Medical Students as Researchers

Should Medical Schools require, encourage, or support active research by students?

As I was recently completing Medical Student Performance Reviews (aka “Dean’s Letters”) for our fourth year class I was, once again, struck by the scope and quality of research undertaken by our students. Our curriculum provides instruction in research methodology, statistical analysis and critical appraisal. It also features active participation in the generation of research hypotheses and development of methodologic approaches to test those hypotheses. However, our students are not required to complete a project to the point of publication during medical school. Nevertheless, many do just that. With the help of members of our Undergraduate Office staff, I compiled the following summary information:

  • 69% of the class were authors of a published article during their medical school career
  • those students contributed to a total of 242 publications
  • in 137 of those publications, our student was the first author

Lest you think these are simple topics of minor interest, let me provide a few examples of publications first authored by one of our students, chosen to highlight the variety and scope of work undertaken. (For the entire list of first author publications go here).

Chang J, Munir S, Salahudeen S, Baranchuk A, Morris C, O’Reilly M, Pal R.  Atrial thrombi detection prior to pulmonary vein isolation: Cardiac computer tomography versus transesophageal echocardiography.  J American College of Cardiology (2013)

Cho CK, Drabovich AP, Batruck I, Diamandis EP.  Verification of a biomarker discovery approach for detection of Down syndrome in amniotic fluid via a multiplex selected reaction monitoring assay.  Journal of Proteomics (2011)

Cusimano M, Pudwell J, Roddy M, Cho CK, Smith GN.  The maternal health clinic: An initiative for cardiovascular risk identification in women with pregnancy-related complication.  American Journal of Obstetrics and Gynecology (2013)

Dossa F, Gao FQ, Scott CJM, Black SE.  Relationship between white matter hyperintensities and hippocampal atrophy in Alzheimer’s Disease.  Canadian Journal of Geriatrics (2009)

Eid L Helm K, Doucette S, McCloskey S, Duffy A, Grof P.  Bipolar disorder and socioeconomic status: What is the nature of this relationship?  International Journal of Bipolar Disorders (2013)

Fernando SM, Szulewski A, Baylis JB, Howes DW.  Motion artifact reduction of ECG signal allows for greater chest compression fraction during CPR.  Canadian Journal of Emergency Medicine (2013).

Ferrara S, Bradi A, Pokrupa R.  Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline.  Canadian Journal of Surgery (2012)

Fitzpatrick AM, Gao LL, Smith BL, Cetrulo CL, Cowell AS, Winograd JM, Yaaremchuk MJ, Austen WG, Liao EC.  Cost and outcome analysis of breast reconstruction.  Annals of Plastic Surgery (2013)

Gray AB et al.  The effect of a coronoid prosthesis on restoring stability to the coronoid-deficient elbow: A biomechanical study.  The Journal of Hand Surgery (2013)

Joundi RA et al.  Persistent suppression of subthalamic beta-band activity during rhythmic finger tapping in Parkinson Disease.  Clinical Neurophysiology (2013)

Kokorovic A, Cheung GW, Breen DM, Chari M, Lam CK, Lam TK.  Duodenal mucosal protein kinase regulates glucose production in rats.  Gastroenterology (2011)

Koppikar S, Baranchuk A, Guzman JC, Morillo C.  Stroke and ventricular arrhythmias>  International Journal of Cardiology (2013)

Lacombe SP, Goodman JM, Spragg CM, Liu S, Thomas SG.  Interval and continuous exercise elicit equivalent postexercise hypotension in prehypertensive men, despite differences in regulation.  Applied Physiology, Nutrition and Metabolism (2011)

Lun G, Atenafu EG, Knox JJ, Sridhar SS, Tannock IF, Joshua AM.  Use of a clinical assistant to screen patients with genitourinary cancer to encourage entry into clinical trials and use of supportive medication: A pilot project at a Canadian cancer centre.  Clinical Genitourinary Cancer (2013)

Osumek JE, Revesz A, Morton JS, Davidge ST, Hardy DB.  Enhanced trimethylation of histone H3 mediates impaired expression of hepatic glucose-6-phosphatase expression in offspring from rat dams exposed to hypoxia during pregnancy.  Reproductive Sciences (2013)

Rogers E, Wang BX, Zhu C, Rowley DR, Ressler SJ, Vyakarnam A, Fish EN.  A host factor that influences the neutrophil response to murine hepatitis virus infection.  Anitviral Research (2012)

Tohidi M, Robinson L, Graham T, Smith G.  Effect of caffeine ingestion on fetal heart rate activity.  J Obstetrics and Gynecology (2013)

Wang M, Reid D.  Virtual reality in pediatric neurorehabilitation: Attention deficit hyperactivity disorder, autism and cerebral palsy.  Neuroepidemiology (2010)

So all this begs two key questions:

How does this happen?

Should it happen? Put another way: Should active participation in research be encouraged or intentionally embedded into medical school curricula?

Let’s start with the easier, first question. Research participation of this breadth and quality comes about, in my view, as a result of three key and mutually interdependent factors.

blog-clarke1. Faculty leadership. We have been fortunate at Queen’s to have the strong support of our current and previous Deans (Richard Reznick and David Walker respectively) to the fostering of research at our centre. Undergraduate education has benefitted from this commitment in many ways, both directly and indirectly. blog-murrayImportantly, our student research efforts have been guided by the dedication and tenacity of two key undergraduate program leaders. Albert Clarke, now Emeritus Professor of Biochemistry, guided a Critical Enquiry course which was, for many years, a distinctive feature of our curriculum and engaged every student at Queen’s in an active research project. More recently, Heather Murray, Associate Professor in the Department of Emergency Medicine, has taken on leadership of the Scholar Competency in our revised curricular structure. In doing so, she has incorporated the spirit of Albert’s Critical Enquiry and embedded it into our curriculum such that every student participates in a discipline specific research group with the goal of developing a hypothesis generating proposal and appropriate research methodology.

2. Faculty support. These efforts, of course, could not have taken place without the active participation of many faculty whose commitment to medical education and research drives them to contribute their time and creative energy. In fact, no fewer than 60 of our full time clinical and basic science faculty members are involved in the support and mentoring of our students in the Critical Enquiry program. The effort they provide, I can assure you, is far beyond the compensation or recognition they receive. They do this, quite simply, because they “buy in” to the value of research in general, and its development in medical school in particular.

blog-students-13. Student engagement. As mentioned earlier, our students are not required to complete or publish their research proposals. At our annual Research Showcase, most of our student body and many faculty turn out to review and celebrate the student research accomplishments of the previous year. A casual stroll through the many posters, conversation with the authors and review of the works selected for oral presentation are sufficient to convince that the dedication of our students to the themes they have engaged is original, genuine and highly insightful. It also speaks to many of the qualities that we should be seeking in medical school applicants and fostering in medical school. All this would suggest we must be doing something right in both domains, and should certainly encourage our ever-evolving admissions processes and curricular design.blog-students-2

The second question I’ve posed is perhaps more complex and controversial. There is increasing competition for time within MD programs as curricular objectives and accreditation requirements become more expansive. Curriculum Committees are called upon to make judgments between equally meritorious proposals for “real estate” and for the attention of students. In doing so, they must address a variety of forces and influences from disparate sources. The relevant accreditation standard from the joint Canadian/American agencies reads as follows:

IS-14. An institution that offers a medical education program should make available sufficient opportunities for medical students to participate in research and other scholarly activities of its faculty and encourage and support medical student participation.

Medical schools would seem to be required to provide opportunities but not ensure all students participate actively. The implied meaning would seem to be that research participation is desirable but not mandatory component of physician training.

The Future of Medical Education in Canada initiative, now in implementation phase, has two key recommendations that would seem to speak to this issue, but perhaps with somewhat divergent messages.

Recommendation III: Build on the Scientific Basis of Medicine

Given that medicine is rooted in fundamental scientific principles, both human and biological sciences must be learned in relevant and immediate clinical contexts throughout the MD education experience. In addition, as scientific inquiry provides the basis for advancing health care, research interests and skills must be developed to foster a new generation of health researchers.

The final sentence of this recommendation would certainly seem to support an active research agenda. On the other hand another FMEC recommendation would seem to suggest medical education should take on a broader, less discipline-focused approach…

Recommendation VII: Value Generalism

Recognizing that generalism is foundational for all physicians, MD education must focus on broadly based generalist content, including comprehensive family medicine. Moreover, family physicians and other generalists must be integral participants in all stages of MD education.

While the call for medical schools to emphasize generalism is certainly not intrinsically inconsistent with a strong research interest, and recognizing that many family medicine specialists make valuable research contributions, it is equally true that the highly focused and largely university-centred approach of those interested in research careers seldom overlaps with the generalist approach. These two recommendations therefore provide a considerable challenge to medical schools and those developing admission criteria and designing curricula.

Another obstacle to the establishment of individual research within a medical school relates simply to the demands on faculty. Effective research requires one-on-one mentoring and supervision. That faculty-student interaction, to be effective, must be intensive and continuing.

So given all these challenges, why bother? There are probably many reasons we could cite, but I’ll provide my top three:

  • The ability to critically assess new information is an essential physician skill, and will be even more important in future years as the volume and pace of new information increases. There is perhaps no better way to acquire that skill than to have engaged personally in the process of hypothesis generation, study design, data collection, analysis, presentation, and finally defending that work through the peer review process.
  • The research process requires mastery of many of the physician competencies we value and aspire to develop in our students, specifically medical expertise, communication, management, scholarship and collaboration.
  • The possibility of sparking, in even a few of our students, an interest in a particular topic or simply an awareness of the power of research process itself is enticing and potentially far reaching. It’s hard to imagine that the minds that developed or contributed to the works listed above won’t be positively influenced and perhaps inspired as a result of the experience.

Unfortunately, we can’t look into any crystal ball to know how many of the young researchers in our graduating class will carry that interest into their careers, or what influence their work will have. However, I think we can take some satisfaction that we have collectively done our best to provide opportunities that will enrich and inform those careers.

Many thanks to Katie Jones, Amanda Consack, Jane Gordon and Jacqueline Schutt of the Undergraduate Office for their assistance in the compilation of information for this article.

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Dr. Paul Belliveau awarded the The John Provan Outstanding Canadian Surgical Educator Award

One of Queen’s own surgical specialists, Dr. Paul Belliveau was awarded the The John Provan Outstanding Canadian Surgical Educator Award, which is given to recognize outstanding contributions to undergraduate surgical education in Canada.

belliveau_small

Dr. Belliveau learned of the distinction at the November 14-16, 2013 CUSEC Symposium held in Ottawa, Ontario.  The award  is sponsored by the Canadian Association of Surgical Chairpersons and was first presented in 1993. The award is a First Nations sculpture, which is presented to, and will remain in the custody of, the award winner for a period of two years. Each award recipient will have her/his name permanently affixed to the award. A smaller version of the same sculpture will remain with the award recipient.

Dr. Belliveau is a dedicated surgeon who is also dedicated to his students and to improving the curriculum in undergraduate medical education.  He has served for many years as a member of the UG Curriculum Committee, and as a Course Director in year two of medical school, where he began the implementation of small group learning as a teaching/learning method.  Dr. Belliveau has also served as a Course Director in Clerkship, as well as a frequent and well-regarded teacher of surgery. He has served as Chair, Undergraduate Surgical Education Committee, a member of the UG Admissions Committee, and a founding member of the UG Evaluation and Assessment Committee.   Currently, Dr. Belliveau serves as Chair of the Awards Committee for student awards in undergraduate medical education.
Congratulations to Dr. Belliveau on receiving this recognition!

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History of Medicine 2013: Queen’s Medicine Takes Boston

Thanks to Hollis Roth, Meds 2016, who is our guest writer for today’s blog article, and to  Stefania Spano (Meds 2016) and Dr. Jacalyn Duffin for their photos.

This fall marked the 16th annual Queen’s History of Medicine trip; what began as a trip planned by Dr. Duffin in 1996 to the National Gallery in Ottawa has quickly became an annual tradition fondly remembered by many classes of Queen’s Medicine graduates. This year marked the fourth History of Medicine trip to Boston and spots were highly coveted, with a wait-list maintained until the very day of departure.

After classes ended on Friday, students eagerly piled on the coach bus and settled in for the long trip to Boston. While the 9-hour ride proved longer than anticipated, students passed the time in a variety of ways. Some diligently studied, others caught up with classmates and on sleep, and an unfortunate few spent the majority of the trip suffering from motion sickness. Arriving in Boston close to midnight, a cluster of students set off to explore the city, while others decided to wait until morning.

After gathering for a group photo on the steps of Massachusetts General Hospital, students spent the rest of the day exploring Boston. With only 36 hours to explore the city, students made the most of their time. Popular sites included the campuses of the Massachusetts Institute of Technology and Harvard University, as well as Fenway Park, the Boston Central Public Library, and sampling a wide variety of local delicacies. It was a lovely (albeit windy) fall day to wander the city amongst colleagues and friends while briefly escaping the rigorous demands of medical school.

explore

Queen’s medical students explore the Harvard campus.  Photo credit: Stefania Spano (Class of 2016)

We began bright and early Saturday morning with a visit to the third oldest hospital in the United States, Massachusetts General Hospital. Massachusetts General is richly steeped in history and houses the Ether Dome, which served as a surgical theatre from 1821-1868 and is a National Historic Site. On October 16 1848, the Ether Dome was the location of the first public demonstration of the surgical use of ether anesthetic by William T.G. Morton. Under the guidance of Professor David S. Jones (MD PhD and the A. Bernard Ackerman Professor of the Culture of Medicine), and Dr. Sukumar P. Desai (Anesthesia, Brigham and Women’s Hospital), students learned how the use of anesthesia drastically redefined surgery.

etherdome

Queen’s medical students at the Ether Dome.  Photo credit: Dr. Duffin

Our final stop on Sunday was Harvard Medical School, where we were privileged to have the Francis A. Countway Library of Medicine opened solely for our use.

Harvard Med School

Harvard Medical School  Photo credit: Stefania Spano (Class of 2016)

The Countway Library is one of the largest medical libraries in the world, serving Harvard Medical School and the Harvard School of Public Health, and contains the Warren Anatomical Museum. Led by Dr. Scott Podolsky (MD and Director of the Center for the History of Medicine), Mr. Dominic Hall (Curator of the Warren Anatomical Museum), and Ms. Joan Thomas (Cataloger, Rare Books), students received guided tours.

Countway Medical Library

Zeyu Li (Class of 2016) with Mr. Dominic Hall, Ms. Joan Thomas, and Dr. Scott Podolsky at the Countway Medical Library.  Photo credit: Dr. Duffin

Highlights of our visit included viewing first editions of Andreas Vesalius’ De humani corporis fabrica (1543) and Charles Darwin’s On the Origin of Species (1859) in the Rare Book Library, and viewing the skull of Phineas Gage in the Warren Anatomical Museum.

Dr. Duffin made a very exciting discovery while exploring the Countway Library. Dr. Duffin has long searched for the origins of an image used as a bookplate for books purchased in the 1920s for our medical library, but even after consulting with colleagues across the world the source remained unknown. Happily, Dr. Duffin was astonished to stumble across the very same image in Hortus Sanitatis (1491) while touring a selection of rare books chosen for our viewing. It was an extremely fortuitous discovery – had this book not been selected for viewing or conveniently left open at the relevant page by the student who had previously viewed it, Dr. Duffin may not have made this connection. It can truly be said that this History of Medicine trip was an educational experience for all!

Hortus Sanitatis

The frontispiece of “Hortus Sanitatis” (1491) and the cause of Dr. Duffin’s jubilation.  Photo credit: Dr. Duffin

We would like to extend our deepest thanks to Dr. Jones, Dr. Desai, Dr. Podolsky, Mr. Hall, and Ms. Thomas for taking the time to share their passion in the History of Medicine with us (on a weekend, no less) and for making us feel so welcome in Boston. As always, a huge thank you is due to Dr. Duffin for her continued support of these annual History of Medicine trips, to Zeyu Li (Class of 2016) for organizing the trip, and to the Aesculapian Society for funding. While I will be deep into clerkship at this point next year, I look forward to hearing about next year’s trip!

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Understanding Competency Based Education Lessons from an unlikely source

I was recently asked to speak at a conference on the topic of Competency Based Education.  My assignment was to provide definitions of that topic and to discuss the advantages and challenges associated with developing such an approach in an undergraduate medical program.

graph-nov12My search for a universally accepted definition of CBE began with a call to Theresa Suart, Educational Developer, who promptly alerted me to the reality that no such thing exists and, in fact, I had stumbled into an area of considerable controversy.  She directed me to helpful references, including a 2010 paper by Jason Frank and colleagues (Medical Teacher 32; 631-637) that is actually a systematic review of published definitions!  They reviewed a total of no fewer than 173 published definitions and, as illustrated in this table from their paper, the topic has been attracting increasing interest in recent years.  All this leads me to doubt the practical utility or relevance of a topic that so many bright people have difficulty even defining.  However, one becomes accustomed to such dilemmas when venturing into the world of medical education, and begins to view such uncertainties as opportunities to re-examine basic principles and search for patterns or examples of prior success that may be applicable.

Screen Shot 2013-11-11 at 2.36.58 PMThe principle I always find useful in assessing educational change is the fundamental triad of associations between Objectives, Learning and Assessment.  One of my first practical lessons in curricular design (and accreditation standards) is that these three components must be closely linked if any medical curriculum is to be effective.  Objectives must drive instruction and learning, and assessment must be linked to the teaching provided and the stated objectives.

 

With this in mind, I searched for a simple example that might help advance our understanding of Competency Based Education.  A conversation with one of my nieces who’d recently completed her Driver’s Education course provided that example.  The granting of a Driver’s License is, in fact, recognition of a competence for which there exists an easily understood and widely accepted global objective, specifically the ability to safely operate an automobile.  That global objective requires a body of knowledge, skills and personal CanDriveattributes which, with apologies to the Royal College and with tongue firmly in cheek, could be expressed as the CanDRIVE competency domains, which centre around a body of knowledge and understanding (the Driving Expert) but require additional attributes, such as (we might conjecture) Judgement, fundamental Literacy, physical Coordination, Social Accountability, Alertness (no cell phones) and Sobriety.  The knowledge component is completely and clearly articulated by the Ministry of Transportation in the Driver’s Manual, and the assessment of competencies is demonstrated in three parts, a written examination with questions taken directly from the manual, a cursory visual assessment involving recognition of traffic signs, and a performance based driving test during which the candidate must demonstrate the global objective (drive the car) while exhibiting the component competency domains (show up sober, pay attention, etc…).

And so, two parts of the educational triad are provided.  The true brilliance of the Ministry of Transportation however, is in how they handle the teaching/learning component.  Fundamentally, they don’t.  Learning is the responsibility of the applicant.  That learning is guided, to be sure, by both implied and explicit expectations, but the candidate is expected to seek out their own education, at their own expense, carried out at their own schedule.  There is absolute clarity, however, of the ultimate goals and no mystery about the eventual summative evaluation (answer the questions, read the eye chart, drive the car).

Screen Shot 2013-11-11 at 9.39.27 AMThus, the Ministry of Transportation has (whether intentionally or not) developed a masterful model of Competency Based Education that:

  • Is based on objectives that are clearly understood by learners and assessors alike.
  • Built on a knowledge base that is discrete, well-described and accessible by all.
  • Requires a set of personal attributes that are understood by all and accepted as relevant to mastery of the competency
  • Does not attempt to assess those attributes individually, but rather evaluates the overall competency in a blended, performance based method, the format (and content) of which is completely understood and open to everyone involved.
  • is truly Learner centred

But, you’ll note, there’s obviously a world of difference between driving a car and practicing Medicine.  Indeed there is.  However, the ability to assess and manage a patient presenting with a particular clinical presentation is, like driving a car, a competency set that requires a combination of knowledge, skills, personal attributes (a set of objectives), that must be learned and must be reliably evaluated.  What can we learn from our simple example that’s relevant to any attempt to develop a Competency Based Medical Education program?

  1. The learning objectives must be developed and expressed in meaningful, pragmatic terms.  Competency to do what?  What specific things should the “competent” learner be able to do?  In this regard, the emerging development of Entrustable Professional Activities will no doubt play a major role.
  2. The assessment should be performance-based and relate clearly and directly to those objectives.  There should be no mystery as to what will be expected, and the method of evaluation must be pre-defined and understood by all.
  3. Learning is primarily driven by the learner, not an inflexible curriculum, nor should it be based on any particular schedule.
  4. The responsibility of the program (or institution) should be to provide clarity regarding learning goals, an environment in which learning can occur, and support for the learning process.

Finally, I provide the reader with the best definition of CBE that I’ve encountered to date, which emerged from the previously mentioned article by Frank and colleagues.  It not only expresses these principles succinctly, but does so in a manner applicable to either driving a car or caring for a trauma patient, perhaps the best test of any definition attempting to capture such a complex combination of knowledge, skills and personal attributes.

 Screen Shot 2013-11-11 at 2.40.05 PM

Thanks to Theresa Suart (Educational Developer) and Lynel Jackson (master graphic designer) for their assistance in the development of this article. 

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Understanding Competency Based Education
Lessons from an unlikely source

I was recently asked to speak at a conference on the topic of Competency Based Education.  My assignment was to provide definitions of that topic and to discuss the advantages and challenges associated with developing such an approach in an undergraduate medical program.

graph-nov12My search for a universally accepted definition of CBE began with a call to Theresa Suart, Educational Developer, who promptly alerted me to the reality that no such thing exists and, in fact, I had stumbled into an area of considerable controversy.  She directed me to helpful references, including a 2010 paper by Jason Frank and colleagues (Medical Teacher 32; 631-637) that is actually a systematic review of published definitions!  They reviewed a total of no fewer than 173 published definitions and, as illustrated in this table from their paper, the topic has been attracting increasing interest in recent years.  All this leads me to doubt the practical utility or relevance of a topic that so many bright people have difficulty even defining.  However, one becomes accustomed to such dilemmas when venturing into the world of medical education, and begins to view such uncertainties as opportunities to re-examine basic principles and search for patterns or examples of prior success that may be applicable.

Screen Shot 2013-11-11 at 2.36.58 PMThe principle I always find useful in assessing educational change is the fundamental triad of associations between Objectives, Learning and Assessment.  One of my first practical lessons in curricular design (and accreditation standards) is that these three components must be closely linked if any medical curriculum is to be effective.  Objectives must drive instruction and learning, and assessment must be linked to the teaching provided and the stated objectives.

 

With this in mind, I searched for a simple example that might help advance our understanding of Competency Based Education.  A conversation with one of my nieces who’d recently completed her Driver’s Education course provided that example.  The granting of a Driver’s License is, in fact, recognition of a competence for which there exists an easily understood and widely accepted global objective, specifically the ability to safely operate an automobile.  That global objective requires a body of knowledge, skills and personal CanDriveattributes which, with apologies to the Royal College and with tongue firmly in cheek, could be expressed as the CanDRIVE competency domains, which centre around a body of knowledge and understanding (the Driving Expert) but require additional attributes, such as (we might conjecture) Judgement, fundamental Literacy, physical Coordination, Social Accountability, Alertness (no cell phones) and Sobriety.  The knowledge component is completely and clearly articulated by the Ministry of Transportation in the Driver’s Manual, and the assessment of competencies is demonstrated in three parts, a written examination with questions taken directly from the manual, a cursory visual assessment involving recognition of traffic signs, and a performance based driving test during which the candidate must demonstrate the global objective (drive the car) while exhibiting the component competency domains (show up sober, pay attention, etc…).

And so, two parts of the educational triad are provided.  The true brilliance of the Ministry of Transportation however, is in how they handle the teaching/learning component.  Fundamentally, they don’t.  Learning is the responsibility of the applicant.  That learning is guided, to be sure, by both implied and explicit expectations, but the candidate is expected to seek out their own education, at their own expense, carried out at their own schedule.  There is absolute clarity, however, of the ultimate goals and no mystery about the eventual summative evaluation (answer the questions, read the eye chart, drive the car).

Screen Shot 2013-11-11 at 9.39.27 AMThus, the Ministry of Transportation has (whether intentionally or not) developed a masterful model of Competency Based Education that:

  • Is based on objectives that are clearly understood by learners and assessors alike.
  • Built on a knowledge base that is discrete, well-described and accessible by all.
  • Requires a set of personal attributes that are understood by all and accepted as relevant to mastery of the competency
  • Does not attempt to assess those attributes individually, but rather evaluates the overall competency in a blended, performance based method, the format (and content) of which is completely understood and open to everyone involved.
  • is truly Learner centred

But, you’ll note, there’s obviously a world of difference between driving a car and practicing Medicine.  Indeed there is.  However, the ability to assess and manage a patient presenting with a particular clinical presentation is, like driving a car, a competency set that requires a combination of knowledge, skills, personal attributes (a set of objectives), that must be learned and must be reliably evaluated.  What can we learn from our simple example that’s relevant to any attempt to develop a Competency Based Medical Education program?

  1. The learning objectives must be developed and expressed in meaningful, pragmatic terms.  Competency to do what?  What specific things should the “competent” learner be able to do?  In this regard, the emerging development of Entrustable Professional Activities will no doubt play a major role.
  2. The assessment should be performance-based and relate clearly and directly to those objectives.  There should be no mystery as to what will be expected, and the method of evaluation must be pre-defined and understood by all.
  3. Learning is primarily driven by the learner, not an inflexible curriculum, nor should it be based on any particular schedule.
  4. The responsibility of the program (or institution) should be to provide clarity regarding learning goals, an environment in which learning can occur, and support for the learning process.

Finally, I provide the reader with the best definition of CBE that I’ve encountered to date, which emerged from the previously mentioned article by Frank and colleagues.  It not only expresses these principles succinctly, but does so in a manner applicable to either driving a car or caring for a trauma patient, perhaps the best test of any definition attempting to capture such a complex combination of knowledge, skills and personal attributes.

 Screen Shot 2013-11-11 at 2.40.05 PM

Thanks to Theresa Suart (Educational Developer) and Lynel Jackson (master graphic designer) for their assistance in the development of this article. 

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