Abstract
INTRODUCTION: In 2018, competency-based medical education (CBME) was introduced to Canadian urology residency training. We examined learner and faculty experiences with CBME five years post-implementation. METHODS: Two online surveys were developed from a scoping review of CBME literature and expert consultation. They covered aspects including unintended consequences, satisfaction, and challenges. They were distributed to Canadian urology residency program directors, faculty, and senior residents from January to June 2023. Respondents rated agreement/satisfaction using a five-point Likert scale. Descriptive analyses considered scores of 4-5 as agreement/satisfaction and 1-2 as disagreement/dissatisfaction. RESULTS: Twenty-nine faculty members (including 10/13 [77%] program directors) and 33/63 (53%) senior residents responded. Overall, 69% of respondents are unsatisfied with CBME, 19% are neutral, and 11% are satisfied. Anxiety and/or fatigue with CBME are reported by 76% of faculty and 66% of residents. CBME is seen as burdensome: 61% of residents frequently trigger assessment requests, while 66% of faculty feel overwhelmed by the volume of requested assessments. Faculty members (83%) and residents (73%) find CBME time-consuming. Over 50% of respondents believe CBME failed to de-emphasize time-based learning, individualize progression, rapidly identify struggling residents, or improve feedback quality. Over 60% agree that CBME has clarified learning expectations and training stages. CONCLUSIONS: There is prevailing dissatisfaction with CBME within Canadian urology training programs, impacting the well-being of both faculty and residents while falling short of delivering personalized training; however, CBME has provided a structured and transparent framework for trainee advancement. Improvements to CBME are needed beyond its initial five years.