Feedback and formative assessment in Competency by Design The experience of residents and supervisors within a urology training program.

Introduction: Competency by Design (CBD) is a form of competency-based medical education implemented in Canadian urology programs since 2018. Regular, multimethod assessments and formative feedback via Entrustable Professional Activities (EPAs) are the cornerstones of CBD. Personalized and regular feedback are the top perceived benefits of CBD by both residents and supervisors; however, evidence shows that in practice, constant feedback-seeking is burdensome, and increased quantity of feedback does not equal increased quality. The experience of CBD implementation has not yet been studied in surgical programs. Our aim was to examine how supervisors and residents have experienced the integration of formative assessment and feedback since the implementation of CBD in a surgical training program.

Methods: Using data from focus groups, a qualitative phenomenological analysis based on the experiences of the residents and supervisors in a urology residency program was performed.

Results: Residents and supervisors felt that CBD allowed for better tracking of resident performance and increased quantity of feedback; however, increased workload, delayed completion of EPA assessments, lack of direct observation in non-surgical activities, variable supervisor guidance, and lack of understanding of CBD were cited as barriers to providing proper feedback and formative assessment.

Conclusions: The participants experienced a lukewarm transition in feedback and formative assessment practices with CBD. As with every process of change, these growing pains may eventually result in meaningful practice improvements and incorporation of a CBD culture into everyday learning activities.