A Multi-Learner, Multi-Level, Multi-Competency Simulation Approach to Competency-based Education of Obstetrical Emergenices

Abstract

The CanMEDS 2015 Framework outlines many key competencies that must be addressed during residency training. The move towards the “Competency by Design” curriculum will require the use of simulation for assessment of these competencies. However, the use of simulation poses many challenges for residency programs including meeting the learning needs of multiple levels of learners, financial constraints, time constraints etc. We performed a program evaluation on an obstetrical emergencies simulation curriculum that involved Obstetrics and Gynecology residency trainees (PGY1-PGY5). Different levels of learners participated in various roles including; first responder (PGY2), second responder (PGY5), confederate roles including patient, nurse or family member (PGY1-3) and assessor (PGY4). This permitted assessment of the following CanMEDS competencies: medical expert and communicator (PGY2); communicator and leader (PGY5); communicator, collaborator and health advocate (PGY1-3) and scholar (PGY4). We were able to determine financial costs, faculty time, and resident time for our existing simulation curriculum and our new simulation curriculum. Residents were surveyed prior to the simulation regarding the learning environment in our pre-existing simulation curriculum and self-efficacy ratings for the competencies mentioned above. Faculty were also surveyed prior to the simulation regarding the residents’ competencies. Station scores were collected for all competencies. Focus groups allowed further exploration of the residents’ and faculty perceptions of the new simulation experience. Lastly, post-simulation surveys of both residents and faculty allowed comparison of pre- and post- learning environment assessment and self- efficacy/performance scores. We had limited station scores from our pre-existing simulation curriculum to allow direct comparison between the specific scenarios The program evaluation determined that this method of incorporating multiple levels of learners provided a feasible and acceptable method of assessing multiple CanMEDS competencies while minimizing financial costs and significantly reducing faculty time requirements.