The influence of resident and faculty gender on assessments in anesthesia competency-based medical education

PURPOSE

Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system.

METHODS

This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored.

RESULTS

In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender.

CONCLUSION

We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.

Implementing competency-based medical education curriculum in undergraduate psychiatric training in India: Opportunities and challenges

Medical education in India is undergoing a landmark transformation under the National Medical Commission implementing competency-based medical education (CBME). The CBME approach intends to ensure that medical graduates acquire the competencies needed to fulfill the health needs of the patient and society. This outcome-based approach shifts the focus from the traditional knowledge-based training to skill-based training valued on attitude, ethics, and communication (AETCOM) competencies. CBME thus aims to create medical professionals capable of providing holistic care with compassion and excellence embracing the global trends. The opportunity posed by the CBME should be utilized to sensitize and create interest among the learners about the science and scope of psychiatry. However, there are many challenges in the successful implementation of CBME, which have to be identified and addressed on time for serving the purpose. A basic tenet in CBME is to continue training until the desired competencies are achieved; in other words, to de-emphasize time-based learning. Moreover, the current COVID 19 pandemic is posing a significant influence on the execution of CBME implemented in August 2019. Online platforms could have several advantages in assisting the implementation of CBME; they provide an alternative to continue teaching-learning and assessment during these times and allow learners with the flexibility to learn at their own pace. In this article, we discuss the opportunities, including digital platforms and challenges to be overcame as well as the need for training the faculty toward assimilating the curriculum in the undergraduate psychiatric training.

Developing a National Competency-Based Diabetes Curriculum in Undergraduate Medical Education: A Delphi Study

OBJECTIVES

In recent years there has been an increased emphasis on competency-based medical education (CBME) in Canada and internationally, as can be seen with the implementation of competency-based curriculums for postgraduate medical education (PGME) through the Royal College of Physicians and Surgeons of Canada. Currently, no Canada-wide consensus exists on educational competencies relating to diabetes in undergraduate medical education (UGME). Our aim in this study was to develop a list of competencies and objectives for UGME in diabetes using a modified Delphi method.

METHODS

Representatives involved in the development of the diabetes curriculum at all 17 medical schools across Canada were contacted. A draft list of competencies and objectives was developed by the research team using the existing curriculums at 9 Canadian medical schools and was organized using the CanMEDS framework. A Delphi method was used, with 2 iterations in order to reach consensus.

RESULTS

Twelve of 17 medical schools agreed to participate. Of the 12 surveys sent in the first round, 8 responses were received (response rate 66.7%). The revised version was then resent to the 8 respondents and 7 responses were received (response rate 87.5%). A list of 9 competencies and 62 objectives was finalized.

CONCLUSIONS

A competency-based consensus curriculum for diabetes education for undergraduate medical students was developed using a modified Delphi method. The final consensus syllabus will be disseminated across the country. This curriculum serves as a step in the transition to competency-based UGME and in ensuring that future medical school graduates are proficient in diabetes care.

From time-based to competency-based standards: core transitional competencies in plastic surgery

PURPOSE

Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training.

METHODS

A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction.

RESULTS

The response rate was 100% (11/11). Using the average rankings of program directors, 26 "core" skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies.

CONCLUSIONS

Overall, 26 competencies have been identified as "core" for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency.