Implementation of Competence by Design in Canadian Neurosurgery Residency Programs
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CitationCadieux, Magalie. 2020. Implementation of Competence by Design in Canadian Neurosurgery Residency Programs. Master's thesis, Harvard Medical School.
AbstractThe Royal College of Physicians and Surgeons of Canada (RCPSC) recently redesigned the Canadian neurosurgery residency training curriculum by implementing a Competence by Design (CBD) training program centered around the assessment of Entrustable Professional Activities (EPAs). This mixed-methods study evaluated the potential benefits and pitfalls of CBD in Canadian neurosurgery residency education.
Two surveys were distributed at three-month intervals to all current first-year neurosurgery residents in Canada. The surveys assessed important educational components: knowledge of the key stakeholders of CBD, potential system barriers, and educational and psychological impacts on residents. Based on the longitudinal survey responses, semi-structured interviews were conducted with residents to investigate in-depth their experience with CBD in neurosurgery. The qualitative analysis followed an explanatory approach and a thematic analysis was performed by two coders.
The surveys had an average response rate of 82% (n = 25). Most residents self-reported that they understood retrospectively the concepts around the intentions of CBD (p = 0.02). The perceived benefits included an evaluation with added feedback that was clearer and more objective. Pitfalls included the amount of time needed to navigate through EPAs (90%) and residents forgetting to initiate the EPA forms (71%). None of the responses changed significantly over time.
During interviews, residents’ key themes centered around the meaning of CBD, the feasibility of EPAs, the importance of assessor variability on EPAs, and a positive learning experience with feedback. Potential solutions identified by the residents to enhance their experience included learning analytics data availability, refinement of the mobile app, and dedicated time to integrate EPAs in the workflow.
This study was the first to assess the benefits and pitfalls of the CBD training program in Canadian neurosurgery programs in the context of an educational framework. In general, residents believed that the theoretical principles behind CBD were valuable to their learning and residency training despite the challenges described. However, in terms of technological ability and having enough time to request EPA assessments, significant barriers to success exist. Long-term studies are required in quality improvement to ease the usage of technology and to determine the definitive outcomes of CBD on residents’ performance and ultimately, on patient care.
Citable link to this pagehttps://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37365299