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 Table of Contents  
INVITED EDITORIAL
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 154-156

Trends and opportunities in medical education: Aligning to societal needs and expectations


Vice President of Education for The Ottawa Hospital, Chief of Medical Education, Research and Scholarship, Academic Director-Medical Education Teaching Clinic (METC); Assitant Professor, Faculty of Medicine University of Toronto, ON, Canada

Date of Web Publication15-Dec-2017

Correspondence Address:
Jerry M Maniate
St. Joseph's Health Centre, 30 The Queensway, Toronto, ON, M6R 1B5
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_98_17

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How to cite this article:
Maniate JM. Trends and opportunities in medical education: Aligning to societal needs and expectations. Arch Med Health Sci 2017;5:154-6

How to cite this URL:
Maniate JM. Trends and opportunities in medical education: Aligning to societal needs and expectations. Arch Med Health Sci [serial online] 2017 [cited 2018 Aug 14];5:154-6. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/154/220841




  Introduction Top


We are living in interesting times, and I would say opportune times. At all levels of society, and in nearly all corners of the globe, there have been tremendous pressures and calls for change. Whether it comes in the political realms with the recent waves of populism and empowerment of disenfranchised population resulting in instability or at the very least uncertainty, or in health care with the increased demands for access to basic coverage all while the system is surging ahead with advances in drugs, devices, and care delivery and doing so within increasing financial constraints. Both medical education and the broader domain of health professional education are embedded within these environments and thus inevitably will either be shifted by it or more dramatically transformed by it. Thus, there is a need to engage in the discussions occurring within the communities we reside and work in, to understand the pressures and to identify the opportunities, in order to not only align with societal needs but also modulate societal expectations to reflect shifting realities.

What are stakeholders in the healthcare system looking for? Our patients are demanding more compassionate care with better healthcare outcomes – safer patient care and improved quality. Our communities are expecting that the medical education system will meet societal needs, but there is also a realization that we have a role to shape or frame expectations in reality. Our medical trainees need to be prepared for the ever-expanding and changing healthcare environment that they will step into, but they are expecting a more supportive educational ecosystem than our predecessors experienced. Our faculty are needing to be equipped for shifting beyond role model to that of teacher, coach, and facilitator, skill sets for which many of them have not been prepared for, in addition to maintaining busy clinical practices and recognized for their involvement. These are not new findings as noted in the reviews of the current state and future directions of medical education that many organizations and jurisdictions conducted in conjunction with the centenary of Flexner's seminal report.[1]


  Trends Top


Over the past decade, there have been several trends impacting medical education that are shaping the transformations that we are now beginning to experience. The first trend has occurred as organizations and institutions develop and adopt educational frameworks, such as the Royal College of Physicians and Surgeons of Canada CanMEDS 2015 Framework.[2] These frameworks are increasingly being adopted by other jurisdictions and have been integral to shift curricular, assessment, and accreditation systems. The second trend is that they have also served as the foundation of the shift to competency-based medical education that incorporates concepts such as milestones and entrustable professional activities.[3],[4],[5] These not only are beginning to be implemented with varying degrees of support but also are growing concerns about feasibility and utility.[6] These two trends are part of a larger third trend relating to the globalization of medical education, where educational frameworks, accreditation standards, curricular methods, and assessment techniques are spilling across borders and adopted often without the necessary caution of contextualization and adaption.[7],[8] Additional trends have included patients and communities calling for increased compassion and caring from healthcare providers (Associated Medical Services Phoenix Project) and the impact of restricted work hours as mandated by the Accreditation Council for Graduate Medical Education regulation and the European Working Time Directive for medical trainees to improve patient safety and optimize learning.[9],[10]


  Opportunities Top


Contextualized learning and assessment of nonmedical expert roles

Patients and families assume that we will be medical experts. They expect that our current medical education system will ensure that our trainees and faculty will have the appropriate knowledge and skills to understand the diagnosis and management that they will require. What they expect however is that we purposefully address the non-Medical Expert (Intrinsic) Roles, such as Communicator, Collaborator, Health Advocate, Scholar, Leader, and Professional as enunciated in educational frameworks such as CanMEDS. These roles are understood to be both situated and context-bound, and in contrast to the traditional methods, we utilize for medical expertise they will require an investment of resources and effort as well as an exploration of the social sciences to identify new approaches to teaching and assessment.[11]

In addition, as we shift from apprenticeship models of medical education, there is an increasing need to appropriately craft and communicate specific goals and objectives that will guide our teaching and assessment systems. This will transform the often-nebulous clinical experiences of traditional rotations into high-value focused opportunities, ones in which both learners and faculty have clarity as to educational expectations. Implementing a robust system of assessment that permits multiple samples of an individual, much like obtaining multiple biopsies of a tumor can increase accuracy in diagnosis. Using performance-based assessments, such as multisource feedback, mini-clinical evaluation exercise, and direct observation of procedural skills, but also measures such as reflective practice can assist as we attempt to identify authentic, pragmatic, and meaningful markers of performance not only to assess the competence of medical trainees but also to practicing clinicians to ensure their ongoing competence.[12],[13]

Direct observation and formative feedback

With the adoption of models of competency-based medical education, it has been recognized that enablers such as direct observation and formative feedback will be required to ensuring competency and consistency in performance. These are not new comments though as Canadian-resident medical trainees have cited them as critical principles for quality postgraduate medical education.[14] Interestingly, these enablers could be and indeed are being implemented into our current model of medical education with significant positive impact on the educational experience of medical trainees. To accomplish this though, there will need to be a cadre of dedicated and trained faculty to not only lay eyes on what medical trainees of all levels do but also to provide them with meaningful formative feedback that can shape their performance. There are implications however to successful implementation which may include that faculty are supported to offset their busy clinical practices to take on these additional roles and responsibilities rather than add them on top of everything else. This however can lead to additional costs in the form of additional clinicians needed in the healthcare system to cover the clinical pressures or impacts on patient care delivery such as delays or increases in wait times.

Timely faculty development

Given the changes occurring, faculty members who traditionally have been strong clinicians and good role models will have additional roles to play, such as teachers, educators, assessors, and program developers. These new roles for faculty not just physicians but also other members of the care team that we will need to recruit for teaching and assessment purposes, will require appropriate targeted faculty development, coaching and even mentoring, to enable them to fulfill these important roles. However, in light of the busyness of clinical practices, whether, in the emergency room, inpatient units, operating rooms, or outpatient settings, there will need to be shift in how, where, when, and what type of faculty development is offered. Increasingly, it will be difficult to enable faculty to attend traditional centralized workshops, given constraints such as distance, time, clinical load, and finances, but rather there may be an opportunity to pursue short and concise just-in-time learning, either in-person and situated in the workplace or technology-enabled. Even still, there will need to be an active integration of observation and formative feedback, much like that proposed for the learners, to guide further professional development. The question will be does this need to be in-person and synchronous, or perhaps we can explore technology-mediated and asynchronous options that embed formative feedback, to access expertise that may or may not be local to the faculty.

Supportive scholarly minded integrated clinical learning networks

There will be an increasing need for the healthcare system and educational enterprise to invest in supporting clinical learning environments that are reflective of societal needs and future practice. All settings, including not only traditional academic health sciences centers, but also increasingly community-academic health centers, community teaching hospitals, long-term care facilities, and community clinics, will need to play a more substantive role in educating health professionals. There will be a need to shift from institution-focused to having a focus on an integrative network that is as much focused on advanced highly specialized care as it is on primary care, disease prevention, and health promotion. Embedding education and research into these contexts means creating opportunities for system-level approaches not only to address clinical challenges but also to share limited resources, maximize clinical expertise, and break through traditional silos. From an education and research perspective, it opens up the possibility of implementing system-level initiatives that crosscut settings, meets clinical needs, and follows the journey of the patient. To successfully achieve this, there will be a need to ensure that our staff, physicians, and also trainees, regardless of location in the network, are supported to think scholarly, to identify challenges, pose questions, and utilize rigorous methodologies to explore innovative solutions that can be implemented, evaluated, refined, and re-evaluated both in a context-appropriate manner and in short timeframes.[15]


  Alignment Top


As I started, we are living in interesting times, but I would also add opportune times. Irrespective of our roles or titles, whether as leaders in medical education such as those in the deanery or hospital administration, or at the frontlines such as clinical teachers and educators, we have an opportunity to dramatically shift the status quo in medical education to be responsive or even ahead of the trends in our healthcare system. It will however take perseverance, courage, support of senior mentors and administration, and a scholarly approach to our educational innovations to shift from where we are to where we need to be to meet the healthcare needs of our populations, patients, and invariably our own parents and families.



 
  References Top

1.
Hodges BD, Albert M, Arweiler D, Akseer S, Bandiera G, Byrne N, et al. The future of medical education: A Canadian environmental scan. Med Educ 2011;45:95-106.  Back to cited text no. 1
[PUBMED]    
2.
Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.  Back to cited text no. 2
    
3.
Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: Theory to practice. Med Teach 2010;32:638-45.  Back to cited text no. 3
[PUBMED]    
4.
Holmboe ES, Edgar L, Hamstra S. The Milestones Guidebook. ACGME; 2016. Available from: https://www.acgme.org/Portals/0/MilestonesGuidebook.pdf. [Last accessed on 2017 May 30].  Back to cited text no. 4
    
5.
Ten Cate O. Entrustment decisions: Bringing the patient into the assessment equation. Acad Med 2017;92:736-8.  Back to cited text no. 5
[PUBMED]    
6.
Whitehead CR, Kuper A. Faith-based medical education. Adv Health Sci Educ Theory Pract 2017;22:1-3.  Back to cited text no. 6
    
7.
Hodges BD, Maniate JM, Martimianakis MA, Alsuwaidan M, Segouin C. Cracks and crevices: Globalization discourse and medical education. Med Teach 2009;31:910-7.  Back to cited text no. 7
[PUBMED]    
8.
Hodges B. Health professions education and globalization: A call for reflexivity. Can Med Educ J 2016;7:e1-e3.  Back to cited text no. 8
[PUBMED]    
9.
Bringing Compassion to Healthcare. AMS Healthcare. Toronto, Canada. Available from: http://www.ams-inc.on.ca/bringing-compassion-to-healthcare/. [Last accessed on 2017 May 30].  Back to cited text no. 9
    
10.
Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD. Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: Systematic review. BMJ 2011;342:d1580.  Back to cited text no. 10
[PUBMED]    
11.
Whitehead CR, Kuper A, Hodges B, Ellaway R. Conceptual and practical challenges in the assessment of physician competencies. Med Teach 2015;37:245-51.  Back to cited text no. 11
[PUBMED]    
12.
Balakrishnan RN, Parsons K. Performance-based assessment: Innovation in medical education. AMHS 2014;2:123-5.  Back to cited text no. 12
    
13.
Ménard L, Ratnapalan S. Teaching moment: Reflection in medicine: Models and application. Can Fam Physician 2013;59:105-7, e57-9.  Back to cited text no. 13
    
14.
Maniate JM, Karimuddin A. A set of principles, developed by residents, to guide Canadian residency education. Acad Med 2009;84:1527-32.  Back to cited text no. 14
[PUBMED]    
15.
Van Melle E, Curran V, Goldszmidt M, Lieff S, Lockyer J, St. Onge C. Toward a Common Understanding: Advancing Education Scholarship for Clinical Faculty in Canadian Medical Schools. Position Paper. Ottawa: ON: Canadian Association for Medical Education; 2012. Available from: http://www.came-acem.ca/docs/positionpapers/CAME-Position-Paper-April-2013-en.pdf. [Last accessed on 2017 May 30].  Back to cited text no. 15
    




 

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