Braund Heather, Dagnone J Damon, Hall Andrew K, Dalgarno Nancy, McEwen Laura, Schultz Karen W, Szulewski Adam
Department of Biomedical and Molecular Sciences and School of Medicine, Queen's University, Kingston, Ontario, Canada.
Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada.
Med Teach. 2025 Apr;47(4):705-712. doi: 10.1080/0142159X.2024.2362909. Epub 2024 Aug 5.
As an early adopter of competency-based medical education (CBME) our postgraduate institution was uniquely positioned to analyze implementation experience data across programs, while keeping institutional factors constant. We described participants' experiences related to CBME implementation across programs derived from early program evaluation efforts within our setting.
This evaluation focused on eight residency programs at a medium-sized academic institution in Canada. Participants ( = 175) included program leaders, faculty, and residents. The study consisted of 3 phases: (1) describing intended implementation; (2) documenting enacted implementation; and (3) comparing intended with enacted implementation to inform adaptations. Each program's findings were summarized in technical reports which were then analyzed thematically. Cross program data were organized by themes.
Six themes were identified. All groups emphasized the need for ongoing refinement of CBME resulting from shared tensions such as increased assessment burden. However, there were some disparate CBME-related experiences between programs such as the experience with entrustable professional activities, the interpretation of retrospective entrustment anchors, and quality of feedback.
We detected several cross-program successes and important challenges related to CBME. Our experience can inform other programs engaging in implementation and evaluation of CBME.
作为基于胜任力的医学教育（CBME）的早期采用者，我们的研究生机构处于独特的地位，可以在保持机构因素不变的情况下，分析各项目的实施经验数据。我们描述了参与者在我们环境中早期项目评估工作中各项目与CBME实施相关的经验。
本次评估聚焦于加拿大一所中等规模学术机构的八个住院医师项目。参与者（n = 175）包括项目负责人、教员和住院医师。该研究包括三个阶段：（1）描述预期实施情况；（2）记录实际实施情况；（3）比较预期与实际实施情况以指导调整。每个项目的研究结果都总结在技术报告中，然后进行主题分析。跨项目数据按主题进行整理。
确定了六个主题。所有群体都强调，由于评估负担增加等共同压力，需要对CBME进行持续完善。然而，各项目之间在一些与CBME相关的经历上存在差异，比如可托付专业活动的经历、回顾性托付锚点的解释以及反馈质量。
我们发现了与CBME相关的几个跨项目成功经验和重要挑战。我们的经验可为其他参与CBME实施和评估的项目提供参考。
