Frequently Asked Questions for Residents
Why choose Queen’s to pursue your postgraduate medical education training?
Queen’s has a strong history of excellence in PGME accreditation. Our state-of-the are Clinical Simulation Centre, small institution size, and collegial atmosphere offers trainees many opportunities and mentoring not widely available at other training institutions
The Accelerated path to CBME at Queen’s
Postgraduate medical education is undergoing transformative change in many countries across the globe, including Canada. The Royal College of Physicians and Surgeons of Canada (RCPSC) has mandated the change to CBME across all 65 postgraduate training programs at 17 institutions across Canada and by the year 2020 every resident will be training in a Competency by Design (CBD) curriculum. The RCPSC has approved Queen’s University’s request to take an accelerated path to CBME and will transition all incoming residents to CBME curriculums across its 29 programs starting July 1st, 2017. In so doing, Queen’s University will be the first institution in the world to be completely competency-based for postgraduate medical education.
What are the advantages of training in a competency-based medical education curriculum?
Training in a CBME curriculum offers an incoming resident a number of advantages:
- Increased flexibility: More options to individualize training experiences at all stages of training meaning more elective rotation time.
- Innovative assessment system: Queen’s programs will be at the leading edge of an exciting new assessment system defined by personalized electronic portfolios, competency-based assessment tools and increased frequency of assessment by physicians, allied HCPs, patients and their family members.
- Individualized learning: All trainees will receive more supervision, assessment and mentorship from faculty supervisors and dedicated academic advisors to ensure competencies are being met for each developmental stage. The trainee and their academic advisor will have the early opportunity to identify areas of strengths and weaknesses at regular intervals and individualize learning plans.
- Regular feedback: Trainees will have the opportunity to be evaluated in real-time and more frequently through mobile technology and our web-based assessment system will allow for enhanced feedback.
- Preparedness for practice: Trainees in the CBME curriculum will take the RCPSC examination 6 months to one year prior to the completion of their training at the end of their Core of Discipline phase. This will allow trainees greater time in their Transition to Practice phase to work more independently in preparation for their own personal practice.
Queen’s strengths to ensure success for the institutional change to CBME:
- Faculty of Health Sciences, Dean, Dr. Richard Reznick is a world-renowned expert in CBME and served as chief architect of the University of Toronto’s pilot CBME programming in Orthopedics, which was the first competency-based postgraduate medical education program in Canada.
- Smaller community, collegial atmosphere, dedicated faculty with institutional commitment to PGME and CBME at Queen’s.
- Universal commitment to CBME from all stakeholders including University, hospitals, departments and administrators.
- An expert panel of project implementers is guiding the project. The CBME Executive leadership team consists of University experts who are overseeing the project and liaising with the Royal College.
- State-of-the-art Queen’s Clinical Simulation Centre and expert faculty educators.
- The leading edge CBME Entrada electronic trainee assessment portfolio developed at Queen’s University.
- Queen’s previous experience with Family Medicine’s transition to the CCC curriculum and expert leadership.
- Queen’s national reputation of excellence in PGME assessment and evaluation.
- A centralized funding formula model (SEAMO) that supports over 90% of our faculty educators.
What is CBD, Competence by Design?
The CBD initiative as defined by the Royal College of Physicians and Surgeons of Canada:
“While “pure” CBME is time-free, CBD is a hybrid model. In this model, the number of years needed to complete a residency program is not expected to change for most residents. Residents will work within the defined time frames of their residency programs, but they will be able to achieve competencies (measured by milestones/EPAs) at their own pace and in a variety of locations.”
Entrustable Professional Activities, or EPAs, are units of competencies in context. As trainees progress through the CBD Competence Continuum, they must demonstrate competency in all outlined EPAs via a set of established milestones. These milestones have been outlined by the RCPSC in the 2015 re-release of the CanMeds Milestones Guide. The CanMeds guide outlines the abilities physicians require to meet the health care needs of the people they serve.
Queen’s University will be using the Royal College CBD model to guide programs not already involved in current cohorts.
Will my residency be longer or shorter?
The length of the residency program for CBME trainees is not expected to change. Residents will be training in a CBME-hybrid model in which competency is still the main focus, however, they will have the opportunity to learn at their own pace, within each programs defined timeline. It is envisioned that early achievement of EPAs and milestones will allow greater elective time to pursue excellence in areas.
What will my rotations look like?
Rotations will generally remain the same length as the traditional rotation length. The milestones and EPAs required to achieve for each rotation will change and will be aligned with the 4 stages of the competence continuum rather than with year of study. As well, there will be fewer mandatory rotations for a given program, thus allowing more flexibility in rotation selection.
Can I do a rotation at a non-CBME institution?
Rotations at other institutions will continue to occur and be encouraged. This will not change and your assessment will be guided by which EPAs and milestones are most relevant for that rotation. This will all be tracked with each trainee’s electronic portfolio.
Will I be tasked with additional administrative responsibilities?
CBME is learner centric and driven. While you will not be tasked with additional administrative responsibilities, you will have greater control over the focus of your assessment. For example, if you think you are ready to be evaluated for a particular EPA, you can bring this forward to your preceptor and request an evaluation. Putting this onus on the learner ensures they remain on track and concentrate on those activities in which they require more assistance or evaluation in order to achieve program milestones. Conversely, an evaluator can also randomly evaluate you and your ability to achieve the EPA without your request, and they will be responsible for ensuring they are meeting their requirements for resident evaluation. In the end, all assessments will be more relevant to what each trainee has accomplished on any given day.
What are the implications of future employment as a resident graduating from a CBME program?
As the RCPSC and Queen’s will implement CBME as a hybrid model, the number of certified physicians annually will remain status quo. Positions will not be saturated with qualified physicians nor will certain specialties experience a shortage.
The research indicates CBME graduates have the potential to be more well-rounded, better prepared for examinations, and ultimately have the ability to become more skilled physicians than their traditionally trained colleagues. This evidence suggests that CBME trained physicians will graduate as high in demand innovators and leaders in medical education.
Will there be a stigma associated with the first CBME graduates?