Training Better Doctors Through CBME

CBME is an outcomes-based approach to medical education, which has replaced an outdated time-based approach.¹ [CanadiEM, pg 2]The goal of CBME is to create physicians who are able to meet the needs of today’s complex healthcare environment where healthcare systems and patient care needs are changing dramatically.² [Ross, pg 1,2] It is a flexible and modern style of learning that has greatly benefited the Canadian health care system during the COVID-19 pandemic, as outlined in a previous post.

CBME focuses on four foundations:¹ [CanadiEM, pg 2]

• Focusing education on patient outcomes
• Emphasizing learner abilities
• De-emphasizing time-based learning
• Increasing individualized trainee plans for the learner

 Residents are more closely monitored and assessed by faculty—they progress once they have demonstrated competency.³ [Queen’s University_Better training, pg 1]

 The Benefits of CBME for Residents

CBME takes advantage of technology, allowing for an improved educational experience for residents in many ways:⁴ [Queen’s University_How CBME Works, pg 3]

• Individualized Learning: Residents will receive more supervision, assessment, and mentorship
• Increased Flexibility: Residents who are moving at an accelerated pace have the ability to explore electives and research
• Innovative Assessments: New electronic assessment systems featuring personalized portfolios, competency-based assessment tools, and increased frequency of assessments
• Meaningful Feedback: Residents will get real-time feedback utilizing mobile technology
• Preparedness for Practice: It is anticipated that residents will sit for their final examinations six months to one year earlier than usual

“CBME has also allowed me to target specific skills most relevant to my chosen career path. For example, knowing that I want to become a palliative care specialist, one of my supervisors sought opportunities to evaluate me and provide feedback on specific skills related to the specialty." – Dr. Julia Tai, Internal Medicine resident³ [Queen’s University_Better training, pg 3]

The Benefits of CBME for Patients⁵ [Queen’s University_What does CBME mean to you?, pg 1,2]

• Patient-centered care: Resident training is much more focused on patient care
• Resident assessments: The patient may be able to contribute to their resident’s assessments
• Physician accountability: Greater accountability for patient care due to improved documentation and real-time assessments

The Benefits of CBME for Faculty⁵ [Queen’s University_What does CBME mean to you?, pg 2]

• Real-time assessments: Resident’s are assessed real-time during clinic
• Learner-driven: Assessments and summary reports allow residents to take responsibility for their own progress
• Well-defined learning outcomes: Entrustable professional activities and milestones provide discrete markers of competence
• Focus on observable competencies: Achieving milestones is a measure of progress and a lack of achieving specific milestones allows faculty to focus on the area where help is needed

"As doctors ourselves, we want to ensure future doctors receive the best possible training and ensure their patients receive the best possible care. We recognized that this training model would increase transparency and accountability for our residents, and situate our school and our faculty members as Canadian and international leaders in medical education. Now that it is launched, we are in a position to help other schools make the same transition.” – Richard Reznick, Dean of the Faculty of Health Sciences, Queen’s University3 [Queen’s University_Better training, pg 2]

The Benefits of CBME for Society⁵ [Queen’s University_What does CBME mean to you?, pg 2]

• Better served: Fulfills medicine’s societal contract to serve patients and communities
• Better focus: Focus on skills such as professionalism, communication, and health advocacy
• Meets health care needs: Tightens gap between medical education, health care delivery, and societal health needs

Successful Implementation of CBME

In a recent case study, we discussed how some Canadian medical universities have successfully implemented CBME across all of their residency programs. One important factor was the use of a robust electronic platform. McMaster University, for example, opted to use the robust and flexible platform, Logibec MedSIS 3C – CBME. This electronic platform provided the following:

• An intuitive platform with a quick onboarding process
• An inclusive solution that worked for both the RCPSC and CFPC
• Real-time, automatic form building of all assessment forms based on templates. This allowed for instantaneous reporting of things such as: Learner Summary Reports, Stage Reports, EPA Summary Reports, EPA Milestone Reports, and other real-time reports
• A mobile interface that allowed for daily, direct observation. Instead of one assessment per block under the previous system, assessments could now be submitted daily via forms on the mobile interface, allowing for real-time CBME observations
• A single solution that worked for everyone, including residents, coaches, and competency committees. This allowed for a single source for all documentation, saving time and resources

This allowed McMaster University to successfully roll out CBME across the majority of their residency programs. Using their example, other programs and institutions can also make the transition as pain-free as possible.

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