Competence by Design Innovators

Successful orientation requires a coordinated effort from the program directors, program administrators and senior residents. There should be dedicated time for program-specific orientation led by a resident or faculty CBD lead. Providing residents with a contact person for questions and support has been beneficial. At Western, residents receive general CBME training during the first week as a part of Surgical Foundations and the Department of Surgery. In my role as resident lead, I discuss the benefits and challenges with first year residents. We review the stages of training and the EPAs they should focus on in the first few months of residency. I introduce them to the Elentra platform and demonstrate how to submit, complete, track, and trigger EPAs.

Teach them creative strategies to consistently trigger and send EPAs after clinical encounters. We developed and posted CBD worksheets near resident workstations. These worksheets listed the EPAs that could be completed during patient encounters and encouraged residents to trigger one EPA per day. Our technical leads used feedback from residents to develop software that would allow senior residents to trigger EPAs for junior residents, which takes some of the pressure off junior residents. Regularly checking in with residents in terms of EPA completion and achieving competency motivates residents to stay on top of EPA completion. Within our program, we have an annual award and prize for the resident with the most EPAs completed.

The clinical workload of residents and faculty often limits time for feedback and EPA completion. A good resident habit is to review and select the EPAs and milestones to be observed during the day and let the evaluator know prior to the clinical rotation. They can then either dedicate five minutes after the clinical encounter or procedure to discuss feedback and complete the EPA electronically in real time or later that day when time permits. These strategies can make the process of feedback and evaluation more efficient. Residents often have challenges that cannot be resolved at a training level. Therefore, creating a forum that provides a safe and inclusive environment for residents to provide feedback can be instrumental in making improvements. For example, Western’s Resident Advisory Committee (RAC) for CBME brings forward resident concerns to administrators, information technology members, and education specialists. Based on resident feedback through the RAC, a solution was created to address the challenge of tracking EPAs. The program administrator prepared a spreadsheet for residents that listed EPAs and milestones within each stage of training. This solution allowed residents to document their progress and led to the development of a specialized report in our electronic portfolio.

The most important thing programs can do for residents in their CBD journey is to create a safe and supportive learning environment for trainees. This requires resident and faculty understanding regarding the stages of training and entrustment scales, universal faculty buy-in for completing EPAs with high quality feedback, and providing residents with time, resources, and support for the completion of EPAs.