Scientific Publications Database

Article Title: Introduction of Competence by Design to Canadian Nephrology Postgraduate Training.
Authors: Pinsk, Maury; Karpinski, Jolanta; Carlisle, Euan
Journal: Canadian journal of kidney health and disease Volume 5
Date of Publication:2018
Abstract:
PURPOSE OF THE REVIEW: The Royal College of Physicians and Surgeons of Canada, with its Competence by Design initiative, is adopting the principles of competency-based medical education for residency training and continuing professional development. This initiative is being undertaken to meet the new standards of medical education in Canada, which include social accountability to meet performance-based outcomes of training. Nephrology is poised to implement Competence by Design into residency training in July 2018 and initiate a continuous quality improvement cycle to periodically renew and update the training requirements to be socially accountable and relevant in the modern age of medicine. The purpose of this review is to describe the process of entrustable professional activity and required training experience development and how they will affect subspecialty training in Canada.SOURCES OF INFORMATION: The construct of competency-based medical education was derived from existing literature searches of the medical education literature, including documentation provided by the Royal College of Physicians and Surgeons of Canada. The content for each entrustable professional activity and milestone was derived by consensus from the community expertise of the working group, existing speciality training requirements, and elements of training requirements that the Royal College has been mandated to superimpose on all training requirements to meet societal expectations.METHODS: The Royal College Specialty Committee in Nephrology participated in 2 years of preparation for this implementation, which has included the creation of a new educational design for the discipline and the elucidation of entrustable professional activities to describe the scope of nephrology practice and to guide teaching, learning, and assessment in residency, and ultimately maintenance of competence in practice.KEY FINDINGS: This article introduces the set of entrustable professional activities for adult and pediatric nephrology and describes the national consultation as part of an ongoing quality improvement of this work.LIMITATIONS: The implementation of Competence by Design will be tested by whether trainees embrace competency-based education by training to just entrustable professional activities, rather than the holistic model idealized in physician training. This is mitigated by the entrustable professional activity development incorporating multiple layers of competencies beyond a procedural skill. Time commitment for faculty will pose additional challenges in increasing the time for assessment of trainees, but is supported by electronic platforms at the Royal College to assist in data gathering and analysis.IMPLICATIONS: Competence by Design in nephrology is an outcomes-based curriculum and assessment platform that aims to train nephrologists to meet societal expectations in an ever-changing and complicated health care system. The goals are to increase safety and professional accountability to society and improve upon the already high standards of training within Canada.CONTEXTE MOTIVANT LA REVUE: Le College royal des medecins et des chirurgiens du Canada, avec son initiative intitulee La competence par conception (CPC), adopte les principes de lapproche par competences en formation medicale pour la formation des residents et le perfectionnement professionnel continu. Cette initiative est entreprise pour repondre aux nouvelles normes en matiere de formation medicale au Canada, qui comprennent notamment la responsabilite envers la societe, pour atteindre des resultats de formation axes sur le rendement. La nephrologie fait partie des specialites medicales qui adopteront des juillet 2018 la CPC pour la formation de leurs residents. La discipline amorce ainsi un cycle damelioration continue de la qualite qui participera a mettre a jour et a renouveler sur une base reguliere les exigences de formation, de facon a demeurer pertinente et socialement responsable a lere de la medecine moderne. Lobjectif de la presente revue est de presenter le processus regissant les activites professionnelles confiees (APC) et lacquisition des experiences de formation exigees, et de decrire la maniere dont il influencera la formation dans les sous-specialites au Canada.SOURCES: Lelaboration de lapproche par competences en formation medicale derive de recherches dans la litterature existante au sujet de la formation medicale, notamment de documents fournis par le College royal des medecins et des chirurgiens du Canada. Le contenu de chacun des jalons et des APC a ete etabli par consensus a partir : i) de lexperience communautaire des membres du groupe de travail; ii) des exigences actuelles en matiere de formation specialisee, et; iii) delements dexigences de formation que lon a demande au College royal de superposer aux precedentes, afin de repondre aux attentes de la societe envers la profession.METHODOLOGIE: Le comite de specialite en nephrologie du College royal a participe a deux annees de preparation pour la mise en oeuvre du programme. Le comite devait dans un premier temps creer un nouveau modele de formation pour la discipline. Ensuite, le comite etait charge de clarifier les APC couvrant tous les champs dapplication de la pratique en nephrologie, et qui guideront lenseignement fait aux residents, leur apprentissage, leur evaluation et le maintien de la competence dans la pratique.PRINCIPAUX RESULTATS: Cet article fait la description de lensemble des APC propres a la nephrologie adulte et pediatrique, et presente la consultation nationale dans le cadre dun processus damelioration continue de la qualite pour la discipline.LIMITES: Le succes de la mise en oeuvre de la CPC sera mesure selon que les stagiaires adopteront lapproche par competences pour leur formation, soit en se concentrant uniquement sur la maitrise des APC, plutot que le modele holistique idealise dans la formation des medecins. Cette situation est attenuee par lelaboration dAPC integrant de multiples niveaux de competences qui vont au-dela des habiletes techniques. Le temps supplementaire requis pour levaluation des stagiaires posera un defi au corps professoral. Les enseignants cliniques pourront toutefois compter sur les plateformes electroniques du College royal pour faciliter la collecte et lanalyse des donnees.CONCLUSION: La CPC en nephrologie consiste en un parcours axe sur les resultats et une plateforme devaluation des competences. Elle aspire a former des nephrologues aptes a repondre aux attentes de la societe envers la discipline, et ce, dans un systeme de sante complexe et en constante evolution. Ses objectifs visent a accroitre la securite et la responsabilite professionnelle envers la societe, et a renforcer les normes deja tres elevees en matiere de formation medicale au Canada.