Competence by Design Innovators

As residents and faculty were feeling overwhelmed with a large burden of information during the rollout of CBD, we set out to design an intervention using a scholarly approach, rooted in multimedia learning theory, and justified with cognitive load theory. The resources we designed greatly helped residents and faculty become familiar with EPAs in the initial stages of CBD and they could easily be incorporated into other residency programs.

Cognitive load theory indicates that mental burden can be decreased by offloading cognitive tasks. Our aim was to deliver a resource that removed some of the guesswork from EPAs by clarifying the expectations for each rotation by stage of training, delivering data in an accessible and familiar format. We created a set of rotation- and stage-specific EPA reference cards based on our program’s curriculum map for bedside use by residents and observers. All cards contained the EPAs for the specified rotation, an icon to visually represent each EPA and the suggested number of observations for each clinical presentation. Providing EPAs mapped to rotations reduces the need for residents and faculty to recall the EPAs and when to achieve them, reducing their cognitive load. Including a visual icon on the cards was based on multimedia learning theory and was intended to further alleviate the cognitive load with visual processing channels. The reference cards were designed to spatially align text and pictures to ensure that both pathways were leveraged. This was designed to facilitate familiarity with EPAs at a faster rate than resources leveraging a single channel.

I would strongly endorse the implementation of EPA reference cards in other programs as they plan their transition to CBD. A survey of residents showed a positive impact on our program’s transition to CBD, indicating that the rotation-specific cards were found to be a quick and helpful reference especially early in the CBD transition and at the beginning of off-service rotations.

So far, the general trends of barriers and facilitators to EPA completion for residents and faculty are consistent with barriers and facilitators that predated CBD or even CBME. While we are collecting better information in larger volumes compared with the pre-CBD era, there is still room for improvement in increasing the quantity and quality of feedback that is provided by faculty and residents. As we work to tackle barriers and promote facilitators, I expect the benefits of CBD will fully come to fruition.

Through my work in improving CBD for residents and faculty, I have learned about the importance of collaboration between programs, whether different specialties within an institution, or the same specialty across Canada. There is commonality among our struggles, so reach out and work with others to share your experiences.