The lived experience of Competence by Design: Canadian resident physicians' perspectives.

PURPOSE: Canadian specialist residency programs are in the process of transitioning to a hybrid time and competence model, Competence by Design (CBD), developed by the Royal College of Physicians and Surgeons Canada. Although there is extensive literature around competency-based medical education (CBME), few studies have evaluated the experience of residents after CBME implementation. The purpose of this study was to obtain a rich perspective on the lived experience of residents. METHODS: We designed a qualitative study with inductive thematic analysis of semistructured interview data. The study population was residents in CBD postgraduate training programs in anesthesiology, internal medicine, or surgery (including all surgical subspecialties) at Dalhousie University (Halifax, NS, Canada). RESULTS: Residents identified the following benefits of their programs and CBD: supportive peers and clinical supervisors, a roadmap for residency, formalized feedback opportunities, and program evolution. Resident-identified drawbacks of CBD included: a lack of transparency around CBD, CBD not as advertised, a lack of buy-in, increased administrative burden, difficulties obtaining evidence for entrustable professional activities (EPAs); the onus for CBD on residents, inconsistent feedback, cumbersome technology, and significant psychological burden. Resident-suggested improvements were reducing the number of EPAs, streamlining EPA requirements, increasing transparency and communication with competence committees, providing incentives and continuous education for clinical supervisors, improving on existing electronic interfaces, and developing technology better suited to the needs of CBD. CONCLUSION: This study highlights that the significant administrative and psychological burden of CBD detracts from clinical learning and enthusiasm for residency. Future research could explore whether overcoming the identified challenges will improve residents' experiences.

RéSUMé: OBJECTIF: Les programmes canadiens de résidence spécialisée sont en train de passer à un modèle hybride de temps et de compétence, soit la compétence par conception (CPC); ce modèle a été élaboré par le Collège royal des médecins et chirurgiens du Canada. Bien qu'il existe une abondante documentation sur la formation médicale fondée sur les compétences (FMFC), peu d'études ont évalué l'expérience des résidentes et résidents après la mise en œuvre de la FMFC. Le but de cette étude était d'obtenir une perspective enrichie quant à l'expérience vécue par les résidents et résidentes. MéTHODE: Nous avons conçu une étude qualitative avec une analyse thématique inductive des données d'entretiens semi-structurés. La population étudiée était composée de résident·es des programmes de formation postdoctorale en anesthésiologie, en médecine interne ou en chirurgie (y compris toutes les surspécialités chirurgicales) à l'Université Dalhousie (Halifax, N.-É., Canada). RéSULTATS: Les personnes interrogées ont identifié les avantages suivants de leurs programmes et de la CPC : le soutien des pairs et des superviseur·es cliniques, une feuille de route pour la résidence, des possibilités de rétroaction officielles et l'évolution du programme. Parmi les inconvénients de la CPC identifiés par les résident·es, mentionnons : un manque de transparence autour de la CPC, une CPC ne correspondant pas à ce qui avait été annoncé, un manque d'adhésion, un fardeau administratif accru, des difficultés à obtenir des preuves de participation à des actes professionnels non supervisés (APNS); le fardeau de la CPC incombant aux résident·es, une rétroaction incohérente, une technologie lourde et un fardeau psychologique important. Les améliorations suggérées par les résident·es comprenaient la réduction du nombre d'APNS, la rationalisation des exigences des APNS, l'augmentation de la transparence et de la communication avec les comités de compétence, l'offre d'incitations et de formation continue aux superviseur·es cliniques, l'amélioration des interfaces électroniques existantes et le développement d'une technologie mieux adaptée aux besoins de la CPC. CONCLUSION: Cette étude souligne que le fardeau administratif et psychologique important de la CPC nuit à l'apprentissage clinique et à l'enthousiasme pour la résidence. Les recherches futures pourraient déterminer si le fait de surmonter les défis identifiés améliorerait l'expérience des résidentes et résidents.

Neurosurgeons' Perspectives on Vascular Entrustable Professional Activities.

This article discusses subspecialty Canadian neurosurgeons' perceptions of entrustable professional activities (EPAs) assessments and variabilities prior to the implementation of the Competence by Design (CBD) system in Canada. Vascular neurosurgeons were asked to reflect on how they would evaluate and give feedback to neurosurgery residents concerning the EPA "Performing surgery for patients with an intracranial aneurysm." Interviews were transcribed and analyzed using a deductive approach. Themes were derived from these interviews and reflected on the subjectivity and biases present in the EPA assessment forms. Indeed, faculty may require more training in the transitioning to a CBD evaluation system.

A Longitudinal Assessment of a Physician Performance Enhancement Program Using Health Data, to Improve Quality of Care and Facilitate Lifelong Learning.

The Personal Quality Index (PQI) provides individual annual reports of benchmarked clinical data to inform practice development. This 5-year longitudinal retrospective study of PQI performance indicators also surveyed department members (n = 104) on utility, using t test, and Wilcoxon test. Technicity increased from 59% in 2014 to 72% in 2018 (P < 0.001). The vaginal birth after cesarean delivery rate did not improve, but the combined forceps/vacuum delivery rate decreased for sites and physicians (P < 0.001). Survey response was 35%. Most physicians (62%) found it valuable, and it informed professional development in 23% of cases. Nevertheless, 42% did not trust the data, and 39% found the process provoked anxiety.

Defining new roles and competencies for administrative staff and faculty in the age of competency-based medical education.

PURPOSE: These authors sought to define the new roles and competencies required of administrative staff and faculty in the age of CBME. METHOD: A modified Delphi process was used to define the new CBME roles and competencies needed by faculty and administrative staff. We invited international experts in CBME (volunteers from the ICBME Collaborative email list), as well as faculty members and trainees identified via social media to help us determine the new competencies required of faculty and administrative staff in the CBME era. RESULTS: Thirteen new roles were identified. The faculty-specific roles were: National Leader/Facilitator in CBME; Institutional/University lead for CBME; Assessment Process & Systems Designer; Local CBME Leads; CBME-specific Faculty Developers or Trainers; Competence Committee Chair; Competence Committee Faculty Member; Faculty Academic Coach/Advisor or Support Person; Frontline Assessor; Frontline Coach. The staff-specific roles were: Information Technology Lead; CBME Analytics/Data Support; Competence Committee Administrative Assistant. CONCLUSIONS: The authors present a new set of faculty and staff roles that are relevant to the CBME context. While some of these new roles may be incorporated into existing roles, it may be prudent to examine how best to ensure that all of them are supported within all CBME contexts in some manner.

Preparedness of Residents and Medical Students for the Transition to Competence by Design in Diagnostic Radiology Post-Graduate Medical Education.

Introduction: This needs assessment evaluated residents' and medical students' knowledge of Competence by Design (CBD), perceived benefits of and challenges or barriers to the transition to CBD for residents, and perceived overall preparedness for the transition to CBD in diagnostic radiology. Materials and Methods: All diagnostic radiology residents and medical students in Canada were eligible to participate in this national cross-sectional, questionnaire-based needs assessment. Knowledge of CBD was evaluated through participants' self-reported rating of their knowledge of CBD on a 5-point Likert scale. Perceived benefits of and challenges or barriers to the transition to CBD for residents were rank ordered. Participants' overall self-reported preparedness for the transition to CBD was assessed on a 5-point Likert scale. Data were summarized by descriptive statistics and bivariate analyses were conducted as appropriate. Results: Ninety-four residents (n = 77) and medical students (n = 17) participated in this needs assessment. Participants' mean ± standard deviation self-reported rating of their overall knowledge of CBD was 2.86 ± .94. Provision of meaningful feedback to learners and learners' ability to identify their own educational needs were among the highest ranked perceived benefits of the transition to CBD, while demands on time and increased frequency of evaluation were among the highest ranked perceived challenges or barriers to the transition to CBD. Few participants reported being either "prepared" (4.7%) or "somewhat prepared" (14.0%) for the transition to CBD. Conclusion: Preparedness for the transition to CBD in diagnostic radiology may be improved. Targeted interventions to augment the preparedness of residents and medical students should be considered.

Knowledge and Perceptions of Competency-Based Medical Education in Diagnostic Radiology Post-Graduate Medical Education: Identifying Priorities and Developing a Framework for Professional Development Activities.

Introduction: We evaluated knowledge and perceptions of an established Competency-Based Medical Education (CBME) model developed by the Royal College of Physicians and Surgeons of Canada, Competence by Design (CBD), and identified evidence-informed priorities for professional development activities (PDAs). Materials and Methods: Teaching faculty and residents at a single, large diagnostic radiology post-graduate medical education (PGME) program were eligible to participate in this cross-sectional, survey-based study. Knowledge of CBD was evaluated through multiple choice questions (MCQs), which assessed participants' understanding of major principles and terms associated with CBD. Participants' perceptions of the anticipated impact of CBD on resident education and patient care were evaluated and priorities for PDAs were identified, which informed a framework for CBD PDAs. Results: Fifty faculty and residents participated. The faculty and resident response rates were 11.6% (n = 29/249) and 55.3% (n = 21/38), respectively. The mean ± standard deviation overall score on MCQs was 39.0% ± 20.4%. The majority of participants perceived the impact of CBD on resident education to be equivocal and to not impact patient care. Knowledge of CBD was not statistically significantly associated with participants' perceptions of the impact of CBD on either resident education or patient care (P > .05). Delivery of high-quality feedback was the greatest priority identified for PDAs. Discussion: Our results and proposed CBD PDAs framework may help to guide diagnostic radiology PGME programs in designing evidence-informed PDAs, which may meaningfully contribute to the successful implementation of CBD in diagnostic radiology PGME. As diagnostic radiology PGME programs throughout the world increasingly implement CBME models, evidence-informed PDAs will become of increasing importance.

Investigating faculty assessment of anesthesia trainees and the failing-to-fail phenomenon: a randomized controlled trial.

PURPOSE: A growing body of evidence has shown that supervisors may "fail to fail" trainees even when they have judged their performance unsatisfactory. This has significant implications for the implementation of a nationwide competency-based education model of residency training. The objective of this study was to determine the incidence of "failing to fail" clearly underperforming residents. METHODS: Study participants were recruited via an email invitation sent to all departments of anesthesia at each of the hospitals affiliated with the University of Toronto. They were randomized into a high-stakes (assessment would affect the resident's progress) or low-stakes (assessment would not affect the resident's progress) group and asked to assess the performance (fail or pass grade) of a struggling resident. Participants assessed a video depicting an actor managing a scripted simulation scenario. It contained several critical clinical mistakes constituting a clear fail performance. The purpose of the study was only disclosed following the assessment. RESULTS: Of the 288 email invitations sent (144 in each group), 158 (54%) participants completed the study, with 93 in the high-stakes group and 65 in the low-stakes group. Twenty-eight participants (17.7%) failed to issue a failing grade, including 23.1% (15/65) in the high-stakes group and 13.9% (13/93) in the low-stakes group (P = 0.14). CONCLUSIONS: Though often discussed, this is the first study to quantitatively show that the "failing-to-fail" phenomenon likely occurs during residency training performance evaluations. Passing underperforming learners can potentially affect patient safety and result in severe personal consequences to the learner. The results indicate the need for better performance assessment training for faculty members.

RéSUMé: OBJECTIF: Des données probantes de plus en plus nombreuses ont montré que les superviseurs pourraient « échouer à échouer ¼ des résidents même s'ils ont jugé leur performance insatisfaisante. Cela a d'importantes répercussions sur la mise en œuvre d'un modèle national de formation en résidence axé sur les compétences. L'objectif de cette étude était de déterminer l'incidence d' « échouer à échouer ¼ les résidents dont les résultats sont clairement inadéquats. MéTHODE: Les participants à l'étude ont été recrutés au moyen d'une invitation par courriel envoyée à tous les départements d'anesthésie de chacun des hôpitaux affiliés à l'Université de Toronto. Ils ont été randomisés en un groupe à enjeu élevé (l'évaluation aurait une incidence sur la progression académique du résident) et un groupe à faible enjeu (l'évaluation n'affecterait pas la progression académique du résident) et on leur a demandé d'évaluer la performance (échec ou passage) d'un résident en difficulté. Les participants ont évalué une vidéo montrant un acteur prenant en charge un cas de simulation scénarisé. La vidéo comportait plusieurs erreurs cliniques critiques constituant clairement un échec. L'objectif de l'étude n'a été divulgué qu'après l'évaluation. RéSULTATS: Sur les 288 invitations par courriel envoyées (144 dans chaque groupe), 158 (54 %) participants ont terminé l'étude, dont 93 dans le groupe à enjeu élevé et 65 dans le groupe à faible enjeu. Vingt-huit participants (17,7 %) n'ont pas donné de note d'échec, dont 23,1 % (15/65) dans le groupe à enjeu élevé et 13,9 % (13/93) dans le groupe à enjeu faible (P = 0,14). CONCLUSION: Bien que cette question soit souvent discutée, il s'agit de la première étude à montrer quantitativement que le phénomène d' « échouer à échouer ¼ survient probablement lors des évaluations pendant la formation en résidence. Le fait de laisser passer des résidents n'ayant pas acquis les compétences peut potentiellement affecter la sécurité des patients et entraîner de graves conséquences personnelles pour le résident. Les résultats indiquent la nécessité d'une meilleure formation à l'évaluation des performances pour les membres du corps professoral.

Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen's Fundamental Innovations in Residency Education)-Part 2: Core of Discipline Stage.

PURPOSE: All postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) model divided into 4 stages of training. Queen's University has been the first Canadian institution to mandate transitioning to CBME across all residency programs, including Diagnostic Radiology. This study describes the implementation of CBME with a focus on the third developmental stage, Core of Discipline, in the Diagnostic Radiology residency program at Queen's University. We describe strategies applied and challenges encountered during the adoption and implementation process in order to inform the development of other CBME residency programs in Diagnostic Radiology. METHODS: At Queen's University, the Core of Discipline stage was developed using the Royal College of Physicians and Surgeons of Canada's (RCPSC) competence continuum guidelines and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones for assessment. New committees, administrative positions, and assessment strategies were created to develop these assessment guidelines. Currently, 2 cohorts of residents (n = 6) are enrolled in the Core of Discipline stage. RESULTS: EPAs, milestones, and methods of evaluation for the Core of Discipline stage are described. Opportunities during implementation included tracking progress toward educational objectives and increased mentorship. Challenges included difficulty meeting procedural volume requirements, inconsistent procedural tracking, improving feedback mechanisms, and administrative burden. CONCLUSION: The transition to a competency-based curriculum in an academic Diagnostic Radiology residency program is significantly resource and time intensive. This report describes challenges faced in developing the Core of Discipline stage and potential solutions to facilitate this process.

Diagnostic Neuroradiology Subspecialty Training: 1 Versus 2 Years; the Canadian Perspective.

BACKGROUND: Canada began a national reform of its post-graduate medical education training programs to a Competence By Design (CBD) model. Trends from accredited neuroradiology programs from the past 10 years were investigated to inform educators and stakeholders for this process. METHODS: A 13-question electronic survey was sent to program directors of all 8 accredited neuroradiology training programs in Canada. Data was requested for each year on the 2008-2019 graduating classes. Questions pertained to program enrolment; program completion; post-training employment; and the sufficiency of 1-year training programs. RESULTS: Response rate was 100%. Over the timeframe studied, the 2-year programs increased in size (P = 0.007), while the 1-year programs remained steady (P = 0.27). 12.2% of trainees enrolled in the 2-year program dropped out after 1 year, and were considered 1-year trainees thereafter. A higher proportion of 2-year trainees obtain positions within academic institutions (89.5 vs 67.2%, P = 0.0007), whereas a higher proportion of 1-year trainees obtain positions within non-academic institutions (29.3 vs 8.1%, P = 0.0007). A higher proportion of those with Canadian board certification in diagnostic radiology who completed a 2-year program obtained a position within a Canadian academic institution compared to non-certified 2-year trainees (P < 0.001). 71.4% of program directors agreed that a 1-year program was sufficient for non-academic staff positions. CONCLUSION: The length of the training program has significant impact on employment in academic vs non-academic institutions. This information can be used to guide the upcoming CBD initiative for neuroradiology programs.

Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen's Fundamental Innovations in Residency Education)-Part 1: Transition to Discipline and Foundation of Discipline Stages.

PURPOSE: The Royal College of Physicians and Surgeons of Canada (RCPSC) has mandated the transition of postgraduate medical training in Canada to a competency-based medical education (CBME) model divided into 4 stages of training. As part of the Queen's University Fundamental Innovations in Residency Education proposal, Queen's University in Canada is the first institution to transition all of its residency programs simultaneously to this model, including Diagnostic Radiology. The objective of this report is to describe the Queen's Diagnostic Radiology Residency Program's implementation of a CBME curriculum. METHODS: At Queen's University, the novel curriculum was developed using the RCPSC's competency continuum and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones. In addition, new committees and assessment strategies were established. As of July 2015, 3 cohorts of residents (n = 9) have been enrolled in this new curriculum. RESULTS: EPAs, milestones, and methods of evaluation for the Transition to Discipline and Foundations of Discipline stages, as well as the opportunities and challenges associated with the implementation of a competency-based curriculum in a Diagnostic Radiology Residency Program, are described. Challenges include the increased frequency of resident assessments, establishing stage-specific learner expectations, and the creation of volumetric guidelines for case reporting and procedures. CONCLUSIONS: Development of a novel CBME curriculum requires significant resources and dedicated administrative time within an academic Radiology department. This article highlights challenges and provides guidance for this process.

An interpretive phenomenological analysis of formative feedback in anesthesia training: the residents' perspective.

BACKGROUND: Consistent formative feedback is cornerstone to competency-by-design programs and evidence-based approaches to teaching and learning processes. There has been no published research investigating feedback from residents' perspectives. We explored the value residents place on feedback in routine operating room settings, their experiences, and understanding of the role of feedback in their training and developing professional identity. METHODS: Interpretive phenomenological analysis of residents' experiences with feedback received in clinical settings involved two focus groups with 14 anesthesia residents at two time points. Analysis was completed in the context of a teaching hospital adapting to new practices to align with nationally mandated clinical competencies. Focus group conversations were transcribed and interpreted through the lens of a social constructivist approach to learning as a dynamic inter- and intra-personal process, and evidence-based assessment standards set by the International Test Commission (ITC). RESULTS: Residents described high quality feedback as consistent, effortful, understanding of residents' thought processes, and containing actionable advice for improvement. These qualities of effective evaluation were equally imperative for informal and formal evaluations. Residents commented that highest quality feedback was received informally, and formal evaluations often lacked what they needed for their professional development. CONCLUSION: Residents have a deep sense of what promotes their learning. Structured feedback tools were seen positively, although the most important determinants of their impact were faculty feedback- and broader evaluation-skills and motivations for both formal and informal feedback loops.

An Assessment of the Continuing Surgical Education Program, a Surgical Preceptor Program for Faculty Members.

OBJECTIVE: The Continuing Surgical Education Preceptor program (CSEP) was designed to meet population needs by facilitating development of new skills by practising surgeons. Elements include entry criteria, dedicated OR time, assigned preceptors, structured assessment of competence, a mechanism for credentialing, and a reimbursement model. This study analyzed the effectiveness of the CSEP in increasing the number of clinician educators performing laparoscopic hysterectomy (LH) without compromising rates of vaginal hysterectomy (VH) and in enhancing residents' training in performing minimally invasive hysterectomy (MIH; either LH or VH). METHODS: We performed a retrospective descriptive study to longitudinally analyze the numbers and proportions of different surgical approaches to hysterectomy at two hospital sites over five years. The CSEP was implemented differently at the two sites. Success of the program was indicated by a surgeon performing 50% or more of hysterectomies as MIH. To assess the impact on resident education, we longitudinally analyzed the number of hysterectomy teaching cases performed as MIH. RESULTS: The proportion of surgeons performing 50% of hysterectomies as MIH steadily increased in the first five years after implementation of the CSEP. At one hospital, the proportion increased from 13% to 56%, due to an increase in LH cases with no change in VH cases. The proportion of resident LH teaching cases increased from 0% to 26%, with a similar rise in the proportion of MIH cases, although it did not quite reach the target proportion of 50% or more. Contrasting the experience of the CSEP between two hospitals revealed that having OR time dedicated to MIH cases provided significantly better results. CONCLUSIONS: The CSEP is an effective and sustainable model of lifelong learning applied to teaching practising surgeons new surgical skills.

Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education.

INTRODUCTION: Since 2022, all Canadian post-graduate medical programs have transitioned to a Competence by Design (CBD) model within a Competency-Based Medical Education (CBME) framework. The CBME model emphasized more frequent, formative assessment of residents to evaluate their progress towards predefined competencies in comparison to traditional medical education models. Faculty members therefore have increased responsibility for providing assessments to residents on a more regular basis, which has associated challenges. Our study explores faculty assessment behaviours within the CBD framework and assesses their openness to opportunities aimed at improving the quality of written feedback. Specifically, we explore faculty's receptiveness to routine metric performance reports that offer comprehensive feedback on their assessment patterns. METHODS: Online surveys were distributed to all 28 radiology faculty at Queen's University. Data were collected on demographics, feedback practices, motivations for improving the teacher-learner feedback exchange, and openness to metric performance reports and quality improvement measures. Following descriptive statistics, unpaired t-tests and one-way analysis of variance were conducted to compare groups based on experience and subspecialty. RESULTS: The response rate was 89% (25/28 faculty). 56% of faculty were likely to complete evaluations after working with a resident. Regarding the degree to which faculty felt written feedback is important, 62% found it at least moderately important. A majority (67%) believed that performance reports could influence their evaluation approach, with volume of written feedback being the most likely to change. Faculty expressed interest in feedback-focused development opportunities (67%), favouring Grand Rounds and workshops. CONCLUSION: Assessment of preceptor perceptions reveals that faculty recognize the importance of offering high-quality written feedback to learners. Faculty openness to quality improvement interventions for curricular reform relies on having sufficient time, knowledge, and skills for effective assessments. This suggests that integrating routine performance metrics into faculty assessments could serve as a catalyst for enhancing future feedback quality.

Developing Leadership Among Dental Residents: An Exploratory Study.

INTRODUCTION: Today's healthcare requires leaders to lead and improve the healthcare sector. CanMEDS framework is the one defining the competencies required for all Saudi residency programs, including dental specialty. Senior residents should demonstrate readiness to transition to practice as a leader. It is imperative to understand the notion of medical education and its influence on the training of future dentists. The major significance of this study is exploring the current leadership development and the integrated training into the Saudi Board Dental Residency Program that has not been systematically studied. METHODS: This was a qualitative study employing the phenomenological approach. The theoretical saturation point determined the sample size using a purposeful sampling technique. Semi-structured interviews were used for data collection using a semi-structured interview guide. A descript platform was used for the recordings' transcription. Ongoing thematic data analysis was done using Nvivo computer software by QSR International. Themes were generated, and the data were interpreted within supported with the most relevant quotations. RESULTS: Sixteen senior residents were required to serve the study purpose. Three themes emerged: awareness of leadership, educational experience, and factors that impacted leadership development. Awareness of residents about the leader's role was limited. Residents developed leadership under the training program with inconsistency and lack of structure. Summative reports were received as part of the assessment, whereas no integral protocol for formative feedback. Specialties, training centers, and coaching were identified as factors that impacted leadership development. CONCLUSION: This study highlighted leadership development during the residency period. The residents struggled and varied in developing leadership skills relying on their educational experience and learning environment. Residency programs may verify equivalent "leader role" education for all specialties and training centers in residency training in Saudi Arabia. Dovetailing leadership coaching with daily teaching workflow and implementing faculty development initiatives to allow for appropriate feedback and assessment of these skills are advised.

Peering Into the Future: A First Look at the CBME Transition to Practice Stage in Diagnostic Radiology.

RATIONALE AND OBJECTIVES: Queen's University (Kingston, ON, Canada) adopted a competency-based medical education (CBME) curriculum for Diagnostic Radiology residency training in an accelerated manner in 2017, with the curriculum comprised of four stages of training. This article focuses on the final stage (Transition to Practice), during which assessment methods of the new national curriculum (implemented in July 2022) were piloted. This study aims to highlight the challenges and opportunities associated with the implementation of CBME in Diagnostic Radiology training and specific considerations for programs undergoing this curricular transition. MATERIALS AND METHODS: Ethics approval was provided by the affiliated hospital Research Ethics Board. All relevant electronic assessments pertaining to all trainees who had completed the Transition to Practice stage (n = 3) were collated, deidentified, analyzed, and presented in tabulated format. RESULTS: A total of 39 evaluations completed by 13 assessors were assessed, with an average time of 3 minutes and 6 seconds to complete an assessment form. Also, 95% of evaluations were rated as entrustments. However, no residents met the minimum number of required entrustments for all five stage-specific Entrustable Professional Activities. These 39 evaluations included 219 milestone rating scores, with 86% rated as "achieved." Following review by the residency program Competence Committee, all three residents were promoted from the Transition to Practice stage. CONCLUSION: Challenges in CBME implementation include the number and quality of resident assessments. Strategies for success may include providing clear guidelines and training for both faculty and residents, early identification and intervention, and adopting a holistic evaluation strategy. CBME has the potential to enhance medical education quality by emphasizing learner progress toward competency and providing personalized feedback and support.

Ready for practice? National recommendations for emergency medicine transition to practice curriculum.

BACKGROUND: Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty. OBJECTIVE: The objective of this study was to develop consensus-based recommendations to optimize the transition to practice phase of emergency medicine training. METHODS: A literature review and results of a survey of emergency medicine (EM) residency program directors informed focus groups of recent (within 5 years) EM graduates. Focus group transcripts were analyzed following conventional content analysis. Preliminary recommendations, based on identified themes, were drafted and presented at the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. Through a live presentation, symposium attendees representing the Canadian national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback to construct a final set of 14 recommendations, 8 targeted toward residency training programs and 6 specific to department leadership. CONCLUSION: The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians.

ABSTRAIT: ARRIèRE-PLAN: La transition de la résidence à la pratique non supervisée représente une étape cruciale de l'apprentissage et de la formation de l'identité professionnelle, mais il y a peu de documentation pour éclairer les programmes de résidence et les programmes de transition des services d'urgence pour les nouveaux professeurs. OBJECTIF: L'objectif de cette étude était d'élaborer des recommandations consensuelles pour optimiser la transition vers la pratique de la formation en médecine d'urgence. MéTHODES: Une recension des écrits et les résultats d'un sondage auprès des directeurs des programmes de résidence en médecine d'urgence (GU) ont informé les groupes de discussion des diplômés récents (moins de cinq ans) en GU. Les transcriptions des groupes de discussion ont été analysées à la suite d'une analyse du contenu classique. Des recommandations préliminaires, fondées sur des thèmes déterminés, ont été rédigées et présentées au Symposium universitaire sur l'éducation de 2022 de l'Association canadienne des médecins d'urgence (ACMU). Au moyen d'une présentation en direct, les participants au symposium représentant la communauté nationale canadienne de la GU ont participé à une discussion dirigée sur les recommandations. Les auteurs ont intégré ces commentaires pour élaborer un ensemble final de 14 recommandations, 8 ciblant les programmes de formation en résidence et 6 ciblant le leadership ministériel. CONCLUSIONS: La communauté canadienne de la GU a utilisé un processus structuré pour élaborer 14 recommandations de pratiques exemplaires afin d'améliorer la transition à la phase de pratique de la formation en résidence ainsi que la période de transition dans la carrière des médecins traitants débutants.