Exploring Self-Regulation Among Surgical Residents During the Period of Competency-Based Medical Education Curricular Implementation

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Horniachek, Marisa
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CBME , Competency-Based Medical Education , Obstetrics and Gynecology , Surgical Residency , Post-graduate Medical Education , Self-Regulated Learning
Abstract
Introduction Competency based medical education (CBME) is being implemented in residency training programs across Canada. CBME, as opposed to a time-based model, involves the progression through residency based on attainment of competencies fundamental to practicing as an independent physician. The proposed advantages of CBME include greater accountability, a more learner-centered approach that allows students to progress at their own pace, and social relevance. In order to ensure that the proposed advantages of CMBE are being realized, the experiences of key stakeholders such as residents should be examined. This study uses the theoretical framework of self-regulated learning to explore the nature of self-regulation for residents in OBGYN during this period of curriculum change. Methods In this qualitative case study two residents who trained in the traditional residency curriculum participated in a focus group. Six residents who trained in the CBME curriculum participated in focus groups and three residents participated in individual interviews. Data was analyzed using a constant comparison analytic strategy. Open coding and an inductive approach were used to identify themes and develop the big ideas. Results Analysis of the responses from the non-CBME residents revealed that Senior OB/Gyn Residents demonstrate awareness of the complex and cyclical nature of their learning, and how SRL aspects are valuable. Constructive feedback with an overt personalized nature was perceived to be most helpful. The quality of feedback received from staff is critical to learning. For the CBME residents OB/GYN Residents are experienced learners who apply aspects of SRL, are aware of expectations and feel the need to adapt. Many facets of feedback were perceived to be incongruent or not inter-related. SRL is appreciated, but the increase in self-efficacy and feelings of independence is not felt to be consistently an outcome of CBME. Conclusion The two big ideas which emerged from this research are: the theoretical underpinnings and proposed benefits of CBME align with resident reported preferences for an education system which would aid in SRL, however, in this study the practical implementation of CBME has not consistently demonstrated these benefits. SRL provides insight into this discrepancy between proposed and actual practice.
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