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Tensions in describing competency-based medical education: a study of Canadian key opinion leaders

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Abstract

The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.

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Acknowledgements

Dr. Ginsburg holds a Canada Research Chair in Health Professions Education.

Author information

Authors and Affiliations

  1. Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada

    Jonathan Sherbino

  2. Centre for Health Education Scholarship and Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Glenn Regehr

  3. Division of Innovation and Education, Department of Medicine, McMaster University, Hamilton, Canada

    Kelly Dore

  4. Department of Medicine, Wilson Centre for Research in Education, University of Toronto, Toronto, Canada

    Shiphra Ginsburg

  5. David Braley Health Science Centre, Rm 5003, 1280 Main St W., Hamilton, ON, L8S 4K1, Canada

    Jonathan Sherbino

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  1. Jonathan Sherbino
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  4. Shiphra Ginsburg
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Correspondence to Jonathan Sherbino.

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Appendix: Interview guide

Appendix: Interview guide

CBME is a term that often gets used (and misused) in many ways. We are interested in your understanding of CBME, specific to the Canadian medical education context. In the next half hour, you will talk about three themes: the philosophies, principles and practices related to CBME.

Question 1: PHILOSOPHY

I am going to start by asking about your philosophy of CBME. By philosophy, I mean theory or conceptual framework.

  • What do you believe are the philosophies that should inform CBME?

    • Does your description align with what the philosophies that inform CBME curricula as developed by the Royal College or CFPC? In what ways does it differ, if at all?

    • What are the core problems with the traditional medical education system that CBME is trying to solve?

    • Do the philosophies that support Royal College or CFPC CBME curricula align with the problems they are trying to solve?

    • Can you describe alternative educational philosophies that may better address the problems in our traditional education system?

      • Why do you think they would be better?

Question 2: Principle

Now let’s talk about principles of CBME. When I refer to the principles, I mean the core components of CBME or the link between the philosophy and its application (i.e., practice). For example, a principle of PBL is self-guided study connecting the philosophy of learning by discovery with the practice of small group tutorials.

  • What are the key principles underlying or supporting your philosophy of CBME?

  • What principles do you think are currently missing in the current model of CBME?

  • Are there assumptions built into these principles that make them susceptible to failure (e.g., sociological, cognitive and learning traits of humans)

Question 3: Practice

Finally, let’s talk about the practices that inform CBME. When I say practice, I am referring to the application or use of an idea or belief. How does an organization operationalize / make CBME principles work.

  • If CBME principles were poorly enacted, what bad set of education practices would you see?

    • Across learners, preceptors, and administrators?

  • Recognizing that CBME will be implemented in different contexts and learning environments, what do the ideal set of practices like look? (By ideal I mean unlimited budget, no operational constraints.)

Question 4: SNOWBALL

Who else would you recommend I interview? Who are thought leaders in the design and/or scholarship of CBME?

Question 5: CONCLUSION

Lastly, is there anything else you want to share with me?

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Sherbino, J., Regehr, G., Dore, K. et al. Tensions in describing competency-based medical education: a study of Canadian key opinion leaders. Adv in Health Sci Educ 26, 1277–1289 (2021). https://doi.org/10.1007/s10459-021-10049-8

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