Preparing for CBME: How often are faculty observing residents?

Abstract

Background The Royal College of Physicians and Surgeons of Canada officially launched ‘Competence by Design’ in July 2017, moving from time-based to outcomes-based training. Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will likely be required to adequately assess whether entrustable professional activities have been achieved. Purpose Characterize faculty and resident experiences of direct observation in a single paediatric residency program, pre-CBME implementation. Qualitatively describe participants’ perceived barriers and incentives to participating in direct observation. Methods Surveys were sent to paediatric residents and faculty asking for demographics, the frequency of resident observation during an average 4-week rotation, perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data were analyzed. Institutional research ethics board approval was received. Results The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency FACULTY observed a resident take a history, perform a physical examination, or deliver a plan, the median faculty reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings. When asked the MINIMUM frequency for each domain, the median FACULTY and RESIDENT reply was 0, except for delivering a plan in the inpatient setting. Faculty reported observing seniors delivering the plan more frequently than junior residents. Faculty and resident median replies for how frequently residents should be observed for each domain were the same, three to four, three to four, and five to six times. Four per cent of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common barriers to observation were too many patients to see and both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if scheduled at the start of the rotation; faculty were provided a better tool for assessment; and if residents asked to be observed. Conclusions This study provides baseline data on how infrequent faculty observation is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation competes with clinical service demands, but better scheduling strategies and assessment tools may help.

Scoping review: exploring residents’ views of supervisor entrustment and its effect on learning and professional development

“…One study examining pediatric residents compared the ideal frequency of direct supervision with that of direct supervision. The findings revealed that even senior residents sought more frequent and prolonged direct supervision of core skills crucial to independent practice, such as physical examinations and delivery planning [ 35 ]. Fig.…”

“…George et al [35] In the acquisition of fundamental clinical skills, such as history-taking, physical examination, and the delivery of care plans, residents often desired more direct observation than faculty members perceived to be necessary. This preference for direct oversight persisted after they had become senior residents.…”

Beyond summative decision making: Illuminating the broader roles of competence committees

“…Underpinning efficiency strategies that seek to streamline the CC review process is the assumption that meaningful assessment for learning occurs throughout daily practices of assessment and observation, and thus is not a required aspect of CC work. Although this is certainly the ideal, we know that direct observation of trainees often competes with the demands and structure of clinical service and occurs less frequently than is desired by either faculty members or trainees 41‐43 . Given the many‐faceted challenge of assessment burden, our study advocates for the development of efficiency strategies that leverage data visualisation methods to retain the depth of review when reducing the length of review time.…”

Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education

“…In contrast, the CBME model emphasizes more frequent, formative assessment of residents to evaluate their progress towards predefined competencies [ 3 ]. As such, faculty members now have increased responsibility for providing assessments to residents on a more regular basis [ 4 ]. This paradigm shift underscores a growing need for feedback that is specific, constructive, and actionable.…”