Schultz Karen, Griffiths Jane
K. Schultz is associate professor and program director, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. J. Griffiths is assistant professor and assessment director, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
Acad Med. 2016 May;91(5):685-9. doi: 10.1097/ACM.0000000000001066.
In 2009-2010, the postgraduate residency training program at the Department of Family Medicine, Queen's University, wrestled with the practicalities of competency-based medical education (CBME) implementation when its accrediting body, the College of Family Physicians of Canada, introduced the competency-based Triple C curriculum.
The authors used a stepwise approach to implement CMBE; the steps were to (1) identify objectives, (2) identify competencies, (3) map objectives and competencies to learning experiences and assessment processes, (4) plan learning experiences, (5) develop an assessment system, (6) collect and interpret data, (7) adjust individual residents' training programs, and (8) distribute decisions to stakeholders. The authors also note overarching processes, costs, and facil itating factors and processes or steps that would have been helpful for CBME implementation.
Early outcomes are encouraging. Residents are being directly observed more often with increased documented feedback about performance based on explicit competency standards (24,000 data points for 150 residents from 2013 to 2015). These multiple observations are being collated in a way that is allowing the identification of patterns of performance, red flags, and competency development trajectory. Outliers are being identified earlier, resulting in earlier individualized modification of their residency training program.
The authors will continue to provide and refine faculty development, are developing an entrustable professional activity field note app for handheld devices, and are undertaking research to explore what facilitates learners' competency development, what increases assessors' confidence in making competence decisions, and whether residents are better trained as a result of CBME implementation.
2009 - 2010年，女王大学家庭医学系的研究生住院医师培训项目在其认证机构加拿大家庭医生学院引入基于能力的三重C课程时，应对基于能力的医学教育（CBME）实施的实际问题。
作者采用逐步方法实施CBME；步骤包括：（1）确定目标，（2）确定能力，（3）将目标和能力映射到学习经历和评估过程，（4）规划学习经历，（5）开发评估系统，（6）收集和解释数据，（7）调整个别住院医师的培训项目，以及（8）向利益相关者公布决策。作者还指出了总体流程、成本以及对CBME实施有帮助的促进因素和流程或步骤。
早期结果令人鼓舞。对住院医师的直接观察更为频繁，基于明确的能力标准，关于表现的记录反馈有所增加（2013年至2015年，150名住院医师有24000个数据点）。这些多次观察结果正在以一种能够识别表现模式、危险信号和能力发展轨迹的方式进行整理。异常值被更早地识别出来，从而更早地对其住院医师培训项目进行个性化调整。
作者将继续提供并完善教师发展培训，正在为手持设备开发一个可托付专业活动现场记录应用程序，并正在开展研究，以探索促进学习者能力发展的因素、增强评估者做出能力决策信心的因素，以及CBME实施是否使住院医师得到了更好的培训。
