A checkup on CBME

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2017 has been another year filled with accomplishments for Queen’s. From the strong performance of our students, to the groundbreaking discoveries of our researchers, we have enjoyed great success and built a strong foundation for 2018. 

 

One of the most innovative projects from the past year has been our national leadership on a new project that is revolutionizing the way we train doctors in Canada. I have asked Dr. Richard Reznick, Dean of the Faculty of Health Sciences, to contribute a guest column to update us on competency-based medical education (CBME) at Queen’s. 

 

Queen's residents hone their skills in a simulation lab.

Queen’s residents hone their skills in a simulation lab.

At the beginning of the summer, Queen’s took a bold step and introduced a new approach to educating specialty residents called competency-based medical education (CBME). With several months of experience in the new system now complete, it is a good time to take the pulse of the project and update the community on our work.

In a CBME approach, the focus is on ensuring residents are evaluated more regularly and consistently, using the reviews to shape their learning over the course of their residency and allowing the residents to closely monitor their own progress and performance to ensure they learn the skills they need.

In addition, the expectations of the competencies expected to be developed in the program are clearly laid out through the delineation of what are referred to as “entrustable professional activities” or EPAs. These spell out exactly how and when residents are ready to independently take care of the many aspects of patient care in a given specialty.

The approach in place at most medical schools today assumes if residents spend enough time on a certain skill or discipline and receive regular feedback from their teachers, they will eventually master their required skills and be ready for their exams and the working world.

Today at Queen’s, written reviews are stored digitally on a resident dashboard. Once filed, a resident has a clear and up-to-date picture of their progress and their next steps. Faculty members have a detailed and comprehensive record to refer back to when evaluating their residents, and the whole system is more accountable for all involved.

Though we had previously implemented competency-based learning in our Family Medicine department, implementing CBME across the board at Queen’s has been achieved years ahead of other medical schools. While others are deploying CBME one program at a time over five years, it was my belief that the best way to deliver this new style of learning was to work as 29 united medical residency programs coordinated by a central team of educators.

This initiative has required a mammoth effort by an incredibly dedicated team of leaders, program directors, educational consultants, and residents, who collectively have used a systems-based approach to effect dramatic change.

It has been a busy fall for me personally, as medical schools and professionals the world over turned to us to learn how we made the transition. In recent months I delivered seven presentations across Canada, the US, and Asia as other schools seek to learn more about how Queen’s made the switch to CBME.

Additionally, dozens of medical leaders attended our November conference on campus and many more are expected at our upcoming CBME webinars.

Our faculty and residents have been equally busy in the ‘classroom’, with over 3,134 resident assessments (and counting) completed by our faculty. This represents a dramatic increase in the amount of feedback these residents would have typically received by this point in their residency. And it is not just the quantity of feedback which makes this important – it is the quality.

There are still several months to go before this year’s cohort of residents completes their first year. Even so, we have been actively seeking ways to continuously improve this system – from refining the review forms to analyzing the assessment results and trends.

Feedback on the CBME program continues to be positive from residents and faculty, and for more on their experience I invite you to read more about CBME in the most recent edition of the Queen’s Alumni Review magazine.

This change has been driven by our goal of preparing doctors for the future of medicine. In order to achieve this, we must ensure each new group of residents is receiving the best possible education. We believe this new delivery method will ensure improved patient care and better outcomes for residents and society as a whole by emphasizing skills first rather than time on the job.

This is the evolution of medical education, and it is happening right here at Queen’s.

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