Competency-Based Medical Residency Education: Automatic Schedulers to Improve Efficiency, Fairness, and Transparency and Help with Accreditation

Postgraduate medical education in Canada continues to refine the mission of clinical education with an emphasis on the mastery of core clinical competencies. The change is being driven by shifting societal and patient needs, as well as mandates for improved quality, safety, and accountability in health care by The Royal College of Physicians and Surgeons of Canada (RCPSC). Along with the College of Family Physicians of Canada and the Collège des médecins du Québec, the RCPSC maintains national standards for the evaluation and accreditation of Canadian residency programs. Accreditation is a type of quality assurance process to ensure residency programs adhere to a set of minimum standards. The aforementioned accrediting bodies for the Canadian residency training programs have outlined a set of competencies that all residents, regardless of specialty, should master by the end of their training. Increasingly, medical schools in Canada are adopting the same core set of competencies as an organizing framework for their curricular designs.

More specifically, residency training programs have transformed their teaching and assessment practices towards competency-based medical education (CBME). The School of Medicine at Queen’s University was an early adopter of this program taking the lead nationally in July 2017 by transforming their residency training from a time-based learning model to a CBME approach within the Queen’s Fundamental Innovations in Residency Education (FIRE) program. The RCPSC established a CBME approach called Competency by Design (CBD) program in 2014 and has rolled out a staggered seven-year transition for all specialty programs across Canada. The plan includes “implementing a more responsive and accountable postgraduate training model with explicit competencies for all trainees” (RCPSC, 2014).

Having received numerous awards in recent years, the School of Medicine at Queen’s University is also a leader in terms of quality of education provided to residents. Peterborough intensive care physician Dr. Gregory Bishop was recently recognized by the Professional Association of Residents of Ontario for his work as a teacher and mentor for the Queen’s University family medicine residents. Dr. Bishop was recognized for the essential role that his clinical teaching played in the development of excellent physicians. Moreover, the Queen’s University’s internal medicine program was also the recipient of the 2018 Professional Association of Residents of Ontario (PARO) Program Excellence Award. This award recognizes the positive and rewarding experience that a residency program provides while training physicians capable of tackling challenges related to their upcoming careers. Both of these awards serve to illustrates the high calibre of teaching and educational excellence that the Queen’s residency program provides.

For healthcare organizations, and postgraduate medical education (PGME) in particular, the benefits of proper physician, resident, and staff scheduling are often frequently highlighted in relation to the accreditation process. Residency programs are faced with the challenges of scheduling and managing hundreds of residents each year ensuring certain number of hours of training in each rotation, while also meeting other criteria set out by the RCPSC. Staff as well as clinicians often face many challenges when creating, managing, and disseminating schedules for rotations. They must take into account a large number of factors: absences, vacations, subspecialities, fairness, on-call coverage, contract compliance, and other personal constraints. In addition, scheduling of residents for rotation assignments and on-call responsibilities is a time-consuming process that dramatically stretches the resources of residency programs. This, in turn, can yield negative consequences for resident morale and learning. Assignment of schedules, in most cases, is carried out by chief residents or program administrators with very little input from the residents involved. The process is very taxing on the chief residents’ time while it also creates animosity and conflicts among residents and the schedulers due to perceived favoritism and fairness issues.

Cloud-based software tools such as automated schedulers can help alleviate some of these issues. For example, implementing an automated solution can help dramatically increase resident satisfaction with the schedule in terms of transparency, perceived equity, and accommodation. In Sept. 2015, similarly Chow et al. report in the Journal of Graduate Medical Education that implementing an automated scheduling system can “increase transparency in the scheduling process, foster a sense of fairness and equality in scheduling, and increase resident ownership for making judicious scheduling choices”. Despite considerable data to motivate this, the adoption of scheduling technology has been lagging. Below are just some of the known challenges emanating from imperfect scheduling:

Staff issues

Creating an annual rotation or a monthly call schedule is a necessary yet burdensome task for residency programs. If not done well, the schedule can be a source of resident dissatisfaction.

Additionally, poorly crafted schedules can often result in errors. These errors can make it hard to effectively to meet accreditation requirements for individual residents. Any confusion in terms of shift assignments can cause issues in terms of delivery of care and can lead to injury and even loss of life.

Program issues

Using outdated scheduling tools, such as spreadsheets, likely means that valuable clinician or administrator time is being wasted in building and upkeeping schedules. Human error is also inevitable in this case. No one is to blame: scheduling is inherently a hard problem. Staff scheduling is an instance of a Constraint Satisfaction Problem (CSP) which is one of the hardest problems in algorithms, operations research, and computer science where the complexity of finding a solution grows exponentially as a function of number of staff or shifts to fill. Moreover, scheduling managers need to reopen a previously published schedule, make alterations and ensure on a regular basis that everyone is working off of the correct schedule. This maintenance work requires even more time and resources and inhibits administrators from handling other more essential tasks in relation to delivery of care and residency education.

All of these issues can consequently lead to a deterioration in the quality of residency education, and perhaps the revoking of the RCPSC accreditation associated with the Canadian residency program where violations of program requirements are cited.

Say goodbye to scheduling errors and improve your work-life balance with MESHAI

While there are a dozen Cloud-based or SaaS (software as a service) schedulers that can address some of the issues and challenges related to scheduling, MESHAI stands out as the superior solution for postgraduate medical residency programs.

Light-weight and low-touch by design, MESHAI is a leading edge technology invented specifically for healthcare professionals. Long gone the days of cumbersome and lengthy software training: if one knows how to use a basic Google/Apple/Outlook calendar, one can use MESHAI right “out of the box”. No matter how large the hospital, program, or organization, the tool can be launched in a day or two. There is virtually no transition time needed. Now, that’s true low-touch software design. The creators of MESHAI boast adherence to Google’s “3 Principles of Excellence” in software targeting “focused utility, simple design, and crafted execution”.

As a ‘one-stop-shop’, this tool ensures that you have all the necessary resources you need in order to create the perfect schedule for residency rotations as well as physicians and nurses in your unit. Rooted in twenty years of research and development, the tool is fully automated via a proprietary algorithmic engine dubbed the “canarmonizer” that takes into account your organization’s policies, labour laws, and personal requests (e.g, vacations) to create your schedule with a click of a button.

Despite the AI (artificial intelligence) in MESHAI, managers are ultimately always in control. Shifts can be assigned manually before the engine runs and manual tweaks and edits are also available before the schedule is published to the staff. In total, there are four methods to create a completed schedule. The choice is yours. Besides, we know far too well: “life does not happen on schedule!” Shift swaps and schedule changes are also handled on the platform with much ease: “Shift Bazaar” feature allows staff to readily trade shifts amongst one another and thus, eliminate the hassle of administrators or staff members having to find someone to cover last-minute shift changes. There are a number of approval processes for these changes to fit any team’s needs.

The MESHAI analytics allow managers and chiefs to view and analyze shift distribution and make wiser and more equitable HR decisions. Want to know how many weekends a resident is on call? Just click their name on the analytics dashboard. The powerful and extensive MESHAI analytics page can further provide transparency and eliminate and doubts on favoritism or inequality.

Customizable towards your needs, MESHAI provides post-graduate residents and administrators with a tool to keep track of the hours and time spent in each rotation for accreditation purposes. Not only can this feature improves the quality of residency program, but also it will be an aid during the time-consuming and expensive accreditation processes to provide evidence of compliance with RCPSC standards. To that end, integration with medical teaching and learning platforms such as Elentra will be beneficial.

In summary, the proper functioning of a postgraduate residency program depends highly on how well its various stakeholders communicate, whether they are physicians, residents, assistants, schedulers, or administrative staff. With MESHAI, you are able to see who is on call at any given time to avoid any communication errors. This is also available for switchboard operators via MESHAI switchboard view. MESHAI balances personal and professional lives and as such helps promote wellness and happiness among caregivers.

MESHAI connects to all external calendars such as Google Calendar, Outlook, and iCal. The application is also available in ‘native mobile app’ format for iOS and Android smartphones and tablets. That means shift assignments are available on a real-time basis to all staff no matter where and how they check their schedules. No stress about the version of the schedule either: if you are connected to the Internet, your schedule is the same as everybody else and you are up-to-date.

In conclusion, residency training can be an exciting transition period along the medical education continuum from medical school to independent practice. However, as the difficulty of residency education and healthcare delivery increases, the goal of saving time associated with the construction of residency schedules and improving schedule quality, becomes ever more important. Overworked residents and caregivers are at much higher risks for medical errors leading to loss of lives and injuries. MESHAI is designed to handle these challenges with ease and give Canadian healthcare professionals time to focus on what they do best: relentless delivery of world-class healthcare.

Thus, with the the widespread adoption of CBME model, it is only appropriate that more post-graduate medical education programs in Canada keep up with innovative technologies that support efficiency, educational quality, and compliance.The CBME training model calls for more frequent and meaningful training, “ensuring that competent residents will move through training in a more individualized and efficient manner, saving valuable resources and promoting excellence in their paths to independent practice”. Implementing MESHAIinto your postgraduate residency program can be one step closer towards achieving that goal.