Dagnone Jeffrey Damon, Bandiera Glenn, Harris Kenneth
Emergency Medicine, Queens University, Ontario, Canada.
Emergency Medicine and Post-Graduate Medical Education, University of Toronto, Ontario, Canada.
Can Med Educ J. 2021 Jun 30;12(3):155-158. doi: 10.36834/cmej.68245. eCollection 2021 Jun.
The adoption of competency-based medical education (CBME) by Canadian postgraduate training programs has created a storm of excitement and controversy. Implementing the system-wide Competency by Design (CBD) project initiated by the Royal College of Physicians & Surgeons of Canada (RCPSC), is an ambitious transformative change challenge. Not surprisingly, tensions have arisen across the country around the theoretical underpinnings of CBME and the practicalities of implementation, resulting in calls for evidence justifying its value. Assumptions have been made on both sides of the argument contributing to an atmosphere of unhealthy protection of the status quo, premature conclusions of CBME's worth, and an oversimplification of risks and costs to participants. We feel that a renewed effort to find a shared vision of medical education and the true value proposition of CBME is required to recreate a growth-oriented mindset. Also, the aspirational assertion of a direct link between CBME and improved patient outcomes requires deferral until further implementation and study has occurred. However, we perceive more concrete and immediate value of CBME arises from the societal contract physicians have, the connection to maintaining self-regulation, and the potential customization of training for learners.
加拿大研究生培训项目采用基于能力的医学教育（CBME）引发了一阵兴奋与争议的浪潮。实施由加拿大皇家内科医师与外科医师学院（RCPSC）发起的全系统“设计中的能力”（CBD）项目，是一项雄心勃勃的变革性挑战。不出所料，全国各地围绕CBME的理论基础和实施的实际情况出现了紧张局面，导致人们呼吁提供证据证明其价值。争论双方都做出了假设，这营造了一种对现状过度保护、对CBME价值过早下结论以及对参与者的风险和成本过度简化的不健康氛围。我们认为，需要重新努力找到医学教育的共同愿景以及CBME的真正价值主张，以重塑一种注重成长的思维模式。此外，关于CBME与改善患者结局之间存在直接联系的理想断言，需要推迟到进一步实施和研究之后。然而，我们认为CBME更具体、更直接的价值源于医生所承担的社会契约、与维持自我监管的联系以及为学习者量身定制培训的潜力。
