Twelve tips for learners to succeed in a CBME program.

The international movement to competency-based medical education (CBME) marks a major transition in medical education that requires a shift in educators' and learners' approach to clinical experiences, the way assessment data are collected and integrated, and in learners' mindsets. Learners entering a CBME curriculum must actively drive their learning experiences and education goals. For some, this expectation may be a significant change from their previous approach to learning in medicine. This paper highlights 12 tips to help learners succeed within a CBME model.

Exploring the nature and focus of feedback when using video playback in gynecology laparoscopy training.

BACKGROUND: Feedback about intraoperative performance remains a cornerstone of surgical training. Video playback offers one potential method for more effective feedback to surgical residents. More research is needed to better understand this method. This study explores the nature of instructional interactions and feedback in the operating room (OR) and when using video playback during post-operative review in obstetrics and gynecology (OBGYN) training. METHOD: This case study occurred between September 2016 and February 2017. Three OBGYN residents and five OBGYN supervising surgeons were involved in six laparoscopic cases. Intraoperative and video playback dialogues were recorded and analysed, the former deductively using codes identified from published literature, and the latter both deductively, using the same codes, and inductively, with codes that emerged from the data during analysis. RESULTS: 1090 intraoperative interactions were identified within 376 minutes of dialogue. Most interactions were didactic, instructing the resident how to use an instrument to perform a task. Deductive analysis of postoperative video playback review identified 146 interactions within 155 minutes. While the most common interaction type remained didactic, a teaching component was included more often. It became apparent that deductive analysis using the intraoperative codes did not adequately capture the nature and focus of feedback during video playback. Hermeneutic phenomenological analysis identified more dialogic video playback sessions with more resident-initiated questions and reflection. CONCLUSIONS: This study demonstrates that the nature of feedback during video playback is fundamentally different from that in the OR, offering a greater potential for collaborative and improved learning.

CONTEXTE: La rétroaction sur la performance peropératoire demeure la pierre angulaire de la formation chirurgicale. Le visionnement de vidéos est un moyen d'offrir une rétroaction plus efficace aux résidents en chirurgie. Des recherches supplémentaires sont nécessaires pour mieux cerner cette méthode. La présente étude explore la nature des interactions pédagogiques et de la rétroaction donnée en salle d'opération et lors du visionnement de vidéos au cours de l'analyse postopératoire dans le cadre de la formation en obstétrique et gynécologie. MÉTHODE: Cette étude de cas a été réalisée entre septembre 2016 et février 2017. Trois résidents et cinq chirurgiens superviseurs en obstétrique et gynécologie ont participé à six interventions laparoscopiques. Les dialogues peropératoires et les échanges qui ont eu lieu lors du visionnement des vidéos ont été enregistrés et analysés, les premiers de manière déductive en utilisant les codes tirés de la littérature, et les seconds à la fois de manière déductive, en utilisant les mêmes codes, et inductive, à l'aide de codes dégagés des données pendant l'analyse. RÉSULTATS: Les interactions peropératoires recensées au cours des 376 minutes de dialogue sont au nombre de 1090. La plupart des rétroactions étaient didactiques, visant à expliquer au résident comment utiliser un instrument pour effectuer une tâche. L'analyse déductive des vidéos postopératoires a permis le repérage de 146 interactions au cours d'une période de 155 minutes. Si la plupart de ces interactions demeuraient didactiques, elles comprenaient plus souvent une composante d'enseignement. Il s'est avéré que l'analyse déductive à l'aide des codes peropératoires ne rendait pas compte de manière adéquate de la nature et de l'objectif de la rétroaction offerte pendant le visionnement des vidéos. L'analyse phénoménologique herméneutique a permis d'identifier des séances de visionnement qui étaient plus dialogiques, comprenant davantage de questions et de réflexions provenant des résidents. CONCLUSION: La présente étude montre que la rétroaction donnée pendant le visionnement des vidéos et celle donnée en salle d'opération sont fondamentalement différentes, et que la première favorise davantage que la seconde l'apprentissage collaboratif et son efficacité.

Ten ways to get a grip on resident co-production within medical education change.

The Royal College of Physicians and Surgeons of Canada (RCPSC) is transforming its national approach to postgraduate medical education by transitioning all specialty programs to competency based medical education (CBME) curriculums over a seven-year period. Queen's University, with special permission from the RCPSC, launched CBME curricula for all incoming residents across its 29 specialty programs in July 2017. Resident engagement, empowerment, and co-production through this transition has been instrumental in successful implementation of CBME at Queen's University. This article aims to use our own experience at Queen's in the context of current literature and rooted in change leadership theory, to provide a guide for educators, learners, and institutions on how to leverage the interest and enthusiasm of trainees in the transition to CBME in postgraduate training. The following ten tips provides a model for avoiding the "black ice" type pitfalls that can arise with learner involvement and ensure a smoother transition for other institutions moving forward with CBME implementation.

Le Collège royal des médecins et chirurgiens du Canada (CRMCC) s'emploie à transformer son approche nationale à la formation médicale postdoctorale en effectuant une transition, répartie sur une période de sept ans, de tous les programmes spécialisés vers des programmes de formation médicale axéesur les compétences (FMAC). En juillet 2017, l'Université Queen, avec une permission spéciale du CRMCC, a lancé des cursus de FMAC pour tous les nouveaux résidents de ses 29 programmes spécialisés. La participation, la capacité d'agiret la coproduction par lesrésidents pendant cette transition ont contribué à la mise en œuvre réussie de la FMAC à l'Université Queen. Le présent article vise à utiliser notre propre expérience à l'Université Queen dans le contexte de la littérature actuelle et est ancrésur la théorie du leadership en matière de changement, pour procurer un guide aux éducateurs, aux apprenants et aux établissements sur la manière de tirer parti de l'intérêt et de l'enthousiasme des apprenantsdans la transition vers la FMAC dans la formation postdoctorale. Les dix conseils suivants proposent un modèle pour éviter les écueils du type « glace noire ¼ qui peuvent survenir avec la participation de l'apprenant et s'assurer une transition plus harmonieuse pour les autres établissements qui vont de l'avant avec la mise en œuvre de la FMFC.

The clinical learning environment.

Learning in a clinical context is foundational in the training of health professionals; there is simply no alternative. The subject of the clinical learning environment (CLE) is at the forefront of discussions. In this introduction to a themed issue on the CLE, we present an expanded conceptual model that approaches the CLE through six different lenses, termed "avenues:" architectural, digital, diversity and inclusion, education, psychological, and sociocultural, with each avenue represented by a paper. The aim is to facilitate dialog around the contributions of different academic disciplines to research on the CLE. Collectively the papers highlight the overlap between the various "avenues" in how they influence each other, and how they collectively have shaped the work to understand and improve the CLE. The expectation is that the various avenues can add to existing knowledge and create new ideas for interventions to improve the clinical learning environment across nations for learners and teachers with the ultimate aim of improving patient care. Research and efforts to improve the CLE are critical to learning, professional socialization and well-being for trainees as they learn and participate in patient care, and to the quality of care they will deliver over decades of practice after graduation.

Psychology and learning: The role of the clinical learning environment.

The clinical learning environment for the postgraduate education of physicians significantly influences the learning process and the outcomes of learning. Two critical aspects of the learning environment, when viewed through a psychology lens are (1) constructs from psychology relevant to learning, such as cognitive load theory and learner self-efficacy; and (2) psychological attributes of the context in which learning occurs such as psychological safety and "Just Culture". In this paper, we address selected psychological aspects of the clinical learning environment, with a particular focus on the establishment and sustainment of psychological safety in the clinical learning environment for physicians. Psychological safety is defined as individuals' perceptions that they can speak out in the learning or working context without consequences for their professional standing or risks to their status on work teams or groups. We close with seven critical strategies for use by educators, learners, health systems leaders, and other stakeholders to contribute to a clinical environment that optimizes learning. These dimensions can also provide avenues for future research to enhance the community's understanding of psychological constructs operating in the clinical learning environment.