Adaptations & Assessment Burden Themes | School of Medicine

CBME Burden of Assessment

Residents and faculty have described a burden of assessment related to the implementation of competency-based medical education (CBME), which may undermine its benefits. Although this concerning signal has been identified, little has been done to identify adaptations to address this problem.

We recently analyzed our programs' experiences with assessment to identify themes related to the burden of assessment with a subsequent focus on identifying adaptations across programs. These adaptations represent responses to the concerning signal of significant burden of assessment within CBME being experienced broadly.

Read more about the study and its findings in Academic Medicine.

Assessment Burden Theme 1:

Disparate mental models of assessment processes in CBME (including subthemes of ‘variable scale interpretation’ and lack of ‘shared performance standards’).

Common Adaptations	Unique Adaptations
Revising entrustment scales for ease of use and clarity	Revising resident resources (e.g., orientation package)
Revisiting conceptualizations of stages and EPAs (to address fragmentation within and across stages, progression, levels of performance within and across EPAs)	Formalizing meaningful resident representation on RPC through Terms of Reference specific to eliciting and sharing feedback at RPC.
Offering faculty development (FD) to clarify entrustment and EPAs (e.g., micro-opportunities linked to other meetings; sharing exemplars; multi-pronged communication strategies.)	Promoting end of block discussions between residents and faculty about CBME that includes a review of entrustment scale.
Sharing tips and tricks emails to support assessment completion (e.g., use of PIN, in-the-moment completion).	Reviewing different assessments to help residents & faculty understand their unique value/contribution.

Assessment Burden Theme 2:

Challenges in workplace -based assessment processes (including subthemes of ‘direct observation’, ‘timeliness of assessment completion’, ‘documentation of performance’, and ‘feedback quality’).

Common Adaptations	Unique Adaptations
Encouraging direct observation through dedicated clinical time for faculty	Highlighting for faculty & residents assessment information that is most useful to the CC in formulating progress and promotion decisions
Leveraging assessment strategies beyond EPA forms (e.g., Periodic Performance Assessments (PPAs))	Raising awareness about assessment opportunities for residents & faculty through EPA cards in clinic
Providing FD specific to enhancing ‘coaching in the moment’ and feedback quality, encouraging assessment initiation and completion, and periodically reviewing software functionality.	Clarifying expectations for residents & faculty
Planning and initiating assessments proactively (e.g., distributing case load at beginning of shift according to EPA needs, striving for balance in who initiates assessments)	Offering incentives to enhance faculty engagement (e.g., competition to see who uses their PIN first and/or most frequently).
	Creating CBME report cards for each faculty member, including number, variety, comprehensiveness, and timeliness of completed assessments.
	Developing prompts to enhance faculty & resident engagement with EPAs. (e.g., Colour-coded ring cards mapping high yield/value EPAs to clinical environments)
	Reminding residents which EPAs are highest value at the beginning of each block and documenting that in Elentra rotation schedule for easy access.
	Meeting regularly with residents to discuss CC decisions and identify strategies to maximize their learning using the EPAs.
	Clarifying expectations and empowering learners to initiate EPA assessments and support completion in the moment.

Assessment Burden Theme 3:

Challenges in performance review and decision making (including subthemes of monitoring performance and cc decisions-making).

Common Adaptations	Unique Adaptations
Enhancing reporting functionality in Elentra software and strategically supplementing by creating tracking sheets, generating graphs.	Enhancing transparency of CC with a resident nominated representative.
Offering professional development opportunities (Academic half days, education rounds, departmental meetings)	Hosting Competence Committee retreat to review each EPA and develop a shared understanding of EPA achievement, CBME processes, and expectations.
	Feeding back to RC Specialty Committee with subsequent changes to EPAs/target numbers.
	Tracking EPA completion by program leaders and CC every four blocks, including reviewing resident progress in relation to other residents.