“Pups”    – ICE Blog

By: Kelly Caverzagie (@KCaverzagie)

I write this post with a heavy heart.  Yesterday, I lost Jasper, my 9-year-old chocolate lab, to a several years battle with cancer.  He was my most faithful friend and companion, always there with his tail wagging to greet me as I walked in the door.   “Pups,” as I called him, was also lovingly stubborn, insisting daily that he be taken for a walk so he could stop to seemingly sniff every blade of grass in our neighborhood.  On a funny note, for some reason, a scrap of bread (of all things) was his favorite treat.  He would always pop his head into the kitchen at the sound of any sort of bread being opened, hoping for a chunk to be tossed his way as a midday treat.  It will forever be a mystery how he knew that it was bread being opened as opposed to something else!   

So, what does this have to do with competency-based education (CBE), you ask?  Likely nothing.  Other than I can’t get either of out my mind right now.  

Lately, I’ve been thinking about our international journey to achieve the goals of CBE and can’t shake the thought that our efforts may have largely stalled.  I have no proof or evidence to back up this claim, other than a sense within the broader education community that this “CBE thing” was a passing fad or something that others are working on for the future.  I suspect that for the rank-and-file health professions educators, CBE is what others do while they (i.e., the front-line folks) continue to see patients and teach.  

Yes, there are pockets of amazing innovation and growth and there should be no doubt the work that is being done by those that are reading this post is essential!  Yet, I feel that most educators simply shrug their shoulders, say “harrumph,” and get back to the daily grind.  Over a decade ago when I started on this journey, I felt like most program directors and institutional leaders were like Jasper, tail wagging with excitement, insisting on exploring new blades of grass.  Maybe it is just me, or my current sadness with losing my Pups, but I don’t sense that excitement from our extended community anymore.  (At least in medical education circles.)  

My theory behind this lackluster engagement is that we are simply asking too much.   

Too much of our programs.  Too much of our leaders.  And way, way too much of our trainees.    Does anyone else feel this way?  

In my day job as an educator at the University of Nebraska, and my roles in advocacy and leadership nationally, I get a sense that most programs, and their leaders, are overwhelmed with operational tasks.  Yes, I acknowledge that this pressure is largely based in clinical productivity, but I also believe it reflects the overwhelming demands that go along with operationalizing CBE within our programs and institutions.  It seems to me that we feel a need to prove that our trainees are up to snuff … to justify or provide irrefutable evidence that they are worthy of (fill in the blank).  Who or what are we justifying to?  Ourselves?  I fear that this inherent desire for justification may unintentionally drive many of our colleagues away from the competency-based training we seek.   

Which leads to another question … have we gotten too academic in our pursuit of competency-based education?  (Yes, that is an oxymoron.)  Do we really need to “prove” the value of our education?  Must we justify that our education is valuable?  Or are we doing that because we are scientists, and this is what we do?  I worry it is the latter.  After all, perfect is the enemy of the good.  While we always strive for improvement, we can’t forget that pretty darn good is just that … pretty darn good.  Are we simply doing too much?  

By being too academic, we create an artificial and overwhelming burden on all stakeholders, that may be standing in the way of greater uptake of CBE in front-line educational programs, particularly in those that do not have the resources or expertise to prove or justify the value of their education.  For most, the joy in the pursuit of competency-based training, which focuses on growth, guidance, coaching, and individualization, is fading or has been lost all together.  

I propose that we learn from Jasper and find our way back to simply enjoying the daily walk and sniffing every blade of grass in the neighborhood, as opposed to analyzing the value that each blade of grass adds to the landscape and over-measuring whether it was cut at the correct height.  Let’s get back to enjoying the journey and focusing less on achieving over-analyzed, standardized outcomes.   

Enjoy the daily walk, my friends.   

See ya, Pups.  Be a good boy.

About the author:
Kelly Caverzagie, MD, FACP, FHM,is a Professor of Internal Medicine and serves as the Associate Dean for Educational Strategy and Learning Environment for the UNMC College of Medicine and Vice-President for Education at Nebraska Medicine. Dr. Caverzagie has expertise in the assessment of learners with a focus on competency-based medical education. He has served in many leadership roles including as a member of the AMA House of Delegates and Council on Medical Education. He is also a member of the ACGME Board of Directors and Co-Chair of the International Conference on Residency Education.

The views and opinions expressed in this post are those of the author(s) and do not necessarily reflect the official policy or position of The University of Ottawa. For more details on our site disclaimers, please see our ‘About’ page

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