Learners in a Canadian Diagnostic-Focused Competency-Based Medical Education Program: A Qualitative Case Study

Abstract

This dissertation explores the experiences of medical residents within a diagnostic-focused specialty, Pathology, who are undergoing training in a competency-based medical education (CBME) curriculum in Canada. Through an instrumental case study design, the research aims to provide a nuanced understanding of the learner experience in a mandated outcomes-based education (OBE) curriculum, with a particular focus on the implications for learner-centered education from an adult learning perspective. The study involved six participants across various stages of their residency - three in their first year, two in their third year, and one in their fourth year. Data collection methods included document analysis of relevant program and Royal College materials related to competence by design, a focus group, individual semi-structured interviews, and researcher journaling. The analysis revealed several key themes: the benefits of an outcomes-based approach, the identification of gaps between prior skills and mandated objectives, the balance between learner autonomy and the need for structured support, the critical role of community practice, and the importance of shared understanding between faculty and learners. The findings suggest that while CBME and OBE programs offer significant advantages in aligning educational outcomes with professional competencies, challenges remain in its implementation, particularly in ensuring that all stakeholders - learners and educators alike - share a common understanding of the curriculum’s goals and expectations. The study contributes to educational theory by reinforcing the importance of learner-centered approaches and the role of communities of practice in professional education. It also offers practical implications for enhancing the design and delivery of CBME programs, highlighting the need for tailored learning approaches, structured support mechanisms, and robust faculty development initiatives. This research adds to the existing literature, underscoring the complexity of transitioning to a CBME framework in medical education and calls for further exploration into the long-term impacts of this approach on both learners and educators. It affirms that OBE often presents as a reductionist approach to education, with mandated outcomes becoming a checklist for learners to complete. It does, however, also affirm that there is merit in learners having a roadmap to their educational program in the form of outcomes lists. The study challenges the concept of OBE in the form of CBME being a learner-centred approach to education and illuminates how the construct of a diagnostic-focused residency training program falls short in providing a holistic competency-focused curricula. The findings have broad relevance for the ongoing evolution of medical and professional education programs.