Exploring stakeholder perspectives regarding the implementation of competency-based medical education: a qualitative descriptive study
DOI:
https://doi.org/10.36834/cmej.76245Abstract
Introduction: Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices.
Methods: We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College’s Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results.
Results: The participants’ perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes.
Conclusion: By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts.
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References
Cooke M, Irby DM, O’Brien BC. Educating physicians: a call for reform of medical school and residency. 1st ed. San Francisco: Jossey-Bass; 2010.
Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach. 2010;32(8):631-637. https://doi.org/10.3109/0142159X.2010.500898. DOI: https://doi.org/10.3109/0142159X.2010.500898
ten Cate O. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ. 2017;34(5). https://doi.org/10.3205/zma001146.
Caverzagie KL, Nousiainen MT, Ferguson PC, et al. Overarching challenges to the implementation of competency-based medical education. Med Teach. 2017;39(6):588-593. https://doi.org/10.1080/0142159X.2017.1315075 DOI: https://doi.org/10.1080/0142159X.2017.1315075
Nousiainen MT, Caverzagie KJ, Ferguson PC, Frank JR, Collaborators I. Implementing competency-based medical education: what changes in curricular structure and processes are needed? Med Teach. 2017;39(6):594-598. https://doi.org/10.1080/0142159X.2017.1315077.
Rachul C, Collins B, Chan MK, Srinivasan G, Hamilton J. Rivalries for attention: insights from a realist evaluation of a postgraduate competency-based medical education implementation in Canada. BMC Med Educ. 2022;22(1):583. https://doi.org/10.1186/s12909-022-03661-8. DOI: https://doi.org/10.1186/s12909-022-03661-8
Schultz K, Griffiths J. Implementing competency-based medical education in a postgraduate family medicine residency training program: a stepwise approach, facilitating factors, and processes or steps that would have been helpful. Acad Med. 2016;91(5):685-689. https://doi.org/10.1097/ACM.0000000000001066. DOI: https://doi.org/10.1097/ACM.0000000000001066
Ross S, Binczyk NM, Hamza DM, et al. Association of a competency-based assessment system with identification of and support for medical residents in difficulty. JAMA Netw Open. 2018;1(7):e184581. https://doi.org/10.1001/jamanetworkopen.2018.4581. DOI: https://doi.org/10.1001/jamanetworkopen.2018.4581
Danilovich N, Kitto S, Price DW, Campbell C, Hodgson A, Hendry P. Implementing competency-based medical education in family medicine: a narrative review of current trends in assessment. Fam Med. 2021;53(1):9-22. https://doi.org/10.22454/FamMed.2021.453158. DOI: https://doi.org/10.22454/FamMed.2021.453158
Harden RM. Outcome-based education--the ostrich, the peacock and the beaver. Med Teach. 2007;29(7):666-671. https://doi.org/10.1080/01421590701729948. DOI: https://doi.org/10.1080/01421590701729948
Hodges BD, Lingard L. The question of competence: reconsidering medical education in the twenty-first century. Ithaca: ILR Press; 2012.
Dagnone JD, Chan MK, Meschino D, et al. Living in a world of change: bridging the gap from competency-based medical education theory to practice in Canada. Acad Med. 2020;95(11):1643-1646. https://doi.org/10.1097/ACM.0000000000003216. DOI: https://doi.org/10.1097/ACM.0000000000003216
Gruppen L, ten Cate O, Lingard L, Teunissen PW, Kogan JR. Enhanced requirements for assessment in a competency-based, time-variable medical education system. Acad Med. 2018;93:s12-s21. https://doi.org/10.1097/ACM.0000000000002066. DOI: https://doi.org/10.1097/ACM.0000000000002066
Jippes E, Van Luijk SJ, Pols J, Achterkamp MC, Brand PL, Van Engelen JM. Facilitators and barriers to a nationwide implementation of competency-based postgraduate medical curricula: a qualitative study. Med Teach. 2012;34(8):e589-602. https://doi.org/10.3109/0142159X.2012.670325. DOI: https://doi.org/10.3109/0142159X.2012.670325
Wagner N, Fahim C, Dunn K, Reid D, Sonnadara RR. Otolaryngology residency education: a scoping review on the shift towards competency-based medical education. Clin Otolaryngol. 2017;42(3):564-572. https://doi.org/10.1111/coa.12772. DOI: https://doi.org/10.1111/coa.12772
Hawkins RE, Welcher CM, Holmboe ES, et al. Implementation of competency-based medical education: are we addressing the concerns and challenges? Med Educ. 2015;49(11):1086-1102. https://doi.org/10.1111/medu.12831. DOI: https://doi.org/10.1111/medu.12831
Brydges R, Boyd VA, Tavares W, et al. Assumptions about competency-based medical education and the state of the underlying evidence: a critical narrative review. Acad Med. 2021;96(2):296-306. https://doi.org/10.1097/ACM.0000000000003781. DOI: https://doi.org/10.1097/ACM.0000000000003781
Boyd VA, Whitehead CR, Thille P, Ginsburg S, Brydges R, Kuper A. Competency-based medical education: the discourse of infallibility. Med Educ. 2018;52(1):45-57. https://doi.org/10.1111/medu.13467. DOI: https://doi.org/10.1111/medu.13467
Gruppen L, Frank JR, Lockyer J, et al. Toward a research agenda for competency-based medical education. Med Teach. 2017;39(6):623-630. https://doi.org/10.1080/0142159X.2017.1315065. DOI: https://doi.org/10.1080/0142159X.2017.1315065
Nousiainen MT, Caverzagie KL, Ferguson KJ, Frank JR. Implementing competency-based medical education: what changes in curricular structure and processes are needed? Med Teach. 2017;39(6):594+598. https://doi.org/10.1080/0142159X.2017.1315077. DOI: https://doi.org/10.1080/0142159X.2017.1315077
Dagnone D, Stockley D, Flynn L, et al. Delivering on the promise of competency based medical education - an institutional approach. Can Med Ed J. 2019;10(1):e28-e38. https://doi.org/10.36834/cmej.43303 DOI: https://doi.org/10.36834/cmej.43303
Stockley D, Egan R, Van Wylick R, et al. A systems approach for institutional CBME adoption at Queen's University. Med Teach. 2020;42(8):916-921. https://doi.org/10.1080/0142159X.2020.1767768. DOI: https://doi.org/10.1080/0142159X.2020.1767768
Upadhyaya S, Rashid M, Davila Cervantes A, Oswald A. Exploring resident perceptions of initial competency based medical education implementation. Can Med Ed J. 2021;12(2):e42-e56. https://doi.org/10.36834/cmej.70943. DOI: https://doi.org/10.36834/cmej.70943
Dagnone D, Stockley D, Truelove AH, et al. Building Capacity for CBME Implementation at Queen’s University. MedEdPublish. 2017;6(1). https://doi.org/10.15694/mep.2017.000015. DOI: https://doi.org/10.15694/mep.2017.000015
ten Cate O, Snell L, Carraccio C. Medical competence: the interplay between individual ability and the health care environmen. Med Teach. 2010;32(8):669-675. https://doi.org/10.3109/0142159X.2010.500897. DOI: https://doi.org/10.3109/0142159X.2010.500897
Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: a systematic review. Res Nurs Health. 2017;40(1):23-42. https://doi.org/10.1002/nur.21768. DOI: https://doi.org/10.1002/nur.21768
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nursing Health Sci. 2013;15(398-405). https://doi.org/10.1111/nhs.12048. DOI: https://doi.org/10.1111/nhs.12048
Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334-340. https://doi.org/10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G DOI: https://doi.org/10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G
Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Global Qual Nursing Res. 2017;4:1-8. https://doi.org/10.1177/2333393617742282. DOI: https://doi.org/10.1177/2333393617742282
Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description - the poor cousin of health research? BMC Med Res Methodol. 2009;9:52. https://doi.org/10.1186/1471-2288-9-52. DOI: https://doi.org/10.1186/1471-2288-9-52
The Royal College of Physicians and Surgeons of Canada. Competence by Design launch schedule. https://www.royalcollege.ca/rcsite/cbd/schedule-status-e. Published 2023.
Patton M, Q. Qualitative research and evaluation methods. 4th ed. Thousand Oaks, CA.: SAGE Publications; 2015.
Varpio L, Bell R, Hollingworth G, et al. Is transferring an educational innovation actually a process of transformation? Advances Health Sc Educ. 2012;17(3):357-367. https://doi.org/10.1007/s10459-011-9313-4. DOI: https://doi.org/10.1007/s10459-011-9313-4
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa
Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ, eds. APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological American Psychological Association.; 2012:57-71.
Braun V, Clarke V. Thematic Analysis. A practical guide. 1st ed. London: SAGE Publications; 2021. https://doi.org/10.53841/bpsqmip.2022.1.33.46 DOI: https://doi.org/10.53841/bpsqmip.2022.1.33.46
Mann S, Truelove AH, Beesley T, Howden S, Egan R. Resident perceptions of Competency-Based Medical Education. Can Med Educ J. 2020;11(5):e31-e43. https://doi.org/10.36834/cmej.67958. DOI: https://doi.org/10.36834/cmej.67958
Hsu T, De Angelis F, Al-Asaaed S, et al. Ten ways to get a grip on designing and implementing a competency-based medical education training program. Can Med Educ J. 2021;12(2):e81-e87. https://doi.org/10.36834/cmej.70723. DOI: https://doi.org/10.36834/cmej.70723
van Diggele C, Burgess A, Mellis C. Planning, preparing and structuring a small group teaching session. BMC Medical Education. 2020;20(2):462. https://doi.org/10.1186/s12909-020-02281-4. DOI: https://doi.org/10.1186/s12909-020-02281-4
Schneiderhan J, Guetterman TC, Dobson ML. Curriculum development: a how to primer. Fam Med Community Health. 2019;7(2):e000046. https://doi.org/10.1136/fmch-2018-000046. DOI: https://doi.org/10.1136/fmch-2018-000046
Biggs J. Constructive alignment in university teaching. HERDSA Review of Higher Education. 2014;1:5-22.
Brauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE Guide No. 96. Med Teach. 2015;37(4):312-322. https://doi.org/10.3109/0142159X.2014.970998. DOI: https://doi.org/10.3109/0142159X.2014.970998
Parson R, Danilovich N, Lochnan H, et al. Twelve tips for bringing competencies into continuing professional development: curriculum mapping. MedEdPublish. 2019;8(2). https://doi.org/10.15694/mep.2019.000145.1. DOI: https://doi.org/10.15694/mep.2019.000145.1
Shoemaker BJE. Integrative Education: A Curriculum for the Twenty-First Century. OSSC Bulletin. 1989;33(2).
Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10-28. https://doi.org/10.1080/01421590500046924. DOI: https://doi.org/10.1080/01421590500046924
Serdyukov P. Innovation in education: what works, what doesn’t, and what to do about it? J Res Innovative Teach Learn. 2017;10(1):4-33. https://doi.org/10.1108/JRIT-10-2016-0007 DOI: https://doi.org/10.1108/JRIT-10-2016-0007
Irby DM, Wilkerson L. Educational innovations in academic medicine and environmental trends. J Gen Intern Med. 2003;18(5):370-376. https://doi.org/10.1046/j.1525-1497.2003.21049.x. DOI: https://doi.org/10.1046/j.1525-1497.2003.21049.x
Robin BR, McNeil SG, Cook DA, Agarwal KL, Singhal GR. Preparing for the changing role of instructional technologies in medical education. Acad Med. 2011;86(4):435-439. https://doi.org/10.1097/ACM.0b013e31820dbee4 DOI: https://doi.org/10.1097/ACM.0b013e31820dbee4
Sood R, Singh T. Assessment in medical education: evolving perspectives and contemporary trends. Natl Med J India. 2012;25(6):357-364. DOI: https://doi.org/10.5005/jp/books/11647_3
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. The Lancet Infectious Diseases. 2020;20(7):777-778. https://doi.org/10.1016/s1473-3099(20)30226-7. DOI: https://doi.org/10.1016/S1473-3099(20)30226-7
Goh P-S, Sandars J. A vision of the use of technology in medical education after the COVID-19 pandemic. MedEdPublish. 2020;9(1). https://doi.org/10.15694/mep.2020.000049.1. DOI: https://doi.org/10.15694/mep.2020.000049.1
Sharma N, Doherty I, Dong C. Adaptive learning in medical education: the final piece of technology enhanced learning? he Ulster medical journal. 2017;86(3):198-200.
Wong EC, Negreanu D, Adreak N, et al. simulation tools in the research and delivery of competency-based medical education and health care: evolving considerations in the contemporary COVID-19 era. Can J Cardiol. 2021;37(3):351-354. https://doi.org/10.1016/j.cjca.2020.10.003. DOI: https://doi.org/10.1016/j.cjca.2020.10.003
Hodges AL, Konicki AJ, Talley MH, Bordelon CJ, Holland AC, Galin FS. Competency-based education in transitioning nurse practitioner students from education into practice. J Am Assoc Nurse Pract. 2019;31(11):675-682. https://doi.org/10.1097/JXX.0000000000000327. DOI: https://doi.org/10.1097/JXX.0000000000000327
Timmerberg JF, Chesbro SB, Jensen GM, Dole RL, Jette DU. Competency-based education and practice in physical therapy: it's time to act! Phys Ther. 2022;102(5). https://doi.org/10.1093/ptj/pzac018. DOI: https://doi.org/10.1093/ptj/pzac018
Van Melle E, Frank JR, Holmboe ES, et al. A core components framework for evaluating implementation of competency-based medical education programs. Acad Med. 2019;94(7):1002-1009. https://doi.org/10.1097/ACM.0000000000002743. DOI: https://doi.org/10.1097/ACM.0000000000002743
Beidas RS, Dorsey S, Lewis CC, et al. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci. 2022;17(1):55. https://doi.org/10.1186/s13012-022-01226-3. DOI: https://doi.org/10.1186/s13012-022-01226-3
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