Perceptions and barriers to competency-based education in Canadian postgraduate medical education

Abstract

Rationale: Competency-based education (CBE) is currently being implemented across Canadian postgraduate medical education programmes through Competence by Design (CBD).¹ Queen's University received permission to initiate CBE in all programmes simultaneously starting in 2017; an institutional initiative termed Competency-based medical education (CBME).² We describe our initial experiences to highlight perceptions and barriers and facilitate implementation at other centers.

Methods: Anonymous online surveys were administered to faculty and residents transitioning to CBE (138 respondents) including (a) Queen's programme leaders (Programme Directors and CBME Leads) [n = 27], (b) Queen's residents [n = 102], and (c) Canadian neurology programme directors [n = 9] and were analysed using descriptive and inferential statistical techniques.

Results: Perceptions were favourable (x = 3.55/5, SD = 0.71) and 81.6% perceived CBE enhanced training; however, perceptions were more favourable among faculty. Queen's programme leaders indicated that CBE did not improve their ability to provide negative feedback. Queen's residents did not perceive improved quality of feedback. National Canadian neurology programme directors did not perceive that their institutions had adequately prepared them. There was variability in barriers perceived across groups. Queen's programme leaders were concerned about resident initiative. Queen's residents felt that assessment selection and faculty responsiveness to feedback were barriers. Canadian neurology programme directors were concerned about access to information technology.

Recommendations: Our results indicate that faculty were concerned about the reluctance of residents to actively participate in CBE, while residents were hesitant to assume such a role because of lack of familiarity and perceived benefit. This discrepancy indicates attention should be devoted to (a) institutional administrative/educational supports, (b) faculty development around feedback/assessment, and (c) resident development to foster ownership of their learning and familiarity with CBE.

Keywords: Competence by Design (CBD); Competency-based education (CBE); Competency-based medical education (CBME); Postgraduate medical education (PGME).