Early adopter advice series on Competence by Design
Dr. Karen Raymer
Former Program Director | McMaster University
What major lessons have you learned as you’ve implemented CBD?
It’s demanding to create and implement a new program while still running an existing one. You need to build a team of good people and you need to delegate. But the bigger thing is ensuring that the curriculum changes improve the educational experience of learners
What has been your biggest challenge in implementing CBD?
Managing data. There’s no problem gathering it and entering it into our system, but understanding that data in a meaningful way is challenging. We don’t have an inherent sense of what the benchmarks are for how many attempts a resident will need to achieve a given EPA; we can only compare them to others within their cohort. If a dashboard can present those resident and cohort numbers visually, we hope to build a sense of the expected trajectory.
What advice would you provide to other CBD Implementers?
Get good help and remember that you’re an expert team with decades of collective experience in how to teach and evaluate learners. Use that experience to make careful decisions about implementation.
How are you tackling the big issue of engaging your faculty and managing their expectations?
Designing and implementing one phase at a time rather than trying to design the entire program at once. We keep just one phase ahead of the first CBD cohort, which means we have the agility to respond and adjust. For example, when we were mapping EPAs to rotations, we had to decide whether to take a minimalist approach or be more inclusive, allowing for every possible learning opportunity for the residents. With feedback, we got the sense that a long list of EPAs is overwhelming. By working iteratively, we avoid having to re-do work as we learn our lessons.
How do you see your program benefiting from CBD?
I see two advantages. The first is that we can ensure our residents are being intentionally trained and evaluated in the aspects of our specialty that are important – rather than leaving it to chance. Under the outgoing system we hope that a resident will be exposed to the clinical experience and skills that they need over time. But with CBD, we identify those skills and ensure they’re being both taught and evaluated. The second is that CBD can set the conditions for residents to receive more useful, specific feedback. The “human nature” barriers don’t magically disappear however; it’s important to coach faculty in how to give feedback, and learners in how to receive it.
What tools are you using to engage faculty?
Development of your frontline faculty is key, but don’t overwhelm them with complexity; keep it as simple as possible. Also, ask your Chair to remunerate the CBD team well, and recognize their time and energy.
What are you particularly proud of about your CBD journey?
I’m proud that our team was able to be creative and flexible in adapting CBD to our program, to ensure that we were actually improving the quality of the residency program and not just implementing a change because we had to.