Evaluating Residents By Competency, Not Time

Jul 5, 2018
Heidi Singer

As medical residencies begin this week, the learning and evaluation process is significantly different in six specialties, including Medical Oncology and Emergency Medicine.

That’s because medical education in Canada is moving to an increasingly customized, intimate teaching approach, with more frequent testing, more hands-on support and supervision by senior physicians, and a greater focus on communication skills such as the ability to deliver bad news to patients. Dubbed “Competence by Design (CBD),” the new format was pioneered at U of T, and is being gradually implemented in every medical school in Canada.

In specialties that have made the switch, such as Otolaryngology, learning is less about logging a certain number of hours, and more about showing – in real time -- that necessary ‘competencies’ have been acquired.

“Now we’re highlighting the skills and professional activities that make up our skillset and signing off on each one as our learners acquire them,” says Professor Paolo Campisi, Vice Chair Education and Director of Postgraduate Education for the Department of Otolaryngology – Head & Neck Surgery. “We test constantly, so each test is lower-stakes, and we intervene early to correct any deficiencies.”

Although it’s very rare for a resident to fail their final exams in the current system, Campisi says correcting problems as soon as they come up is better, since residents are delivering care throughout their learning process. So, if a resident struggles to deliver bad news with clear, compassionate communication skills, that problem will be addressed immediately, benefitting his or her next patient. “The ultimate goal is to make things better for patients,” Campisi says.

Medical students are highly accomplished, and educators have realized, with concern, that many never experienced failure until they reached the high-stakes environment of medicine. Yet, learning to fail – among other ‘soft skills’ is considered important to avoid burnout and other problems.

Marissa Bonyun, a fourth-year resident in Orthopaedic Surgery, likes being evaluated in real time in the workplace because “it gives us the opportunity to become accustomed not just to performing and testing, but also to gauge where we are on a regular basis,” she says. “As adult learners, this more frequent testing puts the focus on constant improvement and making learning goals to achieve and work towards. It’s more of a focus on testing forlearning rather than oflearning.”

Professor Glen BandieraProfessor Glen Bandiera U of T’s Faculty of Medicine pioneered the new style of learning in its Department of Orthopaedic Surgery almost a decade ago. The Department of Family Medicine was also an early adopter. Last year, the Royal College of Physicians and Surgeons, working with Canada’s 17 medical schools, officially rolled out the CBD program for Otolaryngology and Anesthesiology across Canada. This year, the six specialties to sign on are: Emergency Medicine, Forensic Pathology, Medical Oncology, Nephrology, Surgical Foundations, and Urology. A dozen more will make the switch next year. Eventually, 65 specialties will educate residents using the CBD model.

“It has been gratifying to see more and more interest among our faculty members and learners and requests to be involved in CBD,” says Professor Glen Bandiera, Associate Dean, Postgraduate Medical Education, who is overseeing its implementation at the Faculty of Medicine. “It’s important we make sure to support everyone in this process, so we’re working with U of T’s Centre for Faculty Development to offer training to faculty in particular on coaching and providing effective feedback. And just as the new model trains learners to respond to feedback and be flexible with change, we at the Faculty leadership level will be listening to everyone involved and making adjustments as necessary.”

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