Dear Colleagues,

You will recall that in 2010 the Royal College produced a series of white papers to complement and inform the Future of Medical Education in Canada – Postgraduate Project, or FMEC-PG. The overarching goal of FMEC-PG was to ensure that physicians practising in Canada continue to acquire the education and skills they need to serve their communities. As such, the FMEC-PG Project was consistent with our white paper recommendations and our commitment to pursue competency-based medical education, or CBME, a movement that has taken root in many countries around the world — most notably in the United States, Australia and the Netherlands.

When our white papers were in production, we asked members for their input so that we could heighten the papers’ quality, relevance and influence, as well as make sure that they would reflect the collective vision of the Royal College on the complex and important issues involved. Members were generous with their suggestions, supplementing the hard work of the many external experts and senior leaders at the Royal College. The white papers are currently being edited and will soon be published under the banner of Competence by Design. Today, many of the recommendations from those papers are being implemented through a Royal College program that will usher in a new era of CBME.

Many Fellows wonder why change is necessary
Canada’s medical education system was developed more than 100 years ago around a “time-based” locations-specific model (time spent in specific residency rotations) in which students completed their medical training and specialization, and were certified for life. Until relatively recently, we assumed that physicians gain all the experience they need in practice — in essence, that their competency deepens and expands throughout their careers, making further qualification unnecessary.

Assumptions require examination. Evidence demonstrates that while there is a steep learning curve during residency, competency may decrease over time. Advancing from proficiency to mastery requires dedicated effort throughout a specialist’s career to prevent deterioration across the breadth of practice. More than that, medical technologies, procedures and research are changing swiftly. In such an environment, physicians must continually transfer new skills and knowledge into their practice. The evidence shows that this is not happening nearly to the extent that it should, in particular for aging physicians.

In addition, the medical system itself is shifting and changing exponentially. Canadians have greater expectations today for high-quality, timely and safe care than they did even 20 years ago. Physicians need a medical education system that enables them to be more accountable and demonstrate that they are maintaining and/or enhancing their competency and performance over time.

Updating the CanMEDS Physician Competency Framework
So change is needed. The Royal College’s first priority — and the foundational project in our effort to evolve our approach to medical education in Canada — is to further align the CanMEDS Physician Competency Framework to enable the transition towards CBME. In the fall of 2012, we began a three-year project to undertake this work, which will launch in 2015. Here is a summary of what we have planned.

We anticipate that the CanMEDS Roles will remain the same, reflecting the core knowledge, skills and abilities of specialist physicians: the Medical Expert, the Communicator, the Collaborator, the Manager, the Health Advocate, the Scholar and the Professional.

The key shift will be the creation of competency milestones for each CanMEDS Role that can be applied in both residency and throughout a physician’s career. (Milestones are the abilities expected of a physician or trainee at specific points in their development as professionals and are fundamental to CBME.) As such, the CanMEDS milestones will mark a physician’s progression of competence from the start of medical training into practice until retirement. Milestones describe clearly defined targets that will guide learning and assessment, helping learners better focus their activities. We have full confidence that a revamped CanMEDS Framework will become essential to guide learning during residency and throughout practice.

The updated CanMEDS Framework and milestones will enable specialists to demonstrate that they are maintaining their performance over time and are current with constantly evolving medical research, technologies and procedures — and know when to adopt these changes in their practice. For residents, the framework and milestones will be key to identifying areas that need improvement before they sit for their exams.

The Royal College also plans to integrate new content and themes under each CanMEDS Role, such as patient safety, interprofessionalism and accountability for continuity of care. We will create new faculty development and resource tools to support frontline educators who have asked us for practical strategies that make it easier for them to teach and assess each CanMEDS Role.

Over the next few years, the updated framework and milestones will also guide changes to our policies and practices across the organization’s entire cycle of medical education and assessment to align with a CBME approach.

We need your input

To succeed, the Royal College will solicit input and feedback from our many stakeholders, in particular from the Fellows that this important evolution will affect the most. As one example, we plan to host at least two rounds of national consultations in 2013 and 2014.

In the meantime, I ask that you add your voice to our ongoing discussions.

How can CanMEDS be tailored to suit the emerging CBME needs of Canada’s specialist physicians?

How can CanMEDS be tailored to serve the needs of residents?

Share your ideas with us and read other Fellows’ perspectives by using the blog comment function below.


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer

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