Integrated and implicit: How residents learn CanMEDS roles by participating in practice

N. Renting, A.N. (Janet) Raat, Tim Dornan, Etienne Wenger-Trayner, Martha A. van der Wal, Jan C. C. Borleffs, Rijk O. B. Gans, A. Debbie C. Jaarsma

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Abstract

Context
Learning outcomes for residency training are defined in competency frameworks such as theCanMEDS, which ultimately aim to prepare residents better for their future tasks. Although residents’ training relies heavily on learning through participation in the workplace under thesupervision of a specialist, it remains unclear how the CanMEDS framework informspractice-based learning and daily interactions between residents and supervisors.

Objectives
This study aims to explore how the CanMEDS framework informs residents’ practice-basedtraining and supervisory interactions.

Methods
Constructivist grounded theory guided iterative data collection and analyses. Data werecollected by direct observations of residents and supervisors, combined with formal and fieldinterviews. We progressively arrived at an explanatory theory by coding and interpreting thedata, building provisional theories and continuous conversations. Data analysis drew onsensitising insights from Communities of Practice theory, which provided this study with asocial learning perspective.

Results
CanMEDS roles occurred in an integrated fashion and usually remained implicit duringinteractions. The language of CanMEDS was not adopted in clinical practice, which seemedto impede explicit learning interactions. The CanMEDS framework seemed only one of manyfactors of influence in practice-based training: patient records and other documents werehighly influential on daily activities and did not always correspond with CanMEDS roles.Additionally, residents’ position seemed too peripheral to learn certain aspects of the HealthAdvocate and Leader roles.ConclusionsThe CanMEDS framework did not really guide supervisors’ and residents’ practice orinteractions. It did was not explicitly used as a common language to talk about residentperformance and roles. It therefore remains questionable to what extent CanMEDS actuallyhelps improve residents’ learning trajectories and conversations between residents and3supervisors about their progress. This study highlights that the reification of competencyframeworks into the complexity of practice-based learning is not a straightforward exercise.
Original languageEnglish
JournalMedical Education
Early online date09 May 2017
Publication statusEarly online date - 09 May 2017

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