Intended and Unintended Consequences: The Impact of Competence by Design Implementation on the Experiences of Trainees in a Pediatric Residency Program

Abstract

Background: Recent reports from Canadian academic institutions provide insights into the resident experience following Competence by Design (CBD) implementation and have suggested important unintended consequences, such as increased administrative burden. Since pediatric residency programs transitioned in July 2021, half of McMaster University’s Pediatric Residency Program residents were in competency-based medical education (CBME) streams in the 2022-2023 academic year, and half were in non-CBME streams. As a result, our objective was to compare the residents' experiences in these two streams for observation, feedback, assessment, and well-being and burnout. Methods: We studied resident physicians in the McMaster Pediatric Residency Program (n = 37 eligible residents), employing a two-phased quantitative sequential exploratory approach. In Phase 1, residents used electronic journals (e-journals) to log feedback, observation, and assessments over two weeks and time spent on clinical assessments. Phase 2 involved an anonymous survey to recall experiences with assessment, supervision, and observation. Validated single-item measures from the Maslach Burnout Inventory assessed emotional exhaustion and depersonalization. Results: The e-journal response rate was 56.8% (21/37), with complete responses from 10 CBME and 11 non-CBME residents. Our analyses indicated that CBME residents attempted more assessments (p < .01) and spent more time on them (126 minutes vs. 28 minutes for non-CBME residents, p < .01). Both groups reported similar rates of observation and feedback. The survey response rate was 59.5% (22/37), with complete responses from 15 CBME and seven non-CBME residents. Burnout was prevalent, with CBME residents more likely to endorse assessments as a cause of feeling burnt out (p = 0.023). Discussion: Given the significantly increased contribution of clinical assessments to burnout in the CBME cohorts, it is crucial to further investigate this curriculum’s administrative burden and its implications for resident well-being. Further research is needed to explore the changes to the quality and quantity of feedback, observation, and assessment in CBME.