The University of Ottawa Anesthesiology graduate program has been approved by the Royal College of Physicians and Surgeons Canada to trial an innovative competency based approach to graduate medical (ie. residency) education under a Fundamental Innovations in Residency Education (FIRE) grant. This program will be modular based, and candidates will advance through the program as they complete successive modules, as opposed to the basis of time.
The program has also been approved to eliminate curriculum that is non-contributory to the delivery of anesthesia care, and teach the curriculum through innovative and non-traditional approaches that may be more efficient.The net result of these changes is that anesthesiology trainees may complete their training in 4 years instead of the traditional 5 years.
To create a learner-centered competency-based program to effectively train anesthesiologists to respond to the evolving needs of 21st century healthcare and residency education.
To systematically design, implement, and evaluate an evidence and experience based competency based anesthesiology residency program.
This program will:
- Adopt an outcome-based approach to curricular design.
- Value all CanMEDS roles equally.
- Utilize a learner-centered approach to education.
- Promote a modular based spiral curriculum that revisits and reinforces subject areas.
- Incorporate rigorous, robust, and regular (3 R’s) formative and summative assessment.
- Advance trainees to the next module when appropriate milestones are assessed and met.
- Educate perioperative physicians.
- Improve the efficiency of training.
- Provide and strengthen faculty development.
- Evaluate all aspects of the program on a continuous improvement plan
History of Competence By Design
In 2011, the Future of Medical Education in Canada Postgraduate Environmental Scan and the Royal College White Papers both identified the need to shift from the traditional apprenticeship model to competency based medical education or CBD. Multiple environmental influences, such as pressure to maintain efficiency of care, changing patient safety requirements, and introduction of resident duty hour restrictions have significantly impacted the amount of time available for clinician supervision of trainees, and have led to the need to assess individual learners according to standard definitions of “competency”.2 The success of this kind of outcome-based approach to residency education is dependent on serial assessments throughout training. The assessments need to be robust and diverse, and need to occur in a combination of classroom, clinical, and simulated environments.1 To maximize clinical exposure, the standard training requirements for any given specialty must be critically deconstructed to only include those critical elements for practice.
The proposed curriculum will be based on a systematic educational structure that blends self-directed learning that is curated by faculty experts, crisis resource management and procedural skills at the simulation center, which will help acquisition of competencies in the clinical realm. The objective of this structure is to accelerate the learning curve of each resident and optimize educational resource utilization.
There is core knowledge required for all the CanMEDS roles prior to application clinically. This knowledge can be acquired through passive and active learning activities. Passive learning activities include reading and didactic lectures. Trainees will be guided to required reading material and all didactic lectures will converted to online materials. Whenever possible, passive learning will be augmented by an active learning strategy (ie. Exambuilder; pretest, posttest). Passive learning should ideally be completed prior to active learning activities and will augment comprehension, synthesis, and application of the knowledge.
- Required readings from the standard textbooks will be specifically articulated for the given EPAs and milestones through the educational requirements document.
- Trainees will be directed to copyright materials using their uOttawa and The Ottawa Hospital (TOH) access.
- Didactic lectures specific to the national curriculum have been recorded and will be available online for self-directed learning.
Comprehension and Application
Acquired knowledge will be consolidated and applied through active learning strategies that require reflection, discussion, and deliberate practice. Trainees will use the learning case platform which mimics a flipped classroom for case-based learning, which applies knowledge directly to clinical cases within their module. “Hands-on” application of knowledge in a patient safe environment will occur through simulation based education activities wherever possible.
Analysis, Synthesis, and Evaluation
Following passive and active learning strategies, trainees will consolidate their knowledge and skills in the clinical environment with focused and deliberate practice. Faculty will provide graded autonomy in managing cases and emergencies perioperatively. Active reflection and guided coaching on CanMEDS development will be provided through faculty, and self-assessment strategies using the daily Clinical Case Assessment Tool (CCAT). When appropriate, feedback will also be solicited from other members of the health care team or peers using multi-source feedback (Pulse 360). Progress testing using standardized Anesthesia Knowledge Test (AKT) will occur at the 1, 6, and 24 months of anesthesia training.
The Competence Committee (CC) reviews and makes decisions related to the progress of residents, enrolled in a competency-based residency program. Progress will be based on the attainment of specific Enhanced Professional Activities (EPAs) and educational requirements at regular intervals of 4 months. The goal is to ensure that residents are appropriately coached and promoted to the next stage based on achieving the outcomes expected.
CanNASC is a novel simulation based examination, which will incorporate 5 high- fidelity scenarios to ensure that residents are competently safe to deal with rare but life threatening crises which may develop in independent practice. This will occur at the end of 3rd year of training and will serve as a marker for transition to independent practice stage.
The Royal College written exam will now take place in the fall of either the residents’ 4th or 5th year depending on an individualized readiness assessment. The Oral Exam will continue to take place in the late Spring the year following successful completion of the written examination.
According to our mission statement we will develop a robust program of evaluation surrounding the innovations related to the transition to CBD. The Department of Anesthesia and Pain Medicine (DAPM) at the University of Ottawa will lead or collaborate in a programme of research for competency based medical education (CBME) with the Association of Canadian University Departments in Anesthesia (ACUDA). The main imperative is to create a long-term sustainable research programme around medical education with a specific emphasis on competency based medical education (CBME) to help lead the Royal College Competence by Design (CBD) initiative.
The aims of program evaluation are threefold: to enhance the ability of CBD to adequately prepare physicians for practice in the 21st century, to provide peer-reviewed evidence on innovative education and assessment modalities, and to guide the continuous improvement plan (CIP) required from Canadian Residency Accreditation Consortium (CanRAC).
Program evaluation is intended to provide timely and actionable feedback to allow for the adaptive management, as well as rigorously document and validate learning about the CBD initiative. This balances both accountability and learning purposes during the planning, implementation, and evaluation phases of our FIRE grant. Our FIRE grant is planned to sunset in 2021 with potential migration to the Royal College version of CBD Anesthesia.