Lessons learned from Anesthesia & Perioperative Medicine

The past six months has been a whirlwind for Dr. Jennifer Vergel de Dios as she readies the Department of Anesthesia & Perioperative Medicine for the implementation of Competency Based Medical Education (CBME).

Having completed her residency training at Schulich Medicine a few years ago, Dr. Vergel de Dios is well known across the Department, which has been key to her success with this project.  

With only a few weeks until the new intake of residents, the first cohort to be trained and assessed in the new model, Dr. Vergel de Dios has a lot on the go. She took some time to sit down with us, to share her learnings from the past few months, discuss how she approached her role as Department Lead for CBME, and give some advice on how best to manage the transition and implementation.

What are your responsibilities as CBME Lead for your Department?
When I took on the role, I basically had to create my own responsibilities. Along with Arif Al-Areibi, our Residency Program Director, we really had to start from scratch and create all standards and processes for this work.

We felt it was important to focus on three key areas: our faculty and training for them; our off-service Departments; and of course, our residents.

Our end goal was to demystify what CBME is, and alleviate the concerns of our faculty and incoming residents.

To accomplish this goal, we felt it was important to provide as much information and training as possible. But because we have 90 faculty members, we thought it was best to phase in the training; we are using three different stages for the training.

We have used grand rounds to provide training, and we’ve also created workshops with hands-on practical sessions, developed videos, newsletters and a website.

I’ve also worked closely with our off-service Departments so they have the training and resources to support our residents. In doing so, I mapped out our 87 Entrustable Professional Activities (EPAs) across the five years of training to determine the timing and impact of CBME for our specialty and for the off-service Departments. I’ve also shared as much material as possible.

We have eight residents coming on July 1, and I’ve been working very closely with all of them – we will have had three videoconferences prior to July 1. I want them to feel prepared and for them to know they will have to tap into their organizational skills and approach CBME with some patience and flexibility.

It sounds like you have produced a number of tools and resources for faculty and residents?
Yes, we tried our best to create some newsletters providing updates and videos to demonstrate the sharing of feedback and processes. I also created a website where everything is housed. This gives our faculty and residents a central place where they can access all the information.

Some information from the Royal College that’s on the website cannot be publicly posted, but email cbd.western.anes@gmail.com for access.

The workshops have been another great resource for faculty and they seemed to have welcomed the sessions.

What has been your biggest challenge in your role?
The biggest challenge with this role is managing the volume of work. There is a lot to do.

At first, it was stressful about how daunting it was and how to best approach this, but the support I have received from the leadership in our Department has been incredible and it’s made a difference.

I’ve also received feedback from faculty who have found the workshops and training very helpful, so I know it’s making a difference and helping with our transition.

What advice do you have for faculty and residents in your Department, as well as the other programs who will transition to CBME in the near future?
For those people who will be taking on a role similar to mine, it’s important to not expect to receive ready-made implementation materials and guidance relevant to your local settings. You will need to use judgement and create your own materials. This does allow you to create novel things that are better than what’s currently being done.

It’s also important for your specialty to work cohesively at a national level to spread the work and ensure standardization.

I believe it’s really important to remember and remind ourselves that with CBME we will be experiencing a cultural change, and that is often accompanied by a range of emotions from people who may feel frustration or confusion. We need to allow people to feel this and provide the supports, tools and resources so that they can manage the change.

For residents who are coming into the program, they will need to be aware and comfortable with the fact that they may have more knowledge about certain aspects of CBME than some faculty members with whom they will interact.

How will you continue to support faculty and residents moving forward?
Moving forward, we will continue to provide training and collaboration with faculty in our Department and other Departments across the School.  

We will also continue with faculty development and plan to host two or three workshops each year for faculty. We’ve found it effective to utilize grand rounds as a forum for information sharing and training about CBME, and we expect to do this moving forward. The workshops have also been great, but those are resource-intensive and by posting our workshop materials on our website, I hope that allows for information dissemination without being limited by time or location.

Do you have advice to share with your colleagues and departments who will experience this transition to CBME in the future?
As people work through the CBME implementation, I believe it’s important to not lose focus on the overall reason for the change, which is focused on trying to improve patient care.