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The Department of Anesthesiology launched a CBME program July 1 2015, two years ahead of the national rollout of CBD for anesthesiology (for a description of their program, see their ). We checked in with Dr. Daniel Dubois, Associate Program Director and CBD Lead to hear how the first year went.

How have faculty and residents reacted to the change?

The move towards CBME started two years before the launch of the program. We took the opportunity to take a hard look at our program and see how best the competencies required of an anesthesiologist could be taught. This resulted in some major changes to our teaching and assessment approaches. Our faculty were initially very receptive of the changes but over time we have noticed that support has waned.

Residents have been very responsive to the increase in feedback and coaching they receive. Having defined markers of progression helps them understand program expectations and sets a clear bar for promotion. Our first cohort of residents are eager to learn, highly engaged in their clinical work, and taking a mature approach to developing their own personalized learning plans. 

What has been the biggest success?

Our largest gain to date has been the increase in quantity and quality of daily feedback given to residents using the  (CCAT). With the CCAT, the residents receive timely face-to-face feedback from faculty after self-reflection of their own strengths and weaknesses. Having the residents drive their own assessments has led to greater ownership of their individualized daily learning plans and adds value above our monthly ITERs.

What has been the biggest pain point?

The increase in the amount of feedback and assessment, as well as the time required of faculty for other CBME initiatives we implemented, has led some to question the value of each new addition to our curriculum. We recognize the need for ongoing program evaluation and continual adaptation for improvement. Some changes will be for the better and some may have been for nought. Communicating the wins and examining the value added will help us maintain the support needed for ongoing implementation and maintenance. 

What are your next steps?

Ongoing education for both faculty and residents on the benefits of CBME and daily assessment, as well as ways to optimize feedback, will be the focus of our second year of implementation. Continuous faculty development is needed to engage members in becoming champions of the change. While this was done at the outset we recognize ongoing communication is key to successful adoption. 

As with any major change we also need to manage performance and measure the success of our changes against metrics. Planning locally and thinking nationally we need to establish a review process to identify areas for improvement and recognition of success. 

What advice do you have for others getting ready for CBD?

We need not fear the changes that are coming. It goes without saying that the transition will require time and effort. Setting yourself up for success and ensuring adequate lead-in time (we started two years out) will allow for a smooth evolution to CBD. Engage your department in a change management cycle and provide targeted faculty development as your first priority. Don’t reinvent the wheel; review existing literature and what others have already done within and outside your specialty. At �����Ƶ we need to share assessment tools, collaborate on faculty development strategies, and highlight the strengths of existing models. Being leaders of change and working together across specialties will be the key to our success.

The Department of Family Medicine is in its third year of a Triple C, competency-based curriculum. We talked to Dr. Alison Eyre, Resident Program Director, about their experience to date.

How have faculty and residents reacted to the change?

As is often the case with change, our switch to CBME has been described as “painful but worth it” by those involved. In a survey we conducted during our second year, 90% of faculty agreed there was value in CBME. Residents in particular have viewed the change positively; noting it is flexible and gives them the opportunity to provide input on their own learning.

What has been the biggest success?

Our biggest success has been the level of engagement of faculty, residents, and administration. Twenty-six percent of faculty were involved in program planning. Then, to support implementation across a widely geographically dispersed and contextually diverse program, we used a “travelling road show” approach to train and empower faculty locally regarding CBME. Perhaps the most valued tool is the twice yearly Structured Progress Review (SPR) conducted by the resident’s supervisor; 89% of faculty agreed or strongly agreed the SPR has value for the learner. In our department, education is much more conscious   now;    with   the   faculty   more   engaged   and viewing the resident as a whole physician, in line with the educational philosophy of our program.

What has been the biggest pain point?

Budget! Program implementation coincided with government budget cuts so we were asking our faculty to do more for less. Nonetheless, we still had high engagement. I think our biggest challenge of implementing CBME to a diverse program—we are a large bilingual program with residents training in urban, rural, and community settings—led to some of our biggest successes (e.g., faculty development).

What are your next steps?

We have a five-year implementation plan, so we will continue to develop the program; releasing domain-specific  to support regular assessment, as well as enhancing  to support changes. Development of an evaluation framework and logic model will guide future program evaluation.

What advice do you have for others?

Our motto was “There’s always another July 1”. You don’t need to make all the changes at once; go slowly and pilot the tools. Faculty engagement was the key to our success so we advise program directors to invite faculty to provide input during the program planning phase; empower faculty, residents, and administrators to make decisions and own the change; and offer faculty development locally at the faculty member’s site/hospital, as well as organize retreats for faculty to come together away from their regular workplace.

In August 2016, Dr. Christopher Hudson, Dr. Viren Naik, and Dr. Emma J. Stodel collected the World Federation of Societies of Anesthesiologists (WFSA) Innovation Award at the World Congress of Anaesthesiologists in Hong Kong in recognition of the online tools developed to support �����Ƶ’s Department of Anesthesiology’s new competency-based medical education (CBME) program. The WFSA Innovation Awards encourage and support innovation in anaesthesiology that has had – or is likely to have – a positive impact on surgical patient outcomes globally.

For more information about these tools and to see how you can use them in your program to support CBME contact Leah Arsenault at [email protected]. Also see .

Dr. Marcio Gomes

We congratulate Dr. Marcio Gomes, Department of Pathology and Laboratory Medicine, who received the Robert Maudsley Fellowship for Studies in Medical Education. His MHPE thesis is focused on the development of valid assessment tools for assessing the technical skills of pathology residents. Prior to Dr. Gomes’ work, there were no workplace-based assessment tools for assessing technical skills in pathology and laboratory medicine. With the advent of CBD, there is the need for tools that will guide trainees’ learning and provide feedback regarding their progress towards the achievement of Entrustable Professional Activities (EPAs). Current assessment tools are often criticized as assessors tend not to use the extremes of the rating scales; that is, there is a central tendency bias. To address this, Dr. Gomes and colleagues used entrustment decisions as the anchors for assessment, similar to the O-SCORE and OCAT. The resulting Entrustment-based Pathology Assessment Tool (EPAT) was implemented at Western University in June 2016 and is currently undergoing psychometric testing. It will be implemented at �����Ƶ later this year.

The implementation of CBME in residency programs across Canada is certainly a hot topic of conversation for today’s residents. CBD is being viewed both with excitement and trepidation. We asked Dr. Irfan Kherani, PGY-3 Ophthalmology, Ottawa PARO Team’s CBME Liaison, and Member of PGME’s CBME   Subcommittee, to share his insights for Program Directors as they embark on the CBD journey.

What are residents talking about?

While most residents are aware that CBME is coming to their program (if it hasn’t already) many are unsure what CBME is and how it will impact them. Their key questions centre around how CBME will affect service and how it will be resourced.

What can Program Directors do to prepare for CBD?

Regardless of when CBD will be implemented for your specialty, conversations with residents need to start now. CBD provides an opportunity for Program Directors to optimize their program and fully engage faculty and residents in shaping the direction of residency education. Involving residents in discussions early will ensure everyone is on the same page when the new CBD program is launched.

Frequent assessment and feedback are the backbone of CBME. Residents who are not used to receiving regular and documented feedback will need support, as will faculty who are not in the habit of giving it. Daily feedback should be viewed differently to that given on a quarterly or bi-yearly basis; with the focus very much on how to become a better doctor. Residents want to direct their learning experiences and need to be empowered to take ownership of their learning. Consider how you can support and drive residents to achieve excellence rather than viewing “adequate” as sufficient. If frequent observation and feedback is not currently commonplace in your program, start small and introduce the concept of daily assessments slowly. Also, ensure there are learning opportunities for how to give and receive feedback effectively. PGME has online modules for both faculty and residents (to be launched shortly) on these topics.

What is being done at the resident level to prepare for CBD?

CBME continues to be a priority for PARO this year and an area we expect to devote significant organizational resources to over the coming years. We have a number of initiatives underway focused on finding opportunities to optimize medical education in Ontario and look forward to working closely with our partners in PGME, the Royal College, the hospitals, and Resident Doctors of Canada (RDoC) to support our members during the rollout process.

Who can Program Directors turn to for support?

Current residents are an important resource; many are interested in getting involved and have valuable perspectives on CBD implementation. At �����Ƶ we are fortunate to have Leah Arsenault, CBD Coordinator, PGME Office. She has her finger on the pulse of CBD and regularly communicates with other universities to ensure we learn from each other, maximize synergies, and avoid duplication. �����Ƶ already has three programs that have launched CBME: Family Medicine, Anesthesiology, and Otolaryngology—Head and Neck Surgery. Talk to the Program Directors, faculty, residents, and staff in these programs to learn from their experiences. Representatives from PARO are also willing to share insights. Residents are excited to be a part of this transformation of medical education, so please reach out to us!