Kuper Ayelet, Veinot Paula, Leavitt Jennifer, Levitt Sarah, Li Amanda, Goguen Jeannette, Schreiber Martin, Richardson Lisa, Whitehead Cynthia R
Wilson Centre, University Health Network/University of Toronto, Toronto, ON, Canada.
Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Med Educ. 2017 Feb;51(2):158-173. doi: 10.1111/medu.13115. Epub 2016 Nov 15.
While medical curricula were traditionally almost entirely comprised of bioscientific knowledge, widely accepted competency frameworks now make clear that physicians must be competent in far more than biomedical knowledge and technical skills. For example, of the influential CanMEDS roles, six are conceptually based in the social sciences and humanities (SSH). Educators frequently express uncertainty about what to teach in this area. This study concretely identifies the knowledge beyond bioscience needed to support the training of physicians competent in the six non-Medical Expert CanMEDS roles.
We interviewed 58 non-clinician university faculty members with doctorates in over 20 SSH disciplines. We abstracted our transcripts (meaning condensation, direct quotations) resulting in approximately 300 pages of data which we coded using top-down (by CanMEDS role) and bottom-up (thematically) approaches and analysed within a critical constructivist framework. Participants and clinicians with SSH PhDs member-checked and refined our results.
Twelve interrelated themes were evident in the data. An understanding of epistemology, including the constructed nature of social knowledge, was seen as the foundational theme without which the others could not be taught or understood. Our findings highlighted three anchoring themes (Justice, Power, Culture), all of which link to eight more specific themes concerning future physicians' relationships to the world and the self. All 12 themes were cross-cutting, in that each related to all six non-Medical Expert CanMEDS roles. The data also provided many concrete examples of potential curricular content.
There is a definable body of SSH knowledge that forms the academic underpinning for important physician competencies and is outside the experience of most medical educators. Curricular change incorporating such content is necessary if we are to strengthen the non-Medical Expert physician competencies. Our findings, particularly our cross-cutting themes, also provide a pedagogically useful mechanism for holistically teaching the underpinnings of physician competence. We are now implementing our findings into medical curricula.
传统上，医学课程几乎完全由生物科学知识构成，但如今被广泛接受的能力框架明确指出，医生必须具备的能力远不止生物医学知识和技术技能。例如，在具有影响力的加拿大医学教育方向角色中，有六个在概念上基于社会科学和人文科学（SSH）。教育工作者常常对该领域的教学内容感到不确定。本研究具体确定了除生物科学之外，支持对胜任六个非医学专家加拿大医学教育方向角色的医生进行培训所需的知识。
我们采访了58位拥有20多个SSH学科博士学位的非临床大学教员。我们对访谈记录进行了提炼（即浓缩、直接引用），得到了约300页的数据，我们使用自上而下（按加拿大医学教育方向角色）和自下而上（按主题）的方法对其进行编码，并在批判性建构主义框架内进行分析。具有SSH博士学位的参与者和临床医生对我们的结果进行了成员审核并完善。
数据中出现了12个相互关联的主题。对认识论的理解，包括社会知识的建构性质，被视为基础主题，没有这一主题，其他主题就无法教授或理解。我们的研究结果突出了三个锚定主题（正义、权力、文化），所有这些主题都与另外八个关于未来医生与世界及自我关系的更具体主题相关。所有12个主题都是贯穿各领域的，因为每个主题都与所有六个非医学专家加拿大医学教育方向角色相关。数据还提供了许多潜在课程内容的具体示例。
存在一个可界定的SSH知识体系，它构成了重要医生能力的学术基础，且超出了大多数医学教育工作者的经验范围。如果我们要加强非医学专家医生的能力，纳入此类内容的课程变革是必要的。我们的研究结果，尤其是我们的贯穿各领域主题，还为全面教授医生能力的基础提供了一种对教学有用的机制。我们现在正在将我们的研究结果应用于医学课程。
