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Queen’s University to revamp medical training to focus on skills

Competency-based medical education (CBME) allows residents to finish the training at their own pace.

Kevin Van Paassen/The Globe and Mail

Queen's University will be the first institution in Canada to adopt competency-based training for all its medical residents, education that emphasizes the skills residents gain rather than the time they spend doing hospital rotations.

Residents starting in 2017 will be educated through a model that many other countries are also embracing, the university will announce on Tuesday. Competency-based medical education (CBME) allows residents – graduates of medical school who must work in a clinical setting before becoming family doctors or specialists – to finish the training at their own pace.

The Royal College of Physicians and Surgeons of Canada recommended adopting competency-based medical education (CBME) several years ago. Schools and teaching hospitals across the country are shifting their curriculum, specialty by specialty.

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Queen's, however, wanted to change its model wholesale and was approved to do so by the college in December.

"It's a better model because it's … necessary," said Richard Reznick, the dean of the faculty of health sciences and director of the school of medicine. "If our dream is to train doctors and specialists of the future to be better than us – which is my dream – we have to do things differently."

Although young doctors still spend two to five years in residence, the actual time they are on a hospital floor has declined over the past 15 years, Dr. Reznick said.

When he trained as a colon-cancer surgeon, he said, he was in the hospital for 100 hours a week.

"Residents used to be called house officers because they lived in the house, in the hospital," he said. Now, residents in Ontario clock about 72 hours, a reduction that has been the result of pressure from legislative, labour and regulatory bodies.

"The frequency with which you encounter sick patients is way down," Dr. Reznick said. "We can't assume the residents are learning by osmosis. We have to be much more explicit in making sure they are meeting competencies."

Along with measuring specific skills and attitudes to patient care, some of the other elements of the CBME model include more frequent feedback through smaller tests and specific skill evaluations rather than relying on a final licensing exam.

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A pilot implementation at the University of Toronto's orthopedic surgery department found six times more evaluations took place under CBME than under time-based education.

"Rather than just time, we are demanding a higher standard. It's more accountable," said Damon Dagnone, an assistant professor in emergency medicine at Queen's who is leading the training of faculty in the new model.

Medical residents may also end up entering independent practice faster. That could benefit patients by slightly increasing the supply of specialists.

Other schools that have begun introducing competency-based education say some students finish their residency up to a year sooner, while others gain a few months compared with the current time-based model.

And residents will also leave training with more confidence about what they know.

"If you are a family resident and you do two months of obstetric care, there is no guarantee you've done enough deliveries," said Natasha Snelgrove, the president of the Professional Association of Residents of Ontario, which represents 5,000 residents in the province. "Under CBME, we will learn how many deliveries you need to have those skills and make sure every resident has that number," she said.

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"From a patient-safety perspective, it's a much more systematic level of testing of their skills," said Glen Bandiera, the associate dean of postgraduate medical education at the University of Toronto.

Orthopedic surgery at U of T was the first medical department to adopt CBME a couple of years ago. Over the next seven to eight years, the school will start it in its other 80 medical fields.

And the adoption of the model across all medical subspecialities will help other schools that want to use it.

"One of the reasons we wanted to move forward as an institution is that it's vitally important to share our experience and progress across Canada," Dr. Dagnone said.

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About the Author
Postsecondary Education Reporter

Simona Chiose covers postsecondary education for The Globe and Mail. She was previously the paper’s Education Editor, coordinating coverage of all aspects of education, from kindergarten to college and university. She has a PhD in political science from the University of Toronto. More

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