Early adopter advice series on Competence by Design
Dr. Peter Gooderham
Competence by Design Advice from Dr. Gooderham | University of British Columbia
What major lessons have you learned as you’ve implemented CBD?
Assume that faculty and residents know nothing about the underpinnings of CBD, the process, the rationale, where we’ve come from or where we’re going. I learned this partway through CBD implementation as I talked to residents and faculty, and found that I had to go way back and start the conversation again with really foundational information.
What has been your biggest challenge in implementing CBD?
Getting residents to do EPAs on skills they’re not good at. EPAs are formative tools as well as evaluative tools, and residents need to accept that they’ll score 2s and 3s before they perfect the EPA. This incremental process helps focus their learning by giving them specific feedback in a more timely fashion and more frequently.
What advice would you provide to other program directors?
Start with a small, reliable group of residents and faculty as you head toward your CBD launch. Get some early successes with a specific, engaged group of individuals, and let that success grow organically instead of dropping the hammer on day 1 and expecting everyone to be equally responsible.
How are you tackling the big issue of engaging your faculty and managing their expectations?
As a small program, we have the advantage of face time with colleagues. What works best is direct, personal communication. It’s also important to work through the process early so there’s an understanding of where we’re coming from and where we’re going; nothing should be dropped on faculty’s lap at the last second. We’ve targeted certain faculty for completing specific tasks – such as being responsible for particular EPAs – so there’s more individual responsibility as opposed to a swirl “somebody else might take care of this.”
How do you see your program benefiting from CBD?
The formative element of EPAs gives us a better set of documentation. This is important because, instead of providing feedback just for very good or very bad performance, the EPAs also capture the middle ground. That can be where learning is lost in the current system. The residents are getting better training, which is the whole point.
What tools are you using to engage faculty?
The best thing is direct, face-to-face communication. If I email a tool to people, it’s unlikely they’ll find time to view it. But if I go to rounds and play a video it while I’m standing there, they’ll see it. I’ve highjacked rounds on a regular basis to give 10-minute updates on CBD. We’re also completing an EPA handbook, so faculty will have a simple, pared-down idea of what the residents will ask of them.
What are you particularly proud of about your CBD journey?
It’s too early to tell, but I will say that we’ve come a long way in getting a group of neurosurgeons, who tend to be resistant to change, to buy in. We’re rolling out all junior residents starting in July. Engagement and support of faculty have got us this far, which is a feat in itself.