Competency-Based Otolaryngology Training Is Becoming More of a Fixture, But Needs to Be Fully Developed

Competency-based medical education (CBME), a learning model in which students must demonstrate the required knowledge and skill levels on a task before advancing to the next task, has become a crucial part of assessing the clinical competence of residents and fellows—particularly during and after the COVID-19 pandemic, when more traditional education has suffered (Guidance Statement on Competency-Based Medical Education during COVID-19 Residency and Fellowship Disruptions. Accreditation Council for Graduate Medical Education (ACGME). News Release. Updated January 5, 2022).

In addition, entrustable professional activities (EPAs), a clinical assessment component of CBME, serve as a way to translate the broad concept of competency into everyday practice. EPAs were developed to allow “frequent, time-efficient, feedback-oriented, and workplace- based assessment” in daily clinical practice, according to the American Board of Surgery.

Otolaryngology residents need both competency-based and EPA training to be at their best, but such training in the profession is undefined and not yet fully developed in the United States.

Defining Training

“We need both EPAs and [CBME], as the EPAs guide competency-based medical education,” said Sonya Malekzadeh, MD, residency program director and professor of otolaryngology–head and neck surgery at Georgetown University Medical Center in Washington, D.C. She explained that the current training approach is based on a fixed time for training—a standard number of years—and not competency, but some residents may achieve competency earlier than in the current model of required years of training. “With competency-based training, residents remain in training until they can demonstrate knowledge and skills for their specialty and are able to apply the knowledge and skills independently and competently to individual patients,” Dr. Malekzadeh said.

Another issue, according to Dr. Malekzadeh, is that “current training methods are unstructured and unsystematic and are not based on validated teaching methods. Furthermore, our assessment of knowledge and technical skills and overall competency are not objective but based on subjective observation and logbooks.”

Richard V. Smith, MD, professor and university chair in the department of otorhinolaryngology–head and neck surgery, Montefiore Health System/Albert Einstein College of Medicine in New York City, said that the need for competency-based assessment and training is recognized, but that the best methods to assess learners and ensure that there are safe doctors providing high quality care are still a matter of discussion.

“Competency-based assessment of otolaryngology residents is already in existence, using criteria such as the Clinical Competencies and Milestones [2020 Milestones Guidebook for Residents and Fellows, ACGME], but other methodologies are used, such as case logs, which do not, necessarily, rely upon demonstration of competency. This has become even more critical in the area of surgical volume, which can be affected by pandemics and natural disasters, loss of key faculty, or other factors that may be difficult to control and may not be related to competency.”