Introduction to CBME and CBD

an introduction to common NC based medical education and competence by design the faculty perspective competency-based medical education often referred to as CBM II is gaining momentum around the world as medical educators physicians and policy makers ask what is the best way to ensure that our graduating specialists are prepared for the realities of practice within a complex and evolving healthcare system this video is an introduction to competency based medical education and competence by design and how these changes impact us and our trainees Canada has a world-class medical education system and produces some of the world's best physicians but it is rooted in a 100-year old tradition that places significant emphasis on the amount of time a resident spends training in a particular rotation with the modern pressures on our healthcare system evidence tells us that training based primarily on time can leave gaps in a learner's competence in a CBM II system the outcomes expected of a trainee are made explicit and these outcomes are used to guide observation feedback coaching and assessment curriculum is organized around these explicit expectations and to advance in training a resident must demonstrate achievement of the outlined expectations the Royal College recognizes that time must continue to play an important role in medical education and the intention is not to shorten or to lengthen residency training instead the Royal College has developed a hybrid approach that emphasizes achieving and demonstrating confidence within a specific training timeframe this small but significant change is designed to make a good system even better so what is competence by design competence by design or CBD is the Royal Colleges initiative to introduce CBM II into specialty education in Canada in addition to redesigning in practice position assessment and accreditation CBD organizes residency training in two stages and clearly lays up markers for teaching and learning at each stage CBD uses more frequent observations for the purposes of providing quality feedback and coaching it also allows us to identify struggling learners sooner and to take action to support them in a timely manner to operationalize CBD the Royal College has developed a confidence continuum that breaks down residency into four distinct stages transition to discipline foundations of discipline core of discipline and transition to practice in each stage there are specific milestones and epas that our residents are expected to demonstrate in order for residents to progress from one stage to another they must demonstrate that they meet all the competencies expected in their discipline at that stage of competence let's take a closer look at milestones and EPA's an entrust of oppression alack tivity or EPA is a key task of a discipline that an individual can be trusted to perform once sufficient competence has been demonstrated given that us and our residents perform these EPA's on a regular basis it will be relatively easy to find opportunities to observe our residents either directly or indirectly and to give them feedback to support their learning and progress each EPA is made up of a number of milestones which are based on Kamath's 2015 the milestones are the abilities expected of a resident in order to perform the EPA at a stage of competence EPA's are a clever and manageable way of doing a small number of observations that encompass a large number of milestones or abilities we can think of an EPA as a basket or a funnel that holds a number of milestones an EPA can be assessed globally as an entire task or it can be unpacked into its component milestones to help inform feedback and coaching but how will all this work specialties and subspecialties are starting to define specific EPA's and milestones for their discipline that are linked to the desired outcomes of training the EPA's and their component milestones will be used to provide supervisors and residents with clear expectations of the skills and abilities needed at each stage of training these expectations will help us plan teaching and coaching to summarize competency-based medical education is an approach that focuses on outcomes competence by design is the college's initiative to introduce CBM e into specialty education in Canada the competence continuum is a series of distinct but successive stages that will operationalize CPD EPA's are the key tasks of a discipline which often include a series of component milestones milestones are the expected abilities of a physician at a stage of training by clearly defining EPA's and milestones for each discipline teachers and learner's have a common understanding of the expected outcomes that can serve as the basis for coaching and feedback which are integral to learning an assessment but you may wonder how does all of this impact us as supervisors we will observe a residents progress on an EP a multiple times to help coach and teach and to record the residents performance and improvements by regularly observing residents perform in EPA will be able to assess if they can be entrusted to perform the EPA going forward most of the time we'll be doing many of the same things we do now but we'll have more guidance so that we can do these things more efficiently and consistently across the country with the shift to an outcomes-based approach expectations will be explicit and they'll be based on key tasks of each discipline we'll know exactly what to teach and assess and it'll be much easier to detect when a resident is progressing faster or falling behind and we'll also identify gaps in their learning and pinpoint where they need support but how do residents progress from one stage of the continuum to the neck as residents progress a competence committee will review all of the EPA observations that we make along with other performance reports when the competence committee has sufficient information they will signal that the resident can be entrusted with the EPA when a resident has been entrusted with all the EPA's at one stage of training they're ready to move on to the next stage supervisors like us serve an important role in the teaching and assessment of residents now and in the new comments by design system if you have any questions please visit the Royal College website or email CBD at Royal College CA you

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