A message from Dr. Chris Watling: It doesn’t have to be perfect

Many of us in medicine are perfectionists; that trait in many ways serves us well. Competency Based Medical Education (CBME) implementation, though, may threaten our desire to get things just right. So many unknowns cloud the path forward.  

How can I create and map a curriculum that is outcomes-driven but workable? Which assessment tools will I use, when will I use them, and how many assessments do I need? Will the e-portfolio be as user-friendly as promised? How should our competence committee conduct its business? What if training time needs to be extended? If we aren’t careful, these unknowns can be paralyzing.

To move forward, we may need to loosen our grip on perfectionism, embracing instead an iterative process of gradually evolving and enhancing our education programs. Instead of dwelling on the unknowns, we need to start where we can, and to give ourselves permission for the initial product not to be perfect.

Will our approach to CBME be better in 10 years than it is next year? Of course. But will even our initial imperfect forays into CBME improve our educational programs? I believe that they will.

In the soon-to-be-released new postgraduate accreditation standards, a key change will be a heightened focus on quality improvement. And quality improvement is not just about patient safety.

The continuous quality improvement approach applies equally to our education programs, which will benefit from cycles of planning, implementing, evaluating, and refining our CBME strategies. This approach moves us away from thinking about CBME implementation as a herculean but finite task, and toward thinking of it as an ongoing process of evolving and improving.

This year, much attention will be on our first two programs to adopt CBME: Otolaryngology-Head and Neck Surgery and Anesthesia & Perioperative Medicine. I’ve been so impressed by the organization, commitment, and creativity of the Program Directors – Drs. Brian Rotenberg and Arif Al-Areibi - and by the unwavering support of their Department Chairs, Drs. John Yoo and Davy Cheng. I’m confident that these programs are well-positioned to lead the way. We’ll be watching carefully and learning from their experiences.  

Interacting with these program directors has highlighted for me the sheer amount of work that is required within each program to pull off such an ambitious educational project. CBME demands deliberate curriculum planning. Learning experiences and assessments are like puzzle pieces, linking together logically and coherently.  

Creating a CBME curriculum – even if we let go of our need for it to be perfect - requires a higher level of attention to detail than we have seen previously. The product will be stronger for it, but we mustn’t underestimate the effort needed to create that product.   Faculty will need to rally behind and support their program directors, program administrators, CBME leads, competence committee members, and expert assessors.  And Departments and the School itself will need to recognize, value, and reward these individuals for their indispensable contributions.

We live in exciting times for medical education.  We can be part of a historic and legacy-building process that leaves medical education stronger than how we found it.  Major change is daunting, but we need to summon the courage to start, and the humility to acknowledge that we will learn as we go.