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The sum of the parts detracts from the intended whole: competencies and in‐training assessments
Author(s) -
Zibrowski Elaine M,
Singh S Indu,
Goldszmidt Mark A,
Watling Christopher J,
Kenyon Cynthia F,
Schulz Valerie,
Maddocks Heather L,
Lingard Lorelei
Publication year - 2009
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/j.1365-2923.2009.03404.x
Subject(s) - thematic analysis , context (archaeology) , medical education , psychology , set (abstract data type) , perception , relevance (law) , focus group , sample (material) , critical appraisal , qualitative research , medicine , alternative medicine , computer science , paleontology , social science , chemistry , chromatography , marketing , pathology , neuroscience , sociology , political science , law , business , biology , programming language
Objectives Despite the fact that Canadian residency programmes are required to assess trainees' performance within the context of the CanMEDS Roles Framework, there has been no inquiry into the potential relationship between residents' perceptions of the framework and their in‐training assessments (ITA). Using data collected during the study of ITA, we explored residents' perceptions of these competencies. Methods From May 2006–07, a purposive sample of 20 resident doctors from internal medicine, paediatrics, and surgery were interviewed about their ITA experiences. Data collection and analysis proceeded in an iterative fashion consistent with grounded theory. In April 2008, a summary of recurrent themes was presented during a focus group interview of another five residents to afford further elaboration and refinement of thematic findings. Results The in‐training assessment report (ITAR) was perceived as a primary source of residents' information on CanMEDS. Residents' familiarity with the set of competencies appeared to be quite limited and they possessed narrow definitions of the roles. Several trainees questioned the framework's relevance and some appeared confused about the overlapping nature of the roles. Although residents viewed the central Medical Expert role as the most relevant and important competency, they incorrectly perceived it as only involving the acquisition of medical and scientific knowledge. A visual rhetorical analysis of a typical ITAR suggests that the visual features found within this assessment tool may be misrepresenting the framework and the centrality of the Medical Expert role. Conclusions Resident doctors' knowledge of CanMEDS was found to be limited. The visual structure of the ITAR appears to be a factor in residents' apparent distortion of the CanMEDS construct from its original holistic philosophy.