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Competency-based Medical Education Curriculum

This document outlines plans to restructure medical training at an institution to a competency-based model. It discusses transforming the curriculum, faculty development, assessment tools, and training processes. The plans include establishing competency-focused committees and faculty/resident teams. Training workshops will develop materials for each CanMEDS competency. Assessment tools like online logbooks and end-of-rotation evaluations will evaluate competencies. Educational activities like ward rounds and morning meetings will highlight competencies. The overall goal is to implement a competency-based medical education approach to improve training outcomes.

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Building a CBME Curriculum
Redesigning the Curriculum
Basic Concepts in Heath Care Training  “a set or series of interconnected or interdependent parts or entities that act together in a common purpose or produce results impossible by action of one alone”.
Old Training Model Process Structure Outcome Prevent the Six Ds: Death Disease Disability Discomfort Dissatisfaction Destitution (cost) Care Process Anatomy •Focus on Knowledge & Clinical Skills •General & Specialty Rotation
NEW Training Model Process Structure Outcome •OUTCOMES! Care Process Anatomy •Focus on ALL Clinical & Non- clinical Competencies •General & Specialty Rotation + NEW Rotations?
Old Style Rota: General & Subspecialty Traditional Training Programs ………………… ………Who needs them? New Modules/Rotations:  EBM Rotation: EBMers  Research & Audit: Researchers/Quality  Medical Technology: Innovators  Medical Bioethics: Ethical Workforce  Community Health: Economy/Prevention  Medical Education: Teachers/Trainers  Others!
Committed Leadership CanMEDS Skilled Faculty CanMEDS- Based Curricula Simulation Lab Education Department • Both Junior and Senior staff training • Educationalists members The Department of Medicine CanMEDS Syllabus-The Necessary Structures
The Department of Medicine CanMEDS Syllabus 1 • Definition of each Competency 2 • Sub-competency 3 • Recommended Activity 4 • Recommended Method of Delivery 5 • Recommended Assessment Tools
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Optimal clinical, procedural, ethical and patient-centered medical care 1. CanMed Clinical Care Rounds/ Educational Activity 2. CanMed Technical Skills Round* 1. Bedside Ward Round 2. Sitting Ward Rounds 3. Short Case Discussions 4. Long Case Presentations 5. Actual Patient & Simulation –Technical Skill Lab Training 6. Videos/Multimedia  In-training evaluation reports  Mini-clinical evaluation exercise (mini- CEX)  Objective structured clinical examinations OSCE  Multi-source feedback  Critical appraised topic (CAT)  Progression tests  Portfolio  Objective structured assessment of technical skills (OSATS)  Logbooks  Simulation Establish and maintain clinical knowledge appropriate to their practice Educational Activities  Academic half-day teaching  Morning Meetings  Ward Rounds  Grand rounds  Case presentations  Seminars  Review courses  Conferences/Symposia  Exit Rounds  EBM Rotation  Teaching Workshops & Presentations  Literature Searching/PICO Exercises  Critical Appraisal  Journal Club  In-training evaluation reports  Written examinations (multiple choice and open-ending)  Standardized oral examinations  Standardized Patient Examinations  Chart-stimulated recall oral examinations  Logbooks & Rating of attendance, presentations, literature searching/ Journal Club-CAT exercises Medical Expert
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Continuous professional Development Learning Activities Individual or group learning activities that occur on a regular or day to day basis Self-Assessment Programs Out 0f Hospital :  Conferences  Workshops  Courses  Subscription to Knowledge update electronic resources In Hospital :  Grand rounds (1hr/week )  Journal clubs  Morning report  Ward rounds  Half day activities  Residents Knowledge Database  Exit Rounds  MCQs/Multimedia Sessions & Quizzes Personal:  Medical Knowledge Assessment Program (MKSAP)  Cecil's MCQs  's MCQs  Multi-source Feedback  Short Answer Questions  MCQ Scholar
Scholar Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Evidence-Based Medicine  Asking (Relevant) Questions (PICO Exercises)  Acquiring Knowledge (Literature Searching Exercises)  Appraisal (Critical Appraisal Exercises)  Applying Knowledge (Knowledge Translation exercises) Assessment of EBM Process  EBM Rotation  Regular Educational Prescriptions Activity  PICO Exercises  5As in Journal Club, Morning Meetings and Ward Rounds  Computer Lab Training Sessions  Developing Evidence-based Policies, Pathways and Guidelines  Multi-source Feedback  Short Answer Questions  MCQ  Objective structured assessment of technical skills (OSATS) Teaching  Presentation Skills  Time Management Skills  Personal Performance Skills  Teaching e.g. supervision, mentoring  Courses  Workshops  Multi-source Feedback Research  Research & Biostatics  Creating Research Ideas/Banks  Writing research Proposals  Funding your Research  Writing Papers & Thesis  Publishing Research  Courses  Workshops  Research Rotation  Mandatory Research  Multi-source Feedback  Short Answer Questions  MCQ
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Documentation  The Complete H&P  Writing Follow-up Notes (SOAP)  Writing Handing-Over/Sign-out Notes  Writing/Dictating a Discharge Summary  Writing/Dictating a Medical Report  Lectures  Small groups (PBL)  Role modeling  Daily progress note assessment.  Review of dictation summary. Consultation skills  Writing a Consultation Letter  Verbal Consultation Skills  Lectures  Small groups  Role modeling  Direct observation  OSCE  Simulation Counseling skills/ Breaking bad news (verbal and non-verbal )  Effective Rapport  Empathy  Psychosocial Skills  Lectures  Small groups  Videos  Bedside teaching  Role modeling  Direct observation  OSCE  Simulation  Standardized Patient Examination  Patient Survey Communicator
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Clinical Care Collaboration  Leadership skills  Skills  Multidisciplinary/ Interdepartmental Care Dynamics  Resolution of Interpersonal Conflicts  Discharge Planning  Lectures  Small groups (PBL)  Role modeling  Daily progress note assessment.  Review of dictation summary  Written tests (short-answer questions, essays)  In-training evaluation reports (ITERs)  Objective structured clinical examinations (OSCEs)  Simulation  Multi-source feedbackCommunity  Patients’ Friends Societies & Support Groups  Government Bodies Collaboration  Lectures  Small groups International  Research Collaboration  Quality of Care Collaboration  Lectures  Small groups Collaborator
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Health Care  Organization, structure and financing of the healthcare system  Lectures  Multi-source feedback and Peer Evaluation  Simulation  Portfolio  Direct ObservationEffective Healthcare  System/Quality Improvement  Committee membership e.g. M&M committee  Audit & Quality Workshops & Presentations  Economic Appraisal Workshops  Implementation of Change Strategies  Discharge Planning Career Development  Job Searching  Writing curriculum vitae, personal statements and covering letters  Interview Skills  Lectures  Workshops  Small groups Administrative Development  Physician Roles  Time Management Skills  Leadership Skills  Lectures  Workshops  Small groups LEADER/MANAGER
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Patient Healthcare Needs:  Patient Education (disease, drugs, etc)  Health Promotion (lifestyle, social, economic, psychological, environmental)  Disease Prevention e.g. Vaccination, Chemoprophylaxis, Screening)  Timely Referrals e.g. Medical Consultations, Home Health Care  Clinical care Activities e.g. Ward Rounds, Morning Meetings etc  Lectures  Workshops  Essays  Short-answer questions (SAQs)  Direct observation and In- Training Evaluation Reports (ITERs)  Objective structured clinical evaluations (OSCEs) and standardized patients  Multi-source feedback and peer evaluations  Portfolios Community Health Needs  Membership of Patient’s Help Groups  Community Care Service/Participation  Community Service Rotation  Workshops  Conferences Population Determinants of Health  Health Ministry Service/Participation  Population/Public Campaigns  Community Service  Workshops  Conferences HEALTH ADVOCATE
Sub-competency Recommended Activity Recommended Method of Delivery Recommended Assessment Tool Ethical Practice  Ethical Care  Ethical dilemmas  Workshops  Role modeling  Clinical Activities (ward Round, Morning Meetings etc)  Direct observation  In-training evaluation reports (ITERs)  Multi-source feedback  Portfolios Professional Practice  Codes of Conduct  Professional Behaviour  Islamic Moral Values  Legislative Regulation  Workshops  Role modeling  Clinical Activities (ward Round, Morning Meetings etc) Self-Care  Physical & Psychological Health  Stress Management PROFESSIONAL
Current and Future Plans  CanMEDS-skilled Faculty.  Outcome:  CanMEDS Cttee restructuring PLUS a Train-the-Trainers program:  Vertical TTT Program: inclusive of Senior Faculty and Residents  Horizontal TTT Program: Compulsory longitudinal program
Restructuring the System of Training:  The CanMEDS Subcommittee  Outcome:  Expansion of Cttee membership to 6 Seniors (Consultants/Assistants) and 1 Educational Specialist (from the College of Medicine) PLUS 12 Residents from R1, R2 and R3.
Restructuring the System of Training:  The CanMEDS Training Proposal (Syllabus)  Outcome:  The CanMEDS Training Proposal is rich in its content and will serve as a reference at least for the initial drafting of the TTT educational curriculum (together with other resources as outlined below).
The CanMEDS Champions: Faculty & Resident  Outcome:  The new number of members will “set in motion” the practical creation of skilled Champions (from Seniors and Residents) by facilitating the establishment of “ Competency-focused Micro Teams” e.g. Micro-team for the Communicator Role, Micro-team for the Professional Role etc.
The CanMEDS Champions: Faculty & Resident  Outcome:  Each micro-team will consist of 1 Senior and 2 Residents at different levels of training. R1 Resident Consultant R2 Competency Champions Micro-Team
Train-the-Trainers Workshops  Outcome:  Each micro-team will be entrusted with the task of building a full- curriculum for their allocated competency. Material (handouts, power-point etc) prepared would have to be presented to the committee and approved for inclusion in the TTT workshop.  Resources from KAMC CanMEDS Collaborating centre CD as well as from the RCP of Canada website may provide the micro- teams with useful material.  RCP of Canada CanMEDS best practice: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/whatworks
5% Method of Learning
Experiential Learning:
Bloom's Taxonomy of Learning Objectives
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. Knows Shows how Knows how Does Professionalauthenticity Cognition Behaviour facts and concepts problem solving skills labs practice TRAINING OF COMPETENCIES: MILLER
Knowledge (Concepts) Understanding Practice Reflection Assessment
Session Knowledge Understanding Skill/Practice Extras for the Skill Reflection Assessment Documentation: Follow-up Notes Sign-Out/Handing Over notes Lecture: SOAP Sign-out Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios Video on SOAP/Sign-out Ad-hoc Discussion Session Documentation: Consultation (Verbal/Written) Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Video on Consultation Skills Ad-hoc Discussion Session Documentation: -Discharge Summary -Medical Report Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  (Old Discharge Summaries) Ad-hoc Discussion Session Counseling skills/ Breaking bad news (verbal and non-verbal ) Lecture/ SPIKES Cognitive Aid Case Discussion/ Clinical Vignettes Experiential Learning: Role Playing  Video on breaking Bad News/ Counseling Ad-hoc Discussion Session Presentation Skills: PowerPoint Lecture Examples of “good” and “bad” presentations Videos Train-the-Trainers 3Ts in Communicator Role: See-One-Session SOS
Session Knowledge Understanding Skill/Practice Extras for the Skill Reflection Assessment Leadership Skills Lecture: What? How? Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios Video on Leadership Ad-hoc Discussion Session Team Building Skills Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Video on Team Building Skills Ad-hoc Discussion Session Resolution of Interpersonal Conflicts Skills Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Video on Conflict Resolution Ad-hoc Discussion Session Discharge Planning Skills Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Story Telling Ad-hoc Discussion Session Train-the-Trainers 3Ts in COLLABORATOR Role: See-One-Session SOS
Session Knowledge Understanding Skill/Practice Extras for the Skill Reflection Assessment Career Management Skills Lecture: Job Searching Writing curriculum vitae, personal statements and covering letters Interview Skills  Experiential Learning: proposing and completing a career move  Role Playing: Interview skills  Video on good Interview skills Ad-hoc Discussion Session Time Management Skills Lecture Case Discussion/Clinical Vignettes Experiential Learning: Case Scenarios  Video on Time Management Skills Ad-hoc Discussion Session Quality Management/ Improvement Skills Lecture : What is QM? Audit? Management of Change? Case Discussion/Clinical Vignettes Experiential Learning: Case Scenarios Audit Exercise Ad-hoc Discussion Session Discharge Planning Skills Lecture Case Discussion/Clinical Vignettes Experiential Learning: Case Scenarios  Story Telling Ad-hoc Discussion Session Health Organizations/Finance & Physician Roles Lecture Train-the-Trainers 3Ts in Leader Role: See-One-Session SOS
Restructuring the Process of Training
Restructuring the Process of Training and Assessment: 1. CanMEDS Competencies “Teaching Moments”. 2. Competency Structured Topic Presentation. 3. Competency Structured Morning Meeting discussion format. 4. Competency structured Ward Round. 5. Competency-enhancing Cognitive Aids like the 5S Cognitive Aid, Communication Cognitive Aids etc.
Restructuring the Process of Training and Assessment: 6. End-of-Rotation Competency Appraisal Form (ERCA). 7. Online Logbook 8. Using CanMEDS competencies in the Journal Club. 9. Dedicated Morning Meeting on the CanMEDS Competencies; 1st Monday of each Month. 10. Wiggio CanMEDS Resource webpage.
CanMEDS Competencies “Teaching Moments”  Highlighting in an “Explicit” manner a CanMEDS competency whilst dealing with a patient care issue e.g.  Medical Expert with H&P  Collaborator role when referring a patient  Scholar when discussing New evidence, NNT etc  Advocacy when referring to Home Health Care etc  Leader/Manager when dealing with system/process improvement  Communicator when breaking bad news etc  Professionalism when discussing ethical issues etc
The Competency Structured Presentation (CSP)  Classically and for educational purposes both undergraduates and postgraduates present clinical topics in a narrative or case-based style.  In both of these, classic headings that are used include definitions, etiology, epidemiology, clinical presentation, differential diagnosis, investigations, therapy and prognosis etc.
The Competency Structured Presentation (CSP)  These formats of presentation do not explicitly emphasize the new domains of knowledge or skills necessary for both quality of care as outlined above or empower the trainees with all the competencies outlined by CanMeds or similar bodies for a comprehensive outcome-based training and patient care.
The Competency Structured Presentation (CSP)  Topic heading are now deliberately portrayed under competency headings.  Presumably, this conceptual framework or map would assist in realizing a more competency-directed clinical training and decision making and in drafting a comprehensive, high- quality management plan for every patient.  Practical patient-centered care actions and interventions may thus be incorporated in the clinical decision process.
Competency Structured Topic Presentation Bronchial Asthma Medical Expert  History & Physical Exam  Essential Technical Skills (Pulse Oximetry, Peak Flow meter Recording, Use of Inhaler Devices etc)  Essential Investigations/Imaging  Emergency Medical Interventions  Monitoring Response to Treatment  Discharge Planning/Criteria for Discharge Communicator  Presentation Skills Feedback  Counseling skills/ Breaking bad news Collaborator  Essential Consultations & Referrals e.g. Pulmonology, Pulmonary Educator, Allergologist etc This Novel Method of Presentation may assist in realizing a more competency- directed clinical training and decision-making process, and in drafting a comprehensive, high-quality management plan for every patient.
Competency Structured Topic Presentation Bronchial Asthma Advocate  Essential Educational input regarding Asthma and its treatment, Self-management Plans etc  Risk Factors Counseling e.g. smoking, allergens  Referral to Patients’ Friends Societies & Support Groups Leader  Interventions to reduce Cost of care/Length of stay  Quality Indicators/Audit of Asthma care  Economic Comparisons of various interventions Scholar  Evidence-based resources for Asthma guidelines, protocols  Asthma Societies Websites  Update on new studies on Asthma Professional  Ethical challenges in Asthma e.g. Intubation or not, Unorthodox treatments, Refusing steroid therapy etc
3. Competency Structured Morning Meeting Hassan IS, Kuriry H, Al Ansari L, Al-Khathami A, Al-Qahtani M, Al-Anazi T, Faroqui, M, Al-Jahdali H. Competency-Structured Case Discussion in the Morning Meeting: Enhancing CanMeds Integration in Daily Practice. Adv Med Educ Pract. 2015;20;6:353-8.
The CanMeds Ward Round! • 12 Yr old, was admitted with an exacerbation of Bronchial Asthma- a new diagnosis. • CanMed Ward Round: Resident Training –As a medical expert: were the H & P up to CanMeds standard-structured, comprehensive, relevant etc. –As a Communicator: Presentation skill? Body-Language? How did he/she convey the news to the family? Empathy & support? –As a Collaborator: Were the necessary referrals appropriate and professionally arranged?
• 12 Yr old, was admitted with an exacerbation of Bronchial Asthma- a new diagnosis. • CanMed Ward Round: Resident Training – As a Leader: Time and resource utilization are appropriate? – As Health Advocate: Any arrangements with social and other healthcare facilities? – As a Scholar: Literature searching exercise on the options of care and preventive strategies for this particular patient. – As a Professional: Attitude and behavior observation, discussion of the ethical issues re-steroid therapy etc Case Scenario….The CanMeds Way!
End-of-Rotation Competency Appraisal Form (ERCA).  Resident is requested to: 1. Select specific patient care issues 2. Itemize them and 3. Illustrate the selected CanMEDS competency intervention that was used to deal with each of them.
End-of-Rotation Competency Appraisal Form (ERCA).  An example courtesy of Dr Raed Al Enazi R1.
Patient Diagnosis & MRN or Work- related Difficulty Competency Reason(s) for selecting this specific patient/problem Suggested Specific Competency Input(s)/Action(s) to incorporate for the selected patient/problem Recommendations for future use in other similar patients/problems if applicable Deteriorating level of consciousness Medical Expert Patient with prolonged INR (>9), LVF, CKD, DM. septic foot ulcer: many possible reasons! Using the 3Rs to diagnose the cause: Rules of Thumb, Red Flags, Rule-out-worst Scenario Use a bed-side check-list for patients whose level of consciousness deteriorates during their in-patient stay. Advanced Cholangio- carcinoma Communicator Breaking bad news and discussing putting the patient no code with the family Using SPIKES mnemonic for breaking bad news Providing written material on what no-code means Involving Religious affairs department Policy and Procedure for NO Code patients with both Physician and Family educational inputs, written material etc
Patient Diagnosis & MRN or Work- related Difficulty Competency Reason(s) for selecting this specific patient/problem Suggested Specific Competency Input(s)/Action(s) to incorporate for the selected patient/problem Recommendations for future use in other similar patients/problems if applicable Elderly patient with dementia, Parkinsonism, and bed-bound. Admitted with aspiration pneumonia. Collaborator Patient refusing discharge (2 months in the hospital) Multidisciplinary meeting inclusive of MRP, HHC, neurology, social services and family Earlier involvement of care givers in the discharge process/discharge planning. 17 year old female patient with acute sickle cell crisis and acute chest syndrome Health Advocate Patient due to get married Educating patient on her disease Preventative interventions including vaccination Pre-marital counseling and husband screening for genetic Hospital wide genetic disease patient and family education support team, procedure and policy
Patient Diagnosis & MRN or Work- related Difficulty Competency Reason(s) for selecting this specific patient/problem Suggested Specific Competency Input(s)/Action(s) to incorporate for the selected patient/problem Recommendations for future use in other similar patients/problems if applicable Ward-round Time Leader Ward round taking too long Time management skills Use Lean system to make work more efficient (study areas of time wastage) Develop a policy/procedure to Re- organize the ward round Diuretic Resistant fluid overload Scholar How to manage such patients? Literature searching for best available evidence for dealing with this problem. Patient is unhappy with the provided medical care. Professiona l Physician-patient- family conflict with its negative impact on patient care MRP-Family conference Involving trustworthy Colleagues Involving patient relations department Policy-procedure for conflict resolution
Using CanMEDS headings in Journal Club: Competencies Used  Scholar  Communicator (PPT Presentation)  Professional  Leader
Competency Guide: Medical Expert 1. Hypothesis-Driven History Taking and Physical Examination. 2. Detailed Problem-List for comprehensive care inputs 3. Use of Calculators and Scoring Tools for decision-making e.g. BMI Calculator, CURB-65, Well’s Score for PE risk, Creatinine Clearance, NIH Stroke Score, Bode Score for COPD survival prediction, Ranson’s Score etc. UpToDate has a huge collection.
Competency Guide: Medical Expert  4. Patient- and Family Centered management decisions e.g. use of decision-aids.  5. Using the BESD and 5S for comprehensive immediate diagnostic and therapeutic input.  6. Avoiding Cognitive Biases Skills: DD Scheme, Rules of Thumb, Ruling out worst scenario, ROWS, Red Flags etc.  7. Procedural skills-: CanMEDS Technical Skills Round/Simulation Lab: e.g. Lumbar Puncture, Ascitic Tap etc.
Competency Guide: Communicator  Documentation: H&P, SOAP, SBAR/I-PASS Handover, Discharge Summary, Medical Report etc.  Consultation Referrals-using SBAR/I-PASS  Counseling Skills, Dealing with angry clients, Breaking Bad News, Disclosure of Error  Motivational and Therapeutic Communication  Presentations in meetings, committees, conferences etc.
9. Our Wiggio Webpage https://wiggio.com/group_op en_join.php?groupid=26365 00&password=saudimeds&r ef=2542911
The CanMEDS Sub-committee Important and worthwhile achievements Novel models: opportunity for educational research Ahead of other Departments ?
Competency Training Administration Senior Health Staff Patients Junior Health Staff Who Needs Competency –based Training: All who pass through the Health Facility!!!
CBME in Summary Getting theory into practice Is a Complex but Achievable Task Collective Effort Organizational and Individual Responsibilities Patient Right
‫تعالى‬ ‫هللا‬ ‫رضي‬ ‫عائشة‬ ‫عن‬ ‫قالت‬ ‫عنها‬:‫هللا‬ ‫رسول‬ ‫قال‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬"‫إن‬ ‫أحدكم‬ ‫عمل‬ ‫إذا‬ ‫يحب‬ ‫هللا‬ ‫يتقنه‬ ‫أن‬ ً‫ال‬‫عم‬"

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Competency-based Medical Education Curriculum

  • 1.
  • 2.
  • 4.
    Basic Concepts inHeath Care Training  “a set or series of interconnected or interdependent parts or entities that act together in a common purpose or produce results impossible by action of one alone”.
  • 5.
    Old Training Model Process Structure Outcome Preventthe Six Ds: Death Disease Disability Discomfort Dissatisfaction Destitution (cost) Care Process Anatomy •Focus on Knowledge & Clinical Skills •General & Specialty Rotation
  • 6.
    NEW Training Model Process Structure Outcome •OUTCOMES! Care Process Anatomy •Focuson ALL Clinical & Non- clinical Competencies •General & Specialty Rotation + NEW Rotations?
  • 7.
    Old Style Rota: General& Subspecialty Traditional Training Programs ………………… ………Who needs them? New Modules/Rotations:  EBM Rotation: EBMers  Research & Audit: Researchers/Quality  Medical Technology: Innovators  Medical Bioethics: Ethical Workforce  Community Health: Economy/Prevention  Medical Education: Teachers/Trainers  Others!
  • 8.
    Committed Leadership CanMEDS Skilled Faculty CanMEDS- Based Curricula Simulation Lab Education Department • Both Juniorand Senior staff training • Educationalists members The Department of Medicine CanMEDS Syllabus-The Necessary Structures
  • 9.
    The Department ofMedicine CanMEDS Syllabus 1 • Definition of each Competency 2 • Sub-competency 3 • Recommended Activity 4 • Recommended Method of Delivery 5 • Recommended Assessment Tools
  • 10.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Optimal clinical, procedural, ethical and patient-centered medical care 1. CanMed Clinical Care Rounds/ Educational Activity 2. CanMed Technical Skills Round* 1. Bedside Ward Round 2. Sitting Ward Rounds 3. Short Case Discussions 4. Long Case Presentations 5. Actual Patient & Simulation –Technical Skill Lab Training 6. Videos/Multimedia  In-training evaluation reports  Mini-clinical evaluation exercise (mini- CEX)  Objective structured clinical examinations OSCE  Multi-source feedback  Critical appraised topic (CAT)  Progression tests  Portfolio  Objective structured assessment of technical skills (OSATS)  Logbooks  Simulation Establish and maintain clinical knowledge appropriate to their practice Educational Activities  Academic half-day teaching  Morning Meetings  Ward Rounds  Grand rounds  Case presentations  Seminars  Review courses  Conferences/Symposia  Exit Rounds  EBM Rotation  Teaching Workshops & Presentations  Literature Searching/PICO Exercises  Critical Appraisal  Journal Club  In-training evaluation reports  Written examinations (multiple choice and open-ending)  Standardized oral examinations  Standardized Patient Examinations  Chart-stimulated recall oral examinations  Logbooks & Rating of attendance, presentations, literature searching/ Journal Club-CAT exercises Medical Expert
  • 11.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Continuous professional Development Learning Activities Individual or group learning activities that occur on a regular or day to day basis Self-Assessment Programs Out 0f Hospital :  Conferences  Workshops  Courses  Subscription to Knowledge update electronic resources In Hospital :  Grand rounds (1hr/week )  Journal clubs  Morning report  Ward rounds  Half day activities  Residents Knowledge Database  Exit Rounds  MCQs/Multimedia Sessions & Quizzes Personal:  Medical Knowledge Assessment Program (MKSAP)  Cecil's MCQs  's MCQs  Multi-source Feedback  Short Answer Questions  MCQ Scholar
  • 12.
    Scholar Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Evidence-Based Medicine  Asking (Relevant) Questions (PICO Exercises)  Acquiring Knowledge (Literature Searching Exercises)  Appraisal (Critical Appraisal Exercises)  Applying Knowledge (Knowledge Translation exercises) Assessment of EBM Process  EBM Rotation  Regular Educational Prescriptions Activity  PICO Exercises  5As in Journal Club, Morning Meetings and Ward Rounds  Computer Lab Training Sessions  Developing Evidence-based Policies, Pathways and Guidelines  Multi-source Feedback  Short Answer Questions  MCQ  Objective structured assessment of technical skills (OSATS) Teaching  Presentation Skills  Time Management Skills  Personal Performance Skills  Teaching e.g. supervision, mentoring  Courses  Workshops  Multi-source Feedback Research  Research & Biostatics  Creating Research Ideas/Banks  Writing research Proposals  Funding your Research  Writing Papers & Thesis  Publishing Research  Courses  Workshops  Research Rotation  Mandatory Research  Multi-source Feedback  Short Answer Questions  MCQ
  • 13.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Documentation  The Complete H&P  Writing Follow-up Notes (SOAP)  Writing Handing-Over/Sign-out Notes  Writing/Dictating a Discharge Summary  Writing/Dictating a Medical Report  Lectures  Small groups (PBL)  Role modeling  Daily progress note assessment.  Review of dictation summary. Consultation skills  Writing a Consultation Letter  Verbal Consultation Skills  Lectures  Small groups  Role modeling  Direct observation  OSCE  Simulation Counseling skills/ Breaking bad news (verbal and non-verbal )  Effective Rapport  Empathy  Psychosocial Skills  Lectures  Small groups  Videos  Bedside teaching  Role modeling  Direct observation  OSCE  Simulation  Standardized Patient Examination  Patient Survey Communicator
  • 14.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Clinical Care Collaboration  Leadership skills  Skills  Multidisciplinary/ Interdepartmental Care Dynamics  Resolution of Interpersonal Conflicts  Discharge Planning  Lectures  Small groups (PBL)  Role modeling  Daily progress note assessment.  Review of dictation summary  Written tests (short-answer questions, essays)  In-training evaluation reports (ITERs)  Objective structured clinical examinations (OSCEs)  Simulation  Multi-source feedbackCommunity  Patients’ Friends Societies & Support Groups  Government Bodies Collaboration  Lectures  Small groups International  Research Collaboration  Quality of Care Collaboration  Lectures  Small groups Collaborator
  • 15.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Health Care  Organization, structure and financing of the healthcare system  Lectures  Multi-source feedback and Peer Evaluation  Simulation  Portfolio  Direct ObservationEffective Healthcare  System/Quality Improvement  Committee membership e.g. M&M committee  Audit & Quality Workshops & Presentations  Economic Appraisal Workshops  Implementation of Change Strategies  Discharge Planning Career Development  Job Searching  Writing curriculum vitae, personal statements and covering letters  Interview Skills  Lectures  Workshops  Small groups Administrative Development  Physician Roles  Time Management Skills  Leadership Skills  Lectures  Workshops  Small groups LEADER/MANAGER
  • 16.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Patient Healthcare Needs:  Patient Education (disease, drugs, etc)  Health Promotion (lifestyle, social, economic, psychological, environmental)  Disease Prevention e.g. Vaccination, Chemoprophylaxis, Screening)  Timely Referrals e.g. Medical Consultations, Home Health Care  Clinical care Activities e.g. Ward Rounds, Morning Meetings etc  Lectures  Workshops  Essays  Short-answer questions (SAQs)  Direct observation and In- Training Evaluation Reports (ITERs)  Objective structured clinical evaluations (OSCEs) and standardized patients  Multi-source feedback and peer evaluations  Portfolios Community Health Needs  Membership of Patient’s Help Groups  Community Care Service/Participation  Community Service Rotation  Workshops  Conferences Population Determinants of Health  Health Ministry Service/Participation  Population/Public Campaigns  Community Service  Workshops  Conferences HEALTH ADVOCATE
  • 17.
    Sub-competency Recommended ActivityRecommended Method of Delivery Recommended Assessment Tool Ethical Practice  Ethical Care  Ethical dilemmas  Workshops  Role modeling  Clinical Activities (ward Round, Morning Meetings etc)  Direct observation  In-training evaluation reports (ITERs)  Multi-source feedback  Portfolios Professional Practice  Codes of Conduct  Professional Behaviour  Islamic Moral Values  Legislative Regulation  Workshops  Role modeling  Clinical Activities (ward Round, Morning Meetings etc) Self-Care  Physical & Psychological Health  Stress Management PROFESSIONAL
  • 18.
    Current and FuturePlans  CanMEDS-skilled Faculty.  Outcome:  CanMEDS Cttee restructuring PLUS a Train-the-Trainers program:  Vertical TTT Program: inclusive of Senior Faculty and Residents  Horizontal TTT Program: Compulsory longitudinal program
  • 19.
    Restructuring the Systemof Training:  The CanMEDS Subcommittee  Outcome:  Expansion of Cttee membership to 6 Seniors (Consultants/Assistants) and 1 Educational Specialist (from the College of Medicine) PLUS 12 Residents from R1, R2 and R3.
  • 20.
    Restructuring the Systemof Training:  The CanMEDS Training Proposal (Syllabus)  Outcome:  The CanMEDS Training Proposal is rich in its content and will serve as a reference at least for the initial drafting of the TTT educational curriculum (together with other resources as outlined below).
  • 21.
    The CanMEDS Champions:Faculty & Resident  Outcome:  The new number of members will “set in motion” the practical creation of skilled Champions (from Seniors and Residents) by facilitating the establishment of “ Competency-focused Micro Teams” e.g. Micro-team for the Communicator Role, Micro-team for the Professional Role etc.
  • 22.
    The CanMEDS Champions:Faculty & Resident  Outcome:  Each micro-team will consist of 1 Senior and 2 Residents at different levels of training. R1 Resident Consultant R2 Competency Champions Micro-Team
  • 23.
    Train-the-Trainers Workshops  Outcome: Each micro-team will be entrusted with the task of building a full- curriculum for their allocated competency. Material (handouts, power-point etc) prepared would have to be presented to the committee and approved for inclusion in the TTT workshop.  Resources from KAMC CanMEDS Collaborating centre CD as well as from the RCP of Canada website may provide the micro- teams with useful material.  RCP of Canada CanMEDS best practice: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/whatworks
  • 24.
  • 25.
  • 26.
  • 27.
    Miller GE. Theassessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. Knows Shows how Knows how Does Professionalauthenticity Cognition Behaviour facts and concepts problem solving skills labs practice TRAINING OF COMPETENCIES: MILLER
  • 28.
  • 29.
    Session Knowledge UnderstandingSkill/Practice Extras for the Skill Reflection Assessment Documentation: Follow-up Notes Sign-Out/Handing Over notes Lecture: SOAP Sign-out Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios Video on SOAP/Sign-out Ad-hoc Discussion Session Documentation: Consultation (Verbal/Written) Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Video on Consultation Skills Ad-hoc Discussion Session Documentation: -Discharge Summary -Medical Report Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  (Old Discharge Summaries) Ad-hoc Discussion Session Counseling skills/ Breaking bad news (verbal and non-verbal ) Lecture/ SPIKES Cognitive Aid Case Discussion/ Clinical Vignettes Experiential Learning: Role Playing  Video on breaking Bad News/ Counseling Ad-hoc Discussion Session Presentation Skills: PowerPoint Lecture Examples of “good” and “bad” presentations Videos Train-the-Trainers 3Ts in Communicator Role: See-One-Session SOS
  • 30.
    Session Knowledge UnderstandingSkill/Practice Extras for the Skill Reflection Assessment Leadership Skills Lecture: What? How? Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios Video on Leadership Ad-hoc Discussion Session Team Building Skills Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Video on Team Building Skills Ad-hoc Discussion Session Resolution of Interpersonal Conflicts Skills Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Video on Conflict Resolution Ad-hoc Discussion Session Discharge Planning Skills Lecture Case Discussion/ Clinical Vignettes Experiential Learning: Case Scenarios  Story Telling Ad-hoc Discussion Session Train-the-Trainers 3Ts in COLLABORATOR Role: See-One-Session SOS
  • 31.
    Session Knowledge UnderstandingSkill/Practice Extras for the Skill Reflection Assessment Career Management Skills Lecture: Job Searching Writing curriculum vitae, personal statements and covering letters Interview Skills  Experiential Learning: proposing and completing a career move  Role Playing: Interview skills  Video on good Interview skills Ad-hoc Discussion Session Time Management Skills Lecture Case Discussion/Clinical Vignettes Experiential Learning: Case Scenarios  Video on Time Management Skills Ad-hoc Discussion Session Quality Management/ Improvement Skills Lecture : What is QM? Audit? Management of Change? Case Discussion/Clinical Vignettes Experiential Learning: Case Scenarios Audit Exercise Ad-hoc Discussion Session Discharge Planning Skills Lecture Case Discussion/Clinical Vignettes Experiential Learning: Case Scenarios  Story Telling Ad-hoc Discussion Session Health Organizations/Finance & Physician Roles Lecture Train-the-Trainers 3Ts in Leader Role: See-One-Session SOS
  • 32.
  • 33.
    Restructuring the Processof Training and Assessment: 1. CanMEDS Competencies “Teaching Moments”. 2. Competency Structured Topic Presentation. 3. Competency Structured Morning Meeting discussion format. 4. Competency structured Ward Round. 5. Competency-enhancing Cognitive Aids like the 5S Cognitive Aid, Communication Cognitive Aids etc.
  • 34.
    Restructuring the Processof Training and Assessment: 6. End-of-Rotation Competency Appraisal Form (ERCA). 7. Online Logbook 8. Using CanMEDS competencies in the Journal Club. 9. Dedicated Morning Meeting on the CanMEDS Competencies; 1st Monday of each Month. 10. Wiggio CanMEDS Resource webpage.
  • 35.
    CanMEDS Competencies “TeachingMoments”  Highlighting in an “Explicit” manner a CanMEDS competency whilst dealing with a patient care issue e.g.  Medical Expert with H&P  Collaborator role when referring a patient  Scholar when discussing New evidence, NNT etc  Advocacy when referring to Home Health Care etc  Leader/Manager when dealing with system/process improvement  Communicator when breaking bad news etc  Professionalism when discussing ethical issues etc
  • 37.
    The Competency StructuredPresentation (CSP)  Classically and for educational purposes both undergraduates and postgraduates present clinical topics in a narrative or case-based style.  In both of these, classic headings that are used include definitions, etiology, epidemiology, clinical presentation, differential diagnosis, investigations, therapy and prognosis etc.
  • 38.
    The Competency StructuredPresentation (CSP)  These formats of presentation do not explicitly emphasize the new domains of knowledge or skills necessary for both quality of care as outlined above or empower the trainees with all the competencies outlined by CanMeds or similar bodies for a comprehensive outcome-based training and patient care.
  • 39.
    The Competency StructuredPresentation (CSP)  Topic heading are now deliberately portrayed under competency headings.  Presumably, this conceptual framework or map would assist in realizing a more competency-directed clinical training and decision making and in drafting a comprehensive, high- quality management plan for every patient.  Practical patient-centered care actions and interventions may thus be incorporated in the clinical decision process.
  • 40.
    Competency Structured Topic Presentation Bronchial Asthma Medical Expert History & Physical Exam  Essential Technical Skills (Pulse Oximetry, Peak Flow meter Recording, Use of Inhaler Devices etc)  Essential Investigations/Imaging  Emergency Medical Interventions  Monitoring Response to Treatment  Discharge Planning/Criteria for Discharge Communicator  Presentation Skills Feedback  Counseling skills/ Breaking bad news Collaborator  Essential Consultations & Referrals e.g. Pulmonology, Pulmonary Educator, Allergologist etc This Novel Method of Presentation may assist in realizing a more competency- directed clinical training and decision-making process, and in drafting a comprehensive, high-quality management plan for every patient.
  • 41.
    Competency Structured Topic Presentation Bronchial Asthma Advocate Essential Educational input regarding Asthma and its treatment, Self-management Plans etc  Risk Factors Counseling e.g. smoking, allergens  Referral to Patients’ Friends Societies & Support Groups Leader  Interventions to reduce Cost of care/Length of stay  Quality Indicators/Audit of Asthma care  Economic Comparisons of various interventions Scholar  Evidence-based resources for Asthma guidelines, protocols  Asthma Societies Websites  Update on new studies on Asthma Professional  Ethical challenges in Asthma e.g. Intubation or not, Unorthodox treatments, Refusing steroid therapy etc
  • 42.
    3. Competency Structured Morning Meeting Hassan IS,Kuriry H, Al Ansari L, Al-Khathami A, Al-Qahtani M, Al-Anazi T, Faroqui, M, Al-Jahdali H. Competency-Structured Case Discussion in the Morning Meeting: Enhancing CanMeds Integration in Daily Practice. Adv Med Educ Pract. 2015;20;6:353-8.
  • 43.
    The CanMeds WardRound! • 12 Yr old, was admitted with an exacerbation of Bronchial Asthma- a new diagnosis. • CanMed Ward Round: Resident Training –As a medical expert: were the H & P up to CanMeds standard-structured, comprehensive, relevant etc. –As a Communicator: Presentation skill? Body-Language? How did he/she convey the news to the family? Empathy & support? –As a Collaborator: Were the necessary referrals appropriate and professionally arranged?
  • 44.
    • 12 Yrold, was admitted with an exacerbation of Bronchial Asthma- a new diagnosis. • CanMed Ward Round: Resident Training – As a Leader: Time and resource utilization are appropriate? – As Health Advocate: Any arrangements with social and other healthcare facilities? – As a Scholar: Literature searching exercise on the options of care and preventive strategies for this particular patient. – As a Professional: Attitude and behavior observation, discussion of the ethical issues re-steroid therapy etc Case Scenario….The CanMeds Way!
  • 45.
    End-of-Rotation Competency AppraisalForm (ERCA).  Resident is requested to: 1. Select specific patient care issues 2. Itemize them and 3. Illustrate the selected CanMEDS competency intervention that was used to deal with each of them.
  • 46.
    End-of-Rotation Competency AppraisalForm (ERCA).  An example courtesy of Dr Raed Al Enazi R1.
  • 47.
    Patient Diagnosis & MRN orWork- related Difficulty Competency Reason(s) for selecting this specific patient/problem Suggested Specific Competency Input(s)/Action(s) to incorporate for the selected patient/problem Recommendations for future use in other similar patients/problems if applicable Deteriorating level of consciousness Medical Expert Patient with prolonged INR (>9), LVF, CKD, DM. septic foot ulcer: many possible reasons! Using the 3Rs to diagnose the cause: Rules of Thumb, Red Flags, Rule-out-worst Scenario Use a bed-side check-list for patients whose level of consciousness deteriorates during their in-patient stay. Advanced Cholangio- carcinoma Communicator Breaking bad news and discussing putting the patient no code with the family Using SPIKES mnemonic for breaking bad news Providing written material on what no-code means Involving Religious affairs department Policy and Procedure for NO Code patients with both Physician and Family educational inputs, written material etc
  • 48.
    Patient Diagnosis & MRNor Work- related Difficulty Competency Reason(s) for selecting this specific patient/problem Suggested Specific Competency Input(s)/Action(s) to incorporate for the selected patient/problem Recommendations for future use in other similar patients/problems if applicable Elderly patient with dementia, Parkinsonism, and bed-bound. Admitted with aspiration pneumonia. Collaborator Patient refusing discharge (2 months in the hospital) Multidisciplinary meeting inclusive of MRP, HHC, neurology, social services and family Earlier involvement of care givers in the discharge process/discharge planning. 17 year old female patient with acute sickle cell crisis and acute chest syndrome Health Advocate Patient due to get married Educating patient on her disease Preventative interventions including vaccination Pre-marital counseling and husband screening for genetic Hospital wide genetic disease patient and family education support team, procedure and policy
  • 49.
    Patient Diagnosis & MRN orWork- related Difficulty Competency Reason(s) for selecting this specific patient/problem Suggested Specific Competency Input(s)/Action(s) to incorporate for the selected patient/problem Recommendations for future use in other similar patients/problems if applicable Ward-round Time Leader Ward round taking too long Time management skills Use Lean system to make work more efficient (study areas of time wastage) Develop a policy/procedure to Re- organize the ward round Diuretic Resistant fluid overload Scholar How to manage such patients? Literature searching for best available evidence for dealing with this problem. Patient is unhappy with the provided medical care. Professiona l Physician-patient- family conflict with its negative impact on patient care MRP-Family conference Involving trustworthy Colleagues Involving patient relations department Policy-procedure for conflict resolution
  • 50.
    Using CanMEDS headingsin Journal Club: Competencies Used  Scholar  Communicator (PPT Presentation)  Professional  Leader
  • 51.
    Competency Guide: MedicalExpert 1. Hypothesis-Driven History Taking and Physical Examination. 2. Detailed Problem-List for comprehensive care inputs 3. Use of Calculators and Scoring Tools for decision-making e.g. BMI Calculator, CURB-65, Well’s Score for PE risk, Creatinine Clearance, NIH Stroke Score, Bode Score for COPD survival prediction, Ranson’s Score etc. UpToDate has a huge collection.
  • 52.
    Competency Guide: MedicalExpert  4. Patient- and Family Centered management decisions e.g. use of decision-aids.  5. Using the BESD and 5S for comprehensive immediate diagnostic and therapeutic input.  6. Avoiding Cognitive Biases Skills: DD Scheme, Rules of Thumb, Ruling out worst scenario, ROWS, Red Flags etc.  7. Procedural skills-: CanMEDS Technical Skills Round/Simulation Lab: e.g. Lumbar Puncture, Ascitic Tap etc.
  • 53.
    Competency Guide: Communicator Documentation: H&P, SOAP, SBAR/I-PASS Handover, Discharge Summary, Medical Report etc.  Consultation Referrals-using SBAR/I-PASS  Counseling Skills, Dealing with angry clients, Breaking Bad News, Disclosure of Error  Motivational and Therapeutic Communication  Presentations in meetings, committees, conferences etc.
  • 54.
  • 55.
    The CanMEDS Sub-committee Importantand worthwhile achievements Novel models: opportunity for educational research Ahead of other Departments ?
  • 56.
    Competency Training Administration Senior Health Staff Patients Junior Health Staff WhoNeeds Competency –based Training: All who pass through the Health Facility!!!
  • 57.
    CBME in Summary Gettingtheory into practice Is a Complex but Achievable Task Collective Effort Organizational and Individual Responsibilities Patient Right
  • 58.
    ‫تعالى‬ ‫هللا‬ ‫رضي‬‫عائشة‬ ‫عن‬ ‫قالت‬ ‫عنها‬:‫هللا‬ ‫رسول‬ ‫قال‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬"‫إن‬ ‫أحدكم‬ ‫عمل‬ ‫إذا‬ ‫يحب‬ ‫هللا‬ ‫يتقنه‬ ‫أن‬ ً‫ال‬‫عم‬"