Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen’s Fundamental Innovations in Residency Education)-Part 2: Core of Discipline Stage

Abstract

Purpose: All postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) model divided into 4 stages of training. Queen’s University has been the first Canadian institution to mandate transitioning to CBME across all residency programs, including Diagnostic Radiology. This study describes the implementation of CBME with a focus on the third developmental stage, Core of Discipline, in the Diagnostic Radiology residency program at Queen’s University. We describe strategies applied and challenges encountered during the adoption and implementation process in order to inform the development of other CBME residency programs in Diagnostic Radiology. Methods: At Queen’s University, the Core of Discipline stage was developed using the Royal College of Physicians and Surgeons of Canada’s (RCPSC) competence continuum guidelines and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones for assessment. New committees, administrative positions, and assessment strategies were created to develop these assessment guidelines. Currently, 2 cohorts of residents (n = 6) are enrolled in the Core of Discipline stage. Results: EPAs, milestones, and methods of evaluation for the Core of Discipline stage are described. Opportunities during implementation included tracking progress toward educational objectives and increased mentorship. Challenges included difficulty meeting procedural volume requirements, inconsistent procedural tracking, improving feedback mechanisms, and administrative burden. Conclusion: The transition to a competency-based curriculum in an academic Diagnostic Radiology residency program is significantly resource and time intensive. This report describes challenges faced in developing the Core of Discipline stage and potential solutions to facilitate this process.

Preparedness of Residents and Medical Students for the Transition to Competence by Design in Diagnostic Radiology Post-Graduate Medical Education

“…We observed that approximately 1 in 5 residents perceived that they would be evaluated as learners under CBD, whereas only those medical students who will be part of the incoming cohort in July 2022 shall be evaluated as learners under CBD. 1,6 While CBD has been implemented in the diagnostic radiology PGME program at Queen’s University since 2017 as part of an institutional initiative, 4,5 only 2 participants reported being residents from this institution. Few residents may have also been in combined PGME training programs, such as diagnostic radiology and nuclear medicine, with the latter having already transitioned to CBD.…”

“…[1][2][3] Common terms used in CBD are summarized in Box 1. While CBD has been implemented in the diagnostic radiology PGME program at Queen's University since 2017 as part of an institutional initiative, 4,5 diagnostic radiology PGME programs nationally are transitioning to CBD in July 2022 for the incoming cohort. 6 Diagnostic radiology residents ("residents") will be key stakeholders in the transition to CBD.…”

Knowledge and Perceptions of Competency-Based Medical Education in Diagnostic Radiology Post-Graduate Medical Education: Identifying Priorities and Developing a Framework for Professional Development Activities

“…11 Previously, the PGME training of residents in diagnostic radiology at Queen's University, Kingston, Ontario was transitioned to CBD as part of an institutional initiative in 2017. 12,13 Recently, the PGME training of residents in diagnostic radiology in Canada nationally transitioned to CBD in July 2022 for the incoming resident cohort, and thus diagnostic radiology PGME programs nationally are actively preparing. 9,14,15 Implementation of CBME models, such as CBD, requires active involvement of multiple stakeholders not only to ensure successful implementation but also to assure that the intended educational outcomes of CBME are manifested.…”

“…11 Previously, the PGME training of residents in diagnostic radiology at Queen’s University, Kingston, Ontario was transitioned to CBD as part of an institutional initiative in 2017. 12,13 Recently, the PGME training of residents in diagnostic radiology in Canada nationally transitioned to CBD in July 2022 for the incoming resident cohort, and thus diagnostic radiology PGME programs nationally are actively preparing. 9,14,15…”

Analyzing the Administrative Burden of Competency Based Medical Education

“…Competency-based medical education (CBME) is now being adopted into all medical postgraduate programs across Canada. 1,2 The Queen's University Diagnostic Radiology Residency Program was an early adopter of this model, with implementation of CBME in July 2017.…”