Thesis Format
Monograph
Degree
Master of Arts
Program
Education
Supervisor
Hibbert, Kathryn
2nd Supervisor
Ott, Mary
Affiliation
York University
Abstract
This study investigates the unintended consequences of the Royal College's transition to Competence by Design (CBD), a competency-based curriculum in postgraduate medical education. A secondary qualitative analysis using Joseph Schwab’s ‘curriculum commonplaces’ was applied to a data set of interviews with CBD implementation leads across Canada to identify the roles of key actors in the process of curriculum making. Findings demonstrate misalignments that emerged between values and enactment when the needs of teachers, learners and milieu were initially underestimated in design and early implementation phases. These misalignments disconnected assessment practices from experiences of teaching, learning and entrustment. The study contributes an understanding of the sources of unintended consequences and potential resolution through a more thoughtful coordination of curriculum development to inform continued adaptations to ‘CBD 2.0’ as it continues to evolve through the process envisioned by the Royal College.
Summary for Lay Audience
As the medical education system in Canada approached a new millenium, accountability and responsibility to the public for the quality of healthcare in Canada became the driving force behind a considered switch to competency-based education. In 2005, the CanMEDS Physician Competency Framework inaugurated a new educational archetype for medical sub-specialty training standards in Canada to delineate the knowledge, skills and behaviours expected of Canada’s future medical practitioners. The Royal College of Physicians and Surgeons of Canada introduced Competence By Design (CBD) in 2015 as a new curriculum for postgraduate medical education to integrate these competencies into a complete system of training and assessment.
The CBD curriculum is based on Entrustable Professional Activities (EPAs). These requisite standards, acquired and demonstrated during clinical learning opportunities, provide a method of assessment and a means of progression for resident trainees.
Using a framework grounded in the work of curriculum scholar Joseph Schwab, this qualitative study explored the curriculum commonplaces, represented by the subject matter expert, teacher, learner, milieu, and curriculum specialist, as crucial constituents to the creation of curriculum and considered how their engagement in the development and enactment of EPA assessments was reflected in unintended consequences. Interviews with implementation leaders across Canada provided a rich overview of uptake of CBD at national, institutional and program levels and guided an analysis to understand the causes of emerging problems.
The results demonstrate the dominant role of the subject matter expert as the primary source of authority on CBD and reflect an underestimation of the influence of other actors. Consequently, EPA design did not always align with teaching priorities; institutional policies and practices were often at odds with an intent to provide more individualized learning experiences; and challenges to assessment data being used in a meaningful way for learning disrupted the goal to effectively support resident development.
The unintended effects of these misalignments highlight the need for better coordination of actors in all the commonplaces of curriculum making to interrogate, deliberate, and align the design of EPAs as they evolve through the adaptation process currently envisioned by the Royal College.
Recommended Citation
Dengler, Lori E., "Uncommon Places - Joseph Schwab and the Development of Competency-Based Medical Education" (2025). Electronic Thesis and Dissertation Repository. 10704.
https://ir.lib.uwo.ca/etd/10704
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
