Early adopter advice series on Competence by Design
Dr. Leon Tourian
Competence by Design Advice from Dr. Tourian | McGill University
What major lessons have you learned as you’ve implemented CBD?
It’s important to start early. It’s also important start slowly. We began by introducing one mandatory direct observation per month, then one biweekly, , and then weekly, which is where we are now. It’s also a good idea to make tasks optional and first. If you start early, there’s plenty of time to bring in the mandatory requirements.
What has been your biggest challenge in implementing CBD?
As a program director, I have a strong passion to move forward, so the challenge has been for me to lay out the plan in slow motion and follow through with the program committee. It’s also been a challenge with a large program to predict the cost in human and financial resources of doing things like faculty development.
What advice would you provide to other program directors?
You have to get yourself excited about CBD so others will buy in, while recognizing how significant it is as an endeavour, and how much you’re asking of others. Also, you need to flood yourself with information. Since 2015, I’ve been attending ICRE to get the latest information regarding CBME, and I’m on the Royal College CBD website all the time. I speak regularly with other program directors to their ideas and perspectives on CBD implementation.
How are you tackling the big issue of engaging your faculty and managing their expectations?
The smartest thing you can do is make sure your CBD events are accredited. If faculty can earn credit, they’ll show up. I’ve had two events this year and half of our teaching faculty have attended. We also make the events a bit special by asking local businesses to get involved and provide food or drinks.
How do you see your program benefiting from CBD?
Regular assessments allow us to identify weaker residents earlier so faculty can step in and help. Faculty in general are more attuned to residents’ needs. The program will inevitably improve in quality as a result of these things. We’ve already gained a lot from a training perspective.
What tools are you using to engage faculty?
We’ve run successful, well-attended CBD events, and each of them has had the same components: a general introduction and reminder of key CBD concepts; and videos of clinical encounters, which faculty can discuss in groups. They’re able to discuss how they would interact with the resident and come up as a group with specific, actionable feedback.
What are you particularly proud of about your CBD journey?
My success in engaging faculty is what I’m most proud of. My leadership is very supportive of CBD, but without buy-in from faculty, it simply wouldn’t work. As it stands, faculty is very supportive of our CBD transition. They communicate their discontent at times, but they’re engaged and willing, which are the two essential ingredients for success.