Explore the vast range of titles available.

The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.

The hidden curriculum has been investigated as a powerful force on medical student learning and ongoing physician professional development. Previous studies have largely focused on medical students’ experiences as ‘receivers’ of the hidden curriculum. This study examined how residents and newly graduated physicians conceived of their roles as active participants in the hidden curriculum. An interpretative phenomenological study was employed using individual, semi-structured interviews with residents and newly graduated physicians (n = 5) to examine their roles in perpetuating the hidden curriculum. A thematic analysis was conducted using a reflexive approach. Findings include insight into how residents and newly graduated physicians: (a) navigate the hidden curriculum for their own professional development; (b) intervene in others’ enactment of the hidden curriculum; and (c) seek to repair the hidden curriculum for the next generation through their teaching. In light of our findings, we argue that: (a) more research is needed to understand how early career physicians navigate their engagement with the hidden curriculum; (b) students and educators be supported to consider how their agency to impact the hidden curriculum is influenced by the sociocultural context; and (c) residents and early career physicians are poised to powerfully impact the hidden curriculum through the learning environments they create.

Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation. To develop a conceptual model of clinical supervision to inform and guide policy and research. Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with an urban Canadian medical school. Members of 12 Internal Medicine and Emergency Medicine teaching teams (n = 88) were observed during regular clinical activities (216 hours). Sixty-five participants (12 physicians, 28 residents, 17 medical students, 8 nurses) also completed interviews about supervision. Field notes and interview transcripts were analyzed for emergent themes using grounded theory methodology. The term \"clinical oversight\" was developed to describe patient care activities performed by supervisors to ensure quality of care. \"Routine oversight\" (preplanned monitoring of trainees' clinical work) can expose supervisors to concerns that trigger \"responsive oversight\" (a double-check or elaboration of trainees' clinical work). Supervisors sometimes engage in \"backstage oversight\" (oversight of which the trainee is not directly aware). When supervisors encounter a situation that exceeds a trainee's competence, they move beyond clinical oversight to \"direct patient care\". This study elaborates a typology of clinical oversight activities including routine, responsive, and backstage oversight. This new typology provides a framework for clinical supervision policy and for research to evaluate the relationship between supervision and safety.

A new approach to testing operative technical skills, the Objective Structured Assessment of Technical Skill (OSATS), formally assesses discrete segments of surgical tasks using bench model simulations. This study examines the interstation reliability and construct validity of a large-scale administration of the OSATS. A 2-hour, eight-station OSATS was administered to 48 general surgery residents. Residents were assessed at each station by one of 48 surgeons who evaluated the resident using two methods of scoring: task-specific checklists and global rating scales. lnterstation reliability was 0.78 for the checklist score, and 0.85 for the global score. Analysis of variance revealed a significant effect of training for both the checklist score, F(3,44) = 20.08, P < 0.001, and the global score, F(3,44) = 24.63, P < 0.001. The OSATS demonstrates high reliability and construct validity, suggesting that we can effectively measure residents' technical ability outside the operating room using bench model simulations.

Background: This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. Methods: Twenty-three first-year residents were randomly assigned to three groups receiving teaching on six procedures. For each procedure, one group received training on a cadaver model, one received training on a bench model, and one learned independently from a prepared text. Following training, all residents were assessed on their ability to perform the six procedures. Results: Repeated measures analysis of variance revealed a significant effect of training modality for both checklist scores (F 2,44 = 3.49, P <0.05) and global scores (F 2,44 = 7.48, P <0.01). Post-hoc tests indicated that both bench and cadaver training were superior to text learning and that bench and cadaver training were equivalent. Conclusions: Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.

Reliable and valid methods to evaluate student competence are needed in social work education, and practice examinations with standardized clients may hold promise for social work. The authors conducted a critical appraisal of standardized client simulations used in social work education to assess their effectiveness for teaching and for evaluating social work students' competence. Following a comprehensive search, 18 studies, including 515 social work students, were examined. The authors extracted data from these studies and study methods and assessed the results. This review found that studies vary in methodological quality; however, using standardized client simulations is well-received by students. Consistent implementation methods and reliable, valid assessment measures are needed to advance this evaluation method for social work.

Learning to take safe and effective action in complex settings rife with uncertainty is essential for patient safety and quality care. Doing so is not easy for trainees, as they often consider certainty to be a necessary precursor for action and subsequently struggle in these settings. Understanding how skillful clinicians work comfortably when uncertain, therefore, offers an important opportunity to facilitate trainees’ clinical reasoning development. This critical review aims to define and elaborate the concept of ‘comfort with uncertainty’ in clinical settings by juxtaposing a variety of frameworks and theories in ways that generate more deliberate ways of thinking about, and researching, this phenomenon. We used Google Scholar to identify theoretical concepts and findings relevant to the topics of ‘uncertainty,’ ‘ambiguity,’ ‘comfort,’ and ‘confidence,’ and then used preliminary findings to pursue parallel searches within the social cognition, cognition, sociology, sociocultural, philosophy of medicine, and medical education literatures. We treat uncertainty as representing the lived experience of individuals, reflecting the lack of confidence one feels that he/she has an incomplete mental representation of a particular problem. Comfort, in contrast, references confidence in one’s capabilities to act (or not act) in a safe and effective manner given the situation. Clinicians’ ‘comfort with uncertainty’ is informed by a variety of perceptual, emotional, and situational cues, and is enabled through a combination of self-monitoring and forward planning. Potential implications of using ‘comfort with uncertainty’ as a framework for educational and research programs are explored.