Competence by Design. Kenneth A. Harris, MD FRCSC Deputy CEO & Executive Director, Office of Specialty Education February 3, 2016

Transcription

1 Competence by Design Kenneth A. Harris, MD FRCSC Deputy CEO & Executive Director, Office of Specialty Education February 3, 2016 The best health for all. The best care for all.

2 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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4 Key Concepts

5 Define Milestones & EPAs 2/6/2017 5

6 Milestones within an EPA 2/6/2017 6

7 Milestones and EPAs within Four Stages of Residency 2/6/2017 7

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9 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 2/6/2017 9

10 Specific Themes 2/6/

11 Specialties Implementing CBD July 2017 Anesthesiology Otolaryngology Head and Neck Surgery 2/6/

12 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 /6/

13 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 2/6/

14 Change Fundamentals Rhonda St. Croix Change Advisor The best health for all. The best care for all.

15 How people change 2/6/

16 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 2/6/

17 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 2/6/

18 The Road to CBD Dr. Jolanta Karpinski Associate Director, Specialties Unit The best health for all. The best care for all.

19 Trying things on Working the workshops Cohort rollout 2/6/

20 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 interact with Royal College Program faculty teach and assess using CBD standards Residents trained in CBD system enter CPD programs apply procedures PGME offices and CBD policies and 2/6/

21 Cohort Implementation Plan 2/6/

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23 CBD is in our future 36 specialties and subspecialties Activation Workshops and design Implementation planning 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 Neo-Perinatal Med Gastroenterology and Neck Surgery 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 CBD is our reality! 2/6/

24 Working the workshops 2/6/

25 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 2/6/

26 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. 2/6/

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29 Examples of EPAs In the real world Driving on G1 In medicine Running codes 2/6/

30 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 2/6/

31 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 2/6/

32 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 2/6/

33 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 2/6/

34 Assessment for learning Role of coaching Guidance for learning Frequent Link to deliberate practice 2/6/

35 Assessment for progression 2/6/

36 Assessment of EPA Achievement EPA Assessment Encounters Point in time Single rater Specific context 2/6/

37 Putting it together: Wisdom of Crowds 2/6/

38 Assessment of EPA Achievement EPA Assessment Encounters Point in time Single rater Specific context EPA Achievement - Multiple times - Multiple raters - Multiple contexts 2/6/

39 Getting ready for implementation 2/6/

40 Implementation ideas: plan 2/6/

41 Implementation ideas 2/6/

42 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 2/6/

43 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 2/6/

44 Assessment Essential Assessment Elements Minimum data set (MDS) eportfolio Jane Fulford, CPA, CGA Chief Information Officer The best health for all. The best care for all.

45 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 2/6/

46 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 2/6/

47 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 2/6/

48 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 2/6/

49 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 2/6/

50 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 2/6/

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52 Your Input Matters Share your input with the Royal College via: For more information, visit: 2/6/