The Future of Medical Education in Canada: Postgraduate Project

1. The Future of Medical Education in Canada:Postgraduate Project Canadian Conference on Medical Education May 10, 2011

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

3. Liaison and Engagement Consultant Report

4. 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

5. Completed Consultations (Jan 31/2011) * Deans, PG Deans, UG Deans, Program Directors, Education Councils, etc. FMEC Postgraduate Project Liaison and Engagement

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Round 2 Consultations • To discuss the FMEC PG Steering Committee's draft recommendations as they emerge • Web-based survey by invitation • Sampling national organizations • ‘Town hall’ meetings with medical schools • Other targeted audiences (CCME, ICRE, FMF) FMEC Postgraduate Project Liaison and Engagement

13. Environmental Scan Synthesis Report

14. 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

15. ES Activities • Undertook a comprehensive literature review to produce 24 commissioned papers on topics of importance to the future of PGME • Conducted 27 key informant interviews with stakeholders from across Canada to identify themes important to the future of PGME. • Wrote an Environmental Scan Synthesis Reportto summarize and synthesize the findings and point the way forward. FMEC Postgraduate Project Environmental Scan

16. Commissioned papers topic areas Societal needs 1.Health inequities, social responsibility and PGME 2.Generalism in PGME 3.Trends/issues in PGME: inputs/outcomes 4.Training for a socially diverse population 5.International Medical Graduates - current issues 6. Future of health care trends: impact on PGME 7. Integrating patient safety and quality improvement FMEC Postgraduate Project Environmental Scan

17. Commissioned papers topic areas PGME System 8. Governance in PGME in Canada 9. Issues related to residents as workers and learners 10. Length of training in PGME in Canada 11. Accreditation of PGME 12. Distributed education and distance learning in PGME 13. Assessment in PGME 14. Information and educational technology in PGME 15. Integration of CanMEDS expectations & outcomes 16. Innovations in learning, teaching in clinical settings FMEC Postgraduate Project Environmental Scan

18. Commissioned papers topic areas 17. Inter/intra-professional collaborative care 18. Simulation 19. Competency-based training 20. Teaching, learning and assessing professionalism 21. Faculty development for PGME Needs of individual learners 22. The choice of specialty and practice location 23. Resident wellness and work/life balance 24. Supporting the development of residents as teachers FMEC Postgraduate Project Environmental Scan

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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 PGME FMEC Postgraduate Project Environmental Scan

27. 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

28. 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

29. 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

30. Questions? If you have questions, contact: • Dr. Sarita Verma sarita.verma@utoronto.ca • Dr. Joanna Bates joanna.bates@ubc.ca • Dr. Susan Glover Takahashi sglover.takahashi@utoronto.ca • Environmental Scan Secretariat fmec.pg@utoronto.ca FMEC Postgraduate Project Environmental Scan

31. Project Inputs

32. 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

33. Many Players, Many Inputs • CFPC White Papers • RCPSC White Papers • CAIR Residents’ Perspective FMEC Postgraduate Project Project Inputs

34. Public Panel • A lively discussion resulted in 6 priorities: • Maintain competence • Increase inter- and intraprofessional collaboration • Address the hidden curriculum • Re-design training to improve patient- and community-centred health and wellness • Learning environment (IT & professionalism) • Align numbers and types of physicians trained to public need FMEC Postgraduate Project Project Inputs

35. 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

36. 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

37. 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

38. 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

39. 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

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

41. For more information… www.afmc.ca/fmecpg FMEC Postgraduate Project