The CanMEDS newsletter series: New ways to talk about the ...€¦ · (Frank 2011). With the...

The CanMEDS newsletter series: New ways to talk about the C-word: Pssst…it’s still CanMEDS

1 | Page Sandhu G, Rich J and Walker G.R 2013

MedEd Publish www.mededworld.org

Title: New ways to talk about the C-word: Pssst…it’s still CanMEDS

Short title: New ways to talk about the C-word: Pssst…it’s still CanMEDs

Authors: Gurjit Sandhu, Jessica Rich and G. Ross Walker

Institution: Queen’s University

Corresponding author:

Dr. Sandhu, Postgraduate Medical Education, Faculty of Health Sciences, 70 Barrie Street,

Queen’s University, Kingston, Ontario, K7L 3N6, Canada; email: [email protected];

telephone: 613-533-6000 (ext. 77915); fax: 613-533-2132




Abstract

The CanMEDS competency framework reflects core abilities demonstrated by physicians in

meeting the needs of patients today. CanMEDS has been implemented across Canada by The

Royal College of Physicians and Surgeons of Canada, just as other national competency

frameworks are used around the world (Batalden, 2002). Oddly, given the evidence and

momentum of competency based education, medical educators and trainees at Queen’s

University still bristled at mention of CanMEDS. Authors sought feedback from faculty and

residents and learned that the lack of specificity relating to everyday practice as well as

reiteration of common examples made CanMEDS seem vague and/or meaningless. Attention

needed to be brought to the practical and experiential realities of CanMEDS. Authors took a

narrative approach and developed a communication and educational newsletter focused on

‘living CanMEDS.’ Each newsletter focused on a key competency relating to one role, but the

contributing elements were a diverse layering of physician voices discussing initiatives or work

they did relating to the CanMEDS role, popular culture, and educational content from accrediting

bodies. This innovation attempts to expand physicians’ perceptions of what it means to embody

each of the CanMEDS roles.




Introduction

The new challenge of CanMEDS is not in raising awareness about the framework; rather it is

how to engage learners without the audience becoming disgruntled about the C-word (Sherbino

et al. 2011; Whitehead et al. 2011a; Whitehead et al. 2011b). We approached residents and

faculty members involved in Postgraduate Medical Education at Queen’s University, Kingston,

Ontario, about this visceral response and learned many were tired of hearing about CanMEDS.

Residents explained they were dissatisfied with the rhetoric of CanMEDS without really

understanding what it meant in everyday practice. One resident said, “Since I don’t really know

what it means, it means nothing.” Faculty members felt they were already knowledgeable about

CanMEDS roles. Yet, when we listened to the discourse about CanMEDS, the same key

competencies, enabling competencies, and examples were touted. The full scope of competencies

captured within each CanMEDS role was vague or absent.

We are currently in a climate where schools of medicine thread CanMEDS through

undergraduate and postgraduate curricula, continuing medical education, and faculty

development (Frank 2005). Accrediting bodies are attuned to a competency based approach to

assessment (Batalden, 2002) and there is a global expectation for physicians to embody the core

competencies captured by the CanMEDS roles (Epstein, 2007; The Association of Faculties of

Medicine of Canada, 2012). It has become imperative that the discourse no longer be in

generalities with a purpose to garner buy-in to the framework. Instead, attention must be

brought to the practical and experiential realities of CanMEDS (Mickelson & MacNeily 2008).

The CanMEDS framework impacts a diverse group of stakeholders, namely educators, teachers,

trainees, practicing physicians, researchers, additional healthcare professionals and patients

(Frank 2005). Thus, we consciously narrowed the focus of our innovation to Postgraduate

Medical Education by targeting an audience of faculty members and residents.

The Problem at Hand: The need for innovation in CanMEDS education

Faculty and residents possess a strong understanding of what it means to embody each of the

CanMEDS roles in theory; however, they often demonstrate numerous roles and competencies

each day without knowing or recognizing their actions as being part of the CanMEDS framework

(Frank 2011). With the continued focus on competency based education (Batalden et al, 2002),

it is important for faculty and residents to have a strong sense of what CanMEDS competencies

look like in action, from small scale daily tasks to large scale initiatives and accomplishments.

Our objective was to show faculty and residents how physicians in various Postgraduate

Programs at Queen’s University are ‘living CanMEDS.’




The Proposed Solution: The CanMEDS newsletter series

In order to exemplify everyday activities demonstrating CanMEDS at Queen’s University, we

considered the following modes of information dissemination: print publications (such as

newsletters and magazines), conferences, or electronic methods (websites, emails and podcasts).

Understanding our audience has very small windows of free time dispersed throughout each day,

we decided to provide faculty and residents with an interesting and informative snapshot of

information that could be accessed when convenient. Additionally, we were looking to use an

established mode of communication that could effectively capture the voice of a colleague while

simultaneously including visual media. Existing pathways of communication used at Queen’s

include blogs and newsletters. The Dean of Health Sciences maintains a regular blog for the

purpose of provoking thought and interest in current health and wellness headlines. This is

complimented by an educational newsletter highlighting evidence based ideas for effective

teaching. Both of these tools demonstrate an existing institutional commitment to regular and

accessible threads of ongoing professional development.

With these factors in mind, the optimal solution involved creating a print publication that could

be printed and mailed, posted on a website and dispersed electronically through email. Our

requirements for the publication included an easy-to-read, colourful and esthetically pleasing

layout balancing image and text. The type of print publication we thought best complied with

our specifications was a short, one page double-sided newsletter (Appendix A).

To date, a palatable form of CanMEDS education did not exist at Queen’s University.

CanMEDS education typically surfaced during assessment feedback, at conference presentations

and in Grand Rounds; often involving educators stating common examples of collaboration,

communication, and so forth, rather than the interesting intricacies of each role. Most

importantly, the existing education failed to teach residents to recognize when and how they

currently demonstrate multiple CanMEDS roles at one time – even outside of duty hours while

pursuing personal interests. A newsletter held the potential to combine physician voice, extracts

from popular culture as well as educational content concerning CanMEDS provided in Train-the-

Trainer manuals (Lieff et al. 2009) produced by The Royal College of Physicians and Surgeons

of Canada (RCPSC).

The CanMEDS newsletter series consists of six issues annually, each highlighting one of the

non-medical expert CanMEDS roles and a specific key competency (Table 1).




Table 1. Samples of newsletter topics according to CanMEDS role and key physician

competency.

CanMEDS

role

Physician competency

Physicians are able to…. Newsletter topic

In this issue, we aim to highlight…

Communicator

“Accurately convey relevant

information and explanations to

patients and families, colleagues and

other professionals” (Communicator

key competency 3.0.)

Physicians who are explicitly

addressing the hidden curriculum and

transforming learning environments

for medical students and residents

Collaborator

“Participate effectively and

appropriately in an interprofessional

healthcare team” (Collaborator key

competency 1.0.)

Interprofessional collaborations that

help prepare senior residents for

transition to independent practice

Health

Advocate

“Respond to the health needs of the

communities that they serve” (Health

advocate key competency 2.0.)

Physicians in the Department of

Family Medicine (FM) advocating for

compassionate, person-centered care

of women’s health through

involvement in various unique

initiatives in the FM distributed sites

Manager

“Manage their practice and career

effectively” (Manager key competency

2.0.)

Physicians as managers of change;

utilizing and creating the latest tools

in technology and social media for the

purpose of educating residents and

improving patient care

Scholar

“Facilitate the learning of patients,

families, students, residents, other

health professionals, the public, and

others, as appropriate” (Scholar key

competency 3.0.)

Scholars who are informing residents’

learning and advancing clinical

practice through initiatives in

assessment

Professional

“Demonstrate a commitment to their

patients, profession, and society

through ethical practice” (Professional

key competency 1.0.)

Insights and strategies to assist

physicians in maintaining appropriate

professional boundaries with patients

and trainees

For example, an issue discussing physicians as managers emphasized physicians as “managers

of change; utilizing and creating the latest tools in technology and social media for the purpose

of educating residents and improving patient care” (Appendix A).




Ideally, each issue incorporates the voice of two faculty members or residents discussing

initiatives or work that they do relating to the CanMEDS role. Each contributor to the newsletter

is interviewed so that direct quotes are used to tell their personal story. Examples of

contributions have included a radiation oncology resident telling the story of how he began

developing medical applications for iPhones and a pediatrician describing how he uses social

media tools to communicate with patients and families (Appendix A). Both of these stories

demonstrate physicians managing change in technology in their respective fields, yet on the

surface, these physicians appear to be embodying the scholar and communicator roles

respectively.

In addition to showcasing six physician roles and their corresponding competencies, various

Postgraduate Programs are featured in each issue for the purpose of creating diversity in the

CanMEDS examples provided. Featuring diverse Postgraduate Programs also allows faculty and

residents a unique opportunity to hear about and perhaps adopt initiatives and activities

conducted by other specialties. The newsletter may also work to connect individuals with similar

interests.

The final component of each newsletter relates popular culture to the CanMEDS role and

competency. For instance, the issue demonstrating physicians managing change in technology

included an inspirational quote about change, credited to Apple Incorporated (2007). The

inclusion of such content serves to provoke faculty and residents to consider unconventional

illustrations of the CanMEDS roles in their daily lives, perhaps even outside of the clinic or

hospital. In doing so, our hope is that physicians develop a much deeper understanding of the

CanMEDS roles and begin to view them as part of their identity, passion and interests, rather

than an irritating extra responsibility that is imposed on their profession.

Discussion: Insight driving the innovation forward

Factors driving the successful implementation of a similar newsletter series include a strong

institutional commitment to CanMEDS education as well as continued support from the

Associate Dean. An educator’s lens is also invaluable in creating a finished product balancing

theory with practice. We encourage future developers to take a team approach in incorporating

the visions of those who are educationally minded, such as, but not limited to, the Associate

Dean of Postgraduate Medical Education, Educational Developers, Program Directors, Residents

and Education students.

Applying an understanding of education and learning theories will complement the development

of a newsletter serving as an educational tool. Bearing in mind that our readers are adult

learners, we structured the newsletter to comply with how adults learn best. Adult learning

theory states that adults learn from their experiences and prefer to learn about things that are a

good use of their limited time (Merriam 2001; Morrison et al. 2011). Narrative learning theory

suggests that stories make meaning of our experiences and that adults learn from reading others’

stories and telling their own (Charon 2007; Peterkin 2012). The newsletter enables both readers

and contributing authors to deepen their knowledge of the practicalities of CanMEDS through

personal accounts of work-related initiatives occurring daily at their home institution.




Therefore, a newsletter that is interesting to read and esthetically pleasing is also providing

multiple access points and interpretations that delve more deeply into the intricacies of the

CanMEDS roles. Moreover, the newsletters provoke a shift in mindset, where physicians begin

to consider CanMEDS competencies as salient to their identities as healthcare providers,

ultimately impacting their practice and patient care. This incremental change in how physicians

view the boundaries of what each competency entails negates the need to recycle conventional

examples and understandings of CanMEDS roles. The diverse content of the newsletters opens

up possibilities for CanMEDS to be thought of in new and innovative ways.

Success of the CanMEDS newsletter series requires a collaborative approach. The following

elements allow for project sustainability:

Professional associations, such as The Royal College of Physicians and Surgeons of

Canada and the College of Family Physicians of Canada, maintain a commitment to the

ongoing innovation of CanMEDS so that it continues to be a relevant and current

framework for physicians.

Institutional administrations express commitment and financial investment in support of

CanMEDS. In other words, funding and education personnel are essential to the sustained

production of the newsletters.

Physicians and authors maintain ongoing communication regarding initiatives

highlighting CanMEDS roles.

Readers continue to connect with physician narratives.

Recognizing that sustainability involves innovation, we aim to reach an audience of diverse

learners by considering new and multiple formats for dissemination. Beyond print copies and

downloadable versions, we aim to provide mobile learners with podcasts – enhancing

accessibility and adding depth to existing content.

Conclusion

Those interested in developing a similar newsletter series should note that the timeline for

implementation depends on the number of team members working on the project and their

qualifications. A mistake in development would be to discount the time and knowledge required

for graphics design, for example. Additional educator resources are also valued in developing

concepts for upcoming newsletters based on the content and contacts of prior newsletters.

In closing, we acknowledge that the CanMEDS newsletter series represents an incremental step

forward in transitioning an existing framework into a daily reality. This innovation attempts to

expand physicians’ perceptions of what it means to embody each of the CanMEDS roles.

Through providing interesting and timely, institution-specific examples of physician-led

initiatives, the newsletter series helps to draw attention to the daily practicality of CanMEDS

competencies.




Practice Points

Through hard copy and electronic medium, newsletters are an effective means of

reaching diverse learners.

Narrative approach and adult learning theory support the use of physician voices in

sharing and learning from personal experiences.

Providing institution-specific examples of how physicians’ current practices are bringing

CanMEDS roles to life.

An educator’s lens helps conceptualize and deepen understanding of CanMEDS roles

through the layering of educational materials, content from popular culture and physician

narratives.

For access to Queen’s University’s CanMEDS newsletter series, please see:

http://meds.queensu.ca/education/postgraduate/canmeds/newsletters

http://meds.queensu.ca/education/postgraduate/canmeds/newsletters




Declarations of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and

writing of this article.

Notes on Contributors

Gurjit Sandhu, PhD, MEd, BEd, BA is the Educational Developer of Postgraduate Medical

Education at Queen’s University, Kingston, Ontario, Canada.

Jessica Rich, BScH, BEd, is a Research Assistant in Postgraduate Medical Education at Queen’s

University, Kingston, Ontario, Canada

G. Ross Walker, MD, FRCSC, FACS, is Associate Dean of Postgraduate Medical Education and

Assistant Professor, Department of Surgery, Queen’s University, Kingston, Ontario, Canada.


10 | Page Sandhu G, Rich J and Walker G.R

2013


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Appendix A:



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