Exploring stakeholder perspectives regarding the implementation of competency-based medical education: a qualitative descriptive study

Introduction

Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices.

Methods

We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College's Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results.

Results

The participants' perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes.

Conclusion

By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts.

An adaptation-focused evaluation of Canada's first competency-based medical education implementation in radiology

OBJECTIVES

Systematic program evaluation of the Queen's University diagnostic radiology residency program following transition to a competency-based medical education (CBME) curriculum.

METHODS

Rapid Evaluation methodology and the Core Components Framework were utilized to measure CBME implementation. A combination of interviews and focus groups were held with program leaders (n = 6), faculty (n = 10), both CBME stream and traditional stream residents (n = 6), and program staff (n = 2). Interviews and focus groups were transcribed and analyzed abductively. Study team met with program leaders to review common themes and plan potential adaptations.

RESULTS

Strengths of CBME implementation included more frequent and timely feedback as well as the role of the Academic Advisor. However, frontline faculty felt insufficiently supported with regards to the theory and practical implementation of the new curriculum and found assessment tools unintuitive. The circumstances surrounding the curricular implementation also resulted in some negative sentiment. Additional faculty and resident education workshops were identified as areas for improvement as well as changes to assessment tools for increased clarity. Residents overall viewed the changes favorably, with traditional stream residents indicating that they also had a desire for increased feedback.

CONCLUSIONS

Rapid Evaluation is an effective method for program assessment following curricular change in diagnostic radiology. A departmental champion driving enthusiasm for change from within may be valuable. Adequate resident and faculty education is key to maximize change and smooth the transition. Advances in knowledge: This study provides insights for other radiology training programs transitioning to a CBME framework and provides a structure for programmatic assessment.

A systems approach for institutional CBME adoption at Queen's University

The Royal College of Physicians and Surgeons of Canada (RCPSC) has begun the transition to Competency by Design (CBD), a new curricular model for residency education that 'ensure[s] competence, but teaches for excellence'. By 2022, all Canadian specialty programs are anticipated to have completed the CBD cohort process which includes workshops facilitated by a Royal College Clinician Educator. Queen's University in Ontario, Canada, was granted approval by the RCPSC to embark upon an accelerated path to competency-based medical education (CBME) for all our postgraduate specialties. This accelerated path allowed us to take an institutional approach for CBME implementation and ensure that all specialities were part of a system-wide change. Our unique institution-wide approach to CBD is the first of its kind across Canada. From both a theoretical and practical perspective we undertook CBME using a systems approach that allowed us to build the foundations for CBME, implement the change, and plan for sustainability. This has created opportunities to bridge and connect the various programs involved in the implementation of CBME on Queen's campus. The systems approach was an essential part of our strategy to develop a community dedicated to ensuring a successful CBME implementation.

Perceptions and barriers to competency-based education in Canadian postgraduate medical education

RATIONALE

Competency-based education (CBE) is currently being implemented across Canadian postgraduate medical education programmes through Competence by Design (CBD).¹ Queen's University received permission to initiate CBE in all programmes simultaneously starting in 2017; an institutional initiative termed Competency-based medical education (CBME).² We describe our initial experiences to highlight perceptions and barriers and facilitate implementation at other centers.

METHODS

Anonymous online surveys were administered to faculty and residents transitioning to CBE (138 respondents) including (a) Queen's programme leaders (Programme Directors and CBME Leads) [n = 27], (b) Queen's residents [n = 102], and (c) Canadian neurology programme directors [n = 9] and were analysed using descriptive and inferential statistical techniques.

RESULTS

Perceptions were favourable (x = 3.55/5, SD = 0.71) and 81.6% perceived CBE enhanced training; however, perceptions were more favourable among faculty. Queen's programme leaders indicated that CBE did not improve their ability to provide negative feedback. Queen's residents did not perceive improved quality of feedback. National Canadian neurology programme directors did not perceive that their institutions had adequately prepared them. There was variability in barriers perceived across groups. Queen's programme leaders were concerned about resident initiative. Queen's residents felt that assessment selection and faculty responsiveness to feedback were barriers. Canadian neurology programme directors were concerned about access to information technology.

RECOMMENDATIONS

Our results indicate that faculty were concerned about the reluctance of residents to actively participate in CBE, while residents were hesitant to assume such a role because of lack of familiarity and perceived benefit. This discrepancy indicates attention should be devoted to (a) institutional administrative/educational supports, (b) faculty development around feedback/assessment, and (c) resident development to foster ownership of their learning and familiarity with CBE.

Competence committee: How meeting frequency impacts committee function and learner-centered assessment

The Department of Pediatrics at Queen's University wrestled with following the RCPSC guidelines with regards to Competence Committee (CC) meeting frequency, this article outlines adaptations we made to CC function and the rationale for our design decisions. After adopting a monthly meeting approach that focuses on formative assessment and greater resident feedback we have created an enhanced learner-centered assessment process that more fully empowers our residents with timely formative feedback to better support them in actively taking ownership of and responsibility for their learning.

Ten ways to get a grip on resident co-production within medical education change

The Royal College of Physicians and Surgeons of Canada (RCPSC) is transforming its national approach to postgraduate medical education by transitioning all specialty programs to competency based medical education (CBME) curriculums over a seven-year period. Queen's University, with special permission from the RCPSC, launched CBME curricula for all incoming residents across its 29 specialty programs in July 2017. Resident engagement, empowerment, and co-production through this transition has been instrumental in successful implementation of CBME at Queen's University. This article aims to use our own experience at Queen's in the context of current literature and rooted in change leadership theory, to provide a guide for educators, learners, and institutions on how to leverage the interest and enthusiasm of trainees in the transition to CBME in postgraduate training. The following ten tips provides a model for avoiding the "black ice" type pitfalls that can arise with learner involvement and ensure a smoother transition for other institutions moving forward with CBME implementation.