Cristina Cabrera-Muffly, MD, associate professor and residency program director at the department of otolaryngology–head and neck surgery at the University of Colorado Anschutz Medical Campus, noted that one of the goals of the ACGME’s revised Milestones 2.0 is to better define competency within otolaryngology residency training. “There has definitely been a push for medical schools to incorporate EPAs into their curriculum, but specific EPAs haven’t been implemented for our specialty,” she said. Dr. Cabrera-Muffly suggested that the content for competency-based training should be managed by ACGME for residency programs, likely in combination with the Residency Review Committee and the Otolaryngology Program Directors Organization.
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December 2022Catching Up in the United States
When it comes to otolaryngology, Europe and Canada are further along with EPA/CBME than the United States. Programs in Canada have been performing CBME, usually referred to there as competence by design, for some time.
“This international experience may provide a foundation for ongoing efforts in the U.S. Learning from the experience of international colleagues can not only spare us reinventing the wheel but can afford us opportunities for future collaboration,” said Dr. Brenner. “Although thought leaders in otolaryngology in the U.S. are taking a growing interest in this area, relatively few individuals have built a professional focus around leading change through implementation of EPAs in our field. Our specialty can also learn from translatable experiences in medicine, general surgery, and other fields that are exploring EPAs. In some cases, there may even be significant overlap, as with the examples of endocrine surgery or tracheostomy where resources are already being refined.”
EPAs are currently used in medical school curriculum. “There has been discussion in graduate medical education regarding the need for similar constructs. The impact of COVID-19 on training has expedited and facilitated the conversation,” Dr. Malekzadeh said. In the United States, some specialties are starting to explore and incorporate EPAs into the residency curriculum. The American Board of Surgery has implemented a pilot study to explore how this might look in general surgery. “Simulation is another way to assess competency and is being used for not just residency training but also for board certification in other specialties,” Dr. Malekzadeh explained.
The main goal is to remove the subjective component and have a clear and reproducible way to assess and document competency, which eliminates potential bias. —Richard V. Smith, MD
She also noted that while EPA/CBME isn’t very widespread in the United States currently, it is on the rise. The Society of University Otolaryngologists is exploring a national curriculum that could incorporate the concepts of CBME. “It’s very likely that this type of education will be added to residencies nationwide, as we understand the limitations of the current system,” she said. Dr. Malekzadeh added, however, that it will be an intensive effort for each specialty to develop a knowledge base that allows progressive responsibilities for patients.