Otolaryngology residency education: a scoping review on the shift towards competency-based medical education.

BACKGROUND: Residency training programmes worldwide are experiencing a shift from the traditional time-based curriculum to competency-based medical education (CBME), due to changes in the healthcare system that have impacted clinical learning opportunities. Otolaryngology-Head and Neck Surgery (OTL-HNS) programmes are one of the first North American surgical specialties to adopt the new CBME curriculum. OBJECTIVE OF REVIEW: The purpose of this scoping review is to examine the literature pertaining to CBME in OTL-HNS programmes worldwide, to identify the tools that have been developed and identify potential barriers to the implementation of CBME. SEARCH STRATEGY: Four online databases, OVID MEDLINE (R) from 1946 to 5 August 2015, EMBASE 1974 to 5 August 2015, Cochrane and CINAHL databases up to 5 August 2015, were searched using key words related to OTL-HNS and CBME. EVALUATION METHOD: Two researchers independently reviewed the literature in a systematic manner and met to discuss and address any discrepancies at each step of the review process. RESULTS: Of the 207 publications identified in the initial search, 31 were included in this scoping review. Two key themes emerged from the literature: first, OTL-HNS programmes reported a need for new assessment tools that assess competency and also provide the learner with formative feedback. Second, although varieties of tools assessing both technical and non-technical skills have been developed, implementation of such tools has been met with some challenges. These challenges include a lack of faculty support, inadequate administrative support and a lack of knowledge on how to start the transition to CBME. CONCLUSIONS: This scoping review suggests that task-specific checklists, entrustment scales, evaluation portfolios from multiple assessments and faculty training sessions are key aspects to incorporate as OTL-HNS training programmes shift towards a CBME curriculum.

The effect of gender dyads on the quality of narrative assessments of general surgery trainees.

BACKGROUND: Prior studies have shown that gender can influence how learners are assessed and the feedback they receive. We investigated the quality of faculty narrative comments in general surgery trainee evaluation using trainee-assessor gender dyads. METHODS: Narrative assessments of surgical trainees at the University of British Columbia were collected and rated using the McMaster Narrative Comment Rating Scale (MNCRS). Variables from the MNCRS were inputted into a generalized linear mixed model to explore the impact of gender dyads on the quality of narrative feedback. RESULTS: 2,469 assessments were collected. Women assessors tended to give higher-quality comments (p's < 0.05) than men assessors. Comments from men assessors to women trainees were significantly more positive than comments from men assessors to men trainees (p = 0.02). Men assessors also tended to give women trainees more reinforcing than corrective comments than to men trainees (p < 0.01). CONCLUSIONS: There are significant differences in the quality of faculty feedback to trainees by gender dyads. A range of solutions to improve and reduce differences in feedback quality are discussed.

Measuring temporal resolution in infants using mismatch negativity.

We show that the mismatch negativity (MMN) component of the event-related potential can be used to measure auditory temporal resolution in human infants. Infrequent stimuli with silent gaps of 4, 8, or 12 ms modulated the P2 component, generated MMN, and produced a P3a-like positivity. The data indicate that within-channel gap detection thresholds at 6 months are essentially at adult levels under conditions of little adaptation. Since MMN is elicited without attention and does not require a behavioural response, it can be measured similarly across the lifespan. We are now in a position to study the development of cross-channel temporal resolution and adaptation effects in infancy, and to examine how these abilities in infancy relate to later language acquisition.