Raising of shields against the training of medical specialists

Thespecialist medical residents set out on a crusade against an educational reform that they consider “improvised” and even harmful to their learning of the medical profession. Future doctors consider themselves “guinea pigs for educational experimentation”, reveals an unpublished report from the Federation of Resident Physicians of Quebec, dated August 2022, that The duty got.

Since 2017, this new teaching method has forced future medical specialists to have hundreds of evaluation sheets filled out by their superiors during their five years of residency. The purpose of the operation is to promote feedback from medical professors to their students, so that they benefit from their internships in a hospital environment.

This so-called pedagogical revolution, called “competence by design (CPC)”, however has the opposite effect, deplores the Federation of Resident Physicians of Quebec (FMRQ): apprentice doctors claim to spend a lot of time managing these “d ‘entrustable professional activities (APC)’ to the detriment of their real training with patients.

During their five years of residency, students practice medicine with real patients, in hospitals, under the supervision of professors. The teaching method decreed in 2017 obliges medical residents to have their supervisors sign dozens of forms confirming that they have successfully completed the medical acts assigned to them. Students feel like they are harassing their bosses to fill out these forms.

Rather than giving rise to real feedback between teachers and students, the sheets are “filled in hastily”, like a “grocery list”, and give rise to a real “race”, deplores the FMRQ. This administrative burden exhausts students and creates anxiety, because residents fear they will miss their rotation — and their graduation — if they don’t fill out enough EPA forms.

“So what do we learn from this learning model? […] after four years of implementation? A missing pedagogical benefit. Increased cognitive and emotional load. A deleterious effect on the mental health and learning of medical residents. It’s simple: the current implementation model does not work”, indicates the FMRQ’s fresh report on this educational reform.

Of some 4,000 medical residents in Quebec, 3,000 are studying in some sixty medical specialties. Among them, about half are subject to the “CPC method”, which has been gradually implemented in faculties of medicine across Canada for the past five years, underlines the FMRQ.

An obsession

This obligation to have evaluation sheets completed has become central to the career of specialist resident doctors, explains the DD Jessica Ruel-Laliberté, President of the FMRQ. “APC filling” has become an end rather than a means. And this process is time-consuming: Residents have to keep an Excel file of dozens and dozens of EPAs they’ve sent to their supervisors.

“If the Dr X saw me giving birth and he seemed satisfied, I send him an observation sheet. As long as he has not completed it, I cannot check it in my Excel file”, specifies the DD Ruel-Laliberte. Residents wait an average of 13 days before their form is completed by their supervisor, according to a survey conducted by the FMRQ among its members.

“I don’t want to give the impression that we are pointing the finger at our bosses. They are overloaded, like us. Our average work week varies between 60 and 75 hours. “APC filling” is a task that everyone could do without. People do this in the evening, after their day’s work, ”adds the DD Ruel-Laliberte.

It can even become an obsession. Nearly four in 10 (37%) mid-term medical residents in Quebec in 2020-2021 said they “feel uncomfortable taking days off from study or vacations, at the risk of missing opportunities to fill out APCs”, indicates the FMRQ survey.

A “feedback market” is taking place in the training of doctors, according to the FMRQ: has become a transaction between supervising physicians and resident physicians. The APC (or the “feedback” form on which it is “evaluated”) has thus become redeemable. »

In addition to requiring a lot of time, this teaching method is ineffective and is not supported by evidence from science, deplores the FMRQ.

“Culture change”

Despite criticism from resident physicians since the program was established in 2017, medical authorities and medical school deans are championing this “culture shift.”

The Royal College of Physicians and Surgeons of Canada, which introduced competency-based education five years ago, recognizes that adjustments need to be made. The number and nature of CPAs to be evaluated have been modified following comments from the FMRQ. The Royal College says it is listening, especially when it comes to the workload of residents and supervisors.

“This culture shift takes time, so it’s ongoing among faculty and residents in medical education programs across Canada and will continue until new habits become the norm,” says a College report. royal dated 2019.

“While everyone embraces change at their own pace, one can expect some challenges during the transition, such as giving and accepting feedback, and changes in resident learning. Respondents to our blitz survey also found that some teachers are delaying adopting CBD because they either don’t know what it’s for or don’t buy into the change and are waiting to see the results,” the Royal College document adds. .

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The Collège des médecins du Québec (CMQ) also defends this “innovative teaching method”: “We regularly learn about the difficulties and advantages incurred and discuss them with university partners, residents and the Royal College of Physicians and Surgeons from Canada. »

For its part, the Conference of Deans of the Faculties of Medicine of Quebec “continues its discussions with the government and other stakeholders to optimize and preserve the resources necessary for the implementation of this method of teaching which represents a change in culture. major in medical education”.

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