Does Competence by Design better prepare residents facing independent practice?

September 19, 2019 | Author: Royal College Staff


Dr Lara Best

Photo: Lara Best, MD, FRCPC, MMEd

As a new-to-practice radiation oncologist, Lara Best, MC, FRCPC had a personal interest in the competencies required for managing an independent practice for the first time. With Radiation Oncology’s 2019 launch of Competence by Design (CBD), it was a timely decision for Dr. Best to compare the perceived gaps in the traditional time-based training to the solutions offered in CBD. The findings: CBD provides the scaffolding to better prepare residents facing independent practice.

Lara Best

Dr. Lara Best receives the Governor General’s Gold Medal for achieving highest marks for a master’s program at Acadia University.

The findings of her thesis study, Transition to practice in radiation oncology: Mind the gap, can be used to inform evidence-based curricula for the CBD transition to practice (TTP) phase in Radiation Oncology.

Dr. Best’s study identified the most commonly reported gaps in the TTP stage as:

  • –  lack of experience with practice management,
  • –  understanding the structure of our health care system,
  • –  financial planning,
  • –  effective collaboration and communication with other health care team members,
  • –  accurate and timely documentation; and
  • –  adequate exposure to radiotherapy problem-solving related to treatment planning and evaluation.

“Starting a new curricula under CBD can be stressful, but also valuable and rewarding. It provides an opportunity to identify the gaps amidst what is currently working. The new transition to practice phase of CBD can be used to formalize curricula focused on the skills new physicians need but likely had minimal exposure to as residents, such as financial management, practice management, and improved longitudinal follow-up of patients over time.“

The study suggests that gaps in training can be addressed with mentorship, educational resources, simulation, improved graded responsibility, resident longitudinal clinics and formal curricula to increase exposure to radiotherapy planning and evaluation.

“One of the proposed benefits of CBD is that it requires workplace-based evaluation. Thus, we as staff have to provide direct observation and feedback to trainees as they complete tasks. It also requires residents to demonstrate competency of tasks prior to advancement through the phases. This very set-up promotes scaffolding of learning, and improved integration of learners into the medical team and with decision making.“

Given the changing landscape of postgraduate education, Dr. Best notes that we are being given the opportunity to work together across specialities to share evaluation tools, curricular ideas, and methods to overcome roadblocks. By sharing experiences with CBD, we can all improve more quickly.

Thesis supervisors: Dr. Joan Sargeant, Dr. Rene J.L. Murphy.
Article co-authors: Dr. Arpita Sengupta, Dr. Rene J.L. Murphy, Dr. Catherine de Metz, Dr. Theresa Trotter, Dr. Shaun K. Loewen, Dr. Paris-Ann Ingledew and Dr. Joan Sargeant.


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