Competence by Design Innovators

Early in CBD implementation, the Queen’s CBME Resident Subcommittee, comprised of residents, faculty, and technology leads from across programs, identified a gap in the implementation strategy through an informal needs assessment. They found that many front-line faculty were not completing EPA assessments because they did not know how to navigate the assessment platform to create a PIN. In response, the subcommittee developed the CBME Mobile Training Unit (MTU) as a simple, low-cost, concept to deliver whatever front-line faculty needed for assessment completion.

The MTU is a sturdy, plastic, one-metre tall, two-level cart equipped with a tablet set to the assessment platform PIN web page. The cart also carried CBD educational material and quick-tip handouts, as well as coffee and treats for an added element of colleague engagement. Members of the Resident Advisory Committee brought the MTU to identified ”hot spots” where faculty would congregate, such as the surgical lounge and medical grand rounds, and engage them in friendly conversation about CBD, assessments, and related IT challenges, during times that respected their schedules. We felt that by bringing resources to them, rather than having them come to us, we were able to reach the otherwise passive or unengaged members of our community. The MTU was stored in the PGME office with a sign out sheet to encourage faculty and residents to use it for engagement opportunities within their own programs.

Our biggest success came from empowering residents and faculty to be change leaders. In the months preceding and immediately post-CBD implementation, our CBME Resident Subcommittee provided an opportunity for resident leads to voice their concerns in a timely manner and receive frequent updates from the Postgraduate CBME Executive Leadership Team. Resident leads, in their capacity as liaisons, then brought this information back to their own programs. They also acted as educators, teaching both existing, non-CBD cohort residents about CBD, as well as incoming CBD residents about how to navigate the new curriculum and assessment system. This sense of connection and empowerment across programs fostered community through the massive change in PGME structure. Residents, especially the CBME resident leads, perceived that the change was happening with their input, and with co-production in mind, rather than being forced upon them.

The greatest challenge, particularly in the early days, was the burden that new CBD residents felt in asking for multiple EPA assessments and in driving which assessments were completed. First-year residents, who were learning to be physicians in a new environment where they didn’t necessarily know their supervising faculty well, were also having to champion a new assessment system. The engagement of CBME resident leads and the MTU were considerable sources of support.

Other successful initiatives to support the transition included weekly 10-minute CBD updates during grand rounds and weekly five-minute education videos (made using personal phones and emailed to the department to educate both residents and faculty simultaneously). Prior to implementation, and on an ongoing basis post-implementation, front-line faculty and residents should be kept apprised of how to use the electronic platforms and assessments.