Competency based medical education (CBME) in CCFP(EM) programs

It is postulated that implementation of Competency by Design (CBD) in Royal College of Physicians and Surgeons of Canada (RCPSC) programs has helped enhanced skills programs in emergency medicine (CCFP(EM)) move towards a more competency-based residency. The objectives of the study were to identify major competency-based medical educational (CBME) components of CCFP(EM) programs across the country; and determine how programs are delivering these components.

After a rigorous development process (expert content development, and pilot testing), a survey questionnaire was administered to all 17 CCFP(EM) program directors using a modified Dillman technique. Questions were structured and framed using the core components framework of CBME. The final survey included a total of 44 questions under six sections.

There was a 100% response rate. Only 65% of programs currently map their program's curriculum to an explicit outcomes-based framework. All but one program plan to map their program's curriculum to Core Professional Activities that were released by the College of Family Physicians of Canada (CFPC) in May 2021. In 35% of programs, a curriculum is organized around developmental competencies that support resident progression. Individual coaches or a coaching team follow residents longitudinally in 65% of programs. In 81% of programs, the program meets with a resident at regular, pre-defined intervals to discuss their progression. In terms of assessment: data from direct observations are incorporated 94% of the time; 29% of programs have specific criteria for advancement; and all programs have a Competence Committee. With the introduction of CBD in RCPSC programs, 71% of program directors felt there was less understanding of the unique needs of CCFP(EM) residents.

This study summarizes the current state of CBME in CCFP(EM) programs. While many components of CBME are incorporated, further development and innovation is needed to fully adapt CBME to a 1-year training program.