Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education

Jason R Frank¹, Jolanta Karpinski^{2

3

4}, Jonathan Sherbino⁵, Linda S Snell^{4

6}, Adelle Atkinson^{4

7}, Anna Oswald^{4

8

9}, Andrew K Hall^{4

10}, Lara Cooke¹¹, Susan Dojeiji¹², Denyse Richardson^{4

13}, Warren J Cheung^{4

14}, Rodrigo B Cavalcanti^{14

15}, Timothy R Dalseg^{4

16}, Brent Thoma^{4

17}, Leslie Flynn^{4

18}, Wade Gofton¹⁹, Nancy Dudek²⁰, Farhan Bhanji^{4

21}, Brian M-F Wong²², Saleem Razack²³, Robert Anderson^{4

24}, Daniel Dubois²⁵, Andrée Boucher²⁶, Marcio M Gomes²⁷, Sarah Taber²⁸, Lisa J Gorman⁴, Jane Fulford²⁹, Viren Naik^{25

30}, Kenneth A Harris^{31

32}, Rhonda St Croix³³, Elaine van Melle^{4

34}

Affiliations

¹ Centre for Innovation in Medical Education and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.
² Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Competency Based Medical Education, University of Ottawa, Ottawa, ON, Canada.
⁴ Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
⁵ McMaster University, Hamilton, ON, Canada.
⁶ Medicine and Health Sciences Education, McGill University, Montreal, QC, Canada.
⁷ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁹ Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada.
¹⁰ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
¹¹ Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹² Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada.
¹³ Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada.
¹⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁵ HoPingKong Centre, University Health Network, Toronto, ON, Canada.
¹⁶ Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
¹⁷ Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
¹⁸ Departments of Psychiatry and Family Medicine, and Co-Director Master of Health Sciences Education, Queen's University, Kingston, ON, Canada.
¹⁹ Department of Surgery (Division of Orthopedic Surgery), The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
²⁰ Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
²¹ Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
²² Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada.
²³ Centre for Health Education Scholarship, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.
²⁴ Northern Ontario School of Medicine University, Sudbury, ON, Canada.
²⁵ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
²⁶ Department of Medicine (Division of Endocrinology), Universitéde Montréal, Montréal, QC, Canada.
²⁷ Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada.
²⁸ Office of Standards and Assessment, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
²⁹ Canadian Internet Registration Authority, Canada.
³⁰ Medical Council of Canada, Ottawa, ON, Canada.
³¹ Royal College of Physicians and Surgeons of Canada, Canada.
³² Emeritus, Western University, Canada.
³³ Learning and Connecting at the Royal College of Physicians and Surgeons of Canada, Canada.
³⁴ Department of Family Medicine, Queen's University, Kingston, ON, Canada.

PMID: 38525203
PMCID: PMC10959143
DOI: 10.5334/pme.1096

Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education

Jason R Frank et al. Perspect Med Educ. 2024.

. 2024 Mar 18;13(1):201-223.

doi: 10.5334/pme.1096. eCollection 2024.

Authors

Affiliations

¹ Centre for Innovation in Medical Education and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.
² Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Competency Based Medical Education, University of Ottawa, Ottawa, ON, Canada.
⁴ Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
⁵ McMaster University, Hamilton, ON, Canada.
⁶ Medicine and Health Sciences Education, McGill University, Montreal, QC, Canada.
⁷ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁹ Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada.
¹⁰ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
¹¹ Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹² Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada.
¹³ Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada.
¹⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁵ HoPingKong Centre, University Health Network, Toronto, ON, Canada.
¹⁶ Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
¹⁷ Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
¹⁸ Departments of Psychiatry and Family Medicine, and Co-Director Master of Health Sciences Education, Queen's University, Kingston, ON, Canada.
¹⁹ Department of Surgery (Division of Orthopedic Surgery), The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
²⁰ Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
²¹ Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
²² Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada.
²³ Centre for Health Education Scholarship, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.
²⁴ Northern Ontario School of Medicine University, Sudbury, ON, Canada.
²⁵ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
²⁶ Department of Medicine (Division of Endocrinology), Universitéde Montréal, Montréal, QC, Canada.
²⁷ Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada.
²⁸ Office of Standards and Assessment, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
²⁹ Canadian Internet Registration Authority, Canada.
³⁰ Medical Council of Canada, Ottawa, ON, Canada.
³¹ Royal College of Physicians and Surgeons of Canada, Canada.
³² Emeritus, Western University, Canada.
³³ Learning and Connecting at the Royal College of Physicians and Surgeons of Canada, Canada.
³⁴ Department of Family Medicine, Queen's University, Kingston, ON, Canada.

PMID: 38525203
PMCID: PMC10959143
DOI: 10.5334/pme.1096

Abstract

Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.

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Conflict of interest statement

JRF, JK, LSS, FB, VN, ST, JF, KH, RST were employees of the Royal College.JS, AA, AO, AKH, LC, SD, DR, WJC, RBC, TD, BT, LF, WG, ND, BW, RS, RA, DD, AB, MG, and EVM performed contract work for the Royal College.

Figures

Phases of Competence By Design included Plan the Plan, Preparation, Implementation, and Evaluation & Adaptation — **Figure 1**
Phases of Competence by Design development.

The Competence by Design Competence Continuum describes the stages of physician careers from PGME to Certification to Continuing professional development to Transition out of professional Practice — **Figure 2**
The Competence by Design Competence Continuum. Copyright 2012. The Royal College of Physicians and Surgeons of Canada. Reproduced with permission.

See this image and copyright information in PMC

References

1. Snell L, Frank JR, Pihlak R, Sa J. Postgraduate medical education: a ‘pipeline’ to competence. In: Dent JA, Harden RM, Hunt D, (eds.), A Practical Guide for Medical Teachers. 5th ed. New York: Elsevier; 2017.
1. Cooke M, Irby DM, Sullivan W, Ludmerer K. American medical education 100 years after the Flexner report. NEJM. 2006; 355: 1339–44. DOI: 10.1056/NEJMra055445 - DOI - PubMed
1. Ludmerer KM. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. New York: Oxford University Press; 1999.
1. Neufeld VR, Maudsley RF, Pickering RJ, Walters BC, Turnbull JM, Spasoff RA, et al. Demand-side medical education: educating future physicians for Ontario. CMAJ. 1993; 148: 1471–7. - PMC - PubMed
1. Ludmerer KM, Johns MME. Reforming graduate medical education. JAMA. 2005; 294: 1083–7. DOI: 10.1001/jama.294.9.1083 - DOI - PubMed

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Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education

Affiliations

Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

LinkOut - more resources

Full Text Sources