Renting Nienke, Raat A N Janet, Dornan Tim, Wenger-Trayner Etienne, van der Wal Martha A, Borleffs Jan C C, Gans Rijk O B, Jaarsma A Debbie C
Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Research Centre for Talent Development in Higher Education and Society, Hanze University of Applied Sciences, Groningen, the Netherlands.
Med Educ. 2017 Sep;51(9):942-952. doi: 10.1111/medu.13335. Epub 2017 May 9.
Learning outcomes for residency training are defined in competency frameworks such as the CanMEDS framework, which ultimately aim to better prepare residents for their future tasks. Although residents' training relies heavily on learning through participation in the workplace under the supervision of a specialist, it remains unclear how the CanMEDS framework informs practice-based learning and daily interactions between residents and supervisors.
This study aimed to explore how the CanMEDS framework informs residents' practice-based training and interactions with supervisors.
Constructivist grounded theory guided iterative data collection and analyses. Data were collected by direct observations of residents and supervisors, combined with formal and field interviews. We progressively arrived at an explanatory theory by coding and interpreting the data, building provisional theories and through continuous conversations. Data analysis drew on sensitising insights from communities of practice theory, which provided this study with a social learning perspective.
CanMEDS roles occurred in an integrated fashion and usually remained implicit during interactions. The language of CanMEDS was not adopted in clinical practice, which seemed to impede explicit learning interactions. The CanMEDS framework seemed only one of many factors of influence in practice-based training: patient records and other documents were highly influential in daily activities and did not always correspond with CanMEDS roles. Additionally, the position of residents seemed too peripheral to allow them to learn certain aspects of the Health Advocate and Leader roles.
The CanMEDS framework did not really guide supervisors' and residents' practice or interactions. It was not explicitly used as a common language in which to talk about resident performance and roles. Therefore, the extent to which CanMEDS actually helps improve residents' learning trajectories and conversations between residents and supervisors about residents' progress remains questionable. This study highlights the fact that the reification of competency frameworks into the complexity of practice-based learning is not a straightforward exercise.
住院医师培训的学习成果在诸如加拿大医学教育方向与角色框架（CanMEDS框架）等能力框架中有所界定，其最终目标是让住院医师更好地为未来的任务做好准备。尽管住院医师的培训很大程度上依赖于在专科医生的监督下通过参与工作场所的学习，但尚不清楚CanMEDS框架如何为基于实践的学习以及住院医师与上级医生之间的日常互动提供指导。
本研究旨在探讨CanMEDS框架如何为住院医师的基于实践的培训以及与上级医生的互动提供指导。
建构主义扎根理论指导迭代式数据收集与分析。通过对住院医师和上级医生的直接观察，结合正式访谈和实地访谈来收集数据。我们通过对数据进行编码和解释、构建临时理论并进行持续对话，逐步得出一种解释性理论。数据分析借鉴了实践社区理论的敏感见解，该理论为这项研究提供了社会学习视角。
CanMEDS角色以综合的方式出现，并且在互动过程中通常保持隐含状态。临床实践中未采用CanMEDS的语言，这似乎阻碍了明确的学习互动。CanMEDS框架似乎只是基于实践的培训中的众多影响因素之一：患者记录和其他文件在日常活动中具有很大影响力，并且并不总是与CanMEDS角色相对应。此外，住院医师的地位似乎过于边缘，以至于他们无法学习健康倡导者和领导者角色的某些方面。
CanMEDS框架并未真正指导上级医生和住院医师的实践或互动。它并未被明确用作讨论住院医师表现和角色的通用语言。因此，CanMEDS实际上在多大程度上有助于改善住院医师的学习轨迹以及住院医师与上级医生之间关于住院医师进展的对话仍值得怀疑。本研究凸显了一个事实，即把能力框架具体化到基于实践的学习的复杂性中并非易事。
