Abstracts
Abstract
Background: Competency-based medical education (CBME) is an outcomes-based curricular paradigm focused on ensuring that graduates are competent to meet the needs of patients. Although resident engagement is key to CBME’s success, few studies have explored how trainees have experienced CBME implementation. We explored the experiences of residents in Canadian training programs that had implemented CBME.
Methods: We conducted semi-structured interviews with 16 residents in seven Canadian postgraduate training programs, exploring their experiences with CBME. Participants were equally divided between family medicine and specialty programs. Themes were identified using principles of constructivist grounded theory.
Results: Residents were receptive to the goals of CBME, but in practice, described several drawbacks primarily related to assessment and feedback. For many residents, the significant administrative burden and focus on assessment led to performance anxiety. At times, residents felt that assessments lacked meaning as supervisors focused on “checking-boxes” or provided overly broad, non-specific comments. Furthermore, they commonly expressed frustration with the perceived subjectivity and inconsistency of judgments on assessments, especially if assessments were used to delay progression to greater independence, contributing to attempts to "game the system". Faculty engagement and support improved resident experiences with CBME.
Conclusion: Although residents value the potential for CBME to improve the quality of education, assessment and feedback, the current operationalization of CBME may not be consistently achieving these objectives. The authors suggest several initiatives to improve how residents experience assessment and feedback processes in CBME.
Résumé
Contexte : La formation médicale axée sur les compétences (FMFC) est un paradigme d’apprentissage axé sur les résultats et visant à garantir que les diplômés aient les compétences nécessaires pour répondre aux besoins des patients. Bien que l’engagement des résidents soit la clé du succès de la FMFC, peu d’études ont exploré comment ils vivent son introduction. Nous nous sommes penchés sur l’expérience des résidents dans les programmes de formation canadiens qui ont mis en œuvre la FMFC.
Méthodes : Nous avons mené des entrevues semi-structurées avec 16 résidents de sept programmes de formation postdoctorale canadiens, afin de sonder leur expérience de la FMFC. Les participants provenaient de façon égale de la médecine familiale et de programmes de spécialité. Les thèmes ont été dégagés en appliquant les principes de la théorie enracinée constructiviste.
Résultats : Bien que réceptifs aux objectifs de la FMFC, les résidents décrivent des inconvénients de sa mise en pratique, notamment sur le plan de l’évaluation et de la rétroaction. Pour beaucoup d’entre eux, la focalisation sur l’évaluation et le fardeau administratif qui y est lié ont été une source d’anxiété de performance. Les résidents ont l’impression que les évaluations manquent parfois de pertinence, car les superviseurs, se sentant contraints de « cocher des cases », font des commentaires trop généraux et peu ciblés. De plus, un sentiment de frustration a été fréquemment exprimé face à la subjectivité et à l’incohérence perçues des jugements dans les évaluations, surtout lorsque ces dernières sont utilisées pour retarder le cheminement vers une plus grande indépendance, ce qui contribue à des tentatives de « déjouer le système ». L’implication et le soutien du corps professoral ont aidé à bonifier l’expérience des résidents.
Conclusion : Bien que les résidents apprécient le potentiel de la FMFC pour rehausser la qualité de la formation, de l’évaluation et de la rétroaction, son opérationnalisation actuelle ne permet pas d’atteindre ces objectifs de façon systématique. Les auteurs proposent quelques initiatives pour améliorer la façon dont les résidents vivent les processus d’évaluation et de rétroaction dans le cadre de la FMFC.
Appendices
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