INFORMATION FOR STUDENTS
SBV MODEL OF COMPETENCY BASED LEARNING AND TRAINING (CoBaLT) FOR POST GRADUATE EDUCATION
SBV forges ahead in Post Graduate medical education, with the incorporation of the Competency Based Learning and Training Model (CoBALT) into our post graduate training programmes. It is responsible for setting up of high professional standards of learning and training and ensures training of postgraduates who, can function independently as specialists, researchers and teachers, in the Medical Fraternity, by the end of their course.
This academic model represents a progressive step by the university, with focused ideals towards achieving our Mission, Vision and goals to accommodate for the prevailing needs of our Nation.
KEY WORDS USED IN CoBaLT PROGRAM AND THEIR DEFINITIONS
“Competence is defined as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served.”- Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002; 287:226-35.
Domains of competence
These are broad distinguishable areas of competence that in aggregate constitutes a general descriptive framework for a profession. The ACGME / ABMS framework identifies six domains of competence: Patient care (PC), Medical Knowledge (MK), Interpersonal skills and Communication Skills (ISC), Professionalism (P), Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). This same format has been retained for our COBALT program.
Entrustable Professional Activity (EPA)
Since competencies are not directly measurable, they need to be rewritten in a format which is observable and measurable. This format is called ‘Entrustable Professional Activities’ or ‘EPAs’. EPAs describe a measurable activity or task that requires specialized knowledge and skills, and encompasses multiple competencies. They are ‘critical activities’ in the professional life of physicians agreed upon by the speciality community that must be assessed and approved at some point, in the ongoing creation and training of the specialists.
Levels of EPAs
These represent five sequential stages in the development of competency from novice to the expert level.
Level 1 – expected ability of a novice, mostly limited to observation only
Level 2 – ability to perform the activity under strict supervision
Level 3 – ability to perform the activity under loose supervision
Level 4 – ability to perform the activity independently
Level 5 – expertise in the activity; ability to perform the activity independently and teach others.
Milestones are a significant point or an observable marker of an individual’s ability along a developmental continuum. Each EPA is mapped to appropriate domains of competency and the level of competency to be attained by the end of 1st, 2nd and 3rd years of Postgraduate degree course is defined.
The residents do a self-assessment for the EPAS at the time of joining. The faculty will do the assessment at the end of every 3 months for the first year and every six months thereafter, to document the student’s progress. This strategic and objective mapping system allows the training faculty to be intune to the specific progress and difficulties faced by the student, enabling an individualised teaching and training program.
MULTI SOURCE FEEDBACK (MSF)
Multi-source feedback is obtained from different sources including patients, relatives and other health care professionals regarding EPAs which pertain to dealing with patients, their relatives or other health care workers, communication skills, attitude, professionalism etc. They form the basis of assessing the level of competency achieved by the student. SBV uses specially designed, contextually relevant evaluation forms for this purpose.
Residents will record all their activities regarding Patient-Care and Academics in an E-portfolio, on daily basis. The faculty supervisor will review this at regular intervals. A longitudinal view of the residents’ work paints a picture of growth, progress and continuity over a period of time so that the learner can present a profile of accomplishments based on evidence.
The major components of an E-portfolio include
- Curriculum Vitae
- Details of undergraduates training with achievements
- Details of resident training
- Patient care activities
- Participation in Clinical governance and audit
- Teaching learning activities
- Critical incident reporting and reflection on these incidents
- Participation in outreach activities, research academic publications, training courses and extracurricular activities.
- Reflections on these experiences form a major part of the eportfolio.
A hands-on workshop on e-portfolio will be conducted for all incoming residents to enable them to create and manage their e-portfolios effectively.
STEPS INVOLVED IN COMPETENCY BASED LEARNING AND TRAINING (CoBaLT) PROGRAM
- Each speciality has a defined list of competencies to be attained by each resident in the speciality.
- Competencies are attributes which cannot be objectively measure. Hence these competencies have been converted in to a series of measurable activities called Entrustable ‘Professional Activities (EPAs), which once attained, imply that the resident can perform the EPA satisfactorily.
- EPAs are listed in order of General EPAs common to all disciplines followed by EPAs which are specific to the speciality concerned, and include the domains which define the EPA.
- For each EPA an expected level of performance is fixed at the end of each year of the course.
- These levels are called milestones
- The criteria for grading the levels have been fixed by the departmental faculty after comprehensive review.
- The expected level of performance the student should attain for most EPAs by the time of course completion, is generally fixed at Level 4 and Level 3 for complex EPAs which would require further post-doctoral training.
- The EPAs are made available to the postgraduate residents immediately after joining the program.
- They grade their own level on these EPAs at admission.
- The students are graded by the faculty four weeks after admission and the difference in levels, if any, between self-assessment and faculty assessment, would be shared with the student as feedback. This process enables the student to understand the differences between one’s own perspective and that of the trainer.
- On admission, each student is allocated a faculty supervisor who will mentor with the student till the completion of the course.
- The mentor is responsible for following & recording the progress of the student on the EPAs at three month intervals during the first year and six month intervals thereafter.
- PG residents record all activities related to academics & patient care daily in the eportfolio. The faculty mentors reviews the eportfolio every week and provides appropriate feedback to the mentee.
- The students are encouraged to discuss aspects of their training, the difficulties perceived in the course and other relevant issues with the faculty mentors through the eportfolio.
- The faculty mentors respond to the queries and record their observations by their weekly posts on the eportfolio.
- For students not showing ‘Satisfactory’ progress, intervention in the form of a focussed feedback and additional exposure to learning resources and skill training is instituted.
- The EPA and eportfolio monitoring however is not restricted to the faculty mentor alone and will be done by all faculty of the speciality department, for the duration of the course, taking into account the multisource feedback. The whole department works together to monitor the progress of the students & provide constructive feedback.
The unique features of the COBALT approach are opportunities for a tailored intervention based on individual needs and the attention given to both process and outcome. Another major strength of this model is emphasis on reflective practice, which is further supported by continuous feedback and mentoring by the supervisor with additional inputs from departmental colleagues.