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The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education An AFMC project The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education www.afmc.ca/fmec An AFMC project Production of this report has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. The Association of Faculties of Medicine of Canada (AFMC) 265 Carling Avenue, Suite 800 Ottawa, ON K1S 2E1 Table of Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enabling Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 4 5 7 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Complex Realities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Canadian Medical Education: a Global Leader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Physician of the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Medical Education System of the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rethinking Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10 11 11 12 A Collective Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building on Success: AFMC and the Faculties of Medicine . . . . . . . . . . . . . . . . . . . . . . . . . 13 13 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I: Address Individual and Community Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II: Enhance Admissions Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III: Build on the Scientific Basis of Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV: Promote Prevention and Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V: Address the Hidden Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VI: Diversify Learning Contexts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VII: Value Generalism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIII: Advance Inter- and Intra-Professional Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX: Adopt a Competency-Based and Flexible Approach . . . . . . . . . . . . . . . . . . . . . . . . . X: Foster Medical Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 18 20 21 23 24 26 28 29 31 Enabling Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A: Realign Accreditation Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B: Build Capacity for Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C: Increase National Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D: Improve the Use of Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E: Enhance Faculty Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 32 32 32 32 32 Conclusions and Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 1 2 The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education Executive Summary Just as Abraham Flexner’s report did 100 years ago, The Future of Medical Education in Canada (FMEC) project looks at how the education programs leading to the medical doctor (MD) degree in Canada can best respond to society’s evolving needs. In turn, the FMEC project is rooted in the Association of Faculties of Medicine of Canada’s (AFMC’s) articulated social accountability mission for medical schools. Health care has become increasingly complex and faces enormous challenges in providing quality care to diverse populations. An important need has developed for a cohesive and collective vision for the future of medical education in Canada. While Canada’s Faculties of Medicine are leaders in medical education, continually adapting to changing expectations and requirements, the physician of the future requires skills that will involve further adaptations and reforms to our medical education system. The 10 FMEC recommendations for MD education (also known as undergraduate medical education) are grounded in evidence and emerge from a broad and rigorous consultative process. They are as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Address Individual and Community Needs Enhance Admissions Processes Build on the Scientific Basis of Medicine Promote Prevention and Public Health Address the Hidden Curriculum Diversify Learning Contexts Value Generalism Advance Inter- and Intra-Professional Practice Adopt a Competency-Based and Flexible Approach Foster Medical Leadership They are accompanied by five enabling recommendations that will facilitate the implementation of the FMEC recommendations: A. B. C. D. E. Realign Accreditation Standards Build Capacity for Change Increase National Collaboration Improve the Use of Technology Enhance Faculty Development 3 The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education Process The FMEC MD education project comprised four main phases: i) research and analysis, ii) consultation and engagement, iii) development of The Future of Medical Education in Canada: A Collective Vision for MD Education, and iv) knowledge translation, dissemination, and implementation planning. The process began with a full year of data gathering and analysis, including a comprehensive literature review and dozens of national key stakeholder interviews. Other key activities that fed directly into the research phase of the project included national meetings with a panel of experts, a Young Leaders’ Forum, the creation of a Data Needs and Access Group, and international consultations with medical education innovators in Australia, the Netherlands, New Zealand, the United Kingdom, and the United States. Ten evidence-based priority areas for change emerged from this comprehensive data-gathering phase. These priority areas were shaped into preliminary recommendations for change. Once they were drafted, an extensive consultation and engagement phase was undertaken to discuss and validate the recommendations and formulate next steps. Each of the 17 Canadian Faculties of Medicine was consulted, as was the broader academic medicine community at two national forums. The FMEC Collective Vision began to take shape and was further refined by the FMEC Task Force on Implementation Strategy. While the essence and integrity of the original recommendations for change were maintained, the consultations and engagements contributed to the careful language used in each as well as to the development of the enabling recommendations. The following report is the final product of this collaborative initiative. Next Steps The AFMC is committed to the FMEC Collective Vision. The recommendations are crafted to be interpreted and implemented as a whole. However, each of the 17 Canadian Faculties of Medicine will embrace the recommendations in this report in its own unique way. Partnerships and collaborations among faculties with similar interests and priorities will be encouraged and facilitated as this work moves ahead. Improving Canadian MD education programs by implementing these recommendations will not only enhance the quality of education in Canadian medical schools but also better equip Canada’s physicians and health care systems to respond and adapt to the changing health and societal needs that define this nation. 4 The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education The FMEC Collective Vision is a platform for change. A proposed postgraduate project will carry this initiative further by creating linkages between undergraduate and postgraduate medical education and examining related themes and unique challenges and opportunities in the postgraduate context. It will build upon the results of this project and create an even more robust vision for the future that spans two key areas of medical education. A continuing medical education initiative is required to round out the learning continuum and result in a more cohesive and comprehensive collective vision for the future of all medical education in Canada. Recommendations Recommendation I: Address Individual and Community Needs Social responsibility and accountability are core values underpinning the roles of Canadian physicians and Faculties of Medicine. This commitment means that, both individually and collectively, physicians and faculties must respond to the diverse needs of individuals and communities throughout Canada, as well as meet international responsibilities to the global community. Recommendation II: Enhance Admissions Processes Given the broad range of attitudes, values, and skills required of physicians, Faculties of Medicine must enhance admissions processes to include the assessment of key values and personal characteristics of future physicians—such as communication, interpersonal and collaborative skills, and a range of professional interests—as well as cognitive abilities. In addition, in order to achieve the desired diversity in our physician workforce, Faculties of Medicine must recruit, select, and support a representative mix of medical students. Recommendation III: Build on the Scientific Basis of Medicine Given that medicine is rooted in fundamental scientific principles, both human and biological sciences must be learned in relevant and immediate clinical contexts throughout the MD education experience. In addition, as scientific inquiry provides the basis for advancing health care, research interests and skills must be developed to foster a new generation of health researchers. 5 The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education Recommendation IV: Promote Prevention and Public Health Promoting a healthy Canadian population requires a multifaceted approach that engages the full continuum of health and health care. Faculties of Medicine have a critical role to play in enabling this requirement and must therefore enhance the integration of prevention and public health competencies to a greater extent in the MD education curriculum. Recommendation V: Address the Hidden Curriculum The hidden curriculum is a “set of influences that function at the level of organizational structure and culture,” affecting the nature of learning, professional interactions, and clinical practice. Faculties of Medicine must therefore ensure that the hidden curriculum is regularly identified and addressed by students, educators, and faculty throughout all stages of learning. Recommendation VI: Diversify Learning Contexts Canadian physicians practise in a wide range of institutional and community settings while providing the continuum of medical care. In order to prepare physicians for these realities, Faculties of Medicine must provide learning experiences throughout MD education for all students in a variety of settings, ranging from small rural communities to complex tertiary health care centres. Recommendation VII: Value Generalism Recognizing that generalism is foundational for all physicians, MD education must focus on broadly based generalist content, including comprehensive family medicine. Moreover, family physicians and other generalists must be integral participants in all stages of MD education. Recommendation VIII: Advance Inter- and Intra-Professional Practice To improve collaborative, patient-centred care, MD education must reflect ongoing changes in scopes of practice and health care delivery. Faculties of Medicine must equip MD education learners with the competencies that will enable them to function effectively as part of interand intra-professional teams. 6