Patient references in the 2005 and 2015 CanMEDS frameworks

Holly L Adam; Kaylee Eady; Katherine A Moreau

doi:10.36834/cmej.74993

Authors

Holly L Adam University of Ottawa https://orcid.org/0000-0003-1451-4873
Kaylee Eady University of Ottawa https://orcid.org/0000-0002-6041-995X
Katherine A Moreau University of Ottawa https://orcid.org/0000-0002-5955-1689

DOI:

https://doi.org/10.36834/cmej.74993

Abstract

Background: Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks.

Methods: We used document analysis to examine how the term ‘patient(s)’ is referenced in the 2005 and 2015 CanMEDS Frameworks.

Results: Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME.

Conclusion: There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

References

Soon YE, Murray CM, Aguilar A, Boshoff K. Consumer involvement in university education programs in the nursing, midwifery, and allied health professions: a systematic scoping review. Int J Nurs Stud. 2020;109:103619. https://doi.org/10.1016/j.ijnurstu.2020.103619

Towle A, Bainbridge L, Godolphin W, et al. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64–74. https://doi.org/10.1111/j.1365-2923.2009.03530.x

Khalife R, Gupta M, Gonsalves C, et al. Patient involvement in assessment of postgraduate medical learners: a scoping review. Med Educ. 2022. https://doi.org/10.1111/medu.14726

Eady K, Moreau KA. Using parent feedback: a qualitative study of residents’ and physician-educators’ perspectives. Perspect Med Educ. 2018;7(1):33–9. https://doi.org/10.1007/s40037-017-0393-6

Thangarasu S, Renganathan G, Natarajan P. empathy can be taught, and patients teach it best. J Med Educ Curric Dev. 2021;8:23821205211000344. https://doi.org/10.1177/23821205211000346

Sinclair W, Camps L, Bibi F. Looking after children and young people: Ensuring their voices are heard in the pre-registration nursing curriculum. Nurse Educ Pract. 2012;12(4):227–31. https://doi.org/10.1016/j.nepr.2012.03.001

Heidke P, Howie V, Ferdous T. Use of healthcare consumer voices to increase empathy in nursing students. Nurse Educ Pract. 2018;29:30–4. https://doi.org/10.1016/j.nepr.2017.11.007

Wykurz G, Kelly D. Developing the role of patients as teachers: literature review. BMJ. 2002;325(7368):818–21. https://doi.org/10.1136/bmj.325.7368.818

Muir D, Laxton JC. Experts by experience; the views of service user educators providing feedback on medical students’ work based assessments. Nurse Educ Today. 2012;32(2):146–50. https://doi.org/10.1016/j.nedt.2011.08.015

Ahuja AS, Williams R. Involving patients and their carers in educating and training practitioners. Curr Opin Psychiatry. 2005;18(4):374–80. https://doi.org/10.1097/01.yco.0000172054.25284.bb

Stacy R, Spencer J. Patients as teachers: a qualitative study of patients’ views on their role in a community-based undergraduate project. Med Educ. 1999;33(9):688–94. https://doi.org/10.1046/j.1365-2923.1999.00454.x

Towle A & Godolphin W. Patient involvement in health professional education: a bibliography 1975-November 2016. (2016). Retrieved from https://pcpe.health.ubc.ca/node/207

De Rubeis C. Patient and Family Involvement in The Education of Health Professionals Working in Palliative Care: A Scoping Review [Unpublished master’s thesis]. University of Ottawa; 2021.

Abadel FT, Hattab AS. Patients’ assessment of professionalism and communication skills of medical graduates. BMC Med Educ. 2014;14(1). https://doi.org/10.1186/1472-6920-14-28

Greco M, Brownlea A, McGovern J, Cavanagh M. Consumers as educators: implementation of patient feedback in general practice training. Health Commun. 2000;12(2):173–93. https://doi.org/10.1207/S15327027HC1202_4

Ikkos G. Engaging patients as teachers of clinical interview skills. The Psychiatrist. 2003; 27(8):312–15. https://doi.org/10.1192/pb.27.8.312.

Thomson AN. Reliability of consumer assessment of communication skills in a postgraduate family practice examination. Med Educ. 1994;28(2):146–50. https://doi.org/10.1111/j.1365-2923.1994.tb02535.x

Branch VK, Graves G, Hanczyc M, Lipsky PE. The utility of trained arthritis patient educators in the evaluation and improvement of musculoskeletal examination skills of physicians in training. Arthritis Care Res. 1999;12(1):61–9. https://doi.org/10.1002/1529-0131(199902)12:1<61::AID-ART10>3.0.CO;2-G

Dugoff L, Everett MR, Vontver L, Barley GE. Evaluation of pelvic and breast examination skills of interns in obstetrics and gynecology and internal medicine. Am J Obstet Gynecol. 2003;189(3):655–8. https://doi.org/10.1067/S0002-9378(03)00892-5

Hamburger S, Guthrie D, Smith PG, Shaffer K. Teaching the pelvic examination in an internal medicine residency program. West J Med. 1981;134(6):547–8.

Fornari A, Anderson M, Simon S, Korin E, Swiderski D, Strelnick AH. Learning social medicine in the Bronx: an orientation for primary care residents. Teach Learn Med. 2011 Jan 12;23(1):85–9. https://doi.org/10.1080/10401334.2011.536898

Appel DJ, Hoffman MW, Speller NB, Weiner PL, Meryash DL. Parents as teachers: an integral component of a developmental and behavioral pediatrics curriculum. J Dev Behav Pediatr. 1996;17(2):105–6. https://doi.org/10.1097/00004703-199604000-00008

Blasco PA, Kohen H, Shapland C. Parents-as-teachers: design and establishment of a training programme for paediatric residents. Med Educ. 1999;33(9):695–701. https://doi.org/10.1046/j.1365-2923.1999.00334.x

Moreau KA, Eady K, Frank JR, et al. A qualitative exploration of which resident skills parents in pediatric emergency departments can assess. Med Teach. 2016;38(11):1118–24. https://doi.org/10.3109/0142159X.2016.1170783

Agrawal S, Capponi P, López J, et al. From surviving to advising: a novel course pairing mental health and addictions service users as advisors to senior psychiatry residents. Acad Psychiatry. 2016 Jun 1;40(3):475–80. https://doi.org/10.1007/s40596-016-0533-z

Babu KS, Law-Min R, Adlam T, Banks V. Involving service users and carers in psychiatric education: what do trainees think? Psychiatr Bull. 2008;32(1):28–31. https://doi.org/10.1192/pb.bp.107.015354

Donaghy F, Boylan O, Loughrey C. Using expert patients to deliver teaching in general practice. Br J Gen Pract. 2010;60(571):136–9. https://doi.org/10.3399/bjgp10X483346

Colbert CY, Mirkes C, Cable CT, Sibbitt SJB, VanZyl GO, Ogden PE. The patient panel conference experience: what patients can teach our residents about competency issues: Acad Med. 2009;84(12):1833–9. https://doi.org/10.1097/ACM.0b013e3181bf27db

Hobson WL, Avant-Mier R, Cochella S, et al. Caring for the underserved: using patient and physician focus groups to inform curriculum development. Ambul Pediatr. 2005;5(2):90–5. https://doi.org/10.1367/A04-076R.1

Fadden G, Shooter M, Holsgrove G. Involving carers and service users in the training of psychiatrists. Psychiatr Bull. 2005;29(7):270–4. https://doi.org/10.1192/pb.29.7.270

Snaman JM, Kaye EC, Cunningham MJ, et al. Going straight to the source: a pilot study of bereaved parent-facilitated communication training for pediatric subspecialty fellows. Pediatr Blood Cancer. 2017;64(1):156–62. https://doi.org/10.1002/pbc.26089

Moreau KA, Eady K, Tang K, et al. The development of the PARENTS: a tool for parents to assess residents’ non-technical skills in pediatric emergency departments. BMC Med Educ. 2017;17(1):1–10. https://doi.org/10.1186/s12909-017-1042-9

Parham D, Reed D, Olicker A, et al. Families as educators: a family-centered approach to teaching communication skills to neonatology fellows. J Perinatol. 2019 Oct;39(10):1392–8. https://doi.org/10.1038/s41372-019-0441-7

Moreau KA, Eady K, Jabbour M. Exploring residents’ reactions to and use of parent feedback in a pediatric emergency department: A grounded theory study. Med Teach. 2019;41(2):207–14. https://doi.org/10.1080/0142159X.2018.1460658

Naylor S, Harcus J, Elkington M. An exploration of service user involvement in the assessment of students. Radiography. 2015;21(3):269–72. https://doi.org/10.1016/j.radi.2015.01.004

Takahashi S, Abbott C, Oswald A & Frank, JR. (Eds.). CanMEDS teaching and assessment tools guide. [Internet]. 2015; Available from https://cmfdlibrary.librarika.com/search/detail/4900390. [Accessed on Feb 19, 2022]

Carraccio C, Englander R, Van Melle E, et al. Advancing competency-based medical education: a charter for clinician–educators. Acad Med. 2016;91(5):645–9. https://doi.org/10.1097/ACM.0000000000001048

Frank JR. (Ed). The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005

Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

Glasersfeld E von. Radical constructivism: a way of knowing and learning. London: Routledge Falmer. 2002.

Savvides N, Al-Youssef J, Colin M, Garrido C. Journeys into inner/outer space: reflections on the methodological challenges of negotiating insider/outsider status in international educational research. Res Comp Int Educ. 2014; 1;9(4):412–25

Bowen GA, Document analysis as a qualitative research method. Qual Res J. 2009; 9(2): 27-40. https://doi.org/10.3316/QRJ0902027

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687

The Royal College of Physicians and Surgeons of Canada. CanMEDS // Framework. [Internet]. Available from: https://canmeds.royalcollege.ca/en/framework [Accessed on Feb 7, 2022].

Merriam-Webster Dictionary. Interaction. [Internet]. 2022. https://www.merriam-webster.com/dictionary/interaction [Accessed Feb 12, 2022]

El-Haddad C, Hegazi I, Hu W. A patient expectations questionnaire for determining criteria for entrustment decisions. Med Teach. 2021;43(9):1031–8. https://doi.org/10.1080/0142159X.2021.1907324

Moreau K, Eady K, Jabbour M. Patient involvement in resident assessment within the Competence by Design context: a mixed-methods study. Can Med Educ J. 2019;10(1):e84–102. https://doi.org/10.36834/cmej.56881

Jha V, Quinton ND, Bekker HL, Roberts TE. Strategies and interventions for the involvement of real patients in medical education: a systematic review. Med Educ. 2009;43(1):10–20. https://doi.org/10.1111/j.1365-2923.2008.03244.x

Adam HL, Giroux CM, Eady K, Moreau KA. A qualitative study of patients’ and caregivers’ perspectives on educating healthcare providers. Can Med Educ J. 2021;12(4):7–16. https://doi.org/10.36834/cmej.71541