Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Fam Med. 2023 Nov;55(10):667-676. doi: 10.22454/FamMed.2023.294689. Epub 2023 Aug 25.
Competency based medical education (CBME) aims to produce graduates prepared for independent practice. Many equate the outcome of "preparedness for practice" with acquisition of competence. As educators evaluate the outcomes of CBME, being clear on the concept of preparedness for practice will clarify the results that are measured and assessed. This study examined how preparedness for practice is conceptualized in the literature and by family physicians (FPs) in Canada.
This multimethod qualitative descriptive study included (1) rapid review and narrative synthesis, and (2) focus groups with early-career FPs using maximum variation sampling until thematic saturation was reached. Focus groups explored the FPs' conceptualizations of preparedness for practice. Focus groups were audio-recorded, transcribed, and coded before content analysis.
Thirty-four articles met the inclusion criteria, and 59 early-career FPs participated in the focus groups. We found no consensus on the conceptualization of preparedness for practice in the literature; however, the concept often was described as acquiring competencies for program requirements. In the literature and focus groups, we identified four themes for the conceptualization of preparedness for practice. These themes included competence, self-confidence (self-efficacy, self-concept), capability, and adaptability.
Preparedness for practice involves an interplay of dynamic and complex constructs from competence, self-confidence, capability, and adaptability. Preparedness is more than possessing several competencies; it calls for integrating and applying competencies in complex and changing environments. This study aimed to start a discussion on what end point is desirable for residency education and proposed that the end point needs to move beyond competencies.
以能力为基础的医学教育（CBME）旨在培养能够独立行医的毕业生。许多人将“实践准备”的结果等同于能力的获得。随着教育工作者评估 CBME 的结果，明确实践准备的概念将阐明所衡量和评估的结果。本研究考察了文献中和加拿大家庭医生（FPs）如何理解实践准备。
这项多方法定性描述研究包括（1）快速综述和叙述性综合，以及（2）使用最大变异抽样的早期职业 FPs 焦点小组，直到达到主题饱和。焦点小组探讨了 FPs 对实践准备的概念化。在进行内容分析之前，对焦点小组进行了录音、转录和编码。
34 篇文章符合纳入标准，59 名早期职业 FPs 参加了焦点小组。我们在文献中没有发现实践准备概念化的共识；然而，这个概念通常被描述为为项目要求获得能力。在文献和焦点小组中，我们确定了实践准备概念化的四个主题。这些主题包括能力、自信（自我效能感、自我概念）、能力和适应性。
实践准备涉及能力、自信、能力和适应性等动态和复杂结构的相互作用。准备不仅仅是拥有几种能力；它需要在复杂和不断变化的环境中整合和应用能力。本研究旨在就居住教育的期望终点展开讨论，并提出终点需要超越能力。
