| Paper authors: | Marlon Danilewitz, Nicholas Ainsworth, Cindy Liu, Fidel Vila-Rodriguez |
| Year of paper publication: | 2020 |
| Post authors: | Alice Erchov, Sarah Kesler, Fidel Vila-Rodriguez |
| Download the research article: | Danilewitz (2020) Towards a Competency-Based Medical Education |
Introduction
Competency-based medical education (CBME) is an emerging model of training for medical students. Instead of relying simply on the time spent in residency, CBME focuses on having residents achieve necessary skills such that they would be able to perform competently (successfully) and independently in their selected specialties.
CBME has been widely implemented across disciplines such as radiology, dermatology, and surgical specialties. However, it has been unclear how to apply this model to psychiatry training. One reason is that psychiatry does not rely on concrete “tasks” the way that surgery does, making these competency goals harder to measure.
However, a group of residents, academic faculty, and clinical faculty at the University of British Columbia (UBC) have come together to create a roadmap as to how to apply CBME specifically to interventional psychiatry. Interventional psychiatry specifically includes the “procedural treatments” available to treat psychiatric illness, such as neurostimulation techniques like electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). Importantly, both ECT and rTMS are capable of treating even severe and treatment-resistant depression.
Results
“Core” competencies refer to skills that should be completed by all residents. It is likely that most, if not all, graduating psychiatrists will encounter situations needing these skills either directly or indirectly in their career, and establishing a clear set of competencies allows them to practice in a standardized (similar for all individuals) and safe/effective way.
“Advanced” practice refers to skills that differentiate psychiatrists that would be specializing in the area of neurostimulation/interventional psychiatry as compared to general psychiatry, for who these competencies may not be required.
CORE COMPETENCIES (ECT + rTMS)
- Using communication skills and strategies that help the patient and family to make informed decisions regarding their health
- Work with patients and their families to decrease stigma regarding neurostimulation treatments
- Obtain and document informed consent, explaining the risks, benefits, and rationale for neurostimulation
- Be able to refer patients for neurostimulation when appropriate
CORE COMPETENCIES (for ECT)
ADVANCED PRACTICE (for rTMS)
- Conduct appropriate preparations for a patient undergoing neurostimulation
- Plan a course of neurostimulation
- Apply neurostimulation using appropriate techniques
- Document procedures accurately
- Establish and Implement a plan for post-procedure care
- Assess patient response to treatment as indicated
Conclusion
Interventional psychiatry, like other specialties, would benefit from having a high standard of skills and competencies. The authors of this paper created a “roadmap” for how CBME may be implemented into the training of ECT and rTMS. Having a set of standardized skills and milestones would allow for a more effective curriculum to train interventional psychiatrists. This would not only ensure that all patients have the right to the same quality of care, but also increase the expertise and accessibility of emerging neurostimulation treatments. Treatments such as ECT and rTMS may be a keystone in advancing our care for even severe illnesses such as treatment-resistant depression.