Competency Based Medical Education 2015 03 26 N… · Triple C Competency-based LEARNING...
Transcript of Competency Based Medical Education 2015 03 26 N… · Triple C Competency-based LEARNING...
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Competency Based Medical Education
Lessons from the Trenches - The Basics
Rob Anderson Christina Tremblay Catherine Cervin
Northern Constellations March 28, 2015
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Today's Learning Objectives
By the end of this session, participants will be able to:• Describe the two models of CBME that are
being implemented in Canada: CFPC competency assessment program and RCPSC competency by design.
• Build an assessment framework which will support the use of milestones, entrustable professional activities, and skill dimensions.
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The Building Blocks
Design
DEFINED PROGRAM OUTCOMES
Competency-based and guided by CanMEDS-FM
Assess
Triple C Competency-based LEARNING OPPORTUNITIESClinical ExperiencesAcademic ProgramOther Activities
Design and providecurriculum
Triple C Competency-based teaching and learning STRATEGIES
Triple C Competency-based RESOURCESClinical resourcesTeaching Materials Faculty
Outcome-based PROGRAM EVALUATION
ON
GO
ING
ASSESSMEN
T of residents –
based on Evaluation objectives
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Triple C Competency-based Curriculum
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The Big Question
• How do we develop competency based training
AND
• ensureAND
• document
End of training competence?
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Basic Principles
Define Behaviour Observe Behaviour
Assess BehaviourDecide where learner is on competencetrajectory
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Competency Trajectory
Expert
PGY1 Start
PGY2 Start
End Residency
First 3-5 years of Practice
Beginning Professional
Knowledgeable Professional
Novice
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TIME
SETT
ING SUMMATIVE
ASSESSMENT
RESIDENTOWNERSHIP!
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Development of The Evaluation Objectives
• Asked to describe competence in terms of:
– Patient problems and situations– Clinical decision making and judgment– Other qualities and behaviours– Problem areas
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Survey Results / Further Definition • 99 Topics
• 6 Skill Dimensions : Clinical Reasoning, Selectivity, Patient Centered Approach, Communication, Professionalism, Procedural/Psychomotor Skills
• 8 Phases of the Clinical encounter : History, Physical, hypothesis, Investigation, Diagnosis, Management, Referral, Follow-up
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Further Definition of TopicsKey Features
• Definition- The critical steps in the resolution of a problem. Focused on the points where we are most likely to make errors and the areas that are the most difficult in practice.
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Skills – Procedural• Decision to act- consider indications,
contraindications, your skills and context ( that day and time ability ), context of the procedure
• Informed Consent• Preparation: Review - anatomy, sequential
technical steps. potential complications and their management, appropriate equipment
• During Procedure: Keep patient informed (decrease anxiety), ensure comfort and safety
• If problems reevaluate ( ? Stop ? Ask for help)
• Aftercare/Follow-up
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CANMedsRoles
Clinical Domains
Skill Dimensions
Clinical Contexts
CommunicatorCollaboratorProfessionalScholarManagerAdvocate
Care through the Life CycleWomen’s Health + Maternity
Surgical/Procedural Mental Health
Palliative Care/End of Life CareCare of the Underserved
Care of the Elderly
HospitalHomeOffice
Labour delivery wardNursing Home
Operating RoomEmergency Department
SelectivityClinical ReasoningProfessionalismProcedural skillsPatient CentredMethodCommunicator
FAMILY MEDICINEEXPERT
Community
Community
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Levels of competence:
Low levels one well-defined taskdone repeatedly
the same way
High levels multiple tasks, ambiguous,uncertain end-points, partial data,
knows how and why, can justifycan abstract to new situations
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Task 1: Picking a competency
• Work with your table to define:• A population• An observable behavior/task• Timeline of success
• For example: Anesthesia residents inserting a labor epidural in a healthy parturient by the end of 2nd year of residency.
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“I am not interested in Competency Based Education”
Direct quote from Nov 2011 NOSM anesthesia retreat
slide presented byRob Anderson!
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What Changed?
• CanMEDs 2015• Time free “softened” to time as a
resource. • ICRE 2012/13• Workshops (Sherbino and UofT)• CFPC SIFP Working group• Unmatched desire to not have to
completely rebuild … ever!
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LESSON # 1: DON’T WORRY ABOUT THE EVOLVING DEFINITIONS…THEY WILL JUST TELL US!
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Definitions relevant to CBD
• Entrustable Professional Activities (EPA): • A task in the clinical setting that may be
delegated to a resident by their supervisor once competence has been demonstrated
• Milestones: • An observable marker of an individual’s
ability along a developmental continuum
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Competency by Design - Lots of Change!
• Increased resident ownership• Mainport ePortfolio• De-emphasize examinations• New accreditation structure• Competency committees and
coaches• Competency frameworks “Back
Office” vs “Front Office”
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Back Office
• Comprehensive set of milestones created through a set of workshops at the specialty committee
• Defines what it means to be a competent physician
• Map to EPAs and assessments
• Define duration and content of stages
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Front Office
• EPAs and specific milestone assessments
• Each EPA integrates multiple milestones
• Aggregated by ePortfolio• Bank of assessments that have
been identified for the programs• Implementing them is the key!
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Early EPA discussion
• We do this anyway!• Assess what is important, not
everything• Multiple milestones captured per
EPA• Key milestones captured across
multiple EPAs
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Labor Analgesia in the Healthy Parturient
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Competency Committees
• Promotion is resident driven!• Demonstrate that they have met
the bar• The bar must be clear• EPAs, set by the specialty
committee/working groups, will be mapped to CBD stages
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The FPA Journey
• CFPC extending CCC into enhanced skills programs
• Small working group created• Creation of Priority Topics
relevant to anesthesia –validated broadly
• Focus on discriminatory acts, or “key features”
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Priority Topics
• General Anesthesia• Post-operative care• Teamwork• Equipment • Neuraxial Anesthesia• Airway: complex• OR Emergencies
and complications• Pre-anesthesia
assessment
• Acutely ill or injured• Vascular access• Acute pain
management• Procedural Sedation• Know and apply
limits of capacity• Self directed
learning
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Key Features (PT Manage the complex airway)
• Can perform direct laryngosocopy
VS
• Can assess and predict/anticipate the patient with a difficult airway and the stages in which those difficulties may occur.
Or• Perform endotracheal intubation effectively in
elective, urgent and emergent situations that require different approaches
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LESSON # 2: YOU DO NOT HAVE TO ASSESS EVERYTHING, JUST THE RIGHT THINGS!
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Synergistic messages
• Residents own learning and documentation
• Assess the important things• Subjective and workplace
assessment is going to be vital
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Task 2: Defining what is important
• What are the key steps that one must demonstrate to complete the task?
• Keep in mind…• Where do the “incompetents” fall
down.• What is so essential it can’t not be
included
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LESSON # 3: FOCUS ON SMALL WINS WHEN IMPLEMENTING CHANGE.
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Don’t Try to Drink the Ocean!
Image source: www.istockphoto.com
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1. Analyze current practices2. Use the big picture to identify
achievable tasks which will move you toward CBD
3. Identify tools & resources required to achieve those tasks
4. Do the work & create the process5. Implement 6. Evaluate & re-evaluate frequently
Look at what you have & what you need
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Achievable Tasks
• Give residents real-time feedback on how they are doing in the program
• Set clear expectations for the residents & faculty
• Assess performance in the clinical setting
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Curriculum & Assessment for CBD
Tools for Implementation
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Trying our best to wade through the muddy waters of CBD
Developing & facilitating a culture of real-time feedback
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Resident LogBook Report p.1 of 6
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Centralized Learning Space
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Integration with MyCurriculum
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Progress Reporting
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Curriculum & Assessment for CBD
Tools for Implementation
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Gaining some additional clarity on resident & faculty expectations for CBD
Implementation of the new MicroCEXs in place of our Generic Daily Evaluation Card
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LESSON # 4: FACULTY BELIEVE IN AND LIKE COMPETENCY BASED ASSESSMENT…IT MAKES SENSE!
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MicroCEX - Checklist
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MicroCEX – Global Rating Scale
Key Features inform the Global Rating Scale narratives!
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Curriculum & Assessment for CBD
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Further development to
support real time feedback.
Setting clear expectations &
consequences for residents.
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Incorporating the Assessments
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Checklist
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Checklists & Reporting
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Curriculum & Assessment for CBD
Tools for Implementation
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4?
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For the Future
• Mapping to FPA priority topics & Royal College EPAs
• Program syllabus• Online assessment forms rather than
paper• Aggregation software to show overall
resident progress (needs assessment to determine program requirements)
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Overview of Lessons Learned
Lesson # 1: Don’t worry about the evolving definitions…They will just tell us!Lesson # 2: You do not have to assess everything, just the right things!Lesson # 3: Focus on Small wins when implementing change.Lesson # 4: Faculty believe in and like competency based assessment…it makes sense!
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What have you learned in this session?
What is one thing you will change because of this talk?
QUESTIONS?
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Contact Information
Dr. Rob Anderson Program Director, [email protected]
Dr. Cathy CervinAssociate Dean, [email protected]
Christina TremblayAssistant Curriculum Instructional [email protected]