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      Ten ways to get a grip on designing and implementing a competency-based medical education training program Translated title: Dix conseils pour réussir la conception et la mise en œuvre d'un programme d’éducation médicale axée sur les compétences

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          Abstract

          Background

          Globally there is a move to adopt competency-based medical education (CBME) at all levels of the medical training system. Implementation of a complex intervention such as CBME represents a marked paradigm shift involving multiple stakeholders.

          Methods

          This article aims to share tips, based on review of the available literature and the authors’ experiences, that may help educators implementing CBME to more easily navigate this major undertaking and avoid “black ice” pitfalls that educators may encounter.

          Results

          Careful planning prior to, during and post implementation will help programs transition successfully to CBME. Involvement of key stakeholders, such as trainees, teaching faculty, residency training committee members, and the program administrator, prior to and throughout implementation of CBME is critical. Careful and selective choice of key design elements including Entrustable Professional Activities, assessments and appropriate use of direct observation will enhance successful uptake of CBME. Pilot testing may help engage faculty and learners and identify logistical issues that may hinder implementation. Academic advisors, use of curriculum maps, and identifying and leveraging local resources may help facilitate implementation. Planned evaluation of CBME is important to ensure choices made during the design and implementation of CBME result in the desired outcomes.

          Conclusion

          Although the transition to CBME is challenging, successful implementation can be facilitated by careful design and strategic planning.

          Translated abstract

          Contexte

          Partout dans le monde, on observe une tendance en faveur de l’éducation médicale axée sur les compétences (EMAC) à tous les niveaux du système d’éducation médicale. Une intervention complexe comme l’élaboration d’un programme d’EMAC représente un important changement de paradigme qui nécessite l’implication de plusieurs parties prenantes.

          Méthode

          L’objectif de cet article est de partager des conseils dégagés par les auteurs d’une revue de la littérature et de leur propre expérience afin d’aider les éducateurs à mieux s’orienter dans cette entreprise de taille qu’est la mise en œuvre de l’EMAC et à éviter les écueils.

          Résultats

          Une planification minutieuse avant, pendant et après la transition des programmes vers l’EMAC contribue à garantir son succès. L'implication des principales parties prenantes, telles que les stagiaires, le corps enseignant, les membres du comité du programme de résidence et l'administrateur du programme, avant et pendant la mise en œuvre est essentielle. La sélection attentive des éléments clés, comme les activités professionnelles confiables, les évaluations et l'utilisation appropriée de l'observation directe, favorisera l'adoption de l’EMAC. Des tests pilotes peuvent permettre la participation du corps professoral et des apprenants, et à déceler les problèmes logistiques qui peuvent entraver la mise en œuvre. Les conseillers pédagogiques, le recours à la cartographie des programmes d'études et le repérage et la mobilisation de ressources locales peuvent faciliter la mise en œuvre des programmes d’EMAC. L’évaluation planifiée de ces programmes est importante pour garantir que les choix faits lors de leur conception et mise en œuvre aboutissent aux résultats souhaités.

          Conclusion

          Puisque la transition vers l’EMAC peut comporter de nombreux défis, elle peut néanmoins être opérée avec succès grâce à une conception et une planification stratégique minutieuses.

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          Most cited references23

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          Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99.

          This Guide was written to support educators interested in building a competency-based workplace curriculum. It aims to provide an up-to-date overview of the literature on Entrustable Professional Activities (EPAs), supplemented with suggestions for practical application to curriculum construction, assessment and educational technology. The Guide first introduces concepts and definitions related to EPAs and then guidance for their identification, elaboration and validation, while clarifying common misunderstandings about EPAs. A matrix-mapping approach of combining EPAs with competencies is discussed, and related to existing concepts such as competency milestones. A specific section is devoted to entrustment decision-making as an inextricable part of working with EPAs. In using EPAs, assessment in the workplace is translated to entrustment decision-making for designated levels of permitted autonomy, ranging from acting under full supervision to providing supervision to a junior learner. A final section is devoted to the use of technology, including mobile devices and electronic portfolios to support feedback to trainees about their progress and to support entrustment decision-making by programme directors or clinical teams.
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            Competency-based postgraduate training: can we bridge the gap between theory and clinical practice?

            The introduction of competency-based postgraduate medical training, as recently stimulated by national governing bodies in Canada, the United States, the United Kingdom, The Netherlands, and other countries, is a major advancement, but at the same time it evokes critical issues of curricular implementation. A source of concern is the translation of general competencies into the practice of clinical teaching. The authors observe confusion around the term competency, which may have adverse effects when a teaching and assessment program is to be designed. This article aims to clarify the competency terminology. To connect the ideas behind a competency framework with the work environment of patient care, the authors propose to analyze the critical activities of professional practice and relate these to predetermined competencies. The use of entrustable professional activities (EPAs) and statements of awarded responsibility (STARs) may bridge a potential gap between the theory of competency-based education and clinical practice. EPAs reflect those activities that together constitute the profession. Carrying out most of these EPAs requires the possession of several competencies. The authors propose not to go to great lengths to assess competencies as such, in the way they are abstractly defined in competency frameworks but, instead, to focus on the observation of concrete critical clinical activities and to infer the presence of multiple competencies from several observed activities. Residents may then be awarded responsibility for EPAs. This can serve to move toward competency-based training, in which a flexible length of training is possible and the outcome of training becomes more important than its length.
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              The role of assessment in competency-based medical education.

              Competency-based medical education (CBME), by definition, necessitates a robust and multifaceted assessment system. Assessment and the judgments or evaluations that arise from it are important at the level of the trainee, the program, and the public. When designing an assessment system for CBME, medical education leaders must attend to the context of the multiple settings where clinical training occurs. CBME further requires assessment processes that are more continuous and frequent, criterion-based, developmental, work-based where possible, use assessment methods and tools that meet minimum requirements for quality, use both quantitative and qualitative measures and methods, and involve the wisdom of group process in making judgments about trainee progress. Like all changes in medical education, CBME is a work in progress. Given the importance of assessment and evaluation for CBME, the medical education community will need more collaborative research to address several major challenges in assessment, including "best practices" in the context of systems and institutional culture and how to best to train faculty to be better evaluators. Finally, we must remember that expertise, not competence, is the ultimate goal. CBME does not end with graduation from a training program, but should represent a career that includes ongoing assessment.
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                Author and article information

                Journal
                Can Med Educ J
                Can Med Educ J
                CMEJ
                Canadian Medical Education Journal
                Canadian Medical Education Journal
                1923-1202
                24 February 2021
                30 April 2021
                April 2021
                : 12
                : 2
                : e81-e87
                Affiliations
                [1 ]Division of Medical Oncology, University of Ottawa, Ontario, Canada;
                [2 ]University of Sherbrooke medical oncology program; Department of Medicine, Sherbrooke University, Quebec, Canada;
                [3 ]Division of Medical Oncology, Memorial University of Newfoundland and Labrador, Newfoundland and Labrador, Canada;
                [4 ]Department of Oncology, University of Alberta, Alberta, Canada;
                [5 ]Department of Oncology, Queen’s University, Ontario, Canada
                [6 ]Section of Medical Oncology and Hematology, University of Manitoba, Manitoba, Canada
                [7 ]Division of Medical Oncology, University of Calgary, Alberta, Canada
                [8 ]Department of Oncology, McMaster University, Hamilton ON, Canada
                Author notes
                Correspondence to: Tina Hsu MD, FRCPC, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, Canada; fax: 613 247 3511; phone: 613 737 7700 x70185; email: thsu@ 123456toh.on.ca ; Twitter handle:@THsuMD
                Article
                CMEJ-12-e081
                10.36834/cmej.70723
                8105576
                3b79ebf3-b89a-4c74-b525-ae537848fc4c
                © 2021 Hsu, De-Angelis, Al-Asaaed, Basi, Tomiak, Grenier, Hammad, Henning, Berry, Song, Mukherjee; licensee Synergies Partners

                This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License. ( https://creativecommons.org/licenses/by-nc-nd/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is cited.

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