Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
David Braley Health Science Centre, Rm 5003, 1280 Main St W., Hamilton, ON, L8S 4K1, Canada.
Adv Health Sci Educ Theory Pract. 2021 Oct;26(4):1277-1289. doi: 10.1007/s10459-021-10049-8. Epub 2021 Apr 24.
The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.
当前，基于能力的医学教育（CBME）的讨论受到缺乏定义和哲学假设共识的困扰。这种现象影响了课程实施、项目评估，并破坏了与教育界的对话。本研究旨在探讨加拿大主要意见领袖如何描述 CBME 的哲学和实践。采用目的性和滚雪球抽样法，招募了反映机构和学术角色多样性的加拿大主要意见领袖。使用建构主义扎根理论的原则，对半结构化访谈进行了定性主题分析。通过全国性的研究生医学教育教育工作者、研究人员和领导者公开会议，完成了经过修改的综合知识用户检查过程。已获得研究伦理委员会的批准。2018 年 9 月至 11 月期间完成了 17 次访谈。43 名参与者参加了公开会议。没有统一的框架或 CBME 的定义；观点存在异质性。大多数参与者难以确定支撑 CBME 的哲学或理论。CBME 通常通过关键操作实践来定义，包括强调基于工作的评估和学习者与导师之间的辅导关系。CBME 被阐述为解决当前培训模式的问题，包括未能失败、培训结构的严谨性和与公众保持社会契约。CBME 的意外后果包括将能力简化为框架，并对学习环境的变化对居民的健康状况表示关注。本研究表明，加拿大主要意见领袖对 CBME 的定义存在异质性。未来的工作应该探索 CBME 的实施保真度。
