Including patients and caregivers in assessment in the pediatric competence by design curriculum: A national consensus study

Abstract

Although evidence supports diverse assessment strategies, including patient/caregiver involvement in Competency-Based Medical Education (CBME), few residency programs formally include patients/caregivers in assessment. We aimed to determine the milestones for which patient/caregiver inclusion would be valuable in the Canadian Pediatric Competence By Design (CBD) curriculum.

Program directors from 17 Canadian pediatric residency programs were invited to participate in a Delphi study. This Delphi included 209 milestones selected by the study team from the 320 milestones of the draft pediatric CBD curriculum available at the time of the study. In round 1, 16 participants representing 13 institutions rated the value of including patients/caregivers in the assessment of each milestone using a 4-point scale. We obtained consensus for 150 milestones, leaving 59 for re-exposure. In round 2, 14/16 participants rated remaining items without consensus. Overall, 67 milestones met consensus for ‘valuable,’ of which 11 met consensus for ‘extremely valuable.’ The majority of these milestones related to communication skills.

Patient/caregiver assessment is valuable for 21% of milestones in the draft pediatric CBD curriculum, predominantly those relating to communication skills. This confirms the perceived importance of patient/caregiver assessment of trainees in CBME curricula; formal inclusion may be considered. Future directions could include exploring patients/caregivers’ perspectives of their roles in assessment in CBD.

Keywords:

• Assessment
• postgraduate
• medical education research
• work-based
• Communication skills

Acknowledgements

We sincerely thank the Canadian Pediatric Program Directors group and Tyrus Crawford (CHEO Clinical Research Unit REDCap Administrator).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

CanMEDS 2015 Physician Competency Framework (CanMEDS): CanMEDS is a framework for improving patient care by enhancing physician training. Its main purpose is to define the necessary competencies for all areas of medical practice and provide a comprehensive foundation for medical education and practice in Canada (Frank et al. 2015; Royal College of Physicians and Surgeons of Canada 2016).

Competency-based medical education (CBME): An outcomes based approach to the design, implementation, assessment, and evaluation of a medical education program using an organizing framework of competencies (Royal College of Physicians and Surgeons of Canada 2016).

Competence by Design (CBD): A transformational change initiative designed to enhance CBME in residency training and specialty practice in Canada (Royal College of Physicians and Surgeons of Canada 2016).

Entrustable professional activity (EPA): A key task of a discipline that an individual can be trusted to perform without direct supervision in a given health care context, once sufficient competence has been demonstrated (Royal College of Physicians and Surgeons of Canada 2016).

Milestone: The expected ability of a health care professional at a stage of expertise (Royal College of Physicians and Surgeons of Canada 2016).

Additional information

Funding

This project was kindly funded by the CHEO Research Institute Resident Research Grant.

Notes on contributors

Ashlee Yang

Ashlee Yang, MD, FRCPC, was a pediatrics resident at the University of Ottawa/CHEO at the time of this study. She is currently a pediatric endocrinologist and Clinical Instructor, Department of Pediatrics, University of British Columbia and BC Children’s Hospital.

Dennis Newhook

Dennis Newhook, MA, is a Research Analyst, Clinical Research Unit, CHEO Research Institute.

Stephanie Sutherland

Stephanie Sutherland, PhD, is a Research Methodologist, Clinical Research Unit, CHEO Research Institute.

Katherine Moreau

Katherine Moreau, PhD, is an Associate Professor, Faculty of Education, University of Ottawa.

Kaylee Eady

Kaylee Eady, PhD, is an Assistant Professor, Faculty of Education, University of Ottawa.

Nick Barrowman

Nick Barrowman, PhD, is a Senior Statistician, Clinical Research Unit, CHEO Research Institute.

Hilary Writer

Hilary Writer, MD, FRCPC, is a pediatric critical care physician, Assistant Professor and Vice Chair Education, Department of Pediatrics, University of Ottawa and CHEO.