H. McFadgen1, J. Vernon1, K. Alibhai1, R. Brydges2, M. Louridas1 1University of Toronto, Division Of General Surgery, Toronto, Ontario, Canada 2University of Toronto, Temerty Faculty Of Medicine, Toronto, Ontario, Canada
Introduction:
Competency-Based Medical Education (CBME) is a novel framework that has been widely adopted across postgraduate medical education programs over the last decade. Reception of CBME has been variable, with early reports highlighting unanticipated challenges including increased workload and significant wellness impact on trainees. Perceptions of CBME among surgical trainees post-implementation have not been widely explored. The aim of this scoping review is to understand the advantages and disadvantages of CBME from the surgical trainees perspective and consider possible improvements.
Methods:
Medline, Embase, ERIC, and PsycINFO were systematically searched to identify articles discussing the perceptions of CBME in surgical training published prior to November 2023. Two reviewers independently screened eligible articles according to predefined inclusion criteria. Included articles were extracted and deductively coded by two independent reviewers to generate overarching themes. A realist approach was then used to develop programme theories by considering mechanisms acting within each theme.
Results:
Of the 1934 articles identified, 10 were included. Most explored CBME among general surgery (29%), otolaryngology (21%), and orthopedic surgery (21%) programs. The majority of papers were published in Canada (70%), with the remainder from the United States and United Kingdom. Thematic analysis revealed four key themes encompassing trainee perceptions of CBME: 1) Logistics of Implementation, 2) Educational Value, 3) Attitudes, and 4) Psychological Implications. Key advantages of CBME included the ability to create clear training objectives and increase feedback frequency. Identified disadvantages include the administrative burden of completing Entrustable Professional Activities (EPAs), increase in trainee stress levels, and lack of faculty buy-in and participation. Furthermore, EPAs were initiated primarily by residents and only after a self-perceived successful performance, limiting the ability to identify and support struggling learners. Narrative feedback included with EPAs was often delayed and generic, if provided at all. Based on the thematic analysis, five programme theories were developed (Table 1).
Conclusion:
Despite the theoretical benefits of CBME, this review has identified several unanticipated barriers to the uptake and continued use of CBME in surgical training. The detrimental effect on trainee wellbeing is most striking. Future research is required to elucidate the mechanisms within the implementation of CBME that have led to these findings, and explore possible solutions to ultimately inform the next iteration of CBME programs.