Our college and Competence by Design

As I had mentioned in my first blog of 2018, Competence by Design (CBD) is a key topic on my mind as we move forward with the strategic priorities of our college.

One of the changes in the ongoing reform of medical education is a shift towards Competency-Based Medical Education (CBME). CBD is a multi-year transformational change initiative aimed at implementing a CBME approach to delivery of residency training and specialty practice in Canada, led by the Royal College of Physicians and Surgeons of Canada. The underlying rationale is that physicians will be better equipped to meet evolving societal needs and to provide better patient care. CBME is an outcomes-based approach to education delivery where learners must demonstrate that they have acquired all competencies required for unsupervised practice of medicine. It ensures that both learning and assessment are focused and individualized.

Our residency programs have been adopting CBME in a phased manner. Family Medicine has been reforming its residency program since 1998, with a focus on workplace-based assessment and curriculum reform through triple C competency-based curriculum: comprehensive care and education; continuity of care and education; and centered in Family Medicine. Specialty training has been based upon competency framework(s). However, the formalization of the CBD initiative by the Royal College of Physicians and Surgeons of Canada is relatively recent.

Although not a paradigm shift, CBD comes with its own language and vocabulary, such as: entrustable professional activities – a key task of a discipline in a clinical setting that can be delegated to a resident who has demonstrated sufficient competence; milestones – a marker of an individual’s ability along a developmental continuum; competency – observable ability that develops through stages of expertise from novice to mastery; and other terms describing stages of development. The key change with this approach is an emphasis on direct observation and feedback. The preceptor’s role shifts to coaching (assessment for learning) from the earlier position of judgment requiring pass/fail decisions (assessment of learning).

The PGME unit, under the leadership of Associate Dean Dr. Anurag Saxena, is leading the implementation of CBD at the CoM using three guiding principles: collaborative endeavor, distributed leadership and change tailored to developmental readiness. Organization-wide ownership, including by our learners, is at the heart of CBD. The individualized approach to implementation for each residency program requires coordination of efforts, consistent stakeholder engagement and appropriate resources.

Lessons from earlier and ongoing implementation of triple-C curriculum in Family Medicine are particularly informative and I am glad to see these are being applied, along with involvement of our provincial head of Family Medicine, Dr. Kathy Lawrence, in CBD implementation for specialty programs. Fluid coordination between PGME and Faculty Development, led by Dr. Cathy MacLean, also positively reflects how we leverage our strengths in a strategic manner to achieve our goals. Our provincial heads are crucial to success in this implementation and I know they are involved at the outset in CBD implementation in their departments.

Anesthesiology was the first program at our institution to go live with CBD, doing so in July 2017. Being first out of the gate, this program has been instrumental in clearing the path for others to follow. Emergency Medicine, Nephrology and Surgical Foundations are preparing for a July 2018 launch.

I am aware of the challenges inherent in balancing innovation and creativity with delivery of results in a timely manner, and I’m confident that our PGME unit and residency programs will make this transition successfully. CBD implementation in our college is a fine example of integrating academic and administrative leadership in instituting change across our programs, and CBME offers an opportunity to evolve through reflection on our own practices in teaching and learning.



Next step: executing our strategy

Guest Blog by Sinead McGartland, Director of Planning and Projects

In the summer of 2017, with much of what was laid out in The Way Forward accomplished, our college began developing a new strategic plan. This was a time to unite and engage a large audience for input, design and approval of our 2017-2022 strategic plan. With more than 200 people participating, the process was very successful. We came together and proudly articulated why we exist and how we will deliver our plan—reiterated here to remind you. I also share with you information on what happens next.

Why do we exist?

Our vision is that we are leaders in improving the health and well-being of the people of Saskatchewan and the world.

How will we deliver?

As a socially accountable organization, we improve health through innovative and interdisciplinary research and education, leadership, community engagement, and the development of culturally competent, skilled clinicians and scientists. Collaborative and mutually beneficial partnerships with Indigenous peoples and communities are central to our mission.

What will we do?

We are confident that by focusing on seven priorities we will deliver on our mission: research, Indigenous health, health system alignment, social accountability and community engagement, faculty engagement, distributed medical education and quality education. We will also focus on enabling components, such as our people, processes and structures, to ensure our priorities are effectively supported.

How will we know we have accomplished our plan?

The final component is execution.

We need to find the right balance in delivering on each priority while supporting integration and opportunities for synergy across all initiatives. Our leadership team, through senior leadership council, is accountable for the progress of our entire plan. They are the plan’s executive sponsors, and will complete ‘wall walks’ to assess short-term progress as well as formal bi-annual progress checks, and will report outcomes to the college on an annual basis.

For each of our priorities, committing to clearly stated activities will move our high-level plan to a concrete and actionable plan. It’s been statistically shown that simply by writing and sharing our plan, we are 60 to 80 per cent more likely to deliver! Since the high-level strategic plan was shared with the college last spring, work has been completed across each strategic priority, including a vision statement for each, identified objectives, and activities sequenced over the five-year period. For each priority, key indicators that we track to demonstrate progress on delivering our plan are being identified.

At this stage, integration is critical to our success. Some of the specific activities that have been identified benefit other priority areas and some require the same people to complete the work.  Achieving the right balance of moving forward and integrating our work means we can comprehensively and confidently accomplish what we’ve agreed to in our 2017-2022 plan.

As we implement our CoM plan, we are also ensuring alignment with the university’s planning process. Our plan fits nicely into the U of S “weave” identified through its planning processes, where we are aligned with the core areas of curiosity, collaborations and communities.

Contribute to the objectives/activities under the CoM plan:

  • Share what you have been doing or plan to do that contributes to our plan priorities! Send a short paragraph to communications@usask.ca on your activity or achievement, which priority it contributes to, and how it contributes to that priority.
  • Join the many opportunities that will occur over the next few months to inform and influence the next iterations of the plan, including joining the dean for a wall walk to learn about our progress. Watch for more information!

The success of our strategy will come down to the strength of our execution—our past accomplishments tell us we are on the right path for a great future together!

“It is not truly a ‘shared vision’ until it connects with the personal visions of people throughout the organization.”  – Senge (1990)


Everyone can make a difference

I, like many, am still reeling over the outcome of the trial for the killing of Colten Boushie, which has dominated our news since Friday. I hope all our Indigenous students, residents, faculty, staff and patients know that your college supports you.

For me, the first shock was the use of peremptory challenge to eliminate anyone of Indigenous appearance from jury duty. As my wife had once served on a jury, I was familiar with this aspect of our criminal justice system, but it never occurred to me it could be used in such an openly racist manner here in Canada.

As I am in medicine and not law, I will make no further comment on the legal system. But this situation raises two questions for me.

First, what are we all doing this week, this month, and beyond to support Indigenous colleagues, learners, friends and patients? There is little doubt in my mind, if I was from any minority group that experienced this, my world would have changed on Friday night. It is incumbent on the non-Indigenous among us to reach out to our Indigenous community members and reaffirm our commitment to reconciliation and Indigenous health and well-being.

Second, as a part of the education, science and healthcare communities, what can we do to make things better, in response? As citizens we can take political action, and in our professional and learner roles, we can search for our own opportunities to make a positive change to the racism that still exists in our university and healthcare systems. As educators, we have a particular duty and opportunity, expressed by Senator Murray Sinclair, who identifies education as the key to reconciliation.

Our own actions can positively change the collective future of this province. We need to do this for our Indigenous colleagues and students and all members of our college. We need to acknowledge the hurt and anger and work toward a better society, one that is just and honourable. We need to create safe, respectful spaces to dialogue about racism. And we must respect, support and listen to Indigenous people as they make their voices heard.

Everyone can make a difference.