PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-9 (9)
 

Clipboard (0)
None

Select a Filter Below

Journals
Authors
more »
Year of Publication
Document Types
1.  Defining competency-based evaluation objectives in family medicine 
Canadian Family Physician  2012;58(10):e596-e604.
Abstract
Objective
To develop and describe observable evaluation objectives for assessing competence in professionalism, which are grounded in the experience of practising physicians.
Design
Modified nominal group technique.
Setting
The College of Family Physicians of Canada in Mississauga, Ont.
Participants
An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian context with respect to region, sex, language, community type, and experience.
Methods
Using an iterative process, the expert group defined a list of observable behaviours that are indicative of professionalism, or not, in the family medicine setting. Themes relate to professional behaviour in family medicine; specific observable behaviours are those that family physicians believe are indicative of professionalism for each theme.
Main findings
The expert group identified 12 themes and 140 specific observable behaviours to assist in the observation and discussion of professional behaviour in family medicine workplace settings.
Conclusion
Competency-based education literature emphasizes the importance of formative evaluation and feedback. Such feedback is particularly challenging in the domain of professionalism because of its personal nature and the potential for emotional reactions. Effective dialogue between learners and teachers begins with clear expectations and reference to descriptions of relevant, specific behaviour. This research has generated a competency-based resource to assist the assessment of professional behaviour in family medicine educational programs.
PMCID: PMC3470538  PMID: 23064939
2.  Defining competency-based evaluation objectives in family medicine 
Canadian Family Physician  2012;58(7):775-780.
Abstract
Objective
To develop evaluation objectives for assessing competence in procedure skills using a key-features approach. This was part of a multiyear project to develop competency-based evaluation objectives for Certification in Family Medicine.
Design
Nominal group technique.
Setting
The College of Family Physicians of Canada in Mississauga, Ont.
Participants
An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian context with respect to region, sex, language, community type, and experience.
Methods
Using a nominal group technique, the expert group developed the general key features for procedure skills. The expert group also linked the key features to already established skill dimensions in the domain of competence, to the 4 principles of family medicine, and to the CanMEDS roles.
Main findings
The general key features were developed after 5 iterations. Ten key features were outlined and were shown to reflect all the essential skill dimensions in the domain of competence for family medicine. The key features were linked to 2 of the 4 principles of family medicine and to 4 of the CanMEDS roles.
Conclusion
The general key features for procedure skills were developed to assess competence in procedure skills in family medicine.
PMCID: PMC3395528  PMID: 22798466
3.  Clerkship pathway 
Canadian Family Physician  2012;58(6):662-667.
Abstract
Objective
To identify factors that help predict success for international medical graduates (IMGs) who train in Canadian residency programs and pass the Canadian certification examinations.
Design
A retrospective analysis of 58 variables in the files of IMGs who applied to the Collège des médecins du Québec between 2000 and 2008.
Setting
Quebec.
Participants
Eight hundred ten IMGs who applied to the Collège des médecins du Québec through either the “equivalency pathway” (ie, starting training at a residency level) or the “clerkship pathway” (ie, relearning at the level of a medical student in the last 2 years of the MD diploma).
Main outcome measures
Success factors in achieving certification. Data were analyzed using descriptive statistics and ANOVA (analysis of variance).
Results
International medical graduates who chose the “clerkship pathway” had greater success on certification examinations than those who started at the residency level did.
Conclusion
There are several factors that influence IMGs’ success on certification examinations, including integration issues, the acquisition of clinical decision-making skills, and the varied educational backgrounds. These factors perhaps can be better addressed by a regular clerkship pathway, in which IMGs benefit from learner-centred teaching and have more time for reflection on and understanding of the North American approach to medical education. The clerkship pathway is a useful strategy for assuring the integration of IMGs in the North American health care system. A 2-year relearning period in medical school at a clinical clerkship level deserves careful consideration.
PMCID: PMC3374691  PMID: 22859630
4.  Effect of field notes on confidence and perceived competence 
Canadian Family Physician  2012;58(6):e352-e356.
Abstract
Objective
To evaluate the effectiveness of field notes in assessing teachers’ confidence and perceived competence, and the effect of field notes on residents’ perceptions of their development of competence.
Design
A faculty and resident survey completed 5 years after field notes were introduced into the program.
Setting
Five Dalhousie University family medicine sites—Fredericton, Moncton, and Saint John in New Brunswick, and Halifax and Sydney in Nova Scotia.
Participants
First- and second-year family medicine residents (as of May 2009) and core family medicine faculty.
Main outcome measures
Residents’ outcome measures included beliefs about the effects of field notes on performance, learning, reflection, clinical skills development, and feedback received. Faculty outcome measures included beliefs about the effect of field notes on guiding feedback, teaching, and reflection on clinical practice.
Results
Forty of 88 residents (45.5%) participated. Fifteen of 50 faculty (30.0%) participated, which only permitted a discussion of trends for faculty. Residents believed field note–directed feedback reinforced their performance (81.1%), helped them learn (67.6%), helped them reflect on practice and learning (66.7%), and focused the feedback they received, making it more useful (62.2%) (P < .001 for all); 63.3% believed field note–directed feedback helped with clinical skills development (P < .01). Faculty believed field notes helped to provide more focused (86.7%) and effective feedback (78.6%), improved teaching (75.0%), and encouraged reflection on their own clinical practice (73.3%).
Conclusion
Most surveyed residents believed field note use improved the feedback they received and helped them to develop competence through improved performance, learning, reflection, and clinical skills development. The trends from faculty information suggested faculty believed field notes were an effective teaching, feedback, and reflection tool.
PMCID: PMC3374708  PMID: 22700743
5.  Defining competency-based evaluation objectives in family medicine 
Canadian Family Physician  2012;58(4):e217-e224.
Abstract
Objective
To provide a pragmatic approach to the evaluation of communication skills using observable behaviours, as part of a multiyear project to develop competency-based evaluation objectives for Certification in family medicine.
Design
A nominal group technique was used to develop themes and subthemes and to identify positive and negative observable behaviours that demonstrate competence in communication in family medicine.
Setting
The College of Family Physicians of Canada in Mississauga, Ont.
Participants
An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian context with respect to region, sex, language, community type, and experience.
Methods
The group used the nominal group technique to derive a list of observable behaviours that would constitute a detailed operational definition of competence in communication skills; multiple iterations were used until saturation was achieved. The group met several times a year, and membership remained unchanged during the 4 years in which the work was conducted. The iterative process was undertaken twice—once for communication with patients and once for communication with colleagues.
Main findings
Five themes, 5 subthemes, and 106 positive and negative observable behaviours were generated. The subtheme of charting skills was defined using a key-features analysis.
Conclusion
Communication skills were defined in terms of themes and observable behaviours. These definitions were intended to help assess family physicians’ competence at the start of independent practice.
PMCID: PMC3325474  PMID: 22499824
6.  Defining competency-based evaluation objectives in family medicine 
Canadian Family Physician  2011;57(10):e373-e380.
Abstract
Objective
To develop key features for priority topics previously identified by the College of Family Physicians of Canada that, together with skill dimensions and phases of the clinical encounter, broadly describe competence in family medicine.
Design
Modified nominal group methodology, which was used to develop key features for each priority topic through an iterative process.
Setting
The College of Family Physicians of Canada.
Participants
An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian family medicine context with respect to region, sex, language, community type, and experience.
Methods
The group used a modified Delphi process to derive a detailed operational definition of competence, using multiple iterations until consensus was achieved for the items under discussion. The group met 3 to 4 times a year from 2000 to 2007.
Main findings
The group analyzed 99 topics and generated 773 key features. There were 2 to 20 (average 7.8) key features per topic; 63% of the key features focused on the diagnostic phase of the clinical encounter.
Conclusion
This project expands previous descriptions of the process of generating key features for assessment, and removes this process from the context of written examinations. A key-features analysis of topics focuses on higher-order cognitive processes of clinical competence. The project did not define all the skill dimensions of competence to the same degree, but it clearly identified those requiring further definition. This work generates part of a discipline-specific, competency-based definition of family medicine for assessment purposes. It limits the domain for assessment purposes, which is an advantage for the teaching and assessment of learners. A validation study on the content of this work would ensure that it truly reflects competence in family medicine.
PMCID: PMC3192103  PMID: 21998245
7.  Defining competency-based evaluation objectives in family medicine 
Canadian Family Physician  2011;57(9):e331-e340.
Abstract
Objective
To develop a definition of competence in family medicine sufficient to guide a review of Certification examinations by the Board of Examiners of the College of Family Physicians of Canada.
Design
Delphi analysis of responses to a 4-question postal survey.
Setting
Canadian family practice.
Participants
A total of 302 family physicians who have served as examiners for the College of Family Physicians of Canada’s Certification examination.
Methods
A survey comprising 4 short-answer questions was mailed to the 302 participating family physicians asking them to list elements that define competence in family medicine among newly certified family physicians beginning independent practice. Two expert groups used a modified Delphi consensus process to analyze responses and generate 2 basic components of this definition of competence: first, the problems that a newly practising family physician should be competent to handle; second, the qualities, behaviour, and skills that characterize competence at the start of independent practice.
Main findings
Response rate was 54%; total number of elements among all responses was 5077, for an average 31 per respondent. Of the elements, 2676 were topics or clinical situations to be dealt with; the other 2401 were skills, behaviour patterns, or qualities, without reference to a specific clinical problem. The expert groups identified 6 essential skills, the phases of the clinical encounter, and 99 priority topics as the descriptors used by the respondents. More than 20% of respondents cited 30 of the topics.
Conclusion
Family physicians define the domain of competence in family medicine in terms of 6 essential skills, the phases of the clinical encounter, and priority topics. This survey represents the first level of definition of evaluation objectives in family medicine. Definition of the interactions among these elements will permit these objectives to become detailed enough to effectively guide assessment.
PMCID: PMC3173441  PMID: 21918130
8.  Examination outcomes for international medical graduates pursuing or completing family medicine residency training in Quebec 
Canadian Family Physician  2010;56(9):912-918.
ABSTRACT
OBJECTIVE
To review the success of international medical graduates (IMGs) who are pursuing or have completed a Quebec residency training program and examinations.
DESIGN
We retrospectively reviewed IMGs’ success rates on the pre-residency Collège des médecins du Québec medical clinical sciences written examination and objective structured clinical examination, as well as on the post-residency Certification Examination in Family Medicine.
SETTING
Quebec.
PARTICIPANTS
All IMGs taking their examinations between 2001 and 2008, inclusive, and Canadian and American graduates taking their examinations during this same period.
MAIN OUTCOME MEASURES
Success rates for IMGs on the pre-residency and post-residency examinations, compared with success rates for Canadian and American graduates.
RESULTS
Success rates on the pre-residency clinical examinations remained below 50% from 2001 to 2008 for IMGs. Similarly, during the same period, the average success rate on the Certification examination was 56.0% for IMGs, compared with 93.5% for Canadian and American medical graduates.
CONCLUSION
Despite pre-residency competency screening and in-program orientation and supports, a substantial number of IMGs in Quebec are not passing their Certification examinations. Another study is under way to analyze reasons for some IMGs’ lack of success and to find ways to help IMGs complete residency training successfully and pass the Certification examination.
PMCID: PMC2939121  PMID: 20841596
9.  Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study 
BMJ : British Medical Journal  2005;331(7523):1002.
Objective To assess whether the transition from a traditional curriculum to a community oriented problem based learning curriculum at Sherbrooke University is associated with the expected improvements in preventive care and continuity of care without a decline in diagnosis and management of disease.
Design Historical cohort comparison study.
Setting Sherbrooke University and three traditional medical schools in Quebec, Canada.
Participants 751 doctors from four graduation cohorts (1988-91); three before the transition to community based problem based learning (n = 600) and one after the transition (n = 151).
Outcome measures Annual performance in preventive care (mammography screening rate), continuity of care, diagnosis (difference in prescribing rates for specific diseases and relief of symptoms), and management (prescribing rate for contraindicated drugs) assessed using provincial health databases for the first 4-7 years of practice.
Results After transition to a community oriented problem based learning curriculum, graduates of Sherbrooke University showed a statistically significant improvement in mammography screening rates (55 more women screened per 1000, 95% confidence interval 10.6 to 99.3) and continuity of care (3.3% more visits coordinated by the doctor, 0.9% to 5.8%) compared with graduates of a traditional medical curriculum. Indicators of diagnostic and management performance did not show the hypothesised decline. Sherbrooke graduates showed a significant fourfold increase in disease specific prescribing rates compared with prescribing for symptom relief after the transition.
Conclusion Transition to a community oriented problem based learning curriculum was associated with significant improvements in preventive care and continuity of care and an improvement in indicators of diagnostic performance.
doi:10.1136/bmj.38636.582546.7C
PMCID: PMC1273455  PMID: 16239292

Results 1-9 (9)