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Mar 12, 2020

Dr. Roochi Arora, a medical oncology fellow at the Juravinski Cancer Center at McMaster University in Hamilton, Ontario discusses the promise and challenges of competency-based medical education, which has been widely adopted across Canada.  Educators believe this new paradigm in medical education will improve the quality of clinicians despite potential challenges. 

Transcript

ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Geraldine Carroll. In today's episode, we're discussing a new paradigm in medical education. It's called Competency Based Medical Education, also known as CBME. CBME has been widely adopted in medical oncology residency training programs across Canada and beyond. And educators believe this new learning and assessment approach will improve the quality of clinicians, despite potential challenges.

Joining me to discuss the promise and challenges of competency based medical education is Dr. Roochi Arora, a medical oncology fellow at Juravinski Cancer Center at McMaster University in Hamilton, Ontario. Dr. Arora reports no conflicts of interests relevant to this podcast, and full disclosures relating to all Daily News podcasts can be found on the episode pages. Dr. Arora, welcome to the ASCO Daily News Podcast.

Dr. Roochi Arora: Thanks so much for having me, Geraldine.

ASCO Daily News: Research presented at ASCO's annual meeting last year suggests that CBME improves trainee’s confidence and abilities. So, Dr. Arora, is this not happening in the traditional, time-based medical education model?

Dr. Roochi Arora: Well, I would say that the traditional, time-based model has been used for a number of years with very good success. And our Canadian medical education system has produced some excellent physicians over the years. However, there's definitely room for improvement. And given that our profession as physicians, we're a self-regulating body, CBME gives the opportunity for more accountability and more transparency when it comes to our postgraduate training. The purpose of it is really to improve the confidence we have in our trainees, our medical educators, and the public at large in the abilities of the physicians that are being trained in our system.

ASCO Daily News: Can you give me an example of how the tools and process of CBME had a positive outcome for both a trainee and the patient that he or she served?

Dr. Roochi Arora: Oh, definitely. I have a really good example of this, actually. So very recently a resident in our program was working in the clinic, and at the same time she was providing coverage for the chemotherapy suite.

So, while she was working in clinic, she was actually called to the chemotherapy suite to assess a patient because they had a reaction. So, the resident went upstairs, but the physician actually also went with her. And he watched the resident manage the reaction, and in real time the physician was then able to give her immediate feedback based on everything he'd observed and how she handled the entire encounter.

So, it was wonderful for her, the resident, not just for learning in the moment, but actually later as well. Because the physician later wrote her a reference letter and was able to comment on her excellent leadership and collaborative skills. And he actually described the example of when he watched her managing that reaction in the chemo suite.

And, of course, the patient benefited as well, because they had the resident managing them with direct oversight of that physician. And then the resident is now much more confident moving forward in her ability to manage future reactions that patients may have in the chemotherapy suite. And then this, in turn, increases the confidence that patients have in the abilities of the physicians that are being trained in our system.

ASCO Daily News: OK, so you're saying CBME is making both the trainee and the evaluator much more accountable in real time. Having more transparency is excellent, but this process does take more time. So, what do you say to those who are concerned about the extra time required for everyone involved in CBME and the extra cost involved?

Dr. Roochi Arora: Yeah. That's definitely a great point that you raise, and I think it's certainly something we can't ignore. CBME is definitely going to require some more resources, at the very least in the beginning as we get it off the ground. So, faculty members are going to need to be available to do direct observation and provide trainees with immediate feedback, and postgraduate programs will need to have academic coaches as well as a competency committee. And all of this, of course, is added on top of their existing clinical, administrative, research, and personal obligations.

So, I think CBME poses a lot of possible benefits and merits to trainees and to the public at large, but we do need to remember that we're still in the very early stages of acquiring evidence to support CBME as a better educational model compared to our traditional, classic time-based educational model. So, for that reason, I think it's very important for us to continue to study CBME moving forward to make sure that all of our efforts in launching it are fruitful, and that we're also troubleshooting along the way.

ASCO Daily News: So, looking ahead then, what lies ahead for CBME in Canada and elsewhere?

Dr. Roochi Arora: Well, I would say definitely in Canada, educators seem very hopeful that CBME is going to improve the quality of clinicians that are produced in our system, despite the potential challenges along the way. And the Royal College of Physicians and Surgeons of Canada is very supportive of further efforts to study the merits of CBME, as well as ways to better incorporate it into our educational system. The Royal College has done a number of things, such as offering educational research grants and funding to support further study and evidence development on CBME.

ASCO Daily News: Well, we'll be watching to see how CBME develops further in Canada and beyond. So, Dr. Arora, I want to thank you for joining me today on the ASCO Daily News Podcast.

Dr. Roochi Arora: Oh, well, thank you so much for having me.

ASCO Daily News: And thank you to our listeners for joining us for this episode of the Daily News Podcast. Please take a moment to rate and review us on Apple podcasts.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.