Early adopter advice series on Competence by Design
Dr. Brian Rotenberg
Competence by Design Advice from Dr. Rotenberg | Western University
What major lessons have you learned as you’ve implemented CBD?
CBD affects everyone in the medical education continuum, from residents to Program Administrators, PDs, the Royal College, and so on. Given the variety of people impacted by CBD and the different points of views that come with it, it would be unreasonable to assume the CBD program will look exactly as predicted 10 years down the line.
What has been your biggest challenge in implementing CBD?
One of the challenges has been making this smooth within a team that is not familiar with CBD. In particular, when OTO-HNS students rotate into a non-CBME specialty, there are often a lot of questions asked by the supervisors, as they have no knowledge of CBD. This makes for an awkward reality in the field. Currently there is no bridge built that provides an easy solution.
What advice would you provide to other CBD Implementers?
Don’t underestimate the amount of organization involved in rolling out CBD. While the College will provide guidelines, milestones and all other blueprint materials, you will need to put this into practice. This is no small feat. A successful PD is highly organized and can lead a large scale change in their program. There are many facets to a good PD, but someone who is not organized or inclined to plan will impair the success of CBD.
How do you see your program benefiting from CBD?
Doctors are naturally empirical people which bodes well when you introduce a system that responds directly to the needs of both the evolving times and learners. Under CBD, we can address specific issues in real-time and add detail to how the learner acquires strength in one area of specialty.
What are you particularly proud of about your CBD journey?
One of the most surprising realities has been the sheer excitement and positivity displayed toward CBD and its processes. When asked to be guinea pigs for a new program, they said “sign me up coach!” It’s very pleasant to see young, bright people come out and say they like the frequency and quality of the exchanges with their mentor, contributing to a general happiness among the staff. Junior staff have also brought forward many amazing suggestions to make CBD even better at our school.
What tools are you using to engage faculty?
We used a number of tools at the beginning, including seminars, dedicated rounds, instruction on assessment and ePortfolio, and then informal meetings with department leadership to gauge interest and dedication. Now that we’re well into adoption, we’re at a maintenance level with CBME. It’s still discussed at department and RPC meetings, but being fully imbibed into our culture it’s simply a standing item.
How are you tackling the big issue of engaging your faculty and managing their expectations?
To start, people were fearful of change and hesitant to embrace the unknown. We used a strategy of starting with the “why”, and then the “how” to build engagement. Once faculty understood the rationale, that there were strong supports to help, and that it would not create more work, the desire to adopt became strong. There were a few outliers that required personal conversations, but in the end we all realized the benefit of a team approach to success.