CanMEDS and other outcomes

Abstract

As I indicated in a previous editorial (Norman 2007), the world of medical education is increasingly focused, for better or worse, on performance outcomes. One of the most influential taxonomies of outcomes is the CanMEDS roles, developed by the Royal College of Physicians and Surgeons of Canada beginning in 1993 (Frank et al. 1996). It is not alone, of course; we also have the ACGME competencies in the US, The Scottish Doctor and ‘‘Tomorrow’s Doctor’’ in the UK, and several others I don’t know about. But for reasons that I cannot begin to understand, the most widely adopted framework is the Canadian one, officially adopted by 16 countries. To set the stage, the CanMEDS competencies, eight in number: Medical Expert/Clinical Decision-maker, Communicator, Collaborator, Manager, Health Advocate, Scholar, Professional are usually portrayed as a flower with Medical Expert at the centre surrounded by the other 7 roles. One wonders if the dissemination success of the competencies relate in part to the powerful visual appeal of the flower. In this issue, we have two papers related to the CanMEDS roles, which, while using complementary methods, deliver a consistent message. The study by Whitehead et al. (2011) is quite unusual and a really interesting model for research. They recognized that the CanMEDS roles evolved from a large project involving all 5 (then) Ontario medical schools—the Educating Future Physicians of Ontario (EFPO) project, which in turn began in the late 1980’s as a response to a bitter physician strike when government legislated against ‘‘extra-billing’’, i.e. private patients. The ground was fertile for a redefinition of what patients, in Ontario, really wanted from their physicians. Whitehead et al. combed through the archives of the EFPO project, box after box, in the University of Toronto, using Foucauldian discourse analysis. Their findings reveal a disconnect between the overt goal—information to better inform medical schools about the expectations of patients, and the covert message of a profession under siege: