Étude qualitative sur l’expérience des résidents canadiens du modèle de formation médicale axée sur les compétences

Auteurs-es

DOI :

https://doi.org/10.36834/cmej.72765

Résumé

Contexte : La formation médicale axée sur les compétences (FMFC) est un paradigme d’apprentissage axé sur les résultats et visant à garantir que les diplômés aient les compétences nécessaires pour répondre aux besoins des patients. Bien que l’engagement des résidents soit la clé du succès de la FMFC, peu d’études ont exploré comment ils vivent son introduction. Nous nous sommes penchés sur l’expérience des résidents dans les programmes de formation canadiens qui ont mis en œuvre la FMFC.

Méthodes : Nous avons mené des entrevues semi-structurées avec 16 résidents de sept programmes de formation postdoctorale canadiens, afin de sonder leur expérience de la FMFC. Les participants provenaient de façon égale de la médecine familiale et de programmes de spécialité. Les thèmes ont été dégagés en appliquant les principes de la théorie enracinée constructiviste.

Résultats : Bien que réceptifs aux objectifs de la FMFC, les résidents décrivent des inconvénients de sa mise en pratique, notamment sur le plan de l’évaluation et de la rétroaction. Pour beaucoup d’entre eux, la focalisation sur l’évaluation et le fardeau administratif qui y est lié ont été une source d’anxiété de performance. Les résidents ont l’impression que les évaluations manquent parfois de pertinence, car les superviseurs, se sentant contraints de « cocher des cases », font des commentaires trop généraux et peu ciblés. De plus, un sentiment de frustration a été fréquemment exprimé face à la subjectivité et à l’incohérence perçues des jugements dans les évaluations, surtout lorsque ces dernières sont utilisées pour retarder le cheminement vers une plus grande indépendance, ce qui contribue à des tentatives de « déjouer le système ». L’implication et le soutien du corps professoral ont aidé à bonifier l’expérience des résidents.

Conclusion : Bien que les résidents apprécient le potentiel de la FMFC pour rehausser la qualité de la formation, de l’évaluation et de la rétroaction, son opérationnalisation actuelle ne permet pas d’atteindre ces objectifs de façon systématique. Les auteurs proposent quelques initiatives pour améliorer la façon dont les résidents vivent les processus d’évaluation et de rétroaction dans le cadre de la FMFC.

Statistiques

Chargement des statistiques…

Références

Frank JR, Snell LS, Cate O Ten, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32:638–45. https://doi.org/10.3109/0142159X.2010.501190

ten Cate O. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ. 2017;17;34. https://doi.org/10.3205/zma001146

Tannenbaum D, Kerr J, Konkin J, et al. Triple C competency-based curriculum. report of the working group on postgraduate curriculum review – part 1. Coll Fam Physicians Canada. 2011;1:101.

Oandasan I, Wong E, Saucier D, Donoff M, Iglar K, Schipper S. Triple C: linking curriculum and assessment. Can Fam Physician. 2012;58:1165.

The Royal College of Physicians and Surgeons of Canada. What is CBD? Available from: https://www.royalcollege.ca/rcsite/cbd/what-is-cbd-e [Accessed Jun 30, 2020].

Ten Cate O, Scheele F, Ten Cate TJ. Viewpoint: competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82:542–7. https://doi.org/10.1097/ACM.0b013e31805559c7

Lockyer J, Carraccio C, Chan MK, et al. Core principles of assessment in competency-based medical education. Med Teach. 2017;39:609–16. https://doi.org/10.1080/0142159X.2017.1315082

Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: from flexner to competencies. Acad Med. 2002;77:361–7. https://doi.org/10.1097/00001888-200205000-00003

Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. A Core components framework for evaluating implementation of competency-based medical education programs. Acad Med. 2019;94:1002–9. https://doi.org/10.1097/ACM.0000000000002743

Oandasan IF, Saucier D, (eds). Triple C Competency-based Curriculum Report – Part 2 Advancing Implementation Mississauga, ON: College of Family Physicians of Canada; 2013. https://portal.cfpc.ca/resourcesdocs/uploadedFiles/Education/_PDFs/TripleC_Report_pt2.pdf. [Accessed Sept 20, 2020].

Cate O Ten, Carraccio C. Envisioning a true continuum of competency-based medical education, training, and practice. Acad Med. 2019;94:1283–8. https://doi.org/10.1097/ACM.0000000000002687

Gofton W, Dudek N, Barton G, Bhanji F. Workplace-based assessment implementation guide: Formative tips for medical teaching practice. The Royal College of Physicians and Surgeons of Canada. 2017;1st ed.:1–12. Available at: 12. http://www.royalcollege.ca/rcsite/documents/cbd/wba-implementation-guide-tips-medical-teaching-practice-e.pdf

Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32:676–82. https://doi.org/10.3109/0142159X.2010.500704

Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach. 2010;32:631–7. https://doi.org/10.3109/0142159X.2010.500898

Gruppen LD, ten Cate O, Lingard LA, Teunissen PW, Kogan JR. Enhanced requirements for assessment in a competency-based, time-variable medical education system. Acad Med. 2018;93:S17–21. https://doi.org/10.1097/ACM.0000000000002066

ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39:1176–7. https://doi.org/10.1111/j.1365-2929.2005.02341.x

Ellaway RH, Mackay MP, Lee S, et al. The impact of a national competency-based medical education initiative in family medicine. Acad Med. 2018;93:1850–7. https://doi.org/10.1097/acm.0000000000002387

Hsu T, De Angelis F, Al-asaaed S, Basi SK, Tomiak A, Grenier D, et al. Ten ways to get a grip on designing and implementing a competency-based medical education training program. Can Med Educ J. 2021;12. https://doi.org/10.36834/cmej.70723

ICE Blog. Introducing a core components framework for competency-based medical education. Available from: https://icenetblog.royalcollege.ca/2021/11/18/introducing-a-core-components-framework-for-cbme/ [Accessed on Dec 30, 2021].

Lim J, Westerman ME, Stewart NH, Correa R, Eno C. Trainee Perspectives on the writing and implementation of milestones 2.0. J Grad Med Educ. 2021;13:8–10. https://doi.org/10.4300/JGME-D-20-00859.1

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

Harrison CJ, Könings KD, Schuwirth L, Wass V, van der Vleuten C. Barriers to the uptake and use of feedback in the context of summative assessment. Adv Heal Sci Educ. 2015;20:229–45. https://doi.org/10.1007/s10459-014-9524-6

Iobst WF, Sherbino J, Cate O Ten, et al. Competency-based medical education in postgraduate medical education. Med Teach. 2010;32:651–6. https://doi.org/10.3109/0142159X.2010.500709

Mann S, Hastings Truelove A, Beesley T, Howden S, Egan R. Resident perceptions of Competency-Based Medical Education. Can Med Educ J. 2020;11:e31. https://doi.org/10.36834/cmej.67958

Upadhyaya S, Rashid M, Davila Cervantes A, Oswald A. Exploring resident perceptions of initial competency based medical education implementation. Can Med Educ J. 2021:e42–56. https://doi.org/10.36834/cmej.70943

Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident perceptions of assessment and feedback in competency-based medical education: a focus group study of one internal medicine residency program. Acad Med. 2020;95:1712–7. https://doi.org/10.1097/ACM.0000000000003315

Marcotte L, Egan R, Soleas E, Dalgarno NJ, Norris M, Smith CA. Assessing the quality of feedback to general internal medicine residents in a competency-based environment. Can Med Educ J. 2019;10:e32–47. https://doi.org/10.36834/cmej.57323

David V, Walsh M, Lockyer J, Mintz M. Entrustable professional activities: an analysis of faculty time, trainee perspectives and actionability. Can J Gen Intern Med. 2021;16:8–13. https://doi.org/10.22374/cjgim.v16i1.415

Hall AK, Rich J, Dagnone JD, et al. It’s a marathon, not a sprint: rapid evaluation of competency-based medical education program implementation. Acad Med. 2020;95:786–93. https://doi.org/10.1097/ACM.0000000000003040

Federation des medecins residents du Quebec. Year 3 of implementation of competence by design: negative impact still outweighs theoretical benefits observations on the day-to-day reality of CBD. 2020.

Schultz K, Griffiths J. Implementing competency-based medical education in a postgraduate family medicine residency training program: a stepwise approach, facilitating factors, and processes or steps that would have been helpful. Acad Med. 2016;91:685–9. https://doi.org/10.1097/ACM.0000000000001066

Hamza DM, Ross S, Oandasan I. Process and outcome evaluation of a CBME intervention guided by program theory. J Eval Clin Pract. 2020;26:1096–104. https://doi.org/10.1111/jep.13344

Ross S, Poth CA, Donoff MG, et al. Involving users in the refinement of the competency-based achievement system: An innovative approach to competency-based assessment. Med Teach. 2012;34. https://doi.org/10.3109/0142159X.2012.644828

Charmaz K, Belgrave LL. The SAGE handbook of interview research: the complexity of the craft. SAGE Handb Interview Res Complex Cr. 2nd ed. 2012;347–66. https://doi.org/10.4135/9781452218403.n25

Watling C, Lingard L. Grounded theory in medical education research: AMEE Guide No. 70. Med Teach. 2012;34:850–61. https://doi.org/10.3109/0142159x.2012.704439

Charmaz K. Constructing grounded theory: a practical guide through qualitative research. Sage Publications Ltd. London: SAGE Publications Ltd; 2006.

Apramian T, Cristancho S, Watling C, Lingard L. (Re)Grounding grounded theory: a close reading of theory in four schools. Qual Res. 2017;17:359–76. https://doi.org/10.1177/1468794116672914

Morse JM. The significance of saturation. Qual Health Res. 1995;5:147–9. https://doi.org/10.1177/104973239500500201

Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation: how many interviews are enough? Qual Health Res. 2017;27:591–608. https://doi.org/10.1177/1049732316665344

Martin L, Sibbald M, Brandt Vegas D, Russell D, Govaerts M. The impact of entrustment assessments on feedback and learning: trainee perspectives. Med Educ. 2020;54:328–36. http://dx.doi.org/10.1111/medu.14047

Schut S, Driessen E, van Tartwijk J, van der Vleuten C, Heeneman S. Stakes in the eye of the beholder: an international study of learners’ perceptions within programmatic assessment. Med Educ. 2018;52:654–63. https://doi.org/10.1111/medu.13532

Atkinson A, Watling CJ, Brand PLP. Feedback and coaching. Eur J Pediatr. 2021;1–6. https://doi.org/10.1007/s00431-021-04118-8

Watling C, Ginsburg S. Assessment, feedback and the alchemy of learning. Med Educ. 2019;53:76–85. https://doi.org/10.1111/medu.13645

MacNeil K, Cuncic C, Voyer S, Butler D, Hatala R. Necessary but not sufficient: identifying conditions for effective feedback during internal medicine residents’ clinical education. Adv Heal Sci Educ. 2020;25(3):641-654. https://doi.org/10.1111/medu.14154

Harrison C, Wass V. The challenge of changing to an assessment for learning culture. Med Educ. 2016;50:704–6. https://doi.org/10.1111/medu.13058

Ginsburg S, Watling CJ, Schumacher DJ, Gingerich A, Hatala R. Numbers encapsulate, words elaborate: toward the best use of comments for assessment and feedback on entrustment ratings. Acad Med. 2021;96:S81–6. https://doi.org/10.1097/ACM.0000000000004089

Malone K, Supri S. A critical time for medical education: The perils of competence-based reform of the curriculum. Adv Heal Sci Educ. 2012;17:241–6. https://doi.org/10.1007/s10459-010-9247-2

Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach. 2012;34:787–91. https://doi.org/10.3109/0142159x.2012.684916

Boet S, Pigford AAE, Naik VN. Program director and resident perspectives of a competency-based medical education anesthesia residency program in Canada: a needs assessment. Korean J Med Educ. 2016;28:157–68. https://doi.org/10.1111/medu.12637

Upadhyaya S, Rashid M, Davila Cervantes A, Oswald A. Exploring resident perceptions of initial competency based medical education implementation. Can Med Educ J. 2021;12(2):e42-e56. https://doi.org/10.36834/cmej.70943

Acai A, Li SA, Sherbino J, Chan TM. Attending emergency physicians’ perceptions of a programmatic workplace-based assessment system: the McMaster Modular Assessment Program (McMAP). Teach Learn Med. 2019;31:434–44. https://doi.org/10.1080/10401334.2019.1574581

Gaunt A, Patel A, Rusius V, Royle TJ, Markham DH, Pawlikowska T. ‘Playing the game’: How do surgical trainees seek feedback using workplace-based assessment? Med Educ. 2017;51:953–62. https://doi.org/10.1097/acm.0000000000001523

Leung WC. Competency based medical training: review. BMJ. 2002;325 (7366):693–6. https://doi.org/10.1136/bmj.325.7366.693

Pinsk M, Karpinski J, Carlisle E. Introduction of competence by design to Canadian nephrology postgraduate training. Can J Kidney Heal Dis. 2018;5. https://doi.org/10.1177/2054358118786972

Téléchargements

Publié-e

2022-10-25

Comment citer

1.
Branfield Day L, Colbourne T, Ng A, Rizzuti F, English E, Mungroo R, McDougall A. Étude qualitative sur l’expérience des résidents canadiens du modèle de formation médicale axée sur les compétences. Can. Med. Ed. J [Internet]. 25 oct. 2022 [cité 17 juill. 2024];14(2):40-5. Disponible à: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/72765

Numéro

Rubrique

Recherche originale