Canadian Medical Education Research Articles

Building a Generation of Physician Advocates: The Case for Including Mandatory Training in Advocacy in Canadian Medical School Curricula.

There is an increasing focus on the social accountability of physicians as individuals, and of medicine itself. This has led to increasing emphasis on physician advocacy from a wide variety of institutions. The physician advocacy concept is now part of the Health Advocacy competency mandated by the Royal College of Physicians and Surgeons of Canada. Despite its growing prominence, physician advocacy remains poorly integrated into current medical undergraduate curricula. The authors recommend how and why curricular reform should proceed; they focus on Canadian medical education, although they hope their views will be useful in other countries as well.The authors discuss conflicting definitions of physician advocacy, which have previously hampered curriculum development efforts, and suggest a way of reconciling the conflicts. They review current gaps in advocacy-related curricula, suggest that these can be addressed by incorporating practice-based and skills acquisition elements into current didactic teaching, and offer several strategies by which an advocacy curriculum could be implemented, ranging from small modifications to current curriculum to developing new competencies in medical education nationally.The authors present a case for making an advocacy curriculum mandatory for every Canadian medical trainee; they argue that teaching trainees how to fulfill their professional responsibility to advocate may also help them meet the social accountability mandate of medical school education. Finally, the authors explain why making the development and implementation of a mandatory, skill-based curriculum in advocacy should be a priority.

Selecting the best and brightest: A comparison of residency match processes in the United States and Canada

Background Selecting candidates for plastic surgery residency training remains a challenge. In the United States, academic measures (United States Medical Licensing Exam Step I scores, medical school class rank and publications) are used as primary criteria for candidate selection for residency. In contrast, Canadian medical education de-emphasizes academic measures by using a pass-fail grading system. As a result, choosing residents from many qualified applicants may pose a challenge for Canadian programs without objective measures of academic success. Methods A 25-question online survey was distributed to program directors of Canadian plastic surgery residency-training programs. Program directors commented on number of yearly residents and applicants; application sections (ranked in importance using a Likert scale); interview invitation and rank-order list determination; and their satisfaction with the selection process. Results Ten Canadian plastic surgery program directors responded (90.9% response rate). The most important application components determining invitation to interview were letters of reference from a plastic surgeon (mean importance of 5.0 on the Likert scale), clinical electives in plastic surgery (mean 4.6) and electives with their program (mean 4.5). Applicants invited for interview were assessed on the quality of their responses to questions, maturity and personality. The majority of program directors agreed that a clinical elective with their program was important for consideration on their rank-order list. Program directors were neutral on their satisfaction with the selection process. Conclusion Canadian plastic surgery residency programs emphasize clinical electives with their program and letters of reference from colleagues when selecting applicants for interviews. In contrast to their American counterparts, Canadian program directors rely on clinical interactions with prospective residents in the absence of objective academic measures.

Scholarly Success Among Internal Medicine Residents in Canada

Scholar activity is an integral component of postgraduate medical education in Canada. We describe the opportunities in research training among Canadian internal medicine (IM) programs, including program requirements and supportive infrastructure, as well as barriers and enablers of research success. Methods: An email survey was sent to all program directors (PDs) (n = 14) and core IM residents (n = 1119) from English-speaking IM Residency Training Programs in Canada to describe research support and productivity. We evaluated factors associated with achieving an abstract presentation at a scientific meeting or publication of a manuscript in a peer-reviewed journal. Results: A total of 10 of 14 PDs (71%) and 308 of 1119 residents (28%) responded to the survey. Of 10 evaluable programs, 6 had a formal research curriculum and 8 had a mechanism of pairing residents with research mentors. A total of 236 (76%) residents completed a research project during core IM training; of those, 171 (55%) published (n = 84) or presented (n = 150) their research. A mechanism for linking residents with suitable research mentors, instruction on medical writing, and instruction on data analysis were associated with residents' achieving publication in a peer-reviewed journal. Conclusion: Requirements for resident research are variable across Canadian IM programs. Instruction on medical writing and statistics, as well as a mechanism to pair residents with suitable research mentors, contribute to resident research success.

Scholarly Success Among Internal Medicine Residents in Canada

Scholar activity is an integral component of postgraduate medical education in Canada. We describe the opportunities in research training among Canadian internal medicine (IM) programs, including program requirements and supportive infrastructure, as well as barriers and enablers of research success. Methods: An email survey was sent to all program directors (PDs) (n = 14) and core IM residents (n = 1119) from English-speaking IM Residency Training Programs in Canada to describe research support and productivity. We evaluated factors associated with achieving an abstract presentation at a scientific meeting or publication of a manuscript in a peer-reviewed journal. Results: A total of 10 of 14 PDs (71%) and 308 of 1119 residents (28%) responded to the survey. Of 10 evaluable programs, 6 had a formal research curriculum and 8 had a mechanism of pairing residents with research mentors. A total of 236 (76%) residents completed a research project during core IM training; of those, 171 (55%) published (n = 84) or presented (n = 150) their research. A mechanism for linking residents with suitable research mentors, instruction on medical writing, and instruction on data analysis were associated with residents' achieving publication in a peer-reviewed journal. Conclusion: Requirements for resident research are variable across Canadian IM programs. Instruction on medical writing and statistics, as well as a mechanism to pair residents with suitable research mentors, contribute to resident research success.

The Future of Postgraduate Medical Education in Canada.

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.

How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?

Background and aim: In German-speaking countries, the physicians’ roles framework of the “Canadian Medical Education Directives for Specialists” (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called “Practical Year” (PY).Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training. Methods: 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: “relevance for your personal daily work”, “importance for teaching during PY”, and “implementation into actual PY teaching”.Results: In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training.The roles “Communicator”, “Medical Expert”, and “Collaborator” were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals.Conclusion: Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the CanMEDS framework as a conceptual element of PY training.

Designing Assessment Programmes for the Model Curriculum for Emergency Medicine Specialists.

There has been a proliferation of competency-based postgraduate training programmes in emergency medicine (EM) worldwide, including Australia, Canada, Singapore, the United Kingdom, and the United States. Several competency frameworks have been developed at national and international levels as a basis for competency-based postgraduate training programmes. These frameworks include the Accreditation Council of Graduate Medical Education (ACGME) competencies in the United States, the Canadian Medical Educational Directives for Specialists (CanMEDS), and Common Competences for Emergency Medicine in the United Kingdom. In response to this increased emphasis on competency-based education during postgraduate training in EM, the International Federation for Emergency Medicine (IFEM) has recently developed a model curriculum to define the basic minimum standards for specialist training in EM. The goal for specialist training in EM is to ensure that its trainees develop the necessary knowledge, skills, and professional attitudes to provide safe, expert, and independent emergency care within their own country. Accurate assessment of trainees’ progress during specialist training is of paramount importance to the educational process. In recent years there have been changes to the assessment process. Traditionally, assessment has been considered exclusively as a process of measuring whether trainees have acquired the necessary knowledge, skills, and professional attitudes to practice independently as a specialist in EM, or assessment of learning. However, it is now recognized that an equally important function of assessment is to stimulate the individual’s learning process—in other words, assessment for learning. This new paradigm of the role of assessment should be firmly embedded in the educational process. As a result of this conceptual change in assessment, there has been a shift from considering individual methods to programmes of assessment, to allow adequate sampling of performance of complex competencies in authentic contexts.

Designing faculty development to support the evaluation of resident competency in the intrinsic CanMEDS roles: practical outcomes of an assessment of program director needs.

BackgroundThe Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada mandate that faculty members demonstrate they are evaluating residents on all CanMEDS (Canadian Medical Education Directions for Specialists) roles as part of the accreditation process. Postgraduate Medical Education at the University of Ottawa initiated a 5-year project to develop and implement a comprehensive system to assess the full spectrum of CanMEDS roles. This paper presents the findings from a needs assessment with Program Directors, in order to determine how postgraduate medical faculty can be motivated and supported to evaluate residents on the intrinsic CanMEDS roles.MethodsSemi-structured individual interviews were conducted with 60 Postgraduate Program Directors in the Faculty of Medicine. Transcribed interviews were analyzed using qualitative analysis. Once the researchers were satisfied the identified themes reflected the views of the participants, the data was assigned to categories to provide rich, detailed, and comprehensive information that would indicate what faculty need in order to effectively evaluate their residents on the intrinsic roles.ResultsFindings indicated faculty members need faculty development and shared point of care resources to support them with how to not only evaluate, but also teach, the intrinsic roles. Program Directors expressed the need to collaborate and share resources across departments and national specialty programs. Based on our findings, we designed and delivered workshops with companion eBooks to teach and evaluate residents at the point of care (Developing the Professional, Health Advocate and Scholar).ConclusionsIdentifying stakeholder needs is essential for designing effective faculty development. By sharing resources, faculties can prevent ‘reinventing the wheel’ and collaborate to meet the Colleges’ accreditation requirements more efficiently.

Investigating Canadian medical school attrition metrics to inform socially accountable admissions planning

Objective: Attrition from Canadian medical degree programs was never described despite differences in admissions requirements at the 17 faculties of medicine. Knowledge on attrition metrics could help the faculties evaluate new avenues for addressing the Association of Faculties of Medicine’s (AFMC) Future of Medical Education in Canada (FMEC MD) recommendation to enhance admissions practices with the goal to improve social accountability and student diversity.Method: AFMC databases were used to track medical degree completion of all Canadian M.D. students who enrolled between 2003 and 2007. Students were followed and assigned an M.D. completion status as of by July 1, 2013. Bivariate statistics were used to evaluate if demographic, admission and degree progression variables were associated with medical school attrition.Results: Of 11,454 students enrolled in Canadian M.D. programs from 2003 to 2007, only 197 (1.7%) did not complete. Québec had significantly higher attrition than other jurisdictions with age, educational attainment at time of enrolment, MCAT completion and struggling academically associated with attrition.Conclusion: Attrition from Canadian MD programs is rare and associated with differences in admission requirements and possibly suggests an optimum life stage for medical studies. Improved knowledge of attrition-related factors may offer an additional level of evidence for improving the alignment between admissions policies and the social accountability objectives of medical schools.

Competency-structured case discussion in the morning meeting: enhancing CanMEDS integration in daily practice.

Outcome-focused, competency-based educational curricula have become the norm in residency training programs. The Canadian Medical Education Directives for Specialists (CanMEDS) framework is one example of such a curriculum. However, models for incorporating all the competencies in everyday clinical practice have been difficult to accomplish. In this manuscript, a CanMEDS, competency-structured, acute case discussion in a regular morning meeting was undertaken. All the diagnostic and therapeutic interventions were explicitly organized and discussed under their respective CanMEDS competency headings. Post exercise, the majority of residents felt that they were more competent in all the competencies and indicated their willingness to continue having similarly structured acute case discussions in the future.

Perceptions of physician leadership in Botswana

Background . Physician leadership is essential for the strengthening of health systems, especially in underserved settings such as sub-Saharan Africa. To be effective, leaders must be perceived as such by their community. It is unknown how perceptions of physician leadership in Botswana compare with those of the Canadian Medical Education Directives for Specialists (CanMEDS) Physician Competency Framework, which is used to shape the training of Botswana’s future physicians. Objective . To examine if the perceived competencies of physician leadership in Botswana are specifically named in the CanMEDS Framework and thereby inform Botswana’s graduate medical education. Methods . We conducted focus groups discussions with nurses, interns, medical officers and specialists at Princess Marina Hospital and Nyangabgwe Referral Hospital. Key questions focused on describing the qualities of physician leadership. For data analysis we used inductive content coding and comparison with the CanMEDS frameworks. Results . Forty-eight clinicians participated and 111 unique codes were assigned to 503 comments. Eighty-four per cent of comments corresponded to the CanMEDS 2005 competencies; many were captured within the competencies of the medical expert (13.0%), communicator (17.8%), collaborator (15.6%), scholar (14.9%) and professional (31.3%) roles. About 5% of comments mapped to the draft CanMEDS 2015 update, and 11.5% were not specifically described in either version of CanMEDS, including charisma and decisiveness. Conclusion . The CanMEDS frameworks specifically address most of the competencies perceived as important for physician leadership in Botswana. Additional perceptions were identified that may require the attention of existing and aspiring physician leaders and their teachers to ensure they attain and maintain their effectiveness as leaders.

Development and incorporation of hybrid simulation OSCE into in-training examinations to assess multiple CanMEDS competencies in urologic trainees.

As residency training requirements increasingly emphasize a competency-based approach, novel tools to directly evaluate Canadian Medical Education Directives for Specialists (CanMEDS) competencies must be developed. Incorporating simulation allows residents to demonstrate knowledge and skills in a safe, standardized environment. We describe a novel hybrid simulation station for use in a urology resident in-training Objective Structured Clinical Exam (OSCE) to assess multiple CanMEDS competencies. An OSCE station was developed to assess Communicator, Health Advocate, Manager, and Medical Expert (including technical skills) CanMEDS roles. Residents interviewed a standardized patient, interacted with a nurse, performed flexible cystoscopy and attempted stent removal using a novel bladder/stent model. Communication was assessed using the Calgary-Cambridge Observational Guide, knowledge was assessed using a checklist, and technical skills were assessed using a previously validated global rating scale. Video debriefing allowed residents to review their performance. Face and discriminative validity were assessed, and feasibility was determined through qualitative post-examination interviews and cost analysis. All 9 residents (postgraduate years [PGY] 3, 4, 5) completed the OSCE in 15 minutes. Communicator and knowledge scores were similar among all PGYs. Scores in technical skills were higher in PGY-5 compared with PGY-3/4 reside nts (mean score 79% vs. 73%). Residents and exam personnel felt the OSCE station allowed for realistic demonstration of competencies. Equipment cost was $218 for the exam station. We developed and implemented a hybrid simulation-based OSCE station to assess multiple CanMEDS roles. This approach was feasible and cost-effective; it also provided a framework for future development of similar OSCE stations to assess resident competencies across multiple domains.

Psychiatry Trainees’ Attitudes towards Psychotherapy

Background: Psychotherapy education is one of the essential components of specialist training in psychiatry according to the Royal College of Physicians of Canada. How psychiatry trainees perceive psychotherapy has major implications for how trainees will learn about psychotherapy during training, how they will utilize it in their future practice, and how they will integrate it into their professional identity. Methods: The study involved the distribution of questionnaires to psychiatry residents at an Atlantic Canadian Medical School. The survey consisted of Likert-scaled items which assessed residents’ attitudes towards being a psychotherapist and their future study and practice plans in psychotherapy. Results: Surveys were completed by 18 out of 25 residents (72% response rate). Half of participants indicated that conducting psychotherapy was highly rewarding and the majority of residents planned to incorporate psychotherapy into their future practice. Several mean differences were also noted between those residents who completed their undergraduate medical education in Canada versus at International locations. Conclusion: Despite the recent changes in psychotherapy training requirements and concerns about psychotherapy’s role in psychiatry, many residents perceive psychotherapy skills as being important for competent psychiatry practice and plan to incorporate their psychotherapy training into their future practice. Additional implications for teaching, future research, and practice are discussed.

Selecting the best and brightest: A comparison of residency match processes in the United States and Canada.

Selecting candidates for plastic surgery residency training remains a challenge. In the United States, academic measures (United States Medical Licensing Exam Step I scores, medical school class rank and publications) are used as primary criteria for candidate selection for residency. In contrast, Canadian medical education de-emphasizes academic measures by using a pass-fail grading system. As a result, choosing residents from many qualified applicants may pose a challenge for Canadian programs without objective measures of academic success. A 25-question online survey was distributed to program directors of Canadian plastic surgery residency-training programs. Program directors commented on number of yearly residents and applicants; application sections (ranked in importance using a Likert scale); interview invitation and rank-order list determination; and their satisfaction with the selection process. Ten Canadian plastic surgery program directors responded (90.9% response rate). The most important application components determining invitation to interview were letters of reference from a plastic surgeon (mean importance of 5.0 on the Likert scale), clinical electives in plastic surgery (mean 4.6) and electives with their program (mean 4.5). Applicants invited for interview were assessed on the quality of their responses to questions, maturity and personality. The majority of program directors agreed that a clinical elective with their program was important for consideration on their rank-order list. Program directors were neutral on their satisfaction with the selection process. Canadian plastic surgery residency programs emphasize clinical electives with their program and letters of reference from colleagues when selecting applicants for interviews. In contrast to their American counterparts, Canadian program directors rely on clinical interactions with prospective residents in the absence of objective academic measures.

Diversity in medical school admission: insights from personnel recruitment and selection.

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.]

INTERIM PERFORMANCE METRICS OF AN INNOVATIVE, WEB-BASED CANADIAN JOURNAL OF CARDIOLOGY KNOWLEDGE DISSEMINATION PLATFORM

Hamilton, Ontario BACKGROUND: As survival rates from coronary artery disease (CAD) increase, the prevalence of persistent cardiac pain-related conditions is on the rise. Our aim was to disseminate a web-based, multi-media resource centre for persistent cardiac pain, CardiacPain.Net, as a prototype for large-scale knowledge dissemination; partners included Elsevier, the Canadian Journal of Cardiology, the Canadian Cardiovascular Society, the Heart and Stroke Foundation, the Canadian Pain Coalition and Argyle Communications. METHODS: CardiacPain.Net was based on the Canadian Institutes of Health Research (CIHR) knowledge to action cycle as well as the CIHR framework for citizen engagement. Substantive content for dissemination via CardiacPain.Net was designed to tailor specific aspects of knowledge inquiry, synthesis, and product tools (e.g. clinical practice guidelines, diagnostic phenotype criteria). Affected citizens were engaged across all phases of designing architecture. Multi-media design features included open access published resources, narrated video presentations, expert and citizen roundtable discussions, downloadable fact sheets, and an asynchronous discussion forum.Dissemination strategies included opt-in email blasts to Elsevier subscribers (n1⁄4 95,000) every 3 months, online banner advertising, LinkedIn and Google advertizing, and mass social media including Twitter and Facebook. Accreditation of CardiacPain.Net for continuing medical education in Canada and United States was secured to maximize incentive for end-user uptake. Standard dissemination metrics included total site visits and components visited and downloaded. Customized metrics included unique and return visitor rates, bounce rate, stream views, unique end-user tracking, social media trends, and geo-targeting. All metrics were analyzed in aggregate and distributions were examined for outliers and monthly trends. RESULTS: Interim examination of dissemination metrics found that in 3 months since initial launch CardiacPain.Net has had 2,549 total visits, 1,913 unique visits, and 5,418 page views. Specific multimedia presentations and open access resources were viewed and downloaded 414 and 413 times, respectively. Unique and return visitor rates were 71.1% and 28.9% respectively with a bounce rate of 47%. Twitter constituted 75% of all social media interactions (n1⁄4 124) featuring CardiacPain. Net content. Geo-targeting analyses found that unique end-users spanned 25 countries across 5 continents. CONCLUSION: Our interim 3-month analyses suggest that as a large-scale knowledge dissemination prototype, CardiacPain.Net is capable of being far reaching and engaging to end users seeking knowledge on persistent forms of cardiac pain. Linear and Poisson regression analyses at 6 and 12 months follow up are required to determine the influence of design features, region of origin, and operating systems on customized dissemination metrics.

Medical education distribution in British Columbia: a thriving partnership

In the spring of 2008, the University of British Columbia (UBC) graduated 195 [1] students from its distributed undergraduate medical program, the first post-distribution cohort. The distributed program was developed in response to a chronic shortage of physicians in British Columbia [2,3]. The initiative is predicated on a multi-institutional partnership that is the first of its kind in undergraduate medical education in Canada [4]. The partnership currently comprises three sites: the pre-existing Vancouver Fraser Medical Program (VFMP) based at UBC, the Island Medical Program (IMP) based at the University of Victoria (UVic) on Vancouver Island, and the Northern Medical Program (NMP) based at the University of Northern British Columbia (UNBC) in Prince George, which lies approximately 1000 km north of Vancouver [2].

Electronic management of practice assessment data.

The assessment of a practising physician's performance may be conducted for various reasons, including licensure. In response to a request from the College of Physicians and Surgeons of Manitoba (CPSM), the Division of Continuing Professional Development in the Faculty of Medicine, University of Manitoba, has established a practice-based assessment programme - the Manitoba Practice Assessment Program (MPAP) - as the College needed a method to evaluate the competence and performance of physicians on the conditional register. Using a multifaceted approach and CanMEDS as a guiding framework, a variety of practice-based assessment surveys and tools were developed and piloted. Because of the challenge of collating data, the MPAP team needed a computerised solution to manage the data and assessment process. Over a 2-year period, a customised web-based forms and information management system was designed, developed, tested and implemented. The secure and robust system allows the MPAP team to create assessment surveys and tools in which each item is mapped to Canadian Medical Education Directives for Specialists (CanMEDS) roles and competencies. Reports can be auto-generated, summarising a physician's performance on specific competencies and roles. Overall, the system allows the MPAP team to effectively manage all aspects of the assessment programme. Throughout all stages of design to implementation, a variety of lessons were learned that can be shared with those considering building their own customised web-based system. The key to success is active involvement in all stages of the process!

Prognosis: the "missing link" within the CanMEDS competency framework.

BackgroundThe concept of prognosis dates back to antiquity. Quantum advances in diagnostics and therapeutics have relegated this once highly valued core competency to an almost negligible role in modern medical practice. Medical curricula are devoid of teaching opportunities focused on prognosis. This void is driven by a corresponding relative dearth within physician competency frameworks. This study aims to assess the level of content related to prognosis within CanMEDS (Canadian Medical Education Directives for Specialists), a leading and prototypical physician competency framework.MethodsA quantitative content analysis of CanMEDS competency framework was carried out to measure the extent of this deficiency. Foxit Reader 5.1 (Foxit Corporation), a keyword scanning software, was used to assess the CanMEDS 2005 framework documents of 29 physician specialties and 37 subspecialties across the seven physician roles (medical expert, communicator, collaborator, manager, health advocate, scholar, and professional). The keywords used in the search included prognosis, prognostic, prognosticate, and prognostication.ResultsOf the 29 specialties six (20.7%) contained at least one citation of the keyword “prognosis”, and one (3.4%) contained one citation of the keyword “prognostic”. Of the 37 subspecialties, sixteen (43.2%) contained at least one citation of the keyword “prognosis”, and three (8.1%) contained at least one citation of the keyword “prognostic”. The terms “prognosticate” and “prognostication” were completely absent from all CanMEDS 2005 documents. Overall, the combined citations for “prognosis” and “prognostic” were linked with the following competency roles: Medical Expert (80.3%), Scholar (11.5%), and Communicator (8.2%).ConclusionsGiven the fundamental and foundational importance of prognosis within medical practice, it is recommended that physicians develop appropriate attitudes, skills and knowledge related to the formulation and communication of prognosis. The deficiencies within CanMEDS, demonstrated by this study, should be addressed in advance of the launch of its updated version in 2015.

Bridging the continuum: Analysis of the alignment of undergraduate and postgraduate accreditation standards

Several influential national/international bodies including The Bologna Accord, The Carnegie Foundation and The Future of Medical Education in Canada (FMEC) have called for increased coordination across the medical education continuum. FMEC recognizes accreditation as a “powerful lever” and encourages the alignment of undergraduate and postgraduate standards. The Carnegie Foundation includes a similar call for the creation of a more coherent accreditation system. As a first step, using the Canadian context, we present a methodological approach that assesses the example of how well LCME/CACMS undergraduate accreditation standards align with the Royal College of Physician and Surgeons of Canada (RCPSC) postgraduate training standards. We analyzed how closely the 132 LCME/CACMS Medical School accreditation standards aligned with the 155 post-graduate standards from the RCPSC accreditation General Standards (A and B). This comparative evaluation demonstrates that the standards do not align closely. Gaps, redundancies and key differences are highlighted. These results are the first step in understanding how accreditation needs to be adapted and re-aligned across the education continuum to provide consistent and coordinated training and these methods could easily be applied to other contexts and jurisdictions.