Co mpe te nc y Ba se d Me dic a l E duc a tio n CSI M 2019 F o - PowerPoint PPT Presentation

Co mpe te nc y Ba se d Me dic a l E duc a tio n CSI M 2019 F o rd Burse y MD F RCPC F ACP Pro fe sso r o f Me dic ine Me mo ria l Unive rsity

 The following presentation represents the views of the speaker at the time of the presentation. This information is meant for educational purposes, and should not replace other sources of information or your medical judgment.  Learning Objectives  Understand the background behind CBME adoption  Employ CBME concepts and techniques in the education of trainees  Distinguish feedback from coaching  Appreciate the process of CBME as it moves into CPD and assessment of competence in practice

CSIM Annual Meeting 2019 Conflict Disclosures De finition: A Co nflic t o f Inte re st ma y o c c ur in situa tio ns whe re the pe rso na l a nd pro fe ssio na l inte re sts o f individua ls ma y ha ve a c tua l, po te ntia l o r a ppa re nt influe nc e o ve r the ir judg me nt a nd a c tio ns. Company/Organization Details Advisory Board or equivalent Speakers bureau member Payment from a commercial organization. (including gifts or other consideration or ‘in kind’ compensation) Grant(s) or an honorarium Patent for a product referred to or marketed by a commercial organization. Investments in a pharmaceutical organization, medical devices company or communications firm. Participating or participated in a clinical trial

Disc losur e s  Ste e ring Co mmitte e Me mb e r o f F ME C- PG  Ste e ring Co mmitte e Me mb e r o f Ca nME DS 2015  CPD E duc a to r fo r the RCPSC  Me mb e r o f I nte rna tio na l Wo rking Gro up o n CBME

Diagnosis: The Ballistic Model of Med Ed  Competence by Design The International Conference on Residency Education | La conférence internationale sur la formation des résidents 6

Evidence suggests that where a physician trains determines the level of care that physician will provide throughout his/ her career.

Criticisms of Modern Med Ed:  Competence by Design The International Conference on Residency Education | La conférence internationale sur la formation des résidents 8

Competence by Design The outcome of time-base models: Competence drops over time Certification Klass Acad Med 2007 The International Conference on Residency Education | La conférence internationale sur la formation des résidents 1 0

Gro wth o f Me dic a l K no wle dg e  Do ub le s e ve ry 3 ye a rs  Up to 17% o f hig hly q uo te d re se a rc h is sub se q ue ntly re fute d

Holm boe, after Anders Ericsson: Used by Perm ission

T he “Mira c le ” o f Me dic a l E duc a tio n

 Sta nda rdize o utc o me , individua lize pro c e ss  I nte g ra tio n o f kno wle dg e into ro le s  Ha b its o f inq uiry a nd impro ve me nt  Pro fe ssio na l ide ntity fo rma tio n

CBME : Sta rt with Syste m Ne e ds Frenk J, et al. Health professionals for a new century: transforming 16 education to strengthen health systems in an interdependent world. Lancet. 2010

Lifelong Learning Pro fe ssio na l Und e rg ra d ua te Po stg ra d ua te De ve lo pme nt

MOC E duc ational Pr inc iple s Re fle c tio n • Sc o pe o f • Co ntinuo us pra c tic e • Ne e d b a se d impro ve me nt Pe rso na l Cho ic e Learner-centered professional education

Ne w MOC Pro g ra m - Spring 2011 Only T hre e Stre a mline d Se c tio ns Gro up le a rning a c tivitie s Se lf-le a rning a c tivitie s Pra c tic e a sse ssme nt a c tivitie s

What is the E vide nc e ?  Studie s o f the I mpa c t o f Co mme rc ia lly Suppo rte d CME o n Pre sc rib ing Pra c tic e s  Studie s o f Physic ia n Opinio ns a b o ut Bia s in Co mme rc ia lly Suppo rte d CME  Studie s o f Ho w to Me a sure Bia s in Co mme rc ia lly Suppo rte d CME

Aldo us Huxle y  T he re a re thing s kno wn a nd the re a re thing s unkno wn, a nd in b e twe e n a re the do o rs o f pe rc e ptio n

E ffe c tive ne ss o f CME  E ffe c tive ne ss o f CME : Upd a te d Synthe sis o f Syste ma tic Re vie ws; R Ce rve ro a nd J Ga ine s, July 2014  Upd a te d 2003 re po rt (31 pre vio us, 8 ne w)  CME ha s a po sitive impa c t o n physic ia n pe rfo rma nc e a nd pa tie nt he a lth o utc o me s (mo re so o n pe rfo rma nc e tha n pa tie nt o utc o me s)  Sug g e ste d it is b e st if inte ra c tive , use s mo re me tho d s, invo lve s multiple e xpo sure s, is lo ng e r, a nd is fo c use d o n o utc o me s tha t physic ia ns c o nsid e r impo rta nt

Physic ian Se lf- Asse ssme nt

Physic ian Se lf- Asse ssme nt  “L e a rne rs do no t kno w wha t the y do n’ t kno w.”  Syste ma tic Re vie w: Co mpa re d physic ia ns’ se lf-ra te d a sse ssme nts with e xte rna l o b se rva tio ns  Se lf-a sse ssme nt a c c ura c y is po o r to limite d  Ina c c ura c y is inde pe nde nt o f tra ining le ve l, spe c ia lty, do ma in o r ma nne r o f c o mpa riso n  Wo rst a c c ura c y in se lf-a sse ssme nt a mo ng physic ia ns tha t we re le a st skille d a nd mo st c o nfide nt Da vis D e t a l. JAMA 2006;296:9:1094-1102

Self-Assessment Stud y Inc lusio n Crite ria . 1. Co mpa re d physic ia ns' se lf-ra te d a sse ssme nts with e xte rna l o b se rva tio ns 2. Use d q ua ntifia b le a nd re plic a b le me a sure s 3. Study po pula tio n:> 50% pra c tic ing physic ia ns, re side nts, o r simila r he a lth pro fe ssio na ls 4. Co nduc te d in the Unite d K ing do m, Ca na da , Unite d Sta te s, Austra lia , o r Ne w Ze a la nd.

Self-Assessment Are a s o f Se lf-Asse ssme nt 1. T e a c hing skills 2. Clinic a l o r pro c e dura l skills 3. Ge ne ra l me dic a l kno wle dg e 4. L a ng ua g e a nd c ultura l c o mpe te nc e 5. Critic a l a ppra isa l skills

Self-Assessment E xte rna l Asse ssme nts 1. Simula tio n 2. OSCE / Sta nda rdize d pa tie nts 3. I n-tra ining e xa mina tio ns 4. Struc ture d inte rvie ws

Self-Assessment Re sults 17 o f 725 a rtic le s me t inc lusio n c rite ria 20 c o mpa riso ns b e twe e n se lf a nd e xte rna l me a sure s 13 d e mo nstra te d little , no , o r a n inve rse • re la tio nship 7 d e mo nstra te d a po sitive a sso c ia tio n •

3 5 Self-Assessment in Practice Key Messages ‘Personal, unguided reflection’ or any global judgment of one’s ability in a particular domain is… 1.Poorly performed 2.Unlikely to be enhanced through training or education! 3.Needs data and feedback to “inform self- evaluation”

Role for Feedback… Importance of feedback Impact of workplace based assessment on doctor’s education and performance: a systematic review Miller, BMJ 2012 “Performance changes were more likely to occur when feedback was credible and accurate or when coaching was provided to help subjects identify their strengths and weaknesses”

Ac a d Me d. 2018 Jul;93(7):1055-1063. do i: 10.1097/ ACM.0000000000002131. T he R2C2 Mode l in Re side nc y E duc a tion: How Doe s It F oste r Coa c hing a nd Pr omote F e e dba c k Use ? Sa rg e a nt J 1 , L o c kye r JM, Ma nn K , Armso n H, Wa rre n A, Ze tkulic M, So kla ridis S, K ö ning s K D, Ro ss K , Silve r I, Ho lmb o e E , She a re r C, Bo udre a u M. re la tio nship b uilding , e xplo ring re a c tio ns, e xplo ring c o nte nt, a nd c o a c hing Me dic a l E duc a tio n. 53(5):426–427, MAY 2019. DOI: 10.1111/ me du.13833 Br ing ing me a ning to c oa c hing in me dic a l e duc a tion Be n L o ve ll

T he Inte r na tiona l Invita tiona l Summit on Compe te nc y- ba se d CPD April 15-16, 2015 | Otta wa , Ca na da

• 3 White Papers • Rationale for a Change to Competency Based CPD • Implications for Physicians, CPD Providers, and Health Care Institutions • Assessment and Feedback for Continuing Competence and Enhanced Expertise in Practice

CBME P RINCIPLES FOR L EARNING • Education must be based on the health needs of the population served • Primary focus of education and training should be on desired outcomes for and demonstrated needs of learners • Formation of a physician is a continuous progress of expertise throughout their practice life • Opportunities for assessment and feedback should be available CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY 42 BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

K EY E LEMENTS OF A C OMPETENCY B ASED CME M ODEL • Revalidation, recertification, maintenance of competence, and maintenance of licensure systems are different BUT have COMMON GOALS of: CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY 43 BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS