Competence by Design - University of Manitoba · 2020-03-13 · Essentials for successful change...
Transcript of Competence by Design - University of Manitoba · 2020-03-13 · Essentials for successful change...
The best health for all. The best care for all.
Competence by Design
Kenneth A. Harris, MD FRCSC
Deputy CEO & Executive Director, Office of Specialty Education
February 3, 2016
Discussion Topics
• Overview of CanMEDS 2015 and CBD
• Change fundamentals
• The road to CBD
• Assessment & ePortfolio
• Minimum Data Set (MDS)
• Ongoing collaboration
• How to reach us
• Available resources
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Key Concepts
Define Milestones & EPAs
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Milestones within an EPA
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Milestones and EPAs within Four Stages of Residency
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Assessment
• The nature of assessment will change, but the method of service delivery will not • CBD is a hybrid approach to competency-based/outcomes
focused training
• Time will be utilized as a resource to structure training experiences and maintain a high standard of service delivery
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Specific Themes
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Specialties Implementing CBD July 2017
• Anesthesiology
• Otolaryngology – Head and Neck Surgery
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Readiness
• Readiness is multifaceted and involves a variety of partners beyond the Royal College
• Activities are underway with PGDs & CBME Leads to reach shared goal of implementation by July 1st 2017
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A Collaborative Approach with Local Champions & Change Agents
Deans, PG Deans
• Align visits for outreach with schools, collaboratively with Clinical Chairs, Hospitals & Ministries
Program Directors
• Co-create the design for their discipline in SC CBD workshops & bring it home as local champions
Faculty
• Faculty development resources and toolkit
Residents
• Regular engagement sessions with RDoCs and FMRQ
CBME National Faculty Leads
• Close collaboration with College
PG Managers, Program Administrators
• ICRE & advisory groups
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The best health for all. The best care for all.
Change Fundamentals
Rhonda St. Croix
Change Advisor
How people change
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Essentials for successful change
•Shared purpose
•Lead by example & build ownership/commitment
• Build distributed network for the change •Leverage relationships & connections
• Change spreads via peer-to-peer influence starting with early innovators & champions
•Change behaviours, get culture • Small set of inter-connected behaviours creates high impact
•Gather feedback to improve
• A deep cycle of learning & innovation
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Top strategies that work Create & share your CBD story – compelling why
• Link CBD to needs & issues people care about
• What’s the payoff
Build your local network for CBD – create the waves
• Local leadership/sponsorship & change agents
• Give people time to understand, ask questions, address concerns/doubts & make CBD their own
• Liaison roles, retreats, meetings, committees, communiques
Make progress visible
• early disciplines implementing July 1
Translate CBD into simple new behaviours by role
• EPAs, assessments, competence cte, real time feedback
Start now (try/test) & evolve
Support – locally and Royal College
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The best health for all. The best care for all.
The Road to CBD
Dr. Jolanta Karpinski
Associate Director, Specialties Unit
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Trying things on
Working the workshops
Cohort rollout
What Does CBD Rollout Mean? Creation of new version of specialty specific documents in CBD format
Royal College approval of new version of specialty standards
Training programs begin applying new standards to a group of residents
Residents trained under new standards Program faculty teach and assess
interact with Royal College using CBD standards
Residents trained in CBD system enter CPD PGME offices and programs apply CBD policies and procedures
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Cohort Implementation Plan
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CBD is in
our future
Activation Workshops
and design
Implementation
planning
CBD is
our
reality! 36 specialties and subspecialties
Cardiology Anatomical Path Anesthesiology
Clin Imm and Allergy Cardiac Surgery Forensic Path
General Surgery Critical Care Med Medical Oncology
Geriatric Medicine Emergency Med Otolaryngology – Head
and Neck Surgery Neo-Perinatal Med Gastroenterology
Nuclear Medicine General Int Med Surgical Foundations Obs and Gyn General Path
PMR (Rehabilitation) Internal Medicine
Plastic Surgery Nephrology
Psychiatry Neurosurgery
Respirology Pediatrics
Rheumatology Radiation Onc
Urology
Working the workshops
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CBD workshops
Specialty committee supported to attend
• All members and up to 3 guests
Work supported by Royal College CBD team
• Clinician educator, writer
Workshops entail
• Reinventing discipline in CBD framework - Developing EPAs and work-based program assessment for the discipline
- Creating new document suite with CanMEDS 2015 and CBD content and format
• Planning for implementation
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Core Components of CBME • Competencies are clearly articulated.
• Competencies are arranged progressively.
• Learning experiences facilitate the progressive development of competencies.
• Teaching practices promote the progressive development of competencies.
• Assessment practices support and document the progressive development of competencies.
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Examples of EPAs
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In the real world Driving on G1
In medicine Running codes
Progression in Internal Medicine
• Assessing, diagnosing, and initiating management for patients with common acute medical presentations in acute care settings
• Assessing, diagnosing and managing patients with complex or atypical acute medical presentations
• Assessing and managing patients in whom there is uncertainty in diagnosis and/or treatment
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Oversimplification of current system
Rotations • Rotation specific objectives
In-training evaluation reports • Global assessment • Timely? • ?linked to clinical activities
Progression through training • Onus to demonstrate lack of progression
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Oversimplification of CBD
• Training is sequenced in stages
• Supervisors and residents focus on EPAs designated for that stage
• Clinical and other training experiences are the basis to acquire the skills to achieve those tasks
• Supervisors document observations of resident’s performance on EPAs
• Coaching model: what can I do better?
• Competence Committees review progress
• Residents progress through stages
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Assessment in CBD
• Assessment for learning
• Re-emphasis on assessment in the workplace
• Assessment focused on discrete clinical tasks
• Assessment for purposes of learning
• Requirement for demonstration of competence
• Assessment as collection of evidence of progression
• Distinct promotion from one stage to another - Competence Committees
• Tracking and coaching along the pathway
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Assessment for learning
• Role of coaching
• Guidance for learning
• Frequent
• Link to deliberate practice
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Assessment for progression
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Assessment of EPA Achievement
• EPA Assessment Encounters
• Point in time
• Single rater
• Specific context
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Putting it together: Wisdom of Crowds
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Assessment of EPA Achievement
• EPA Assessment Encounters
• Point in time
• Single rater
• Specific context
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EPA Achievement - Multiple times - Multiple raters - Multiple contexts
Getting ready for implementation
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Implementation ideas: plan
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Implementation ideas
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Sample of some CBD Resources – • Introduction to competency-based medical education (CBME) and
Competence by Design (CBD): Video (7:33)
• Understanding Entrustable Professional Activities (EPAs): Video (5:11)
• CBD Cheat Sheet – brief summary of all key CBD concepts
• EPA Fast Facts – provides a brief overview of EPAs and how will be used within CBD
• Competence by Design (CBD): An Overview (March 2016 PPT)
• Answering your CBD Questions: Part 1 - The Rationale
• Answering your CBD Questions: Part 2 – CBD Implementation
• Answering your CBD Questions: Part 3 – Glossary of CBD and CBME Terms
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Implementation ideas: do
Reinforce current strengths
• Value of clinical experiences
• Supervisor interaction with resident
New behaviours
• Focused, explicit clinical tasks
• More frequent “small” assessments
• Resident is “the last patient of the day”
• New language: “let’s go learn!”
New structures
• New clinical experiences
• Competence Committees
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The best health for all. The best care for all.
Assessment Essential Assessment Elements
Minimum data set (MDS) ePortfolio
Jane Fulford, CPA, CGA
Chief Information Officer
Assessment Essential Elements Key Points
• Agreement with the ‘Six Essential Elements of the CBD Assessment Strategy’
• Use of the assessment forms is not mandatory, provided faculties are in compliance with both the required use of the Six Essential Elements and the transfer of data related to the minimum data set
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Six Essential Elements of the Assessment Strategy
1. Assessment requirements, as defined by the Specialty committee, and
inclusive of:
• EPAs, as defined by the Specialty Committee
• CanMEDS-based milestones, as defined by the Specialty Committee
2. Increased emphasis on direct and indirect observation
3. Many low-stakes observations of focused clinical tasks
4. Narrative, actionable, timely, concrete recorded feedback
5. Curation, collation, and group decision-making by a Competence Committee
6. Stages and progression of increasing entrustment, facilitated by group
entrustment decisions at the Competence Committee level
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Minimum Data Set (MDS) | Key points
•An agreed upon sample of assessment data will be transferred from PGME offices to the Royal College via a third party vendor as a method to: • Maintain oversight of the CBD system
• Enable Royal College operational functions (e.g., exam planning and credentialing)
• Ensure continuous quality improvement
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Minimum Data Set | Key Points • Agreed to the transfer of a specific data set to the Royal College
• Domain I – Progression, credentialing, examinations and planning • Learner identified to RC at point of entry into PGME
• RC Status Categories for learners identified by Faculty/Program, as decided by Competence Committee: • Resident promoted to exam-eligible and,
• Resident is certification-eligible
• Domain II and IV – Learning Analytics, Benchmarking and CQI of overall system and CBD redesign • Aggregate, de-identified learner assessment and system-tracked data shared with
the Royal College will include: • EPA Achieved status, time-stamped
• Learner Action (promote to next stage), time stamped
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Minimum Data Set | Key Points
•Domain III – Progressive Accreditation System • Detailed discussion deferred while further development work continues on the new standards and accreditation process
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Minimum Data Set | Key Points
Data Stewardship Committee
• Ensure oversight of types of assessment data collected and transferred to the Royal College
• Facilitate discussion and transparency among key stakeholders in the new CBD system and safeguard privacy concerns
• Continuous review of data points shared within MDS in order to ensure appropriateness and ability of the MDS to answer key questions, ensure rigorous standards, and measure outcomes of the CBD system
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Your Input Matters
Share your input with the Royal College via:
• www.facebook.com/TheRoyalCollege
• https://twitter.com/Royal_College
• www.linkedin.com
For more information, visit:
• www.royalcollege.ca/cbd
• www.royalcollege.ca/cbd/resources
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