Liaison and Engagement Consultant Report

Liaison and Engagement Consultant

ReportPresentation to the

FMEC PG Steering Committee andPG Deans Advisory Committee

February 7, 2011

Completed Consultations (Jan 31/2011)

FMEC Postgraduate Project 2 Liaison and Engagement

Stakeholders Completed

Educators * 37

Academic Chairs 14

Students/Residents 12

Government 9

Nursing & Allied Health 6

Hospital Authorities 3

Medical Associations 11

Colleges 15

Other 5

Total 112

* Deans, PG Deans, UG Deans, Program Directors, Education Councils, etc.

Completed Consultations (cont’d)


Stakeholders National West ON/MN PQ/Atlantic Total

Educators 10 12 7 8 37

Academic Chairs 11 1 2 - 14

Students/Residents 2 4 3 3 12

Government 1 6 - 2 9

Nursing & Allied Health 6 - - - 6

Hospital Authorities 1 - 1 1 3

Medical Associations 2 3 1 5 11

Colleges 7 3 2 3 15

Other 2 1 2 2 5

Total 42 30 16 24 112

Mandate of the LEC Team

• Liaise between the FMEC PG Steering Committee and the Canadian PGME community

• Raise awareness of project• Solicit issues, concerns, priorities

and successes


Organization of the Comments

• Organized under six broad themes:– Strengths of the PGME system– Purpose of PGME in Canada– Governance and processes– Pedagogy– Transitions– Financial and human resources


Organization (cont’d)

• Significant overlap across many themes – but issues have generally been identified under only one theme.

• Vulnerabilities, risks and opportunities are grouped together under themes.

• All “blue sky” ideas are provided in appendix to the LEC report


Interpretive Cautions

• Stakeholders were asked for opinions and ideas – not evidence

• Counts are not provided:– The number of participants in each

meeting varied, and not all opinions were consensus opinions

• Priorities are not assigned:– For similar reasons, we could not assign

priorities or weights to the issues


1. Strengths

• University-based system:– Focus on education over service delivery– Focus on evidence-based practice– Exposure to clinical research

• Accreditation process:– National standards create consistent

quality– Rigor of standards creates high quality– On-site, peer reviews are valued


1. Strengths (cont’d)

• CanMEDS:– Keeps focus on all competencies

• Less frequently mentioned:– Scope and quantity of clinical exposure– National CaRMS match– Quality and dedication of PGME faculty


2. Purpose of PGME

• Disconnect between society’s needs and PGME “outputs”:– Trend to specialization when generalists are

needed– Need for focus on chronic disease management– Need for greater focus on geriatrics and mental

health, rather than surgery and paediatrics– Need to address crisis in mental health, aging

population, and marginalized populations.


2. Purpose of PGME (cont’d)

• Need for stronger patient focus:– Put needs of patients before the needs of

residents– Achieve full potential of the CanMEDS framework– Embrace inter-professional care and continuity of

care in a meaningful way– Pay more than lip service to patient safety and

patient satisfaction– Develop effective strategies to recruit and retain

physicians in rural, remote and northern communities (role of FP at risk in some communities)


2. Purpose of PGME (cont’d)

• Need for a Health Human Resources Plan:– National initiative– Data-driven, reflecting population demographics – Reflective of changes in models of care, advances

in technology and new research.– Involving all primary health care professions

• Change in educational strategy:– Educate health professionals to span the

boundaries between specialties rather than extended specialty education


3. Governance and Processes

• Complex governance structure should be streamlined

• Accreditation processes:– Perceived as onerous– Desire for more than just written feedback– Can contribute to unnecessarily protracted training

• Leadership:– Need to “step up to the plate” in health human

resources planning– Respond to erosion of public accountability within

medical profession


3. Governance and Processes

• Student Selection:– Although a UGME issue, the impacts on PGME

are profound– Need for greater emphasis on:

• Desired characteristics related to non-medical expert CanMEDS roles

• Probability of practising in remote or rural locations

– More career counselling is desired to match interests, aptitudes and employment opportunities


3. Governance and Processes (cont’d)

• Resident Assessment– Need for more information to follow learners

from UG to PG to practice– More frequent and ongoing assessment, and

less emphasis on final examinations– Need for development of self-assessment skills– “Unionization” of resident population

reportedly affecting educators’ motivation to provide meaningful assessments



• Resident Assessment– Need for more information to follow learners from UG

to PG to practice– More frequent and ongoing assessment, and less

emphasis on final examinations.– Need for development of self assessment skills– “Unionization” of resident population reported

affecting educators’ motivation to provide meaningful assessments

– No reliable models or tools for teaching and assessment of CanMEDS competencies, and inconsistent appreciation of CanMEDS among supervisors



• Accreditation– Concerns regarding standards, structure and time-

intensive administrative burden of accreditation-related processes:

• Barrier to innovation and flexibility• For some specialties, standards believed to be no longer

relevant for contemporary practice.• Process is onerous for participating universities



• Length of Training– Specialty programs generally perceived as

unnecessarily protracted:• Trend to subspecialization and complexity of medical practice• Desire for one or more fellowships (improve employment

options and/or not yet confident to enter independent practice)• Entering practice in mid-thirties is unprecedented in other

professions• Trend to shorter work week for residents may lead to longer

training if approach to education is not radically altered

– Suggested strategies to shorten training:• Graduated licensure• Funded sabbaticals to acquire additional credentials



• Streaming– Much discussion – and little consensus – on current

streaming practices– Suggested streaming strategies included:

• Choose a specialty later in training (instead of second year of medical school)

• Allow medical students to begin specialization immediately• Provide flexibility in the system so that student or resident

can change specialties mid-stream• Tailor training to meet the individualized needs of the

learner• Reintroduce the rotating internship• Remove requirement of generalist courses for technical

specialist



• Flexibility of Training– Need for more flexibility within the system:

• More flexible and individualized career paths for residents

• Opportunity to re-enter formal education after graduation

• Flexibility to change or introduce programs at local or regional level



• Resident Association Agreements– Perceived to have gone beyond wellness

issues and are creating issues for educators

– Shorter work week has many repercussions:

• Potential for longer training time• Reduction of service component affecting

hospitals’ manpower and resident remuneration

• Impact on continuity of care


4. Pedagogy

• Models of Education:– Desire for more innovative models of education,

including competency-based education– Desire for more collaboration and harmonization

across jurisdictions and institutions (including sharing of materials and best practices)

• Curriculum Improvements– Need for more effective teaching of inter-

professional and intra-professional care– Need to teach about clinical systems


4. Pedagogy (cont’d)

• Faculty Development:– Educators feel they do not have skills or tools to

assess non-medical expert competencies– Trend to distributed sites creates challenges for

ensuring quality of teaching faculty across all sites

• Adoption of Technology:– Use of simulation– Web-based learning, especially to support DME– Use of telecommunications and social networking



• Competency-based Education:– Considerable interest in CBE, especially to

shorten training period and contribute to ongoing rather than episodic assessment

– Concern about logistical implications (e.g., variable length of rotations, unpredictability of length of rotations and timing of completion)

– Concern that focus would shift to those competencies that are easily quantified (e.g., technical expertise and knowledge)



• Distributed Medical Education:– Perceived as necessary – to increase

capacity for PGME– Perceived as desirable – to better prepare

residents for community-based practice– Creates challenges for:

• Faculty development and support• Accreditation processes• Identifying and dealing with poor resident

performance



• Transitions:– Need more emphasis on continuous learning –

from admission to retirement– Transitions are too abrupt – need strategies to

smooth such as:• Rotating internship• Graduated licensure• More gradual reduction of supervision during residency

– More emphasis on life-long learning, perhaps reinforced by a modified fee schedule

– Better support to independent practice


5. Human and Financial Resources

• Human Resource Shortages– Trend to DME is frustrated by shortage of

community-based preceptors:• Reduces physician time available to meet clinical

workload• Fee schedule does not remunerate for teaching time• “Volunteerism” is not a sustainable strategy

– Trend to shorter work week makes teaching less attractive for physicians in academic centres as well (due to reduced contribution to service delivery)


5. Human and Financial Resources (cont’d)

• Issues with Current Funding– PGME is subsidized by clinical practice plans

and hospitals– Funding for PGME has not kept up with

inflation or growth– Funding does not recognize additional

resources to supervise, assess and remediate IMGs

– Inconsistent remuneration policies, especially for community-based preceptors



• Remuneration for Residents– Residents are seeking consistent

remuneration across programs and provinces– Residents also looking for additional

financial, educational, personal and developmental supports

– Other stakeholders suggested remuneration is for service delivery, and as education to service ratio increases, remuneration should decrease



• Continued Financial Pressures– Expectation that current fiscal pressures will

persist in medium term, resulting in risk of reduced funding for hospitals, universities and physicians

– Need to demonstrate that medical education is as cost-effective as possible:

• Use technology to reduce labour intensity• Work with other health professions to ensure all

professions working to maximum scope of practice


Round 2 Consultations

• Purpose:– To discuss the FMEC PG Steering

Committee's draft recommendations as they emerge

• Stakeholders are expecting a second round of consultations


Round 2 Consultations (cont’d)

• Suggested Approach to Round 2:1. Circulate recommendations electronically,

soliciting input on overall content and direction and identify any major omissions

2. Conduct additional consultations with up to 10 national organizations to solicit feedback

3. Organize ‘town hall’ meetings at each of the 17 medical schools to solicit feedback

4. Participate in the CCME (May 2011) and ICRE (Sept 2011)


Comments and Questions?

Documents

Liaison and Engagement Consultant Report