireland (n = 275) had only completed 2, 5 and 7 weeks, respectively, of their scheduled 10-week clinical medicine and surgery attachments, prior to the Irish shutdown of all in-person non-essential activities, including medical student education.

METHODS

We developed and delivered an online case-based program, focused on history-taking skills and clinical reasoning, using simulated patients and video technologies. 12 tutorials were delivered over 6 weeks to 35 subgroups of 8 students in line with program learning outcomes. Both simulated patients (n = 36), and tutors (n = 45, from retired clinical professors to newly graduated physicians), were rapidly upskilled in Blackboard Collaborate and Microsoft Teams, and also in the provision of constructive feedback. We evaluated this newly developed program by the following three criteria: student attendance, achieved grades, and student feedback.

RESULTS

Attendance at the 12 tutorials was higher amongst group 1 and 2 students (75 and 73%) by comparison with group 3 students (60%) (p = < 0.001). Of the 273 students that sat the Year 3 Semester 2 online long case assessment, 93% were successful. Despite group 1 students having the least prior clinical experience, results were similar to those of groups 2 and 3 (1st honors, 2nd honors, pass, and fail grades for group 1, 39%, 33%, 23% and 6%; group 2, 34%, 41%, 17% and 8%; group 3, 39%, 25%, 28% and 7%) (p = 0.48). An increased attendance rate at tutorials was associated with higher numbers of honors grades (p = < 0.001). Anonymous feedback from the students demonstrated considerable satisfaction with program: > 85% agreed that the online program was interactive and very educational.

CONCLUSIONS

Use of online video technology, tutors of varied experience, and simulated patients were demonstrated to replicate patient encounters, and to facilitate the development of clinical skills remotely during the COVID-19 pandemic.

Analysis of Obligatory Involvement of Medical Students in Pandemic Response in the Czech Republic: Competencies, Experiences, and Legal Implications

Objectives: Medical students in the Czech Republic were mandated by the law to take part in the COVID-19 pandemic response in order to expand healthcare capacity. Our study aimed to analyze student's competencies defined in the legislation and compare them with competencies assigned to them in clinical settings during their deployment. Methods: Online survey with statistical analysis of collected data. Results: The survey was completed by 997 respondents. A major convergence between the system of credentials defined in the legal framework and the competencies that students performed were identified. Conclusion: Medical students represented a valuable resource for addressing shortages of qualified healthcare staff in critical situation. However, the system of competencies and credentials must be aligned with the educational framework to clearly define acquisition of competencies during the course of medical studies and the legal framework regulating students' deployment must ensure consistency of actual and formal competencies in order to guarantee high standards of care and safety of the patients.

The mediating role of general academic emotions in burnout and procrastination among Chinese medical undergraduates during the COVID-19 pandemic: A cross-sectional study

Background

Academic procrastination has become more prevalent during the COVID-19 pandemic due to teaching/learning changes. This phenomenon induces academic burnout, which is already serious among medical students. However, the academic emotion, which is the factor most vulnerable to changes in the academic environment, is still unknown. Therefore, the current study aimed to investigate the mediating role of general academic emotions in procrastination and burnout among Chinese medical students during the COVID-19 pandemic.

Methods

This cross-sectional study enrolled 995 medical students from China Medical University. We applied the Chinese version of the Maslach Burnout Inventory Student Survey (MBI-SS), the Aitken Procrastination Inventory (API) and the General Academic Emotion Questionnaire for College Students (GAEQ) to evaluate the variables of interest. We examined the mediation effects of GAEs by hierarchical linear regression analysis.

Results

Correlation analyses showed a significant positive correlation between procrastination and burnout. Procrastination and burnout positively and negatively correlated with negative academic emotions, respectively. Hierarchical linear regression analyses showed that procrastination had positive associations with negative academic emotions, while it had negative associations with positive academic emotions. The contributions (as mediators) of GAEs to burnout and procrastination were 21.16% (NAEs), 29.75% (PAEs), 54.25% (NDEs) and 23.69% (PDEs).

Conclusions

The results indicate that academic emotions had mediating effects on procrastination and burnout. Medical students' worries about the uncertainty of the learning environment may have exacerbated academic burnout. Targeted improvements in the teaching environment to communicate encouragement and reduce anxiety and helplessness among medical undergraduates for implementing medical education while preventing and controlling the infection.

Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries

To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.

Nursing Education Practice Update 2022: Competency-Based Education in Nursing

INTRODUCTION

Competency-based education (CBE) is increasingly emphasized in nursing. Professional organizations and regulatory bodies are calling for radical transformation in nursing education along with increased emphasis on developing clinical judgment.

METHODS

This practice update article provides a brief history of CBE in a variety of educational settings including health professions education and demonstrates the value of CBE strategies. The article also provides examples of the application of CBE to nursing education.

CONCLUSION

CBE offers the opportunity to enhance interprofessional education, increase the use of simulation, and improve clinical judgment in new graduate and advanced practice nurses.