Integrated and implicit: how residents learn Can MEDS roles by participating in practice

Context Learning outcomes for residency training are defined in competency frameworks such as the Can MEDS framework, which ultimately aim to better prepare residents for their future tasks. Although residents’ training relies heavily on learning through participation in the workplace under the supervision of a specialist, it remains unclear how the Can MEDS framework informs practice‐based learning and daily interactions between residents and supervisors. Objectives This study aimed to explore how the Can MEDS framework informs residents’ practice‐based training and interactions with supervisors. Methods Constructivist grounded theory guided iterative data collection and analyses. Data were collected by direct observations of residents and supervisors, combined with formal and field interviews. We progressively arrived at an explanatory theory by coding and interpreting the data, building provisional theories and through continuous conversations. Data analysis drew on sensitising insights from communities of practice theory, which provided this study with a social learning perspective. Results Can MEDS roles occurred in an integrated fashion and usually remained implicit during interactions. The language of Can MEDS was not adopted in clinical practice, which seemed to impede explicit learning interactions. The Can MEDS framework seemed only one of many factors of influence in practice‐based training: patient records and other documents were highly influential in daily activities and did not always correspond with Can MEDS roles. Additionally, the position of residents seemed too peripheral to allow them to learn certain aspects of the Health Advocate and Leader roles. Conclusions The Can MEDS framework did not really guide supervisors’ and residents’ practice or interactions. It was not explicitly used as a common language in which to talk about resident performance and roles. Therefore, the extent to which Can MEDS actually helps improve residents’ learning trajectories and conversations between residents and supervisors about residents’ progress remains questionable. This study highlights the fact that the reification of competency frameworks into the complexity of practice‐based learning is not a straightforward exercise.