Rabski Jessica E, Saha Ashirbani, Cusimano Michael D, Dabns Frcsc
1Injury Prevention Research Office, St. Michael's Hospital, Toronto.
3Department of Surgery, Division of Neurosurgery, University of Toronto, Ontario, Canada.
J Neurosurg. 2020 Dec 11;135(3):949-954. doi: 10.3171/2020.7.JNS201688. Print 2021 Sep 1.
Competency-based medical education (CBME), an outcomes-based approach to medical education, continues to be implemented across many postgraduate medical education programs worldwide, including a recent introduction into Canadian neurosurgical training programs (July 2019). The success of this educational paradigm shift requires frequent faculty observation and evaluation of residents performing defined tasks of the specialty. A main challenge involves providing residents with frequent performance evaluations and feedback that are feasible for faculty to complete. This study aims to define what is currently happening and what changes are needed to make CBME successful for the certification of neurosurgeons' competence.
A 55-item questionnaire was emailed nationwide to survey Canadian neurosurgical faculty.
Fifty-two complete responses were received and achieved a distribution highly correlated with the number of faculty neurosurgeons practicing in each Canadian province (Pearson's r = 0.94). Two-thirds (35/52) of faculty reported currently taking a median of 10 minutes to complete evaluation forms at the end of a resident's rotation block. Regardless of the faculty's province of practice (p = 0.50) or years of experience (p = 0.06), they reported 3 minutes (minimum 1 minute, maximum 10 minutes, interquartile range [IQR] 3 minutes) as a feasible amount of time to spend completing an evaluation form following an observation of a resident's performance of an entrustable professional activity (EPA). If evaluation forms took 3 minutes to complete, 85% of respondents (44/52) would complete EPA evaluations weekly or daily. The faculty recommended 5 minutes as a feasible amount of time to provide oral feedback (minimum 1 minute, maximum 20 minutes, IQR 3.25 minutes), which was significantly higher (p = 0.00099) than their recommended amount of time for completing evaluation forms. The majority of faculty (71%) stated they would prefer to access resident evaluation forms through a mobile application compared to a paper form (12%), an evaluation website (8%), or through a URL link sent via email (10%; p = 0.0032).
To facilitate the successful implementation of CBME into a neurosurgical training curriculum, resident EPA assessment forms should take 3 minutes or less to complete and be accessible through a mobile application.
基于胜任力的医学教育（CBME）是一种基于结果的医学教育方法，目前仍在全球许多研究生医学教育项目中实施，包括最近引入加拿大神经外科培训项目（2019年7月）。这种教育范式转变的成功需要教员频繁观察和评估住院医师执行该专业的特定任务。一个主要挑战是为住院医师提供频繁的绩效评估和反馈，且教员能够切实完成这些工作。本研究旨在确定目前的情况以及需要做出哪些改变，以使CBME在神经外科医生能力认证方面取得成功。
通过电子邮件向加拿大全国的神经外科教员发送了一份包含55个条目的问卷。
共收到52份完整回复，其分布与加拿大每个省份执业的神经外科教员数量高度相关（皮尔逊相关系数r = 0.94）。三分之二（35/52）的教员报告称，目前在住院医师轮转结束时完成评估表的中位数时间为10分钟。无论教员所在的执业省份（p = 0.50）或工作年限（p = 0.06）如何，他们都表示在观察住院医师完成一项可托付专业活动（EPA）后，3分钟（最短1分钟，最长10分钟，四分位间距[IQR] 3分钟）是完成一份评估表的可行时间。如果评估表需要3分钟完成，85%的受访者（44/52）会每周或每天完成EPA评估。教员们建议5分钟作为提供口头反馈的可行时间（最短1分钟，最长20分钟，IQR 3.25分钟），这显著高于他们建议的完成评估表的时间（p = 0.00099）。大多数教员（71%）表示，与纸质表格（12%）、评估网站（8%）或通过电子邮件发送的URL链接（10%）相比，他们更愿意通过移动应用程序访问住院医师评估表（p = 0.0032）。
为促进CBME在神经外科培训课程中的成功实施，住院医师EPA评估表应在3分钟或更短时间内完成，并可通过移动应用程序访问。
