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Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician’s career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

Objective To identify the perception of the last level students of the professional and technical health training programs regarding their competences to perform in the MIAS, and to evaluate the presence of said competences within the curricular contents of the health programs in Santander. Methods A transversal descriptive study was carried out in 451 students and a documentary review of curricula was performed for 26 programs. The content of an online questionnaire on the perception of competences in the areas of knowledge, attitudes and abilities was constructed and validated. Results In the documentary review, deficiencies were found in the inclusion of competencies such as leadership (80%) and differential approach in care (84%). In the perception survey, 36% of the students stated that they had regular or deficient knowledge about Integral Routes of Health Care, benefit plans and actors of the health system. Additionally, 7.5% stated they were not competent to carry out intersectoral coordination activities, epidemiological surveillance or public health research. Conclusion: The results show the need to include in the curricula of health programs some fundamental aspects for the proper implementation of MIAS. © 2017, Universidad Nacional de Colombia. All rights reserved.

Background: The objective structured clinical examination (OSCE), originally designed with experts assessing trainees’ competence, is more frequently employed with an element of peer assessment and feedback. Although peer assessment in higher education has been studied, its role in OSCEs has not reviewed. Aims: The aim of this study is to conduct a scoping review and explore the role of peer assessment and feedback in the OSCE. Methods: Electronic database and hand searching yielded 507 articles. Twenty-one full records were screened, of which 13 were included in the review. Two independent reviewers completed each step of the review. Results: Peer-based OSCEs are used to assess students’ accuracy in assessing OSCE performance and to promote learning. Peer examiners (PE) tend to award better global ratings and variable checklist ratings compared to faculty and provide high-quality feedback. Participating in these OSCEs is perceived as beneficial for learning. Conclusions: Peer assessment and feedback can be used to gauge PE reliability and promote learning. Teachers using these OSCEs must use methodology which fits their purpose. Competency-based education calls for diversification of assessment practices and asks how assessment impacts learning; the peer-based OSCE responds to these demands and will become an important practice in health professions education. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

[No abstract available]

In interprofessional service networks, employees cross professional boundaries to collaborate with colleagues and clients with expertise and values different from their own. It can be a struggle to adopt shared work practices and deal with “multivoicedness.” At the same time, networks allow members to engage in meaningful service provision, gain a broader understanding of the service provided, and obtain social support. Intertwined network struggles and resource gains have received limited attention in the interprofessional care literature to date. The aim of the study was to investigate the learning potential of the co-existing struggles and resource gains. This article reports findings from two interprofessional networks. Interviews were conducted with 19 employees and thematically analysed. Three types of struggles and six types of resource gains of networking were identified. The struggles relate, first, to the assumptions of networking following similar practices to those in a home organisation; second, to the challenges of dealing with the multivoicedness of networking; and, third, to the experienced gap between the networking ideals and the reality of cooperation. At the same time, the network members experience gains in emotional resources (e.g., stronger sense of meaningfulness at work), cognitive resources (e.g., understanding the customer needs from alternative perspectives), and social resources (e.g., being able to rely on other professionals’ competence). Learning potential emerged from the dynamics between coexisting struggles and resource gains. © 2017 Taylor & Francis.

Objective: To assess the number of pathology tests ordered by general practice registrars during their first 18e24 months of clinical general practice. Design: Longitudinal analysis of ten rounds of data collection (2010e2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars). Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%. Main outcome measure: Number of pathology tests requested per consultation. The time unit foranalysiswas the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms. Results: 876 registrars contributed data for 114 584 consultations. The number of pathology tests requested increased by 11% (95% CI, 8e15%; P < 0.001) per training term. Conclusions: Contrary to expectations, pathology test ordering by general practice registrars increased significantly during their first 2 years of clinical practice. This causes concerns about overtesting. As established general practitioners order fewer tests than registrars, test ordering may peak during late vocational training and early career practice. Registrars need support during this difficult period in the development of their clinical practice patterns. © 2017 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.

The changing nature of healthcare education and delivery is such that clinicians will increasingly find themselves practicing in contexts that are physically and/or conceptually different from the settings in which they were trained, a practice that conflicts on some level with socio-cultural theories of learning that emphasize learning in context. Our objective was therefore to explore learning in ‘professionally distant’ contexts. Using paramedic education, where portions of training occur in hospital settings despite preparing students for out-of-hospital work, fifty-three informants (11 current students, 13 recent graduates, 16 paramedic program faculty and 13 program coordinators/directors) took part in five semi-structured focus groups. Participants reflected on the value and role of hospital placements in paramedic student development. All sessions were audio recorded, transcribed verbatim and analyzed using inductive thematic analysis. In this context six educational advantages and two challenges were identified when using professionally distant learning environments. Learning could still be associated with features such as (a) engagement through “authenticity”, (b) technical skill development, (c) interpersonal skill development, (d) psychological resilience, (e) healthcare system knowledge and (f) scaffolding. Variability in learning and misalignment with learning goals were identified as potential threats. Learning environments that are professionally distant from eventual practice settings may prove meaningful by providing learners with foundational and preparatory learning experiences for competencies that may be transferrable. This suggests that where learning occurs may be less important than how the experience contributes to the learner’s development and the meaning or value he/she derives from it. © 2016, Springer Science+Business Media Dordrecht.

The requirement of employability in the job market prompted universities to conduct internship training as part of their study plans. There is a need to train students on important academic and professional skills related to the workplace with an IT component. This article describes a statistical study that measures satisfaction levels among students in the faculty of Information Technology and Computer Science in Jordan. The objective of this study is to explore factors that influence student satisfaction with regards to enrolling in an internship training program. The study was conducted to gather student perceptions, opinions, preferences and satisfaction levels related to the program. Data were collected via a mixed method survey (surveys and interviews) from student-respondents. The survey collects demographic and background information from students, including their perception of faculty performance in the training poised to prepare them for the job market. Findings from this study show that students expect internship training to improve their professional and personal skills as well as to increase their workplace-related satisfaction. It is concluded that improving the internship training is crucial among the students as it is expected to enrich their experiences, knowledge and skills in the personal and professional life. It is also expected to increase their level of confidence when it comes to exploring their future job opportunities in the Jordanian market. © 2017 Elsevier Ltd

Background We studied prevalence and predictors of meaningful self-reflection among surgical residents and with prompting/structured interventions, sought to improve/sustain resident skills. Methods Residents from six programs recorded 1032 narrative self-reflective comments (120 residents), using a web-based platform. If residents identified something learned or to be improved, self-reflection was deemed meaningful. Independent variables PGY level, resident/surgeon gender, study site/Phase1: July2014-August2015 vs. Phase2: September2015-September2016) were analyzed. Results Meaningful self-reflection was documented in 40.6% (419/1032) of entries. PGY5's meaningfully self-reflected less than PGY1-4's, 26.1% vs. 49.6% (p = 0.002). In multivariate analysis, resident narratives during Phase 2 were 4.7 times more likely to engage in meaningful self-reflection compared to Phase1 entries (p < 0.001). Iterative changes during Phase2 showed a 236% increase in meaningful self-reflection, compared to Phase1. Conclusions Surgical residents uncommonly practice meaningful self-reflection, even when prompted, and PGY5/chief residents reflect less than more junior residents. Substantial/sustained improvements in resident self-reflection can occur with both training and interventions. © 2017 Elsevier Inc.

Context: Learning outcomes for residency training are defined in competency frameworks such as the CanMEDS 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 CanMEDS framework informs practice-based learning and daily interactions between residents and supervisors. Objectives: This study aimed to explore how the CanMEDS 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: CanMEDS roles occurred in an integrated fashion and usually remained implicit during interactions. The language of CanMEDS was not adopted in clinical practice, which seemed to impede explicit learning interactions. The CanMEDS 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 CanMEDS 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 CanMEDS 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 CanMEDS 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. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education