the future of medical education in canada: postgraduate project
DESCRIPTION
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. Liaison and Engagement Consultant Report. Mandate of the LEC Team. - PowerPoint PPT PresentationTRANSCRIPT
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
Options & Possible Solutions
Options & Possible Solutions
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)
FMEC Postgraduate Project Liaison and Engagement
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
FMEC Postgraduate Project Liaison and Engagement
1. Strengths
• University-based system– Focus on learning, evidence-based
practice, research
• Accreditation process– Rigorous national standards, peer review
• CanMEDS– Focus on all competencies
FMEC Postgraduate Project Liaison and Engagement
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
FMEC Postgraduate Project Liaison and Engagement
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
FMEC Postgraduate Project Liaison and Engagement
4. Develop and Improve PGME Pedagogy
• Models of education• Curricular innovations• Faculty development• Adoption of technology• Distributed/integrated medical
education• Transitions• Career Development
FMEC Postgraduate Project Liaison and Engagement
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
FMEC Postgraduate Project Liaison and Engagement
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.
FMEC Postgraduate Project Environmental Scan
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
FMEC Postgraduate Project Environmental Scan
Commissioned papers topic areas
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
FMEC Postgraduate Project Environmental Scan
Commissioned papers topic areas
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
FMEC Postgraduate Project Environmental Scan
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
FMEC Postgraduate Project Environmental Scan
Commissioned Papers: 9 themes
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
FMEC Postgraduate Project Environmental Scan
Commissioned Papers: 9 themes
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
FMEC Postgraduate Project Environmental Scan
Commissioned Papers: 9 themes
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
FMEC Postgraduate Project Environmental Scan
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
FMEC Postgraduate Project Environmental Scan
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
FMEC Postgraduate Project Environmental Scan
Key Informants: 9 themes
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
FMEC Postgraduate Project Environmental Scan
Key Informants: 9 themes
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
FMEC Postgraduate Project Environmental Scan
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
FMEC Postgraduate Project Environmental Scan
Questions?
If you have questions, contact: •Dr. Sarita [email protected] •Dr. Joanna [email protected]•Dr. Susan Glover [email protected]•Environmental Scan [email protected]
FMEC Postgraduate Project Environmental Scan
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
FMEC Postgraduate Project Project Inputs
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
FMEC Postgraduate Project Project Inputs
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
International Consultations
• 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)
FMEC Postgraduate Project Project Inputs
International Consultations
• 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
FMEC Postgraduate Project Project Inputs
The FMEC PG Steering Committee drew on multiple lines of evidence to develop recommendations.
Options & Possible Solutions
Options & Possible Solutions
Options & Possible Solutions
Options & Possible Solutions
STEERING GROUP
Recommendations
For more information…
www.afmc.ca/fmecpg
FMEC Postgraduate Project