Defining competency-based evaluation objectives in family medicine: dimensions of competence and priority topics for assessment.

OBJECTIVE: To develop a definition of competence in family medicine sufficient to guide a review of Certification examinations by the Board of Examiners of the College of Family Physicians of Canada. DESIGN: Delphi analysis of responses to a 4-question postal survey. SETTING: Canadian family practice. PARTICIPANTS: A total of 302 family physicians who have served as examiners for the College of Family Physicians of Canada's Certification examination. METHODS: A survey comprising 4 short-answer questions was mailed to the 302 participating family physicians asking them to list elements that define competence in family medicine among newly certified family physicians beginning independent practice. Two expert groups used a modified Delphi consensus process to analyze responses and generate 2 basic components of this definition of competence: first, the problems that a newly practising family physician should be competent to handle; second, the qualities, behaviour, and skills that characterize competence at the start of independent practice. MAIN FINDINGS: Response rate was 54%; total number of elements among all responses was 5077, for an average 31 per respondent. Of the elements, 2676 were topics or clinical situations to be dealt with; the other 2401 were skills, behaviour patterns, or qualities, without reference to a specific clinical problem. The expert groups identified 6 essential skills, the phases of the clinical encounter, and 99 priority topics as the descriptors used by the respondents. More than 20% of respondents cited 30 of the topics. CONCLUSION: Family physicians define the domain of competence in family medicine in terms of 6 essential skills, the phases of the clinical encounter, and priority topics. This survey represents the first level of definition of evaluation objectives in family medicine. Definition of the interactions among these elements will permit these objectives to become detailed enough to effectively guide assessment.

Defining competency-based evaluation objectives in family medicine: key-feature approach.

OBJECTIVE: To develop key features for priority topics previously identified by the College of Family Physicians of Canada that, together with skill dimensions and phases of the clinical encounter, broadly describe competence in family medicine. DESIGN: Modified nominal group methodology, which was used to develop key features for each priority topic through an iterative process. SETTING: The College of Family Physicians of Canada. PARTICIPANTS: An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian family medicine context with respect to region, sex, language, community type, and experience. METHODS: The group used a modified Delphi process to derive a detailed operational definition of competence, using multiple iterations until consensus was achieved for the items under discussion. The group met 3 to 4 times a year from 2000 to 2007. MAIN FINDINGS: The group analyzed 99 topics and generated 773 key features. There were 2 to 20 (average 7.8) key features per topic; 63% of the key features focused on the diagnostic phase of the clinical encounter. CONCLUSION: This project expands previous descriptions of the process of generating key features for assessment, and removes this process from the context of written examinations. A key-features analysis of topics focuses on higher-order cognitive processes of clinical competence. The project did not define all the skill dimensions of competence to the same degree, but it clearly identified those requiring further definition. This work generates part of a discipline-specific, competency-based definition of family medicine for assessment purposes. It limits the domain for assessment purposes, which is an advantage for the teaching and assessment of learners. A validation study on the content of this work would ensure that it truly reflects competence in family medicine.