Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system.
This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored.
In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender.
We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.
RéSUMé: OBJECTIF: La formation médicale fondée sur les compétences (FMFC) repose sur des évaluations fréquentes des stagiaires en milieu de travail, ce qui donne l’occasion de refléter les préjugés conscients et implicites dans ces évaluations. Notre objectif était d’examiner l’influence du genre des résident·es et des professeur·es sur les évaluations de la performance des résident·es au sein d’un système de FMFC. MéTHODE: Cette étude de cohorte rétrospective s’est déroulée d’août 2017 à janvier 2021 à l’aide des données d’évaluation des résident·es provenant de deux évaluations en milieu de travail : L’évaluation de l’anesthésie clinique par événement (ACEA – Anesthesia Clinical Encounter Assessment) et les Actes professionnels non supervisés (APNS). Des données autodéclarées sur le genre ont également été extraites. Le critère d’évaluation principal, soit les différences fondées sur le genre dans les cotes de confiance des résident·es sur l’ACEA et les APNS, a été évalué à l’aide d’une régression logistique à effets mixtes, les différences étant rapportées par les rapports de cotes et les intervalles de confiance (α = 0,01). Les différences fondées sur le genre dans la réception des commentaires en texte libre sur l’ACEA et les APNS ont également été explorées. RéSULTATS: Au total, 14 376 évaluations ACEA et 4467 évaluations APNS ont été analysées. Il n’y avait pas de différences significatives dans les cotes de confiance obtenues avec l’un ou l’autre des outils d’évaluation entre les résidents et les résidentes. Indépendamment du genre de la personne réalisant l’évaluation, les taux de confiance entre les résidentes et les résidents n’étaient pas significativement différents pour toutes les années de formation postdoctorale. De plus, les résident·es ont reçu des commentaires liés à leurs forces et leurs actes sur les deux évaluations à des fréquences comparables, quel que soit le genre du corps professoral. CONCLUSION: Nous n’avons constaté aucune différence fondée sur le genre dans les cotes de confiance telles qu’évaluées par les ACEA et les APNS, ce qui suggère une absence de préjugés genrés envers les résident·es au sein de ce système de FMFC. Compte tenu de l’hétérogénéité considérable en matière de clémence des évaluateurs et évaluatrices, les travaux futurs seraient plus fiables s’ils utilisaient des scores ajustés en fonction de ladite clémence plutôt que des scores bruts.

UNASSIGNED: the present study was designed to take a student\'s perception regarding the current dental education curriculum.
UNASSIGNED: A structured, pre-validated questionnaire made on Google Forms was shared amongst participants pursuing undergraduate dental program in a DCI recognized dental college via e-mail, Facebook or WhatsApp. The questionnaire consisted of questions about the admission procedure (5questions), curriculum design (12 questions) teaching methods (5 questions) and assessment (5 questions) methods. The respondents were divided into 2 focus groups; Pre-clinical: BDS first & second year students and Clinical: BDS third & fourth year students.
UNASSIGNED: The questionnaire was circulated amongst a total of 510 potential candidates, out of which 403 responded (response rate 79%). 48.4% (195/403) were from government dental colleges and 51.6% (206/403) were from private dental colleges. Preclinical group had 89 students (1st year = 27, 2nd year = 62) and clinical group 344 students (3rd year = 138, 4th year = 176). Students of both focus groups responded similarly to many questions relating to curriculum (need of syllabus revision, p = 0.912; horizontal/vertical integration, p = 0.076; and early clinical exposure p = 0.843), teaching methods (need of mixed teaching methods) and assessment methods (methods which are not based on quota-chasing p = 0.588). Statistically significant difference was seen to \"whether the students are able to retain or relate to the basic sciences subjects taught in first & second year\" (p < 0.0001).
UNASSIGNED: Students expressed a need for a horizontal & vertical integration of topics, frequent syllabus revision, Early Clinical Exposure, a mixed teaching method, and better assessment methods.

BACKGROUND: Mass chemical exposure emergencies are infrequent but can cause injury, illness, or loss of life for large numbers of victims. These emergencies can stretch and challenge the available resources of healthcare systems within the community. Political unrest in the Middle East, including chemical terrorist attacks against civilians in Syria and increasing chemical industry accidents, have highlighted the lack of hospital preparedness for chemical incidents in the region. This study aimed to evaluate the effectiveness of a course designed to empower frontline healthcare providers involved in mass casualty incidents with the basic knowledge and essential operational skills for mass chemical exposure incidents in Saudi Arabia.
METHODS: A mixed-methods approach was used to develop a blended learning, simulation enhanced, competency-based course for major chemical incidents for front line healthcare providers. The course was designed by experts from different disciplines (disaster medicine, poisoning / toxicology, and Hazard Material Threat - HAZMAT team) in four stages. The course was piloted over five days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia). The 41 participants were from different government health discipline sectors in the country. Pre- and post-tests were used to assess learner knowledge while debriefing sessions after the decontamination triage session and simulation-enhanced exercises were used for team performance assessment.
RESULTS: The overall knowledge scores were significantly higher in the post-test (69.47%) than the pre-test (46.3%). All four knowledge domains also had significant differences between pre- and post-test results. There were no differences in the pre and post-test scores for healthcare providers from the different health disciplines. A one-year post-event survey demonstrated that participants were satisfied with their knowledge retention. Interestingly, 38.3% had the opportunity to put this knowledge into practice in relation to mass chemical exposure incidents.
CONCLUSIONS: Delivering a foundation level competency-based blended learning course with enhanced simulation training in major chemical incidents for front line healthcare providers may improve their knowledge and skills in response to such incidents. This in turn can improve the level of national preparedness and staff availability and make a crucial difference in reducing the health impacts among victims.

Using simulation in high-stakes assessments has been evolving as a method to improve the assessment process. There is a concurrent need to address challenges and establish best practices to ensure the best quality when implementing high-stakes evaluations. The aim of this study is to provide an insight for stakeholders about using multiple modalities of simulation in high-stakes evaluations by presenting challenges, best practices, and future directions described in the relevant literature. A scoping review of original studies (from the year 1994-2021) including the use of common modalities (standardized patients, high-fidelity mannequins, part-task trainers, virtual simulation, and hybrid simulation) was conducted. The search covered the common databases: PubMed, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Initial screening in the databases resulted in 111,253 articles. After the application of a refining search strategy, 47 articles were included for comprehensive evaluation. Most articles were about credentialing/licensure purposes of assessment. Many articles were specialty-specific, especially focusing on anesthesia. Most challenges described were related to the validity of the assessment that should be considered in the planning phase. Best practices were mostly related to planning for measures to assure the validity of the assessment tools and process. The use of multimodality simulation for high-stakes assessment is growing despite challenges; this growth is associated with the accumulation of experience shared in literature. This growth will help to improve planning, practices, and goals achievement from such an application.

Medical education in India is undergoing a landmark transformation under the National Medical Commission implementing competency-based medical education (CBME). The CBME approach intends to ensure that medical graduates acquire the competencies needed to fulfill the health needs of the patient and society. This outcome-based approach shifts the focus from the traditional knowledge-based training to skill-based training valued on attitude, ethics, and communication (AETCOM) competencies. CBME thus aims to create medical professionals capable of providing holistic care with compassion and excellence embracing the global trends. The opportunity posed by the CBME should be utilized to sensitize and create interest among the learners about the science and scope of psychiatry. However, there are many challenges in the successful implementation of CBME, which have to be identified and addressed on time for serving the purpose. A basic tenet in CBME is to continue training until the desired competencies are achieved; in other words, to de-emphasize time-based learning. Moreover, the current COVID 19 pandemic is posing a significant influence on the execution of CBME implemented in August 2019. Online platforms could have several advantages in assisting the implementation of CBME; they provide an alternative to continue teaching-learning and assessment during these times and allow learners with the flexibility to learn at their own pace. In this article, we discuss the opportunities, including digital platforms and challenges to be overcame as well as the need for training the faculty toward assimilating the curriculum in the undergraduate psychiatric training.

UNASSIGNED: The Royal College of Physicians and Surgeons of Canada officially launched \'Competence by Design\' in July 2017, moving from time-based to outcomes-based training. Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will likely be required to adequately assess whether entrustable professional activities have been achieved.
UNASSIGNED: Characterize faculty and resident experiences of direct observation in a single paediatric residency program, pre-CBME implementation. Qualitatively describe participants\' perceived barriers and incentives to participating in direct observation.
UNASSIGNED: Surveys were sent to paediatric residents and faculty asking for demographics, the frequency of resident observation during an average 4-week rotation, perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data were analyzed. Institutional research ethics board approval was received.
UNASSIGNED: The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency FACULTY observed a resident take a history, perform a physical examination, or deliver a plan, the median faculty reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings. When asked the MINIMUM frequency for each domain, the median FACULTY and RESIDENT reply was 0, except for delivering a plan in the inpatient setting. Faculty reported observing seniors delivering the plan more frequently than junior residents. Faculty and resident median replies for how frequently residents should be observed for each domain were the same, three to four, three to four, and five to six times. Four per cent of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common barriers to observation were too many patients to see and both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if scheduled at the start of the rotation; faculty were provided a better tool for assessment; and if residents asked to be observed.
UNASSIGNED: This study provides baseline data on how infrequent faculty observation is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation competes with clinical service demands, but better scheduling strategies and assessment tools may help.

Interest in the field of Paediatric and Adolescent Gynaecology (PAG) has increased substantially over the last decade. Currently there is minimal consensus on how to interpret and validate professional experience, medical knowledge and surgical skills for doctors (accredited in Obstetrics and Gynaecology) who have an interest in and wish to achieve sub-specialisation in PAG. The challenge for the future of PAG is to create a framework of guidelines and references which in turn culminates in improvement and harmonisation in PAG healthcare delivery. The development of a post-specialty training curriculum in PAG for accredited practitioners was a logical next step after EBCOG introduced the PACT curriculum for OBGYN trainees. The guiding principle in the development of the PAG curriculum has been to strive for harmonisation in teaching and training in PAG within Europe. The new EURAPAG curriculum is divided in 17 chapters which in turn have been subdivided into medical and surgical sections plus a baseline skills section. The content has been determined through a consensus procedure amongst European gynaecologists and trainees. The medical chapters involve pathology that requires conservative treatment, prevention, education or lifestyle adjustment. The chapters that are both medical and surgical have a surgical (alternative) treatment ranging from vaginal procedures to advanced hysteroscopic and laparoscopic procedures and laparotomy. Currently, the framework for any medical education is workplace based competency training. Specific tools have been developed for workplace based assessments, such as direct observation (DO) of clinical task performance, Objective Structured Assessment of Technical Skills (OSATS), mini-clinical evaluation exercise (Mini-CEX) or case-based discussion (CBD). To measure progress in this PAG post-specialty training curriculum, the subspecialty trainee will be required to maintain and update a portfolio of experience and competency.

OBJECTIVE: In recent years there has been an increased emphasis on competency-based medical education (CBME) in Canada and internationally, as can be seen with the implementation of competency-based curriculums for postgraduate medical education (PGME) through the Royal College of Physicians and Surgeons of Canada. Currently, no Canada-wide consensus exists on educational competencies relating to diabetes in undergraduate medical education (UGME). Our aim in this study was to develop a list of competencies and objectives for UGME in diabetes using a modified Delphi method.
METHODS: Representatives involved in the development of the diabetes curriculum at all 17 medical schools across Canada were contacted. A draft list of competencies and objectives was developed by the research team using the existing curriculums at 9 Canadian medical schools and was organized using the CanMEDS framework. A Delphi method was used, with 2 iterations in order to reach consensus.
RESULTS: Twelve of 17 medical schools agreed to participate. Of the 12 surveys sent in the first round, 8 responses were received (response rate 66.7%). The revised version was then resent to the 8 respondents and 7 responses were received (response rate 87.5%). A list of 9 competencies and 62 objectives was finalized.
CONCLUSIONS: A competency-based consensus curriculum for diabetes education for undergraduate medical students was developed using a modified Delphi method. The final consensus syllabus will be disseminated across the country. This curriculum serves as a step in the transition to competency-based UGME and in ensuring that future medical school graduates are proficient in diabetes care.

UNASSIGNED: Little has been published about competency-based education in academic medicine, in particular how competencies are or should be assessed. This paper re-examines a competency-based assessment for M.S. students in clinical research, and \"assesses the assessment\" 4 years into its implementation.
UNASSIGNED: Data were gathered from student surveys and interviews with program advisors, and common themes were identified. We then made refinements to the assessment, and student surveys were administered to evaluate the impact of the changes.
UNASSIGNED: Research results suggested the need to improve communication, time the assessment to align with skills development and opportunities for planning, streamline, and clarify expectations with examples and templates. After implementing these changes, data suggest that student satisfaction has improved without any reduction in academic rigor.
UNASSIGNED: The effective implementation of competency-based training in clinical and translational research requires the development of a scholarly literature on effective methods of assessment. This paper contributes to that nascent body of research.

BACKGROUND: Receiving feedback while in the clinical workplace is probably the most frequently voiced desire of students. In clinical learning environments, providing and seeking performance-relevant information is often difficult for both supervisors and students. The use of entrustable professional activities (EPAs) can help to improve student assessment within competency-based education. This study aimed to illustrate what students\' perceptions are of meaningful feedback viewed as conducive in preparing for performing EPA unsupervised.
METHODS: In a qualitative multicentre study we explored students\' perceptions on meaningful feedback related to EPAs in the clinical workplace. Focus groups were conducted in three different healthcare institutes. Based on concepts from the literature, the transcripts were coded, iteratively reduced and displayed.
RESULTS: Participants\' preferences regarding meaningful feedback on EPAs were quite similar, irrespective of their institution or type of clerkship. Participants explicitly mentioned that feedback on EPAs could come from a variety of sources. Feedback must come from a credible, trustworthy supervisor who knows the student well, be delivered in a safe environment and stress both strengths and points for improvement. The feedback should be provided immediately after the observed activity and include instructions for follow-up. Students would appreciate feedback that refers to their ability to act unsupervised.
CONCLUSIONS: There is abundant literature on how feedback should be provided, and what factors influence how feedback is sought by students. This study showed that students who are training to perform an EPA unsupervised have clear ideas about how, when and from whom feedback should be delivered.