Competence by Design in Cardiac Surgery Resident Training: A Qualitative Thematic Analysis

A new training model known as "Competence by Design" (CBD) is centered on evaluating "entrustable professional activities" and "milestones" and it represents a paradigm change from time-based to outcome-based learning and evaluation. This study presents a qualitative quality assurance and improvement assessment of the current state of CBD in cardiac surgery training at a single center.

An initial questionnaire was distributed to three focus groups: educators, traditional-system trainees, and CBD trainees. Building on the questionnaire responses, in-depth interviews were conducted and qualitative thematic data analysis was performed to identify recurrent themes.

Thirteen participants were interviewed (6 educators and 7 residents, n = 4 traditional-system trainees and n = 3 CBD trainees). Thematic analysis generated 16 themes, including six major themes. CBD (1) promotes a more standardized approach to surgical training, (2) allows for more objective assessment of residents' progress, (3) encourages a focused approach to specific skill development, (4) comes with increased administrative workloads, (5) allows for early recognition of struggling or failing residents with documentation, and (6) presents challenges in understanding and implementation for both residents and educators.

To our knowledge, this is the first study to assess the benefits and pitfalls of CBD in a Canadian cardiac surgery training program with feedback from both educators and trainees. Our participants felt that CBD has value in providing more standardized training, more elaborate and well-documented assessments, more detailed and meaningful feedback, and outcome-based training focused on the acquisition of surgical skills despite increased administrative workloads. Our participants identified specific challenges involved in understanding and implementing the CBD model.