Practical solutions for implementation of Transition to Practice curricula in a competency-based medical education model.

Background: Although transition from residency to practice represents a critical learning stage, there is a paucity of literature to inform local curriculum development and implementation.Objectives: To describe local curriculum development for Transition to Practice (TTP) for use within a competency-based medical education model, including important content and suitable teaching and assessment strategies. Design: We reviewed the literature to construct a definition and develop initial curriculum content for TTP. We then gathered local residency program directors’ views on TTP content, teaching, and assessment via online survey and an international educational conference workshop. Results: We identified 21 important TTP content areas in the literature and analyzed 35 survey responses, representing 33 residency programs. Survey participants viewed Further sophistication of clinical skills, How to set up a practice, and Time management skills as the three most important content areas. Views on content importance varied by program. For learning and teaching strategies, most respondents preferred: assessing what residents could do, providing real-life practice opportunities, and offering workplace-based assessments. Conclusions: TTP curricula implementation should reflect nationally set, specialty-specific curriculum elements; locally developed priority content; and learning and teaching strategies. Individual learner needs and imminent practice context should guide faculty approaches to curriculum delivery

Reclaiming physician identity: It’s time to integrate ‘Doctor as Person’ into the CanMEDS framework

In 1996, the Royal College of Physicians & Surgeons of Canada (RCPSC) adopted the CanMEDS framework with seven key roles: medical expert, communicator, collaborator, health advocate, manager, professional, and scholar. For many years, CanMEDS has been recognized around the world for defining what patients need from their physicians. From the start, the RCPSC acknowledged that these roles should  evolve over time to continue to meet patient and societal needs (updates in 2005 & 2015).  We propose that  an 8th role is now needed in the framework: “Doctor as Person”. Interestingly, this role was present in the foundational work through the Educating Future Physicians for Ontario (EFPO) project that the RCPSC drew upon in creating CanMEDS more than 20 years ago. Given today’s challenges of providing care in an increasingly stressed Canadian healthcare system, physicians are struggling more than ever with health and wellness, burnout, and the deterioration of the clinical environment. From the patient perspective, there is growing concern that physician-patient interactions are becoming increasingly impersonal and decreasingly patient-centered. The crack emerging in the foundation of physician identity needs to be remedied. We need to pay close attention to how we define ourselves as physicians, by better identifying the competencies required to navigate the personal and professional challenges we face. Only in so doing can we ward off the threat that exists in losing authentic human to human care interactions. Formalizing Doctor as Person as an 8th role in the CanMEDS framework will help patients and physicians create the space to have essential conversations about the humanity of medical care.&nbsp

Exploring the experience of residents during the first six months of family medicine residency training

Background: The shift from undergraduate to postgraduate education signals a new phase in a doctor’s training. This study explored the resident’s perspective of how the transition from undergraduate to postgraduate (PGME) training is experienced in a Family Medicine program as they first meet the reality of feeling and having the responsibility as a doctor.Methods: Qualitative methods explored resident experiences using interpretative inquiry through monthly, individual in-depth interviews with five incoming residents during the first six months of training.  Focus groups were also held with residents at various stages of training to gather their reflection about their experience of the first six months. Residents were asked to describe their initial concerns, changes that occurred and the influences they attributed to those changes.Results: Residents do not begin a Family Medicine PGME program knowing what it means to be a Family Physician, but learn what it means to fulfill this role. This process involves adjusting to significant shifts in responsibility in the areas of Knowledge, Practice Management, and Relationships as they become more responsible for care outcomes.Conclusion: This study illuminated the resident perspective of how the transition is experienced. This will assist medical educators to better understand the early training experiences of residents, how these experiences contribute to consolidating their new professional identity, and how to better align teaching strategies with resident learning needs

Net community production in the North Atlantic Ocean derived from Volunteer Observing Ship data

The magnitude of marine plankton net community production (NCP) is indicative of both the biologically driven exchange of carbon dioxide between the atmosphere and the surface ocean and the export of organic carbon from the surface ocean to the ocean interior. In this study the seasonal variability in the NCP of five biogeochemical regions in the North Atlantic was determined from measurements of surface water dissolved oxygen and dissolved inorganic carbon (DIC) sampled from a Volunteer Observing Ship (VOS). The magnitude of NCP derived from dissolved oxygen measurements (NCPinline image) was consistent with previous geochemical estimates of NCP in the North Atlantic, with an average annual NCPinline image of 9.5 ± 6.5 mmol O2 m−2 d−1. Annual NCPinline image did not vary significantly over 35° of latitude and was not significantly different from NCP derived from DIC measurements (NCPDIC). The relatively simple method described here is applicable to any VOS route on which surface water dissolved oxygen concentrations can be accurately measured, thus providing estimates of NCP at higher spatial and temporal resolution than currently achieved

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

A description of the Canadian entry-level physiotherapist

grantor: University of TorontoA Description of the Canadian Entry-Level Physiotherapist profiles the Canadian physiotherapist at the entry-to-practice level and reviews the adequacy of three descriptions of the competencies of the Canadian pbysiotherapist at the entry-to-practice level. In the context of physiotherapy, competencies are the knowledge, skills, and attitudes required for safe, independent, entry-level physiotherapy practice. This analytic, qualitative study reviewed two available descriptions of the Canadian entry-level physiotherapist, and developed a third description using a functional-analysis model to profile the Canadian entry-level physiotherapist and the inventory of competencies. A comparison of the three descriptions of the Canadian entry-level physiotherapist found that there is some overlap and linkages among them. A Description of the Canadian Entry-Level Physiotherapist can be used in teaching and evaluating physiotherapy students; in the review and revision of the national certification examination; and in measures taken to ensure and improve the quality of Canadian physiotherapy practice.M.A

Managing residents in difficulty within CBME residency educational systems: a scoping review

Abstract Background Best practices in managing residents in difficulty (RID) in the era of competency-based medical education (CBME) are not well described. This scoping review aimed to inventory the current literature and identify major themes in the articles that address or employ CBME as part of the identification and remediation of residents in difficulty. Methods Articles published between 2011 to 2017 were included if they were about postgraduate medical education, RID, and offered information to inform the structure and/or processes of CBME. All three reviewers performed a primary screening, followed by a secondary screening of abstracts of the chosen articles, and then a final comprehensive sub-analysis of the 11 articles identified as using a CBME framework. Results Of 165 articles initially identified, 92 qualified for secondary screening; the 63 remaining articles underwent full-text abstracting. Ten themes were identified from the content analysis with “identification of RID” (41%) and “defining and classifying deficiencies” (30%) being the most frequent. In the CBME article sub-analysis, the most frequent themes were: need to identify RID (64%), improving assessment tools (45%), and roles and responsibilities of players involved in remediation (27%). Almost half of the CBME articles were published in 2016–2017. Conclusions Although CBME programs have been implemented for many years, articles have only recently begun specifically addressing RID within a competency framework. Much work is needed to describe the sequenced progression, tailored learning experiences, and competency-focused instruction. Finally, future research should focus on the outcomes of remediation in CBME programs