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Changing campus: Competency-based medical education

Changing campus: Competency-based medical education

In this guest blog originally posted on Dean on Campus Dr. Damon Dagnone discusses how Queen's is leading the way in competency-based medical education. Dr. Dagnone is an assistant professor in the Department of Emergency Medicine and the Faculty Lead for CBME at Queen’s University.

Recognizing the growing importance of patient simulation and surgical skills in health sciences education, the School of Medicine building at Queen's houses 8,000 square feet of clinical simulation space

For centuries, physicians have occupied a unique place in society. We are privileged to hold positions that are respected, trusted, well-compensated, and considerably more autonomous than those found in most other professions. In return, we provide kind, compassionate, and competent care to those in need. We also devote years of our lives to education, with many of us today spending up to fifteen years in university and residency while we learn our craft. Finally, but certainly not least of all, it is our responsibility under this ‘social contract’ to educate the next generation of physicians.

While those of us at Queen’s are proud to care for our patients, and to continue to learn and grow as physicians through faculty development, we are perhaps most aware of our roles as educators of students, clerks, residents, and fellows. Many of us have been witness to significant changes in the healthcare needs of our patients. Accordingly, it is our societal obligation to constantly adapt our methods of teaching to ensure that our graduates remain kind, compassionate, and above all, competent physicians who will ultimately be better doctors than we ourselves have been.

One of our key challenges as medical educators is to correctly identify new educational practices that will benefit our learners. I am very pleased to say that that’s where we find ourselves today; we have found a better way to educate physicians and we have begun to plan changes to our curricula in ways that will provide our trainees with maximum benefit yet minimum disruption.

Through a partnership with the Royal College of Physicians and Surgeons of Canada (RCPSC), we have set a goal to be the first university in the country to implement competency-based medical education (CBME) across all of our specialty programs. The concept of CBME de-emphasizes time-based learning. Instead of requiring residents to complete a pre-determined period of time (such as one year) at one level before moving on to the next, they will instead be promoted once they have demonstrated competency in a particular field. This ensures that competent residents will move through training in a quicker and more efficient manner, saving valuable resources and shortening their paths to independent practice.

The RCPSC launched its own Competency by Design (CBD) project in 2014 and mapped out a seven-year transition for all specialty programs in Canada. It recommended implementing a more responsive and accountable training model with explicit competencies for all trainees, coupled with more frequent and meaningful assessments. We at Queen’s have not only embraced this concept, but in consultation with the RCPSC, we have taken on a national leadership role by designing and implementing our own parallel, accelerated path to CBME. We have made a commitment that all incoming Queen’s residents will start their training using a CBME-based model by July 2017.

Much work has already been done. Many innovative assessment initiatives have already been introduced across a variety of programs, and a new online assessment and evaluation system – designed and built here at Queen’s – will be launched on July 1st. Together, these projects will facilitate frequent and meaningful feedback on the performance of faculty and residents alike. Programs have also started to identify the multiple tasks that their trainees must be able to perform at the end of residency, known as ‘entrustable professional activities’, as well as the ‘developmental milestones’ that they must achieve along the way.

[Dr. Damon Dagnone]
Dr. Damon Dagnone

This is undoubtedly an ambitious goal, yet there is much to support the fact that it is attainable within the timelines that we have set for ourselves. The Department of Family Medicine at Queen’s University, in partnership with the College of Family Physicians of Canada (CFPC), recently transitioned to an analogous competency-based curriculum. Our colleagues in Family Medicine are well-placed to provide our specialty programs with a wealth of expert knowledge and advice drawn from their own experience. Queen’s also benefits from many other assets including a relatively small institutional size, a collegial atmosphere, a centralized funding formula for teaching faculty, a dedicated CBME transition team, outstanding information technology resources, and a Dean who is a world-renowned educational scholar.

During our last accreditation process, the RCPSC and CFPC declared that “education is not just an add-on, it is in the air that is breathed by the faculty at Queen’s.” They praised the dedication of our program directors and stated that they were “blown away” by our remarkable culture of education. They realized something that our faculty, learners, and alumni already know: that the School of Medicine is a special place. In an environment like this, we have every reason to believe that such a huge initiative will be successful. I invite the readers of the Dean’s blog not only to watch this change occur over the next few years, but to become active participants. We welcome your feedback and input, from individual comments below to opportunities for collaboration and partnership. We look forward to hearing from you.

I would like to acknowledge Nicholas Snider, PGME Director of Marketing and Recruitment, for his assistance in writing this blog.

Read more: Dean on Campus

[cover - Queen's Alumni Review Digital Special Edition Fall 2015]