Réexamen de la proposition de valeur de la formation médicale axée sur les compétences

The adoption of competency-based medical education (CBME) by Canadian postgraduate training programs has created a storm of excitement and controversy. Implementing the system-wide Competency by Design (CBD) project initiated by the Royal College of Physicians & Surgeons of Canada (RCPSC), is an ambitious transformative change challenge. Not surprisingly, tensions have arisen across the country around the theoretical underpinnings of CBME and the practicalities of implementation, resulting in calls for evidence justifying its value. Assumptions have been made on both sides of the argument contributing to an atmosphere of unhealthy protection of the status quo, premature conclusions of CBME’s worth, and an oversimplification of risks and costs to participants. We feel that a renewed effort to find a shared vision of medical education and the true value proposition of CBME is required to recreate a growth-oriented mindset. Also, the aspirational assertion of a direct link between CBME and improved patient outcomes requires deferral until further implementation and study has occurred. However, we perceive more concrete and immediate value of CBME arises from the societal contract physicians have, the connection to maintaining self-regulation, and the potential customization of training for learners.L’adoption de la formation médicale axée sur les compétences (FMAC) dans les programmes canadiens d’études postdoctorales a suscité une tempête d’enthousiasme et de controverse. La mise en œuvre à l’échelle du système du projet Compétence par conception (CPC), lancé par le Collège royal des médecins et chirurgiens du Canada (CRMCC), pose le défi d’un changement ambitieux et transformateur. Il n’est pas surprenant que des tensions soient apparues dans tout le pays autour des fondements théoriques de la FMAC et des aspects pratiques de sa mise en œuvre, donnant lieu à des demandes de preuves pour démontrer sa valeur.1 Détracteurs et partisans ont avancé des suppositions, contribuant à un climat malsain de protection du statu quo, à des conclusions prématurées sur la valeur de la FMAC et à une simplification exagérée des risques et des coûts pour les participants. Nous estimons qu’un effort pour retrouver une vision commune de l’éducation médicale et une proposition sérieuse quant à la valeur de la FMAC sont de mise afin de restaurer une attitude orientée vers l’avancement. De plus, il conviendrait de s’abstenir d’affirmer l’existence d’un lien direct entre la FMAC et l’amélioration des résultats pour les patients en attendant qu’une mise en oeuvre plus étendue et que de la recherche plus approfondie aient eu lieu. Cependant, on peut observer dans la FMAC une valeur concrète et immédiate découlant de la présence d’un engagement des médecins envers la société, de son orientation vers le maintien de l’autorégulation et de la personnalisation potentielle de la formation pour les apprenants

The current utility and future use of the medical student performance record: A survey of perceptions across Canada

Introduction: The MSPR is a Canada wide tool that provides aggregate information on MD students’ performance during training and used widely as part of PG admissions. This survey study elicits the perceptions of PG admissions stakeholders on the current use and future utility of the MSPR in Canada. Methods: PG admissions stakeholders across the faculties of medicine were convenience sampled for a 15-question online survey in the fall of 2018. Participants were asked how and when the MSPR is incorporated into the admissions process and perceptions and recommendations for improvement Data are summarized descriptively and thematically. Results: Responses came from 164 participants across the 17 faculties of medicine. The MSPR was widely used (92%), most commonly in the file review process (52%) for professionalism issues. The majority of responses indicated that MSPRs were not fair for all MD students (60%) and required revision (74%) with greater emphasis required on transparency, professionalism, and narrative comments. Discussion: The results indicate that though MSPRs are widely used in PG admissions their perceived value is limited to a few specific sources of information and to specific parts of the admissions process. There are significant concerns from PG stakeholders on the utility of MSPRs and future changes should align with the needs of these stakeholders while balancing the concerns of students and undergraduate programs

Quais São as Opções Profissionais para Médicos Que Não Ingressam no Internato Médico?

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International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine

There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership

International federation for emergency medicine model curriculum for emergency medicine specialists the core curriculum and education committee for the international federation for emergency medicine

ABSTRACT To meet a critical and growing need for emergency physicians and emergency medicine resources worldwide, physicians must be trained to deliver time-sensitive interventions and lifesaving emergency care. Currently, there is no globally recognized, standard curriculum that defines the basic minimum standards for specialist trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for training of specialists in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed to provide a framework for educational programs in emergency medicine. The focus is on the basic minimum emergency medicine educational content that any emergency medicine physician specialist should be prepared to deliver on completion of a training program. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance physician education in basic emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to expand emergency medicine within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught. This variability will reflect the existing educational milieu, the resources available, and the goals of the institutions' educational leadership with regard to the training of emergency medicine specialists

International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine

There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research