Abstracts
Abstract
Background: The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies.
Methods: Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted.
Results: 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts.
Conclusion: This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.
Résumé
Contexte : Le référentiel de compétences CanMEDS pour les médecins sera mis à jour en 2025. Cette révision intervient à un moment où la société, les soins de santé et l’enseignement médical sont bouleversés et en pleine mutation à cause de la pandémie de la COVID-19; on est aussi à l’heure où l’on reconnaît de plus en plus les effets du colonialisme, de la discrimination systémique, des changements climatiques et des nouvelles technologies sur les soins de santé et la formation des médecins. Pour éclairer cette révision, nous avons tenté d’extraire de la littérature scientifique les concepts émergents se rapportant aux compétences des médecins.
Méthodes : Les concepts émergents ont été définis comme des idées ayant trait aux rôles et aux compétences des médecins qui sont débattues dans la littérature, mais qui sont absentes ou sous-représentées dans le cadre CanMEDS 2015. Nous avons réalisé une recherche documentaire, un examen des titres et des résumés, et une analyse thématique pour repérer les concepts émergents. Les métadonnées de tous les articles publiés dans cinq revues d’éducation médicale entre le 1er octobre 2018 et le 1er octobre 2021 ont été extraites. Quinze auteurs ont effectué un examen des titres et des résumés pour relever et étiqueter les concepts sous-représentés. Deux auteurs ont procédé à une analyse thématique des résultats pour dégager les concepts émergents. Une vérification a été faite par les membres de l’équipe.
Résultats : Parmi les 4973 articles dépouillés, 1017 (20,5 %) abordaient un concept émergent. Les dix thèmes suivants sont ressortis de l’analyse thématique : l’équité, la diversité, l’inclusion et la justice sociale; l’antiracisme; humanisme des médecin; la médecine fondée sur les données; les systèmes adaptatifs complexes; l’environnement de l’apprentissage clinique; les soins virtuels; le raisonnement clinique; l’expertise adaptative; et la santé planétaire. L’ensemble de ces thèmes ont été approuvés comme concepts émergents par l’équipe de rédaction.
Conclusion : Cet examen de la littérature a permis de relever dix concepts émergents qui peuvent servir à éclairer la révision du référentiel de compétences CanMEDS pour les médecins qui aura lieu en 2025. La publication en libre accès de ce travail favorisera la transparence du processus de révision et le dialogue continu sur les compétences des médecins. Des groupes de rédaction ont été recrutés pour développer chacun des concepts émergents et pour examiner la façon dont ils pourraient être intégrés dans la version du référentiel CanMEDS de 2025.
Appendices
Bibliography
- Frank J. The CanMEDS Project: The Royal College of Physicians and Surgeons of Canada moves medical education into the 21st Century. In Ottawa, ON: Royal College of Physicians and Surgeons of Canada; 2004; p. 8. Available from: https://www.researchgate.net/publication/271702100_A_history_of_CanMEDS_-_chapter_from_Royal_College_of_Physicians_of_Canada_75th_Anniversary_history [Accessed Feb 11, 2022].
- Frank J. The CanMEDS 2005 Physician Competency Framework. 2005. Available from: http://rcpsc.medical.org/canmeds/CanMEDS2005/CanMEDS2005_e.pdf [Accessed Feb 1, 2022].
- Frank JR, Snell L, Sherbino J Editors. CanMEDs 2015 Physician Competency Framework. 2015 p. 1-30. Available from: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications
- Shaw E, Oandasan I, Fowler N, editors. CanMEDS-FM 2017: A competency framework for family physicians across the continuum. Mississauga, ON: The College of Family Physicians of Canada; 2017.
- Peterkin A, Roberts M, Kavanagh L, Havey T. Narrative means to professional ends: new strategies for teaching CanMEDS roles in Canadian medical schools. Can Fam Physician. 2012 Oct 1;58(10):e563-9.
- Shadid AM, Bin Abdulrahman AK, Bin Dahmash A, et al. SaudiMEDs and CanMEDs frameworks: similarities and differences. Adv Med Educ Pract. 2019;10:273-8. https://doi.org/10.2147/AMEP.S191705
- Koster AS, Mantel-Teeuwisse AK, Woerdenbag HJ, et al. Alignment of CanMEDS-based undergraduate and postgraduate pharmacy curricula in The Netherlands. Pharmacy. 2020 Sep;8(3):117. https://doi.org/10.3390/pharmacy8030117
- Frank JR, Langer B. Collaboration, communication, management, and advocacy: teaching surgeons new skills through the CanMEDS Project. World J Surg. 2003 Aug 1;27(8):972-8. https://doi.org/10.1007/s00268-003-7102-9
- Abi-Rafeh J, Safran T, Azzi AJ. COVID-19 pandemic and medical education: a medical student's perspective. Can Med Educ J. 2020 Sep;11(5):e118-20. https://doi.org/10.36834/cmej.70242
- Brown A, Kassam A, Paget M, Blades K, Mercia M, Kachra R. Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners. Can Med Educ J. 2021 Jun;12(3):28-43. https://doi.org/10.36834/cmej.71149
- Cherak SJ, Brown A, Kachra R, et al. Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions. Can Med Educ J. 2021 Jun;12(3):54-69. https://doi.org/10.36834/cmej.70995
- Giuliani M, Samoil D, Agarwal A, et al. Exploring the perceived educational impact of COVID-19 on postgraduate training in oncology: impact of self-determination and resilience. Can Med Educ J. 2021 Feb;12(1):e180-1. https://doi.org/10.36834/cmej.70529
- Li HOY, Bailey AMJ. Medical education amid the COVID-19 Pandemic: New Perspectives for the Future. Acad Med J Assoc Am Med Coll. 2020 Nov;95(11):e11-2. https://doi.org/10.1097/ACM.0000000000003594
- Thoma B, Monteiro S, Pardhan A, Waters H, Chan T. Replacing high-stakes summative examinations with graduated medical licensure in Canada. CMAJ. 2022 Feb 7;194(5):E168-70. https://doi.org/10.1503/cmaj.211816
- Hall AK, Nousiainen MT, Campisi P, et al. Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic. Med Teach. 2020 Jul 2;42(7):756-61. https://doi.org/10.1080/0142159X.2020.1766669
- Dinh-Le C, Chuang R, Chokshi S, Mann D. Wearable health technology and electronic health record integration: scoping review and future directions. JMIR MHealth UHealth. 2019 Sep 11;7(9):e12861. https://doi.org/10.2196/12861
- Gostin LO, Halabi SF, Wilson K. Health data and privacy in the digital era. JAMA. 2018 Jul 17;320(3):233-4. https://doi.org/10.1001/jama.2018.8374
- Social determinants of health inequities in Indigenous Canadians through a life course approach to Colonialism and the residential school system. Health Equity. Available from: https://www.liebertpub.com/doi/full/10.1089/heq.2019.0041 [Accessed on Feb 18, 2022].
- Cuevas AG, Ong AD, Carvalho K, et al. Discrimination and systemic inflammation: a critical review and synthesis. Brain Behav Immun. 2020 Oct 1;89:465-79. https://doi.org/10.1016/j.bbi.2020.07.017
- Homan P. structural sexism and health in the United States: a new perspective on health inequality and the gender system. Am Sociol Rev. 2019 Jun 1;84(3):486-516. https://doi.org/10.1177/0003122419848723
- Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40(1):105-25. https://doi.org/10.1146/annurev-publhealth-040218-043750
- Myers SS. Planetary health: protecting human health on a rapidly changing planet. The Lancet. 2017 Dec 23;390(10114):2860-8. https://doi.org/10.1016/S0140-6736(17)32846-5
- Van Melle E. New and emerging concepts as related to the CanMEDS roles: overview. Royal College of Physicians and Surgeons of Canada; 2015. Available from: https://www.royalcollege.ca/rcsite/documents/canmeds/emerging-concepts-e.pdf [ Accessed on Feb 1, 2022].
- Pappas C, Williams I. Grey literature: its emerging importance. J Hosp Librariansh. 2011 Jul;11(3):228-34. https://doi.org/10.1080/15323269.2011.587100
- Maguire M, Delahunt B. Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars. Irel J High Educ . 2017 Oct 31;9(3). Available from: https://ojs.aishe.org/index.php/aishe-j/article/view/335 [Accessed on Feb 17, 2022]
- Zotero. Roy Rosenzweig Center for History and New Media; 2022. Available from: https://www.zotero.org/
- Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019 Aug 8;11(4):589-97. https://doi.org/10.1080/2159676X.2019.1628806
- Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan 1;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
- Barnabe C, Osei-Tutu K, Maniate JM,et al. Equity, diversity, inclusion, and social justice in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75845
- Osei-Tutu K, Duchesne N, Barnabe C, et al. Anti-racism in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75844
- Waters HM, Oswald A, Constantin E, Thoma B, Dagnone JD. Physician humanism in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75536
- Thoma B, Paprica PA, Kaul P, Cheung WJ, Hall AK, Afflect E. Data-informed medicine in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75440
- Van Aerde J, Gomes MM, Giuliani M, Thoma B, Lieff S. Complex Adaptive systems in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75538
- Hall J, Atkinson A, Chan MK, Tourian L, Thoma B, Pattani R. The clinical learning environment in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75537
- Stovel RG, Dubois D, Chan TM, Snell L, Thoma B, Ho K. Virtual care in CanMEDS 2025. Can Med Educ J. 2023; https://doi.org/10.36834/cmej.75439
- Young M, Szulewski A, Anderson R, Thoma B, Monteiro S. Clinical reasoning in CanMEDS 2025. Can Med Educ J. 2023; https://doi.org/10.36834/cmej.75843.
- Cupido N, Fowler N, Sonnenberg LK et al. Adaptive expertise in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75445
- Green S, Labine N, Luo OD, et al. Planetary health in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75438
- Greenwood M, Leeuw S de, Lindsay N. Challenges in health equity for Indigenous peoples in Canada. The Lancet. 2018 Apr 28;391(10131):1645-8. https://doi.org/10.1016/S0140-6736(18)30177-6
- Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada: Calls to Action. Winnipeg, Manitoba; 2015 Available from: https://ehprnh2mwo3.exactdn.com/wp-content/uploads/2021/01/Calls_to_Action_English2.pdf [Accessed on Feb 16, 2022].
- Solomon CG, LaRocque RC. Climate Change - A Health Emergency. N Engl J Med. 2019 Jan 17;380(3):209-11. https://doi.org/10.1056/NEJMp1817067
- Walpole SC, Barna S, Richardson J, Rother HA. Sustainable healthcare education: integrating planetary health into clinical education. Lancet Planet Health. 2019 Jan;3(1):e6-7. https://doi.org/10.1016/S2542-5196(18)30246-8
- Hackett F, Got T, Kitching GT, MacQueen K, Cohen A. Training Canadian doctors for the health challenges of climate change. Lancet Planet Health. 2020 Jan;4(1):e2-3. https://doi.org/10.1016/S2542-5196(19)30242-6
- Denecke K, Gabarron E, Petersen C, Merolli M. Defining participatory health informatics - a scoping review. Inform Health Soc Care. 2021 Sep 2;46(3):234-43. https://doi.org/10.1080/17538157.2021.1883028
- Webster P. Virtual health care in the era of COVID-Lancet Lond Engl. 2020;395(10231):1180-1. https://doi.org/10.1016/S0140-6736(20)30818-7
- Uhl-Bien M. Complexity and COVID-19: leadership and followership in a complex world. J Manag Stud. 2021;58(5):1400-4. https://doi.org/10.1111/joms.12696
- Kannampallil TG, Goss CW, Evanoff BA, Strickland JR, McAlister RP, Duncan J. Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS ONE. 2020 Aug 6;15(8):e0237301. https://doi.org/10.1371/journal.pone.0237301
- Mylopoulos M, Kulasegaram K, Woods NN. Developing the experts we need: fostering adaptive expertise through education. J Eval Clin Pract. 2018;24(3):674-7. https://doi.org/10.1111/jep.12905
- Merchant RM, Topjian AA, Panchal AR, et al. Part 1: executive summary: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S337-57. https://doi.org/10.1161/CIR.0000000000000918