1
|
Wong L, Sacoransky E, Hopman W, Islam O, Chung AD, Kwan BYM. Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education. MEDICAL EDUCATION ONLINE 2024; 29:2357412. [PMID: 38810150 PMCID: PMC11138222 DOI: 10.1080/10872981.2024.2357412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Since 2022, all Canadian post-graduate medical programs have transitioned to a Competence by Design (CBD) model within a Competency-Based Medical Education (CBME) framework. The CBME model emphasized more frequent, formative assessment of residents to evaluate their progress towards predefined competencies in comparison to traditional medical education models. Faculty members therefore have increased responsibility for providing assessments to residents on a more regular basis, which has associated challenges. Our study explores faculty assessment behaviours within the CBD framework and assesses their openness to opportunities aimed at improving the quality of written feedback. Specifically, we explore faculty's receptiveness to routine metric performance reports that offer comprehensive feedback on their assessment patterns. METHODS Online surveys were distributed to all 28 radiology faculty at Queen's University. Data were collected on demographics, feedback practices, motivations for improving the teacher-learner feedback exchange, and openness to metric performance reports and quality improvement measures. Following descriptive statistics, unpaired t-tests and one-way analysis of variance were conducted to compare groups based on experience and subspecialty. RESULTS The response rate was 89% (25/28 faculty). 56% of faculty were likely to complete evaluations after working with a resident. Regarding the degree to which faculty felt written feedback is important, 62% found it at least moderately important. A majority (67%) believed that performance reports could influence their evaluation approach, with volume of written feedback being the most likely to change. Faculty expressed interest in feedback-focused development opportunities (67%), favouring Grand Rounds and workshops. CONCLUSION Assessment of preceptor perceptions reveals that faculty recognize the importance of offering high-quality written feedback to learners. Faculty openness to quality improvement interventions for curricular reform relies on having sufficient time, knowledge, and skills for effective assessments. This suggests that integrating routine performance metrics into faculty assessments could serve as a catalyst for enhancing future feedback quality.
Collapse
Affiliation(s)
- Laura Wong
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Ethan Sacoransky
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Omar Islam
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Andrew D. Chung
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Benjamin Y. M. Kwan
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| |
Collapse
|
2
|
Kalun P, Braund H, McGuire N, McEwen L, Mann S, Trier J, Schultz K, Curtis R, McGuire A, Pereira I, Dagnone D. Was it all worth it? A graduating resident perspective on CBME. MEDICAL TEACHER 2024:1-9. [PMID: 38742827 DOI: 10.1080/0142159x.2024.2339408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Our institution simultaneously transitioned all postgraduate specialty training programs to competency-based medical education (CBME) curricula. We explored experiences of CBME-trained residents graduating from five-year programs to inform the continued evolution of CBME in Canada. METHODS We utilized qualitative description to explore residents' experiences and inform continued CBME improvement. Data were collected from fifteen residents from various specialties through focus groups, interviews, and written responses. The data were analyzed inductively, using conventional content analysis. RESULTS We identified five overarching themes. Three themes provided insight into residents' experiences with CBME, describing discrepancies between the intentions of CBME and how it was enacted, challenges with implementation, and variation in residents' experiences. Two themes - adaptations and recommendations - could inform meaningful refinements for CBME going forward. CONCLUSIONS Residents graduating from CBME training programs offered a balanced perspective, including criticism and recognition of the potential value of CBME when implemented as intended. Their experiences provide a better understanding of residents' needs within CBME curricula, including greater balance and flexibility within programs of assessment and curricula. Many challenges that residents faced with CBME could be alleviated by greater accountability at program, institutional, and national levels. We conclude with actionable recommendations for addressing residents' needs in CBME.
Collapse
Affiliation(s)
- Portia Kalun
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Heather Braund
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Natalie McGuire
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Laura McEwen
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Steve Mann
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Jessica Trier
- Queen's Health Sciences, Queen's University, Kingston, Canada
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Canada
- Providence Care Hospital, Kingston, Canada
| | - Karen Schultz
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Rachel Curtis
- Queen's Health Sciences, Queen's University, Kingston, Canada
- Department of Ophthalmology, Queen's University, Kingston, Canada
| | - Andrew McGuire
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Ian Pereira
- Queen's Health Sciences, Queen's University, Kingston, Canada
| | - Damon Dagnone
- Queen's Health Sciences, Queen's University, Kingston, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| |
Collapse
|
3
|
Dhami N, Hamza DM, Daniels VJ. Motivations for Entrustable Professional Activity Assessment: Gaps Between Curriculum Theory and Resident Reality. J Grad Med Educ 2024; 16:166-174. [PMID: 38993299 PMCID: PMC11234313 DOI: 10.4300/jgme-d-23-00470.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/23/2023] [Accepted: 01/27/2024] [Indexed: 07/13/2024] Open
Abstract
Background Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. Objective This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. Methods This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents' primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Results Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Conclusions Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.
Collapse
Affiliation(s)
- Neil Dhami
- is a PGY-4 Resident, General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deena M Hamza
- is an Innovation Scientist, Health Professions Education Scientist, Director, Research & Evaluation, Postgraduate Medical Education, Adjunct Assistant Professor, Department of Medicine, Edmonton, Alberta, Canada, and Vice-Chair, Canadian Association for Medical Education Foundation, Ottawa, Ontario, Canada; and
| | - Vijay J Daniels
- is Professor, Division of General Internal Medicine, Associate Chair of Education and Faculty Development, Department of Medicine, and Assistant Dean of Assessment, MD Program, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
4
|
Gordon M, Daniel M, Ajiboye A, Uraiby H, Xu NY, Bartlett R, Hanson J, Haas M, Spadafore M, Grafton-Clarke C, Gasiea RY, Michie C, Corral J, Kwan B, Dolmans D, Thammasitboon S. A scoping review of artificial intelligence in medical education: BEME Guide No. 84. MEDICAL TEACHER 2024; 46:446-470. [PMID: 38423127 DOI: 10.1080/0142159x.2024.2314198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Artificial Intelligence (AI) is rapidly transforming healthcare, and there is a critical need for a nuanced understanding of how AI is reshaping teaching, learning, and educational practice in medical education. This review aimed to map the literature regarding AI applications in medical education, core areas of findings, potential candidates for formal systematic review and gaps for future research. METHODS This rapid scoping review, conducted over 16 weeks, employed Arksey and O'Malley's framework and adhered to STORIES and BEME guidelines. A systematic and comprehensive search across PubMed/MEDLINE, EMBASE, and MedEdPublish was conducted without date or language restrictions. Publications included in the review spanned undergraduate, graduate, and continuing medical education, encompassing both original studies and perspective pieces. Data were charted by multiple author pairs and synthesized into various thematic maps and charts, ensuring a broad and detailed representation of the current landscape. RESULTS The review synthesized 278 publications, with a majority (68%) from North American and European regions. The studies covered diverse AI applications in medical education, such as AI for admissions, teaching, assessment, and clinical reasoning. The review highlighted AI's varied roles, from augmenting traditional educational methods to introducing innovative practices, and underscores the urgent need for ethical guidelines in AI's application in medical education. CONCLUSION The current literature has been charted. The findings underscore the need for ongoing research to explore uncharted areas and address potential risks associated with AI use in medical education. This work serves as a foundational resource for educators, policymakers, and researchers in navigating AI's evolving role in medical education. A framework to support future high utility reporting is proposed, the FACETS framework.
Collapse
Affiliation(s)
- Morris Gordon
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
- Blackpool Hospitals NHS Foundation Trust, Blackpool, UK
| | - Michelle Daniel
- School of Medicine, University of California, San Diego, SanDiego, CA, USA
| | - Aderonke Ajiboye
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Hussein Uraiby
- Department of Cellular Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nicole Y Xu
- School of Medicine, University of California, San Diego, SanDiego, CA, USA
| | - Rangana Bartlett
- Department of Cognitive Science, University of California, San Diego, CA, USA
| | - Janice Hanson
- Department of Medicine and Office of Education, School of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Mary Haas
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maxwell Spadafore
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Colin Michie
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Janet Corral
- Department of Medicine, University of Nevada Reno, School of Medicine, Reno, NV, USA
| | - Brian Kwan
- School of Medicine, University of California, San Diego, SanDiego, CA, USA
| | - Diana Dolmans
- School of Health Professions Education, Faculty of Health, Maastricht University, Maastricht, NL, USA
| | - Satid Thammasitboon
- Center for Research, Innovation and Scholarship in Health Professions Education, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
5
|
Frank JR, Hall AK, Oswald A, Dagnone JD, Brand PLP, Reznick R. From Competence by Time to Competence by Design: Lessons From A National Transformation Initiative. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:224-228. [PMID: 38550713 PMCID: PMC10976982 DOI: 10.5334/pme.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education, and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Competency Based Medical Education, and Professor, Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J. Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Standards and Accreditation, Royal College of Physicians & Surgeons of Canada, Ottawa, ON, Canada
| | - Paul L. P. Brand
- Clinical Medical Education, University Medical Centre and University of Groningen, the Netherlands
- Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
| | - Richard Reznick
- Queen’s University, Immediate Past President Royal College of Physicians and Surgeons of Canada, Canada
| |
Collapse
|
6
|
Ingledew PA, Lalani N, Keane F. Exposure Is More Than Distance or Time: The Evolution of Competence-Based Medical Education in Radiation Oncology Training. Int J Radiat Oncol Biol Phys 2024; 118:879-885. [PMID: 38401971 DOI: 10.1016/j.ijrobp.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/22/2023] [Indexed: 02/26/2024]
Affiliation(s)
- Paris-Ann Ingledew
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Surgery, University of British Columbia Faulty of Medicine, Vancouver, British Columbia, Canada.
| | - Nafisha Lalani
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | - Florence Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
7
|
de Heer MH, Driessen EW, Teunissen PW, Scheele F. Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans. Front Med (Lausanne) 2024; 11:1339857. [PMID: 38455473 PMCID: PMC10917951 DOI: 10.3389/fmed.2024.1339857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Curricula for postgraduate medical education have transformed since the introduction of competency based medical education (CBME). Postgraduate training plans offer broader training with different competencies and an outcome-based approach, in addition to the medical technical aspects of training. However, CBME also has its challenges. Over the past years, critical views have been shared on the potential drawbacks of CBME, such as assessment burden and conflicts with practicality in the workplace. Recent studies identified a need for a better understanding of how the evolving concept of CBME has been translated to curriculum design and implemented in the practice of postgraduate training. The aim of this study was to describe the development of CBME translations to curriculum design, based on three consecutive postgraduate training programs spanning 17 years. Method We performed a document analysis of three consecutive Dutch gynecology and obstetrics training plans that were implemented in 2005, 2013, and 2021. We used template analysis to identify changes over time. Results Over time, CBME-based curriculum design changed in several domains. Assessment changed from a model with a focus on summative decision to one with an emphasis on formative, low-stakes assessments aimed at supporting learning. The training plans evolved in parallel to evolving educational insights, e.g., by placing increasing emphasis on personal development. The curricula focused on a competency-based concept by introducing training modules and personalized authorization based on feedback rather than on a set duration of internships. There was increasing freedom in personalized training trajectories in the training plans, together with increasing trust towards the resident. Conclusion The way CBME was translated into training plans has evolved in the course of 17 years of experience with CMBE-based education. The main areas of change were the structure of the training plans, which became increasingly open, the degree to which learning outcomes were mandatory or not, and the way these outcomes were assessed.
Collapse
Affiliation(s)
- Merel H. de Heer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands
| | - Erik W. Driessen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Pim W. Teunissen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Fedde Scheele
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands
- Athena Institute, Faculty of Science, VU, Amsterdam, Netherlands
| |
Collapse
|
8
|
Hamza DM, Hauer KE, Oswald A, van Melle E, Ladak Z, Zuna I, Assefa ME, Keto-Lambert D, Ross S. Response to: Letter to the Editor about 'Making sense of competency-based medical education'. MEDICAL TEACHER 2023; 45:794-795. [PMID: 37036142 DOI: 10.1080/0142159x.2023.2195723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Deena M Hamza
- Postgraduate Medical Education, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Anna Oswald
- Postgraduate Medical Education, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
- Department of Medicine, Division of Rheumatology, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Elaine van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Zeenat Ladak
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Ines Zuna
- Undergraduate Medical Education, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Mekdes E Assefa
- Global Health, School of Public Health, University of Alberta, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Alberta, Canada
| | - Shelley Ross
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| |
Collapse
|
9
|
Kassam A, Lord J, Ellaway RH. Response to: 'Making sense of competency-based medical education'. MEDICAL TEACHER 2023; 45:793. [PMID: 36931314 DOI: 10.1080/0142159x.2023.2189536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Aliya Kassam
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jason Lord
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Departments of Critical Care Medicine and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|