A Program in Transition: A Shifting Mind-set

To the Editor: Across Canada, residency programs are transitioning to competency-based medical education (CBME). In brief, CBME is an outcomes-based educational approach that will change the design, implementation, assessment, and evaluation of residency programs.1 Over the past year, we have provided a resident’s perspective for the redesign of our program’s curriculum as it transitions to CBME. In planning for the transition progresses, a challenging source of discussion has been how to facilitate the culture shift necessary for CBME-based learning and assessment. How do residents dissociate not being deemed competent from feeling a sense of personal failure? Learners and educators already find feedback challenging. Negative feedback is often viewed as failure, even when intended as constructive. In CBME, residents will aim to become “competent” in preestablished milestones. Yet, the expectation is that for most skills, residents will not achieve competency until later in their training. For CBME to succeed, residents must transition from perceiving feedback as a high-stakes process to, instead, viewing it as a continuous and essential part of achieving competency. Learners will have to adjust their expectations, and approach assessments as opportunities for growth rather than notifications of failure. The intention of the CBME framework, which relies on many low-stakes assessments, is that learners will use these assessments as opportunities to identify weaknesses, set learning goals, and then receive the tools needed to facilitate their learning. Educators will have to emphasize that specific feedback is not meant as a global reflection of a learner and be cognizant that feedback be given in a safe environment since “receiving feedback sits at the intersection of these two needs—our drive to learn and our longing for acceptance.”2 The opportunity to be involved in the CBME transition process has spurred us toward becoming intentional about our own learning, thoughtful of knowledge gaps, and inquisitive of feedback—accepting it modestly while being open to our own vulnerability. The transition to CBME is ongoing, and as it progresses, critical self-reflection by learners and educators alike to adapt their mind-sets and maintain a positive learning environment is essential for the success of not only trainees but also residency programs. Alanna Wong, MDSecond-year resident, University of Toronto Medicine, Royal College Emergency Resident Medicine Program, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-2421-5017. Niran Argintaru, MDFourth-year resident, University of Toronto Medicine, Royal College Emergency Resident Medicine Program, Toronto, Ontario, Canada; [email protected]; Twitter: @EMNiran; ORCID: http://orcid.org/0000-0002-4029-1231. First published online February 13, 2018

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