Karen Schultz

Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches

BackgroundRecognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs.MethodsA working group comprised of global health educators from Ontarios six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training.ResultsThe main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontarios family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies.ConclusionsThe shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied to other aspects of residency curriculum development.

Assessing the Relationship of Learning Approaches to Workplace Climate in Clerkship and Residency

Purpose. To determine what approaches to learning are adopted by clinical clerks and residents and whether these approaches are associated with demographic factors, specialty, level of training, and perceptions of the workplace climate. Method. In 2001–02, medical clerks (n = 532) and residents (n = 2,939) at five medical schools in Ontario, Canada, were mailed the Workplace Learning Questionnaire. The correlation between the approaches to learning at work and perceived workplace climate and the influence of gender, age, location, residency program and level of training on outcomes were measured. Results. A total of 1,642 clerks and residents responded (47%). The factor structure and reliability of the Workplace Learning Questionnaire were confirmed for these respondents. A surface-disorganized approach to learning was correlated with perception of heavy workload (r = .401, p < .001). The deep approach to learning was correlated with perception of choice–independence in the workplace and a supportive–receptive workplace (r = .32, p < .001; r = .23, p < .001). The climate factors, perception of choice–independence and supportive–receptive workplace, were correlated (r = .60, p < .001). There were significant differences among the mean scores for scales based on residency, year of training, and location of training. Conclusions. Perception of the workplace climate was associated with the approach to learning in the workplace of clerks and residents. Perception of heavy workload was associated with less effective approaches to learning. These associations varied with the residency program and the level of training.

Developing and successfully implementing a competency-based portfolio assessment system in a postgraduate family medicine residency program.

The use of portfolios in postgraduate medical residency education to support competency development is increasing; however, the processes by which these assessment systems are designed, implemented, and maintained are emergent. The authors describe the needs assessment, development, implementation, and continuing quality improvement processes that have shaped the Portfolio Assessment Support System (PASS) used by the postgraduate family medicine program at Queen’s University since 2009. Their description includes the impetus for change and contextual realities that guided the effort, plus the processes used for selecting assessment components and developing strategic supports. The authors discuss the identification of impact measures at the individual, programmatic, and institutional levels and the ways the department uses these to monitor how PASS supports competency development, scaffolds residents’ self-regulated learning skills, and promotes professional identity formation. They describe the “academic advisor” role and provide an appendix covering the portfolio elements. Reflection elements include learning plans, clinical question logs, confidence surveys, and reflections about continuity of care and significant incidents. Learning module elements cover the required, online bioethics, global health, and consult-request modules. Assessment elements cover each resident’s research project, clinical audits, presentations, objective structured clinical exam and simulated office oral exam results, field notes, entrustable professional activities, multisource feedback, and in-training evaluation reports. Document elements are the resident’s continuing medical education activities including procedures log, attendance log, and patient demographic summaries. The authors wish to support others who are engaged in the systematic portfolio-design process or who may adapt aspects of PASS for their local programs.

The Application of Entrustable Professional Activities to Inform Competency Decisions in a Family Medicine Residency Program.

Assessing entrustable professional activities (EPAs), or carefully chosen units of work that define a profession and are entrusted to a resident to complete unsupervised once she or he has obtained adequate competence, is a novel and innovative approach to competency-based assessment (CBA). What is currently not well described in the literature is the application of EPAs within a CBA system. In this article, the authors describe the development of 35 EPAs for a Canadian family medicine residency program, including the work by an expert panel of family physician and medical education experts from four universities in three Canadian provinces to identify the relevant EPAs for family medicine in nine curriculum domains. The authors outline how they used these EPAs and the corresponding templates that describe competence at different levels of supervision to create electronic EPA field notes, which has allowed educators to use the EPAs as a formative tool to structure day-to-day assessment and feedback and a summative tool to ground competency declarations about residents. They then describe the system to compile, collate, and use the EPA field notes to make competency declarations and how this system aligns with van der Vleuten’s utility index for assessment (valid, reliable, of educational value, acceptable, cost-effective). Early outcomes indicate that preceptors are using the EPA field notes more often than they used the generic field notes. EPAs enable educators to evaluate multiple objectives and important but unwieldy competencies by providing practical, manageable, measurable activities that can be used to assess competency development.

Teaching Quality Improvement in Graduate Medical Education: An Experiential and Team-Based Approach to the Acquisition of Quality Improvement Competencies.

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