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Keywords:

  • competency-based medical education;
  • developmental-behavioural paediatrics;
  • entrustable professional activities;
  • training program;
  • workplace-based assessment

Abstract

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

For our specialist paediatric workforce to be suitably equipped to deal with current childhood morbidity, a high level of competence in developmental-behavioural paediatrics (DBP) is necessary. New models of training and assessment are required to meet this challenge. An evolution of training in DBP, built around the centrepiece of competency-based medical education, is proposed. Summative assessment based upon entrustable professional activities, and a menu of formative workplace-based assessments specific to the DBP context are key components. A pilot project to develop and implement these changes is recommended.

‘Our family is moving interstate. We are very concerned about our eight year old, who is well behind with schoolwork, seems worried about everything, has major meltdowns and is being bullied. There are fights all the time at home – we are all struggling to cope. Could anyone in the local area recommend a paediatrician who is an expert in developmental and behavioural issues?’

The ‘New Morbidity’ has been a reality for decades. Clinical problems with a child's development, learning, behaviour and mental health are highly prevalent[1-6] and constitute a major societal health and social burden.[3, 7] These conditions are prominent in the clinical life of general paediatricians as well as subspecialists in community child health.[3, 7-13] In an Australian survey of general paediatricians, conditions involving challenging behaviour, psychological disturbance or family dysfunction were identified as the most difficult clinical conditions to deal with.[4] The work is inherently difficult for many reasons, including biopsychosocial complexity, chronicity, time demands, interfaces between non-aligned systems and access barriers to necessary interventions.[4, 7, 14-16]

High-quality teaching and supervision in developmental-behavioural paediatrics (DBP) is undoubtedly accessed by a proportion of trainees. Several positive developments on the training front have been welcomed. The inception of the Community Child Health (CCH) training programme was a major leap forward. Some benchmarks for DBP training exist within this framework (CCH curriculum, mandatory DBP component, involvement in a tutorial series). The combined CCH/General Paediatrics training pathway has proven popular. The capacity for extra training positions with a DBP component has been created in Australia via the federally funded Specialist Training Program initiative. CCH has recently been formally recognised as a paediatric subspecialty by the Australian Practitioner Registration Health Authority, further legitimising responsibilities of this group for clinical and training leadership within the field of DBP.

This paper examines how the consistency and rigour of postgraduate training in DBP could be further improved. A strong focus is on assessment, as assessment drives learning. It aims to promote a framework for training in DBP that improves accountability of training institutions and health services for the production of paediatricians competent in DBP. It also aspires to encourage those providing subspecialist training in CCH to push the bar ever higher, to extend leadership and teaching to all levels of paediatric training, and to expand the critical mass of teachers and mentors in DBP, to the benefit of future trainees, and ultimately, the children and families we see.

Training and Assessment in DBP – Evolutionary Goals

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

Increasing the utility of the curriculum

The ‘constructive alignment’ of training curricula is a key plank of contemporary educational practice.[17] In an aligned curriculum, teaching and learning activities (TLA) are designed to lead to explicitly stated learning outcomes, and assessment methods clearly reflect achievement of these outcomes.

The practical utility of training curricula relevant to DBP training could be further enhanced for supervisors and trainees alike if summative assessment methods (e.g. the supervisor report) clearly mapped onto learning objectives, recommended TLAs for each learning objective were collated, and a developmental axis to the curriculum, which would outline progression from early to advanced levels of competence, was included.

Introduction of specific summative assessment in DBP

DBP is one of the clinical areas which is not examinable in any depth in the current mid-training examination process. The difficulty in setting discriminating written exam questions in DBP has been highlighted previously.[18] In the clinical examination, the short duration of individual patient stations, and the requirement for an on-the-spot diagnostic formulation, limits capacity to evaluate a trainee's ability to handle a complex developmental-behavioural case of the sort that would be commonplace in future practice.[19, 20] Thus, performance in the clinical examination is ‘tangential to professional function’ in DBP.[21]

Once the mid-training exams are completed, the current summative measure of a paediatric trainee's clinical and professional competence is the assessment of key supervisors. A generic supervisor report form serves as the reporting tool for a diversity of clinical settings.[22] This evaluation mechanism has a number of major limitations. Items on the form are not clearly aligned with curricular learning objectives. The generic CCH supervisor report, for example, does not mandate a detailed, focused assessment of competency in clinical skills pertinent to CCH practice areas (DBP, Child Protection, Population Health), with a greater emphasis placed instead on professional qualities. The end of rotation supervisor report is prone to common errors and biases, and has been demonstrated to have poor reliability.[23, 24] Supervisors may never have directly observed the learner perform a given task,[22, 25] instead extrapolating from trainee self-reports of clinical encounters and other visible activities (e.g. presentations).[22, 26, 27] It has been demonstrated that clinical competence is thus inferred from only two dimensions of their performance – case presentation ability and interpersonal skills.[28, 29]

Assessment drives learning.[30] A summative process that requires the specific assessment of key DBP skills would create much-needed quality benchmarks and encourage broader exposure to DBP in paediatric training.

Opportunities for direct observation and feedback

Prominent medical educators remind us that the ability to gather accurate data from the medical interview, observation and examination of patients remains a doctor's most important diagnostic tool.[31-34] This is clearly true of DBP. Investigations (biological, neuropsychological and of social environment) can add key information, but appropriate diagnostic formulation remains heavily dependent on clinical skills. In addition to diagnostic accuracy, doctor–patient communication is key to an effective clinical encounter.[28, 31] These skills will not necessarily improve with experience alone.[28, 35] Trainees and supervisors alike are notoriously poor at assessing their own weaknesses. It is difficult to locate blind spots without skilled guidance.[32, 36] Trainees and students at all levels of medical education report a scarcity of feedback from educational supervisors derived from directly observed performance.[25, 26, 31, 34, 37] A recent study of paediatric trainees in New Zealand confirmed the rarity of direct observation.[38] Norcini and Burch state that this ‘lack of assessment and feedback, based on observation of performance in the workplace, is one of the most serious deficiencies in current medical education practice’ (2007: 857).[31] There is a wealth of evidence supporting the efficacy (and effect size) of feedback on changing clinical performance.[26, 31, 36, 39, 40] The benefit of regular, direct observation by supervisors on the acquisition of clinical competence and delivery of clinical care has been demonstrated.[38, 41-45] A training culture in DBP that ensures adequate direct observation of trainees is both a worthy and necessary aspiration.

Simplifying accreditation

Postgraduate medical education programmes frequently use ‘dwell time’ as a proxy for the acquisition of competence.[46] The focus is on ‘time spent immersed in a setting, rather than what is actually learned there’,[47] a phenomenon which has been described as the ‘tea bag’ model of medical education.[48] It has been demonstrated locally that simply making DBP terms mandatory does not guarantee acquisition of competence in key DBP skills.[11, 12] Furthermore, the complexity of time-based accreditation of CCH advanced training has become a major problem for the administration of the training programme.[49] Training rotations now often involve multiple sites, with changeable permutations of quantity and quality of the developmental-behavioural component. A training paradigm that has the potential to simplify training accreditation, and thus reduce confusion for trainees, supervisors and accrediting bodies, is deserving of further exploration.

Competency-Based Medical Education

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

Origins – what is competency-based medical education (CBME)?

Competence can be defined as ‘the ability to do something successfully’ (ten Cate and Scheele 2007: 543).[50] It is a state of being, not an activity to be completed.[50] The theoretical background to a competency-based training framework is provided by Miller's pyramid of professional competence (Fig. 1).[51] There are four tiers to the pyramid, with each level having an impact on how well a doctor will carry out their professional role. The bottom tier (‘knows’) and the next tier (‘knows how’) are cognitive levels – they are concerned with knowledge. The upper two tiers are behavioural levels; they are concerned with one's actions. The third tier (‘shows how’) denotes competence. It describes having the capacity to perform a particular task. The top tier (‘does’) is concerned with actual performance in a workplace setting. Professional authenticity increases as we move up the pyramid.[51]

figure

Figure 1. Miller's pyramid of professional competence.

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The movement towards competency-based medical education began to gather momentum in the 1990s. This reflected a conceptual shift in the view of a competent doctor from ‘someone who knows’ to ‘someone who does’ (Klaas 2007: 532).[52] Increased public expectation of competence and safety in medical practitioners, and therefore of transparency in the processes of training and accrediting them, have provided impetus for this shift.[40, 52-54] The introduction of competency-based training frameworks into postgraduate training programmes has occurred more recently, but is gaining increasing prominence world-wide.[50, 55] Organisations such as the General Medical Council and the Post Graduate Medical Education and Training Board in the UK and the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties in the US have mandated a change to competency-based postgraduate specialty training.[22, 54] Locally, the Australian Medical Council encourages the same.[40] In recent times, our own training institution, The Royal Australasian College of Physicians (RACP), has introduced several workplace-based assessment (WBA) tools and upgraded the training curricula. Psychiatry training in Australia and New Zealand is undergoing something of a competency-based training revolution, which is particularly noteworthy for DBP, given the overlap in conditions seen by both specialties.[56]

Rationale and advantages of competency-based medical education

In competency-based training frameworks, criterion-referenced assessment standards (expected competencies) are clearly defined in a curriculum,[17] with learning activities and assessment methods aligned to drive their attainment. There is a recognised need to assess outcomes at all four levels of Miller's pyramid, but it is the increased focus on the top tier – performance – that is the sine qua non of competency-based training.[17] Pertinent feedback is structurally assured by a programme of regular workplace-based formative assessments.[17, 40] Direct observation of professional skills features prominently in assessment of performance.[29, 32] Competency-based education encourages reflection, a key principle of adult learning.[33, 40, 53] The identification of trainees in difficulty can happen in a more accurate, transparent and timely fashion.[40] Appropriate remediation can then be aligned with unambiguous expected standards.[40, 53] The potential for more flexibility in training (e.g. less rigid, arbitrary time-based requirements) is raised.[40, 47, 50, 53]

Competency-Based Training in DBP – Recommended Key Components

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

Mandatory formative activities: WBA in DBP

If we wish to influence how and what our trainees are learning, then the nature and content of our assessment methods is a major determinant.[17, 31, 57] Assessment strategies need to target what is important, not just what is most conveniently measured.[17] WBA is the assessment of day-to-day practices undertaken in the working environment’ (Miller and Archer 2010: 1–6).[39] The use of well-designed WBA tools enhances the prospect of true constructive alignment in a curriculum.[39] A programme of assessment of varying types (an assessment ‘toolbox’) is necessary to ensure that all curricular learning objectives are aligned with methods best suited to measure their achievement.[17, 54, 55]

Several WBA tools have been introduced to CCH training as part of an RACP-wide strategy. The introduction of others is being explored. Some of these tools appear suitable to use as they are in DBP. Others, however, are either not relevant (e.g. Direct Observation of Procedural Skills) or in need of substantial modification to suit the developmental-behavioural paediatric context.[27] Carraccio et al. acknowledge the difficulty in sourcing tools to capture the diversity of competencies that need assessment.[22] They advocate taking up this challenge by developing novel assessment tools that are valid, reliable and practical.[22, 27]

A suggested toolbox for the WBA of performance in DBP is outlined in Box 1.

Box 1. Suggested menu of workplace-based assessment tools for developmental-behavioural paediatrics

Direct observation of patient encounters;

  • Brief aspects (Mini-CEX†)
  • Full consultation (Long case observation tool for DBP§)

Direct observation of professional activities;

  • Teaching§
  • Case conference facilitation§

Multi-source feedback‡

Reports and letters‡ (DBP-specific audit tool§)

Reflective practice tools

  • Clinical (case-based discussion†)
  • Other professional encounters (professional qualities reflection‡)

†In use currently.

‡Proposed by Royal Australasian College of Physicians education committee.

§Requires development. DBP, developmental-behavioural paediatrics; Mini-CEX, Mini-Clinical Evaluation Exercise.

Summative assessment in DBP: Entrustable Professional Activities (EPAs)

Analysis of evidence from a variety of different sources (direct observation, indirect clinical supervision, other WBA tools) over the course of a training period informs summative assessment of a trainee.[55] The creation of a specific supervisor assessment process based upon EPAs, a concept originally put forward by Ten Cate and Scheele,[50] is recommended. EPAs identify crucial specialty activities that are familiar to trainees, supervisors and the public.[21, 50] When a doctor has consistently demonstrated high level of performance on a particular task, he/she can be ‘entrusted’ to do so independently. Adequate knowledge, skills and professional attitudes underpin performance, and are thus captured in the EPA construct.[58] Supervisors make a deliberate decision about a trainee's competence by signing off on their ability to perform any given EPA.[50] The presence of overall competence is inferred from the assessment of sufficient EPAs.[50] EPAs are used to build a competency-based curriculum,[59] providing a ‘bridge’ between the curriculum and actual professional practice.[58, 59] The use of EPAs assists the linkage of abstract general competencies (e.g. the RACP Professional Qualities, CanMEDS core competencies) to clinical care.[21] The recently introduced competency-based training programme of the Australian and New Zealand College of Psychiatrists has invested in the use of EPAs.[60] The conceptual basis behind EPAs has also been utilised in the Pediatric Milestones project in the US.[61]

Criteria for EPA selection have been suggested.[59] Development of the key EPAs involves an analysis of activities that are central to the specialty.[61, 62] Decisions need to be made on the number and scope of EPAs.[62] A list of 10–20 items is suggested as a sensible initial target.[59] Individual EPAs are then described in more detail. The title of the EPA will usually contain a verb, emphasising performance.[59] Content and scope, including required knowledge and skills, is then summarised. TLAs are recommended. Assessment methods (e.g. WBA tools) appropriate for each EPA are identified, with an assessment ‘blueprint’ devised that will adequately cover the range of EPAs. Successful completion of the training programme requires the certification of all EPAs by accredited supervisors.

A framework for EPA development in DBP is presented in Box 2.

Box 2. Entrustable Professional Activities in DBP – framework for development

Title

Short description

Required knowledge, skills and attitudes

Professional competencies addressed (as described in RACP Professional Qualities Curriculum)

Recommended teaching and learning activities

Assessment blueprint

Developmental progression – behavioural anchors

  1. Basic (minimum standard end of basic training)
  2. Proficient (minimum standard end of general paediatric training)
  3. Advanced (minimum standard end of CCH subspecialty training)
  4. Post specialty qualification (further skill development beyond fellowship)

CCH, Community Child Health; RACP, Royal Australasian College of Physicians.

As a starting point for discussion, a suggested list of EPAs for DBP (largely derived from the CCH curriculum) is outlined in Box 3.[63]

Box 3. Entrustable Professional Activities (EPAs) in developmental-behavioural paediatrics (DBP) – suggested shortlist

EPA 1=ASSESSMENT IN DBP

Performs a comprehensive assessment of a child's development, behaviour, learning and emotion taking into account biological, psychological and social environmental factors

EPA 2=DIAGNOSTIC FORMULATION

Integrates information from multiple sources into a coherent diagnostic formulation

EPA 3=MANAGEMENT PLAN

Uses diagnostic formulation to construct an individualised, multimodal management plan

EPA 4=PROVIDING FEEDBACK TO PARENTS AND CHILD

Communicates assessment findings effectively to parents and child/young person

EPA 5=WRITTEN COMMUNICATION

Summarises assessment findings and management plan succinctly in written reports

EPA 6=CASE CO-ORDINATION – CHRONIC DISORDER MODEL

Effectively co-ordinates the implementation of the management plan and provides ongoing follow-up under a chronic disorder model

EPA 7=BUILDING RESILIENCE

Sets up an explicit process of building resilience of the child/young person and their family

EPA 8=PROVIDES ACCESS TO INFORMATION AND RESOURCES

Educates those involved about nature of problems through provision of appropriate information and resources

EPA 9=USE OF PSYCHOTROPIC MEDICATIONS IN DBP

Effectively and safely prescribes and monitors the use of relevant medications

EPA 10=OFFICE-BASED COUNSELLING IN DBP

Provides supportive family counselling and targeted practical advice across the range of developmental and behavioural conditions

EPA 11=COMMUNICATION WITH OTHER AGENCIES

Communicates and works effectively with professionals in other systems (within health, education, disability and non-government sectors)

EPA 12=ADVOCACY

Advocates for appropriate assistance for child and family

EPA 13=TEAMWORK

Works effectively within a multidisciplinary team

EPA 14=TEACHING IN DBP

Delivers good quality teaching of DBP to various audiences (medical students, other health professionals, paediatric trainees)

Developmental model of competence progression

It is not ideal to have a curriculum that only states a ‘list of exit learning outcomes’, without any guidance towards the stepwise increments in competence that map out a learning journey.[54] It is therefore helpful if the curriculum is written, using behavioural descriptors, to define a trajectory of competence progression towards the exit goals.[54, 61] This helps orientate learners to their next skill ‘target’[17] and helps reduce supervisor variance regarding competency decisions.[36] An expected developmental progression of competency should be outlined for each EPA.

In Box 4, a simplified set of progressive descriptors for a selected aspect of DBP practice (diagnostic formulation) is presented. This example is based on the model utilised in the competency-based training programme of the Australian and New Zealand College of Psychiatrists.[40] An additional feature in this table are skill milestones that extend beyond the postgraduate specialty qualification, to emphasise the lifelong nature of the acquisition of competence.

Box 4. Competence progression matrix

Aspect of practice: Diagnostic Formulation
BasicProficientAdvancedPost specialty qualification
*minimum standard end of basic training*minimum standard end of general paediatric training*minimum standard end of CCH subspecialty training*further skill development
Derives accurate biopsychosocial (BPS) assessment data – requires supervision to link salient factorsIntegrates information from multiple sources into a coherent BPS diagnostic formulation. Ability to do so in majority of typical cases, but requires supervision to assist with more complex or unusual casesSophisticated ability to integrate information from multiple sources into a coherent BPS diagnostic formulation. Ability to do so in complex or unusual cases. Able to skilfully facilitate diagnostic formulation discussions at a multidisciplinary team levelAdditional skills in supervising others in formulation of their cases
CCH, Community Child Health.

A more detailed example of a behavioural descriptor for advanced practice in another aspect of DBP practice (assessment) is provided in Box 5.

Box 5. Example Entrustable Professional Activity descriptor – Assessment in developmental-behavioural paediatrics (DBP) (Advanced level = minimum standard for end of Community Child Health subspecialty training)

Biopsychosocial assessment framework comprehensive enough to deal with the most complex presentations (severe neuropsychological deficits and their resultant behavioural and emotional consequences, complex family dynamics, biological co-morbidity) in children of varying ages

Interview skills;

  • History taking structured, methodical, sensitive, appropriately detailed with no important omissions
  • Facilitates child and family in telling their story, with appropriate use of questioning techniques, listening skills, positive body language, empathy and respect
  • A good standard of communication skills demonstrated throughout, with appropriate listening and facilitative skills and good body language; clearly reaches the high standard

A good physical examination covering all essential aspects

Makes appropriate observations of developmental skills, behaviour and mental state

Use of adequate range of assessment methods (including office tools to directly elicit developmental skills and behaviour such as Griffiths, Renfrew language scales, ADOS)

Effective interview and examination skills around child abuse, neglect and family violence

Ability to conduct an acute mental health risk assessment

Assessment structured to suit DBP context

Time efficient

Diligent gathering of collateral data

Judicious cross referral for assessments by allied health professionals

Appropriate biological investigation strategy

Capacity to supervise assessment skills of DBP subspecialty trainee

Capacity to provide consultation/liaison opinion to other paediatricians and psychiatrists

ADOS, Autism Diagnostic Observation Schedule.

Certification of training

Whilst CBME makes the flexible duration of training theoretically possible, there are significant constraints which will make this aim difficult to actualise in the short term.[34] It is recommended, however, that temporally defined requirements in CCH training be simplified.[49] Total training time should remain prescribed. Minimum training time requirements for each component, however, could be removed, and replaced with EPAs. Concurrent accreditations of training time are therefore abolished.[49] The use of log books of DBP cases could help assure breadth of experience. Research or quality assurance skills would remain the focus of the advanced training project.

Site Accreditation

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

A shift towards decentralised accreditation of training sites is recommended. To achieve this, guidelines could be provided to supervisors of DBP training rotations, who would bear responsibility for communicating to the training body (Specialist Advisory Committee, SAC) how the various EPAs are able to be acquired in these positions (e.g. with a yearly report). Evaluation by trainees would provide an important feedback loop. The effect of these changes would be to reduce the administrative burden of site accreditation, whilst maintaining accountability for the integrity of training positions.

Vertical Integration into Basic Training

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

Insight into the reality of the DBP component of general paediatric practice often arrives late in training, if at all.[11] The competency-based training framework described earlier provides a mechanism for the creation of Basic Training benchmarks for performance in DBP. The successful attainment of a range of key EPAs in DBP could sit alongside the examination process as mandatory for passage to Advanced Training. This would create a requirement for active engagement in DBP practice from day one of Basic Training.[12, 15, 64]

Streaming within CCH Training

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

There has been a long-running debate among professional colleagues in CCH over the need for more defined subspecialty training pathways within CCH. Many CCH specialists will go on to practice predominantly in one of the three pillars of CCH – Developmental-Behavioural Paediatrics, Child Protection or Population Health. The training programme restructure described earlier creates a mechanism for defining a solid base of competency across all three domains, and also potentially allows for ‘streaming’ into differentiated pathways towards higher level competencies in any of the three domains.

Implementation

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

A summary of the proposed changes is presented in Box 6. An exciting opportunity exists to not only enhance training in DBP, but to contribute to the evolution of competency-based training within the other pillars of the subspecialty of CCH (Child Protection, Population Health), as well as paediatric training more broadly. As a preliminary step, a working day has been conducted involving the SAC in CCH and education staff from the Royal Australasian College of Physicians, with a view to developing a small-scale pilot to test the feasibility of the proposed approach. This will be followed by broader consultation with the College Education Committee and other relevant stakeholders of the CCH training programme.

Box 6. Summary of proposed changes

Curriculum

Clear statements of summative assessment criteria for competence in developmental-behavioural paediatrics through use of Entrustable Professional Activities

Developmental progression towards advanced competence clearly described

Systematic collation of recommended teaching and learning activities

Programme of Assessment

Extended suite of workplace-based assessment tools employed to assist in teaching and assessment of competence in DBP

Specific supervisor form redesigned around EPAs

Accreditation

Simplification of time-based requirements

Decentralisation of training site accreditation

DBP, developmental-behavioural paediatrics; EPAs, Entrustable Professional Activities.

Conclusion

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

Demand for paediatric assessment and management of developmental and behavioural problems highlights the importance of this service to children and their families. They deserve to be managed by an appropriately skilled paediatrician whose competence in DBP has been explicitly and transparently certified during their training. The competency-based training framework described earlier seeks to bring the pathway to such certification into sharper focus. A training culture in DBP in which reflective supervision, direct observation and structured formative assessment are firmly entrenched should enrich the journey along this training path.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References

The author would like to thank Professor Olle ten Cate (University Medical Centre, Utrecht, the Netherlands) and Michelle Orkin (RANZCP) for their generous advice, and Julie Gustavs, Jane Lesslie, Michael McDowell, Doug Shelton and Catherine Skellern for their very helpful commentary.

References

  1. Top of page
  2. Abstract
  3. Training and Assessment in DBP – Evolutionary Goals
  4. Competency-Based Medical Education
  5. Competency-Based Training in DBP – Recommended Key Components
  6. Site Accreditation
  7. Vertical Integration into Basic Training
  8. Streaming within CCH Training
  9. Implementation
  10. Conclusion
  11. Acknowledgements
  12. References