title: Competency-Based Medical Education: Can Both Junior Residents and Senior Residents Achieve Competence After a Sports Medicine Training Module?
abstract: BACKGROUND
  Competency-based medical education as a resident-training format will move postgraduate training away from time-based training, to a model based on observable outcomes. The purpose of this study was to determine whether junior residents and senior residents could demonstrate clinical skills to a similar level, after a sports medicine rotation.
  
  
  METHODS
  All residents undertaking a three-month sports medicine rotation had to pass an Objective Structured Clinical Examination. The stations tested the fundamentals of history-taking, examination, image interpretation, differential diagnosis, informed consent, and clinical decision-making. Performance at each station was assessed with a binary station-specific checklist and an overall global rating scale, in which 1 indicated novice, 2 indicated advanced beginner, 3 indicated competent, 4 indicated proficient, and 5 indicated expert. A global rating scale was also given for each domain of knowledge.
  
  
  RESULTS
  Over eighteen months, thirty-nine residents (twenty-one junior residents and eighteen senior residents) and six fellows (for a total of forty-five participants) completed the examination. With regard to junior residents and senior residents, analysis using a two-tailed t test demonstrated a significant difference (p < 0.01) in both total checklist score and overall global rating scale; the mean total checklist score (and standard deviation) was 56.15% ± 10.99% for junior residents and 71.87% ± 8.94% for senior residents, and the mean global rating scale was 2.44 ± 0.55 for junior residents and 3.79 ± 0.49 for senior residents. There was a significant difference between junior residents and senior residents for each knowledge domain, with a significance of p < 0.05 for history-taking and p < 0.01 for the remainder of the domains.
  
  
  CONCLUSIONS
  Despite intensive teaching within a competency-based medical education model, junior residents were not able to demonstrate knowledge as well as senior residents, suggesting that overall clinical experience is critically important for achieving competency as measured by the Objective Structured Clinical Examination.
authors.affiliation: Women's College Hospital, Toronto, Canada Mt. Sinai Hospital, Toronto, Canada tim.dwyer@wchospital.ca.
authors.forename: Tim
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: Toronto East General Hospital, Toronto, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Wright
authors.affiliation: The Wilson Centre, Toronto, Canada.
authors.forename: Kulamakan M
authors.initials: KM
authors.lastname: Kulasegaram
authors.affiliation: Women's College Hospital, Toronto, Canada Mt. Sinai Hospital, Toronto, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Theodoropoulos
authors.affiliation: Women's College Hospital, Toronto, Canada.
authors.forename: Jaskarndip
authors.initials: J
authors.lastname: Chahal
authors.affiliation: Women's College Hospital, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wasserstein
authors.affiliation: The Wilson Centre, Toronto, Canada.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ringsted
authors.affiliation: The Wilson Centre, Toronto, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Hodges
authors.affiliation: Women's College Hospital, Toronto, Canada.
authors.forename: Darrell
authors.initials: D
authors.lastname: Ogilvie-Harris
mesh_terms: D002170:Canada; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D017145:Models, Educational; D013178:Sports Medicine / Q000193:education*