Strategies identified by program directors to improve adoption of the CanMEDS framework

Perception of the compatibility of Quebec residency program characteristics with the advanced access model: a cross-sectional study

BACKGROUND

The advanced access (AA) model is among the most recommended innovations for improving timely access in primary care (PC). AA is based on core pillars such as comprehensive planning for care needs and supply, regularly adjusting supply to demand, optimizing appointment systems, and interprofessional collaborative practices. Exposure of family medicine residents to AA within university-affiliated family medicine groups (U-FMGs) is a promising strategy to widen its dissemination and improve access. Using four AA pillars as a conceptual model, this study aimed to determine the theoretical compatibility of Quebec's university-affiliated clinics' residency programs with the key principles of AA.

METHODS

A cross-sectional online survey was sent to the chief resident and academic director at each participating clinic. An overall response rate of 96% (44/46 U-FMGs) was obtained.

RESULTS

No local residency program was deemed compatible with all four considered pillars. On planning for needs and supply, only one quarter of the programs were compatible with the principles of AA, owing to residents in out-of-clinic rotations often being unavailable for extended periods. On regularly adjusting supply to demand, 54% of the programs were compatible. Most (82%) programs' appointment systems were not very compatible with the AA principles, mostly because the proportion of the schedule reserved for urgent appointments was insufficient. Interprofessional collaboration opportunities in the first year of residency allowed 60% of the programs to be compatible with this pillar.

CONCLUSIONS

Our study highlights the heterogeneity among local residency programs with respect to their theoretical compatibility with the key principles of AA. Future research to empirically test the hypotheses raised by this study is warranted.

Benchmarking a Canadian Anesthesiology Resident Research Program against national norms using a logic model framework: a quality improvement study

Background

Canadian specialty training programs are expected to deliver curriculum content and assess competencies related to the CanMEDS Scholar role. We evaluated our residency research program and benchmarked it against national norms for quality improvement purposes.

Methods

In 2021 we reviewed departmental curriculum documents and surveyed current and recently graduated residents. We applied a logic model framework to assess if our program's inputs, activities, and outputs addressed the relevant CanMeds Scholar competencies. We then descriptively benchmarked our results against a 2021 environmental scan of Canadian anesthesiology resident research programs.

Results

Local program content was successfully mapped to competencies. The local survey response rate was 40/55 (73%). In benchmarking, our program excelled in providing milestone-related assessments, research funding, administrative, supervisory, and methodologic support, and requiring a literature review, proposal presentation, and local abstract submission as output. Acceptable activities to meet research requirements vary greatly among programs. Balancing competing clinical and research responsibilities was a frequently reported challenge.

Conclusions

The logic model framework was easily applied and demonstrated our program benchmarked well against national norms. National level dialogue is needed to develop specific, consistent scholar role activities and competency assessments to bridge the gap between expected outcome standards and education practice.

Review of Challenges to the Implementation of Competence by Design in Post-Graduate Medical Education: What Can Diagnostic Radiology Learn from the Experience of Other Specialty Disciplines?

Competence by Design (CBD) is a medical education initiative instituted by the Royal College of Physicians and Surgeons of Canada to improve the training of resident physicians in specialty disciplines. CBD integrates Competency Based Medical Education with traditional specialty discipline post-graduate medical education (PGME) training through the application of an organizational framework of competencies. Various specialty disciplines in Canada have transitioned to CBD since 2017 in a staggered approach. Diagnostic radiology PGME programs in Canada are expected to transition to CBD in 2022 for the incoming resident physician cohort. This article reviews potential challenges to the implementation of CBD in diagnostic radiology PGME programs and proposes evidence-informed targeted strategies and solutions to address these challenges. It is important for diagnostic radiology PGME programs to understand the challenges pertaining to the implementation of CBD so that they may be able to successfully implement this or similar medical education initiatives in their programs. Moreover, as radiology subspecialty PGME programs, such as nuclear medicine, interventional radiology, neuroradiology, and pediatric radiology, likewise transition to CBD and diagnostic radiology PGME programs internationally increasingly implement other Competency Based Medical Education models, the implications of the challenges pertaining to the implementation of CBD will further become of increasing importance.

Program directors' reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework

BACKGROUND

Outcomes of national policy change impact all levels of the organizational hierarchy. The medical education literature is sparse on how reflections from program directors (PDs) on past large-scale policy changes can inform future policy initiatives. To fill this gap, we conducted a national survey on PDs' perceptions of, and reflections on, decision-making in medical education, accreditation procedures, and the CanMEDS framework implementation.

METHODS

The survey was distributed to former Canadian specialty medicine PDs (N = 684). Descriptive analysis was performed on quantitative data, thematic analysis was performed on qualitative comments, and comparisons between the quantitative and qualitative findings were performed to identify areas of convergence and/or divergence.

RESULTS

A total of 265 (38.7%) former PDs participated. Quantitative analysis revealed that 52.8% of respondents did not feel involved in decision-making regarding policy changes, 45.1% of respondents did not feel prepared to assess the CanMEDS Roles, and PDs were divided on the reasonableness of accreditation documentation. Qualitative analysis produced four themes: communication, resources, expectations of outcomes, and buy-in. Nine sub-themes were also identified. A high level of convergence was identified across the content, with only four areas of divergence identified.

CONCLUSIONS

Our findings have the potential to inform future policy and/or accreditation changes. Without the lens of those charged with overseeing the implementation, policy evaluation and quality improvement will remain uninformed. PDs, therefore, bring unique insights into our understanding of national policy changes, and without the voices of these frontline implementers, the true success of policy change implementation will be hindered.