Northern Constellations April 2014

Conflict Declaration Dr. Crichton chairs the CFPC Working Group on the Certification Process 2

Dr Chris Rossi Site Director FM RoCS NOSM Sault Ste Marie Chair Section Family Medicine NOSM Full time Family Doctor practicing in Sault Ste Marie with ADMG and Sault Area Hospital I have no industry financial or personal relationships to disclose

Objectives Describe the components of the Triple C competency based curriculum Explain the rationale supporting these key directions Outline NOSM Triple C Family Medicine situation 4

Triple C Competency-based Curriculum 5 www.cfpc.ca/triple_c

Competence Competence in medicine is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. Epstein RM, Hundert EM, 2002 6

Competency-based Education is an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from an analysis of societal and patient needs. It deemphasizes time-based training and promises greater accountability, flexibility, and learner centredness. Adapted from: Frank JR, Snell L, ten Cate O, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: theory to practice. Med Teacher. 2010;32:638-45. 7

Observable Competencies An observable ability of a health professional, integrating multiple components such as knowledge, skills, values and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition. Frank JR, Snell L, ten Cate O, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: theory to practice. Med Teacher. 2010;32:638-45. 8

Triple C Competency-based Curriculum 9

Triple C Competency-based Curriculum... is a Family Medicine residency curriculum that provides the relevant learning contexts and strategies to enable residents to integrate competencies, while acquiring evidence to determine that a resident is ready to begin to practice in the specialty of Family Medicine. Alignment Sub-committee of the Triple C Competency-based Curriculum Task Force, November 2011 10

Introducing CanMEDS - Family Medicine (CanMEDS-FM) Seven Roles with FM Expert as integrating Role Four Principles inspire and inform the Roles as roots Adapted from the CanMEDS Physician Competency Diagram with permission of the Royal College of Physicians and Surgeons of Canada. Copyright 2009.

1. Comprehensive Care and Education Residency programs should prepare residents For comprehensive care of patients: - Across Life cycles, Clinical settings, Clinical responsibilities - Including special populations and core procedures Through a comprehensive curriculum: - Modeling comprehensive care 12

2. Continuity of Education and Patient Care Continuity of care: Follow patients over time Follow patients in different settings Experience relationship and responsibility of care Continuity of education: Continuity of supervision and assessment Continuity of learning environment Continuity of curriculum and continuous integration 13

3. Centred in Family Medicine Family Medicine programs will have: Control of goals and curricular elements Primarily Family Medicine contexts and teachers - Augmented as required with other experiences Content relevant to the needs of Family Medicine trainees Opportunities to develop professional identity as a Family Physician 14

A) Domains of Clinical Care The Domains are arranged by: Life cycle Clinical settings Spectrum of clinical responsibilities Care of underserved patients Procedural skills 15

Care of Patients Across the Life Cycle Children and adolescents Adults Women s health, including maternity care Men s health care Care of the elderly End of life and palliative care 16

Care of Patients Across Clinical Settings Across urban and rural settings Ambulatory / office practice Hospital Long term care Emergency settings Care in the home Other community-based settings 17

Spectrum of Clinical Responsibilities Prevention and health promotion Diagnosis and management of presenting problems Acute, Subacute, Chronic Chronic disease management Rehabilitation Supportive care Palliation 18

Care of Patients Across Clinical Settings Across urban and rural settings Ambulatory / office practice Hospital Long term care Emergency settings Care in the home Other community-based settings 19

Care of Underserved Patients Including, but not limited to: Aboriginal patients Patients with mental illness or addiction Recent immigrants 20

Assessment of Learners Assessment Embedded in the curriculum Directly related to expected program outcomes Involves repeated sampling over time Programs must be primarily responsible for planning and managing the evaluation system 21

Assessment of Learners Samples observable competencies Within all seven CanMEDS-FM Roles Across the Domains of Clinical Care Guided by the CFPC Evaluation Objectives Resulting in consistent demonstration of competence Performance is criterion-referenced rather than norm-referenced 22

Assessment of Learners Field Documentation Notes should identify: The skill dimension assessed Clinical Reasoning Selectivity Communication Skills Patient-Centred Approach Professionalism Procedure Skills Feedback given Judgment of the performance 23

Assessment of Learners Processes and methods of assessment are integrated into the curriculum Assessment is an ongoing, formative process (Field notes) Progress is monitored (Primary preceptors) Educational planning, including remediation, is individualized (Primary preceptors and RAC) Promotion criteria and summative decisions are competency-based (RAC) 24

Rationale for Changing the Family Medicine Residency Curriculum An important mission of the CFPC is to improve the health of Canadians by promoting high standards of medical education and care in family practice The standards for postgraduate Family Medicine residency needs to be revisited, because of changing clinical and educational contexts 25

Rationale for Moving to a Triple C Competency-based Curriculum Rising to the challenge to better train family physicians, able to adapt to dynamic environments: - Based on educationally sound strategies and increased efficiency in training - With heightened authenticity of Family Medicine education - With increased accountability for educational outcomes 26

Triple C Competency-based Curriculum 27 www.cfpc.ca/triple_c

Sault Ste Marie Experience

Stakeholders Residents Family Medicine Preceptors Specialty Preceptors Other Medical Learners

Resident Input Block rotations are very popular Long tradition of providing Family Medicine appropriate learning on specialty blocks Very little service component so learning is Family Medicine specific even on specialty blacks Residents somewhat nervous about change to longitudinal curriculum Some residents are choosing this site because of the strong block system

FM Preceptor Feedback We could do a better job on continuity for our residents We need to look at management of our scheduling for residents and students and other learners to maximize our teaching capacity (CCC students present 8 months of the year) It would be easier to judge growth in competency over a longer period of time rather than a four month consecutive block.

Specialty Preceptor Feedback All have previously been taught in a block system and all teaching experience has been in a block system Strong preference for the immersion experience in a block system Makes it easier to learn skills by repetition Lets the preceptor have confidence that the learners can do any given skill if they have been through the see one: do one: teach one type of learning that we all remember Especially important for procedural skills

Other learners The CCC program sends SSM learners for 8 blocks yearly Many of the preceptors in FM teach both FM and UG learners but do not have the space for the learners to be together in the same block By setting the FM blacks as 4 consecutive blocks we have many preceptors who can t take the UG learners either early in the year or late in the year as the PG learner overlaps the times the clerks need FM time

Positive feedback re Blocks but can we make this more consistent with TRIPLE C?

Comprehensive Indicators from learners are that they feel this program does a good job in this domain We will learn later about how this is tracked and documented Primary preceptor meetings track competency and comprehension

Focus on Continuity SSM has piloted a trial of having the 4 blocks of FM be unlinked in each year R 1 s do 2 blocks early in the year and then a block mid year and a block late in the year, all with the same preceptor This preceptor becomes the residents primary preceptor for the next 2 years R2 s do the same type of schedule but with a different preceptor for second year and maintaining the same primary preceptor

CCC block Schedule FM FM FM FM Rur -al FM Rur -al FM Traditional schedule FM FM FM FM FM Rur -al FM Rur -al

Results Residents very happy and enjoy coming back to family medicine monthly. They feel centred in family medicine Patients enjoy seeing the same learner multiple times Residents are getting a more longitudinal view of family medicine with more continuity and repeat visits Does not disrupt the traditional specialty blocks as is done just before academics when block is over For primary preceptors spacing the FM blocks allows them to see remarkable growth over time in the residents Easier to schedule other learners around the shorter blocks

Centred in Family Medicine Trial of change in the Surgery block in SSM Surgery traditionally criticised as not teaching skills pertinent to Family medicine Change to 2 weeks surgery and call with a primary surgical preceptor 2 weeks of surgical sub-specialty work with choice of ENT, vascular, plastics and urology done predominantly in out patient clinics Mixed feedback about this change so far

Acknowledgment Portions of this PowerPoint presentation were adapted from one authored by: Danielle Saucier, MD, MA(Ed), CCFP, FCFP Shirley Schipper, MD, CCFP On behalf of the Alignment sub-committee of the Triple C Competency-based Curriculum Task Force: Danielle Saucier, MD, MA (Ed), CCFP, FCFP (Co-chair) Ivy Oandasan, MD, MHSc, CCFP, FCFP (Co-chair) Michel Donoff, MD, CCFP, FCFP Karl Iglar, MD, CCFP Shirley Schipper, MD, CCFP Eric Wong, MD, MClSc(FM), CCFP Suggested citation: Saucier D, Oandasan I, Donoff M, Iglar K, Schipper S, Wong E. Triple C competency-based curriculum: A brief overview [PowerPoint presentation]. Mississauga ON: College of Family Physicians of Canada; 2011. 40

For More Information To better understand the Triple C Curriculum, please view the other resources in the Triple C Toolkit: http://www.cfpc.ca/triple_c/ 41