Implementing a Competency-Based Curriculum in a Pediatric Training Program. Author: Moyez Ladhani Date: October 25, 2014

Implementing a Competency-Based Curriculum in a

Pediatric Training Program

Author: Moyez Ladhani Date: October 25, 2014

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d’appareils médicaux ou un cabinet de communication.

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Three Take Home Points

• Many organizations are moving to a competency-based education model in place of the historical time-based model

• Competency-based education hopes to develop a competent holistic physician and makes sense • Key to success:

» Stepwise approach

» The proper assessment of learners

» The development of the assessors i.e. the faculty » Involve the key stakeholders

» You have many of the tools already

• Dr. Lucy Giglia • Dr. Julia Frei • Dr. Kim Genier • Dr. Anne Moffat • Dr. Willa Liao • Shirley Ferguson • Adrianna Flaiani • Dr. Moyez Ladhani • Dr. Andrea Hunter • Dr. Natasha Johnson • Dr. Katrin Scheinemann • Dr. April Kam • Dr. Audrey Lim • Dr. Anne Niec

Introduction:

• Congratulations you have been selected as the Pediatric Program director

Goals:

1. Implement a competency-based curriculum into the McMaster University, pediatric residency program. 1. Develop a tool, the Mini Milestones Assessment

(Mini-MAS) to assess intrinsic medical competencies and progression through milestones using the Dreyfus Developmental Model.

1. Test the psychometric theories to assess the reliability, validity, acceptability and feasibility of the Mini-MAS tool. 1. FIRE: Fundamental Innovations in Residency Education.

Goals:

1. Implement a competency-based curriculum into the McMaster University, pediatric residency program.

1. Develop a tool, the Mini Milestones Assessment (Mini-MAS) to assess intrinsic medical competencies and progression through milestones using the Dreyfus Developmental Model. 1. Test the psychometric theories to assess the reliability,

validity, acceptability and feasibility of the Mini-MAS tool. 1. FIRE: Fundamental Innovations in Residency Education.

CBME

• Competency-based education is 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 (p636)

• Frank, J. R., Mungroo, R., Ahmad, Y., Wang, M., De Rossi, S., & Horsley, T. (2010). Toward a definition of competency-based education in medicine: A systematic review of published definitions. Medical Teacher, 32(8), 631-637.

Tea- Steeping model

• The current model of education is a time-based model. Hodges describes this as the “tea-steeping model”: “we put the student (tea) in medical school (hot water) for a fixed period of time and voila! After a historically

determined interval of time, we assume a competent practitioner, like a good cup of tea, will result”

• Hodges, B. D. (2010). A tea-steeping or i-doc model for medical education?. Academic Medicine, 85(9 Suppl), S34-44.

Ostrich, Peacock and the Beaver

What the beaver must do

• Communication with staff and students • Educational strategies • Learning opportunities • Course content • Student progression • Assessment • Educational environment • Student selection

• Harden, R. M. (2007). Outcome-based education--the ostrich, the peacock and the beaver. Medical Teacher, 29(7), 666-671.

What the beaver must do

• Communication with staff and students • Educational strategies • Learning opportunities • Course content • Student progression • Assessment • Educational environment • Student selection CBE| Ladhani

2013-2014

• A two-day retreat was initially held to develop the curriculum;

• Members of the residency training committee including

general pediatric faculty and resident representatives from each year were present.

2013-2014

• The curriculum was started for only the general pediatric rotations as a pilot and to limit the number of faculty involved.

• The PGY 1 residents’ General Pediatric experiences ( 22 weeks) » CTU-4 weeks

» Community Brampton-4 weeks

» Community St. Joseph’s Healthcare-4 weeks » CTU Waterloo-4 weeks

» Float call at McMaster-6 weeks

• Occurred in the form of competency-based education with learning outcomes, milestones and assessment.

Learning Outcomes

What the beaver must do

• Communication with staff and students • Educational strategies • Learning opportunities • Course content • Student progression • Assessment • Educational environment • Student selection

Educational strategies

• The residents had exposure to a variety of clinical situations and teaching sessions.

• Clinical Exposure-Total 22 weeks:

» CTU-4 weeks

» Community Brampton-4 weeks

» Community St. Joseph’s Healthcare-4 weeks » CTU Waterloo-4 weeks

» Float call at McMaster-6 weeks

» Academic Half Day including Clinical Skills Days

» Simulation

» Longitudinal CanMEDS Competencies (LCC) » Journal Club

» Department Grand Rounds » Division of General Pediatrics

Grand Rounds

» Morbidity and Mortality Rounds » CTU Teaching Sessions

» Subspecialty Rounds » Work in Progress

Faculty Development Courses

Department Conferences

Neonatal Resuscitation Program (NRP)/ Pediatric Advanced Life Support (PALS) courses

Case Based Teaching Sessions (self directed)

Mac at Night Curriculum PREP The Curriculum

Self Directed Modules: CPSO, RCPSC, CPS and Pedialink Peer and Faculty Mentors

Student Progression and Assessment

assessment program.

• The PGY 1 resident had to meet the milestones and objectives successfully.

• The competency-based medical education (CBME)

curriculum was considered a comprehensive block of 22 weeks and thus they had the full time period to achieve the stated objectives.

Student Progression and Assessment

formative to allow the resident to reflect on areas of improvement.

• At the end of their 22 weeks, all assessments were

reviewed to see if the learner had met their objectives and reached the appropriate milestones.

Student Progression and Assessment

• Objective Structured Clinical exam (OSCE) twice a year. • Multiple Choice Questions (MCQ) and Short Answer

Questions (SAQ) twice a year.

• American Board of Pediatrics (ABP) In Training Exam, an MCQ exam held annually

• STACER • Portfolio

• Multi-Source Feedback (MSF) • Procedure Log Book

• End of Rotation Evaluation

• Mini-MAS

Three Take Home Points

• Many organizations are moving to a competency-based education model in place of the historical time-based model

• Competency-based education hopes to develop a competent holistic physician and makes sense • Key to success:

» Stepwise approach

» The proper assessment of learners

» The development of the assessors i.e. the faculty » Involve the key stakeholders

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