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Designing an Assessment Program for the Competency-based Era

Tim Dwyer

出版	University of Toronto, 2016
URL	http://books.google.com.hk/books?id=yxzKtwEACAAJ&hl=&source=gbs_api

註釋

Background The introduction of CBME at the University of Toronto division of orthopedics is an opportunity to examine the concepts of CBME. While much has been written about CBME's potential advantages and disadvantages, further research is required to support this new model of training. Aims The first aim was to develop and evaluate a program of performance-based, in-training assessment tools, covering the breadth of competencies including clinical skills, the intrinsic CanMEDS roles, and performance of technical procedures. The second aim was to use these assessments to examine the premise that all residents can achieve a minimal level of competency after a subspecialty rotation. Results The sports medicine OSCE and OSATS were used to assess clinical skills and performance of technical procedures respectively. Each of these assessment tools demonstrated a significant difference in performance between junior and senior residents, with many junior residents unable to achieve a minimal level of competence. As a result, a modified Angoff method of standard setting was used to set different pass marks for junior and senior residents when assessing clinical skills. Using simulation to assess resident performance of Entrustable Professional Activities, many junior residents were not able to achieve a minimal level of competency, despite having been previously deemed competent. Finally, an OSCE used to assess residents' application of the intrinsic CanMEDS roles demonstrated a significant difference in performance between resident groups depending on year of training. Conclusion The assessment tools used to assess clinical skills, intrinsic CanMEDS roles, and performance of technical procedures demonstrated sufficient evidence of validity for use in CBME. These assessments demonstrate that many junior residents are not able to achieve a minimal level of competence. These findings affect the fundamental concept of achieving competence before progression in CBME, and lend credibility to hybrid versions of CBME.