Building a Shared Mental Model of Competence Across the Continuum: Trainee Perceptions of Subinternships for Residency Preparation

INTRODUCTION Toward a vision of competency-based medical education (CBME) spanning the undergraduate to graduate medical education (GME) continuum, University of Minnesota Medical School (UMMS) developed the Subinternship in Critical Care (SICC) offered across specialties and sites. Explicit course objectives and assessments focus on internship preparedness, emphasizing direct observation of handovers (Core Entrustable Professional Activity, “EPA,” 8) and cross-cover duties (EPA 10). METHODS To evaluate students’ perceptions of the SICC's and other clerkships’ effectiveness toward internship preparedness, all 2016 and 2017 UMMS graduates in GME training ( n = 440) were surveyed regarding skill development and assessment among Core EPAs 1, 4, 6, 8, 9, 10. Analysis included descriptive statistics plus chi-squared and Kappa agreement tests. RESULTS Respondents ( n = 147, response rate 33%) rated the SICC as a rotation during which they gained most competence among EPAs both more (#4, 57% rated important; #8, 75%; #10, 70%) and less explicit (#6, 53%; #9, 69%) per rotation objectives. Assessments of EPA 8 (80% rated important) and 10 (76%) were frequently perceived as important toward residency preparedness. Agreement between importance of EPA development and assessment was moderate (Kappa = 0.40-0.59, all surveyed EPAs). CONCLUSIONS Graduates’ perceptions support the SICC's educational utility and assessments. Based on this and other insight from the SICC, the authors propose implications toward collectively envisioning the continuum of physician competency.

Strategies identified by program directors to improve adoption of the CanMEDS framework

Background: Challenges associated with the use of the CanMEDS physician competency framework (CanMEDS) have been the subject of several studies. Most of these have focused on the adoption of specific roles in an Anglophone context. This study aims to investigate how Francophone postgraduate medical education (PGME) program directors have integrated the CanMEDS framework into their programs.Methods: We invited Francophone PGME program directors to participate in group interviews aimed at exploring their experiences using the CanMEDS framework. We used an open-ended interview guide and realized a thematic analysis of the transcripts. Results: We held five group interviews between February and December 2014 with 17 Francophone program directors representing 13 out of a maximum of 62 different specialties/subspecialties. Although program directors endorsed the framework, its integration was seen as challenging, particularly the assessment of non-medical expert roles. To overcome these challenges, they relied on common strategies including a longitudinal approach to the framework, improving inter-program collaboration, and subcontracting the teaching of certain roles.Conclusion: While integrating the CanMEDS framework into their programs, Francophone program directors struggled with teaching and assessing non-medical expert roles and ensuring their longitudinal integration over time. Directors relied on various strategies, some of which (e.g., subcontracting) may ultimately limit the adoption of the framework as a whole.___Contexte: Les défis associés à l'utilisation du référentiel de compétences CanMEDS pour les médecins ont fait l'objet de plusieurs études. La plupart de ces études ont portées sur l'adoption de rôles spécifiques dans un contexte anglophone. Cette étude vise à explorer comment les directeurs de programmes d’études médicales postdoctorales (EMP) francophones ont intégré CanMEDS dans leurs programmes.Méthodes: Nous avons invité les directeurs de programmes EMP francophones à participer à des entrevues de groupe. Ces entrevues visaient à explorer leur expérience de l’utilisation du référentiel CanMEDS. Nous avons utilisé un guide d'entrevue ouvert et nous avons fait une analyse thématique des transcriptions. Résultats: Nous avons tenu cinq entrevues de groupe entre février et décembre 2014 avec 17 directeurs de programmes de 13 des 62 spécialités/sous-spécialités. Bien que les directeurs de programmes appuient le référentiel, son intégration a été perçue comme un défi, notamment en ce qui a trait à l'évaluation des rôles autres que celui d'expert médical. Pour surmonter ces défis, ils se sont appuyés sur des stratégies communes, notamment une approche longitudinale du référentiel, l'amélioration de la collaboration entre les programmes et la sous-traitance de l'enseignement de certains rôles.Conclusions: À travers le processus d’intégration du référentiel CanMEDS, les directeurs de programmes EMP francophones ont de la difficulté à enseigner et à évaluer les rôles autres que celui d'expert médical ainsi qu’à veiller à leur intégration respective et continue au fil du temps. Ils ont eu recours à diverses stratégies, dont certaines (p. ex., la sous-traitance) pourraient ultimement limiter l'adoption du référentiel dans son ensemble.

The Model for Thais Physician Competency Development Based on Focus Discussion Group (FDG): A Review

Current changes and priorities in the country regarding population patterns and health care programs will require reforms in older health care and the increasing incidence of chronic diseases. In this study, the data was collected using with a systematic-purposive sampling using the snowball Delphi technique, key informants comprising 21 experts were selected from the Medical Council of Thailand, the Medical Association of Thailand and Health Systems Research Institute (HSRI). The tools used in this research include in-depth interview, the Likert scale with five-level Likert items for measuring the dispersion and congruence of consensus, and the Likert scale with three-level Likert items for content validity which is analyzed using the items of objectives congruence (IOC), the median (MD) and the quartile deviation (QD). The results show to be both valid and reliable for measuring physicians’ competency in Thailand. The results of the competency-based instrument can be used as of to be the healthcare public policy to encourage and guide regarding healthcare agencies to modify their competency according to the evaluation criteria, and also cultivate physicians with strong knowledge and skills, innovation and redesign the curriculum in medical schools inevitably. Overall, the level of physician’s desirable competency will be increased in Thailand.

The Aging Physician and Other Professionals

Capacity to practice ones’ profession safely and effectively may become an issue as physicians or other professionals age. While this chapter will focus primarily on the psychiatric assessment of the aging physician, impairment due to illness in persons employed in other healthcare positions, the military, aviation, the judicial system, and law enforcement present similar public safety concerns. The assessment of a physician is used as a model for the evaluation of these other professionals. The role of the state physician’s health committees and physician competency committees in arranging for assessment, support, and monitoring of the impaired aging physician is discussed. Also discussed are mandatory screening and reporting regarding fitness for duty.