the future of medical education in canada: postgraduate project

The Future of Medical Education in Canada:Postgraduate Project

Canadian Conference on Medical Education

May 10, 2011

The FMEC PG Steering Committee drew on multiple lines of evidence to develop recommendations.

Options & Possible Solutions




STEERING GROUP

Recommendations

Liaison and Engagement Consultant Report

Mandate of the LEC Team

• Liaise between the FMEC PG Steering Committee and the Canadian PGME community

• Raise awareness of project• Solicit issues, concerns, priorities

and successes

FMEC Postgraduate Project Liaison and Engagement

Completed Consultations (Jan 31/2011)


Stakeholders Completed

Educators * 37

Academic Chairs 14

Students/Residents 12

Government 9

Nursing & Allied Health 6

Hospital Authorities 3

Medical Associations 11

Colleges 15

Other 5

Total 112

* Deans, PG Deans, UG Deans, Program Directors, Education Councils, etc.

Interpretive Cautions

• Stakeholders were asked for opinions and ideas – not evidence

• Counts are not provided:– The number of participants in each

meeting varied, and not all opinions were consensus opinions

• Priorities are not assigned:– For similar reasons, we could not assign

priorities or weights to the issues


1. Strengths

• University-based system– Focus on learning, evidence-based

practice, research

• Accreditation process– Rigorous national standards, peer review

• CanMEDS– Focus on all competencies


2. Revisit the Purpose of PGME

• Disconnect between society’s needs and PGME “outputs”

• Need for stronger patient-centered focus

• Nimble and Forward- thinking educational strategies


3. Review PGME Governance and Processes

• Complex governance structure• Accreditation• Leadership (HHR planning, public

accountability)• Student selection• Resident assessment• Streaming, flexibility and length of

training• Resident association agreements


4. Develop and Improve PGME Pedagogy

• Models of education• Curricular innovations• Faculty development• Adoption of technology• Distributed/integrated medical

education• Transitions• Career Development


5. Fix Human and Financial Resources

• Health human resource planning• Issues with current funding of Med.

Ed.• Resident remuneration• Teacher remuneration• Efficiency of health care access


Round 2 Consultations

• To discuss the FMEC PG Steering Committee's draft recommendations as they emerge 1. Web-based survey by invitation2. Sampling national organizations3. ‘Town hall’ meetings with medical

schools4. Other targeted audiences (CCME, ICRE,

FMF)FMEC Postgraduate Project Liaison and Engagement

Environmental Scan Synthesis Report

Goal of Environmental Scan Project

• To conduct a thorough review of postgraduate medical education (PGME) in Canada and

• Establish whether the structure and processes of the current system are designed for the best possible outcomes to meet current and future societal needs.

FMEC Postgraduate Project Environmental Scan

ES Activities

I. Undertook a comprehensive literature review to produce 24 commissioned papers on topics of importance to the future of PGME

II. Conducted 27 key informant interviews with stakeholders from across Canada to identify themes important to the future of PGME.

III. Wrote an Environmental Scan Synthesis Report to summarize and synthesize the findings and point the way forward.


Commissioned papers topic areas

Societal needs1.Health inequities, social responsibility and PGME2.Generalism in PGME 3.Trends/issues in PGME: inputs/outcomes4.Training for a socially diverse population5.International Medical Graduates - current issues6. Future of health care trends: impact on PGME7. Integrating patient safety and quality improvement



PGME System8. Governance in PGME in Canada9. Issues related to residents as workers and learners10. Length of training in PGME in Canada 11. Accreditation of PGME12. Distributed education and distance learning in PGME 13. Assessment in PGME14. Information and educational technology in PGME15. Integration of CanMEDS expectations & outcomes16. Innovations in learning, teaching in clinical settings



17. Inter/intra-professional collaborative care18. Simulation19. Competency-based training20. Teaching, learning and assessing professionalism21. Faculty development for PGME

Needs of individual learners22. The choice of specialty and practice location23. Resident wellness and work/life balance24. Supporting the development of residents as teachers


Commissioned Papers: 9 themes

Societal needs for health care

CP-1) PGME programs collectively are responsible to meet the HHR needs of society

CP-2) The PGME system hinders nimble responses to changes, needs and shifts



The PGME System CP-3) UGME, PGME and CME are

interdependent but need a more integrated and collaborative approach

CP-4) Communication and collaboration across the PGME system are underdeveloped

CP-5) Emerging disconnect between the content and design of PGME and the outcomes we expect



The PGME System - continued

CP-6) PGME best practice integrates competency-based education and assessments with apprenticeship models

CP-7) Increasing expectations of clinical teachers



Needs of Individual Learners

CP-8) Enhanced attention to enculturation and the development of professional identity recognized

CP-9) Tensions between the interests and needs of residents, societal needs and PGME structures


Key Informant Interviews

Key Steps for Key Informant interviews included:• Purposeful sampling based on TUFH Framework • 27 interviews from across Canada• Conducted interviews (transcripts + field notes)• Sorted interview data by categories• Identified themes across all interviews• Summary report


Key Informants: 9 themes

Societal Needs for Health Care

KI-1) Developing a More Socially Accountable Curriculum

KI-2) Planning to Meet the Needs of Canadians

KI-3) Fostering Collaborative Practice to Support Patient Centeredness and Patient Safety



The PGME System

KI-4) Working Effectively within Complex Structures and Systems

KI-5) Broadening Learning and Assessment Approaches in PGME

KI-6) Nurturing an Effective and Sustainable Teaching Workforce



Needs of Individual Learners

KI-7) Clarifying the Physician's Function, Identity and Integration in the Health Care System

KI-8) Valuing and Integrating all CanMEDS Roles

KI-9) Fostering a Healthy and Sustainable Physician Workforce through PGMEFMEC Postgraduate Project Environmental Scan

Synthesis of Commissioned papers and Key Informant Interviews

VERY HIGH degree of congruence among both streams of research

• PGME to (re)focus attention on societal needs

• Physician workforce must have needed mix of skills and must practice according to society’s expectations

• PGME is complex and changing which creates challenges for educators and learners FMEC Postgraduate Project Environmental Scan

Synthesis of Commissioned papers and Key Informant Interviews

Some ‘surprising’ messages • Accreditation as a tool to enable and facilitate

change. • Governance structure for PGME is perceived as

complex and cumbersome, but works well. • Funding and human resources requirements to

support PGME is unclear from research• Competency-based education is a helpful model

to improve learner centered PGME but more work needed.

• Information and simulation technology are important tools - rather than solutions


Essential messages

1. Need to foster a PGME system that is focused on meeting societal needs

2. PGME governance is complex and requires ongoing support, partnership and collaboration to function efficiently and effectively

3. Residents are tomorrow’s physicians – PGME must support these learners in their professional and personal aspirations


Questions?

If you have questions, contact: •Dr. Sarita [email protected] •Dr. Joanna [email protected]•Dr. Susan Glover [email protected]•Environmental Scan [email protected]


mailto:[email protected]




Project Inputs

Many Players, Many Inputs

• In addition to the Environmental Scan and Liaison and Engagement, there are important project inputs:– Public Panel– National Public Opinion Poll– National Survey of Program Directors– International Consultations

FMEC Postgraduate Project Project Inputs

Many Players, Many Inputs

• CFPC White Papers• RCPSC White Papers• CAIR Residents’ Perspective


Public Panel

• A lively discussion resulted in 6 priorities:1. Maintain competence 2. Increase inter- and intraprofessional

collaboration 3. Address the hidden curriculum 4. Re-design training to improve patient- and

community-centred health and wellness5. Learning environment (IT &

professionalism)6. Align numbers and types of physicians

trained to public need FMEC Postgraduate Project Project Inputs

National Public Opinion Poll

• Confidence in Canada’s health care system is at a modern high point

• Most important aspect of health care: – quality of health care services – 43% – equal access – 38%

• High level of trust in nurses (84%) and doctors (81%)

• 78% feel that medical schools are producing too few graduates


National Survey of Program Directors

• Challenges/issues Canadians face that can be impacted by PGME– Improve patient outcome– Improve patient safety– Improve cost efficiencies/effectiveness

• Educational challenges/issues that can be impacted by PGME?– Effective assessment of learners– Supporting clinical teachers– Graduating ready for practice physicians

FMEC Postgraduate Project CCME 2011 – Hot Topic

International Consultations

• US Themes:– increase public health training– enhance physician resources planning– emphasize team-based approaches to

care– focus more on community needs

FMEC Postgraduate Project CCME 2011 – Hot Topic


• UK Themes– enhance community and generalist

exposure– improve information flow from MD

education to PG education (critical for patient safety)

– improve skills of educators– update curriculum (i.e. leadership)



• France Themes– increase alignment with CanMEDS

competency approach– ensure accessibility by reducing tuition– provide flexibility and opportunity for re-

entry– modernize MD curriculum around

competency and social accountability


The FMEC PG Steering Committee drew on multiple lines of evidence to develop recommendations.





STEERING GROUP

Recommendations

For more information…

www.afmc.ca/fmecpg

FMEC Postgraduate Project

the future of medical education in canada: postgraduate project

Documents