• Margaret Hanley, Cindy Shearer, and Patricia Livingston.
• Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
• Can J Anaesth. 2019 Nov 1; 66 (11): 1320-1327.

PurposeCanadian residency programs are transitioning from time-based to competency-based medical education (CBME). The anesthesia department at Dalhousie University enrolled its first CBME cohort in 2016, one year prior to national anesthesia rollout. Early implementation allowed a unique opportunity to examine faculty anesthesiologists' experiences with the transition.MethodsUsing Rogers' Diffusion of Innovations (DOI) theory, we conducted a qualitative interview study. In-depth interviews were held with faculty members (n = 12) at varying stages of innovation adoption (e.g., innovators/early adopters, early/late majority, and laggards) at two time points: onset of CBME and one year later. Interview data were analyzed based on the DOI promoting factors: relative advantage, compatibility, complexity, trialability, and observability.ResultsRelative advantage: Early adopters believed CBME had benefits over the traditional curriculum, while laggards viewed the change as an unproven paradigm shift. CBME was compatible with the values of early adopters, who appreciated resident accountability for learning. Trialability, the degree to which an intervention can be trialed and modified, arose with the early/late majority group, who described an organic process of adaptation over the year. All groups mentioned the need for observable results. Innovators and early adopters were confident CBME would improve learner experiences. Early/late majority noted expedited skill acquisition and improved quality of feedback. Laggards believed observable results would take many years to emerge, if ever. The early/late majority group showed the most progress toward adoption over the study time period, moving from skeptical optimism to active investment.ConclusionTargeted interventions for faculty uptake should emphasize the trialability and observable results achieved over time. These efforts may have the greatest impact in the early/late majority group.

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