Department of Medicine, Division of General Internal Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L-2V7, Canada.
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
BMC Med Educ. 2022 Aug 9;22(1):609. doi: 10.1186/s12909-022-03673-4.
There remains a paucity of evidence for curricula for the transition to practice (TTP) stage of Competence by Design internal medicine (IM) training programs. Current entrustable professional activities are based on expert consensus rather than robust subspecialty-specific needs assessment.
A scoping review was completed to identify studies with TTP focus. A national survey was conducted to identify transition experiences for general internal medicine physicians. Results were assessed by grounded theory analysis to identify core topics for TTP curricula.
Neither scoping review nor national survey identified TTP topics related to the CanMEDS Medical Expert role. Scoping Review: 41 relevant studies were identified. Most (97.6%) were from North America. The most common study types were observational (survey) or curriculum (13/41 31.7% for each). Only two studies were exclusively in IM, and the most common subspecialty studied was surgical (13/41, 31.7%). The most common TTP topics were mentorship, billing and coding, practice management, negotiating contract and job, and financial aspects of practice. National Survey: There were 44 respondents, with the majority (25/44, 56.8%) having completed an IM subspecialty fellowship. Most (38/44) completed medical school in Canada, and most were from academic practice settings (33/44, 75.0%). The most common TTP topics were billing and coding, personal financial planning, practice management, work-life balance and mentorship. Grounded Theory Analysis: There were six themes that encompassed all TTP topics from the scoping review and national survey, being (i) building a career, (ii) continuing professional development, (iii) expectations of the profession, (iv) practice management, (v) Life, health and well-being and (vi) clinical skills. Curriculum competencies and resources for curriculum development were provided.
This study identifies topics critical for curricula development for IM transition to practice. Further research is required to evaluate effectiveness of curricula including topics and themes developed from this scoping review and national survey.
以能力为基础的设计内科（IM）培训计划在向实践过渡（TTP）阶段的课程方面仍然缺乏证据。目前的可委托专业活动是基于专家共识，而不是针对具体亚专业的需求评估。
完成了范围综述以确定以 TTP 为重点的研究。进行了一项全国性调查，以了解普通内科医生的过渡经验。通过扎根理论分析评估结果，以确定 TTP 课程的核心主题。
范围综述和全国性调查都没有确定与 CanMEDS 医学专家角色相关的 TTP 主题。范围综述：确定了 41 项相关研究。其中大多数（97.6%）来自北美。最常见的研究类型是观察性（调查）或课程（各占 13/41，31.7%）。只有两项研究专门针对 IM，研究最多的亚专业是外科（13/41，31.7%）。最常见的 TTP 主题是指导、计费和编码、实践管理、协商合同和工作以及实践的财务方面。全国性调查：共有 44 名受访者，其中大多数（25/44，56.8%）完成了内科亚专业奖学金。大多数（38/44）在加拿大完成了医学院学习，大多数来自学术实践环境（33/44，75.0%）。最常见的 TTP 主题是计费和编码、个人财务规划、实践管理、工作与生活平衡和指导。扎根理论分析：有六个主题涵盖了来自范围综述和全国调查的所有 TTP 主题，即（i）职业发展，（ii）专业发展，（iii）职业期望，（iv）实践管理，（v）生活、健康和幸福，（vi）临床技能。提供了课程能力和课程开发资源。
本研究确定了内科过渡到实践课程开发的关键主题。需要进一步研究评估课程的有效性，包括从本次范围综述和全国性调查中开发的主题和主题。
