48 Evaluation without representation: Paediatric residents perspectives on CBME
Bibliographic record
Abstract
Abstract Background Paediatrics transitioned in 2021 to Competence By Design (CBD), a postgraduate education model spearheaded by the Royal College of Physicians and Surgeons of Canada (Royal College). CBD replaced a time-based training system with one based on competencies demonstrated through regular observations of trainee performance. Although intended to be learner-centered, resident voices have been underrepresented in CBD’s design. Objectives We sought to (1) understand how paediatric residents perceived CBD as impacting their education and evaluation, and (2) explore their ideas to improve its implementation. Design/Methods We compared three Canadian postgraduate paediatric residency programs. First, we reviewed Royal College and program-specific documents regarding CBD to understand local and national priorities for its implementation. Program directors and local education leads were then interviewed to understand local priorities and implementation practices at these programs. Lastly, we conducted interviews with paediatric residents that began residency the year that CBD was launched. We used reflexive, inductive analysis to analyze their perspectives on how CBD has affected their education and develop learner-informed recommendations for improvement. Results We interviewed six program directors and CBD leads. Identified programmatic benefits included improved trainee surveillance, facilitated curriculum change, and competency committees. Challenges included untrained faculty, workplace-based assessment tensions, and administrative burden on residents and staff. Subsequent interviews with ten paediatric residents demonstrated CBD as having limited benefit to their education, leading to a checklist mentality of EPA completion and disengagement with the CBD system. These perceptions were influenced by (1) administrative burden, (2) poor quality feedback from disengaged staff with limited coaching experience, and (3) a lack of collaborative communication between the residents, their programs, and the Royal College. Residents suggested improvements, including: decreasing the number of assessments to alleviate time burden on both residents and faculty; implementing formal coaching instruction for residents and staff; and improving dialogue between Royal College, competency committees, and residents and physician evaluators to build buy-in with the system and facilitate continuing process improvement. Conclusion If we are to effectively adapt postgraduate educational systems to equip learners with the skills to meet the needs of the societies they serve, centering resident voices in curricular revision is paramount to maximize learner buy-in, minimize unintended administrative burden, and guide the development of necessary institutional supports (e.g., formal coaching) to ensure successful system transformation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.054 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.009 | 0.008 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.002 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".