Early adopter advice series on Competence by Design
Dr. Daniel Dubois
Competence by Design Advice from Dr. Dubois | University of Ottawa
What major lessons have you learned as you’ve implemented CBD?
When you’re implementing such a massive change, you need to make sure you’re communicating closely with all stakeholders – faculty and residents – and cultivating a shared mental model and vision of what you’re trying to do. Another major lesson for me was that much of the point of CBD is to prepare residents for a career that includes lifelong learning, because CBD is part of mastery learning.
What has been your biggest challenge in implementing CBD?
Creating culture change so that residents are more accepting of feedback. Residents tend to see CBD as an evaluation process that can be harmful to them. We need to convince them that a single evaluation doesn’t add to our overall impression of them – that, instead, CBD is about amassing small data pieces that will show residents’ overall progress.
What advice would you provide to other program directors?
CBD has five core components, yet so many groups become overly focused on the EPAs and milestone assessments. If groups placed more emphasis on the other four components – programmatic assessments, tailoring learning for the workplace, ensuring a sequence progression for residents, and competency-focused coaching instruction – people would be more apt to notice changes and benefits.
How are you tackling the big issue of engaging your faculty and managing their expectations?
We’ve worked hard to make the process manageable for faculty. We simplify every form and communicate continually about what we’re trying to achieve. We also repeatedly make the point that CBD does not radically change how we’ve been doing things. We’re just fixing issues, such as providing more feedback to ensure residents can progress.
How do you see your program benefiting from CBD?
The major benefit is that CBD has given us pause to consider what we can do differently as educators. We’re actually sitting down and talking about individual residents earlier, which means we’re able to identify those who are struggling and engage them. This is far more beneficial than having a resident in a huge panic in their final year.
What tools are you using to engage faculty?
We use regular email communication as well as messages on our @OttawaAnesthesiology Twitter handle. And we discuss CBD implementation plans and issues at our retreats. Probably the most useful engagement tool is an electronic whiteboard in the faculty lounge. Posting information there promotes important conversations among faculty.
What are you particularly proud of about your CBD journey?
The biggest point of pride for us is that we’ve maintained a pragmatic approach to CBD implementation. We’ve kept it simple. We had no “burning platform” for this change but, at the same time, many faculty wanted to see our program become even better.