CanMEDS Roles Research Articles

Graduate reflections on Community Service: a view of roles in practice

BackgroundIn South Africa, newly qualified physiotherapists transition to the workplace during community service, often in diverse healthcare settings, attending to patients with complex ailments. The transition is complicated by the shortage of rehabilitation personnel, especially in rural and peri-urban areas. While higher education curricula should prepare students for the workplace, the roles and expectations of new therapists remain unclear. Assessing how well current curricula, built around the CanMEDS framework, equip students with the competencies needed for entry-level community service practice will help to improve physiotherapy training practices. This study investigated the experiences of community service physiotherapists to inform curriculum design and graduate outcomes.MethodsA descriptive qualitative study was conducted. Graduates were purposefully sampled during their community service year via a class group contact, with a snowball approach to recruit diverse participants. Semi-structured interviews were conducted over MS Teams, recorded, and transcribed. Reflexive deductive coding was used to interpret the data, which was analysed around the CanMEDS roles and graduate outcomes, as well as curriculum constraints and enablers to the workplace transition.ResultsTen community service physiotherapists placed in five different provinces participated. Most identified strongly with their core role as clinicians and felt prepared in terms of clinical skills. However, aspects of roles linked to advocacy, leadership, and professionalism were more complex to navigate. The contexts of placements and the nuances of how the healthcare system operated in each province impacted their experience.ConclusionThe study highlighted varied readiness levels among community service physiotherapists. While many felt competent in specific clinical tasks, there are significant gaps in their preparation for broader community practice challenges. Participants noted their undergraduate training adequately prepared them for the clinician role but not for roles integrating collaboration, communication, patient and professional advocacy. Quality clinical placements and the role of educators were crucial, yet the protective nature of these placements limited exposure to real-world scenarios. Insufficient mentorship and support contributed to feelings of isolation. To enhance preparedness, the curriculum should integrate more experiences addressing real-world challenges, which value multiple competencies and outcomes. Future research should examine the development of context-appropriate competency frameworks and long-term effects of community service on career development.

Clinical Pharmaceutical Reasoning in Hospital Pharmacy Practice using the DRIP framework: a New Approach for a Perfectionist Profession

Clinical pharmacists are responsible for safe medication use in hospitals. Most clinical pharmacists are perfectionists. However, in their decision-making process, they have to embrace uncertainty, while interpreting available data, and integrating knowledge and clinical experience. In clinical practice, how to teach and master clinical pharmaceutical reasoning is unclear. We developed the DRIP framework including different aspects on drug, indication and patient and a stepwise approach to support clinical pharmaceutical reasoning by students, residents in hospital pharmacy and clinical pharmacists. The DRIP framework was first introduced during the daily report with residents and faculty of the clinical pharmacy. The framework was implemented in daily clinical practice to handle drug safety alerts, and to optimise drug therapy during ward rounds, multidisciplinary consultations, and in entrustmentbased discussions with residents. Pharmacists using the DRIP framework felt more confident that relevant aspects of a complex pharmaceutical problem had been considered, they learned to anticipate on the issues behind an apparently simple pharmaceutical question, and to explain their reasoning. Several CANMEDS roles can be simultaneously trained by using our approach. We are developing a course for residents in clinical pharmacy and pharmacology to teach the competency of clinical pharmaceutical reasoning using the DRIP framework.

Incorporating a situational judgement test in residency selections: clinical, educational and organizational outcomes

BackgroundComputer-based assessment for sampling personal characteristics (Casper), an online situational judgement test, is a broad measure of personal and professional qualities. We examined the impact of Casper in the residency selection process on professionalism concerns, learning interventions and resource utilization at an institution.MethodsIn 2022, admissions data and information in the files of residents in difficulty (over three years pre- and post- Casper implementation) was used to determine the number of residents in difficulty, CanMEDS roles requiring a learning intervention, types of learning interventions (informal learning plans vs. formal remediation or probation), and impact on the utilization of institutional resource (costs and time). Professionalism concerns were mapped to the 4I domains of a professionalism framework, and their severity was considered in mild, moderate, and major categories. Descriptive statistics and between group comparisons were used for quantitative data.ResultsIn the pre- and post- Casper cohorts the number of residents in difficulty (16 vs. 15) and the number of learning interventions (18 vs. 16) were similar. Professionalism concerns as an outcome measure decreased by 35% from 12/16 to 6/15 (p < 0.05), were reduced in all 4I domains (involvement, integrity, interaction, introspection) and in their severity. Formal learning interventions (15 vs. 5) and informal learning plans (3 vs. 11) were significantly different in the pre- and post-Casper cohorts respectively (p < 0.05). This reduction in formal learning interventions was associated with a 96% reduction in costs f(rom hundreds to tens of thousands of dollars and a reduction in time for learning interventions (from years to months).ConclusionsJustifiable from multiple stakeholder perspectives, use of an SJT (Casper) improves a clinical performance measure (professionalism concerns) and permits the institution to redirect its limited resources (cost savings and time) to enhance institutional endeavors and improve learner well-being and quality of programs.

A84 COMPETENCY BASED MEDICAL EDUCATION: O-SCORE CHARACTERISTICS OF PROCEDURAL AND COGNITIVE ASSESSMENTS IN GASTROENTEROLOGY RESIDENCY TRAINING

Abstract Background Competency based medical education has become the new standard for medical education which shifts the focus of training toward a competency, rather than time-based in framework known in Canada as ‘Competence by Design’ (CBD). CBD assesses a physician trainee’s ability to demonstrate competence in CanMEDS roles via entrustable professional activities (EPAs). EPAs utilize the O-SCORE as the metric for assessing competence. This score was developed and validated for surgical/procedural subspecialties; however, CBD currently coopts this scale for both procedural and non-procedural (cognitive) EPAs. Assessor expertise has also been shown to have an important role in performance assessments, but has not been studied in the context of CBD. Aims Our study aims to assess for differences in O-SCORE utilization between cognitive and procedural EPAs, and whether assessor characteristics are associated with trends in assessment. Methods Anonymized data for all Adult GI subspecialty EPAs completed from Jun 2019 to Jan 2023 at the University of Alberta was obtained. Evaluator sex, clinical vs academic practice, advanced training expertise, and EPA score was extracted. Locally a score of 5 denotes competence, while a 1-3 indicates competence was not yet achieved. A score of 4 may be accepted as evidence of competence (neutral score), at the discretion of the local competency committee. Data was analyzed via T-tests and ANOVA with post hoc Games-Howell testing with 95% confidence intervals (CI). A p-value of ampersand:003C0.05 was significant. Results 2264 EPAs were assessed including 1385 cognitive and 879 procedural EPAs. The number of EPAs completed by evaluators ranged from 11 to 165 with a mean of 60 (standard deviation: 40). Results of O-SCORE usage is summarized in Figure 1A-B. The majority of EPAs indicate competence, with 20-25% neutral, and ampersand:003C10% did not achieve competence. Less than one of third of evaluators utilized a score of 1 or 2 across all EPAs, and zero evaluators utilized a score of 1 for cognitive EPAs. Most commonly evaluators to utilized 3/5 options of the O-SCORE. Separated by EPA type, it was most common to utilize 2/5 and 4/5 options for cognitive and procedural EPAs respectively. Results of demographic comparisons are outlined if Figure 1C-E. Male and clinical evaluators submitted higher scores on average. Hepatologists submitted higher scores than all other advanced training areas for total, cognitive, and procedural EPAs. Conclusions Across total, cognitive, and procedural EPAs there are low rates in the utilization of the whole O-SCORE scale, and our study highlights a discrepancy between procedural and cognitive EPAs. In addition, there small but significant differences in the mean EPAs score awarded between different evaluator demographics (male, clinical, hepatologists providing higher scores). Figure 1. A) Number and proportion of Entrustable Professional Activities (EPA) stratified by type and competence evaluation. B) Number and proportion of Entrustable Professional Activities (EPA) stratified by type with scored 1-5 and percent (%) of staff utilizing each score stratified by EPA type C) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator sex and EPA type. D) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator academic vs clinical status and EPA type. E) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator advanced training and EPA type. CI: Confidence interval; SD: standard deviation; *: pampersand:003C0.05 Funding Agencies None

Making assessment a team sport: a qualitative study of facilitated group feedback in internal medicine residency.

Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.

Automating the Identification of Feedback Quality Criteria and the CanMEDS Roles in Written Feedback Comments Using Natural Language Processing.

Manually analysing the quality of large amounts of written feedback comments is time-consuming and demands extensive resources and human effort. Therefore, this study aimed to explore whether a state-of-the-art large language model (LLM) could be fine-tuned to identify the presence of four literature-derived feedback quality criteria (performance, judgment, elaboration and improvement) and the seven CanMEDS roles (Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional) in written feedback comments. A set of 2,349 labelled feedback comments of five healthcare educational programs in Flanders (Belgium) (specialistic medicine, general practice, midwifery, speech therapy and occupational therapy) was split into 12,452 sentences to create two datasets for the machine learning analysis. The Dutch BERT models BERTje and RobBERT were used to train four multiclass-multilabel classification models: two to identify the four feedback quality criteria and two to identify the seven CanMEDS roles. The classification models trained with BERTje and RobBERT to predict the presence of the four feedback quality criteria attained macro average F1-scores of 0.73 and 0.76, respectively. The F1-score of the model predicting the presence of the CanMEDS roles trained with BERTje was 0.71 and 0.72 with RobBERT. The results showed that a state-of-the-art LLM is able to identify the presence of the four feedback quality criteria and the CanMEDS roles in written feedback comments. This implies that the quality analysis of written feedback comments can be automated using an LLM, leading to savings of time and resources.

How can peer teaching influence the development of medical students? a descriptive, longitudinal interview study

Abstract Background Peer-assisted learning (PAL) – where students take up a teaching role at an early stage of their training—is widely used in medical curricula. Many qualitative studies have investigated the perceptions and benefits of PAL, but no studies have longitudinally explored how peer teachers experienced their development. This could allow for a better understanding of PAL. In this study, we explored the perceived impact of being a peer teacher on the development of personal and professional competencies as a medical student. Methods We longitudinally conducted semi-structured interviews with peer teachers, during their 2-year teaching period in the skills lab at the University of Antwerp and applied descriptive thematic analysis. Results In total we gathered 47 interviews in 13 peer teachers (9 female, 4 male,. 1–7 interviews each). Peer teachers reported an increase in self-confidence, which gradually transformed into self-efficacy in clinical and teaching skills., Participants told us to be inspired by the previous generation of peer teachers. Their motivation shifted from personal benefits to benefiting others while becoming a role model themselves. The peer teachers illustrated how they developed maturity by integrating different CanMEDS roles. They grew in reflection, changed/transformed an initial mark-driven study drive into more patient-centered ambitions, and started developing a personal style. Conclusions Our study suggests that being a peer teacher leads to more self-efficacy, in clinical and teaching skills, to become a role model with as motivation to benefit others and to grow towards a good doctor maturity. Although the task is to teach peers, this opportunity nurtures the practice and integration of various CanMEDS roles, not only that of scholar but also communicator, collaborator and leader, thereby positively influencing their personal and professional development and their identity as a doctor (professional role).

Exploring the experiences of Canadian medical students with a background in the arts and humanities.

Arts and Humanities (A/H) training is a powerful strategy to help medical students develop key competencies which align with the CanMEDS roles that Canadian physicians are expected to embody. Students with backgrounds in A/H may enter medical school with the skills and dispositions that A/H training provides. This paper explores the varied experiences of medical students with prior A/H backgrounds, with an emphasis on how they navigate relationships with their student cohorts and participate in undergraduate medical training environments. Descriptive qualitative research methodology was used to conduct and analyze semi-structured interviews exploring the perspectives of Canadian medical students with either a A/H degree or training in A/H (n = 13). Domains such as identity, integration of interests, and challenges in maintaining A/H interests during medical training were explored. Participants described their A/H identity as intertwined with their identity as medical trainees and described their sense of interconnection between the disciplines. Challenges included imposter syndrome and difficulties in relating with peers from science backgrounds. Participants described returning to their A/H interests as a tool for wellness amidst medical training. Medical students with a background in A/H training describe this background as offering both affordances and challenges for their sense of identity, belonging, and wellness. These students offer an untapped resource: they come with dispositions of value to medicine, and they perceive a positive, hidden A/H curriculum that supports their maintenance of these dispositions during training. Understanding more about these hidden treasures could help foster the development of well-rounded and humanistic physicians in the entire medical class.

Medical escape games: experimenting with a new teaching method

With escape games gaining in popularity, we decided to adapt the concept of an existing medical escape game to the needs of our family medicine residents, by simulating clinical situations and creating puzzles with medical content. This activity was a fun way to integrate theoretical learning while developing a number of CanMEDS roles. Overall, the residents were very satisfied with the topics chosen and the interactive aspect of the experience. This escape game requires few resources, is adaptable to different environments and can be adjusted according to students' needs.

Designing a User-Friendly Context-Specific Assessment Tool for Community-Based Teachers.

Graduate medical education (GME) programs must ensure that they are able to collect accurate information about resident competence through assessment tools that are fit for purpose. An assessment form or process is called “fit for purpose” when there is good alignment between the tool (how something is assessed) and the intent (the specific knowledge, skill, or attitude/belief that is being assessed).In our family medicine GME program, we identified that the generic workplace-based summative assessment tool provided to community-based family medicine obstetrics (FMOB) clinical teachers was not fit for purpose. As a result, these teachers were uncertain about program expectations regarding competence, the assessment form was challenging and frustrating to complete, and our program struggled to extract useful assessment data from completed assessment forms. To address this issue, we took a systematic approach to develop a workplace-based assessment tool that was specific to the clinical context of FMOB and user-friendly for clinical teachers.Our goals were to develop: (1) a fit-for-purpose workplace-based assessment tool for community-based FMOB teachers that could be used for accurate assessment without the need for faculty development, and (2) an evidence-guided process for designing similar context-specific tools in the future. We met our first goal through designing the FMOB competence rubric (FMOB-CR) tool. The FMOB-CR is comprised of 2 elements. The first is a rubric containing specific statements and examples of resident performance. The rubric clearly outlines the expected level of competence on a 3-point rating scale (“cause for concern,” “acceptable competence,” “exemplary competence”), organized by the 6 Skill Dimensions of Family Medicine (similar to CanMEDS roles).1 The second element is a simple online assessment form in which FMOB teachers specify their resident's level of competence in each Skill Dimension, guided by the statements and examples in the rubric.The FMOB-CR uses plain language and context-specific clinical examples along with a simple online assessment form to clearly communicate expectations of competence to teachers (and residents) without additional faculty development. This user-friendly tool should make it easier for FMOB clinical teachers to better identify residents who are underperforming, which will allow the program to be more effective in intervening and supporting residents in difficulty.To meet our second goal, we developed an evidence-guided process for designing workplace-based assessment tools that are fit for purpose for specific clinical contexts. Our design process included: assembling a tool development team with relevant expertise, including a resident; consultations with FMOB teachers and residents; environmental scan and review of local assessment forms and assessments used by other FMOB GME programs; a modified Delphi process with local GME program faculty to develop and refine the table of competence statements; a consensus-building process within the research team to revise the statements for the rating scale; and implementation of the assessment rubric with concurrent collection of validity evidence. For both the FMOB-CR and the development process, we collected validity evidence according to Messick's unified concept of validity.2The Table details the validity evidence collected to date. Fifteen FMOB teachers surveyed showed strong agreement across 5 items about the utility of the rubric in allowing them to accurately assess residents (overall M=3.25/4, Likert scale 1=strongly disagree to 4=strongly agree), and across 3 items about the usefulness of the rubrics in helping them to understand program expectations of resident competence (overall M=3.36/4); 14 of 15 teachers preferred the new form to the old one.We hope that the worked example of the FMOB-CR and its development process may serve as a blueprint for other institutions to develop context-specific assessment tools.

Education of the clinical embryology laboratory professional: development of a novel program delivered in a laboratory medicine department

Clinical embryologists are responsible for the handling, evaluation, and care of human gametes and preimplantation embryos within the context of an assisted reproductive technology laboratory. They are integral members of a team of professionals who provide care for fertility patients. Despite the increasing recognition of clinical embryologists as professionals, training requirements, continuing professional development, and appropriate credentialing have lagged in several countries. In many cases, individuals enter the profession with training limited to technical aspects provided by individual laboratory directors through an apprenticeship model. In this article, we present the rationale for rigorous formal training in clinical embryology, introduce CanEMB competencies for practicing professional clinical embryologists that are founded on CanMEDs role principles, and present a nascent Masters of Health Sciences degree program in Laboratory Medicine with a specialization in clinical embryology. This 2-year program has unique features including a Clinical Embryology Skills Development Laboratory, research capstone project, and 200-hour placement within a practicing assisted reproductive technology laboratory. Importantly, this program is delivered through a university-based Department of Laboratory Medicine and Pathobiology in partnership with a Department of Obstetrics and Gynecology. Thus, this program represents a formal acceptance of clinical embryology as a clinical laboratory science. It can be adopted elsewhere to provide a relevant, robust education that will meet current and future needs of the profession.

The CASPER preparation program innovation: increasing self-perceived competence and confidence of underrepresented applicants on the novel CASPER Snapshot and CanMEDS roles

BackgroundUnderrepresented Minorities in Medicine (URMMs) may face financial and social limitations when matriculating into medical schools. Performance on situational judgment tests such as Computer-based Assessment for Sampling Personal Characteristics (CASPER) can be enhanced by coaching and mentorship. The CASPER Preparation Program (CPP) coaches URMMs to prepare for the CASPER test. During the coronavirus 2019 pandemic (COVID-19), CPP implemented novel curricula on the CASPER Snapshot and CanMEDS roles.MethodsPre and post-program questionnaires were completed by the students, which assessed their: 1) confidence in understanding the CanMEDS roles, and 2) perceived confidence in performing well and their familiarity and preparedness with the CASPER Snapshot. With a second post-program questionnaire, participants’ scores on the CASPER test as well as medical school application outcome were also assessed.ResultsParticipants reported a significant increase in the URMMs’ knowledge, self-perceived competency to complete the CASPER Snapshot, and their anxiety significantly decreased. The level of confidence in understanding CanMEDS roles for a career in healthcare increased as well. The majority (91%) agreed that the feedback received from tutors was adequate and the virtual component of the program was beneficial during COVID-19. 51% of students scored in the highest quartile on the CASPER test and 35% received an offer of admission from CASPER-requiring medical schools.ConclusionPathway coaching programs have the potential to increase confidence and familiarity amongst URMMs for the CASPER tests and CanMEDS roles. Similar programs should be developed with the aim to increase the chances of URMMs matriculating into medical schools.

Qualitative evaluation of the contribution of CanMEDS roles in the development of area of focused competence diplomas.

While many Area of Focused Competency (AFC) Diplomas are available to those who have completed Pediatric residency training, it is not known which competencies are enhanced within each AFC discipline. Our objective was to determine which CanMEDS roles were targeted by existing AFCs available to those who have completed Pediatric residency training and identify gaps within CanMEDs roles that may be fulfilled by the development of new AFCs. A qualitative study was undertaken using document analysis methodology to compare CanMEDS competencies across AFCs available to those with Royal College examination eligibility or certification in Pediatrics. RCPSC Competency Training Requirements documents were used to compare and contrast the competencies in each AFC with competencies established in Pediatric residency training. Key and Enabling Competencies were compared for each CanMEDS role to identify differences. Ten AFCs were identified with eligibility requirements including Royal College examination eligibility or certification in Pediatrics. All 10 AFCs included at least one new Medical Expert competency, for a total of 42 unique competencies in this role across all AFCs. The Scholar role had only 10 new competencies across seven AFCs, while only one AFC added a single unique competency in the Collaborator role. The majority of new competencies contributed by AFCs lie within the CanMEDS role of Medical Expert. The Scholar and Collaborator roles have the least differences when comparing competencies of existing AFCs to those competencies established in Pediatric residency training. Developing additional AFCs that offer advanced skills in these roles may help close this gap within the discipline of Pediatrics.

Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies.

Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies.

Patient references in the 2005 and 2015 CanMEDS frameworks.

Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks. We used document analysis to examine how the term 'patient(s)' is referenced in the 2005 and 2015 CanMEDS Frameworks. Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME. There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

Global health competencies in postgraduate medical education: a scoping review and mapping to the CanMEDS physician competency framework.

Global Health opportunities are popular, with many reported benefits. There is a need however, to identify and situate Global Health competencies within postgraduate medical education. We sought to identify and map Global Health competencies to the CanMEDS framework to assess the degree of equivalency and uniqueness between them. JBI scoping review methodology was utilized to identify relevant papers searching MEDLINE, Embase, and Web of Science. Studies were reviewed independently by two of three researchers according to pre-determined eligibility criteria. Included studies identified competencies in Global Health training at the postgraduate medicine level, which were then mapped to the CanMEDS framework. A total of 19 articles met criteria for inclusion (17 from literature search and two from manual reference review). We identified 36 Global Health competencies; the majority (23) aligned with CanMEDS competencies within the framework. Ten were mapped to CanMEDS roles but lacked specific key or enabling competencies, while three did not fit within the specific CanMEDS roles. We mapped the identified Global Health competencies, finding broad coverage of required CanMEDS competencies. We identified additional competencies for CanMEDS committee consideration and discuss the benefits of their inclusion in future physician competency frameworks.

Intrinsic or Invisible? An Audit of CanMEDS Roles in Entrustable Professional Activities

Postgraduate medical education in Canada has quickly transformed to a competency-based model featuring new entrustable professional activities (EPAs) and associated milestones. It remains unclear, however, how these milestones are distributed between the central medical expert role and 6 intrinsic roles of the larger CanMEDS competency framework. A document review was thus conducted to measure how many EPA milestones are classified under each CanMEDS role, focusing on the overall balance between representation of intrinsic roles and that of medical expert. Data were extracted from the EPA guides of 40 Canadian specialties in 2021 to measure the percentage of milestones formally linked to each role. Subsequent analyses explored for differences when milestones were separated by stage of postgraduate training, weighted by an EPA's minimum number of observations, or sorted by surgical and medical specialties. Approximately half of all EPA milestones (mean = 48.6%; 95% confidence interval [CI] = 45.9, 51.3) were classified under intrinsic roles overall. However, representation of the health advocate role was consistently low (mean = 2.95%; 95% CI = 2.49, 3.41), and some intrinsic roles-mainly leader, scholar, and professional-were more heavily concentrated in the final stage of postgraduate training. These findings held true under all conditions examined. The observed distribution of roles in EPA milestones fits with high-level descriptions of CanMEDS in that intrinsic roles are viewed as inextricably linked to medical expertise, implying both are equally important to cultivate through curricula. Yet a fine-grained analysis suggests that a low prevalence or late emphasis of some intrinsic roles may hinder how they are taught or assessed. Future work must explore whether the quantity or timing of milestones shapes the perceived value of each role, and other factors determining the optimal distribution of roles throughout training.

Does peer teaching improve academic results and competencies during medical school? A mixed methods study

BackgroundThis study investigates the impact of Peer-Assisted Learning (PAL) in clinical skills on peer teachers’ academic scores and competencies; however, controversy remains on this topic, and concrete evidence on its impact lacking.MethodsWe performed a mixed methods study combining a retrospective cohort study with a modified Delphi survey. Peer teachers and Skills Lab faculty members participated in this study. A validated questionnaire, the CanMEDS Competency Based Inventory (CCBI), and group interviews were used to assess the outcomes of PAL. Our results were also triangulated with literature data.ResultsIn 3 consecutive cohorts of medical students (n = 311), 78 participated in PAL. Peer teachers obtained higher scores from the start of the study, at different timepoints in medical school, and on their final scores compared to all other students. Interestingly their progress followed the same path and magnitude as other well-performing students. However, based on our findings from a modified Delphi survey (CCBI interviews) and a literature review, we found further supporting evidence for a positive impact of PAL on the competencies of physical skills (medical expert), teamwork and leadership (collaborator), lifelong learning (scholar), and for admitting uncertainty/limits (professional) within the CanMEDS roles.ConclusionsWe conclude that higher achieving students are more likely to volunteer for a peer tutoring program; however this does not significantly augment their academic scores as compared to above well-performing non-teaching fellow students. Importantly, our modified Delphi survey indicated which CanMEDS roles were positively impacted by PAL: medical expert, collaborator, scholar and professional.

Surgical trainees achieving the CanMEDS roles in the COVID-19 era: What have we learned and where do we go?

Summary The COVID-19 pandemic has substantially changed the practice of medicine with a shift to virtual clinical encounters, alternative management of surgical diseases owing to restrictions on elective operations, and physician redeployment to other medical services requiring coverage. These changes may limit opportunities for trainees to gain surgical expertise and have the potential to drastically affect postgraduate surgical education. However, the pandemic has also created a number of opportunities to navigate these challenges and enhance how surgical education is delivered. For example, there are now more learning opportunities available to trainees because of virtual educational sessions. We highlight some considerations in adapting postgraduate surgical training to achieve competency in the CanMEDS roles in the COVID-19 era.

An online Delphi study to investigate the completeness of the CanMEDS Roles and the relevance, formulation, and measurability of their key competencies within eight healthcare disciplines in Flanders

BackgroundSeveral competency frameworks are being developed to support competency-based education (CBE). In medical education, extensive literature exists about validated competency frameworks for example, the CanMEDS competency framework. In contrast, comparable literature is limited in nursing, midwifery, and allied health disciplines. Therefore, this study aims to investigate (1) the completeness of the CanMEDS Roles, and (2) the relevance, formulation, and measurability of the CanMEDS key competencies in nursing, midwifery, and allied health disciplines. If the competency framework is validated in different educational programs, opportunities to support CBE and interprofessional education/collaboration can be created.MethodsA three-round online Delphi study was conducted with respectively 42, 37, and 35 experts rating the Roles (n = 7) and key competencies (n = 27). These experts came from non-university healthcare disciplines in Flanders (Belgium): audiology, dental hygiene, midwifery, nursing, occupational therapy, podiatry, and speech therapy. Experts answered with yes/no (Roles) or on a Likert-type scale (key competencies). Agreement percentages were analyzed quantitatively whereby consensus was attained when 70% or more of the experts scored positively. In round one, experts could also add remarks which were qualitatively analyzed using inductive content analysis.ResultsAfter round one, there was consensus about the completeness of all the Roles, the relevance of 25, the formulation of 24, and the measurability of eight key competencies. Afterwards, key competencies were clarified or modified based on experts’ remarks by adding context-specific information and acknowledging the developmental aspect of key competencies. After round two, no additional key competencies were validated for the relevance criterion, two additional key competencies were validated for the formulation criterion, and 16 additional key competencies were validated for the measurability criterion. After adding enabling competencies in round three, consensus was reached about the measurability of one additional key competency resulting in the validation of the complete CanMEDS competency framework except for the measurability of two key competencies.ConclusionsThe CanMEDS competency framework can be seen as a grounding for competency-based healthcare education. Future research could build on the findings and focus on validating the enabling competencies in nursing, midwifery, and allied health disciplines possibly improving the measurability of key competencies.