The Future of Medical Education in Canada

There needs to be a radical new approach to the training of doctors – with more emphasis on patient-centred care, preventive health care and working in teams with other health professionals, according to a much-anticipated new report. — from The Globe and Mail, January 29, 2010: MD schools call for radical rethink of doctor training

This is the report that was endorsed by all 17 Canadian medical schools:
Association of Faculties of Medicine of Canada (AFMC). The Future of Medical Education in Canada: A Collective Vision for MD Education. Ottawa: AFMC, 2010.

Just as Abraham Flexner’s report did 100 years ago, The Future of Medical Education in Canada (FMEC) project looks at how the education programs leading to the medical doctor (MD) degree in Canada can best respond to society’s evolving needs. In turn, the FMEC project is rooted in the Association of Faculties of Medicine of Canada’s (AFMC’s) articulated social accountability mission for medical schools.

The 10 FMEC recommendations for MD education are, according to this report,  ”grounded in evidence and emerge from a broad and rigorous consultative process”. They are:

1. Address Individual and Community Needs
2. Enhance Admissions Processes
3. Build on the Scientific Basis of Medicine
4. Promote Prevention and Public Health
5. Address the Hidden Curriculum (influences affecting the nature of learning, professional interactions and clinical practice)
6. Diversify Learning Contexts
7. Value Generalism
8. Advance Inter- and Intra-Professional Practice
9. Adopt a Competency-Based and Flexible Approach
10. Foster Medical Leadership

These recommendations are accompanied by five enabling recommendations that will facilitate the implementation of the FMEC recommendations:
A. Realign Accreditation Standards
B. Build Capacity for Change
C. Increase National Collaboration
D. Improve the Use of Technology
E. Enhance Faculty Development

---

Knowledge Translation – CMAJ series

This series began in 2009, when CMAJ was still an Open Access journal.  Link to free full text for Parts 1-5 below at http://tiny.cc/CMAJ_KT.

• Part 1:
  Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ 2009;181(3-4):165-8.
• Part 2:
  Brouwers M, Stacey D, O’Connor A. Knowledge creation: synthesis, tools and products. CMAJ 2009 Nov 2. [Epub ahead of print]
• Part 3:
  Kitson A, Straus SE. The knowledge-to-action cycle: Identifying the gaps.  CMAJ 2009 Nov 30. [Epub ahead of print]
• Part 4:
  Harrison MB, Légaré F, Graham ID, Fervers B. Adapting clinical practice guidelines to local context and assessing barriers to their use.  CMAJ 2009 Dec 7. [Epub ahead of print]
• Part 5:
  Wensing M, Bosch M, Grol R. Developing and selecting interventions for translating knowledge to action.  CMAJ 2009 Dec 21  [Epub ahead of print]
• Part 6:
  Davis D, Davis N.  Selecting educational interventions for knowledge translation. CMAJ 2010 Jan. 5 [Epub ahead of print; subscribers only]

---

CME articles: Academic Medicine January 2010; 85 (1)

The January 2010 issue of Academic Medicine contains a number of articles of interest to CME  providers. The publisher is providing some of these these free of charge (for now).
RSS feed for this issue

• Bellande BJ, Winicur ZM, Cox KM.  Commentary: Urgently needed: a safe place for self-assessment on the path to maintaining competence and improving performance. Acad Med. 2010 Jan;85(1):16-8.  PubMed – http://www.ncbi.nlm.nih.gov/pubmed/20042814
• Camilleri M, Parke DW 2nd. Perspective: Conflict of interest and professional organizations: considerations and recommendations. Acad Med. 2010 Jan;85(1):85-91.  PubMed -  http://www.ncbi.nlm.nih.gov/pubmed/20042830
• Davis DA, Baron RB, Grichnik K, Topulos GP, Agus ZS, Dorman T.  Commentary: CME and its role in the academic medical center: increasing integration, adding value. Acad Med. 2010 Jan;85(1):12-5.  PubMed  - http://www.ncbi.nlm.nih.gov/pubmed/20042813
• Dubovsky SL, Kaye DL, Pristach CA, DelRegno P, Pessar L, Stiles K. Can academic departments maintain industry relationships while promoting physician professionalism? Acad Med. 2010 Jan;85(1):68-73.  PubMed   - http://www.ncbi.nlm.nih.gov/pubmed/20042827
• Kawczak S, Carey W, Lopez R, Jackman D. The effect of industry support on participants’ perceptions of bias in continuing medical education. Acad Med. 2010 Jan;85(1):80-4. PubMed   – http://www.ncbi.nlm.nih.gov/pubmed/20042829
• Lo B. Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead. Acad Med. 2010 Jan;85(1):9-11.  PubMed   - http://www.ncbi.nlm.nih.gov/pubmed/20042812
• Steinman MA, Boscardin CK, Aguayo L, Baron RB. Commercial influence and learner-perceived bias in continuing medical education. Acad Med. 2010 Jan;85(1):74-9. PubMed  - http://www.ncbi.nlm.nih.gov/pubmed/20042828

---

Office Clichés Best Forgotten in 2010

The Brooke, an equestrian welfare charity in the UK, surveyed 3,000 people to identify the most annoying office clichés of 2009. Some of my pet peeves are on this list. Let’s banish them forever! See below for the top 20 annoying clichés.  I would add those annoying old ones that people still use:  ”Taking it to the next level” and “Pushing the envelope”.

1. At the end of the day
2. What goes around, comes around
3. It’s not rocket science
4. Thinking outside the box
5. Flogging a dead horse
6. Don’t shoot the messenger
7. Going forward
8. By the close of play
9. Give you the heads up
10. Live and learn
11. C’est la vie
12. Don’t put all your eggs in one basket
13. Hit the ground running
14. Always look on the bright side of life
15. Suck it and see
16. Don’t look a gift horse in the mouth
17. Don’t worry, be happy
18. I know it’s a big ask
19. I’m out
20. There are no flies on me

Read more about the survey here; and, if you work in a cubicle, this rendition of  The Cubicle Song is worth another listen.

---

Medical Education January 2010; 44 (1) – free online!

The January 2010 issue of Medical Education is now online, and for now, it is free online! Here are the contents of this issue:

• The state of the science in health professional education
• On complexity and craftsmanship
• The value of paradoxical tensions in medical education research
• Identities as performances: encouraging visual methodologies in medical education research
• The gross anatomy laboratory: a prototype for simulation-based medical education
• Patients in health professional education: so much known, so much yet to understand
• How does research on motor skills translate into clinical skills learning?
• Medical education and other disciplines
• To err is human
• The power of feedback
• Improving the flexibility and efficiency of testing
• Self-organisation, integration and curriculum in the complex world of medical education
• It’s NOT rocket science: rethinking our metaphors for research in health professions education
• Identity, identification and medical education: why should we care?
• A critical review of simulation-based medical education research: 2003–2009
• Active patient involvement in the education of health professionals
• Motor skill learning and performance: a review of influential factors
• Cognitive load theory in health professional education: design principles and strategies
• Diagnostic error and clinical reasoning
• State of the science in health professional education: effective feedback
• A primer on classical test theory and item response theory for assessments in medical education

---

Lake Superior State University 2009 List of Banished Words

Here is the 2009 list of banished words from Lake Superior State University. From the site:
Lake Superior State University “maverick” word-watchers, fresh from the holiday “staycation” but without an economic “bailout” even after a “desperate search,” have issued their 34th annual List of Words to Be Banished from the Queen’s English for Mis-use, Over-use and General Uselessness. This year’s list may be more “green” than any of the previous lists and includes words and phrases that people from “Wall Street to Main Street” say they love “not so much” and wish to have erased from their “carbon footprint.”

---

CMAJ Holiday Review 2009

It’s that time of year again, when the major medical journals publish their Christmas (AKA holiday) reading. Below are some of my favourites from the CMAJ Holiday Review, from the December 2009 issue of CMAJ. For past Christmas issues, see Christmas Journal Issues.

 Faux Review: A report on the zombie outbreak of 2009: how mathematics can save us (no, really)
An outbreak of zombification wreaked havoc recently in Canada and the rest of the world. Mathematical models were created to establish the speed of zombie infection and evaluate potential scenarios for intervention, mainly because mathematicians don’t have anything better to do with their time. We review the development of these models and their effect on the undead.

Research: Snappy answers to stupid questions: an evidence-based framework for responding to peer-review feedback
We developed a Scale of Silliness (SOS) and a Scale of Belligerence (SOB) to facilitate the assessment of inadequate peer-review feedback and guide users in preparing suitable responses to it. The SOB score is tempered by users’ current mood, as captured by the Mood Reflective Index (MRI), and dictates the Appropriate Degree of Response (ADR) for the particular situation.

Satire: Compendium of rejected CMAJ manuscripts: 2009

---

CACHE/ACEMC 2010, April 28-30, St. John’s NL

The 2010 Annual Conference of the Canadian Association of Continuing Health Education will be held in St. John’s, Newfoundland & Labrador.  

Consider submitting an abstract; read more here:  http://tiny.cc/CACHE_call
The submission deadline is December 14, 2009.

Are doctors whippersnappers?

I just came across this delightful poem, published by Gilda Radner in the November 17, 1988 issue of the New England Journal of Medicine:

DOCTORS ARE WHIPPERSNAPPERS

Doctors are whippersnappers in ironed white coats
Who spy up your rectums and look down your throats
And press you and poke you with sterilized tools
And stab at solutions that pacify fools.
I used to revere them and do what they said
Till I learned what they learned on was already dead.

Radner G. Doctors are whippersnappers. New England J Med 1988; 319 (2): 1358.

---

Interview with Dr. David Sackett, pioneer in evidence-based medicine

Here is an interesting interview from the October 30 issue of The Globe and Mail:
Picard A. ‘When we began, we were almost pariahs’ : A research pioneer [Dr. Dave Sackett] tells André Picard about the battle for evidence-based medicine

Excerpts:  Dave Sackett, a professor emeritus at McMaster University in Hamilton, has been awarded the prestigious Gairdner Wightman Award, which is given to a Canadian who has demonstrated outstanding leadership in medicine   …  Dr. Sackett is a pioneer in the field of clinical epidemiology and evidence-based medicine, which aim to teach health professionals how to separate good research from bad and apply it to the individual needs of their patients. He is also a world expert on the design and implementation of clinical trials  …  I see the Gairdner not as an individual award but as an award for clinical epidemiology and evidence-based medicine. It’s an award for a delightful bunch of talented people and the credit goes to all of them, not to me. So I accept this on their behalf.
More about the recipient

Listen to Dr. David Sackett on “The Agenda” with Steve Paikin

---