Preparing anesthesiology faculty for competency-based medical education.

PURPOSE: Competency-based medical education (CBME) is quickly becoming the dominant organizing principle for medical residency programs. As CBME requires changes in the way medical education is delivered, faculty will need to acquire new skills in teaching and assessment in order to navigate the transition. In this paper, we examine the evidence supporting best practices in faculty development, propose strategies for faculty development for CBME-based residency programs, and discuss the results of faculty development initiatives at the pioneering anesthesia CBME residency program at the University of Ottawa. SOURCE: Review of the current literature and information from the University of Ottawa anesthesia residency program. PRINCIPAL FINDINGS: Faculty development is critical to the success of CBME programs. Attention must be paid to the competence of faculty to teach and assess all of the CanMEDS roles. At the University of Ottawa, some faculty development initiatives were very successful, while others were hindered by factors both internal and external to the residency program. Many faculty development activities had low attendance rates. CONCLUSIONS: Faculty development must be considered in the rollout of any new educational initiative. Experts suggest that faculty development for CBME should incorporate educational activities using multiple teaching and delivery methods, and should be offered longitudinally through the planning, development, and implementation phases of curriculum change. Additionally, these educational activities must continue until all faculty have demonstrated an acceptable level of competence. Faculty buy-in is paramount to the successful delivery of any faculty development program that is not mandatory in nature.

Curriculum reform for residency training: competence, change, and opportunities for leadership.

PURPOSE: Certain pressures stemming from within the medical community and from society in general, such as the need for increased accountability in resident training and restricted resident duty hours, have prompted a re-examination of methods for training physicians. Leaders in medical education in North America and around the world champion competency-based medical education (CBME) as a solution. The Department of Anesthesiology at the University of Ottawa launched Canada's first CBME program for anesthesiology residents on July 1, 2015. In this paper, we discuss the opportunities and challenges associated with CBME and delineate the elements of the new CBME program at the University of Ottawa. SOURCE: Review of the current literature. PRINCIPAL FINDINGS: Competency-based medical education addresses some of the challenges associated with physician training, such as ensuring that specialists are competent in all key areas and reducing training costs. In principle, competency-based medical education can better meet the needs of patients, providers, and other stakeholders in the healthcare system, but its success will depend on support from all involved. As CBME is implemented, anesthesiologists have the opportunity to become leaders in innovation and medical education. The University of Ottawa has implemented a CBME program with a twofold purpose, namely, to focus learning opportunities on the development of the specific competencies required of practicing anesthesiologists and to test the effectiveness of a reduction in the length of training. CONCLUSION: Canadian anesthesia residency programs will soon transition to CBME in order to promote better transparency, accountability, fairness, fiscal responsibility, and patient safety. Competency-based medical education offers significant potential advantages for healthcare stakeholders.

Designing and Implementing a Competency-Based Training Program for Anesthesiology Residents at the University of Ottawa.

Competency-based medical education is gaining traction as a solution to address the challenges associated with the current time-based models of physician training. Competency-based medical education is an outcomes-based approach that involves identifying the abilities required of physicians and then designing the curriculum to support the achievement and assessment of these competencies. This paradigm defies the assumption that competence is achieved based on time spent on rotations and instead requires residents to demonstrate competence. The Royal College of Physicians and Surgeons of Canada (RCPSC) has launched Competence by Design (CBD), a competency-based approach for residency training and specialty practice. The first residents to be trained within this model will be those in medical oncology and otolaryngology-head and neck surgery in July, 2016. However, with approval from the RCPSC, the Department of Anesthesiology, University of Ottawa, launched an innovative competency-based residency training program July 1, 2015. The purpose of this paper is to provide an overview of the program and offer a blueprint for other programs planning similar curricular reform. The program is structured according to the RCPSC CBD stages and addresses all CanMEDS roles. While our program retains some aspects of the traditional design, we have made many transformational changes.

Developing a sustainable electronic portfolio (ePortfolio) program that fosters reflective practice and incorporates CanMEDS competencies into the undergraduate medical curriculum.

The University of Ottawa (uOttawa) Faculty of Medicine in 2008 launched a revised undergraduate medical education (UGME) curriculum that was based on the seven CanMEDS roles (medical expert, communicator, collaborator, health advocate, manager, scholar, and professional) and added an eighth role of person to incorporate the dimension of mindfulness and personal well-being. In this article, the authors describe the development of an electronic Portfolio (ePortfolio) program that enables uOttawa medical students to document their activities and to demonstrate their development of competence in each of the eight roles. The ePortfolio program supports reflective practice, an important component of professional competence, and provides a means for addressing the "hidden curriculum." It is bilingual, mandatory, and spans the four years of UGME. It includes both an online component for students to document their personal development and for student-coach dialogue, as well as twice-yearly, small-group meetings in which students engage in reflective discussions and learn to give and receive feedback.The authors reflect on the challenges they faced in the development and implementation of the ePortfolio program and share the lessons they have learned along the way to a successful and sustainable program. These lessons include switching from a complex information technology system to a user-friendly, Web-based blog platform; rethinking orientation sessions to ensure that faculty and students understand the value of the ePortfolio program; soliciting student input to improve the program and increase student buy-in; and providing faculty development opportunities and recognition.

The Academic Support Process (ASP) website: helping preceptors develop resident learning plans and track progress.

BACKGROUND: At times, preceptors struggle with aspects of resident education. Many are looking for more support and faculty development in this area. AIMS: To address preceptors' needs for resources and provide a proactive framework for their teaching, the Academic Support Process (ASP) website was developed and evaluated. Preceptors' (N = 35) experiences using the ASP website, as well as their perceptions of its usefulness in supporting resident education, were identified. METHODS: The research comprised two phases: a self-directed workshop involving the creation of a web-based learning plan for a standardised scenario of a resident in difficulty followed by 3 months use of the ASP website with residents in their practice. Information on their experiences was solicited via surveys and focus group interviews. RESULTS: Findings revealed the ASP website enabled preceptors to find words for their concerns around resident competency, gave them a proactive teaching framework, expanded their arsenal of teaching strategies, and supported a customised approach for all learners along the performance spectrum. However, there were a number of challenges encountered by the preceptors that affected site use and buy in. CONCLUSIONS: Results are promising. Next steps involve developing a clear strategy for adoption.

eLearning, knowledge brokering, and nursing: strengthening collaborative practice in long-term care.

Interprofessional collaboration is vital to the delivery of quality care in long-term care settings; however, caregivers in long-term care face barriers to participating in training programs to improve collaborative practices. Consequently, eLearning can be used to create an environment that combines convenient, individual learning with collaborative experiential learning. Findings of this study revealed that learners enjoyed the flexibility of the Working Together learning resource. They acquired new knowledge and skills that they were able to use in their practice setting to achieve higher levels of collaborative practice. Nurses were identified as team leaders because of their pivotal role in the long-term care home and collaboration with all patient care providers. Nurses are ideal as knowledge brokers for the collaborative practice team. Quantitative findings showed no change in learner's attitudes regarding collaborative practice; however, interviews provided examples of positive changes experienced. Face-to-face collaboration was found to be a challenge, and changes to organizations, systems, and technology need to be made to facilitate this process. The Working Together learning resource is an important first step toward strengthening collaboration in long-term care, and the pilot implementation provides insights that further our understanding of both interprofessional collaboration and effective eLearning.

Grounding theories of W(e)Learn: a framework for online interprofessional education.

Interprofessional care (IPC) is a prerequisite for enhanced communication between healthcare team members, improved quality of care, and better outcomes for patients. A move to an IPC model requires changing the learning experiences of healthcare providers during and after their qualification program. With the rapid growth of online and blended approaches to learning, an educational framework that explains how to construct quality learning events to provide IPC is pressing. Such a framework would offer a quality standard to help educators design, develop, deliver, and evaluate online interprofessional education (IPE) programs. IPE is an extremely delicate process due to issues related to knowledge, status, power, accountability, personality traits, and culture that surround IPC. In this paper, a review of the pertinent literature that would inform the development of such a framework is presented. The review covers IPC, IPE, learning theories, and eLearning in healthcare.

W(e)Learn: a framework for online interprofessional education.

A framework is required to guide online Interprofessional Education (IPE) (Casimiro et al., 2009). The purpose of this paper is to present such a framework: W(e)Learn. W(e)Learn can be used as a quality standard and a guide to design, develop, deliver and evaluate online IPE in both pre- and post-qualification educational settings. The framework is presented in the spirit that educational programs have defining features that, when carefully designed with the appropriate blend of factors, can help achieve desired outcomes. W(e)Learn must now be applied in various contexts to assess its constructs and its applicability.

An online interprofessional learning resource for physicians, pharmacists, nurse practitioners, and nurses in long-term care: benefits, barriers, and lessons learned.

The importance of collaborative practice in health care has been emphasized.1,21, 2 There is a critical need for convenient and flexible education opportunities that support the development of collaborative practice skills among the health care workforce. Consequently, the purpose of this project was to create and evaluate an online learning resource for physicians, nurses, nurse practitioners, and pharmacists working in long-term care that provided practitioners with the skills, knowledge, and motivation necessary to enhance their ability to act as an interprofessional team while providing clinical care. The Demand-Driven Learning Model 3 was used to guide the project. Findings revealed learners enjoyed the programme and acquired new skills and knowledge relating to collaborative practice that they transferred to their workplace resulting in higher levels of collaborative practice. The data did not reveal significant changes in the learners' attitudes towards collaborative practice; perhaps because the participants were early adopters and already had positive attitudes. Requests to change organizational structure to enhance collaborative practice were minimal, as was the impact of the resource on resident care. Given the short time frame from completion of the learning resource to the evaluation, this is perhaps not surprising as it is reasonable to expect that these types of changes will take time to take effect within the organization. Follow-ups at a later date are suggested.

Assessing satisfaction with care in long-term care homes: current and best practices.

Given the increased call for accountability and quality of care in long-term care, it is important that government and long-term care provider organizations contemplate resident and family satisfaction with long-term care. This article highlights important considerations and provides practical recommendations for conducting satisfaction surveys in long-term care homes in terms of content, method of implementation and analysis, and use of findings. We conclude by recommending three surveys worthy of consideration by the government and long-term care provider organizations in Canada.