Competence by Design Innovators

This process reinforced for me that change is scary for people to think about – but that it’s doable if you create a team around you and implement in small pieces. As one example, we did a workplace-based assessment for one EPA, used it, got feedback from residents and faculty and then presented what we had learned in a workshop to the whole group. The important thing is to take one step, address concerns, and move forward from there.

The major thing has been working with faculty and residents to overcome the concerns they had about CBD – the time it would take, for example, and concerns that this new way of doing things might not be a better way. But CBD turned out not to be nearly as challenging as we had thought.

Start small and enlist a group of people around you that includes people who are typically early adopters. It’s also a good idea to get a “doubter” onside. If you can convert someone who wasn’t enthusiastic at the outset, it goes a long way to allay the fears of others. You need to create a solid group of believers.

We’ve talked about CBD in various venues, putting it on the agenda for staff meetings and having lots of informal hallway conversations. Informal communication has been important because it gives people a chance to air their thoughts. We also struck a CBD implementation subcommittee to brainstorm ways to move forward, which ensured that many voices were heard.

My personal view is that CBD will require a more collaborative approach between teachers and learners in the training programs. That shared responsibility will strengthen learning, improve teaching, bring more questions forward and challenge the programs to do a better job of educating residents.

We’ve used workshops and grand rounds to introduce ideas to faculty. We also use email, usually sending information about one or two specific things at a time to avoid overwhelming people. But most important have been frequent, more informal discussions about small bites of the process.

I’m most proud of the people in my department who have been working together so effectively toward a shared goal. Their enthusiasm has made implementation easier than I would have anticipated, with everyone sharing the desire to test new ideas.