Early adopter advice series on Competence by Design
Dr. Hariharan Iyer
Competence by Design Advice from Dr. Iyer | Western University
What major lessons have you learned as you’ve implemented CBD?
Although there was a lot of anxiety about how CBD implementation would pan out, we didn’t experience a dramatic change in how we operate. What CBD requires is a culture change and frameshift about how things are documented and signed off.
What has been your biggest challenge in implementing CBD?
Our software presented a challenge because residents had to log in and closely scrutinize their EPAs to discover the number of observations they needed. We remedied this inconvenience by printing pocket cards that list all EPAs and the associated observations. Residents can tuck the cards into their ID badges.
What advice would you provide to other program directors?
Don’t panic. Although a culture shift is required to make CBD work, it’s totally doable to implement efficiently if you plan ahead. Make sure you have a competency committee in place before you begin, plan the meeting dates, and ensure the committee has representation from allied health staff.
How are you tackling the big issue of engaging your faculty and managing their expectations?
This was a real concern because of our program’s mix of clinicians, scientists, researchers and educators. How could we get the message to percolate all the way down? Eighteen months before implementation, we did orientation workshops for faculty about what CBD means, why it’s being implemented and how. A year ahead, we began to promote and educate about CBD at every bi-monthly citywide department meeting. We explained: What is an EPA? What is a milestone? What are the stages of training, etc.? We also did a live demonstration of our CBD software, from logging in to clicking the final stages of an evaluation form.
How do you see your program benefiting from CBD?
The major advantage is that we are now able to identify very specific issues with a trainee much earlier in the process. For example, if someone is good at a procedure overall, but needs help with some granular aspect, CBD provides the framework where we can isolate that aspect and deliver remediation for the resident.
What tools are you using to engage faculty?
For us, regular workshops and information sessions at our citywide division meetings have been the key. We initially planned a full-day retreat, but decided that would overload faculty with information. If you plan adequately ahead of time, the challenge with faculty buy-in can be easily circumvented.
What are you particularly proud of about your CBD journey?
I’m satisfied that despite all the challenges and anxiety, we seem to have sailed through very smoothly. The reason is that we planned early, put a competency committee in place ahead of time, and gave ourselves the room to iron out the issues.