The future of medical education

Competency Based Medical Education (CBME) is a popular topic of conversation at Schulich Medicine & Dentistry these days. With postgraduate medical education programs at the School and across the country preparing for the transition, staff, faculty and learners are attending town halls, grand round lectures, and retreats to understand what it means to them and how they can best prepare.

Dr. Jay Rosenfield, vice dean, Medical Education is enthusiastic about this transition and sees it as an opportunity for positive change for learners and faculty alike. He also believes this new transition will allow for a broader medical education reform that is responsive to the health care needs of the community.

Dr. Rosenfield joined the Schulich Medicine & Dentistry team in September 2017. He brought with him an excellent mix of experience and expertise to lead medical education at the School through to an exciting future.

His leadership in medical education can’t be overstated. Just a few of his credits include co-leading the Future of Medical Education in Canada - MD Project of the Association of Faculties of Medicine of Canada, and currently co-leading the implementation of the Transitions Recommendation of the Future of Medical Education in Canada - PG Project. In this role he is overseeing national efforts for effective integration across the continuum of medical education from Doctor of Medicine programs, through residency and into practice, including transformative changes in competency based curricula, final year of medical school structure, selection into residency processes, and assessment methodologies.

Schulich Medicine & Dentistry is planning to implement a fully integrated CBME program across the medical education continuum, spanning undergraduate medical education training, residency and fellowships, and continuing medical education.

In doing so, it will be one of a very few schools in North America to simultaneously tackle this broad implementation. Research will play a critical role in that implementation.

According to Dr. Strong by collaborating with researchers in the Centre for Education Research and Innovation Schulich Medicine & Dentistry will be ‘writing the book’ on this transformation.

Dr. Rosenfield envisions that the School will do this through leadership in the development of an integrated health and education system, based in London, its academic teaching hospitals, and extending into the distributed medical education network of Southwestern Ontario, and the Schulich Medicine & Dentistry – Windsor Campus.

The School will build on the recognition that Schulich Medicine is already a leader in distributed education and take advantage of our newly minted academies model of distributed education.

It will develop models of transformative learning, including support for those teaching and in practice, to enable all learners to become change agents for better health of individuals and populations. The School will also become a leader in the use of simulation learning (across all education portfolios), and expand the use of technology-aided educational offerings to provide flexibility and accessibility to students.  

The value of CBME

Dr. Rosenfield believes that CBME allows for a more individualized approach to the learner, allowing them to master the skills they need in their chosen specialty, and providing clear expectations as to what learners need to be able to perform competently at each stage of their training.

“CBME also offers a new framework for faculty interactions with learners, allowing faculty to act in multiple roles, such as being coaches, mentors,  assessors, as well as traditional teachers and preceptors,” said Dr. Rosenfield.

Because of the structure CBME offers throughout the medical education journey, faculty are provided with opportunities to understand students’ skillsets, their strengths, and where they may need more time practising to master a specific skill. And because of its sophisticated assessment process, which is integrated between programs, students and patients will benefit.

“This will require more hands-on effort than before,” said Dr. Rosenfield. “We need to be there supporting faculty through this new paradigm.”

In the early days of CBME, Dr. Rosenfield believes the School needs to provide frequent ongoing communication to lessen the anxiety that accompanies a change of this kind, as well as considerable faculty development support to our excellent faculty mentors.

“We have to make this not scary,” Dr. Rosenfield said. “To observe learners, to coach, to role model, to assess – our skilled teaching faculty do this all the time.”

The good news is that education teams across the School are fully engaged in the process, and are actively planning, communicating and sharing information as it is learned and needed.

Medical education – the next evolution

Dr. Rosenfield believes that transition to CBME is only one chapter in the story about the future of medical education. The next evolution, he says, will challenge medical schools to think differently about their resources, teaching environments, partnerships and use of technology.

According to the new Vice Dean, today, medical educators appreciate and agree that medical learners need to be exposed to learning in all settings – urban, rural, regional, large, small, and community-based, and experience state-of-the-art environments, as well as those with limited access to the latest technology. The fact is that most health care isn’t delivered in a hospital anymore, and because of that, more training needs to move outside of that environment.

“The next evolution is an integrated health and education system, which will include a network of alliances and partners supporting teaching and learning in different environments so that students are prepared to deliver the full spectrum of health care. It will be more decentralized and will provide students and faculty more time to spend together.”  

Interprofessional education will also figure prominently, and the School will provide all learners with the opportunity to enrich their core experiences with research, joint degrees and global health.

Dr. Rosenfield believes that in addition to new and changing environments, the future of medical education will also provide more opportunities for students to spend with individual faculty and, ultimately, patients.

These changes will not happen overnight and Dr. Rosenfield is looking forward to working with students, staff, faculty and the School’s hospital and community partners to determine how it can all be achieved. He’s more than optimistic, however.

“Students want to come to a school where they are seeing the best clinical care and getting the best teaching,” he said. “And once it’s all in place, we will have one of the best medical education systems across the continuum and achieve our strategic plan direction of being a destination of choice for medical learners.”