Excitement and apprehension over shift to competency-based medical education

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  1. Geoffrey Tse MB FRCSC

    It is the way of thinking and approaches to problem solving that is most important for young learning doctors. It is impossible to be “completely” “educated” or “experienced” in the never ending spectrum of illnesses, diseases, injuries and all health problems. The junior doctors should be trained for the skills and principles necessary for future exposures to previouly in-experience or even undeveloped medical treatments or strategies, rather than learning current individual diseases and treatments. It is the attitude and approaches, not the wide spectrum of healthcare problems, that need to be imparted to these learners. Having said that, it is very difficult to develope a way to assess the “competency” of attitude. Time is still a factor, and it is widely variable for individuals and specialized fields, and no “standard” length/duration of training can be rigidly imposed. there is still a need for “completion of training” assessment by regulating bodies like the Royal College or the Family Practice Colleges.

  2. Milos Trube

    There is no high quality evidence to support this national change across all specialties, so we have to really hope this small group of like-minded ‘experts’ know what they are doing and have a collective wisdom to predict the future. Otherwise we have simply added an immense administrative burden with no positive impact and quite possibly a negative effect on training. Not only is this an experiment in residency training, but an experiment in the value of evidence.

  3. Karine

    I’m concerned with “talented residents will finish faster and those who experience difficulties will be identified sooner”. There is a high competitivity culture in medicine, through the whole process of medical training, but also during residency, while residents are constantly compared to each other. This might put an even higher pressure on them, the pressure to finish as fast as possible to proove they’re fast learners (and perhaps to start to make big money asap). I have to say, I’m no expert, I only know the field as a doctor’s partner. This might be an interesting way of improving medical training, but in my view, it’s important to consider their mental health, their state mind through the process. Also, there might be a significant difference among men and women that should be considered (the orthopedic project at U Toronto, was it mostly with male residents?)

    • Milos Trube

      The highly touted U of T orthopedics experiment was conducted on a small group of very outstanding resident applicants. They were even separate from the “2nd tier” U of T orthopedics residents who were streamed through the regular program. Of course they succeeded, as this was an outstanding example of selection bias. There is no way to know, as you point out, other residents (M and F) will have the same success. The experts making these wholesale changes designed experiments to have pre-determined outcomes and are now happily touting the methodologically flawed pilot projects as if they prove something. A better experiment of this style of residency would have been randomizing the residents accepted into either a competency-based or traditional curriculum across an entire specialty in the country to see what happens. The evidence provided as justification to the RCPSC changes is very weak.

  4. Concerned Professor

    This is not feasible in 2017. Nor in 2019. Faculty across the country are already burdened, and dishonest in their evaluation of trainees. This will fix neither of those two fundamental problems.

    • Aa

      I’ve wondered if this move serves to benefit the hospital associations and provincial governments by causing a lengthening of residencies rather than a neutral or contracting effect.

      Getting an experienced physician for longer at 10% of the cost is a great business move.

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