Mar 21, 2018
CBD Newsletter Introduction
Education
Many of you have already started and are participating in one of our CBD field tests - thank you! The feedback you’re providing will help improve the process for the groups that will follow. Later in the Newsletter, we’ll be hearing from some faculty and residents about their experience so far. For those of you who haven’t started yet, I’d like to tell you a lot about one of the major changes (and major advantages) of CBD – Workplace Based Assessment.
The focus on assessment in CBD is Entrustable Professional Activities (EPAs). These are tasks you and your residents do every day that your Royal College Specialty Committee has identified as key tasks of the discipline. Therefore, the focus is on assessing residents on these important tasks as you’re working together every day.
Some examples of EPAs are:
Internal Medicine EPA - Discharge Planning: This EPA focuses on formulating, communicating and implementing discharge plans for patients with common medical conditions from acute care settings. The supervisor reviews and discusses the discharge plan and documentation and directly observes the resident communicating the plan to the patient and family.
Nephrology EPA - Monitoring and providing medical management for patients with stable renal disease: This EPA includes patients with the full breadth of renal conditions and focuses on surveillance of renal function and the secondary prevention of renal deterioration. This will be observed in the outpatient setting.
A new concept in CBD is the formalization of entrustment. We already make entrustment decisions now. For example, at first, we may want residents to review every patient they see in the clinic. As time progresses, you will decide when they can see certain patients without immediate review as long as the case is discussed at some point in the clinic. We will now be asking you to make these types of decisions in an explicit, more formalized way when you assess the residents based on their performance. You will be asked to decide in an EPA assessment whether you will entrust them with the task. If they can perform the task independently, you’ve entrusted them. If not, you’ll need to spend some more time to coach them and provide feedback on what they need to do what they need to do to enable you to entrust them.
Your entrustment assessment, along with those of many another faculty, will be used by the Competence Committee (more about these in a future newsletter) to make the ultimate decision about where the trainee should be entrusted in that EPA.
Whatever your entrustment decision, a critical component of the process is providing the resident with some feedback on their performance. Again, this is something we already do when we work with residents. However, now the feedback will be documented to allow Competence Committees to assess a resident’s progress.
Frequent assessment of residents in authentic clinical settings as they perform key tasks of the disciplines, coupled with timely feedback, is one of the major enhancements that CBD has to offer. It will take time to adapt to this process. We will be offering guidance on how to use the electronic tools to perform these assessments and how to integrate them into your busy days.
A couple of key points to address concerns that we’ve heard: while some EPA assessments will require direct observations, it’s OK to do an assessment based on case discussions. You may also choose to directly observe one element of an EPA (e.g. the informed consent component of a Prescribing Chemotherapy EPA) and base the rest of your assessment on the case discussion. If time is especially limited you may focus your assessment that day on one or two key elements of the EPA and assess the other elements in a subsequent encounter. Ultimately all of this information will aid the Competence Committee in making data-driven decisions about the competence of our trainees.
