Critical Analysis of a Pedagogical Paradigm Shift in Medical Residency in Québec

Medical progress over the past two centuries essentially took place because medicine became increasingly grounded \nin scientific research, reflecting reverence for rigour, rationality, scientific method, and evidence. In the early \n20th century, the Flexner report (1910) led to this decisive momentum being driven even more rapidly. \nCentral to this history is the content of learning, but also the pedagogical framework of the training aimed at \nthe learning of that content. In the 21st century, the learning content of medical training is clearly on the side of \nevidence and rigour. But what of the pedagogical framework of medical training and, in the case at hand, medical \nresidency? \n \nIn 2009, the University of Toronto piloted a pedagogical approach in medical residency developed by the Royal \nCollege of Physicians and Surgeons of Canada (RCPSC) entitled Competence by Design (CBD). \nCBD is a direct descendant of competency-based education (CBE), a pedagogical movement launched in the \nUnited States in the wake of the Soviets’ Sputnik satellite, which was sent into orbit in 1957. Today, the CBE \ntrend is to be found in general education (elementary, secondary, and postsecondary), vocational education, and \nmedical education. \n \nOn what theoretical framework is the RCPSC’s CBE (CBD) based? Was this framework scientifically validated, \nwholly or partially? \n \nThe following pages maintain that the RCPSC’s CBE did not follow an exemplary, rigorous process and is not \nbased on evidence from scientific research, in either general pedagogy or medical education. More specifically, \nwe assert that the Canadian and Québec medical world, in adopting the RCPSC’s CBE, has moved away from \nthe evidence, necessary rigour, and conscientious caution it usually shows with regard to medical innovations. \nAs we move forward in this text, we also briefly examine the effectiveness of CBE’s sometimes co-occurring \npedagogical methods that can also provide at least a partial alternative to traditional residency and CBE applied \nto residency (e.g., technology-enhanced simulation, standardized patients, deliberate practice, mastery learning, \nand competency-based progression).

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