Emerging concepts in the CanMEDS physician competency framework
DOI:
https://doi.org/10.36834/cmej.75591Abstract
Background: The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies.
Methods: Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted.
Results: 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts.
Conclusion: This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.
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References
Frank J. The CanMEDS Project: The Royal College of Physicians and Surgeons of Canada moves medical education into the 21st Century. In Ottawa, ON: Royal College of Physicians and Surgeons of Canada; 2004; p. 8. Available from: https://www.researchgate.net/publication/271702100_A_history_of_CanMEDS_-_chapter_from_Royal_College_of_Physicians_of_Canada_75th_Anniversary_history [Accessed Feb 11, 2022].
Frank J. The CanMEDS 2005 Physician Competency Framework. 2005. Available from: http://rcpsc.medical.org/canmeds/CanMEDS2005/CanMEDS2005_e.pdf [Accessed Feb 1, 2022].
Frank JR, Snell L, Sherbino J Editors. CanMEDs 2015 Physician Competency Framework. 2015 p. 1-30. Available from: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications
Shaw E, Oandasan I, Fowler N, editors. CanMEDS-FM 2017: A competency framework for family physicians across the continuum. Mississauga, ON: The College of Family Physicians of Canada; 2017.
Peterkin A, Roberts M, Kavanagh L, Havey T. Narrative means to professional ends: new strategies for teaching CanMEDS roles in Canadian medical schools. Can Fam Physician. 2012 Oct 1;58(10):e563-9.
Shadid AM, Bin Abdulrahman AK, Bin Dahmash A, et al. SaudiMEDs and CanMEDs frameworks: similarities and differences. Adv Med Educ Pract. 2019;10:273-8. https://doi.org/10.2147/AMEP.S191705
Koster AS, Mantel-Teeuwisse AK, Woerdenbag HJ, et al. Alignment of CanMEDS-based undergraduate and postgraduate pharmacy curricula in The Netherlands. Pharmacy. 2020 Sep;8(3):117. https://doi.org/10.3390/pharmacy8030117
Frank JR, Langer B. Collaboration, communication, management, and advocacy: teaching surgeons new skills through the CanMEDS Project. World J Surg. 2003 Aug 1;27(8):972-8. https://doi.org/10.1007/s00268-003-7102-9
Abi-Rafeh J, Safran T, Azzi AJ. COVID-19 pandemic and medical education: a medical student's perspective. Can Med Educ J. 2020 Sep;11(5):e118-20. https://doi.org/10.36834/cmej.70242
Brown A, Kassam A, Paget M, Blades K, Mercia M, Kachra R. Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners. Can Med Educ J. 2021 Jun;12(3):28-43. https://doi.org/10.36834/cmej.71149
Cherak SJ, Brown A, Kachra R, et al. Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions. Can Med Educ J. 2021 Jun;12(3):54-69. https://doi.org/10.36834/cmej.70995
Giuliani M, Samoil D, Agarwal A, et al. Exploring the perceived educational impact of COVID-19 on postgraduate training in oncology: impact of self-determination and resilience. Can Med Educ J. 2021 Feb;12(1):e180-1. https://doi.org/10.36834/cmej.70529
Li HOY, Bailey AMJ. Medical education amid the COVID-19 Pandemic: New Perspectives for the Future. Acad Med J Assoc Am Med Coll. 2020 Nov;95(11):e11-2. https://doi.org/10.1097/ACM.0000000000003594
Thoma B, Monteiro S, Pardhan A, Waters H, Chan T. Replacing high-stakes summative examinations with graduated medical licensure in Canada. CMAJ. 2022 Feb 7;194(5):E168-70. https://doi.org/10.1503/cmaj.211816
Hall AK, Nousiainen MT, Campisi P, et al. Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic. Med Teach. 2020 Jul 2;42(7):756-61. https://doi.org/10.1080/0142159X.2020.1766669
Dinh-Le C, Chuang R, Chokshi S, Mann D. Wearable health technology and electronic health record integration: scoping review and future directions. JMIR MHealth UHealth. 2019 Sep 11;7(9):e12861. https://doi.org/10.2196/12861
Gostin LO, Halabi SF, Wilson K. Health data and privacy in the digital era. JAMA. 2018 Jul 17;320(3):233-4. https://doi.org/10.1001/jama.2018.8374
Social determinants of health inequities in Indigenous Canadians through a life course approach to Colonialism and the residential school system. Health Equity. Available from: https://www.liebertpub.com/doi/full/10.1089/heq.2019.0041 [Accessed on Feb 18, 2022].
Cuevas AG, Ong AD, Carvalho K, et al. Discrimination and systemic inflammation: a critical review and synthesis. Brain Behav Immun. 2020 Oct 1;89:465-79. https://doi.org/10.1016/j.bbi.2020.07.017
Homan P. structural sexism and health in the United States: a new perspective on health inequality and the gender system. Am Sociol Rev. 2019 Jun 1;84(3):486-516. https://doi.org/10.1177/0003122419848723
Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40(1):105-25. https://doi.org/10.1146/annurev-publhealth-040218-043750
Myers SS. Planetary health: protecting human health on a rapidly changing planet. The Lancet. 2017 Dec 23;390(10114):2860-8. https://doi.org/10.1016/S0140-6736(17)32846-5
Van Melle E. New and emerging concepts as related to the CanMEDS roles: overview. Royal College of Physicians and Surgeons of Canada; 2015. Available from: https://www.royalcollege.ca/rcsite/documents/canmeds/emerging-concepts-e.pdf [ Accessed on Feb 1, 2022].
Pappas C, Williams I. Grey literature: its emerging importance. J Hosp Librariansh. 2011 Jul;11(3):228-34. https://doi.org/10.1080/15323269.2011.587100
Maguire M, Delahunt B. Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars. Irel J High Educ . 2017 Oct 31;9(3). Available from: https://ojs.aishe.org/index.php/aishe-j/article/view/335 [Accessed on Feb 17, 2022]
Zotero. Roy Rosenzweig Center for History and New Media; 2022. Available from: https://www.zotero.org/
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019 Aug 8;11(4):589-97. https://doi.org/10.1080/2159676X.2019.1628806
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan 1;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
Barnabe C, Osei-Tutu K, Maniate JM,et al. Equity, diversity, inclusion, and social justice in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75845
Osei-Tutu K, Duchesne N, Barnabe C, et al. Anti-racism in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75844
Waters HM, Oswald A, Constantin E, Thoma B, Dagnone JD. Physician humanism in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75536
Thoma B, Paprica PA, Kaul P, Cheung WJ, Hall AK, Afflect E. Data-informed medicine in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75440
Van Aerde J, Gomes MM, Giuliani M, Thoma B, Lieff S. Complex Adaptive systems in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75538
Hall J, Atkinson A, Chan MK, Tourian L, Thoma B, Pattani R. The clinical learning environment in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75537
Stovel RG, Dubois D, Chan TM, Snell L, Thoma B, Ho K. Virtual care in CanMEDS 2025. Can Med Educ J. 2023; https://doi.org/10.36834/cmej.75439
Young M, Szulewski A, Anderson R, Thoma B, Monteiro S. Clinical reasoning in CanMEDS 2025. Can Med Educ J. 2023; https://doi.org/10.36834/cmej.75843.
Cupido N, Fowler N, Sonnenberg LK et al. Adaptive expertise in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75445
Green S, Labine N, Luo OD, et al. Planetary health in CanMEDS 2025. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75438
Greenwood M, Leeuw S de, Lindsay N. Challenges in health equity for Indigenous peoples in Canada. The Lancet. 2018 Apr 28;391(10131):1645-8. https://doi.org/10.1016/S0140-6736(18)30177-6
Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada: Calls to Action. Winnipeg, Manitoba; 2015 Available from: https://ehprnh2mwo3.exactdn.com/wp-content/uploads/2021/01/Calls_to_Action_English2.pdf [Accessed on Feb 16, 2022].
Solomon CG, LaRocque RC. Climate Change - A Health Emergency. N Engl J Med. 2019 Jan 17;380(3):209-11. https://doi.org/10.1056/NEJMp1817067
Walpole SC, Barna S, Richardson J, Rother HA. Sustainable healthcare education: integrating planetary health into clinical education. Lancet Planet Health. 2019 Jan;3(1):e6-7. https://doi.org/10.1016/S2542-5196(18)30246-8
Hackett F, Got T, Kitching GT, MacQueen K, Cohen A. Training Canadian doctors for the health challenges of climate change. Lancet Planet Health. 2020 Jan;4(1):e2-3. https://doi.org/10.1016/S2542-5196(19)30242-6
Denecke K, Gabarron E, Petersen C, Merolli M. Defining participatory health informatics - a scoping review. Inform Health Soc Care. 2021 Sep 2;46(3):234-43. https://doi.org/10.1080/17538157.2021.1883028
Webster P. Virtual health care in the era of COVID-Lancet Lond Engl. 2020;395(10231):1180-1. https://doi.org/10.1016/S0140-6736(20)30818-7
Uhl-Bien M. Complexity and COVID-19: leadership and followership in a complex world. J Manag Stud. 2021;58(5):1400-4. https://doi.org/10.1111/joms.12696
Kannampallil TG, Goss CW, Evanoff BA, Strickland JR, McAlister RP, Duncan J. Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS ONE. 2020 Aug 6;15(8):e0237301. https://doi.org/10.1371/journal.pone.0237301
Mylopoulos M, Kulasegaram K, Woods NN. Developing the experts we need: fostering adaptive expertise through education. J Eval Clin Pract. 2018;24(3):674-7. https://doi.org/10.1111/jep.12905
Merchant RM, Topjian AA, Panchal AR, et al. Part 1: executive summary: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S337-57. https://doi.org/10.1161/CIR.0000000000000918
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Copyright (c) 2022 Brent Thoma, Anna Karwowska, Louise Samson, Nicole Labine, Heather Waters, Meredith Giuliani, Teresa M Chan, Adelle Atkinson, Evelyn Constantin, Andrew K Hall, Carlos Gomez-Garibello, Nancy Fowler, Leon Tourian, Jason Frank, Rob Anderson, Linda Snell, Elaine Van Melle
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