Training Flexible and Responsive Health Professionals

Jul 18, 2018

Professors Suzan Schneeweiss and Glen BandieraProfessors Suzan Schneeweiss and Glen Bandiera
For many of us in the Post MD Education portfolio, this month is a busy one as programs welcome their latest cohort of medical residents into the first year of their postgraduate training, and planning is in high gear for fall.

Continuing Professional Development — having delivered more than 400 accredited programs in 2017-18 — is hard at work developing programs for the upcoming academic year. Our full program offerings can be found here

And the post-graduate medical education office has assisted six residency programs that have “gone live” this academic year with competency-based medical education (CBME): emergency medicine, forensic pathology, medical oncology, nephrology, surgical foundations, and urology have all developed their curricula and assessment strategies to align with the national colleges. Another 11 programs will make the shift in 2018-19.

This is a significant step forward in the continued evolution of medical education. Replacing the time-based “apprenticeship model,” CBME offers more frequent observations, assessments and feedback for residents to gradually demonstrate the acquisition of skills.

The University of Toronto has been well ahead of the country in making the shift to CBME. Our orthopedics program has been using a competency-based model as an approved pilot project by the Royal College for almost 10 years. Similarly, the Department of Psychiatry has moved forward in advance of the national roll-out with an approved pilot program of its own. The Departments of Anesthesia and Otolaryngology - Head and Neck Surgery have completed their first year using the new national CBME model. These programs are demonstrating key lessons that are influencing the national directions.
One of those lessons is the volume of data and the skills needed to interpret that data.

Assessment data — achievements and comments based on multiple competencies observed multiple times per resident — need cogent analysis and interpretation.

Anesthesia, for example, has created a functional dashboard of 6,000 data points that yields an overall performance score per resident. The key to managing this process has not only been a strong technology platform — thanks to Discovery Commons and investments made by the Department of Anesthesia and the PGME office — but also robust faculty development. Faculty members will need help in understanding the new model, particularly the role that each of their assessments will have in the eventual decision-making about learner promotion and the role of coaching and feedback at the time of each assessment. This work will be led by Professor Susan Glover Takahashi

No question, this approach to learning increases the load, particularly in the transitional early years. Everyone is focused on patient care and so we should be. But we must be mindful to ensure that our faculty and residents do not feel overwhelmed by the stress of multiple assessments and continual evaluation. 
Ideally, CBME training will set up the next generation of physicians to be more flexible with change and respond well to feedback — qualities that all healthcare practitioners need in a complex environment.

That same drive for flexibility is seen in our work in Continuing Professional Development. CPD strives to develop programs that enhance perfomance of health practitioners and improve health care outcomes using a variety of learning formats to meet the needs of individual practitioners. Increasingly, programs are being developed using a variety of assessment and feedback strategies. These include online simulation-based programs such a ImageSim, blended learning programs such as the Safe Opioid Prescribing program and live conferences with test-enhanced learning such as the SickKids Annual Paediatric Update.

CPD has also taken a leadership role in the development of programs to build the competencies of CPD developers through programs such as the Certficate Program in CPD Foundations, which was recently awarded the Royal College CPD Providers Innovation Award, the fourth year that CPD has been honoured with this award.

We want to understand the impact of such changes moving forward, and so scholarship is integral to everything we do. Post MD Education promotes research and scholarship through research and development grants and awards both in CPD and PGME.

By bringing PGME and CPD together under a single portfolio, we are co-creating a system where learners are not passing through a series of silos. The ultimate goal — one that is shared by our colleagues in the MD Program who are also working on this — is the creation of a cohesive continuum of learning that focuses on training customized to meet the needs of the learner.

It’s about putting aside organizational structures to ensure the Faculty of Medicine is ready to support health professionals from the moment they come into their training to the moment they choose to hang up their stethoscope for the last time. 

Glen Bandiera
Associate Dean, Postgraduate Medical Education
Faculty of Medicine

Suzan Schneeweiss
Associate Dean, Continuing Professional Development
Faculty of Medicine

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