An eye for competency

Dr Kunal Patel 21 Aug 2019
Image by Nathan DeFiesta

Emerging within the education space, particularly from a health perspective, is the use of competencies. You hear the word thrown about quite a bit and usually with no structure behind it. Some countries have used competency-based education for some time, others have not and it is only now being seen as a real option for training health workers. It is defined as Competency-based education, or in this case, Competency-Based Medical Education (CBME) and this means that defined objectives of individual educational programs are administered and evaluated through outcomes and associated milestones. These milestones are met throughout the programs and not necessarily at the end.

Canada has been utilizing CBME, however, the standards of which vary from school to school, discipline to discipline. Recently, work carried out by Danielle Wentzell in Calgary, looked at the implementation of CBME within ophthalmology residency programs across North America. Interestingly, in Canada, there has been a call for all ophthalmology residency programs to incorporate CBME by 2021. Can we say the same for other specialities in healthcare or even further, for other countries in the likes of Europe and beyond?

Though the review was more general than using any specific methodology, it did look at evidence between 1995 and 2018. This showed that there have been good plans or intentions in place for CBME but there have been barriers to its implementation. These were commonly cultural, institutional, and resource-related. Money talks, especially in North America and the US, and providing income and financial support for those involved in CBME is clearly seen as a factor and potential barrier. What this ultimately results in and should be expanded on in follow up work is a lack of a large, strong contingent of trainers who are competent in CBME. Additionally, when it came to assessment, the current ‘toolbox’ that allows for assessment does not currently meet the standards set for CBME.

On reflection, the authors discuss their own ophthalmology residency program at Queen’s, which is described as being the only CBME compliant program for ophthalmology in Canada. This example is worth the read but for comparison, I feel a more structured review is needed and not a general one.

Overall, this work is worth a look, as it highlights the barriers faced when it comes to implementing CBME and the current gaps. The Queen’s program is a good model to be inspired by, but as the authors state cultural barriers will always be faced and those barriers in Canada could be quite different to those in your own back yard.