Defining fitness for purpose in South African anaesthesiologists using a Delphi technique to assess the CanMEDS framework

Abstract

Background: Training of South African anaesthesiologists is based on the Canadian Medical Education Directives for Specialists (CanMEDS). However, the applicability of CanMEDS in this context has not been assessed. An expert panel participated in a Delphi process to create an appropriate expanded list of CanMEDS competencies that may be used in the future to assess fitness for purpose of local graduates. Methods: This descriptive study comprised a representative panel of 16 experts surveyed electronically over three rounds to assess the importance of the existing CanMEDS roles and enabling competencies and suggested additions deemed applicable locally. The primary outcome was the creation of a list of competencies applicable to South Africa. Results: There was a 100% response rate for all three rounds. Based on the existing seven CanMEDS meta-competencies (Medical Expert, Collaborator, Communicator, Leader, Scholar, Professional and Health Advocate), respondents scored the importance of 89 enabling competencies and 19 additional competencies. Seven CanMEDS enabling competencies did not achieve consensus and were excluded. Nineteen new enabling competencies and two new meta-competencies (Humaneness, Context Awareness) achieved consensus and were added. Median ratings of importance of meta-competencies showed highest scores for Medical Expert and Collaborator and lowest scores for Health Advocate. Weighting of meta-competencies revealed highest scores for Medical Expert and Professional with all others equally weighted. Conclusion: This study has formulated an adapted CanMEDS list of enabling competencies with the addition of the two new metacompetencies of Context Awareness and Humaneness for use in South African anaesthesiology. This provides a means with which future graduates may be assessed for fitness for purpose.

Are South African anaesthesiologists fit for purpose? A comparison of opinions of graduates, teachers and examiners

“…All anaesthesiologists involved in formal or informal teaching of trainees preparing for their exit examination were eligible for inclusion and invited to participate. Exclusion criteria were participation in the previous Delphi study 28 and those not involved in teaching. The second group comprised all official national Fellowship of the College of Anaesthetists of South Africa (FCA) examiners as appointed by the CMSA to perform examinations at exit level.…”

“…The second group comprised all official national Fellowship of the College of Anaesthetists of South Africa (FCA) examiners as appointed by the CMSA to perform examinations at exit level. Exclusion criteria were participation in the previous Delphi study 28 and non-examiners. Where dual teacher and examiner roles were noted, participants were counted as examiners.…”

“…The survey interrogated perceptions of preparedness for nine meta-competences with their associated 101 enabling competences derived from a previous study. 28 Each of the nine meta-competences had a variable number of enabling competences (Table I), with all 101 scored individually. The Cronbach's alpha reliability coefficient for the questionnaire was calculated.…”

“…The authors previously attempted to define FnFP of South African anaesthesiologists by assessing this framework's applicability to South African anaesthesiology. 28 Using a Delphi method to determine what meta-and enabling competences were deemed appropriate by a representative panel of national public and private practice experts, the authors broadened the definition of FnFP in the South African anaesthesiology context with unique components that were deemed under-represented by CanMEDS. Amendments were made to the seven original specialist roles (medical expert, communicator, collaborator, scholar, leader, professional, health advocate) suggested by CanMEDS 29 by expanding them to nine with the addition of humaneness and context awareness ( Figure 1).…”

“…A comprehensive list of 101 enabling competences (Annexure) provided a means with which local anaesthesiology graduates' FnFP could be measured more objectively. 28…”