Nguyen David-Dan, Lafontaine Marie-Lyssa, Mann Uday, Siron Nicolas, Letendre Julien, Aubé-Peterkin Mélanie, Rourke Keith F, Domes Trustin, Lee Jason Y, Bhojani Naeem
Division of Urology, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2025 Apr;19(4):104-108. doi: 10.5489/cuaj.8947.
In 2018, competency-based medical education (CBME) was introduced to Canadian urology residency training. We examined learner and faculty experiences with CBME five years post-implementation.
Two online surveys were developed from a scoping review of CBME literature and expert consultation. They covered aspects including unintended consequences, satisfaction, and challenges. They were distributed to Canadian urology residency program directors, faculty, and senior residents from January to June 2023. Respondents rated agreement/satisfaction using a five-point Likert scale. Descriptive analyses considered scores of 4-5 as agreement/satisfaction and 1-2 as disagreement/dissatisfaction.
Twenty-nine faculty members (including 10/13 [77%] program directors) and 33/63 (53%) senior residents responded. Overall, 69% of respondents are unsatisfied with CBME, 19% are neutral, and 11% are satisfied. Anxiety and/or fatigue with CBME are reported by 76% of faculty and 66% of residents. CBME is seen as burdensome: 61% of residents frequently trigger assessment requests, while 66% of faculty feel overwhelmed by the volume of requested assessments. Faculty members (83%) and residents (73%) find CBME time-consuming. Over 50% of respondents believe CBME failed to de-emphasize time-based learning, individualize progression, rapidly identify struggling residents, or improve feedback quality. Over 60% agree that CBME has clarified learning expectations and training stages.
There is prevailing dissatisfaction with CBME within Canadian urology training programs, impacting the well-being of both faculty and residents while falling short of delivering personalized training; however, CBME has provided a structured and transparent framework for trainee advancement. Improvements to CBME are needed beyond its initial five years.
2018年，基于能力的医学教育（CBME）被引入加拿大泌尿外科住院医师培训。我们在实施五年后考察了学习者和教员对CBME的体验。
通过对CBME文献的范围综述和专家咨询，开发了两项在线调查。调查涵盖了意外后果、满意度和挑战等方面。于2023年1月至6月分发给加拿大泌尿外科住院医师项目主任、教员和高年级住院医师。受访者使用五点李克特量表对同意/满意度进行评分。描述性分析将4至5分视为同意/满意，1至2分视为不同意/不满意。
29名教员（包括10/13[77%]的项目主任）和33/63（53%）的高年级住院医师回复了调查。总体而言，69%的受访者对CBME不满意，19%持中立态度，11%满意。76%的教员和66%的住院医师报告了对CBME的焦虑和/或疲劳。CBME被视为负担沉重：61%的住院医师经常触发评估请求，而66%的教员因所需评估的数量而感到不堪重负。教员（83%）和住院医师（73%）发现CBME很耗时。超过50%的受访者认为CBME未能减少对基于时间的学习的强调、未能实现个性化进展、未能迅速识别有困难的住院医师或提高反馈质量。超过60%的人同意CBME明确了学习期望和培训阶段。
加拿大泌尿外科培训项目中普遍存在对CBME的不满，这影响了教员和住院医师的幸福感，同时未能提供个性化培训；然而，CBME为学员的进步提供了一个结构化且透明的框架。在最初的五年之后，CBME仍需改进。
