Christopher Hudson
University of Ottawa
Background: Competency-based medical education (CBME) involves identifying the abilities required by physicians in their specialty and then designing curriculum to support the achievement and assessment of these specific competencies. The purpose of this study was to investigate whether a focused CBME curriculum would accelerate the development of foundational competencies for anesthesia residents.
Methods: The knowledge and skills of 11 residents who were 6 months into an anesthesiology CBME program were compared to those of 9 residents who were 18 months into a traditional training program (non-CBME) who had received six months of anesthesia training and 12 months of basic clinical training. The Anesthesia Knowledge Test (AKT)-1 was administered to all residents at the outset of training to determine baseline knowledge. Six (CBME) or 18 (non-CBME) months into their program, the residents underwent a multi-faceted assessment using the AKT-6, an 8 station Objective Structured Clinical Examination (OSCE; using checklists and global rating scales (GRS)), and the Clinical Case Assessment Tool (CCAT).
Results: AKT-1 scores were similar for CBME and non-CBME residents (57 vs. 52%; p=0.0869). The AKT-6 scores for CBME residents were significantly higher than for non-CBME residents (73% vs. 61%; p=0.0273). However, the improvement in scores (AKT-6 minus AKT-1) did not differ significantly between the two groups (14% v. 13%; p=0.4688). Non-CBME residents scored higher than CBME residents on the OSCE (GRS scores 4.9 v. 4.5, p=0.0163 and checklist scores 86.6% v. 79.0%, p=0.0302) and in all stages of the clinical encounter on the CCAT (pre-operative p=0.0002; intra-operative p=0.0097; and post-operative p=0.003).
Conclusion: CBME residents scored significantly higher on knowledge tests compared to non-CBME residents, while their clinical skills performance was significantly lower.
