CanMEDS Roles Research Articles

The Web-based CanMEDS Resident Learning Portfolio Project (WEBCAM): how we got started.

The CanMEDS framework is ubiquitous in Canadian postgraduate medical education; however, training programs do not have a universal method of assessing competence. We set out to develop a novel portfolio that allowed trainees to generate a longitudinal record of their training and development within the framework. The portfolio provided an objective means for the residency program director to document and evaluate resident progress within the CanMEDS roles.

Mind the Gap: The Prospects of Missing Data

The increasing use of workplace-based assessments (WBAs) in competency-based medical education has led to large data sets that assess resident performance longitudinally. With large data sets, problems that arise from missing data are increasingly likely. The purpose of this study is to examine (1) whether data are missing at random across various WBAs, and (2) the relationship between resident performance and the proportion of missing data. During 2012-2013, a total of 844 WBAs of CanMEDs Roles were completed for 9 second-year emergency medicine residents. To identify whether missing data were randomly distributed across various WBAs, the total number of missing data points was calculated for each Role. To examine whether the amount of missing data was related to resident performance, 5 faculty members rank-ordered the residents based on performance. A median rank score was calculated for each resident and was correlated with the proportion of missing data. More data were missing for Health Advocate and Professional WBAs relative to other competencies (P < .001). Furthermore, resident rankings were not related to the proportion of missing data points (r = 0.29, P > .05). The results of the present study illustrate that some CanMEDS Roles are less likely to be assessed than others. At the same time, the amount of missing data did not correlate with resident performance, suggesting lower-performing residents are no more likely to have missing data than their higher-performing peers. This article discusses several approaches to dealing with missing data.

Erasmus: an Advocate for the Nursing CanMeds Roles

In Gouda, they celebrated the Year of Erasmus with an exhibition in the Gouda Museum (www.museumgouda.nl). The title of the exhibition was, ‘I Yield To No One’ (‘Ik wijk voor niemand’). Five-hundred years ago in 1516, Desiderius Erasmus had the honor of having the first printed edition of the New Testament in Greek titled, ‘Novum Instrumentum’.

Epistemology, culture, justice and power: non-bioscientific knowledge for medical training.

While medical curricula were traditionally almost entirely comprised of bioscientific knowledge, widely accepted competency frameworks now make clear that physicians must be competent in far more than biomedical knowledge and technical skills. For example, of the influential CanMEDS roles, six are conceptually based in the social sciences and humanities (SSH). Educators frequently express uncertainty about what to teach in this area. This study concretely identifies the knowledge beyond bioscience needed to support the training of physicians competent in the six non-Medical Expert CanMEDS roles. We interviewed 58 non-clinician university faculty members with doctorates in over 20 SSH disciplines. We abstracted our transcripts (meaning condensation, direct quotations) resulting in approximately 300 pages of data which we coded using top-down (by CanMEDS role) and bottom-up (thematically) approaches and analysed within a critical constructivist framework. Participants and clinicians with SSH PhDs member-checked and refined our results. Twelve interrelated themes were evident in the data. An understanding of epistemology, including the constructed nature of social knowledge, was seen as the foundational theme without which the others could not be taught or understood. Our findings highlighted three anchoring themes (Justice, Power, Culture), all of which link to eight more specific themes concerning future physicians' relationships to the world and the self. All 12 themes were cross-cutting, in that each related to all six non-Medical Expert CanMEDS roles. The data also provided many concrete examples of potential curricular content. There is a definable body of SSH knowledge that forms the academic underpinning for important physician competencies and is outside the experience of most medical educators. Curricular change incorporating such content is necessary if we are to strengthen the non-Medical Expert physician competencies. Our findings, particularly our cross-cutting themes, also provide a pedagogically useful mechanism for holistically teaching the underpinnings of physician competence. We are now implementing our findings into medical curricula.

“It’s Complicated”: Understanding the Relationships Between Checklists, Rating Scales, and Written Comments in Workplace-Based Assessments

Purpose: The shift towards competency-based medical education in postgraduate medical training has transformed the way competence is taught and measured within medical education. Competency-based medical education is built upon the belief that competence can be assessed using frequent and meaningful assessments, many of which consist of both quantitative and qualitative evaluations. In order to understand associations between various quantitative and qualitative evaluations used in workplace-based assessments, this study aimed to explore the relationships that exist between assessors’ checklist scores, ratings, and written comments. Method: Data from the McMaster Modular Assessment Program (McMAP)1 were collected and analyzed using an explanatory mixed-methods design. McMAP was designed to assess the CanMEDS roles of postgraduates specializing in emergency medicine using checklists, rating scales, and written comments for both task-specific and global appraisals of competence. These workplace-based assessment checklist and rating scale scores were analyzed using regression analyses. Narrative comments, corresponding with the aforementioned numeric scores, were rated by a content expert using a modified version of the Completed Clinical Evaluation Report Rating2 and used as predictor variables in the regression analyses. The written comments appearing in the workplace-based assessment were also independently analyzed by two of the authors using content analysis. Results: Communicator and collaborator workplace-based assessments from 342 McMAP evaluations of postgraduate year (PGY) 1 and PGY2 residents were analyzed using logistic regression and content analysis. Results from the two regression models indicated that the task-specific ratings provided by faculty assessors were significant in determining whether the “done, but needs attention” checklist category was used. Furthermore, the “done, but needs attention” checklist category was most significant in determining whether a written comment, mentioning specific strengths and weaknesses, would appear in the McMAP assessment. Subsequent analysis of the qualitative comments suggested meaningful differences in the type of written feedback provided in workplace-based assessments. Our analysis supports the notion of a hidden code3 used by assessors to communicate levels of competence. Conclusions: This study highlights some of the relationships that exist between checklists, rating scales, and written comments. As more institutions transition toward competency-based medical education, it becomes imperative that relationships among different forms of assessment are known in order to develop and implement comprehensive assessment programs. Findings from this study suggest that task and global ratings are differentially related to checklists, which has broader implications for the development of assessment tools. Furthermore, the presence of a hidden code creates challenges when interpreting information obtained from workplace-based assessments.

Preparing anesthesiology faculty for competency-based medical education.

Competency-based medical education (CBME) is quickly becoming the dominant organizing principle for medical residency programs. As CBME requires changes in the way medical education is delivered, faculty will need to acquire new skills in teaching and assessment in order to navigate the transition. In this paper, we examine the evidence supporting best practices in faculty development, propose strategies for faculty development for CBME-based residency programs, and discuss the results of faculty development initiatives at the pioneering anesthesia CBME residency program at the University of Ottawa. Review of the current literature and information from the University of Ottawa anesthesia residency program. Faculty development is critical to the success of CBME programs. Attention must be paid to the competence of faculty to teach and assess all of the CanMEDS roles. At the University of Ottawa, some faculty development initiatives were very successful, while others were hindered by factors both internal and external to the residency program. Many faculty development activities had low attendance rates. Faculty development must be considered in the rollout of any new educational initiative. Experts suggest that faculty development for CBME should incorporate educational activities using multiple teaching and delivery methods, and should be offered longitudinally through the planning, development, and implementation phases of curriculum change. Additionally, these educational activities must continue until all faculty have demonstrated an acceptable level of competence. Faculty buy-in is paramount to the successful delivery of any faculty development program that is not mandatory in nature.

Mit welchem Kompetenzniveau kommen ärztliche Berufsanfänger im Beruf an? – Eine Befragung von Weiterbildungsbefugten in Bayern

BackgroundUndergraduate training aims to enable medical students to become fully qualified physicians. The aim of the study was to explore the competences that newly graduated doctors (beginners) bring along from medical school into their postgraduate training. In this way areas can be identified that need to be better addressed during either under- or postgraduate training. MethodsCompetencies were assessed using a paper-based questionnaire that was sent out to 405 physicians in Bavaria being in the possession of a postgraduate training license in internal medicine, surgery and anaesthesiology. The questionnaire included items exploring the fields of competencies outlined in the CanMeds role descriptions. The results were analyzed using descriptive and exploratory methods. Results190 of 405 questionnaires (47 %) were returned. 96 % of the participants were male, the average age was 54 years. The results indicated that most young medical professionals had the necessary theoretical knowledge to take up postgraduate training. However, putting theory into practice does not work well enough from the physician's point of view. DiscussionAn approach to further support the transfer of enormous amounts of theoretical knowledge acquired during years of study into medical expertise is needed. In this respect, recently published competence-based curricula for under- and postgraduate training might prove useful.

Assessment of the Intrinsic CanMEDS Roles in Diagnostic Radiology Residents using an Objective Structured Clinical Assessment (OSCE)

This article was migrated. The article was not marked as recommended. Purpose: Non-Medical Expert or Intrinsic CanMEDS Roles, as outlined by the Royal College of Physicians and Surgeons of Canada, can be difficult to evaluate in an objective and specialty-specific manner. This study investigates an Objective Structured Clinical Examination (OSCE) evaluation tool to assess these competencies for Diagnostic Radiology Residents. Methods: A five station CanMEDS OSCE was developed for postgraduate year 3 and 4 Residents to evaluate the Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional Roles. Performance was assessed by postgraduate year 5 Residents using standardized scoring rubrics. CanMEDS OSCE scores were correlated with American College of Radiology (ACR) scores and Medical Expert OSCEs. Results: Seventy Residents in three separate cohorts (n=21, 26, 23) participated in the CanMEDS OSCE. Mean station scores were consistent across cohorts. In general, one-way ANOVAs showed no effect of postgraduate year on station scores. There were no significant correlations between CanMEDS OSCE scores and ACR exam scores or CanMEDS OSCE scores and Medical Expert OSCE scores, demonstrating divergent construct validity. In turn, this indicates construct validity for the CanMEDS OSCE by demonstrating that unique competencies are being measured. In contrast, there was a correlation between ACR exam scores and Medical Expert OSCE scores, confirming that these both assess the same construct. Conclusions: An OSCE can be a useful assessment tool to assess Intrinsic CanMEDS Roles in a specialty-specific manner. Correlational analyses indicate that unique competencies are being evaluated that are not captured by other traditional assessment means.

"Making Progress Towards Our Strategic Goals".

It remains a great privilege for me to serve the Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists as Dean, backed up by a talented Board and Staff. We have continued to focus on delivery of our 2013–2017 strategic plan to promote our vision “to reduce the burden of pain in society through education, advocacy, training and research.” In my first report in 2014, I said that I would like to concentrate our efforts in five areas [1]. How have we progressed in these and in other areas? Training and education of specialist pain medicine physicians remains at the heart of the Faculty’s role. The year 2015 marked the launch of our redesigned curriculum and training program, the culmination of many months of work by the authoring groups and the Curriculum Redesign Steering Committee. A Learning and Development Committee was established to assume responsibility for ongoing oversight, support and evaluation of the training program. The revised curriculum training program is competency-based and is based on particular CanMEDS roles. It focuses on the patient’s perspective, and is delivered centrally (with a knowledge focus) and in the Training Units (with a skill’s focus). It incorporates ongoing work-based formative assessment and progressive summative assessment, completed in two stages, the core training stage and the practice development stage. In order to progress it is mandatory for each applicant to pass a multiple choice questionnaire examination that tests their foundation knowledge of pain medicine. E-learning resources for the nine essential topic areas, as well as cultural competency, communication, management and professionalism resources, have all been developed. Two new Clinical Skills Courses (basic and advanced) have been designed and delivered to trainees. The delivery in accredited training units …

Burning the Midnight Oil: A Focus Group Study of Medical Student Night Call Preferences

Abstract BACKGROUND: Call is an integral component of clerkship, providing unique clinical and educational opportunities. Recently, traditional call has been the subject of scrutiny, resulting in changes to call requirements. Canadian Pediatric clerkships currently employ a variety of call modalities, including night float, evening call, and overnight call. OBJECTIVES: To explore the impact that call modalities have on medical students, and elucidate preferences. DESIGN/METHODS: We conducted focus groups of 5-7 medical students each. Participants were asked about their experiences with various call systems during clerkship. Verbatim transcripts were analyzed independently by 2 team members using grounded-theory. All codes were further reviewed by the Principal Investigator. RESULTS: Thirty-eight students participated in 6 focus groups. Four over-arching themes were identified as influencing call preferences: (1) Educational value, including patient volume and variety, hands-on experience, and teaching; (2) Quality of life, including fatigue/burn-out, ability to maintain a healthy lifestyle, and free time; (3) Continuity and quality of patient care; (4) Contribution to professional identity and acquisition of CanMEDS roles. Overnight call was described as a “rite of passage”, contributing to improved time management skills, a sense of collegiality, and self-perception as future physicians. With traditional call, post-call days provide opportunity to maintain well-being, although some believe 24-hour shifts impair ability to learn. Moreover, this call modality results in the lowest patient continuity of care. With regard to night float, most students appreciate focused call duties, and enjoy consistency with residents, resulting in greater bonding and teaching. However, they have difficulty adjusting to a nocturnal schedule, and lament missing daytime educational activities during call week. Evening call has the fewest patient encounters, least teaching, and worst fatigue and burn-out. Nonetheless, this call modality has the best patient continuity of care with no loss of daytime work. Students designated overnight call and night float as their preferred modalities, with evening call being unanimously rated least favourite. Students believe that specific goal-setting, and feedback from residents and staff are lacking across all call modalities. CONCLUSION: Students emphasize educational value and quality of life as important determinants of their call experience. Interestingly, acquisition of professional attributes and continuity of care play an important role in determining call preferences. We suggest that integrating the above elements and introducing a formal “call curriculum”, may make the clerkship call experience more standardized and beneficial to medical students, facilitating their growth as medical professionals.

The underemployed ophthalmologist—results of a survey of recent ophthalmology graduates

ObjectiveTo survey recent graduates of Canadian ophthalmology residency programs with regard to current employment, fellowship, job finding strategies, operating room time and resources, scope of practice, and reasons for difficulty in finding a job. DesignCross-sectional survey. ParticipantsGraduates of Canadian ophthalmology residency programs between 2009 and 2013 inclusive. MethodsAn electronic survey in English and French distributed via Surveymonkey to Canadian ophthalmology graduates from 2009 to 2013. ResultsOf the eligible ophthalmologists, 72% responded, and 81% of respondents had what they considered a job placement. The class of 2009 had the highest (100%) and the class of 2012 had the lowest (55%) employment rate. Of the respondents, 68% completed or were completing a fellowship, with retina being the most popular. Eighty percent of those with a job had operating room time with a median of 4 days per month, and 61% stated that their practice was open to all consultations, with cataract being the most common. Respondents felt adequately trained within the CanMEDS roles with the exception of manager. Only 11% felt they were adequately trained to run a business. ConclusionsIt is important that an ophthalmology health human resources strategy is developed to ensure that newly trained ophthalmologists can practice their skills to serve health-care needs now and in the future.

LO090: Introduction of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

Introduction / Innovation Concept: Expanding point of care ultrasound education in emergency medicine (EM) programs is a necessary part of curriculum development. Our objective was to integrate core and advanced applications for point of care ultrasound in caring for critically ill patients with undifferentiated shock. We chose to develop and implement an educational module using the systematic approach of the RUSH Exam for EM residents in our institution. Methods: After review of the literature in point-of-care ultrasound, a module was designed. An educational proposal outlining the RUSH Exam training within the -EM and CCFP-EM curricula was submitted to and accepted by the residency training committee. The objectives and goals were outlined in accordance with CanMEDS roles, and the ultrasound director provided supervision for the project. Curriculum, Tool, or Material: An 8-hour educational module was implemented between October 7 and November 18, 2014. All residents received formal training on the core applications in FAST and aortic scans prior to implementation. The following components of the RUSH Exam were included: two hours of didactic teaching with video clips on advanced cardiac, IVC, DVT, and pulmonary assessment; three hours of hands-on practice on standardized patients performed in the simulation lab to practice image acquisition and interpretation; one hour of didactic teaching on the overall approach to a patient with undifferentiated shock using the RUSH Exam; and two hours of hands-on RUSH Exam practice. A corresponding research project integrating a SonoSim Livescan training platform, a simulation-based testing device, demonstrated improvement in resident performance, subjective comfort with imaging patients in shock and making clinical decisions based on the findings. Conclusion: This 8-hour RUSH Exam educational module combined theoretical learning and hands-on practice for trainees. This module significantly broadened the scope of ultrasound training in our curriculum by providing the necessary skills in approaching patients in shock in a systematic fashion. Future direction will include ongoing education in this area and expansion as appropriate.

P099: Development and qualitative evaluation of an emergency medicine simulation book to facilitate the use of simulation for our local EM program

Introduction / Innovation Concept: Simulation-based medical education (SBME) has seen increased application in medical education. Emergency medicine (EM) trainees must develop a diverse skill set to smoothly transition to clinical practice and ensure optimal patient outcomes. The competency-based medical education (CBME) framework helps ensure residents develop the required expertise relevant to each of the CanMEDs roles. Simulation is a valuable supplement to hands-on clinical experience and allows skill development in a low-risk setting. The EM Simulation book serves to facilitate the effective application of simulation in our curriculum. Methods: A number of resources were compiled to meet the needs of our simulation program within Memorial University of Newfoundland. Personal knowledge/experience of the author and local contacts provide site relevant content. Prior training helped in review and selection of materials on simulation theory and debriefing. Core EM resources were sourced for information on procedural training. Literature review on simulation was used to compile a list of resources and materials for further reading. The development and revision of the manual continues as an iterative process with sequential edits based on review and feedback. Qualitative evaluation of the design and value of this document is planned to get feedback from key stakeholders including learners, faculty and simulation lab staff. Curriculum, Tool, or Material: The final product is a 94-page document provided in print and electronic format to the EM residents and several faculty involved in simulation. It introduces residents to our simulation program, provides relevant background information and orients them to this modality of curriculum delivery. Theory and rationale behind SBME is included. Information on the key role of debriefing is highlighted. Several core EM procedural topics are covered with tips on practice station set up. Additional learning resources are noted, including information on case development for potential teachers. Conclusion: The simulation book brings together key information to optimize the simulation-based medical education experience for EM residents at Memorial University.

Effectiveness of a Core-Competency-based Program on Residents' Learning and Experience.

BackgroundThe Care of the Elderly (COE) Diploma Program is a six-to-twelve-month enhanced skills program taken after two years of core residency training in Family Medicine. In 2010, we developed and implemented a core-competency–based COE Diploma program (CC), in lieu of one based on learning objectives (LO). This study assessed the effectiveness of the core-competency–based program on residents’ learning and their training experience as compared to residents trained using learning objectives.MethodsThe data from the 2007–2013 COE residents were used in the study, with nine and eight residents trained in the LO and CC programs, respectively. Residents’ learning was measured using preceptors’ evaluations of residents’ skills/abilities throughout the program (118 evaluations in total). Residents’ rating of training experience was measured using the Graduate’s Questionnaire which residents completed after graduation.ResultsFor residents’ learning, overall, there was no significant difference between the two programs. However, when examined as a function of the four CanMEDS roles, there were significant increases in the CC residents’ scores for two of the CanMEDS roles: Communicator/Collaborator/Manager and Scholar compared to residents in the LO program. With respect to residents’ training experience, seven out of ten program components were rated by the CC residents higher than by the LO residents.ConclusionThe implementation of a COE CC program appears to facilitate resident learning and training experience.

Learnt and perceived professional roles of a new type of nurse specialized in Gerontology and Geriatrics, a qualitative study.

To gain insight into a new type of nurse specialized in gerontology and geriatrics, how they find meaning in the care of older persons and how this relates to the seven professional roles derived from the CanMEDS theoretical framework. To promote the quality of care for older persons in the Netherlands, one of the measures taken is the training and deployment of Registered Nurses specialized in Gerontology and Geriatrics. We focus on their professional roles in this study, to gain insight into the extent to which they fulfil their professional standards. A qualitative study, consisting of seven focus group interviews. The study population included 67 Registered Nurses. Data were collected between October 2011-May 2013. Nurses work in all seven CanMEDS roles, but not with all competences associated with these seven roles. The more distant the role is from patient activities, the less frequently competences such as social networks; design; research; innovation of care; legal, financial and organizational frameworks; professional ethics and professional innovation are mentioned. Nurses engage in activities consistent with nursing care for older people; however, despite their training, they are mainly focused on direct-patient care. Their limited awareness of the complete range of professional competences risks the stagnation of their development in professional roles such as health advocate, scholar and professional, which will not lead to an improvement in the care for older persons.

The "Profiles" document: a modern revision of the objectives of undergraduate medical studies in Switzerland.

The Joint Commission of the Swiss Medical Schools (SMIFK/CIMS) decided in 2000 to establish a Swiss Catalogue of Learning Objectives (SCLO) for undergraduate medical training, which was adapted from a similar Dutch blueprint. A second version of the SCLO was developed and launched in 2008. The catalogue is a prerequisite for the accreditation of the curricula of the six Swiss medical faculties and defines the contents of the Federal Licensing Examination (FLE). Given the evolution of the field of medicine and of medical education, the SMIFK/CIMS has decided to embark on a total revision of the SCLO. This article presents the proposed structure and content of Profiles, a new document which, in the future, will direct the format of undergraduate studies and of the FLE. Profiles stands for the Principal Relevant Objectives for Integrative Learning and Education in Switzerland. It is currently being developed by a group of experts from the six Swiss faculties as well as representatives of other institutions involved in these developments. The foundations of Profiles are grounded in the evolution of medical practice and of public health and are based on up-to-date teaching concepts, such as EPAs (entrustable professional activities). An introduction will cover the concepts and a tutorial will be displayed. Three main chapters will provide a description of the seven 2015 CanMEDS roles, a list of core EPAs and a series of ≈250 situations embracing the most frequent and current conditions affecting health. As Profiles is still a work in progress, it is hoped that this paper will attract the interest of all individuals involved in the training of medical students.

Content validity of workplace-based portfolios: A multi-centre study

Background: Portfolios are used as tools to coach and assess students in the workplace. This study sought to evaluate the content validity of portfolios as reflected in their capacity to adequately assess achieved competences of medical students during clerkships.Methods: We reviewed 120 workplace portfolios at three medical universities (Belgium and the Netherlands). To validate their content, we developed a Validity Inventory for Portfolio Assessment (VIPA) based on the CanMEDS roles. Two raters evaluated each portfolio and indicated for each VIPA item whether the portfolio provided sufficient information to enable satisfactory assessment of the item. We ran a descriptive analysis on the validation data and computed Cohen’s Kappa to investigate interrater agreement.Results: The portfolios adequately covered the items pertaining to the communicator (90%) and professional (87%) roles. Coverage of the medical expert, collaborator, scholar and manager roles ranged between 75% and 85%. The health advocate role, covering 59%, was clearly less well represented. This role also exhibited little interrater agreement (Kappa < 0.4).Conclusions: This study lends further credence to the evidence that portfolios can indeed adequately assess the different CanMEDS roles during clerkships, the health advocate role, which was less well represented in the portfolio content, excepted.

An objective structured clinical exam to measure intrinsic CanMEDS roles

BackgroundThe CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE) is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise.MethodWe developed the CanMEDS In-Training Exam (CITE), a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary) and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA) was used to investigate differences between year of residency, sex, and the type of residency program.ResultsIn total, 63 residents participated in the CITE; 40 residents (63%) were from internal medicine programs, whereas the remaining 23 (37%) were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, p<0.05. Noninternal medicine residents scored higher in terms of the Professional competency overall, whereas internal medicine residents scored significantly higher in the Collaborator competency overall.DiscussionThe OSCE checklists developed for the assessment of intrinsic CanMEDS roles were functional, but the specific items within stations required more uniformity to be used between stations. More generic types of checklists may also improve correlations across stations.ConclusionAn OSCE measuring intrinsic competence is feasible; however, further development of our cases and checklists is needed. We provide a model of how to develop an OSCE to measure intrinsic CanMEDS roles that educators may adopt as residency programs move into competency-based medical education.

The role of European physicians in the assessment of work disability: A comparative study

Aims: The aim of this study was to describe and compare the role and tasks of the physicians involved in the medical assessment which takes place at the transition from short-term to long-term work disability in the 14 European countries as well as the required knowledge, skills and competencies to carry out those tasks. Methods: We organized a multi-stage research model consisting of written information, an expert group meeting and data analysis (from 14 European countries), using both Donabedian's triad model and the CanMEDS framework. Results: Most of the resources and information the physician has available at the start of the assessment, concurs. Some of the resources are only in some countries specific for insurance medical assessments. The process steps are more or less comparable in the participating countries as is the output. Set against the CanMEDS framework the physician, while carrying out the long-term work disability assessment fulfils all the roles to a greater or lesser extent. Conclusion: Most of the input and structure in this survey concur and although there are differences, so do process and output. Despite the difference in degree to which the CanMEDS roles are fulfilled, depending on the national legislation and operationalization of the assessment, we can conclude that physicians in all countries need to have all seven CanMEDS roles when carrying out the assessment of long-term work disability. Physicians require specific knowledge, skills and competencies, in addition to general medical knowledge, skills and competencies.

A feedback system in residency to evaluate CanMEDS roles and provide high-quality feedback: Exploring its application

Introduction: Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed whether feedback was provided on the intended roles and explored differences in quality of written feedback.Methods: In the feedback system, CanMEDS roles were assigned to five authentic situations: Patient Encounter, Morning Report, On-call, CAT, and Oral Presentation. Quality of feedback was operationalized as specificity and inclusion of strengths and improvement points. Differences in specificity between roles were tested with Mann–Whitney U tests with a Bonferroni correction (α = 0.003).Results: Supervisors (n = 126) provided residents (n = 120) with feedback (591 times). Feedback was provided on the intended roles, most frequently on Scholar (78%) and Communicator (71%); least on Manager (47%), and Collaborator (56%). Strengths (78%) were mentioned more frequently than improvement points (52%), which were lacking in 40% of the feedback on Manager, Professional, and Collaborator. Feedback on Scholar was more frequently (p = 0.000) and on Reflective Professional was less frequently (p = 0.003) specific.Discussion and conclusion: Assigning roles to authentic situations guides supervisors in providing feedback on different CanMEDS roles. We recommend additional supervisor training on how to observe and evaluate the roles.