Role Of Medical Expert Research Articles

The role of medical physics experts in clinical trials: A guideline from the European Federation of Organisations for Medical Physics

The EFOMP working group on the Role of Medical Physics Experts (MPEs) in Clinical Trials was established in 2010, with experts from across Europe and different areas of medical physics.Their main aims were: (1) To develop a consensus guidance document for the work MPEs do in clinical trials across Europe. (2) Complement the work by American colleagues in AAPM TG 113 and guidance from National Member Organisations. (3) To cover external beam radiotherapy, brachytherapy, nuclear medicine, molecular radiotherapy, and imaging.This document outlines the main output from this working group. Giving guidance to MPEs, and indeed all Medical Physicists (MP) and MP trainees wishing to work in clinical trials. It also gives guidance to the wider multidisciplinary team, advising where MPEs must legally be involved, as well as highlighting areas where MPEs skills and expertise can really add value to clinical trials.

Uprooting the CanMEDS flower? Equity, social justice, and the Medical Expert role.

Uprooting the CanMEDS flower? Equity, social justice, and the Medical Expert role.

What About Empathy? A Qualitative Study Exploring the Role of a Podcast as an Asynchronous Empathy Teaching Tool.

Though medical education podcasts are fast gaining popularity, they are overwhelmingly focused on teaching the medical expert role of physicians. We explored how medical learners and educators engaged with and learned from an empathy and communication-focused podcast and sought their recommendations for integrating the podcast into medical curricula. Six virtual, semi-structured focus groups were conducted with educators and learners within a large urban hospital and university setting. Participants were asked to listen to pre-selected episodes of the About Empathy podcast in advance. Thematic analysis was used to explore experiences and perceptions of empathy teaching and learning. There were 24 participants. We identified six themes related to the podcast and empathy learning: (1) forging connection through stories, (2) creating space to reflect on empathy, (3) shifting perspectives and biases, (4) feeling validated and enabling self-compassion, (5) gaining knowledge and building skills through empathetic communication, and (6) translating new knowledge and skills into practice. Participants highlighted that the podcast's portability and asynchronous nature allowed them to be more fully present, reflective, and intentional in their learning. The About Empathy podcast was experienced as a flexible, just-in-time tool that promoted self-agency over one's learning, reflective practice, and knowledge and skill acquisition, particularly with respect to empathic communication. Benefits of asynchronous e-learning tools such as podcasts support a shift to a blended learning model. Challenges finding a curricular home for this empathy-focused podcast require further consideration.

The role of healthcare providers in expanding legal abortion: Qualitative insights from Argentina, Ireland, and South Korea.

Abortion laws are key in creating an enabling environment that facilitates the advancement of people's sexual and reproductive health and rights. Around 50 countries have liberalized their abortion laws in the last decades by adding new grounds allowing abortion. The road toward the expansion of legal abortion is a long, highly sensitive, and difficult process. The specific role of healthcare providers in influencing abortion law reforms has been scarcely studied. With the objective to better understand their (potential) roles, a qualitative study was conducted in 2021 focusing on three countries that had recently liberalized their abortion regulations: Argentina, South Korea, and Ireland. For each country, key informant interviews were conducted with actors in advocacy for legal change, the majority with healthcare providers. The study results indicate that healthcare providers can contribute to the expansion of legal abortion through their influence on public and legal debates. Healthcare providers were found to be scientifically credible and trustworthy. Their voice and argumentation counteracted anti-rights arguments and addressed information gaps, by providing specific clinical experiences and medical information. Healthcare providers amplified women's experiences through their testimonies and had entry points within governmental bodies, which facilitated their advocacy. These healthcare providers often functioned as individual operating obstetrician/gynecologists or general practitioners who were engaged in networks of health professionals or had previous advocacy experience. In a global context of social and political contention around abortion, extending the engagement of healthcare providers in law and policy deliberation on abortion appears to be useful. This requires recognizing the diversity of roles that healthcare providers can take up, creating a safe environment in which they can operate, equipping them with skills that go beyond the medical expert role and facilitating strategic partnerships that seek complementarity between multiple stakeholders, building on the uniqueness of each stakeholder's expertise.

Psychiatrists as forensic authorities: evaluation of dangerous habitual offenders in West Germany during the 1960s - the Helmut Hoinka case.

Preventive detention for highly dangerous habitual offenders has been in force in Germany for 90 years. The necessity of this measure is hotly debated from a legal perspective. However, the assignment of preventive detention is largely determined by the opinion of medical experts. This article discusses the role of medical experts and the issues they face in evaluating the dangerousness of habitual offenders using the case of the marriage swindler Helmut Hoinka, prosecuted several times in the Federal Republic of Germany in the 1960s. Helmut Hoinka's case was chosen for analysis because of the rare opportunity to access detailed materials that allowed us to follow in detail the reasoning of the medical experts who evaluated Hoinka: medical reports stored in the Gerd Huber Archive at the University of Ulm, and Hoinka's court case from the State Archive of North Rhine-Westphalia. To examine these sources, we implemented the historical-critical method. The medical experts who evaluated Hoinka were aware of the defendant's criminal record prior to the evaluation, which was a source of bias. In addition, the criteria for classifying the offender as a dangerous habitual offender were open to a wide range of interpretations. Hoinka's high level of intelligence was negatively emphasized. Some test results were considered unreliable because it was assumed that Hoinka had manipulated his answers. Personal value judgments were allowed in assessing Hoinka's personality. Hoinka's criminal behavior was considered a medical symptom of psychopathy because it violated general moral and social norms. The medical reports of both experts showed that the psychiatrists believed in the genetic nature of psychopathy and criminal behavior. Their criminological prognosis was fully supported by the court in imposing the sentence. Challenges to Hoinka's criminological prognosis were the experts' personal biases, their belief in the theory of genetic predisposition to crime, the lack of clear criteria for antisocial personality disorder, and the absence of forensic recommendations for "psychopathic" criminals. The experts' opinion on Hoinka's criminal predisposition was crucial to the imposition of the sentence.

Technology-Enhanced Learning in the Education of Oncology Medical Professionals: A Systematic Literature Review

As cancer continues to be a significant global health challenge, the education of oncology professionals plays a crucial role in providing quality cancer care and achieving optimal patient outcomes. In order to meet the growing need for flexible, accessible, and effective training, this study examines the role of technology-enhanced learning (TEL) in the education of oncology medical professionals. Following the PRISMA guidelines, this systematic review included 34 articles published between 2012 and 2022 in EBSCO and PubMed databases. Findings reveal a diverse range of digital tools being used in oncology training, despite a shortage of advanced educational technologies and limited functional improvement compared to traditional instruction. Since the training primarily targeted at multiple professions in the medical expert role, with radiation oncologists being overrepresented, other oncology domains should be examined more thoroughly in the future, taking into account distinct professional abilities, e.g. communication, collaboration, and leadership skills with reference to the CanMEDS framework. Although the training programmes generally resulted in positive outcomes according to the Kirkpatrick evaluation model, experimental research designs were rather limited. Therefore, the substantial contribution and limitations of TEL in oncology education need to be clarified. Precise reporting of digital tools and instructional processes, as well as challenges encountered, is highly recommended to increase transparency and replicability. Research methodology in digital oncology education remains a major concern and should be addressed accordingly in future research.

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.

Perceptions of the CanMEDS Competencies of Faculty and Students in Different Curriculum Systems of a Medical School in China.

IntroductionThe Ottawa-Shanghai Joint School of Medicine (OSJSM) has adopted the uOttawa’s undergraduate medical education (UGME) program vertically integrated (VI) curriculum.However, limited information is available regarding whether the VI and non-VI curricula foster different perspectives on necessary competencies.MethodsThis study included 167 undergraduate medical students and 142 faculty members from different curricula at the Shanghai Jiao Tong University School of Medicine. Participants completed a questionnaire, rating the importance of competencies relating to the seven CanMEDS roles.ResultsThe cognitive level regarding the competencies required to be a successful clinician was significantly higher among participants from VI versus non-VI curricula. All participants gave the highest ratings to the Medical Expert and Professional roles, and rated the Health Advocate role as least important. Competency ratings did not significantly differ between students from VI versus non-VI curricula. Ratings between VI and non-VI faculty showed only one significant difference, namely the competence of“Constantly update clinical knowledge and professional skills” was ranked significantly higher by faculty of non-VI curricula. In the top rated 10 competencies, the Communicator role was considered more important by participants from VI versus non-VI curricula.ConclusionThe cognitive level regarding the competencies was related to the curriculum system. The Communicator role seemed to be paid more attention in VI curricula, however, other competencies was not demonstrated to be related to the curriculum system.

Three Sources of Validation Evidence Needed to Evaluate the Quality of Generated Test Items for Medical Licensure

Issue: Automatic item generation is a method for creating medical items using an automated, technological solution. Automatic item generation is a contemporary method that can scale the item development process for production of large numbers of new items, support building of multiple forms, and allow rapid responses to changing medical content guidelines and threats to test security. The purpose of this analysis is to describe three sources of validation evidence that are required when producing high-quality medical licensure test items to ensure evidence for valid test score inferences, using the automatic item generation methodology for test development. Evidence: Generated items are used to make inferences about examinees’ medical knowledge, skills, and competencies. We present three sources of evidence required to evaluate the quality of the generated items that is necessary to ensure the generated items measure the intended knowledge, skills, and competencies. The sources of evidence we present here relate to the item definition, the item development process, and the item quality review. An item is defined as an explicit set of properties that include the parameters, constraints, and instructions used to elicit a response from the examinee. This definition allows for a critique of the input used for automatic item generation. The item development process is evaluated using a validation table, whose purpose is to support verification of the assumptions related to model specification made by the subject-matter expert. This table provides a succinct summary of the content and constraints that were used to create new items. The item quality review is used to evaluate the statistical quality of the generated items, which often focuses on the difficulty and the discrimination of the correct and incorrect options. Implications: Automatic item generation is an increasingly popular item development method. The generated items from this process must be bolstered by evidence to ensure the items measure the intended knowledge, skills, and competencies. The purpose of this analysis is to describe these sources of evidence that can be used to evaluate the quality of the generated items. The important role of medical expertise in the development and evaluation of the generated items is highlighted as a crucial requirement for producing validation evidence.

Transition to practice curriculum for general internal medicine physicians: scoping review and Canadian national survey

BackgroundThere remains a paucity of evidence for curricula for the transition to practice (TTP) stage of Competence by Design internal medicine (IM) training programs. Current entrustable professional activities are based on expert consensus rather than robust subspecialty-specific needs assessment.MethodsA scoping review was completed to identify studies with TTP focus. A national survey was conducted to identify transition experiences for general internal medicine physicians. Results were assessed by grounded theory analysis to identify core topics for TTP curricula.ResultsNeither scoping review nor national survey identified TTP topics related to the CanMEDS Medical Expert role. Scoping Review: 41 relevant studies were identified. Most (97.6%) were from North America. The most common study types were observational (survey) or curriculum (13/41 31.7% for each). Only two studies were exclusively in IM, and the most common subspecialty studied was surgical (13/41, 31.7%). The most common TTP topics were mentorship, billing and coding, practice management, negotiating contract and job, and financial aspects of practice. National Survey: There were 44 respondents, with the majority (25/44, 56.8%) having completed an IM subspecialty fellowship. Most (38/44) completed medical school in Canada, and most were from academic practice settings (33/44, 75.0%). The most common TTP topics were billing and coding, personal financial planning, practice management, work-life balance and mentorship. Grounded Theory Analysis: There were six themes that encompassed all TTP topics from the scoping review and national survey, being (i) building a career, (ii) continuing professional development, (iii) expectations of the profession, (iv) practice management, (v) Life, health and well-being and (vi) clinical skills. Curriculum competencies and resources for curriculum development were provided.ConclusionsThis study identifies topics critical for curricula development for IM transition to practice. Further research is required to evaluate effectiveness of curricula including topics and themes developed from this scoping review and national survey.

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.

Clinical Objectives of the Canadian Licensing Examination: Exploring the Representation of Oncology.

Every physician should be comfortable caring for cancer patients, yet medical education in oncology is known as inadequate. Our study explored this issue from an assessment perspective, by determining the representation of oncology and other health priorities in the clinical learning objectives for the Medical Council of Canada Qualifying Examination Part 1 (MCCQE Part 1). The Medical Council of Canada lists objectives for the MCCQE Part 1, based on CanMEDS roles for medical graduate competency. These objectives guide exam question development and can be used as a study guide for learners. Our study focused on the Medical Expert role and mapped the clinical objectives for oncologic, cardiovascular, cerebrovascular and chronic lower respiratory disease. The clinical objectives contained 190 topics under the Medical Expert role. Oncology content was found in 57 (30%), cardiovascular disease in 56 (29.5%), cerebrovascular disease in 21 (11%) and chronic lower respiratory disease in 7 (3.7%). In objectives with oncology content, gastrointestinal cancer (16, 28%), non-specific indicators of cancer (7, 12%) and genitourinary/musculoskeletal cancers (6, 10.5%) were most frequent. Content coding had inter-rater agreement greater than 99%, with kappas from 0.73 to 1.00. Oncology was highly represented in the clinical objectives listed for the MCCQE Part 1. With existing research showing limited oncology content on examinations and in medical curricula, our results were unexpected. This finding could signal the efficacy of initiatives seeking to improve oncology education and emphasizes the importance of continuing improvements in oncology education to meet patient and healthcare system needs.

Susceptibility to Undue Influence: The Role of the Medical Expert in Estate Litigation.

Objectives:Medical experts are increasingly asked to assist the courts with Will challenges based on the determination of testamentary capacity and potential undue influence. Unlike testamentary capacity, the determination of undue influence has been relatively neglected in the medical literature. We aim to improve the understanding of the medical expert role in providing the courts with an opinion on susceptibility to undue influence in estate litigation.Method:Medical experts with experience in the assessment of testamentary capacity and susceptibility to undue influence collaborated with experienced estate litigators. The medical literature on undue influence was reviewed and integrated. The lawyers provided a historical background and a legal perspective on undue influence in estate litigation and the medical experts provided a clinical perspective on the determination of susceptibility to undue influence. Together, they provided recommendations for how the medical expert could best assist the court.Results:Susceptibility to undue influence is frequently used in estate litigation to challenge the validity of Wills and is defined as subversion of the testator’s free will by an influencer, resulting in changes to the distribution of the estate. While a determination of undue influence includes the documentation of indicia or suspicious circumstances under which the Will was drafted and executed, medical experts should focus primarily on the susceptibility of the testator to undue influence. This susceptibility should be based on a consideration of cognitive function, psychiatric symptoms, physical and behavioural function, with evidence derived from the medical documentation, the medical examination, and the history.Conclusions:The determination of undue influence is a legal one, but medical experts can help the court achieve the most informed legal decision by providing relevant information on clinical issues that may impact the testator’s susceptibility to undue influence.

Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study

BackgroundEntrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship.MethodsWe analyzed changes in self-entrustment ratings of students and the supervisors’ ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation.ResultsEPA 1 (“Take a patient’s history”), EPA 2 (“Assess physical & mental status”) and EPA 8 (“Document & present a clinical encounter”) were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors’ ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial.ConclusionsUsing formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students’ development toward self-entrusted, indirect supervision levels.

Role of Librarians and Medical Information Experts in Response to Covid-19 in Iran

Human being has always faced different critical situations and unpredictable events such as floods, earthquakes and terrible infectious diseases such as cholera, plague, tuberculosis and influenza. However, it is believed that the Coronavirus (Covid-19) has been the most shocking pandemic that led to destructive effects in all geographical areas of the world and all aspect of terrestrial life. The governments increasingly enact quarantines, curfews, closures, and other restrictive controls against the countries, citizens, and institutions and deploy their facilities to tackle the infection and prevent its spread (1). Amid the anxiety of lock downs and the cancellation of educational programs around the world, researcher support has not stopped, and a group of knowledge brokers, led by librarians and medical informantionists, are constantly providing information services. Information is an urgent and essential commodity in any crisis. Therefore, librarians and information experts have to be always prepared to meet the information needs of society and provide the users with access to information.

Clinical oncology module for the ESTRO core curriculum

IntroductionClinical oncologists are physicians with the competencies to manage cancer patients through the entire disease pathway combining the competencies of radiation and medical oncologists. The 4th edition of the European Society for Radiotherapy and Oncology Core Curriculum for Radiation Oncology/Radiotherapy (ESTRO curriculum) has received wide support by the clinical oncology community. The aim was to develop a clinical oncology module that could be combined with the ESTRO curriculum to enable clinical oncology trainees to follow a single curriculum. Materials and methodsA range of stakeholders including National Society representatives, an oncologist from a low- middle-income country, and a recently appointed specialist, developed and commented on iterations of the curriculum. Further modifications were made by the ESTRO Education Council. ResultsThe module is based on the CanMEDS 2015 framework and identifies 20 enabling competencies in the Medical Expert role that are required in addition to the ESTRO curriculum for the training of clinical oncologists. Recommendations are made for the levels of Entrustable Professional Activities (EPAs) to be attained by the end of training. ConclusionsThe Clinical Oncology module, when combined with the ESTRO curriculum, covers the entire cancer pathway rather than being modality specific. It is hoped it will aid in the development of comparable standards of training in clinical oncology across Europe and may also have utility in low- and middle-income countries as well as providing a single curriculum for trainees.

MHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments

ABSTRACT Diagnostic assistance using mobile technology is instrumental to timely and adequate care in resource-scarce settings, particularly for acute burns. Little is known, however, as regards to how remote diagnostic consultation in burns affects the work process. This article reviews a doctoral thesis on this topic based on four studies conducted in the Western Cape, South Africa prior to and in a very early phase of the implementation of an app for burn remote diagnostic assistance. The aim was to increase knowledge on how remote diagnostic assistance for burn injuries can influence the role and work of medical experts in a resource-poor setting. The congruence model was used as a reference framework to study the ‘input’ (study 1), ‘tasks’ (studies 2 and 3) and ‘people’ (study 4) involved. The results show higher burn incidence in young children (75.4 per 10 000) and gender differences primarily among adults. The quality of images was considered by experts as better when viewed on smartphones and tablets than on computers. The accuracy of burn size assessments was high overall but low for burn depth (ICC = 0.82 and 0.53 respectively). Experts described four positions pertaining to remote consultations: clinical specialist, gatekeeper, mentor and educator. They perceived images as improving accuracy of consultation and stressed the need for verbal communication among clinicians during critical situations. In conclusion, experts are satisfied with the quality of images seen on handheld devices and can accurately assess burn size using these, yet burn depth assessment is more challenging without additional clinical information. mHealth for diagnostic assistance can benefit current image-based consultation by systematising information quality, introducing enhanced security and improved access to experts. Remaining challenges include the necessity of verbal communication in some instances and replacing existing informal organisational practices.

After the ordeal: health communication messages in a pregnancy-OSG

The increase use of internet open up a broad spectrum of usage. Among those are the use of sharing platform such as Instagram and facebook for particular communities. Support groups are essential part of health treatment and recovery, in this case for pregnancy condition. One can try to find solace and information through online support group. Online support group enable people from around the globe to communicate, discuss and encourage others with similar condition. This article delves the question of how women use internet-based health support group. The researcher conduct qualitative discourse analysis on an online pregnancy support group and various literatures which explores the use of internet-based support group. The findings show that women use online support group because they found lack of support offline, they need information and emotional support regarding their pregnancy loss and the recovery process, the role of medical expert and the spouses are perceived differently.

Obstetrics and gynaecology trainees' perceptions of the CanMEDS expertise model: implications for training from a regional questionnaire study in the United Kingdom

The CanMEDS expertise model is a multi-domain competency framework for doctors. The aims of this study were to assess the perceived importance of the CanMEDS roles and achievement among obstetrics and gynaecology trainees of all grades with a view to identifying opportunities to enhance training. This study was exempt from formal ethical or institutional registration. The data collection was completed in 2017. Following a video introduction, the trainees completed a questionnaire. For each of the CanMEDS domains, trainees of different tiers perceived them to be equally important. Indeed, the junior and senior cohorts of trainees perceived all domains to be equally important, as signified by the significant degree of score correlation. Age was a significant variable for achievement of competency in the roles of a Medical Expert (p = .01), a Communicator (p = .04), a Collaborator (p = .002), a Scholar (p = .01) and a Professional (p = .03). Grade was significant for the Medical Expert (p = .001) and Leader (p = .001) role. Better alignment of clinical activities with CanMEDS competencies and faculty development will complement the training in leadership skills.Impact statementWhat is already known on this subject? The CanMEDS medical expertise model is a multi-domain framework of seven components. This framework has been utilised to assess the training efficacy of curricula and unlock opportunities for improvement. The research application of the CanMEDS framework within Obstetrics and Gynaecology is limited.What does this study add? Results indicate that all trainees recognise the importance of CanMEDS roles: age and grade are significant variables in the perceived achievement of CanMEDS roles. The study identifies areas for improvement in the current training strategy.What are the implications for clinical practice/future research? Research should formalise the assessment of competencies in non-technical skills. Efforts should focus on identifying the activities which will develop leadership skills.

Tracing the Boundaries of the Natural: Medicine and the Inquiry on Miracles in Early Modern Canonization Trials.

Between the seventeenth and eighteenth centuries, the inquiry on miracles in the canonization process reveals a fundamental cooperation between medicine and religion. During the last stage of the trials, theologians, lawyers, and physicians concurred with refined reports to accomplish full analysis of the alleged miracles. The promoter of the faith had the task of doubting the supposed miracle healing on juridical, medical and theological grounds; the lawyer supporting the cause responded to any inconsistency in witnesses' depositions; the physician had the task of finding any natural causes which could lead to a natural recovery of the subject. The interplay of these tripartite disciplines underlies early modern probation of supposed miracles. In this paper I will examine the institutional and cultural consequences of the demand for evidence in canonization trials: on the one hand, the increasing role of medical experts in the assessment of miracles and the friction between them and the other members of the committee; on the other hand, the rise of a new method of inquiry in the legal arena.