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Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: an Institutional Implementation Pilot Study

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Abstract

Canadian radiation oncology (RO) residency programs transitioned to a competency-based medical education (CBME) training model named Competence by Design (CBD) in July 2019. Prior to this, CBD was piloted in a single RO training program to characterize assessment completion and challenges of implementation. Six residents and seven staff participated in a mixed-methods study and were oriented to CBD. Four Entrustable Professional Activities were assessed over a 4-week-long block and documented using online assessment forms. Anonymized assessments were analyzed to characterize completion. Post-pilot surveys were completed by 4/6 residents and 5/7 staff. Semi-structured post-pilot focus groups were conducted with all residents. Assessments were requested and documented on a weekly basis. Narrative comments were found in 68.1% of assessments, of which 26.7% described specific examples of observed competence or recommendations for improvement. Three of five staff believed that assessments have a negative impact on clinical workflow. Three themes were identified: (1) direct observation is the most challenging aspect of CBD to implement; (2) feedback content can be improved; and (3) staff attitude, clinical workflow, and inaccessibility of assessment forms are the primary barriers to completing assessments. This study demonstrates that CBD assessments can be completed regularly in an outpatient radiation oncology setting and that implementation challenges include improving feedback quality, promoting direct observation, and continuing faculty development to improve perceptions of this assessment model. Further study is required to identify best practices and expectations for the discipline in the era of CBME.

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Data Availability

Surveys and semi-structured interview guides are included in the supplemental materials, and all research data are stored in an institutional repository and will be shared upon request.

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Acknowledgements

The results of this study have been presented in part at the Competency-Based Medical Education Program Evaluation Summit, September 2019, Ottawa, Ontario, and the Canadian Association of Radiation Oncology Annual Scientific Meeting, October 2019, Halifax, Nova Scotia.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Toronto, 700 University Ave 7th Floor, Toronto, Ontario, M5G 2M9, Canada

    Amir H. Safavi

  2. Department of Oncology, Juravinski Cancer Centre, McMaster University, 699 Concession Street 3rd Floor, Hamilton, ON, L8V 5C2, Canada

    Julianna Sienna, Barbara K. Strang & Crystal Hann

Authors
  1. Amir H. Safavi
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  2. Julianna Sienna
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  3. Barbara K. Strang
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  4. Crystal Hann
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Amir H. Safavi and Julianna Sienna. The first draft of the manuscript was written by Amir H. Safavi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Crystal Hann.

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Ethics Approval, Consent to Participate, and Consent for Publication

This protocol was reviewed and received approval from our institutional review board (HIREB: #4782). Informed consent for participation and publication was obtained from all participants.

Conflict of Interest

BKS is a member of the Royal College of Physicians and Surgeons’ Radiation Oncology Competence by Design Working Group. AHS, JS, and CH declare no conflicts of interest.

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Safavi, A.H., Sienna, J., Strang, B.K. et al. Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: an Institutional Implementation Pilot Study. J Canc Educ 38, 274–284 (2023). https://doi.org/10.1007/s13187-021-02112-0

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  • DOI: https://doi.org/10.1007/s13187-021-02112-0

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