Competence by Design Innovators

The opportunity to participate in medical education and see our program blossom has played a key role in my decision to work in Northern Ontario. It has been an exciting, evolving journey. NOSM Psychiatry has expanded from just three to 15-18 residents at three different sites in Northern Ontario — Thunder Bay, Sault Ste. Marie, and North Bay. Psychiatry transitioned to CBD in 2020 and it’s helping to enhance residency training in delivering care to an underserviced area.

In many ways, CBD is a completely new culture with its own language and meaning — EPAs, competence, coaching, milestones. It can be a lot to take in when you’re already busy. EPA cards were created to make the transition clear and user-friendly for residents and supervisors. The EPAs are on lanyards at a variety of clinical sites as quick reference points. They provide an easy-to-read, colourful format highlighting essential points of EPAs from transition to discipline to transition to practice. We are currently working on coaching cards for additional support.

I worked closely with our instructional designer, Christina Tremblay, an experienced lead in the initiation of CBD in other programs. She was familiar with the Royal College's vast array of educational tools and resources. We met weekly to discuss the essential steps and to create a map for implementation. We reviewed EPAs and standards, provided faculty development workshops, and discussed what roles and committees we required for success. A CBD Implementation Committee, with representation from the resident body at all three clinical sites, was established to support engagement and communication. Forming and supporting the Competence Committee at the onset of implementation was critical. We launched with a robust orientation and established plan for our first CBD residents. We are committed to ongoing review and evaluation and we remain flexible and open to making any necessary changes.

Faculty engagement at a distance is an ongoing challenge — some strategies we used included creating a faculty newsletter and information sheets, and offering virtual training sessions. We also had to be respectful of existing workloads and responsibilities. More communication is required than you would expect for people to comprehend some of the subtleties of CBD, like EPAs, coaching and learning plans. Look for opportunities to communicate. We continue to meet regularly with residents to discuss concerns and questions. Residents often still have a pass/fail mindset and some have viewed EPAs the same way. We regularly provide reminders and reassurance that one should not expect to achieve competence the first time an EPA is attempted. There is still a long way to go in moving our culture to one where frequent documented feedback and coaching are the norms, but as faculty and residents see the value, we are starting to see the shift.

Overall benefits include improved communication and collegiality, greater faculty and resident engagement, more summative feedback to evaluate performance, and the opportunity to assist learner needs earlier. CBD highlights the importance of greater engagement and alliance between supervisor and resident, which impacts all clinical encounters with learners. The academic program and clinical rotations have been (and continue to be) enhanced. CBD also encourages residents to take the lead in their own education.