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| CHALLENGE |
RESPONSE |
LESSONS LEARNED AND ONGOING STRUGGLES |
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| 1. Gaps in the engagement in and understanding of CBD by faculty, trainees and other partners
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Provide resources and guidance that are consistent and comprehensive Encourage ongoing, repeated, regular, bite-sized consumption of CBD information Incorporate CBD boosters into regular meetings and training times Tailor approach to the specific discipline, program, and relevant clinical workflow Identify trusted champions to support rollout
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Orientation to CBD is a continuous process, not a one-time event Balance repetition versus new onboarding versus advanced content where there may be short leadership cycles (e.g., PD terms) Expect that groups may not initially know what they need; with experience, faculty developers become better able to anticipate needs
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| 2. Lack of time and resources for program leaders to implement CBD
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Partner with schools to create local champions Advocate on behalf of schools for local resources to build capacity and share tasks to free up time for key program leaders (e.g., arrange for groups of programs at a single school to learn together about designing a Competence Committee) Create or curate both comprehensive and bite-sized content options to address specific key needs (e.g., competence committees, EPA observations, coaching) Create content and resources that are easy to access, can be shared, require little effort to use, and can be adapted locally Leverage existing educational events to introduce and reinforce key CBD concepts
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Be mindful of change fatigue and variations in capacity, especially when competing major changes come up (pandemic, accreditation visits, transition to electronic medical records etc.) Time challenges need regular attention; the goal is that these challenges will become less prominent as CBD processes are developed and refined and as culture change evolves
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| 3. Heterogeneity of needs among programs, specialties and schools
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Clear communication, trust, negotiation, and flexibility with respect to the heterogeneity are required to coordinate national- and local-level faculty development initiatives
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Accept that not all partners need or want your support While this initially took significant time and effort, the ability to be flexible and adapt to heterogeneity eventually became a strength of the system
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| 4. Difficulty getting the right support and resources to the right people at the right time
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Stratify support and resources by groups (e.g., by stage of transition or role) Curate and push content to targeted groups at anticipated times of need Build networks that welcome and onboard new members Celebrate quick wins and champions
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When creating resources, plan times to pause and ensure they are relevant, accessible, and organized in a way that users can find and access them Anticipate turnover in leadership roles (PDs, CBME Leads, etc.) Be mindful of overwhelming users with resources that are not directly relevant
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| 5. Changing the culture of teaching and assessment toward a growth mindset
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Emphasize the teaching and feedback benefits of EPAs and CBME for trainees, beyond their role in assessment Shrink the change: provide clear direction on what is changing and what is staying the same Share best practices to demonstrate successes
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Be aware of behaviours and practices that may undermine growth mindset principles (e.g., trainees only seeking a WBA when they feel as though they will be “entrusted,” which will turn low-stakes assessments into high-stakes assessments and encourage a culture in which trainees do not benefit from ongoing coaching to achieve competence) Carefully consider how other factors are shaping this culture change (data presentation in portfolios, hidden curriculum around actions of competence committees, etc.) Be patient: meaningful culture change takes time and effort and occurs at varying paces in different contexts
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