Redefining our postgraduate training model with Competency by Design

2018-19 was a watershed year for the Psychiatry Department’s implementation of the new Competency by Design (CBD) model of resident training. Focused on measurable outcomes, CBD is based on a framework of predefined competencies to improve resident learning and assessment. The Department has been implementing CBD over the last few years, starting with a small group of residents paving the way through the pilot program, while their peers study in the traditional model of training. 2018-19 saw the first full cohort of PGY1s experience CBD.

The logistical challenges of revamping an entire training model are significant. The entire, five-year curriculum had to be mapped, including the program’s many diverse rotations and over 350 lectures. Faculty faced challenges as they adapted to shorter rotations and familiarized themselves with the new assessment processes.

CBD organizes training into stages, providing guidance for teaching and learning at each stage. The competency stages are assessed using a series of entrustable professional activities (EPAs) which are comprised of measureable milestones. Residents must demonstrate competence on EPAs to progress through their stages of training. This approach provides more opportunities for self-assessment and improvement, while ensuring that residents advance at a pace that matches their development.

To help residents navigate the new assessment process, faculty coaches were introduced this year. Each resident is matched with a faculty member who serves as their coach, meeting with them every 2 months. Their coach works with them to review their EPAs and other assessment results, helps them develop a learning plan to target areas that may need work, and can arrange additional learning experiences in areas where they’re excelling. This type of close relationship is key to the CBD method and allows residents to directly benefit from their coach’s experience.

Dr. Hamza Riaz, who recently completed his PGY1 residency, has served as the resident CBD rep for the past year. He says that being included in the CBD implementation process has been inspiring, as has collaborating with the faculty members involved in the process.

“You get a sense that everyone involved genuinely wants to improve learning. We’ve got a big residency program, and issues are inevitable when making this kind of change, but we’re working together to address them quickly as they come up.”

In 2023, Riaz’s cohort will complete their residency having experienced five full years of CBD. While those years will likely have their fair share of challenges for residents and faculty alike, the result will be better education for residents and better care for patients.