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Better training, better care

Residents hone their skills in a simulation lab. (Photo by Greg Black)

As many students and faculty enjoyed their summers and awaited the start of the new academic year, the Queen’s School of Medicine has been hard at work pioneering a new form of training for medical residents. This new approach, called competency-based medical education (CBME), represents a foundational change to the way doctors are trained.

While traditional training methods for residents emphasize time on the job, competency-based medical education focuses on the successful execution of skills. Residents are more closely monitored and assessed by faculty, and the residents will be promoted progress once they have demonstrated competency in a particular field. 

This summer, Queen’s became the first medical school in North America to launch competency-based medical education across all of its medical residency programs. This leadership position has attracted interest from around the world, prompting calls from a variety of medical schools and associations seeking more information about how competency-based medical education works and how Queen’s was able to deploy it so quickly. Many other medical schools will be converting their residency programs to a competency-based approach in the coming years through a multi-year project started by the Royal College of Physicians and Surgeons of Canada in 2014 – but Queen’s, in consultation with the Royal College, designed and implemented an accelerated path.

“CBME represents the evolution of medical education, and our leadership in its implementation places Queen’s at the forefront of transformative change,” says Richard Reznick, Dean of the Faculty of Health Sciences. “As doctors ourselves, we want to ensure future doctors receive the best possible training and ensure their patients receive the best possible care. We recognized that this training model would increase transparency and accountability for our residents, and situate our school and our faculty members as Canadian and international leaders in medical education. Now that it is launched, we are in a position to help other schools make the same transition.”

With the new group of 130 residents now two months into their placement, the pace of work doesn’t slow down. Damon Dagnone, the faculty lead for competency-based medical education within the Postgraduate Medical Education department at Queen’s, likens the deployment to a race and says July was the “end of the first preparatory leg, and the beginning of the second leg of three". It will take five years before every program has a cohort complete their residencies and, along the way, there are plans to refine and enhance the program. For example, this fall, the School of Medicine hopes to bring allied health professionals such as nurses, social workers, and respiratory therapists into the assessment process across all residency programs.

Importantly, Queen’s has had some initial experience with CBME. The Family Medicine program pioneered a version of competency-based education called the Triple C curriculum – which is rooted in comprehensive education, continuity of patient care, and centred in family medicine.

Dr. Dagnone says while there were some initial worries about how to put the new model into practice across all specialty programs, the support structures and the IT systems have delivered as promised and, as a result, the faculty and residents have had a smooth transition to competency-based learning.

“There is a lot of pride within our team because of how well prepared we were for the launch, how well things have gone since July, and how residents and faculty have embraced this new concept,” says Dr. Dagnone. “We will continue to monitor and evaluate competency-based medical education in the years ahead to ensure it results in the improved patient, resident, and societal outcomes it was designed to achieve.”

Internal medicine resident Julia Tai, one of the new arrivals this July, says her skills have improved significantly since her arrival, which she attributes to the challenge of her newfound responsibility as a resident coupled with the regular feedback she has been receiving through CBME.

“I heard about competency-based medical education at Queen’s when I was interviewing for a residency position here, although it was hard to know exactly what it entailed until I started my residency in July,” says Dr. Tai. “There has been a lot of support for us in the transition to competency-based medical education. All of the faculty members have been extremely approachable and receptive of the new evaluation process. CBME has also allowed me to target specific skills most relevant to my chosen career path. For example, knowing that I want to become a palliative care specialist, one of my supervisors sought opportunities to evaluate me and provide feedback on specific skills related to the specialty."

There was some skepticism at first, externally and internally, about whether Queen’s could transition all of its specialty residency programs at once in two years. Dr. Reznick says the successful deployment demonstrates the importance of the system-wide approach adopted by the School of Medicine, which built an “excited and charged community of scholars”.

“I gave out my home number to our team so they could call if there were any issues but it never rang once, and even since the launch things have been incredibly smooth,” says Dr. Reznick. “Our success has proven the value of our model and, along the way, engaged the pride and the community spirit of our faculty members. I want to thank our team who has rolled up their sleeves and worked hard over the past two and a half years to ensure we were able to launch on time.”

The School of Medicine is hosting a competency-based medical education conference November 8 and 9, and those interested in learning more are welcome to attend or visit the School of Medicine’s website.