Early adopter advice series on Competence by Design
Dr. Janice Chisholm
Competence by Design Advice from Dr. Chisholm | Dalhousie University
What major lessons have you learned as you’ve implemented CBD?
Change takes time and should happen slowly. If you start early, you can use an incremental approach that’s painless because faculty never notices a major shift. Starting early also gives you time to shift your strategy. For example, we’ve learned that on certain rotation s you are more likely to see certain experiences than others and so we now give the residents a roadmap to help guide them to where they will most likely complete EPAs.
What has been your biggest challenge in implementing CBD?
For us, the challenges have been on the technology side. We have a home-grown e-portfolio for anesthesiology, which residents love because they can see all the assessments they need to do, and on which rotations. But it doesn’t communicate well with the university’s one45 software platform. I believe other schools are having IT challenges as well so getting familiar with the IT platform early is essential.
What advice would you provide to other program directors?
Focus your energy on faculty development to get staff to complete timely assessments and give quality feedback. Faculty needs to know this, because our job is to tell residents how they can improve. We’ve accomplished that in our program by running workshops with staff about how to write narratives.
How are you tackling the big issue of engaging your faculty and managing their expectations?
For us, it hasn’t been hard to engage faculty. Anesthesiology has an advantage in implementing a CBME system because most schools have been doing daily evaluations all along. That said, we’ve engaged faculty through email, grand rounds, posters and other kinds of saturation. We’ve drilled into faculty the importance of assessments and how residents cannot move forward without them.
How do you see your program benefiting from CBD?
Our program is more focused than before CBD. The residents feel like they’re coming through the program as competent clinicians who are good at self-assessment, which serves them well. As they graduate and move all over the country, their good experience with Dalhousie improves our reputation. So that serves the program.
What tools are you using to engage faculty?
Assessment and coaching workshops are extremely useful – especially ones that are interactive and focused on self-reflection allowing faculty to accumulate section 3 credits for Maintenance of Certification. We also give little awards at the end of each year for the best assessment, which helps engage people.
What are you particularly proud of about your CBD journey?
I’m most proud of our teamwork. Our process started with two or three people revamping the curriculum and has grown to more than 20 faculty and residents engaging really well together to move us through the process. It would be tough to manage this magnitude of change as a lone program director.