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Alharbi NS. Evaluating competency-based medical education: a systematized review of current practices. BMC MEDICAL EDUCATION 2024; 24:612. [PMID: 38831271 PMCID: PMC11149276 DOI: 10.1186/s12909-024-05609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals. METHOD This systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals. RESULTS Thirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations' objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria. CONCLUSION This review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.
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Affiliation(s)
- Nouf Sulaiman Alharbi
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
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Rees CE, Davis C, Nguyen VNB, Proctor D, Mattick KL. A roadmap to realist interviews in health professions education research: Recommendations based on a critical analysis. MEDICAL EDUCATION 2024; 58:697-712. [PMID: 38073499 DOI: 10.1111/medu.15270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 05/03/2024]
Abstract
CONTEXT Realist evaluation is increasingly employed in health professions education research (HPER) because it can unpack the extent to which complex educational interventions work (or not), for whom under what circumstances and how. While realist evaluation is not wedded to particular methods, realist interviews are commonly the primary, if not only, data collection method in realist evaluations. While qualitative interviewing from an interpretivist standpoint has been well-articulated in the HPER literature, realist interviewing differs substantially. The former elicits participants' views and experiences of a topic of inquiry, whereas realist interviewing focuses on building, testing and/or refining programme theory. Therefore, this article aims to help readers better understand, conduct, report and critique realist interviews as part of realist evaluations. METHODS In this paper, we describe what realist approaches are, what realist interviewing is and why realist interviewing matters. We outline five stages to realist interviewing (developing initial programme theory, realist sampling/samples, the interview itself, realist analysis and reporting realist interviews), drawing on two illustrative cases from our own realist evaluations employing interviewing to bring theory to life. We provide a critical analysis of 12 realist evaluations employing interviewing in the HPER literature. Alongside reporting standards, and our own realist interviewing experiences, this critical analysis of published articles serves to foreground our recommendations for realist interviewing. CONCLUSIONS We encourage HPE researchers to consider realist interviews as part of realist evaluations of complex interventions. Our critical analysis reveals that realist interviews can provide unique insights into HPE, but authors now need to report their sampling approach, type of interviewing and interview questions more explicitly. Studies should also more explicitly draw on existing realist interviewing literature and follow reporting guidelines for realist evaluations. We hope this paper provides a useful roadmap to conducting, reporting and critically appraising realist interviews in HPER.
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Affiliation(s)
- Charlotte E Rees
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Corinne Davis
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Van N B Nguyen
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Karen L Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Frank JR, Hall AK, Oswald A, Dagnone JD, Brand PLP, Reznick R. From Competence by Time to Competence by Design: Lessons From A National Transformation Initiative. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:224-228. [PMID: 38550713 PMCID: PMC10976982 DOI: 10.5334/pme.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education, and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Competency Based Medical Education, and Professor, Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J. Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Standards and Accreditation, Royal College of Physicians & Surgeons of Canada, Ottawa, ON, Canada
| | - Paul L. P. Brand
- Clinical Medical Education, University Medical Centre and University of Groningen, the Netherlands
- Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
| | - Richard Reznick
- Queen’s University, Immediate Past President Royal College of Physicians and Surgeons of Canada, Canada
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Frank JR, Karpinski J, Sherbino J, Snell LS, Atkinson A, Oswald A, Hall AK, Cooke L, Dojeiji S, Richardson D, Cheung WJ, Cavalcanti RB, Dalseg TR, Thoma B, Flynn L, Gofton W, Dudek N, Bhanji F, Wong BMF, Razack S, Anderson R, Dubois D, Boucher A, Gomes MM, Taber S, Gorman LJ, Fulford J, Naik V, Harris KA, St. Croix R, van Melle E. Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:201-223. [PMID: 38525203 PMCID: PMC10959143 DOI: 10.5334/pme.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.
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Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Jolanta Karpinski
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Competency Based Medical Education, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Linda S. Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Medicine and Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Dojeiji
- Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | - Denyse Richardson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B. Cavalcanti
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- HoPingKong Centre, University Health Network, Toronto, ON, Canada
| | - Timothy R. Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Leslie Flynn
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Departments of Psychiatry and Family Medicine, and Co-Director Master of Health Sciences Education, Queen’s University, Kingston, ON, Canada
| | - Wade Gofton
- Department of Surgery (Division of Orthopedic Surgery), The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Nancy Dudek
- Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Farhan Bhanji
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Brian M.-F. Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Saleem Razack
- Centre for Health Education Scholarship, University of British Columbia and BC Children’s Hospital, Vancouver, BC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrée Boucher
- Department of Medicine (Division of Endocrinology), Universitéde Montréal, Montréal, QC, Canada
| | - Marcio M. Gomes
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Taber
- Office of Standards and Assessment, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Lisa J. Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Jane Fulford
- Canadian Internet Registration Authority, Canada
| | - Viren Naik
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Medical Council of Canada, Ottawa, ON, Canada
| | - Kenneth A. Harris
- Royal College of Physicians and Surgeons of Canada, Canada
- Emeritus, Western University, Canada
| | - Rhonda St. Croix
- Learning and Connecting at the Royal College of Physicians and Surgeons of Canada, Canada
| | - Elaine van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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Pusic MV, Ellaway RH. Researching models of innovation and adoption in health professions education. MEDICAL EDUCATION 2024; 58:164-170. [PMID: 37495269 DOI: 10.1111/medu.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Despite the constant presence of change and innovation in health professions education (HPE), there has been relatively little theoretical modelling of such change, the experiences of change, the ideology associated with change or the unexpected consequences of change. In this paper, the authors explore theoretical approaches to the adoption of innovations in HPE as a way of mapping a broader theoretical landscape of change. METHOD The authors, HPE researchers with an interest in technology adoption and systemic change, present a narrative review of the literature based on a series of thought experiments regarding how communities and individuals respond to the introduction of new ideas or methods. This research investigates the stages of innovation adoption, from the emergence and hype around new ideas to the concrete experiences of early adopters. RESULTS When an innovation first emerges, there is often little concrete information available to inform potential adopters, leaving it susceptible to hype, both positive and negative. This can be described using the Gartner Hype Cycle model, albeit with important caveats. Once the adoption of an innovation gets underway, early adopter user experiences can inform those that follow. This can be described using Rogers' diffusion of innovation model, again with caveats. Notably, neither model goes beyond the point of single point-in-time, yes/no, individual adoption. Other approaches, such as learning curve theory, are needed to track uptake and maintenance by individuals over time. SIGNIFICANCE This expanded theoretical base, while still somewhat instrumentalist, combined with complementary theoretical perspectives can afford opportunities to better explore reasons for variance, volunteerism and resistance to change. In summary, change is complicated and nuanced, and better models and theories are needed to understand and work meaningfully with change in HPE. To that end, the authors seek to encourage richer and more thoughtful research and scholarly thinking about change and a more nuanced approach to the pursuit of change in HPE as a whole.
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Affiliation(s)
- Martin Victor Pusic
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- American Board of Medical Specialties, Chicago, Illinois, USA
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Grierson L, Cavanagh A, Youssef A, Lee-Krueger R, McNeill K, Button B, Kulasegaram K. Inter-institutional data-driven education research: consensus values, principles, and recommendations to guide the ethical sharing of administrative education data in the Canadian medical education research context. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:113-120. [PMID: 38045068 PMCID: PMC10690000 DOI: 10.36834/cmej.75874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Administrative data are generated when educating, licensing, and regulating future physicians but these data are rarely used beyond their pre-specified purposes. The capacity necessary for sensitive and responsive oversight that supports the sharing of administrative medical education data across institutions for research purposes needs to be developed. Method A pan-Canadian consensus-building project was undertaken to develop agreement on the goals, benefits, risks, values, and principles that should underpin inter-institutional data-driven medical education research in Canada. A survey of key literature, consultations with various stakeholders and five successive knowledge synthesis workshops informed this project. Propositions were developed, driving subsequent discussions until collective agreement was distilled. Results Consensus coalesced around six key principles: establishing clear purposes, rationale, and methodology for inter-institutional data-driven research a priori; informed consent from data generators in education systems is non-negotiable; multi-institutional data sharing requires special governance; data governance should be guided by data sovereignty; data use should be guided by an identified set of shared values; and best practices in research data-management should be applied. Conclusion We recommend establishing a representative governance body, engaging trusted data facility, and adherence to extant data management policies when sharing administrative medical education data for research purposes in Canada.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, and Scientist, McMaster Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Alice Cavanagh
- Michael G. DeGroote School of Medicine, McMaster University and Health Policy PhD Program, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Alaa Youssef
- Stanford School of Medicine, Department of Radiology, Stanford Center for Artificial Intelligence in Medicine and Imaging, California, USA
| | - Rachelle Lee-Krueger
- Faculty of Education, University of Ottawa, Ontario, Canada
- Education Consultant, Office of Continuing Medical Education & Professional Development, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kestrel McNeill
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Ontario, Canada
| | - Brenton Button
- Northern Ontario School of Medicine University, Ontario, Canada
- Faculty of Education, University of Winnipeg, Manitoba, Canad
| | - Kulamakan Kulasegaram
- Department of Community and Family Medicine, University of Toronto and Scientist at Wilson Centre, University of Toronto, Ontario, Canada
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Shah AP, Walker KA, Walker KG, Cleland J. Context matters in curriculum reform: An analysis of change in surgical training. MEDICAL EDUCATION 2023; 57:741-752. [PMID: 36869257 DOI: 10.1111/medu.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. METHODS Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. RESULTS The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. CONCLUSIONS Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Aggarwal M, Abdelhalim R. Are early career family physicians prepared for practice in Canada? A qualitative study. BMC MEDICAL EDUCATION 2023; 23:370. [PMID: 37226128 DOI: 10.1186/s12909-023-04250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND In Canada, the College of Family Physicians of Canada (CFPC) introduced Competency Based Medical Education to prepare and train family medicine residents to be competent to enter and adapt to the independent practice of comprehensive family medicine. Despite its implementation, the scope of practice is narrowing. This study aims to understand the degree to which early career Family Physicians (FPs) are prepared for independent practice. METHOD A qualitative design was used for this study. A survey and focus groups were conducted with early-career FPs who completed residency training in Canada. The survey and focus groups examined the degree of preparedness of early career FPs in relation to 37 core professional activities identified by the CFPC's Residency Training Profile. Descriptive statistics and qualitative content analysis were conducted. RESULTS Seventy-five participants from across Canada participated in the survey, and 59 participated in the focus groups. Early career FPs reported being well prepared to provide continuous and coordinated care for patients with common presentations and deliver various services to different populations. FPs were also well prepared to manage the electronic medical record, participate in team-based care, provide regular and after-hours coverage, and assume leadership and teaching roles. However, FPs reported being less prepared for virtual care, business management, providing culturally safe care, delivering specific services in emergency care hospitals, obstetrics, self-care, engaging with the local communities, and conducting research activities. CONCLUSIONS Early career FPs do not feel fully prepared for practice in all 37 core activities in the Residency Training Profile. As part of the introduction of the three-year program by the CFPC, the postgraduate family medicine training should consider providing more exposure to learning opportunities and developing curricula in the areas where FPs are unprepared for practice. These changes could facilitate the production of a FP workforce better prepared to manage the dynamic and complex challenges and dilemmas faced in independent practice.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Reham Abdelhalim
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Ross S, Lawrence K, Bethune C, van der Goes T, Pélissier-Simard L, Donoff M, Crichton T, Laughlin T, Dhillon K, Potter M, Schultz K. Development, Implementation, and Meta-Evaluation of a National Approach to Programmatic Assessment in Canadian Family Medicine Residency Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:188-198. [PMID: 35671407 PMCID: PMC9855760 DOI: 10.1097/acm.0000000000004750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The growing international adoption of competency-based medical education has created a desire for descriptions of innovative assessment approaches that generate appropriate and sufficient information to allow for informed, defensible decisions about learner progress. In this article, the authors provide an overview of the development and implementation of the approach to programmatic assessment in postgraduate family medicine training programs in Canada, called Continuous Reflective Assessment for Training (CRAFT). CRAFT is a principles-guided, high-level approach to workplace-based assessment that was intentionally designed to be adaptable to local contexts, including size of program, resources available, and structural enablers and barriers. CRAFT has been implemented in all 17 Canadian family medicine residency programs, with each program taking advantage of the high-level nature of the CRAFT guidelines to create bespoke assessment processes and tools appropriate for their local contexts. Similarities and differences in CRAFT implementation between 5 different family medicine residency training programs, representing both English- and French-language programs from both Western and Eastern Canada, are described. Despite the intentional flexibility of the CRAFT guidelines, notable similarities in assessment processes and procedures across the 5 programs were seen. A meta-evaluation of findings from programs that have published evaluation information supports the value of CRAFT as an effective approach to programmatic assessment. While CRAFT is currently in place in family medicine residency programs in Canada, given its adaptability to different contexts as well as promising evaluation data, the CRAFT approach shows promise for application in other training environments.
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Affiliation(s)
- Shelley Ross
- S. Ross is professor and director, Research and Innovation, Teaching and Assessment Support Program, Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ORCID: http://orcid.org/0000-0001-9581-3191
| | - Kathrine Lawrence
- K. Lawrence is associate professor and assessment director and provincial head, Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheri Bethune
- C. Bethune is professor, Northern Ontario School of Medicine, clinical professor, Memorial University of Newfoundland, Newfoundland, Canada, and clinician educator, College of Family Physicians of Canada; ORCID: http://orcid.org/0000-0002-6230-6262
| | - Theresa van der Goes
- T. van der Goes is family physician (retired), medical educator, and director of assessment, University of British Columbia Family Medicine Residency Program, Vancouver, British Columbia, Canada
| | - Luce Pélissier-Simard
- L. Pélissier-Simard is associate professor, Department of Family Medicine and Emergency Medicine, and associate academic director, Centre de Développement Professionnel, Faculté de médecine et des sciences de la santé de l’Université de Sherbrooke, Sherbrooke, Québec, Canada; ORCID: http://orcid.org/0000-0002-9402-1798
| | - Michel Donoff
- M. Donoff is family physician, professor, and associate chair, Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Crichton
- T. Crichton is family physician and senior advisor, Postgraduate Medical Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Thomas Laughlin
- T. Laughlin is an associate professor, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, and clinical associate professor, Discipline of Family Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Kiran Dhillon
- K. Dhillon is clinical lecturer, Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada, and member, Certification Process and Assessment Committee, College of Family Physicians of Canada
| | - Martin Potter
- M. Potter is assistant professor, Family Medicine and Emergency Department, Université de Montréal, Montréal, Québec, Canada
| | - Karen Schultz
- K. Schultz is professor and assessment director, Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada, and chair, Certification Process and Assessment Committee, College of Family Physicians of Canada; ORCID: http://orcid.org/0000-0003-0208-3981
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Lee-Krueger RCW, Moreau K, Delva D, Eady K, Giroux CM, Archibald D. Fundamental Teaching Activities in Family Medicine Framework: Analysis of Awareness and Utilization. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:274-283. [PMID: 35180743 PMCID: PMC9722374 DOI: 10.1097/ceh.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In 2015, the College of Family Physicians of Canada, in performing their commitment to supporting its members in their educational roles, created the Family Medicine Framework (FTA). It was designed to assist family medicine educators with an understanding of the core activities of educators: precepting, coaching, and teaching within or beyond clinical settings. Given that an examination of member awareness of FTA has not been previously undertaken, our primary objective was to conduct an evaluation on its utility and application. METHODS In partnership with College of Family Physicians of Canada Faculty Development Education Committee members, we used a practical participatory evaluation approach to conduct a two-phase mixed-methods evaluation of the FTA. We distributed an electronic survey in French and English languages to Canadian faculty development, program, and site directors in family medicine. We then conducted follow-up interviews with self-selected participants. RESULTS Of the target populations, 12/15 (80%) faculty development directors (FDDs), 12/18 (66.7%) program directors, and 34/174 (19.5%) site directors completed the electronic survey. Subsequently, 6 FDDs, 3 program directors, and 3 site directors completed an interview (n = 12). Findings indicate that awareness of the FTA was highest among FDDs. Facilitators who encourage teachers to use the FTA and barriers for low uptake were also identified. DISCUSSION This evaluation illuminated that varied levels of awareness of the FTA may contribute to the low uptake among education leaders. We also suggest future research to address possible barriers that hinder effective applications of the FTA in faculty development initiatives.
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Affiliation(s)
- Rachelle C. W. Lee-Krueger
- Mrs. Lee-Krueger: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Moreau: Associate Professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Delva: Professor, Department of Family Medicine, Queens University, Kingston, Ontario, Canada. Dr. Eady: Senior Research Associate, Center for Research on Educational and Community Services, Faculties of Education and Social Sciences, University of Ottawa, Ottawa, Ontario, Canada. Dr. Giroux: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Archibald: Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine Moreau
- Mrs. Lee-Krueger: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Moreau: Associate Professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Delva: Professor, Department of Family Medicine, Queens University, Kingston, Ontario, Canada. Dr. Eady: Senior Research Associate, Center for Research on Educational and Community Services, Faculties of Education and Social Sciences, University of Ottawa, Ottawa, Ontario, Canada. Dr. Giroux: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Archibald: Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dianne Delva
- Mrs. Lee-Krueger: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Moreau: Associate Professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Delva: Professor, Department of Family Medicine, Queens University, Kingston, Ontario, Canada. Dr. Eady: Senior Research Associate, Center for Research on Educational and Community Services, Faculties of Education and Social Sciences, University of Ottawa, Ottawa, Ontario, Canada. Dr. Giroux: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Archibald: Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kaylee Eady
- Mrs. Lee-Krueger: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Moreau: Associate Professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Delva: Professor, Department of Family Medicine, Queens University, Kingston, Ontario, Canada. Dr. Eady: Senior Research Associate, Center for Research on Educational and Community Services, Faculties of Education and Social Sciences, University of Ottawa, Ottawa, Ontario, Canada. Dr. Giroux: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Archibald: Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine M. Giroux
- Mrs. Lee-Krueger: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Moreau: Associate Professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Delva: Professor, Department of Family Medicine, Queens University, Kingston, Ontario, Canada. Dr. Eady: Senior Research Associate, Center for Research on Educational and Community Services, Faculties of Education and Social Sciences, University of Ottawa, Ottawa, Ontario, Canada. Dr. Giroux: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Archibald: Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Archibald
- Mrs. Lee-Krueger: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Moreau: Associate Professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Delva: Professor, Department of Family Medicine, Queens University, Kingston, Ontario, Canada. Dr. Eady: Senior Research Associate, Center for Research on Educational and Community Services, Faculties of Education and Social Sciences, University of Ottawa, Ottawa, Ontario, Canada. Dr. Giroux: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr. Archibald: Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Hosseini S, Yilmaz Y, Shah K, Gottlieb M, Stehman CR, Hall AK, Chan TM. Program evaluation: An educator's portal into academic scholarship. AEM EDUCATION AND TRAINING 2022; 6:S43-S51. [PMID: 35783081 PMCID: PMC9222891 DOI: 10.1002/aet2.10745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 06/15/2023]
Abstract
Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.
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Affiliation(s)
- Shera Hosseini
- Faculty of Health SciencesMcMaster Institute for Research on AgingMcMaster Education Research, Innovation, and TheoryMcMaster UniversityHamiltonOntarioCanada
| | - Yusuf Yilmaz
- McMaster Education Research, Innovation and Theory (MERIT) Program & Office of Continuing Professional DevelopmentFaculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Department of Medical EducationFaculty of MedicineEge UniversityIzmirTurkey
| | - Kaushal Shah
- Department of Emergency MedicineWeill Cornell Medical SchoolNew YorkNew YorkUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Christine R. Stehman
- Department of Emergency MedicineUniversity of Illinois College of Medicine ‐ Peoria/OSF HealthcarePeoriaIllinoisUSA
| | - Andrew K. Hall
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Teresa M. Chan
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
- McMaster Program for Education Research, Innovation, and Theory (MERIT)McMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methodology, Impact, and EvidenceMcMaster UniversityHamiltonOntarioCanada
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Baranova K, Goebel EA, Wasserman J, Osmond A. A Survey on Changes to the Canadian Anatomical Pathology Certification Examination Due to Coronavirus Disease 2019 and Implications for Competency-Based Medical Education. Acad Pathol 2021; 8:23742895211060711. [PMID: 34926797 PMCID: PMC8679023 DOI: 10.1177/23742895211060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023] Open
Abstract
The coronavirus disease 2019 pandemic resulted in a dramatic change in the Royal
College of Physicians and Surgeons of Canada assessment process through
elimination of the oral and practical components of the 2020 Anatomical
Pathology examination. Our study sought to determine stakeholder opinions and
experiences on these changes in the context of the 2019 implementation of
competency-based medical education. Surveys were designed for residents and
practicing pathologists. In total, 57 residents (estimated response rate 29%)
and 185 pathologists (estimated response rate 19%) participated across Canada;
67% of pathologists disagreed with the 2020 Royal College examination changes,
compared with 30% for residents (P = <.00001). When asked whether the Royal
College examination should be eliminated, 95% of pathologists indicated they
would be against this, compared to only 34% of residents (P = <.00001).
Perceptions on changes to and importance of different components of assessment
in competency-based medical education were similar between pathologists and
residents, with participants perceiving assessment practices to have changed
fairly little since its implementation, with the exception of more frequent
feedback. Analysis of narrative comments identified several common themes around
assessment, including the need for objectivity and standardization and the
problem of failure-to-fail. However, residents identified numerous elements of
their performance that can be assessed only through longitudinal evaluation.
Pathologists, on the other hand, tended to view these aspects of performance as
laden with bias. Our results will hopefully help guide future innovation in
assessment by characterizing different stakeholder perspectives on key issues in
medical education.
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Affiliation(s)
- Katherina Baranova
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Emily A. Goebel
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Jason Wasserman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ontario, Canada
| | - Allison Osmond
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Sherbino J, Regehr G, Dore K, Ginsburg S. Tensions in describing competency-based medical education: a study of Canadian key opinion leaders. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1277-1289. [PMID: 33895905 DOI: 10.1007/s10459-021-10049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.
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Affiliation(s)
- Jonathan Sherbino
- Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
- David Braley Health Science Centre, Rm 5003, 1280 Main St W., Hamilton, ON, L8S 4K1, Canada.
| | - Glenn Regehr
- Centre for Health Education Scholarship and Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kelly Dore
- Division of Innovation and Education, Department of Medicine, McMaster University, Hamilton, Canada
| | - Shiphra Ginsburg
- Department of Medicine, Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
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Torres-Calixto MG. Trends and challenges of medical education. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.84330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this article is to reflect on the contextual factors that influence medical education, in order to provide some recommendations about the challenges that physicians face.
A literature review was conducted to write this reflection paper, and it was found that the education of health professionals has undergone significant changes that are based on the development of biomedical sciences, technology, and pedagogy, and are influenced by the needs of the general population, the requirements of the health systems of each country, and scientific progress.
These changes have given rise to challenges inherent to the special characteristics of each country and related to the quantity, quality, and relevance of the training of physicians. In this regard, it has been suggested that, in the face of such changes, it is necessary to design curricula that integrate all aspects of health care, consider the supply and demand of medical services, emphasize professionalism, take into account the pedagogical training of health sciences teachers, comply with quality standards, assist students in selecting undergraduate programs adequately (in this case Medicine), and ensure relevant clinical practice scenarios.
It should also be noted that medical education has not adapted adequately to the aforementioned changes in many countries and, therefore, the development of teaching and learning strategies has lagged behind and physicians in such countries do not have the capacity to provide the health care required by the general population in a proper manner.
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Sloychuk J, Szafran O, Duerksen K, Babenko O. Association Between Family Medicine Residents' Mindsets and In-Training Exam Scores. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2020; 4:33. [PMID: 33426482 DOI: 10.22454/primer.2020.796230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction In medical practice, a mastery mindset is important for engaging in lifelong learning. The objective of this study was to examine the association between family medicine residents' scores on mindset measures and their performance on in-training examinations (ITE). Methods This was a secondary data analysis of a cohort of family medicine residents. Following ethics approval, residents' ITE scores from each of the 2 years of residency were linked with residents' responses to a mindsets survey that they had taken at the midpoint of residency training. Multiple regression analysis was used to investigate the relationship between residents' mindset scores and their ITE scores. Of 85 residents, 46 (54%) had complete data for the three data collection points. Results Residents' ITE scores in year 1 were most predictive of their ITE scores in year 2 (β=0.72; P<.001). Mastery mindset scores were negatively associated with residents' performance on the ITE in year 2 (β=-0.29; P=.004). Conclusion While the observed negative relationship between residents' mastery mindset scores and their ITE performance may be disconcerting, it is not surprising. In clinical settings, residents are individually coached by preceptors and provided with specific, actionable feedback to support their learning. With respect to formative assessments, residents likely require explicit training on how to use their assessment results (ITE scores) to support their self-directed learning. This finding has practical implications for residency programs in using ITEs as formative assessments.
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Affiliation(s)
- Janelle Sloychuk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Olga Szafran
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberley Duerksen
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Dagnone JD, Chan MK, Meschino D, Bandiera G, den Rooyen C, Matlow A, McEwen L, Scheele F, St Croix R. Living in a World of Change: Bridging the Gap From Competency-Based Medical Education Theory to Practice in Canada. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1643-1646. [PMID: 32079931 DOI: 10.1097/acm.0000000000003216] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Within graduate medical education, many educators are experiencing a climate of significant change. One transformation, competency-based medical education (CBME), is occurring simultaneously across much of the world, and implementation will require navigating numerous tensions and paradoxes. Successful transformation requires many types of power and is most likely to happen when the medical education community of professionals is engaged in designing, experimenting, acting, and sensemaking together.In this complex climate, the craft of change facilitators and community leaders is needed more than ever. National top-down policies and structures, while important, are not sufficient. The operationalization of new advances is best done when local leaders are afforded room to shape their local context. An evidence-based approach to thinking about the transformative change associated with CBME needs to be adopted. In this age of entrustment, 3 priorities are paramount: (1) engage, entrust, and empower professionals with increasing shared ownership of the innovation; (2) better prepare education professionals in leadership and transformational change techniques in the complex system of medical education; and (3) leverage the wider community of practice to maximize local CBME customization. These recommendations, although based largely on the Canadian experience, are intended to inform CBME transformation in any context.
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Affiliation(s)
- Jeffrey Damon Dagnone
- J.D. Dagnone is associate professor of emergency medicine and competency-based medical education faculty lead, Queen's University, Kingston, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6963-7948
| | - Ming-Ka Chan
- M.-K. Chan is associate professor and clinician educator of pediatrics and child health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diane Meschino
- D. Meschino is assistant professor, Department of Psychiatry, University of Toronto (Women's College Hospital), Toronto, Ontario, Canada
| | - Glen Bandiera
- G. Bandiera is professor of emergency medicine and associate dean of postgraduate medical education, University of Toronto, Toronto, Ontario, Canada
| | - Corry den Rooyen
- C. den Rooyen is an educationalist and change manager, Utrecht, the Netherlands
| | - Anne Matlow
- A. Matlow is faculty lead, strategic initiatives, postgraduate medical education, University of Toronto, Toronto, Ontario, Canada
| | - Laura McEwen
- L. McEwen is director of assessment and evaluation for postgraduate medical education, Queen's University, Kingston, Ontario, Canada
| | - Fedde Scheele
- F. Scheele is professor of health systems innovation and education, Athena Institute, VU University and Amsterdam UMC, and a practicing clinician, obstetrics and gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Rhonda St Croix
- R. St. Croix is change advisor, The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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Hamza DM, Ross S, Oandasan I. Process and outcome evaluation of a CBME intervention guided by program theory. J Eval Clin Pract 2020; 26:1096-1104. [PMID: 31927788 PMCID: PMC7496603 DOI: 10.1111/jep.13344] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022]
Abstract
RATIONALE Competency-based medical education (CBME) has gained momentum as an improved training model, but literature on outcomes of CBME, including evaluation of implementation processes, is minimal. We present a case for the following: (a) the development of a program theory is essential prior to or in the initial stages of implementation of CBME; (b) the program theory should guide the strategies and methods for evaluation that will answer questions about anticipated and unintended outcomes; and (c) the iterative process of testing assumptions and hypotheses will lead to modifications to the program theory to inform best practices of implementing CBME. METHODS We use the Triple C Competency-based Curriculum as a worked example to illustrate how process and outcome evaluation, guided by a program theory, can lead to meaningful enhancement of CBME curriculum, assessment, and implementation strategies. Using a mixed methods design, the processes and outcomes of Triple C were explored through surveys, interviews, and historical document review, which captured the experiences of various stakeholders. FINDINGS The theory-led program evaluation process was able to identify areas that supported CBME implementation: the value of a strong nondirective national vertical core supporting the transformation in education, program autonomy, and adaptability to pre-existing local context. Areas in need of improvement included the need for ongoing support from College of Family Physicians of Canada (CFPC) and better planning for shifts in program leadership over time. CONCLUSIONS Deliberately pairing evaluation alongside change is an important activity and, when accomplished, yields valuable information from the experiences of those implementing and experiencing a program. Evaluation and the development of an updated program theory facilitate the introduction of new changes and theories that build on these findings, which also supports the desired goal of contributing toward cumulative science rather than "reinventing the wheel."
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Affiliation(s)
- Deena M. Hamza
- Postgraduate Medical EducationUniversity of AlbertaEdmontonAlbertaCanada
| | - Shelley Ross
- Department of Family MedicineUniversity of Alberta, EdmontonAlbertaCanada
| | - Ivy Oandasan
- Department of EducationCollege of Family Physicians of CanadaTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
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Lochnan H, Kitto S, Danilovich N, Viner G, Walsh A, Oandasan IF, Hendry P. Conceptualization of Competency-Based Medical Education Terminology in Family Medicine Postgraduate Medical Education and Continuing Professional Development: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1106-1119. [PMID: 31996559 DOI: 10.1097/acm.0000000000003178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To examine the extent, range, and nature of how competency-based medical education (CBME) implementation terminology is used (i.e., the conceptualization of CBME-related terms) within the family medicine postgraduate medical education (PGME) and continuing professional development (CPD) literature. METHOD This scoping review's methodology was based on Arksey and O'Malley's framework and subsequent recommendations by Tricco and colleagues. The authors searched 5 databases and the gray literature for U.S. and Canadian publications between January 2000 and April 2017. Full-text English-language articles on CBME implementation that focused exclusively on family medicine PGME and/or CPD programs were eligible for inclusion. A standardized data extraction form was used to collect article demographic data and coding concepts data. Data analysis used mixed methods, including quantitative frequency analysis and qualitative thematic analysis. RESULTS Of 470 unique articles identified, 80 (17%) met the inclusion criteria and were selected for inclusion in the review. Only 12 (15%) of the 80 articles provided a referenced definition of the coding concepts (i.e., referred to an article/organization as the definition's source), resulting in 19 highly variable-and 12 unique- referenced definitions of key terms used in CBME implementation (competence, competency, competency-based medical education). Thematic analysis of the referenced definitions identified 15 dominant themes, among which the most common were (1) a multidimensional and dynamic concept that encompasses a variety of skill components and (2) being able to use communication, knowledge, technical skills, clinical reasoning, judgment, emotions, attitudes, personal values, and reflection in practice. CONCLUSIONS The construction and dissemination of shared definitions is essential to CBME's successful implementation. The low number of referenced definitions and lack of consensus on such definitions suggest more attention needs to be paid to conceptual rigor. The authors recommend those involved in family medicine education work with colleagues across medical specialties to develop a common taxonomy.
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Affiliation(s)
- Heather Lochnan
- H. Lochnan is assistant dean of continuing professional development, Education Programming, Faculty of Medicine, an endocrinologist, and professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. S. Kitto is director of research, Office of Continuing Professional Development, and professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada. N. Danilovich is a research associate, Office of Continuing Professional Development, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada. G. Viner is director of evaluation in postgraduate program and associate professor, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada. A. Walsh is professor emeritus, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. I.F. Oandasan is director, Education/directrice, Éducation, College of Family Physicians of Canada, Mississauga, Ontario, Canada. P. Hendry is vice dean of continuing professional development and professor of surgery, Faculty of Medicine, University of Ottawa, and a cardiac surgeon, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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