Early adopter advice series on Competence by Design

 Good advice from Paula Nixon

LAUNCH : 2018 to 2025

Paula Nixon, program administrator and education officer, Postgraduate Programs


Good advice from Paula Nixon | University of Toronto


Discipline :
Forensic Pathology (2018), Anatomical Pathology (2019), Hematological Pathology (2022), Medical Microbiology (2024-25) and Neuropathology (2022)



What lessons have you learned as you’ve implemented CBD?

Although CBD is a seismic shift in the delivery and documentation of residency training, the essence of what residents need to learn remains the same. CBD is an opportune time to examine how your program is delivered. We don’t often get a chance to take a step back and look at the curriculum in a holistic way and make those improvements that may otherwise have been difficult to make.


What would you consider to be your biggest achievement around CBD implementation?

I’ve managed to keep all programs on track, and they’ve met our deadlines. I’ve worked very hard to stay organized and maintain good working relationships with my program directors and the PGME office. I’m proud of the work all my programs have done to date and proud of how well our residents have adjusted.


What tools and resources did you use that proved to be very helpful?

The PGME office at the University of Toronto has created very easy-to-follow templates for programs to use. After being part of the first cohort to enter CBD with Forensic Pathology and now working with Anatomical Pathology, Hematological Pathology, and Neuropathology, I’ve been able to see how the process has evolved. Our PGME office continues to improve its templates to make things even easier for us. The reporting can be quite complicated in part because Competence Committees have to look at many data points. I have also worked on making reporting more user-friendly by creating a color-coded summary report to present data from our assessment system — along with other data — to Competence Committee members for review.


What was the most effective tool for keeping people engaged in CBD implementation? What were the greatest challenges?

The fact that I am involved in five residency programs gives me the opportunity to use my knowledge of how one program navigates CBD engagement to help another program. Regular communication is the most important element of the CBD engagement process. We ran several "roadshows" at the start of implementation so that faculty across all hospital sites had opportunities to learn more and ask questions. We also ensure all new residents are well-oriented to CBD from the start. As programs move forward with adoption, I communicate regularly with everyone involved, producing how-to guides and FAQs on certain aspects. I listen to any concerns and questions from our residents and feed these back to the team so we can assess what we can change or adapt to meet needs. One of the biggest challenges is having two cohorts: one on the former system and one proceeding through CBD. They compare their experiences which makes them worry sometimes, so addressing their concerns is very important.


What advice would you give other programs starting their CBD journey?

Learn as much as you can about CBD prior to implementation so that you understand the terminology and processes. Start working on the documentation as early as possible so you give yourself enough time. Reach out to others to learn from their successes and experiences — several of us have now gone through the process so we have knowledge to share.


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