A competency-based continuous assessment programme as part of a revised curriculum for postgraduate radiology training at the University of the Free State

[摘要] English: Recent times have witnessed a shift in the educational philosophy of postgraduateradiology training programmes. Internationally, curricula have undergone revision,with many changes based on the principles of outcomes-based education. As such,these curricula prescribe learning outcomes and essential competencies �?includinggeneric competencies central to all competent physicians. Continuous assessment iscommonplace and many curricula prescribe regular formal formative workplace-basedassessments that contribute to learning and training.Comparing the University of the Free Sate (UFS) postgraduate radiology trainingprogramme with the recently revised international curricula revealed several importantshortcomings such as the lack of an outcomes-based educational methodology, theabsence or poor definition of learning outcomes and competencies �?in specific theabsence of CanMEDS (Canadian Medical Education Directives for Specialists)competencies �?the absence of formative assessment that culminate in feedback andremedial action, and the neglect of behaviour and attitudes during formal assessment.These shortcomings represented a problem in terms of ensuring the quality ofradiology graduates and the safety of their patients.Addressing the problem required a revision of the UFS postgraduate radiologycurriculum �?defining learning objectives, formulating outcomes and incorporating allrequired competencies �?as well as the development of a formative competency-basedcontinuous assessment programme for postgraduate radiology training.The research was therefore aimed at the development of a competency-based,continuous assessment programme that could be integrated into a revised curriculumfor postgraduate radiology training at the UFS.The methods used to achieve this aim included a literature overview, Delphi surveyand semi-structured interviews. The conceptualisation and contextualisation ofpostgraduate radiology education was accomplished through an extensive literatureoverview that garnered information on the concepts of competence and performancebasededucation, as well as essential concepts related to assessment in education.The Delphi method guides decision-making through consensus; an ideal researchmethod for determining what should and should not be included in a revisedcurriculum. The content of the revised curriculum was therefore researched using aDelphi questionnaire survey. The effectiveness of assessment, and decisions about itsimplementation, are influenced by the views and opinions of those responsible forassessment. Qualitative methods of research collect rich, detailed and descriptive dataand as such, semi-structured interviews are ideal for gaining a detailed understandingof individuals' ideas and views of a particular topic. In this study, semi-structuredinterviews with pivotal role-players involved in South African postgraduate radiologyeducation informed decisions about the proposed continuous assessment programmefor radiology training at the UFS.The results of the research contributed richly to achieving the aim of the research. Acombination of the information from the literature overview, the results of the Delphisurvey and the findings of the semi-structured interviews informed the development ofthe continuous assessment programme. This assessment programme was based onformative workplace-based assessments, conducted formally and resulting in feedbackand remedial action. The assessments included in the programme ensured appraisalof the entire spectrum of competencies including knowledge, skills and the genericphysician competencies (communication, teamwork, professionalism, management andadministrative skills, research and education, and patient support and advocacy).Recommendations about curricular changes were based on information from theliterature overview and the results and conclusions from the Delphi survey. Some ofthe more important recommendations were the compartmentalisation of the curriculumaccording to levels of increasing difficulty and integration, merging competencies(knowledge and skills) according to the different levels of training, the inclusion ofCanMEDS-based generic physician competencies and the insertion of a summativeassessment prior to independent after-hours radiology call, and a mandatoryintermediate summative examination halfway through the training period.The research culminated in the development of a performance-based formativecontinuous assessment programme, blueprinted on a revised postgraduate radiologycurriculum �?these addressed the shortcomings of the UFS postgraduate curriculum.Assessment according to the curriculum aims to guide a registrar through the differentinstructional periods (training levels), document the trainee's progress and ensure theacquisition of essential competencies �?all in a bid to ensure the quality of radiologygraduates and the safety of the public they serve.

[发布机构] University of the Free State