Alignment of Learning Objectives in Canadian Plastic Surgery Residency Programs

Competence by Design (CBD) is a model of medical education developed by the Royal College of Physicians and Surgeons of Canada. CBD emphasizes an outcomes-based approach to residency training, replacing traditional models of time-based training. CBD focuses on the achievement of Entrustable Professional Activities (EPAs), which are key tasks of a discipline. Misalignment of educational priorities between teachers and learners can negatively impact learning and quality of care. This study aims to compare the learning priorities of plastic surgery residents and attendings, as well as explore perceptions of CBD.

An online survey was administered to plastic surgery residents and attendings identified via the Canadian Society of Plastic Surgeons mailing list. Participants ranked milestones by learning priority using a 5-point Likert scale. Participants were also asked their opinions on CBD, and responses were analyzed thematically.

A total of 76 participants (25 residents and 51 attendings) responded to the survey (15% response rate). Residents ranked gathering a relevant clinical history as less important than attendings (odds ratio = 0.38, 95% confidence interval 0.14-0.98, P = .049). Residents and attendings had comparable rankings for the other 18 EPA milestones. Thematic analysis revealed that while CBD is perceived to have benefits for trainees, concerns pertain to excessive administrative burden and subjective evaluation. There was also inconsistency in the way EPAs are utilized by attendings with regard to when they were initiated/completed and how milestones were scored.

Overall, this exploratory study showed good concordance between resident and attending plastic surgeon prioritization of EPA milestones. Perceived benefits and limitations of CBD in plastic surgery are similar to those reported in other specialties. Many attendings have knowledge gaps in the implementation of EPA evaluations.