Implementation of competence committees during the transition to CBME in Canada: A national fidelity-focused evaluation

This study evaluated the fidelity of competence committee (CC) implementation in Canadian postgraduate specialist training programs during the transition to competency-based medical education (CBME).
A national survey of CC chairs was distributed to all CBME training programs in November 2019. Survey questions were derived from guiding documents published by the Royal College of Physicians and Surgeons of Canada reflecting intended processes and design.
Response rate was 39% (113/293) with representation from all eligible disciplines. Committee size ranged from 3 to 20 members, 42% of programs included external members, and 20% included a resident representative. Most programs (72%) reported that a primary review and synthesis of resident assessment data occurs prior to the meeting, with some data reviewed collectively during meetings. When determining entrustable professional activity (EPA) achievement, most programs followed the national specialty guidelines closely with some exceptions (53%). Documented concerns about professionalism, EPA narrative comments, and EPA entrustment scores were most highly weighted when determining resident progress decisions.
Heterogeneity in CC implementation likely reflects local adaptations, but may also explain some of the variable challenges faced by programs during the transition to CBME. Our results offer educational leaders important fidelity data that can help inform the larger evaluation and transformation of CBME.

本研究针对加拿大专科住院医师培训项目在向基于能力的医学教育（Competency-Based Medical Education, CBME）转型过程中的能力委员会（Competence Committee, CC）实施保真度开展评估。
2019年11月，研究团队向所有CBME培训项目发放了针对能力委员会主席的全国性调查问卷，问卷题目源自加拿大皇家内科与外科医师学院发布的指导文件，该文件明确了能力委员会的预设工作流程与架构设计。
本次调查的有效回收率为39%（113/293），覆盖全部符合资质的专科领域。各项目的能力委员会规模介于3至20人之间，其中42%的项目吸纳了外部委员，20%的项目配备了住院医师代表。多数项目（72%）表示，会在委员会会议前完成住院医师评估数据的初步梳理与整合，部分数据则会在会议期间进行集体审议。在判定住院医师的可委托专业活动（Entrustable Professional Activity, EPA）完成情况时，绝大多数项目严格遵循全国专科指南，仅53%的项目存在例外情形。在制定住院医师进度判定决策时，文档化的职业操守顾虑、EPA叙述性评价及EPA委托评分被赋予了最高权重。
能力委员会实施过程中的异质性，既可能反映了各地的本土化调整，也可部分解释各项目在向CBME转型期间面临的各类差异化挑战。本研究的结果可为教育管理者提供重要的实施保真度数据，助力CBME的整体评估与体系转型。