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

• 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

Company/Organization Details Advisory Board or equivalent Speakers bureau member Payment from a commercial

• rganization. (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

• rganization.

Investments in a pharmaceutical

• rganization, medical devices

company or communications firm. Participating or participated in a clinical trial

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

• ve r the ir judg me nt a nd a c tio ns.

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

• n CBME

The International Conference on Residency Education | La conférence internationale sur la formation des résidents

Diagnosis: The Ballistic Model of Med Ed

 Competence by Design

6

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

The International Conference on Residency Education | La conférence internationale sur la formation des résidents

Criticisms of Modern Med Ed:

 Competence by Design

8

The International Conference on Residency Education | La conférence internationale sur la formation des résidents

The outcome of time-base models: Competence drops over time

1 0

Competence by Design

Klass Acad Med 2007 Certification

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
• 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

16

Frenk J, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.

• Lancet. 2010

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

Lifelong Learning

MOC E duc ational Pr inc iple s

• Ne e d b a se d

Pe rso na l

• Co ntinuo us

impro ve me nt Re fle c tio n

• Sc o pe o f

pra c tic e 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

• 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

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

• r education!

3.Needs data and feedback to “inform self- evaluation”

3 5

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

• ccur 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

• ste r

Coa c hing a nd Pr

• mote F

e e dba c k Use ?

Sa rg e a nt J1, L

• 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

• ve ll

April 15-16, 2015 | Otta wa , Ca na da

T he Inte r na tiona l Invita tiona l Summit on Compe te nc y- ba se d CPD

• 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

42

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

CBME PRINCIPLES FOR LEARNING

• 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

43

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

KEY ELEMENTS OF A COMPETENCY BASED CME MODEL

• Revalidation, recertification, maintenance of

competence, and maintenance of licensure systems are different BUT have COMMON GOALS of:

44

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

KEY ELEMENTS OF A COMPETENCY BASED CME MODEL

• A. Ensuring physicians demonstrate a

commitment to lifelong learning through:

• CPD activities
• Use of multiple strategies and tools to assess

competence and performance and improve quality of care provided

• B. Enabling physicians to progress through

learning cycles based on:

• Practice scope
• Performance data
• Competency framework

45

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

SCOPE OF PRACTICE……AS TIME

GOES ON…..

Competencies

AT

Certification Competencies

Revised SINCE

Certification

NEW

Competencies

ADDED ENHANCED Expertise

Competencies Transition

OUT of

Practice

Revised Out of scope

CAG

I

BS Pra c tic e Audit

I

BD Pra c tic e Audit

Ca na dia n GRS

Ba se d o n the UK

to o l a nd mo difie d fo r use in Ca na da via input fro m b o th Ac a de mic a nd Co mmunity b a se d c e ntre s

A we b b a se d to o l tha t a sse sse s q ua lity

fro m the d o ma ins o f

 T

he c linic ia ns pe rspe c tive a nd

 T

he pa tie nts e xpe rie nc e

E

a c h d o ma in ha s 6 d iffe re nt ite ms tha t a re e va lua te d

Ca na dia n GI Glo b a l Ra ting Sc a le

The endoscopy Global Rating Scale-Canada: development and implementation of a quality improvement tool. MacIntosh D, Dubé C, Hollingworth R, Veldhuyzen van Zanten S, Daniels S, Ghattas G. Can J

• Gastroenterol. 2013 Feb;27(2):74-82

50

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

CANADIAN GI GLOBAL RATING SCALE

Clinical Quality Dimension

• Appropriateness
• Information/Consent
• Comfort
• Safety
• Quality
• Timely results

Quality of the Patient Experience

• Equality
• Timeliness
• Choice
• Privacy and Dignity
• Aftercare
• Ability to provide

Feedback to the Service

51

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

CANADIAN GI GLOBAL RATING SCALE

• Levels and

corresponding activity

– D basic data gathering – C periodic review of data – B response to

• pportunities for

improvement identified – A response to changes is assessed

52

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

CANADIAN GI GLOBAL RATING SCALE

• This quality improvement tool is intended

to be iterative and can be used to plan CBCPD for

– An individual – A team of Physicians/Surgeons – An Interprofessional team – A Regional Health Authority – A Nation

Se c tio n 3: Pr

ac tic e Asse ssme nt

 E

ng a g ing in fo rma l pro c e ss tha t pro vide s da ta a nd fe e db a c k

Knowledge Assessment

• Self assessment programs

3 credits per hour No maximum Performance Assessment

• Simulation
• Audit and feedback
• Multisource feedback
• Educational / administrative

assessment strategies

Ultima te Outc o me s fo r Clinic a l Ca re & E duc a tio n

A c o mpe te nt (a t a minimum)

pra c titio ne r a lig ne d with:

CMS T r iple Aim

L inking Clinic al and E duc ational outc ome s

National Health Service – UK. http://www.wipp.nhs.uk/tools_gpn/unit6_education.php

Competencies Triple Aim

Que stio ns/ Disc ussio n

Continuing Medical Education/Professional Development within a Competency Based Medical Education Framework

Jocelyn Lockyer Ford Bursey Denyse Richardson

58

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

EXAMPLES OF INNOVATIONS IN

LEARNING

• Small groups that

meet regularly

• Simulation
• Activities that

inform self- assessment and self-directed learning activities

ASSESSMENT FOR LEARNING

• Audit and

feedback

• Multisource

feedback

• Direct observation

in workplace

59

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

QUESTIONS FOR DISCUSSION (1)

• How do we help physicians identify their

scope(s) of practice?

• How can we ensure that physicians can
• btain data about population needs?

– What sources are available? – How good are they? – What can be done to improve these data?

60

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

QUESTIONS FOR DISCUSSION (2)

• How can we approach the development
• f systems/initiatives to provide regular

assessment and feedback to physicians?

– What tools might be available?

61

CONTINUING MEDICAL EDUCATION/PROFESSIONAL DEVELOPMENT WITHIN A COMPETENCY BASED MEDICAL EDUCATION FRAMEWORK | ICBME COLLABORATORS

QUESTIONS FOR DISCUSSION (3)

• What strategies are needed to ensure

physicians can learn throughout their practice life ensuring they recognize the interrelationship between

– CPD – Performance – Competency frameworks – Scope of practice

We b e lie ve that in the future , e xpe rtise rathe r than e xpe rie nc e will unde rlie c o mpe te nc y-b ase d prac tic e and…c e rtific atio n.

 Ag g arwal & Darzi, NE

JM 2006

CBME is o n the Ho rizo n…