Dore Kelly L, Bogie Bryce Jm, Saperson Karen, Finlay Karen, Wasi Parveen
Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ontario, Canada.
Can Med Educ J. 2021 Jun 30;12(3):70-81. doi: 10.36834/cmej.70434. eCollection 2021 Jun.
Outcomes of national policy change impact all levels of the organizational hierarchy. The medical education literature is sparse on how reflections from program directors (PDs) on past large-scale policy changes can inform future policy initiatives. To fill this gap, we conducted a national survey on PDs' perceptions of, and reflections on, decision-making in medical education, accreditation procedures, and the CanMEDS framework implementation.
The survey was distributed to former Canadian specialty medicine PDs ( = 684). Descriptive analysis was performed on quantitative data, thematic analysis was performed on qualitative comments, and comparisons between the quantitative and qualitative findings were performed to identify areas of convergence and/or divergence.
A total of 265 (38.7%) former PDs participated. Quantitative analysis revealed that 52.8% of respondents did not feel involved in decision-making regarding policy changes, 45.1% of respondents did not feel prepared to assess the CanMEDS Roles, and PDs were divided on the reasonableness of accreditation documentation. Qualitative analysis produced four themes: communication, resources, expectations of outcomes, and buy-in. Nine sub-themes were also identified. A high level of convergence was identified across the content, with only four areas of divergence identified.
Our findings have the potential to inform future policy and/or accreditation changes. Without the lens of those charged with overseeing the implementation, policy evaluation and quality improvement will remain uninformed. PDs, therefore, bring unique insights into our understanding of national policy changes, and without the voices of these frontline implementers, the true success of policy change implementation will be hindered.
国家政策变化的结果会影响组织层级的各个层面。医学教育文献中鲜有关于项目主任（PDs）对过去大规模政策变化的反思如何为未来政策举措提供信息的内容。为填补这一空白，我们针对PDs对医学教育决策、认证程序和加拿大医学教育专业标准（CanMEDS）框架实施的看法及反思开展了一项全国性调查。
该调查面向加拿大前专科医学项目主任（n = 684）发放。对定量数据进行描述性分析，对定性评论进行主题分析，并对定量和定性结果进行比较，以确定趋同和/或分歧领域。
共有265名（38.7%）前项目主任参与。定量分析显示，52.8%的受访者认为自己未参与政策变化的决策，45.1%的受访者认为自己未做好评估CanMEDS角色的准备，且项目主任们对认证文件的合理性存在分歧。定性分析产生了四个主题：沟通、资源、结果期望和认同。还确定了九个子主题。在内容上发现了高度的趋同，仅确定了四个分歧领域。
我们的研究结果有可能为未来的政策和/或认证变化提供信息。如果没有负责监督实施的人员的视角，政策评估和质量改进将仍然缺乏依据。因此，项目主任为我们理解国家政策变化带来了独特的见解，没有这些一线实施者的声音，政策变化实施的真正成功将受到阻碍。
