Competence By Design

Our curriculum and assessment tools

The PM&R Residency Program is officially a hybrid program, with our PGY-1-2 residents being the formal CBD cohort, and the current PGY3-5 residents the traditional cohort. These distinctions are important only for rotation planning and the timing of the Royal College Exam. Within the program, all residents will be assessed using the same tools. All residents are expected to complete the assigned EPAs during clinical encounters for each rotation, and ITERs will continue to be filled out at the end of rotation.

** Faculty and residents should read through the updated CBD Curriculum Map and the list of EPAs and their specified details, in order to be familiar with expectations going forward. **

What are the major changes I need to know about?

The major change with the CBD curriculum is the introduction of "stages of training" for residents, rather than just progressing year to year. Residents will start in the "transition to discipline (TD)" stage, with expectations specific to their skill level. They will then progress through "foundations of discipline (FD)" followed by "core of discipline (CD)" stages, occurring from their PGY-1 through 4 years. The certification exam will occur at the end of 4th year (only for residents starting in 2020 and beyond - does not apply to any resident currently in program), and following the exam residents will complete an additional stage of "transition to practice (TP)". To facilitate this, increased measurement of objective performance is required, to allow for broad evaluation of how each resident is progressing. Although the formal stages and change in exam timing will not occur immediately, our goal is to implement many of the processes required to achieve this over the next year, and be able to support our teachers and our residents in this transition.

How do I score an EPA?

A foundation of the CBD philosophy is to judge each individual performance on its own, against a standard set of criteria rather than non-specific expectations. Residents are no longer scored as "meets expectations" or similar, and no longer compared to others in a similar year of training. Instead, we are asking clinical teachers to judge whether or not they would TRUST the learner to perform the task being observed. The following scale is now used for these bedside direct observations:

1. "I had to do" - Resident required complete guidance, did not do, or was not given opportunity to do

2. "I had to talk them through" - Resident able to perform task, but requires constant direction

3. "I had to prompt them from time to time" - Demonstrates some independence, but requires intermittent direction

4. "I needed to be in the room just in case" - Independence but unaware of risks and still requires supervision for safe practice

5. "I did not need to be there" - Complete independence (theoretically!), understands risks and performs safely, practice ready

It is expected that residents will score in the 1 - 3 range as they start to attempt the required tasks, and that through supervised practice and with coaching and feedback, they progress to the score of 4-5, signalling competence in the particular EPA.

The biggest difference for most faculty and residents with EPAs is the switch to the "Entrustment Scale". We are used to rating systems using anchors such as "meets expectations" or "above expectations" historically, and these anchors may still appear on some ITERs at the end of rotation. However, with each specific clinical encounter, the "Entrustment Scale" asks the supervisor, could you trust the resident to complete the specified task? For more information and some real world examples of how to apply this, click HERE for the Royal College Entrustability Scales module.

** Additional one-pager on scoring for case review discussions available here

Updated July 2020