Between stethoscope and algorithm: is Canadian medical education ready for AI-enabled care?

In 2010, the Association of Faculties of Medicine of Canada, Collège des médecins du Québec, College of Family Physicians of Canada, and Royal College of Physicians and Surgeons of Canada launched the Future of Medical Education in Canada Postgraduate (FMEC PG) Project to examine postgraduate medical education (PGME) in Canada and make recommendations for improvement. One recommendation that emerged concerns the transitions learners experience across the undergraduate medical education-PGME-practice continuum. The FMEC PG, using a thorough process, developed projects to address these often-tumultuous transitions for the learner, aiming to provide support, tools, and standards for the learner's educational journey.With leadership by two senior academics and the Transitions Implementation Committee, three working groups helped implement these transitions projects, which addressed (1) the medical-school-to-residency transition, (2) career planning and the residency matching process, and (3) the residency-to-practice transition. Work products include the development of a learner education handover protocol and the establishment of pan-Canadian entrustable professional activities to be used nationally to help define expectations for new graduates entering residencies. A postmatch boot camp tool and a simulated night on-call tool were developed and are available to all medical schools. National standards are being promoted for career services counseling and best practices in residency selection. A practice management curriculum framework, mentorship resources, resiliency training for graduating residents, and the entry-level disciplines of residency are also being explored.Ultimately, with system-wide change and better integration of all players, transitions for Canada's learners will greatly improve.

1 Razack S, Hodges B, Steinert Y, Maguire M. Seeking inclusion in an exclusive process: discourses of medical school student selection. Med Educ 2015;49:36–47. 2 Boelen C, Heck JE, World Health Organization. Defining and Measuring the Social Accountability of Medical Schools. Geneva: WHO 1995. http://apps.who.int/iris/ bitstream/10665/59441/1/ WHO_HRH_95.7. pdf?ua=1. [Accessed 15 August 2014.] 3 Association of Faculties of Medicine of Canada. The Future of Medical Education in Canada – A Collective Vision for MD Education. Ottawa, ON 2010. http://www. afmc.ca/future-of-medicaleducation-in-canada/medicaldoctor-project/pdf/collective_ vision.pdf. [Accessed 15 August 2014]. 4 Cleland JA, Nicholson S, Kelly N, Moffat M. Taking context seriously: explaining widening access policy enactments in UK medical schools. Med Educ 2015;49:25–35. 5 Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Washington, DC 2013. http:// www.lcme.org/publications. htm#dci. [Accessed 15 August 2014.] 6 Ho M-J, Shaw K, Liu T-H, Norris J, Chiu Y-T. Equal, global, local: discourses in Taiwan’s international medical graduate debate. Med Educ 2015;49:48–59. 7 Association of Faculties of Medicine of Canada, College of Family Physicians of Canada, Coll ege des M edecins du Qu ebec, and Royal College of Physicians and Surgeons of Canada. The Future of Medical Education in Canada – A Collective Vision for Postgraduate Medical Education. Ottawa, ON 2012. http://www. afmc.ca/future-of-medicaleducation-in-canada/ postgraduate-project/pdf/ FMEC_PG_Final-Report_EN.pdf. [Accessed 15 August 2014.] 8 Institute of Medicine. Graduate Medical Education That Meets the Nation’s Health Needs. Washington, DC 2014. http://www.iom.edu/ Reports/2014/Graduate-MedicalEducation-That-Meets-the-NationsHealth-Needs.aspx. [Accessed 15 August 2014.]

Looking to the Future of Obstetrics and Gynaecology Training in Canada: A Resident's Perspective

Faced with the need to modernize and improve the postgraduate medical education experience and to maintain the high quality of physicians that Canadians expect, in 2010, four organizations –Association of Faculties of Medicine of Canada (AFMC); Collège des Médecins du Québec (CMQ); College of Family Physicians of Canada (CFPC); and Royal College of Physicians and Surgeons of Canada (RCPSC) formed a consortium to conduct a review of Postgraduate Medical Education (PGME) in Canada. In 2012, the Consortium published the Future of Medical Education in Canada Postgraduate (FMEC PG) project’s 10 recommendations for change in PGME. One of these recommendations was to ‘Establish Effective Collaborative Governance in PGME’. The recommendation stated- ‘Recognizing the complexity of PGME and the health delivery system within which it operates, integrate the multiple bodies (regulatory and certifying colleges, educational and healthcare institutions) that play a role in PGME into a collaborative governance structure in order to achieve efficiency, reduce redundancy, and provide clarity on strategic directions and decisions’ The purpose of this paper is to describe the creation, function and dissolution of a collaborative governance structure within the complex system of PGME and the challenges that were faced in its sustainability. The lessons learned are applicable internationally where integration of multiple organizations is being attempted. A fundamental question remains as to whether a consensus-based decision-making process can ever be achieved among organizations with overlapping mandates and in some cases, hierarchical structures?

Medical and health care professional education in the 21st century: institutional, national and global perspectives

BackgroundThis commentary provides an overview of forthcoming activities by Obesity Canada (OC) to inform obesity competencies in medical education. Competencies in medical education refer to abilities of medical professionals to appropriately provide patients the care they need. A recognized Canadian framework for informing medical competencies is CanMEDs. Additionally, the Obesity Medicine Education Collaborative (OMEC) provides 32 obesity specific medical competencies to be integrated across medical education curriculum. OC released the first globally recognized Adult Obesity Clinical Practice Guideline (CPGs) in 2020 inclusive of 80 recommendations. Referring to the CanMEDs and OMEC competencies, OC is developing medical education competencies for caring for patients who have obesity in line with the recent CPGs that can be applied to health professions education programs around the world. MethodsActivities being completed by OC’s Education Action Team include a scoping review to summarize Canadian obesity medical education interventions or programs. Next, with expert consensus a competency set is being developed by utilizing the CanMEDs Framework, OMEC and the CPGs. Following this, OC will initially survey undergraduate medical programs across the country and determine to what degree they are meeting the competencies in content delivery. These findings will lead to a national report card outlining the current state of obesity medical education in Canada within undergraduate medical education. ResultsTo date, OC has completed the scoping review and the competency set. The Education Action Team is in the process of developing the survey tools to assess the current delivery of obesity medical education in Canada. ConclusionThe evidenced-based report card will support advocacy to refine and enhance future educational initiatives with the overall goal of improving patient care for individuals living with obesity. The process being applied in Canada may also be applicable and modified for other regions to assess and better obesity medical education.

As we mark the 100th anniversary of the Flexner report which revolutionized the process of medical education, there is again concern that we face a critical need for change in the process of medical education in order to meet the needs of learners, teachers, and patients. In this symposium, panelists shared perspectives on medical education reform from throughout the world, including The Future of Medical Education in Canada, the role of regulators in contributing to reform, the evolution of accreditation standards, the current state of medical education in Southeast Asia, and the perspectives of a medical student on medical education reform. In the “Audience discussion” section, themes emerged surrounding medical education as a social good, the need for governmental support of medical education, the cost of medical education and the rise of for-profit medical schools, and embracing a broader view of health professional education. There remain remarkable parallels in calls for reform in medical education at the turn of the twentieth and twenty-first centuries but education which is patient-centered and actively involves the voices of our patients and our students is likely to be a hallmark.

Addressing anti-Black racism in medical education in Canada has become increasingly urgent as more Black learners enter medical institutions and bring attention to the racist harms they face. We sought to gather evidence of experiences of racism among Black medical learners and to explore the contexts within which racism is experienced by learners. Drawing on critical race and structural violence theories, we conducted interviews with Black medical faculty, students, residents, and staff at the University of Saskatchewan College of Medicine between May and July 2022. We thematically analyzed interviews using instrumental case study methodology. Thematic analyses from 13 interviews revealed 5 central themes describing experiences of racism and the compounding nature of racist exposures as learners progressed in medicine. Medical learners experienced racism through uncomfortable encounters and microaggressions. Blatant acts of racism were instances where patients and superiors harmed students in various ways, including through use of the N-word by a superior in 1 instance. Learners also experienced curricular racism through the absence of the Black body in the curriculum and the undue pathologizing of Blackness. Medical hierarchies reinforced anti-Black racism by undermining accountability and protecting powerful perpetrators. Finally, Black women medical learners identified intersecting oppressions and misogynoir that compounded their experience of racism. We propose that experiences of racism may worsen as learners progress in medicine in part because of increases in the sources of and exposure to racism. Anti-Black racism in medical education in Canada is experienced subtly through microaggressions or blatantly from different sources including medical faculty. As Black learners progress in medicine, anti-Black racism may become worse because of the compounding effects of exposures to a wider range of sources of racist behaviour.

The Association of Faculties of Medicine of Canada launched the Future of Medical Education in Canada (FMEC) Project in 2007. The FMEC Project's overarching goal was to comprehensively examine the current state of undergraduate medical education, concentrating on its alignment with current and future societal needs. Like Flexner's work, the FMEC Project used a process of reflection and renewal; unlike Flexner's work, the FMEC Project used multiple techniques to gather information, including literature reviews, key informant interviews, international visits, and a series of consultations with stakeholders and expert groups. The project's final report, The Future of Medical Education in Canada: A Collective Vision, put forth 10 recommendations that summarized priority areas for academic medicine and medical training in Canada at the start of the 21st century. The current article reviews FMEC Project recommendations in relation to the priorities set out by Flexner in 1910. In some areas, such as the scientific basis of medical education, there is striking congruence between Flexner's views and today's collective vision. In other areas, such as community-based learning, opinion appears to have shifted markedly over the past century, and concepts such as interprofessionalism may represent distinctly modern domains. While Flexnerian themes tend to center on the notion of medicine as science, present-day priorities converge on the link between academic medicine and societal needs. By looking back on Flexner's work, we can see where his vision has taken us. As well, we see more clearly the new frontiers that academic medicine will continue to explore.

Billed as the proceedings of a conference on medical education in Canada, the United Kingdom, the United States, and Australia, this book is, in fact, much more than mere transactions. Sponsored by the Royal Society of Medicine Foundation, Inc, and the Josiah Macy, Jr, Foundation, the December 1990 conference was preceded by more than a year of careful planning and preparation. The 37 participants (20 from the United States) received penultimate drafts of the major chapters three weeks before the conference. Respondents arrived with their prepared commentaries, and a great deal of time was left for discussion by the group at large. The careful preparation and sequencing of the conference are evident in the book, which benefits from excellent introductory and closing chapters by the editors. As a participant, although not an author of any of the major pieces, I can attest that the conference worked as a conference just

1. Introduction: The Struggle over Medical Knowledge, Caragh Brosnan and Bryan S. Turner PART 1: THEORETICAL PERSPECTIVES 2. The Hidden Curriculum: A Theory of Medical Education, Frederic W. Hafferty and Brian Castellani 3. From Classification to Integration: Bernstein and the Sociology of Medical Education, Paul Atkinson and Sara Delamont 4. Pierre Bourdieu and the Theory of Medical Education: Thinking 'Relationally' about Medical Students and Medical Curricula, Caragh Brosnan PART 2: KEY ISSUES: MEDICAL STUDENTS AND MEDICAL KNOWLEDGE 5. The Medical School Culture, Heidi Lempp 6. Gender and Medical Education, Elianne Riska 7. The Inclusion of Disabled People in Medical Education, Gary L. Albrecht 8. The Status of Complementary and Alternative Medicine (CAM) in Biomedical Education: Towards a Critical Engagement, Alex Broom and Jon Adams 9. Evidence-based Medicine and Medical Education, Stefan Timmermans and Neetu Chawla 10. Crisis or Renaissance? A Sociology of Anatomy in UK Medical Education, Samantha Regan de Bere and Alan Petersen 11. Bioethics and Medical Education: Lessons from the United States, Carla C. Keirns, Michael Fetters and Raymond De Vries 12. Sociology in Medical Education, Graham Scambler 13. Epistemology, Medical Science, and Problem-based Learning: Introducing an Epistemological Dimension into the Medical School Curriculum, Margot L. Lyon PART 3: MEDICAL EDUCATION IN NATIONAL CONTEXTS 14. Medical Education and the American Healthcare System, William C. Cockerham 15. Tomorrow's Doctors, a Changing Profession: Reformation in the UK Medical Education System, Oonagh Corrigan and Ian Pinchen 16. The Challenges to Achieving Self-sufficiency in Canadian Medical Education, Ivy Lynn Bourgeault and Jennifer Aylward 17. Innovations in Medical Education: European Convergence, Politics and Culture, Fred C.J. Stevens

Introduction: It is difficult for learners to perform accurate self-assessments. This difficulty may be exaggerated in unskilled learners, a phenomenon termed the Dunning-Kruger Effect (Dunning & Kruger, 1999). Learners with the least amount of knowledge or skill may paradoxically be more likely to evaluate themselves favorably compared with their peers. This phenomenon is particularly relevant in medicine where we rely on self-directed learning not only in many of our undergraduate and postgraduate programs, but in guiding the pursuit of continuing medical education. The objectives of this study are to 1) determine whether the Dunning-Kruger Effect is present in medical education settings, 2) to determine the quality of studies in this area, and 3) to determine how this effect, if present, could influence approaches to the learner in difficulty. Methods: This is a review of the literature. PubMed databases were searched for all relevant articles. Included studies reported self-assessment of medical trainees or staff and comparison with an external rating. Studies were identified using select keywords and MeSH terms. Only studies published in English were included. No publication date limits were adopted. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality. Both authors independently abstracted data and rated study quality. Results: Eighty-six articles were identified in the PubMed search. On abstract review, 45 studies were found to meet criteria for further full article review. Studies were variable in setting and approach to self and external assessment. Criteria were not met for pooled analyses/meta-analysis. Results are presented as a summary of findings with special consideration of findings based on level of training (undergraduate, postgraduate, staff clinician). Conclusion: This review summarizes the current literature on the Dunning-Kruger Effect in medical education and provides an assessment of the quality of studies in this area to date. The potential relevance of the Dunning-Kruger Effect in medical education is discussed as are implications for interventions to support the learner in difficulty. Additional study in this area is indicated, in particular given the significant upcoming changes to postgraduate medical education in Canada in the era of Competence By Design (CBD).

The Council on Medical Education in Pediatrics (COMSEP) interrupts our “attributes of great clinical teachers” series to celebrate a birthday and 3 births! Although primarily medical educators have celebrated these events, COMSEP feels that all pediatricians should commemorate these milestones. One hundred years ago, in 1910, Abraham Flexner published a Carnegie Foundation–sponsored report about the status of medical education in Canada and the United States.1 His findings and recommendations led, in large part, to the transformation of medical education in North America. In 2010, on the anniversary of Flexner's seminal report, 2 new reports on the state of medical education in North America were released.2,3 In addition, a landmark conference was held to discuss ways to reform medical education in the 21st century.4 The purpose of this article is to provide the reports and conference background and highlight the main recommendations. In a subsequent article, we will evaluate pediatric education systems in relation to the 2010 recommendations. When the Carnegie Foundation for the Advancement of Teaching published Flexner's Medical Education in the United States and Canada ,1 medical education in the United States and Canada was chaotic, unregulated, and of poor quality. Few standards for admission or promotion existed, basic science instruction was mostly nonexistent, and few students were carefully supervised in hospital-based clinical practice. Within a decade of the Flexner report (Table 1), the number of medical schools had decreased by one-third, entrance requirements to medical school had been standardized and enforced, curricula had been standardized (2 years of basic science followed by 2 years of clinical science), medical schools had forged links to universities, … Address correspondence to William V. Raszka Jr, MD, Department of Pediatrics, University of Vermont College of Medicine, Given Courtyard, Burlington, VT 05405. E-mail: william.raszka{at}uvm.edu

The Future of Medical Education in Canada Postgraduate (FMEC PG) Project was launched in 2010 by a consortium of four organizations: the Association of Faculties of Medicine of Canada, the Collège des Médecins du Québec, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada. The FMEC PG study set out to review the state of the Canadian postgraduate medical education (PGME) system and make recommendations for improvements and changes. The extensive process included literature reviews, commissioned papers, stakeholder interviews, international consultations, and dialogue with the public and learners. The resulting key findings and 10 recommendations, published in a report in 2012, represent the collective vision of the consortium partner organizations for PGME in Canada. Implementation of the recommendations began in 2013 and will continue beyond 2016.In this article, the authors describe the complex process of developing the recommendations, highlight several recommendations, consider implementation processes and issues, and share lessons learned to date. They reflect on the ways in which the transformation of a very complex and complicated PGME system has required many stakeholders to work together on multiple interventions simultaneously. Notwithstanding the challenges for the participating organizations, changes have been introduced and sustainability is being forged. Throughout this process, the consortium partners and other stakeholders have continued to address the social accountability role of all physicians with respect to the public they serve.

Fund-raising is a new practice in medical education research. This qualitative study explores a cross-sectional analysis of philanthropy in medical education in Canada and Europe and identifies some common characteristics in the fund-raising system, key roles and characteristics of research sites that have had success. Medical education research sites that had received donations greater than Can$100000 were identified by searching publicly available sources. Interviews were conducted with 25 individuals from these and other sites, in four categories: medical education leaders (n=9); philanthropy-supported chairholders and researchers (n=5); donors of over Can$100000 (n=7), and advancement professionals (n=4). Interview transcripts were inductively coded to identify themes. Five factors associated with success in accessing philanthropic sources were identified in the sample: support of the organisation's senior leadership; a charismatic champion who motivates donors; access to an advancement office or foundation; impetus to find funds beyond traditional operating budgets, and understanding of the conceptual and practical dimensions of fund-raising. Three types of donor (medical education insider, donor collective and general philanthropist), four faculty roles (trailblazers, rock stars, 'Who? Me?' people and future fund-raisers) and six stages in the fund-raising cycle were also identified. Philanthropy is a source of funding with the potential to significantly advance education research. Yet competence in fund-raising is not widely developed among medical education research leaders. Successful accessing of philanthropic sources of funding requires the ability to articulate the impact of philanthropy in medical education research in a way that will interest donors. This appears to be challenging for medical education leaders, who tend to frame their work in academic terms and have trouble competing against other fund-raising domains. Medical education research institutes and centres will benefit from developing greater understanding of the conception and practices of fund-raising.