The Future of Postgraduate Medical Education in Canada

Busing, Nick; Harris, Ken; MacLellan, Anne-Marie; Moineau, Geneviève; Oandasan, Ivy; Rourke, James; Saxena, Anurag

doi:10.1097/acm.0000000000000815

Cited by 42 publications

(31 citation statements)

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“…Competency-based medical education (CBME) is an outcome-based approach to physician development that has been proposed to address the need for better accountability and outcomes in medicine. 1 , 2 …”

Section: Overview Of Competence By Designmentioning

confidence: 99%

Introduction of Competence by Design to Canadian Nephrology Postgraduate Training

Pinsk

Karpinski

Carlisle

2018

Can J Kidney Health Dis

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Purpose of the review:The Royal College of Physicians and Surgeons of Canada, with its Competence by Design initiative, is adopting the principles of competency-based medical education for residency training and continuing professional development. This initiative is being undertaken to meet the new standards of medical education in Canada, which include social accountability to meet performance-based outcomes of training. Nephrology is poised to implement Competence by Design into residency training in July 2018 and initiate a continuous quality improvement cycle to periodically renew and update the training requirements to be socially accountable and relevant in the modern age of medicine. The purpose of this review is to describe the process of entrustable professional activity and required training experience development and how they will affect subspecialty training in Canada.Sources of information:The construct of competency-based medical education was derived from existing literature searches of the medical education literature, including documentation provided by the Royal College of Physicians and Surgeons of Canada. The content for each entrustable professional activity and milestone was derived by consensus from the community expertise of the working group, existing speciality training requirements, and elements of training requirements that the Royal College has been mandated to superimpose on all training requirements to meet societal expectations.Methods:The Royal College Specialty Committee in Nephrology participated in 2 years of preparation for this implementation, which has included the creation of a new educational design for the discipline and the elucidation of entrustable professional activities to describe the scope of nephrology practice and to guide teaching, learning, and assessment in residency, and ultimately maintenance of competence in practice.Key findings:This article introduces the set of entrustable professional activities for adult and pediatric nephrology and describes the national consultation as part of an ongoing quality improvement of this work.Limitations:The implementation of Competence by Design will be tested by whether trainees embrace competency-based education by training to just entrustable professional activities, rather than the holistic model idealized in physician training. This is mitigated by the entrustable professional activity development incorporating multiple layers of competencies beyond a procedural skill. Time commitment for faculty will pose additional challenges in increasing the time for assessment of trainees, but is supported by electronic platforms at the Royal College to assist in data gathering and analysis.Implications:Competence by Design in nephrology is an outcomes-based curriculum and assessment platform that aims to train nephrologists to meet societal expectations in an ever-changing and complicated health care system. The goals are to increase safety and professional accountability to society and improve upon the already high standards ...

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Section: Overview Of Competence By Designmentioning

confidence: 99%

Introduction of Competence by Design to Canadian Nephrology Postgraduate Training

Pinsk

Karpinski

Carlisle

2018

Can J Kidney Health Dis

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“…This access problem cannot be explained by solely the number of available physicians, because Canada has significantly increased its total number of doctors in the last quarter century. (Eggertson, ; Busing et al ., ) And Canada and the USA both have roughly 2.5 physicians per 1000 persons. (OECD, ) Interestingly, this problem would be at least partially remedied by physicians recently completing their residences and now too often being underemployed or unemployed, being appointed to hospital medical staffs with appropriate staffing and diagnostic capabilities, an option discussed later in this paper.…”

Section: Canadian Healthcare Operational and Fiscal Issuesmentioning

confidence: 99%

What can the Canadians and Americans learn from each other's health care systems?

Weil

2016

Health Planning & Management

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Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single-payer system to save 12-20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32.0 million (2015) Americans still uninsured would have at least minimal coverage when incurring medical expenditures. Also, the USA could use smart cards to evaluate eligibility and to process health insurance claims; these changes resulting in an estimated 15% reduction in US health expenditures without adversely effecting access or quality of care. Such a strategy would result in the eventual loss of 2.5 million white-collar jobs at hospitals, physician offices and insurance companies, a long-term economic gain. Only a few would agree with the statement that Canada already functions with a multi-payer reimbursement system as evidenced by (1) a federal-provincial, tax-supported plan, administered by each of the provinces, providing universal coverage for hospital and physician services and (2) roughly 60% of its residents receiving employer-paid health insurance benefits, underwritten primarily by investor-owned plans, that are less than effective to reimburse for pharmaceuticals, dental and other healthcare services. What could be learned from the USA and particularly from Western European countries is possibly implementing an approach, whereby at least upper-income Canadians could opt out of their federal-provincial plan and purchase private insurance coverage - being eligible for far more comprehensive "private" benefits for hospital, physician, pharmaceutical, dental and other healthcare services. Aside from generating billions of additional needed revenues from the private sector, it could (1) help eliminate long waits for non-emergent physicians' care by appointing newly minted specialists to their medical staffs; (2) offer prompt admissions for elective cases to "private" wings of hospitals; (3) increase available funding for what is currently an undercapitalized system; (4) enhance the system's sluggish operations; and (5) encourage more competition among various providers. Although such a two-tier approach, such as available in the USA and elsewhere, is politically dead on arrival in Canada today, private insurance being already legal and commonly available there. Interestingly, this recommended solution is utilized in most western European countries where there is a higher percentage than in Canada of public (versus private) funding of their total health expenditures. Because of various vested interests, attempts to implement any of the aforementioned proposals will undoubtedly result in co...

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“…In the United States (US), the Medical Scientist Training Program (MSTP) [ 7 ] established in 1964, continues to provide the majority of support for MD-PhD training to students at select medical schools [ 8 ]. Canada has a similar MD-PhD model [ 9 , 10 ]. However, MD-PhD programs are not the only approach to clinician-scientist training.…”

Section: Introductionmentioning

confidence: 99%

The clinician-scientist track: an approach addressing Australia’s need for a pathway to train its future clinical academic workforce

Eley

2018

BMC Med Educ

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BackgroundClinician-scientist training represents the epitome of preparation for biomedical scientific discovery. The significance of, and need for, clinician-scientists is universally recognised as essential to progress medical research across what is regarded as the ‘translational gap’. Despite a rich history of cutting-edge biomedical research, Australia has no infrastructure or career pathway for training clinician-scientists.DiscussionThe Clinician-scientist Track (CST) was developed to address this concern at the University of Queensland. The CST concept began in 2010 with the Concurrent MD-Masters that allowed students to undertake a research Masters concurrently with their medical program. The rationale was to offer an attractive and realistic option to recruit our highest performing students into a research higher degree, with the underlying aim of encouraging those most capable, to transfer to the MD-PhD. The Concurrent MD-Masters was immediately popular and remains so. Over 8 years, enrolments rose seven-fold (60 MD-Masters, 36 MD-PhDs). The transfer rate from MD-Masters to MD-PhD is 28% supporting our original aim.ConclusionsMany challenges remain for the future of the program. These challenges are underpinned by a culture that values clinician-scientists as crucial to ensuring that high quality health and medical research is undertaken and translated to patient care, but lags behind in establishing an infrastructure to develop and maintain a new generation of this vital workforce. A future challenge is to develop a coordinated approach to a supported Australian MD-PhD pathway for our most talented and committed students beginning in the undergraduate Bachelor’s degree into the medical degree and throughout specialty training. Shared responsibility is necessary between institutions and stakeholders to support and nurture newly trained MD-PhDs into the post-graduate years. Flexibility across this medical training continuum that allows integration of both degrees will help ensure students make the most meaningful connections between the research and the medicine. What is paramount will be acknowledging the career expectations of an emerging cohort of medical students, in particular females, wishing to pursue research. Without these considerations we risk losing our next generation of potential clinician-scientists.

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The Future of Postgraduate Medical Education in Canada

Cited by 42 publications

References 1 publication

Introduction of Competence by Design to Canadian Nephrology Postgraduate Training

Introduction of Competence by Design to Canadian Nephrology Postgraduate Training

What can the Canadians and Americans learn from each other's health care systems?

The clinician-scientist track: an approach addressing Australia’s need for a pathway to train its future clinical academic workforce

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