The Competency-based Curriculum through the lens of the Resident

The Competency-based
Curriculum through the lens
of the Resident
M Kennedy Hynes, M Nousiainen,
P Ferguson, S Glover Takahashi
• We do not have an
affiliation (financial or
otherwise) with a
pharmaceutical,
medical device or
communications
organization.
• Nous n‟avons aucune
affiliation (financière
ou autre) avec une
entreprise
pharmaceutique, un
fabricant d‟appareils
médicaux ou un
cabinet de
communication.
Research shows that understanding
the „student experience‟ of learning
and teaching improves educational
practice
(Cantillion & Jones, 1999; Mann, 1994; Wolf, Balson, Facuett & Randall, 1989).
Research Context and Purpose
• This research reports on the residents' views of
the current Orthopaedic Surgery „experiment‟ in
delivery of a curriculum which is solely
competency-based.
• The residents' views were specifically explored
about which CanMEDS Roles and Entrustable
Professional Activities (EPA‟s) would be
important to track and develop in order for them
to become competent physicians.
Competency-based Education
• “…an approach to preparing physicians for
practice that is fundamentally oriented to
graduate outcome abilities and organized
around competencies derived from an analysis
of societal and patient needs. It deemphasizes
time-based training and promises greater
accountability, flexibility, and learner
centeredness” (Frank et al., 2010, p. 636).
CanMEDS Roles
Entrustable Professional
Activites (EPAs)
• „a critical part of professional work that can
be identified as a unit to be entrusted to a
trainee once sufficient competence has
been reached‟
(ten Cate, 2006)
Methodology
Mixed Methods Study
 Qualitative individual interviews
 Quantitative Survey
Population
 Orthopaedic Surgery Residents from the University of Toronto
-Competency-based Curriculum residents – Subgroup 1 (n=9)
-Time-based curriculum residents – Subgroup 2 (n=64)
Sample
 Individual Interviews – Subgroup 1 (n=5)
 Quantitative Survey – Subgroup 1 and 2 (n=21)
Analysis
Using grounded theory the data sets were
explored iteratively to understand what
residents view as important to their training
.
About CanMEDS
- by method
- by group
FROM INTERVIEW OF CBC RESIDENTS
CanMEDS Roles: Importance to becoming competent
Comments
“I think as you go through and become more of a senior resident
instead of a junior, you become more aware of these issues. The
issues that relate to each Role and how you can learn from your
staff without them formally teaching it. That takes experience
and time and the ability to look beyond the Medical Expert
component – which again, is always at the forefront”
“I think right now the number one [CanMEDS Role] that
everybody would say would definitely be medical expert just
because of the fact that it is overwhelmingly what is expected of
us, what is taught, what is tested, and it’s also what allows you to
be good at the other ones”
In contrast to interviews, in the survey
Scholar and Professional Roles were listed
as the two most important Roles after
Medical Expert.
FROM SURVEY OF ALL RESIDENTS
CanMEDS Roles: Importance to becoming competent
100%
90%
80%
70%
60%
50%
40%
Not at all important
30%
Not Important
20%
Somewhat Important
10%
Important
0%
Very Important
FROM SURVEY OF ALL RESIDENTS
CanMEDS Roles - Resident Rated Personal Competence by
CanMEDS Role for Subgroup 1 & 2
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Not at all competent
Not competent
Somewhat competent
Competent
Very Competent
About EPAs
- by method
- by group
FROM INTERVIEW OF CBC RESIDENTS
EPAs: Importance to becoming competent
FROM SURVEY OF ALL RESIDENTS
Top 5 EPAs ranked by Subgroup 1 & 2
Rank
EPA
1
2
3
4
5
Clinical evaluation of MSK system
Completing history and physical
Stabilization of multiple trauma patients for transfers
Basic closed reduction, non-op care (wrist)
Obtaining consent from a patient and/or caregiver
N(%) of residents
ranked as 1 & 2
N=20
13 (65%)
12 (60%)
10 (50%)
10 (50%)
9 (45%)
Limits
• Interview small (5) and limited to sample
convenience from CBC group [ 5/9 or 56%
of CBC group]
• Group 1(CBC) for survey = 44% (4 of 9)
• Group 2 (regular) for survey = 39% (21/64)
Next Steps
• Implementation informed by learners‟
views
• Compare with faculty views
• Compare interests/needs/directions
• Compare confidence/competence
Thank you
• Participant
• Program Leaders:
– Dr Peter Ferguson, Dr. Markku Nousiainen
Questions
– Melissa Kennedy Hynes
melissa.kennedy@utoronto.ca