J.D. Dagnone is associate professor of emergency medicine and competency-based medical education faculty lead, Queen's University, Kingston, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6963-7948.
M.-K. Chan is associate professor and clinician educator of pediatrics and child health, University of Manitoba, Winnipeg, Manitoba, Canada.
Acad Med. 2020 Nov;95(11):1643-1646. doi: 10.1097/ACM.0000000000003216.
Within graduate medical education, many educators are experiencing a climate of significant change. One transformation, competency-based medical education (CBME), is occurring simultaneously across much of the world, and implementation will require navigating numerous tensions and paradoxes. Successful transformation requires many types of power and is most likely to happen when the medical education community of professionals is engaged in designing, experimenting, acting, and sensemaking together.In this complex climate, the craft of change facilitators and community leaders is needed more than ever. National top-down policies and structures, while important, are not sufficient. The operationalization of new advances is best done when local leaders are afforded room to shape their local context. An evidence-based approach to thinking about the transformative change associated with CBME needs to be adopted. In this age of entrustment, 3 priorities are paramount: (1) engage, entrust, and empower professionals with increasing shared ownership of the innovation; (2) better prepare education professionals in leadership and transformational change techniques in the complex system of medical education; and (3) leverage the wider community of practice to maximize local CBME customization. These recommendations, although based largely on the Canadian experience, are intended to inform CBME transformation in any context.
在研究生医学教育中，许多教育工作者正在经历一个重大变革的氛围。一种转变，即基于能力的医学教育（CBME），正在世界范围内同时发生，实施将需要应对许多紧张局势和悖论。成功的转变需要多种类型的权力，当医学教育专业人员社区共同参与设计、实验、行动和理解时，最有可能发生。在这种复杂的环境中，变革推动者和社区领导者的技艺比以往任何时候都更加需要。国家自上而下的政策和结构虽然重要，但并不足够。当给予当地领导人塑造其当地背景的空间时，新进展的实施效果最佳。需要采用循证方法来思考与 CBME 相关的变革。在这个委托的时代，有 3 个优先事项至关重要：（1）让专业人员参与、委托和授权，让他们对创新有越来越多的共同所有权；（2）更好地培养教育专业人员在领导和变革性变革方面的技能，以适应医学教育的复杂体系；（3）利用更广泛的实践社区来最大限度地实现本地 CBME 的定制化。这些建议虽然主要基于加拿大的经验，但旨在为任何情况下的 CBME 变革提供信息。
