A message from Dr. Chris Watling: Stronger together

I’ve been thinking lately about the interconnectedness of residency training. Residents pass through a diverse landscape of learning environments. In some of these environments, they may feel very at home, surrounded by teachers from the discipline in which they are training. In others – those environments we have traditionally called 'off-service rotations' – they may be the lone representative of their discipline, and their teachers may have a limited understanding of their specific learning goals.

Competency Based Medical Education (CBME) asks us to be deliberate in our selection of learning environments, taking care to ensure that the desired learning outcomes can be met. Programs can’t afford to simply send residents to off-service rotations with fingers crossed that they will learn what they need to learn. They need for those off-service rotations to be as connected to their curriculum goals as possible.  

Family Medicine’s 'Triple C' competency-based approach has already begun to grapple with this challenge. Foundational to the 'Triple C' approach is that it is centred in Family Medicine. Whether a resident is learning in a community family practice or on a surgical or medical service at an urban academic hospital, that orientation needs to shine through. But achieving a curriculum that remains centred in the principles and learning needs of one discipline is no easy feat as residents move across learning venues.

Our Royal College programs will begin addressing this same issue in July, when two programs – Otolaryngology/Head and Neck Surgery and Anesthesiology – welcome their first cohorts of CBME residents. The training of these residents will not be entirely confined to their home programs or Departments, of course; they will also spend time in other learning environments, like the Emergency Department or the Critical Care Unit.

In July 2018, several other programs will also introduce the CBME curricula. Soon, virtually every corner of our clinical training environment – from the pathology laboratory, to the palliative care unit, to the operating room of a community hospital – will become part of the training of these pioneering residents.

What has become clear to me is that residency training is our collective responsibility. Succeeding in this collective mission is going to require communication and cooperation. Whether an individual program is an early or late adopter of CBME for its own residents, the CBME way of doing things will impact them sooner, rather than later.

All faculty will soon face requests from residents and programs to complete workplace-based assessments related to CBME milestones and entrustable professional activities. Program directors may need to lay the groundwork for success with a phone call or a meeting with an off-service supervisor to discuss what they hope their residents will learn, and how they need their residents to be assessed. CBME residents may need to explain to their supervisors how their assessments work and talk about their specific learning goals. Openness to these conversations is essential; efforts to facilitate CBME will ultimately benefit all of our residents.

Interconnectedness is thus inescapable, and affords us with a tremendous opportunity to accelerate the process of transition to CBME. Programs that are not slated to adopt CBME for a few years can gain experience with the CBME approach through their encounters with off-service residents. These encounters may even spark ideas for innovations that programs may decide to adopt earlier than their full transition, to further reinforce the habits and practices of CBME.  

In this regard, cooperation is not just limited to teaching and assessing residents. Competence committees may choose to include a faculty member from another discipline, potentially strengthening the decision-making process and embedding the notion of residency training as a shared responsibility. Programs may share innovations and best practices, as CBME does not come with a concise recipe book and the sharing of grassroots approaches to its challenges will elevate all of our educational programs.

At the Centre for Education Research & Innovation, work is underway to explore how cross-cutting assessors – faculty members trained to assess residents across disciplines – may mitigate the assessment burden on each program. And within our early adopter programs, brilliantly creative ideas have already emerged that will light the way for others to follow.

In CBME, we really are all in this together. When our first cohort of CBME residents graduate to competent and confident practice, we will all be able to take pride in the role we have played in getting them there.