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Godschalx-Dekker JA, Gerritse FL, van Mook WNKA, Luykx JJ. Do deficiencies in CanMEDS competencies of dismissed residents differ according to specialty? MEDICAL TEACHER 2023; 45:772-777. [PMID: 36652604 DOI: 10.1080/0142159x.2023.2166477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Program directors dismiss a small percentage of residents from residency training programs, presumably due to underperformance or lack of progress. Whether underperformance in competency domains differs by residents' specialty is unknown. METHODS In 2021, we analysed the case law of Dutch residents who were dismissed from training by the program director, and who challenged this dismissal before the national conciliation board between 2011 and 2020. Across medical specialties we compared which of the CanMEDS competency domains these residents failed to meet. RESULTS We found 116 cases of residents dismissed from their training programmes who challenged the decision of the program director before the board. In general, most residents were unable to meet the requirements of several CanMEDS competency domains (usually: medical expert, communicator, and professional). In surgery, all dismissed residents failed to meet the competency domain of the medical expert, while most of the dismissed psychiatry residents met this domain. In specialties with a primarily diagnostic task, more dismissed residents failed to meet the competency domain of the scholar, while dismissed general medicine residents (for example family medicine and nursing homecare) were less likely to do so. Residents in general medicine, more often than other specialties, however, failed to meet the competency domain of the professional. CONCLUSION Residents dismissed from training, who challenged their dismissal, failed to meet the requirements of multiple CanMEDS competency domains. Competency domain failures differ by specialty.
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Affiliation(s)
- Judith A Godschalx-Dekker
- Department of Hospital Psychiatry and Medical Psychology, Flevoziekenhuis Almere, The Netherlands
- Department of Psychiatry St. Jansdal, Lelystad, The Netherlands
- GGZ Central, Flevoland, The Netherlands
| | - Frank L Gerritse
- Department of Hospital Psychiatry, Tergooi MC, Blaricum, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Jurjen J Luykx
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- GGNet Mental Health, Warnsveld, The Netherlands
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Stegers-Jager KM, Cohen-Schotanus J, Themmen APN. The Four-Tier Continuum of Academic and Behavioral Support (4T-CABS) Model: An Integrated Model for Medical Student Success. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1525-1530. [PMID: 28445223 DOI: 10.1097/acm.0000000000001685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Not all students cope successfully with the demands of medical school, and students' struggles may result in study delay or dropout. To prevent these outcomes, medical schools need to identify students who are experiencing academic difficul ties and provide them with timely interventions through access to support programs. Although the importance of early identification and intervention is well recognized, less is known about successful strategies for identifying and supporting struggling students.Building on the literature and their own empirical findings, the authors propose an integrated, school-wide model for medical student success comprising a continuum of academic and behavioral support. This Four-Tier Continuum of Academic and Behavioral Support (4T-CABS) model focuses on improving both academic and behavioral outcomes by offering support for students at four levels, which range from adequate instruction for all, to targeted small-group interventions, to individualized support, and also include exit support for students who might be better off in another degree program. Additionally, medical schools should provide both academic and behavioral support; set high, yet realistic expectations and clearly communicate these to students; and intervene early, which requires timely identification of at-risk students who would benefit from the different types and tiers of support. Finally, interventions should be evidence based and fit the needs of the identified groups of students. The authors argue that adopting the core principles of the 4T-CABS model will enable medical schools to maximize academic engagement and performance for all students.
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Affiliation(s)
- Karen M Stegers-Jager
- K.M. Stegers-Jager is assistant professor, Institute of Medical Education Research Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. J. Cohen-Schotanus is emeritus professor of medical education, Center for Research and Innovation in Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. A.P.N. Themmen is professor of experimental endocrinology and medical education, Institute of Medical Education Research Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation(s)
- Steven Burr
- Deputy Director of Assessment, Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Peninsula Schools of Medicine & Dentistry, Plymouth University, Devon PL4 8AA
| | - Hilary Neve
- Director of Small Group Learning, Professionalism and Social Engagement in the Peninsula Schools of Medicine & Dentistry, Plymouth University, Devon
| | - Yee Leung
- Consultant Spinal Surgeon in the Department of Orthopaedics, Musgrove Park Hospital, Taunton, Somerset
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Cardellach F, Vilardell M, Pujol R. [Training doctors for the future: A review 10 years later]. Med Clin (Barc) 2016; 147:313-5. [PMID: 27033432 DOI: 10.1016/j.medcli.2016.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/27/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Francesc Cardellach
- Facultad de Medicina, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Miquel Vilardell
- Facultad de Medicina, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ramon Pujol
- Facultad de Medicina, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, España.
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van Mook WNKA, van Luijk SJ, Zwietering PJ, Southgate L, Schuwirth LWT, Scherpbier AJJA, van der Vleuten CPM. The threat of the dyscompetent resident: A plea to make the implicit more explicit! ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:559-74. [PMID: 24927810 DOI: 10.1007/s10459-014-9526-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/28/2014] [Indexed: 05/26/2023]
Abstract
Although several examples of frameworks dealing with students' unprofessional behaviour are available, guidance on how to deal locally or regionally with dysfunctional residents is limited (Hickson et al. in Acad Med 82(11):1040-1048, 2007b; Leape and Fromson in Ann Intern Med 144(2):107-115, 2006). Any 'rules' are mostly unwritten, and often emerge by trial and error within the specialty training programme (Stern and Papadakis in N Engl J Med 355(17):1794-1799, 2006). It is nevertheless of utmost importance that objectives, rules and guidelines comparable to those existing in undergraduate training (Project Team Consilium Abeundi van Luijk in Professional behaviour: teaching, assessing and coaching students. Final report and appendices. Mosae Libris, 2005; van Mook et al. in Neth J Crit Care 16(4):162-173, 2010a) are developed for postgraduate training. And that implicit rules are made explicit. This article outlines a framework based on the lessons learned from contemporary postgraduate medical training programmes.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands,
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Esen UI. Postgraduate training in medical professionalism. Br J Hosp Med (Lond) 2014; 75:148-50. [DOI: 10.12968/hmed.2014.75.3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical professionalism receives little attention in postgraduate medical education, despite its importance in producing clinically and professionally competent specialists. Guidance for translating professionalism from postgraduate curricula into practice is lacking. This is the challenge for every postgraduate training programme.
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Affiliation(s)
- Umo I Esen
- Consultant Obstetrician and Gynaecologist in the Department of Obstetrics and Gynaecology, South Tyneside NHS Foundation Trust, South Shields NE34 0PL
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Nothnagle M, Reis S, Goldman RE, Anandarajah G. Fostering professional formation in residency: development and evaluation of the "forum" seminar series. TEACHING AND LEARNING IN MEDICINE 2014; 26:230-238. [PMID: 25010233 DOI: 10.1080/10401334.2014.910124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Residency training is a critical time for physicians' professional formation. However, few structured interventions exist to support residents in this transformative process of integrating personal and professional values, a process that is essential to physician identity formation and preservation of core values such as service and compassion. PURPOSES The authors created a seminar series, the "Forum," to support resident professional formation and address the hidden curriculum as part of a larger intervention to support self-directed learning skills such as goal setting and reflection. METHODS Ninety-minute sessions with senior residents and faculty held every other month include opportunities for individual reflection, small- and large-group discussion, and brief didactic components focused on skills such as teaching and leadership. The qualitative program evaluation included analyses of individual semistructured interviews with resident and faculty participants from 2008 to 2011 and of notes recorded by an observer during the 1st year's sessions. RESULTS Residents appreciated the focus on relevant issues, presence of faculty, opportunities for reflection and interactivity, and inclusion of practical skills. Effects attributed to the Forum included gaining practical skills, feeling a deeper connection to one another and a sense of community, and recognizing progress in their own professional development and growth. Elements described in the literature as essential to professional formation, including encouraging reflection, use of narrative, role modeling, addressing the hidden curriculum, and fostering an authentic community, were recognized by participants as integral to the Forum's success. CONCLUSIONS A group forum for reflection and discussion with peers and role models, tailored to local needs, offers an effective structure to foster professional formation in residency.
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Affiliation(s)
- Melissa Nothnagle
- a Department of Family Medicine , Alpert Medical School of Brown University , Pawtucket , Rhode Island , USA
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O'Sullivan H, van Mook W, Fewtrell R, Wass V. Integrating professionalism into the curriculum. MEDICAL TEACHER 2012; 34:155-157. [PMID: 22288994 DOI: 10.3109/0142159x.2011.595600] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Professional values and behaviours are intrinsic to all medical practice yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism in the twenty-first century raises challenges not only for the adaptation of the medical training programme to changing societal values but also for ensuring that trainees gain the skills for self-directed continuous development and future revalidation. This article is an introduction to the AMEE Guide in Medical Education No 61: Integrating Professionalism into the Curriculum ( www.amee.org ), which is based on the extensive contemporary available literature. An evidence-based approach has been taken throughout the Guide as it focuses on instilling professionalism positively into both undergraduate and postgraduate training. It takes a structured, stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning of the trainee. A few well-evaluated case studies for both teaching and assessment have been selected to illustrate the recommendations.
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Affiliation(s)
- Helen O'Sullivan
- Institute of Learning and Teaching, Faculty of Health and Life Sciences, The University of Liverpool, UK.
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O'Sullivan H, van Mook W, Fewtrell R, Wass V. Integrating professionalism into the curriculum: AMEE Guide No. 61. MEDICAL TEACHER 2012; 34:e64-e77. [PMID: 22289014 DOI: 10.3109/0142159x.2012.655610] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Professional values and behaviours are intrinsic to all medical practice, yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism for the twenty-first century raises challenges not only to adapting the course to changing societal values but also for instilling skills of ongoing self-directed continuous development in trainees for future revalidation. This Guide is based on the contemporary available literature and focuses on instilling Professionalism positively into both undergraduate and postgraduate training deliberately avoiding the more negative aspects of Fitness to Practise. The literature on Professionalism is extensive. An evidence-based approach has been taken throughout. We have selected only some of the available publications to offer practical advice. Comprehensive reviews are available elsewhere (van Mook et al. 2009a-g). This Guide takes a structured stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning. Finally, a few well-evaluated case studies for both teaching and assessment have been selected to illustrate our recommendations.
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Affiliation(s)
- Helen O'Sullivan
- Institute of Learning and Teaching, Faculty of Health and Life Sciences, The University of Liverpool, UK.
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Campos AI. [New professionalism, medical education and healthcare systems]. CIENCIA & SAUDE COLETIVA 2011; 16:2725-32. [PMID: 21709970 DOI: 10.1590/s1413-81232011000600011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 03/30/2011] [Indexed: 11/22/2022] Open
Abstract
The scope of this paper is to discuss how so-called "new professionalism" can help in how the education of physicians is conducted, by taking into account the effects of globalization both on the situation of health and on the needs of health professionals with particular emphasis on European Union countries, which are engaged in a profound process of reform in university education. To achieve this, first we present the basic concepts of "new professionalism" and the key strategies of current medical education, which is to train physicians capable of dealing with ethical, scientific and professional challenges that are arising at the beginning of this century. The interdependence of reforms in the undergraduate, graduate and ongoing training areas is then emphasized. The challenges and difficulties to be faced when switching to different stages of medical education are then outlined. It was concluded that, notwithstanding recent reforms in medical education, their great complexity and the still limited availability of contrasting assessments of their results, there are strong synergies between the principles and values of the "new professionalism" and the objectives of the reforms.
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Affiliation(s)
- Alberto Infante Campos
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, España.
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van Mook WNKA, Van Luijk SJ, Fey-Schoenmakers MJG, Tans G, Rethans JJE, Schuwirth LW, van der Vleuten CPM. Combined formative and summative professional behaviour assessment approach in the bachelor phase of medical school: a Dutch perspective. MEDICAL TEACHER 2010; 32:e517-31. [PMID: 21090939 DOI: 10.3109/0142159x.2010.509418] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Teaching and assessment of professional behaviour (PB) has been receiving increasing attention in the educational literature and educational practice. Although the focus tends to be summative aspects, it seems perfectly feasible to combine formative and summative approaches in one procedural approach. AIMS AND METHOD Although, many examples of frameworks of professionalism and PB can be found in the literature, most originate from North America, and only few are designed in other continents. This article presents the framework for PB that is used at Maastricht medical school, the Netherlands. RESULTS The approach to PB used in the Dutch medical schools is described with special attention to 4 years (2005-2009) of experience with PB education in the first 3 years of the 6-year undergraduate curriculum of Maastricht medical school. Future challenges are identified. CONCLUSIONS The adages 'Assessment drives learning' and 'They do not respect what you do not inspect' [Cohen JJ. 2006. Professionalism in medical education, an American perspective: From evidence to accountability. Med Educ 40, 607-617] suggest that formative and summative aspects of PB assessment can be combined within an assessment framework. Formative and summative assessments do not represent contrasting but rather complementary approaches. The Maastricht medical school framework combines the two approaches, as two sides of the same coin.
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van Mook WNKA, Gorter SL, De Grave WS, van Luijk SJ, Wass V, Zwaveling JH, Schuwirth LW, Van Der Vleuten CPM. Bad apples spoil the barrel: Addressing unprofessional behaviour. MEDICAL TEACHER 2010; 32:891-8. [PMID: 21039099 DOI: 10.3109/0142159x.2010.497823] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Given the changes in society we are experiencing, the increasing focus on patient-centred care and acknowledgement that medical education including professionalism issues needs to continue not only in the residency programmes but also throughout the doctors career, is not surprising. Although most of the literature on professionalism pertains to learning and teaching professionalism issues, addressing unprofessional behaviour and related patient safety issues forms an alternative or perhaps complementary approach. This article describes the possibility of selecting applicants for a medical school based on personality characteristics, the attention to professional lapses in contemporary undergraduate training, as well as the magnitude, aetiology, surveillance and methods of dealing with reports of unprofessional behaviour in postgraduate education and CME.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care, Maastricht University Medical Centre, P. Debeijelaan 25, 6202 AZ Maastricht, The Netherlands.
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