Early adopter advice series on Competence by Design
Dr. Damien Noone
Program Director | University of Toronto
What major lessons have you learned as you’ve implemented CBD?
Dissenters can end up being your best allies. In my experience, the people who thought it would be most difficult to transition to CBD have turned out to be the most active and effective in implementing it. Also, I learned to feed people information only on a need-to-know basis. There’s a lot to learn and dumping excessive information on people doesn’t serve anyone. Not everyone needs to know everything!
What has been your biggest challenge in implementing CBD?
At the beginning, many faculty thought the onus should be on the residents to make sure evaluations were done. I had to make the case that this is a collaborative effort, and that the power differential between faculty and residents could present a substantial barrier. Faculty understand now that it’s important to have an open attitude on both sides.
What advice would you provide to other program directors?
Keep it simple. Physicians have a tendency to overcomplicate things. If you need to design an assessment, think about the data you really require. Don’t worry about recording every detail about time of day, the patient’s age, gender, etc., etc. Otherwise you’ll end up with a spreadsheet from here to eternity. Also, attend every workshop and join every committee you can to learn about CBD. It’s a great privilege to be at the forefront of this transition and we should be embracing it wholeheartedly.
How are you tackling the big issue of engaging your faculty and managing their expectations?
We’ve identified people who might have an interest in elements of CBD, such as coaching and providing feedback. We gamify elements of CBD, such as creating leaderboards for EPAs. I also put CBD evaluation links onto people’s phones so it’s easier for them to do them on the go. The important balance is to provide ample information while keeping the process simple.
How do you see your program benefiting from CBD?
There’s personal benefit for me as the program director because CBD is new and exciting and a great opportunity to be part of an important transition in medicine. The program benefits because training is more effective and people enjoy it more. We’ve found that residents give better feedback evaluations about the rotations where CBD is in play.
What tools are you using to engage faculty?
I use anything I can find on the Royal College’s CBD website and on the University of Toronto’s PGME/CBD web pages. I also make video screen captures on issues such as how to fill in an assessment. I deliver the information by putting links on people’s phones.
What are you particularly proud of about your CBD journey?
I am personally most proud of my efforts to step up and take on the responsibility of training faculty on how coach and give feedback. I went from being fairly isolated in my work in pediatric nephrology to collaborating with many people in the hospital and university locally as well as nationally. I’m proud to be involved in something new and exciting.