Competency-based faculty development: applying transformations from lessons learned in competency-based medical education.

Faculty development in medical education is often delivered in an ad hoc manner instead of being a deliberately sequenced program matched to data-informed individual needs. In this article, the authors, all with extensive experience in Faculty Development (FD), present a competency-based faculty development (CBFD) framework envisioned to enhance the impact of FD. Steps and principles in the CBFD framework reflect the lessons learned from competency-based medical education (CBME) with its foundational goal to better train physicians to meet societal needs. The authors see CBFD as a similar framework, this one to better train faculty to meet educational needs. CBFD core elements include articulated competencies for the varied educational roles faculty fulfill, deliberately designed curricula structured to build those competencies, and an assessment program and process to support individualized faculty learning and professional growth. The framework incorporates ideas about where and how CBFD should be delivered, the use of coaching to promote reflection and identity formation and the creation of communities of learning. As with CBME, the CBFD framework has included the important considerations of change management, including broad stakeholder engagement, continuous quality improvement and scholarship. The authors have provided examples from the literature as well as challenges and considerations for each step.

Dans l'enseignement médical, le perfectionnement du corps professoral se fait souvent de façon ad hoc et non dans le cadre d'un programme structuré en fonction des besoins individuels définis sur la base de données. Dans cet article, les autrices, qui ont toutes une vaste expérience en matière de perfectionnement du corps professoral (PCP), présentent un cadre pour le perfectionnement fondé sur les compétences (PCPFC) visant à renforcer les effets du PCP. Les étapes et les principes de ce cadre reflètent les enseignements tirés de la formation médicale fondée sur les compétences (FMFC), dont l'objectif fondamental est de former les médecins de façon à ce qu'ils puissent répondre aux besoins de la société. De manière analogue, le cadre PCPFC viserait à mieux former le corps professoral pour qu'il puisse répondre aux besoins éducatifs. Les éléments centraux du cadre comprennent la définition des compétences pour chacun des rôles que les enseignants remplissent, la création de programmes de formation structurés et axés sur le développement de ces compétences et l'élaboration d'un programme d'évaluation ainsi qu'un processus pour soutenir de manière individualisée l'apprentissage et la croissance professionnelle des enseignants. Le cadre présente des idées sur les modalités des formations de PCPFC, sur l'environnement dans lequel elles interviennent, sur l'utilisation du coaching pour promouvoir la réflexion et la construction d'identité et sur la création de communautés d'apprentissage. Tout comme la FMFC, le cadre du PCPFC répond aux importants enjeux liés à la gestion du changement, y compris l'engagement des parties prenantes, l'amélioration continue de la qualité et la recherche. Les autrices proposent des exemples tirés de la littérature scientifique et passent en revue les défis et les points importants à considérer pour chaque étape.

Development, Implementation, and Meta-Evaluation of a National Approach to Programmatic Assessment in Canadian Family Medicine Residency Training.

The growing international adoption of competency-based medical education has created a desire for descriptions of innovative assessment approaches that generate appropriate and sufficient information to allow for informed, defensible decisions about learner progress. In this article, the authors provide an overview of the development and implementation of the approach to programmatic assessment in postgraduate family medicine training programs in Canada, called Continuous Reflective Assessment for Training (CRAFT). CRAFT is a principles-guided, high-level approach to workplace-based assessment that was intentionally designed to be adaptable to local contexts, including size of program, resources available, and structural enablers and barriers. CRAFT has been implemented in all 17 Canadian family medicine residency programs, with each program taking advantage of the high-level nature of the CRAFT guidelines to create bespoke assessment processes and tools appropriate for their local contexts. Similarities and differences in CRAFT implementation between 5 different family medicine residency training programs, representing both English- and French-language programs from both Western and Eastern Canada, are described. Despite the intentional flexibility of the CRAFT guidelines, notable similarities in assessment processes and procedures across the 5 programs were seen. A meta-evaluation of findings from programs that have published evaluation information supports the value of CRAFT as an effective approach to programmatic assessment. While CRAFT is currently in place in family medicine residency programs in Canada, given its adaptability to different contexts as well as promising evaluation data, the CRAFT approach shows promise for application in other training environments.

(The shift to) online delivery of a rural faculty development program in research skills: lessons learned.

BACKGROUND: While rural physicians are the ideal candidates to investigate health and healthcare issues in rural communities, they often lack the required skills, competencies, and resources. As a result, research skills development programs are crucial to help ensure communities receive the quality of care they deserve. Memorial University of Newfoundland created a research skills development program called 6for6 to empower and enable rural physicians to research solutions to community-specific health needs. 6for6 program delivery was exclusively in-person until 2019. However, with limitations introduced due to the COVID-19 pandemic, organizations around the globe needed to respond quickly. As we work to return to a post-pandemic environment, program administrators and educators worldwide are unsure whether to retain or remove the changes made to programs to adapt to the pandemic restrictions. Therefore, this work addresses the impact of the online delivery model in two areas: 1) attainment of competencies (specifically research skills, knowledge, and attitudes); and 2) participant experiences, defined as the ease of attendance, the capacity to interact with team members and peers, and challenges or barriers associated with navigating program resources. METHODS: We compared the effect of an online delivery model pivoted to adapt pandemic restrictions with the original model (primarily face-to-face) on the acquisition of learning competencies and participant experience using a mixed-methods study. Various data collection methods, such as a pre-post program survey, post-program focus group, and structured observation, were utilized. RESULTS: From 2014 to 2021, 35 physicians attended the program (30 face-to-face and five online). The Wilcoxon-sign-rank test did not show any significant differences in the participants' median change of research competency scores who attended face-to-face and online learning, respectively: knowledge (32.6, 26.8), attitudes (3.8, 3.5), and skills (32.4, 20.0). Flexibility and accessibility were key aspects of participants' experiences during the online model. Comparison with previous years demonstrated no significant challenges with the virtual delivery model, yet participants struggled with mentorship challenges and learning-life balance. CONCLUSIONS: Although presenting some unique challenges, the online model did not negatively affect learner competencies. Likewise, it provided opportunities for rural physicians to attend learning sessions and interact with experts and peers while remaining in their communities.

Making sense of adaptive expertise for frontline clinical educators: a scoping review of definitions and strategies.

Adaptive expertise has been promoted as an emerging model of expertise in health professions education in response to the inherent complexities of patient care; however, as the concept increasingly influences the structure of professional training and practice, it creates the potential for misunderstandings of the definition and implications of adaptive expertise. To foster a common understanding of the concept, we conducted a scoping review to explore how adaptive expertise has been discussed within health professions education literature. Five databases-MedLine, PubMed, ERIC, CINAHL, and PsycINFO-were searched using the exact term "adaptive expertise", producing 212 unique articles. Fifty-eight articles met inclusion criteria. In the included articles, authors discussed the conceptual implications of adaptive expertise for health professions education, strategies for training for adaptive expertise, and research findings aimed at supporting the development of adaptive expertise or utilizing adaptive expertise as a theoretical framework. The goal of this scoping review is to establish a resource for frontline educators tasked with fostering the development of adaptive expertise in learners through education initiatives. A common understanding of adaptive expertise is essential to ensuring effective implementation in training programs.

Assessing a research training programme for rural physicians.

INTRODUCTION: To assess the effect of a training programme called 6for6 (the programme) on research competency and productivity amongst rural physicians. The programme develops the research skills of six rural physicians over six weekends. Physicians learn about various research methods and writing techniques through blended learning components. METHODS: We conducted a quasi-experimental study, comparing research competency and productivity between intervention and non-equivalent control groups and over time through a repeated measures design. Generalized linear mixed model (GLMM), ANOVA, and Cochran Q tests were conducted. The intervention was provided to five groups of 6 rural physicians each between 2014 and 2019. Main outcome measures: self-assessed research competency (knowledge, attitudes and skills) and productivity (publications, grants and presentations of research-related work at conferences) were our primary and secondary outcomes, respectively. We measured the outcomes before, during and after the programme. Controls: Rural physicians who expressed interest in the programme and later enrolled. RESULTS: This study shows that, amongst its thirty participants, overall research competency was significantly different between intervention and control groups (65.7% ± 37.6% and 58.6% ± 14.4%, P < 0.05 for GLMM). The percentage of participants who were productive before, during and after the programme was 26.7%, 16.7% and 50.0%, respectively. Overall, productivity rates were significantly different between intervention and control groups (rate difference was 72.2/100 person-years, P < 0.05 for GLMM). CONCLUSION: This study suggests that the programme improves research competency and productivity for rural physicians. Rural physicians who wish to improve their research competency would benefit from participating in similar programmes.

Résumé Introduction: Évaluer l'effet d'un programme de formation intitulé 6for6 (le programme) sur les compétences en recherche et la productivité parmi les médecins des régions rurales. Le programme permet à six médecins en région rurale d'acquérir des compétences en recherche durant six fins de semaine. Les médecins apprennent diverses méthodologies de recherche et techniques de rédaction par l'entremise d'un programme d'apprentissage mixte. Méthodologie: Nous avons réalisé une étude quasi-expérimentale, qui comparait les compétences en recherche et la productivité entre des groupes non-équivalents intervention et témoin, et dans le temps, par une méthodologie à mesures répétitives. Un modèle linéaire à effets mixtes généralisé (GLMM), un modèle d'analyse de variance, et des tests Q de Cochran ont été réalisés. L'intervention a été appliquée à 5 groupes de 6 médecins en région rurale, entre 2014 et 2019 dans tous les cas. Paramètre d'évaluation: compétences en recherche évaluées par l'apprenant (connaissances, attitudes et compétences) et productivité (publications, subventions et présentation des travaux de recherche aux congrès) étaient respectivement nos paramètres d'évaluation principal et secondaire. Nous avons mesuré les paramètres avant, durant et après le programme. Les médecins en région rurale ayant manifesté de l'intérêt à l'égard du programme ont été inscrits. Résultats: L'étude montre que parmi les 30 participants, les compétences générales en recherche étaient significativement différentes entre les groupes intervention et témoin (65,7 ± 37,6% et 58,6 ± 14,4%, P < 0,05 pour le GLMM). Le pourcentage de participants qui étaient productifs avant, durant et après le programme était respectivement de 26,7, 16,7 et 50,0%. Dans l'ensemble, la productivité était significativement différente entre les groupes intervention et témoin (différence des taux: 72,2 par 100 années-personnes, P < 0,05 pour le GLMM). Conclusion: Cette étude laisse penser que le programme améliore les compétences en recherche et la productivité chez les médecins en région rurale. Les médecins en région rurale qui souhaitent améliorer leurs compétences en recherche bénéficieront de programmes semblables. Mots-clés: Compétences en recherche, programme de formation en recherche, santé en région rurale, communautés rurales.

Rural health research capacity building: an anchored solution.

Rural physicians face many challenges with providing rural health care, which often leads to innovative solutions. Despite their creativity with overcoming barriers, there is a lack of support for rural health research - an area of health care where research makes great impacts on small communities. Rural research capacity building (RRCB) is essential to support rural physicians so that they can conduct relevant research, but RRCB programs are sparse. Thus, our team at Memorial University of Newfoundland, Canada, has created an RRCB ecosystem through the 6for6 and Rural360 programs, which outline a pathway for rural physicians to make meaningful contributions to their communities through research. This article describes the RRCB ecosystem and explains how the 6for6 and Rural360 programs address the need for RRCB. Designed to train six rural physicians over six sessions per year, 6for6 fosters learning of research practices through a conceptual framework that envelops complexity science, systems thinking, and anchored instruction. The use of this framework allows the learning to be grounded in issues that are locally relevant for each participant and follows guiding principles that enable many types of learning. Rural360 continues the pathway by providing an in-house funding opportunity with an iterative review process that allows participants to continue developing their research skills and, ultimately, secure funding for their project. This anchored delivery model of RRCB programming is made possible through many support systems including staff, librarians, instructors, the university, and other stakeholders. It has successfully helped form communities of practice, promotes collaboration both between learners and with third parties, encourages self-organization with flexibility for learners outside of the in-house sessions, and ultimately drives social accountability in addressing local healthcare issues.

Evaluation plan of the 6for6 research skills program for rural and remote physicians.

Overwhelming issues and barriers often prevent rural and remote physicians (RRPs) from pursuing the many socially accountable research questions they encounter on a daily basis. Although research training programs can empower RRPs to rise to these challenges, there is a lack of evidence on how they should be developed and refined. At Memorial University, a faculty development program (FDP) called 6for6 has been helping RRPs surmount their research quagmires and engage in scholarship since 2014. After an initial three-year (2014-17) pilot, we prepared a detailed plan to evaluate the 6for6 research FDP for RRPs and inform future years of delivery. Using a modified Delphi method and participatory action model a group of program team members, stakeholders and evaluation experts developed an evaluation plan including a logic model and an evaluation matrix addressing five key themes. To our knowledge, this is the first evaluation plan for a research-focused FDP targeting RRPs. While this plan was developed specifically for the 6for6 FDP, our approach to its development may be useful to any institution interested in evaluating an FDP with limited resources.

Rural360: incubating socially accountable research in the Canadian North.

People in Northern Newfoundland and Coastal Labrador (NNCL), Canada, face major challenges obtaining accessible and contextually-relevant healthcare. Rural360 is a socially accountable research incubator that provides funding for NNCL physicians to research solutions to these issues. NNCL graduates of the adjoined 6for6 research training program for rural physicians are invited to submit the research project they have conceptualised as part of that initiative as a letter of intent, and subsequently as a research proposal, to Rural360. These submissions are reviewed by relevant subject matter experts as part of the Rural360 adjudication process. This process is iterative and strives to guide and assist participants in refining their submission. The overarching objective of Rural360 is to collaborate with rural physicians to conduct, disseminate or otherwise catalyze unsupported community-based research in NNCL. In so doing, it is highly socially accountable, empowering participants to become change-makers who investigate contextually important health issues that emerge from NNCL communities.

Examining Medical Student Specialty Choice Through a Gender Lens: An Orientational Qualitative Study.

Phenomenon: A growing number of women are entering the medical workforce, yet their distribution across medical specialties remains nonuniform. We sought to describe how culture, bias, and socialization shape gendered thinking regarding specialty choice at a Canadian undergraduate medical institution. APPROACH: We analyzed transcripts from the Career Choices Project: 16 semistructured focus group discussions with 70 students graduating from Memorial University of Newfoundland in 2003, 2006, 2007, and 2008. The questions and prompts were designed to explore factors influencing specialty choice and did not specifically probe gender-based experiences. Focus groups were audio-recorded, transcribed, and deidentified before analysis. Analysis was inductive and guided by principles of orientational qualitative inquiry using a gender-specific lens. FINDINGS: The pursuits of personal and professional goals, as well as contextual factors, were the major themes that influenced decision-making for women and men. Composition of these major themes varied between genders. Influence of a partner, consideration of familial commitments (both present and future), feeling a sense of connectedness with the field in question, and social accountability were described by women as important. Both genders hoped to pursue careers that would afford "flexibility" in order to balance work with their personal lives, though the construct of work-life balance differed between genders. Women did not explicitly identify gender bias or sexism as influencing factors, but their narratives suggest that these elements were at play. Insights: Our findings suggest that unlike men, women's decision-making is informed by tension between personal and professional goals, likely related to the context of gendered personal and societal expectations.

Preparing teachers for competency-based medical education: Fundamental teaching activities.

INTRODUCTION: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers. METHODS: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development. RESULTS: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools. CONCLUSIONS: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.