Defining the New MCC Blueprint

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  • Thank you for the opportunity to highlight some of the work we have completed over the past few months,We’ll provide a refresher on the background and context, describe the process usedhighlight the information sources used to define the propose MCC assessment blueprint and test specifications and then talk about next steps in preparation for our workshops tomorrow
  • From a project perspective our main objective is to ensure that the critical core competencies, knowledge, skills and behaviors required of a physician entering supervised and unsupervised practice are being appropriately assessedand in doing so will ensure that MCC assessment will fulfill all the requirements and standards for credentialing examinations and provide a clear and deliberate process to update the exam specifications while responding to ongoing developments in the profession
  • To engage Council members in a consultation about the proposed Blueprint and Test SpecificationsFormatThis afternoonGather initial feedback on the blueprint and test specificationsTomorrowProposed Blueprint Linkages with CanMEDSWorkshop #1 – explore feedback from afternoon, gaps and issues – healthy discussion on the proposed blueprintWorkshop #2 – explore opportunities & next steps
  • As you may be aware, we held a subject matter expert panel meeting to use the information sources to draft a blueprint and test specifications in mid-May. It was a 3 day meeting and involve 12 experts from various stakeholder groups and MCC staff from examinations and research.We’ll take a little bit of time to highlight three of the reports that were used to inform the blueprint and test specifications, but throughout the 3 day workshop we obtained a common understanding of candidates at two decisions points – entry into supervised and unsupervised practices, developed a common blueprint and then test specifications for assessment leading up to those two decision points.
  • In addition to their expert judgment that the panel brought to the discussionwe’ll be highlight some three of the reports that were instrumental in guiding the development of the proposed blueprint and test specifications
  • We have highlighted the 4 Reports used during a subject matter expert panel meeting to draft a blueprint and test specifications in mid-May. It was a 3 day meeting and involve 12 experts from various stakeholder groups and MCC staff from examinations and research.but throughout the 3 day workshop we obtained a common understanding of candidates at two decisions points – entry into supervised and unsupervised practices, developed a common blueprint and then test specifications for assessment leading up to those two decision points.
  • As with any development work, we engaged a wide range of physicians as subject matter experts and many played multiple roles from various stakeholder organizations.Internal and external views represented on the panel.From an internal MCC perspective, we had representatives from University and MRA Council, the Central Examination Committee, Objectives and Test CommitteesExternalRCPSC, CFPCAnd UGME and PGME DeansRepresented a diverse group who effectively came together to collaborate.
  • As a reminder, our key outputs from our workshop in mid-May were candidates clearly identifieda common blueprint and test specifications for assessments leading up to the two decision points.
  • We defined an undifferentiated candidate (regardless of specialty) at two decisions points, entering into supervised practice and entering into unsupervised practice. This was more logistical as we broke the group into smaller groups to define test specifications and needed a common understanding of who were thinking about
  • The common blueprint was developed that we then used to propose test specifications.Dimensions of Care - Focus of care for the patient, family, community and/or population. Physician Activities - Reflects the scope of practice and behaviors of a physician practicing in CanadaI’ll walk through some of the key points in the definitions.
  • Health Promotion and Illness Preventionprocess of enabling people to increase control over their health and its determinants, and thereby improve their health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor reduction but also to arrest its progress and reduce its consequences once established. Concepts include screening, periodic health exam, health maintenance, patient education and advocacy, and community and population health.Acute careBrief episode of illness, within the time span defined by initial presentation through to transition of care. Concepts includes urgent, emergent, and life-threatening conditions, new conditions, and exacerbation of underlying conditions. ChronicIllness of long duration that includes but is not limited to illnesses with slow progression.Psychosocial AspectsPresentations rooted in the social and psychological determinants of health Concepts include life challenges, income, culture, and the impact of the patient’s social and physical environment.
  • Assessment/ DiagnosisA physicians exploration of illness and disease through gathering, interpreting and synthesizing relevant information Concepts include history taking, physical examination and investigation.ManagementThe processes used to generating, planning, organizing care in collaboration with patients, families, communities, populations, and health care professionalsConcepts include finding common ground, agreeing on problems and goals of care, time and resource management, roles to arrive at mutual decisions for treatmentCommunicationInteractions with patients, families, caregivers, other professionals, communities and populations. Elements include active listening, relationship development, education, verbal, non-verbal and written communication Concepts include patient centered interview, disclosure of error, informed consent).Professional BehaviorsAttitudes, knowledge, and skills based on clinical and/or medical administrative competence, communication skills, ethics, societal, and legal duties resulting in the wise application of behaviors that demonstrate a commitment to excellence, respect, integrity, empathy, accountability and altruism.Concepts include self- awareness, reflection, life-long learning, scholarly habits and physician health for sustainable practice).
  • Not sure where to put this slide.
  • Take a 15 m break and then resume with a consultation on the topic
  • Before go into thisTablets or phonesTwo ways to do this – text or you can go online at xxxxxxx
  • Dimensions of Care - Focus of care for the patient, family, community and/or population. Physician Activities - Reflects the scope of practice and behaviors of a physician practicing in Canada
  • Explore how well the different dimensions resonate positively with you
  • Based on dimensions of care and physician activities, what key words are missing?
  • Once we had obtained consensus on the propose blueprint structure and general description of the dimensions, we then tasked the group with defining test specifications at
  • Once we had obtained consensus on the propose blueprint structure and general description of the dimensions, we then tasked the group with defining test specifications for assessment leading up to two decision points
  • Decision 1 – entry into supervised practiceWalkthrough areasPhysician activitiesDimensions of careFrom a dimensions of care, there was more of a weighting on acute and chronic areas, but still a clear indicator that health promotion and illness prevention and psychosocial aspects were important. In part this represents some of the data from the Incidence and prevalance of disease in Canada
  • Identified constraints that underpin the blueprint.The constraints are common across the two decision pointsComplexity – read slide
  • Decision 1 – entry into supervised practiceWalkthrough areasPhysician activitiesDimensions of careFrom a dimensions of care, there was more of a weighting on acute and chronic areas, but still a clear indicator that health promotion and illness prevention and psychosocial aspects were important. In part this represents some of the data from the Incidence and prevalance of disease in Canada
  • For assessments leading up to decision point 2For dimensions of care, there was a slight shift between acute and chronic care with chronic being weighted as slightly more focus would be required at this stageFor physician activities, there is about a 60% weighting on the medical expert, and 40% on communications and professionalism, not that it isn’t important but the focus for unsupervised practice was on the expert role.
  • Across the two specifications, we have consistent test specification constraints with them being equal with the exception of complexity (mutiple morbidities) at D1 at least 10% at D2 at least 20%.The other constraints were sampling across age including adult women of childbearing age and the frail elderly, an even balance between men and womenSampling across special populations, immigrant, LGBTrans-gender, rural, disabled etc. and also settings, remote, long term care / home visits.The general theme was to keep the constraints fairly broad to enable test committees to do what they do best and enable some evolution of the examinations based on changing populations.
  • Placeholder for their response
  • When we compare the two decisions points for Dimensions of care there was a Minor decrease of emphasis on Acute care with a corresponding increase in Chronic care in assessments leading up to entry into unsupervised practice as that would be more of the situations faced in a practice environment for an undifferentiated physician
  • When we compare the two decisions points for Physician activities, there was a little bit more movementMinor decrease of emphasis on assessment and diagnosis, less emphasis on communication, and a greater focus on Management in assessments leading up to entry into unsupervised practice, again, as that would be more of the situations faced in a practice environment for an undifferentiated physician
  • Considering the bluprint, associated test specifications and constraints is there consensus on the proposal moving forward with consultations.
  • And initial discussions have identified some opportunities along the physician assessment continuum – from undergraduate education to Physician performance enhancement – revalidationWalkthrough slideOpportunity to come back once we know what we are doing for potential business/assessment opportunities and making use of existing MCC structures like TAC to help move these agendas forward.What role would you see your committee playing?
  • Open ended question for thinking about tomorrow
  • Thank you for your time, and we will be using some of the material and information gathered this afternoon to enrich our workshop discussions tomorrow.
  • The common blueprint was developed that we then used to propose test specifications that we highlighted yesterday included….Dimensions of Care - Focus of care for the patient, family, community and/or population. Physician Activities - Reflects the scope of practice and behaviors of a physician practicing in Canada
  • Decision 1 – entry into supervised practiceFrom a dimensions of care, there was more of a weighting on acute and chronic areas, but still a clear indicator that health promotion and illness prevention and psychosocial aspects were important. In part this represents some of the data from the Incidence and prevalance of disease in CanadaThere was general equal weighting across the two types of physician activities medical expert with assessment/diagnosis & management at 50% communication and professional behaviours at 50 %. This reflected the experts view that both broad categories were equally important entering supervised practice.
  • For assessments leading up to decision point 2For dimensions of care, there was a slight shift between acute and chronic care with chronic being weighted as slightly more focus would be required at this stageFor physician activities, there is about a 60% weighting on the medical expert, and 40% on communications and professionalism, not that it isn’t important but the focus for unsupervised practice was on the expert role.
  • On table there is a reference to the RC CanMEDS roles for reference purposesWe will project the definition on xx screen and the question / activity will be on xx screen.
  • MCC objectives organized thru CanMEDS
  • Cindy to take notes and type inShout out and then vote – some of the activities we will be doing during our workshops
  • The common blueprint was developed that we then used to propose test specifications.Dimensions of Care - Focus of care for the patient, family, community and/or population. Physician Activities - Reflects the scope of practice and behaviors of a physician practicing in Canada
  • Health Promotion and Illness Preventionprocess of enabling people to increase control over their health and its determinants, and thereby improve their health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor reduction but also to arrest its progress and reduce its consequences once established. Concepts include screening, periodic health exam, health maintenance, patient education and advocacy, and community and population health.Acute careBrief episode of illness, within the time span defined by initial presentation through to transition of care. Concepts includes urgent, emergent, and life-threatening conditions, new conditions, and exacerbation of underlying conditions. ChronicIllness of long duration that includes but is not limited to illnesses with slow progression.Psychosocial AspectsPresentations rooted in the social and psychological determinants of health Concepts include life challenges, income, culture, and the impact of the patient’s social and physical environment.
  • Assessment/ DiagnosisA physicians exploration of illness and disease through gathering, interpreting and synthesizing relevant information Concepts include history taking, physical examination and investigation.ManagementThe processes used to generating, planning, organizing care in collaboration with patients, families, communities, populations, and health care professionalsConcepts include finding common ground, agreeing on problems and goals of care, time and resource management, roles to arrive at mutual decisions for treatmentCommunicationInteractions with patients, families, caregivers, other professionals, communities and populations. Elements include active listening, relationship development, education, verbal, non-verbal and written communication Concepts include patient centered interview, disclosure of error, informed consent).Professional BehaviorsAttitudes, knowledge, and skills based on clinical and/or medical administrative competence, communication skills, ethics, societal, and legal duties resulting in the wise application of behaviors that demonstrate a commitment to excellence, respect, integrity, empathy, accountability and altruism.Concepts include self- awareness, reflection, life-long learning, scholarly habits and physician health for sustainable practice).
  • When we compare the two decisions points for Dimensions of care there was a Minor decrease of emphasis on Acute care with a corresponding increase in Chronic care in assessments leading up to entry into unsupervised practice as that would be more of the situations faced in a practice environment for an undifferentiated physician
  • When we compare the two decisions points for Physician activities, there was a little bit more movementMinor decrease of emphasis on assessment and diagnosis, less emphasis on communication, and a greater focus on Management in assessments leading up to entry into unsupervised practice, again, as that would be more of the situations faced in a practice environment for an undifferentiated physician
  • In thinking about the proposed blueprint in context of the assessment continuum.Progression from Undergraduate education, MCC QE Part IPost graduate training, Part IICertification through RC, CFPC or CMQLicensureConsidering Physician Performance Enhancement - revalidation
  • And initial discussions have identified some opportunities along the physician assessment continuum – from undergraduate education to Physician performance enhancement – revalidationWalkthrough slideOpportunity to come back once we know what we are doing for potential business/assessment opportunities and making use of existing MCC structures like TAC to help move these agendas forward.What role would you see your committee playing?
  • Defining the New MCC Blueprint

    1. 1. BLUEPRINT PROJECT Blueprint Project Team September 2013 Defining the New MCC Blueprint Consultation with Council 1
    2. 2. Defining the New Blueprint • Background and Context • Process • Information sources overview • Candidates, the Blueprint & Test Specifications • Next Steps 2
    3. 3. ARTF Recommendations 3 1. LMCC becomes ultimate credential (legislation issue) 2. Validate and update the blueprints for all MCC examinations 3. More frequent scheduling of the exams and associated automation (and harmonization of MCCQE II) 4. IMG assessment enhancement and national standardization (NAC & Practice Ready Assessment) 5. Revalidation of physicians (FMRAC will lead this one) 6. Implementation oversight, including the R&D Committee priorities and R&D Budget Recommendations to focus on MCC’s reassessment and realignment of exams:
    4. 4. Core vs. Discipline-Specific Competencies Assessment Review Task Force: • There is general consensus that the current MCC examinations should concentrate on the assessment of those core competencies, including knowledge, skills, attitudes and behaviours, required of every physician entering independent practice 4
    5. 5. 5 Item Development Scoring Fairness Standard Setting Longitudinal Outcomes Test Content/ Blueprinting R&D Validity Agenda
    6. 6. Purpose of the Blueprinting • … is to assure the public that physicians licensed to practice medicine have the required knowledge, skills and attitudes for safe and effective patient care. • Only those who meet this standard are qualified to enter professional practice 6
    7. 7. MCC’s Present Blueprints • MCCQE Part I – Equal distribution of questions based on discipline • Medicine, Pediatrics, PHELO, Psychiatry, Obstetrics/ Gynecology, Surgery • MCCQE Part II – Distributed by discipline – Also by skill • History, Physical Examination, Management, Counseling/Education, P atient Interaction 7
    8. 8. Project Objectives • ensure that critical core competencies, knowledge, skills and behaviors required of a physician entering supervised and unsupervised practice are being appropriately assessed The process will • ensure that MCC assessments continue to fulfill all the requirements and standards for credentialing examinations • provide a clearly documented and deliberate process to • update exam specifications • respond to ongoing developments in the profession 10
    9. 9. This afternoon… • “Competency-based Assessment: The Good, The Bad, and The Puzzling” Dr. Kevin Eva • “Defining the New MCC Blueprint” Dr. Claire Touchie • “MCC Blueprint: Building Consensus” Blueprint Project Team 11
    10. 10. Defining the New Blueprint Claire Touchie, MD, FRCPC for the Blueprint Project team
    11. 11. Purpose of this session • Provide information about the process • Review the blueprint and test specs • Provide an opportunity for consultation over the next two days 13
    12. 12. Purpose & Format 1. To engage Council members in a consultation about the proposed Blueprint and Test Specifications 2. Format a. This afternoon • Gather initial feedback on the blueprint and test specifications b. Tomorrow • Linkages with CanMEDS • Workshop #1 – explore feedback from afternoon • Workshop #2 – explore opportunities & next steps 14
    13. 13. Defining the Blueprint Blueprint and Test Specifications Defined 2 candidates Common Blueprint Test Specifications for each decision point Subject Matter Experts 12 Experts 3 day meeting 4 Reports Current Issues PGY-1 supervision Incidence and Prevalence National Survey 15
    14. 14. Documents used Current Issues in Health Professional and Health Professional Trainee Assessment Supervising PGY-1 Residents Incidence and Prevalence National Survey 16
    15. 15. Supervising New PGY-1 Residents: A Case Study of Supervisors expectations vs. Residents’ perceptions
    16. 16. Ten EPAs defined 1. Recognition and initial management of a critically ill patient 2. Disclosure of medical errors 3. Interpretation of investigations (laboratory, ECG, radiographs) with proper communication of results to patients 4. Management of intravenous fluids 5. Handover of patient care to colleagues/other service 18
    17. 17. Ten EPAs defined 6. Discharge prescription writing including medication reconciliation 7. Coordination of patient discharge/transfer (including counseling of patient, organizing follow-up and completing discharge summary) 8. Completion of admission and/or post-operative orders 9. Obtaining informed consent 10. Obtaining advanced directives/goals of care (code status) 19
    18. 18. PGY1 CS PGY1 CS PGY1 CS IVF Informed consent Goals of care No supervision Indirect supervision Direct supervision Not performed EPAs that varied between SUPERVISORS and RESIDENTS 20
    19. 19. EPAs Resident Responses: DAYTIME vs. NIGHTTIME Day Night Day Night Day Night Critically ill Critically ill Handover Handover Patient D/C Patient D/C No supervision Indirect supervision Direct supervision Not performed 21
    20. 20. How does this help in setting the blueprint? • Helps to define who is the candidate at Decision point 1 – entry to supervised practice • Use this information to ensure that the knowledge, skills and attitudes associated with the EPAs are assessed prior to entering residency 22
    21. 21. Incidence and Prevalence of Diseases and other Health Related Issues in Canada
    22. 22. Incidence and Prevalence Data • Determine what Canadian physicians see in their practice • E.g.: Frequency of clinical presentations • Review certain areas of importance for the practice of medicine in Canada • Other needed specific competencies • Care of Elderly • Population Health • Care of Aboriginal people • Patient safety 24
    23. 23. Inpatient Hospitalization (Excluding Maternal Cases) Emergency Department Outpatient care/Clinics 1 Appendicitis Abdominal/ Pelvic Pain Anxiety 2 Gallstones Chest/ Throat Pain Supervision of Normal Pregnancy 3 Fracture of Lower Leg, Including Ankle Open Wound, Wrist/ Hand Depressive Disorder 4 Abdominal/ Pelvic Pain Back Pain Backache 5 Schizophrenia Other Medical Care Contraception Counsel/ Advice 6 Excessive and Irregular Menstruation Urinary Tract Infection Abdominal Pain 7 Convalescence Sore Throat Upper Respiratory Infection 8 Mental/ Behavioural Disorder Due to Alcohol Upper Respiratory Infection Urinary Tract Infection 9 Complications of Procedures Diarrhea and Gastroenteritis Essential Hypertension 10 Pancreatitis Sprain/ Strain of Ankle/ Foot Acute Pharyngitis Main Diagnosis – 19 to 44 25
    24. 24. Main Diagnosis – 65+ 26 Hosp. Inpt Emergency Ambulatory (AB) Ambulatory (NS) COPD Chest/throat pain UTI HTN Heart failure Other med care Chemotx DM II ACS UTI Chest pain COPD Pneumonia Abdo/pelvic pain Surg dressing Backache Femur # COPD Other med care UTI Knee arthrosis Pneumonia HTN Anxiety Other med care Cellulitis Repeat prescription Pneumonia Atrial flutter/fib. Heart failure Pneumonia Dementia
    25. 25. National Survey of the Physicians, Pharmacists, Nurses and Public in Canada: 2013
    26. 26. • Provide the judged importance of the knowledge, skills and attitudes (KSAs) • Different stakeholders: Physicians, Pharmacists, Nurses, and the public 28 Purpose of the National Survey
    27. 27. • Based on the MCC Objectives ◦ Medical expert: expert ◦ Non-medical expert: communicator, collaborator, health advocate, manager, scholar, and professional • Two decision points ◦ Supervised: for a physician starting residency training who is assessing a patient at the initial presentation. ◦ Unsupervised: for any newly licensed physician entering unsupervised practice who is assessing a patient at the initial presentation. 29 National Survey Design- Physicians
    28. 28. unsupervised supervised Overlap between supervised and unsupervised decision points n = 327 n = 122 30
    29. 29. Importance of Roles 31 0 10 20 30 40 50 60 70 80 Supervised Unsupervised PercentageofVery/Extremely Importantquestions Medical Expert Non Medical Expert
    30. 30. Medical Expert Questions 32 0 20 40 60 80 100 120 140 Determine Cause Initiate Management NumberofQuestions Supervised Unsupervised
    31. 31. Non Medical Expert 0 10 20 30 40 50 60 70 80 90 100 Percentoftotalsurveyquestions Supervised Unsupervised 33
    32. 32. Public – open ended question As a person who used services provided by the Canadian health care system, what are the most important competencies that a physician should have? 34
    33. 33. Public Survey 0 500 1000 1500 Concerns around time Centered on the patient Knowledge/Credibility Doctor Characteristics Public Survey 35
    34. 34. Conclusions 1. Complete overlap of survey questions “Very/Extremely Important” across supervised and unsupervised decision points 2. Non-medical expert questions were proportionally as important as the medical expert questions (i.e., collaborator, communicator, professionalism) at the first decision point 3. At supervised level – Determine Cause slightly more important 4. At unsupervised level – Initiate Management slightly more important 36
    35. 35. MCC Blueprint SME Consultation
    36. 36. Defining the Blueprint Blueprint and Test Specifications Defined 2 candidates Common Blueprint Test Specifications for each decision point Subject Matter Experts 12 Experts 3 day meeting 4 Reports Current Issues PGY-1 supervision Incidence and Prevalence National Survey 38
    37. 37. Who were the SMEs? Blueprint MRA Rep of Council Central Examination Committee Objectives Committee Test Committees RCPSCCFPC UGME Deans PGME Deans University Rep of Council 39
    38. 38. SME Panel Meeting – Defining the Proposal Candidate Descriptions (D1 & D2) Blueprint Test Specifications (D1 & D2) 40
    39. 39. Blueprint Undifferentiated physician at 2 decision points Decision Point 1 Entering supervised practice Decision Point 2 Entering unsupervised practice 41
    40. 40. MCC Common Blueprint
    41. 41. Proposed Common Blueprint 43 Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects PhysicianActivities Assessment/ Diagnosis Management Communication Professional Behaviors
    42. 42. Definitions Dimensions of Care Focus of care for the patient, family, community and/or population. Health Promotion and Illness Prevention The process of enabling people to increase control over their health and its determinants, and thereby improve their health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor reduction but also to arrest its progress and reduce its consequences once established. This includes but is not limited to screening, periodic health exam, health maintenance, patient education and advocacy, and community and population health. Acute Brief episode of illness, within the time span defined by initial presentation through to transition of care. This dimension includes but is not limited to urgent, emergent, and life-threatening conditions, new conditions, and exacerbation of underlying conditions. Chronic Illness of long duration that includes but is not limited to illnesses with slow progression. Psychosocial Aspects Presentations rooted in the social and psychological determinants of health that include but are not limited to life challenges, income, culture, and the impact of the patient’s social and physical environment. 44
    43. 43. Definitions Physician Activities Reflects the scope of practice and behaviors of a physician practicing in Canada Assessment/ Diagnosis Exploration of illness and disease through gathering, interpreting and synthesizing relevant information that includes but is not limited to history taking, physical examination and investigation. Management Process that includes but is not limited to generating, planning, organizing care in collaboration with patients, families, communities, populations, and health care professionals (e.g., finding common ground, agreeing on problems and goals of care, time and resource management, roles to arrive at mutual decisions for treatment). Communication Interactions with patients, families, caregivers, other professionals, communities and populations. Elements include but are not limited to active listening, relationship development, education, verbal, non-verbal and written communication (e.g. patient centered interview, disclosure of error, informed consent). Professional Behaviors Attitudes, knowledge, and skills based on clinical and/or medical administrative competence, communication skills, ethics, societal, and legal duties resulting in the wise application of behaviors that demonstrate a commitment to excellence, respect, integrity, empathy, accountability and altruism. (e.g., self- awareness, reflection, life- long learning, scholarly habits and physician health for sustainable practice). 45
    44. 44. Consultations to date • General comfort with and support of the proposed Blueprint • Varied responses for Psychosocial Aspects – Name itself may be seen as pejorative – Having it explicit may socialize it – Should be incorporated in the other 3 Dimensions of Care • Initial considerations regarding weightings between decision points • Patient-safety is not explicit 46
    45. 45. Refreshment Break 47
    46. 46. MCC Blueprint: Building Consensus
    47. 47. Practice Poll • Übermeetings tool – Web: mcc.ubermeetings.com – Text: 613-519-1313 • Who would you have liked to meet? 49
    48. 48. Proposed Common Blueprint 50 Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects PhysicianActivities Assessment/ Diagnosis Management Communication Professional Behaviors
    49. 49. Consultation • What was your first reaction to the Blueprint? – One word…. 51
    50. 50. Consultation • How well do the dimensions and titles resonate with you? – Do the Dimensions of Care resonate positively with you? – Do the Physician Activities resonate positively with you? – Should Psychosocial Aspects of care be used as a title? 52
    51. 51. Consultation • When you think of being a physician, what key words are missing in the definitions? 53
    52. 52. Test Specifications
    53. 53. Proposed Common Blueprint 55 Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects PhysicianActivities Assessment/ Diagnosis Management Communication Professional Behaviors
    54. 54. Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects Row Percent PhysicianActivities Assessment/ Diagnosis 30±5 Management 20±5 Communication 30±5 Professional Behaviors 20±5 Column Percent 20±5 30±5 30±5 20±5 100 Assessment leading up to Decision 1: Entry into Supervised Practice 56
    55. 55. Constraints Decision 1 – Entry into Supervised Practice Specification 1 – Constraints CONSTRAINT CATEGORY DESCRIPTION CONDITION Complexity multiple morbidities at least 10% Age Neonate, infant/child, adolescent, adult, adult women of childbearing age, frail elderly sample across the age categories including adult woman of childbearing age and the frail elderly Gender male, female balance evenly (minimum of 40% each) Special populations Included but not limited to immigrant, LGBT, rural, disabled and First Nation populations; end of life patients; refugees; inner city poor, the addicted and the homeless sample across categories Setting Included but not limited to rural or remote settings, long term care institutions and home visits sample across categories 57
    56. 56. Consultation For Decision 1 (supervised practice) • Do you agree with the weightings? 58
    57. 57. Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects Row Percent PhysicianActivities Assessment/ Diagnosis 30±5 Management 20±5 Communication 30±5 Professional Behaviors 20±5 Column Percent 20±5 30±5 30±5 20±5 100 Assessment leading up to Decision 1: Entry into Supervised Practice 59
    58. 58. Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects Row Percent PhysicianActivities Assessment/ Diagnosis 25±5 Management 35±5 Communication 20±5 Professional Behaviors 20±5 Column Percent 20±5 25±5 35±5 20±5 100 Assessment leading up to Decision 2: Entry into Unsupervised Practice 60
    59. 59. Constraints Decision 2 – Entry into Unsupervised Practice Specification 2 – Constraints CONSTRAINT CATEGORY DESCRIPTION CONDITION Complexity multiple morbidities at least 20% Age Neonate, infant/child, adolescent, adult, adult women of childbearing age, frail elderly sample across the age categories including adult woman of childbearing age and the frail elderly Gender male, female balance evenly (minimum of 40% each) Special populations Included but not limited to immigrant, LGBT, rural, disabled and First Nation populations; end of life patients; refugees; inner city poor, the addicted and the homeless sample across categories Setting Included but not limited to rural or remote settings, long term care institutions and home visits sample across categories 61
    60. 60. Consultation For Decision 2 (unsupervised practice): • Do you agree with the weightings? 62
    61. 61. Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects Row Percent PhysicianActivities Assessment/ Diagnosis 25±5 Management 35±5 Communication 20±5 Professional Behaviors 20±5 Column Percent 20±5 25±5 35±5 20±5 100 Assessment leading up to Decision 2: Entry into Unsupervised Practice 63
    62. 62. Comparison between Two Decision points – Dimensions of Care 20 30 30 2020 25 35 20 0 5 10 15 20 25 30 35 40 Health Promotion & Illness Prevention Acute Chronic Pyschosocial Aspects Weighting% Dimensions of Care Test Specification Weightings between Decision 1 and 2 D1-Entry into Supervised Practice D2-Entry into Unsupervised Practice 64
    63. 63. Comparison between Two Decision points – Physician Activities 30 20 30 20 25 35 20 20 0 5 10 15 20 25 30 35 40 Assessment/Diagnosis Management Communication Professional Behaviors Weighting% Physician Activities Test Specification Weightings between Decision 1 and 2 D1-Entry into Supervised Practice D2-Entry into Unsupervised Practice 65
    64. 64. Consultation • Do the differences between the two specifications make sense? 66
    65. 65. Consensus Scale 1 Activity 1. Think about how comfortable you are with the blueprint & test specifications? 2. Identify where you are on the scale? 1 2 3 4 5 I hate it! I don’t like it I can live with & support it I like it I love it! 1. Source: Facilitators Guide to Participatory Decision Making by Sam Kaner Do we have consensus to move forward? 67
    66. 66. Next Steps
    67. 67. Next Steps for MCC Blueprint & Specifications Stakeholder consultations Input & Impact Approval Current QEs Gap Analysis Changes New content Structures Future View Research & Analysis Assessment strategies & tools Partnership opportunities Jan. 2014 Future 2016-2017 69
    68. 68. Next Steps • Planning for implementation underway – pending approved Blueprint and Specifications • Preliminary impacts identified – Transition QEI and QEII to the blueprint, with a focus on • Content – Complex cases with multi-morbidity; frail elderly cases; psychosocial cases • Assessment Tools Adjustments – Unfolding CDM cases – New OSCE item formats etc. – Assessment Evolution will be required to meet the blueprint envisioned 70
    69. 69. TransitionQEI&QEIItoBP-Content TransitionQEI&QEIItoBP- AssessmentTools Timeline July 2013 May 2017 Oct 2013 Jan 2014 Apr 2014 Jul 2014 Oct 2014 Jan 2015 Apr 2015 Jul 2015 Oct 2015 Jan 2016 Apr 2016 Jul 2016 Oct 2016 Jan 2017 Apr 2017 Classification finalized with CEC Configure Item Bank (report & structure) Reclassify, migrate & clean QEI content Analyze Pool Pilot Define pilot requirements / strategy Translate content Implementation Identify potential item type innovation (tweak & improve) Investigate Unfolding cases in CDM Item formats (i.e. new OSCE stations) Design Establish Test Specs for QEI & QEII (interim targets for current exams) Test Committees to develop content for known gaps Test Committees to develop content based on pool analysis TC Committee Structure & Content Development Review (i.e. committees, process etc.) Other Develop Reclassify, migrate & clean QEII content Transition QEI and QEII to the blueprint 71
    70. 70. AssessmentEvolutionTimeline TBD July2013 May2017 Oct2013 Jan2014 Apr2014 Jul2014 Oct2014 Jan2015 Apr2015 Jul2015 Oct2015 Jan2016 Apr2016 Jul2016 Oct2016 Jan2017 Apr2017 Identifyoptions,needs assessments, scopeof opportunities&prioritize Establish/fosterrelationships Design,develop,implement assessmentstrategies Establishtimeframetargets (i.e.years) Establishsupportingbusiness model Opportunitieswouldspanrelationships,needsassessment,potential solutions,design/development,businessmodeling/deliveryand implementation/monitoringactivities: E-Portfolio(UniversityAssessmentToolsupport)couldinclude accreditingschoolOSCEsatgraduation(i.e.survey/needsassessment) Mini-CEXasanassessmentforleadinguptodecision1 Technicalskills/procedureassessmenttools(DOPS) ITER&FITER HarmonizewiththeRCPSC Timelinetobeestablished Assessment Evolution through Partnerships 72
    71. 71. Assessment Evolution Opportunities 73
    72. 72. Consultation • As we continue discussion tomorrow, what could be better? 74
    73. 73. Until Tomorrow
    74. 74. Day 2 – Workshop Consultations
    75. 75. Proposed Common Blueprint Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects PhysicianActivities Assessment/ Diagnosis Management Communication Professional Behaviors 77
    76. 76. Assessment leading up to Decision 1: Entry into Supervised Practice Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects Row Percent PhysicianActivities Assessment/ Diagnosis 30±5 Management 20±5 Communication 30±5 Professional Behaviors 20±5 Column Percent 20±5 30±5 30±5 20±5 100 78
    77. 77. Assessment leading up to Decision 2: Entry into Unsupervised Practice Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects Row Percent PhysicianActivities Assessment/ Diagnosis 25±5 Management 35±5 Communication 20±5 Professional Behaviors 20±5 Column Percent 20±5 25±5 35±5 20±5 100 79
    78. 78. Workshop Mapping CanMEDs • Based on consultations-to-date, there has been a view to map the MCC Assessment Blueprint to CanMEDs roles to ensure alignment considering a comprehensive view of physician assessment • Activity – Map CanMEDs roles to the Blueprint components • Dimensions of Care • Physician Activities 80
    79. 79. Proposed Common Blueprint Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects PhysicianActivities Assessment/ Diagnosis Management Communication Professional Behaviors 81
    80. 80. Mapping CanMEDs Roles • For the specific dimension select all the CanMEDS roles that can be mapped 82
    81. 81. Mapping CanMEDs Physician Activities Reflects the scope of practice and behaviors of a physician practicing in Canada Assessment/ Diagnosis Exploration of illness and disease through gathering, interpreting and synthesizing relevant information that includes but is not limited to history taking, physical examination and investigation. 83
    82. 82. Physician Activities Reflects the scope of practice and behaviors of a physician practicing in Canada Management Process that includes but is not limited to generating, planning, organizing care in collaboration with patients, families, communities, populations, and health care professionals (e.g., finding common ground, agreeing on problems and goals of care, time and resource management, roles to arrive at mutual decisions for treatment). Mapping CanMEDs 84
    83. 83. Physician Activities Reflects the scope of practice and behaviors of a physician practicing in Canada Communication Interactions with patients, families, caregivers, other professionals, communities and populations. Elements include but are not limited to active listening, relationship development, education, verbal, non-verbal and written communication (e.g. patient centered interview, disclosure of error, informed consent). Mapping CanMEDs 85
    84. 84. Physician Activities Reflects the scope of practice and behaviors of a physician practicing in Canada Professional Behaviors Attitudes, knowledge, and skills based on clinical and/or medical administrative competence, communication skills, ethics, societal, and legal duties resulting in the wise application of behaviors that demonstrate a commitment to excellence, respect, integrity, empathy, accountability and altruism. (e.g., self- awareness, reflection, life-long learning, scholarly habits and physician health for sustainable practice). Mapping CanMEDs 86
    85. 85. Dimensions of Care Focus of care for the patient, family, community and/or population. Health Promotion and Illness Prevention The process of enabling people to increase control over their health and its determinants, and thereby improve their health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor reduction but also to arrest its progress and reduce its consequences once established. This includes but is not limited to screening, periodic health exam, health maintenance, patient education and advocacy, and community and population health. Mapping CanMEDs 87
    86. 86. Dimensions of Care Focus of care for the patient, family, community and/or population. Acute Brief episode of illness, within the time span defined by initial presentation through to transition of care. This dimension includes but is not limited to urgent, emergent, and life-threatening conditions, new conditions, and exacerbation of underlying conditions. Mapping CanMEDs 88
    87. 87. Dimensions of Care Focus of care for the patient, family, community and/or population. Chronic Illness of long duration that includes but is not limited to illnesses with slow progression. Mapping CanMEDs 89
    88. 88. Dimensions of Care Focus of care for the patient, family, community and/or population. Psychosocial Aspects Presentations rooted in the social and psychological determinants of health that include but are not limited to life challenges, income, culture, and the impact of the patient’s social and physical environment. Mapping CanMEDs 90
    89. 89. Mapping CanMEDs Roles • Discussion… 91
    90. 90. Practice Poll Prep • What is the best thing to do in Ottawa? – Brainstorm – Vote 92
    91. 91. Workshop #1 Gaps and Issues: Dimensions, Definitions and Specifications
    92. 92. Workshop #1 Gaps & Issues • Explore in more detail feedback from yesterday’s initial consultation to establish key take-aways in consultation with Council members 94
    93. 93. Proposed Common Blueprint Dimensions of Care Health Promotion and Illness Prevention Acute Chronic Psychosocial Aspects PhysicianActivities Assessment/ Diagnosis Management Communication Professional Behaviors 95
    94. 94. Overall Blueprint - Feedback • What key words are missing? – Add key words on Sunday pm 96
    95. 95. Overall Blueprint - Feedback • Insert responses from Consensus scale if not all 3-5’s 97
    96. 96. Overall Blueprint • What are the critical take-aways we need to consider as part of this consultation from your perspective? 98
    97. 97. Definitions Dimensions of Care Focus of care for the patient, family, community and/or population. Health Promotion and Illness Prevention The process of enabling people to increase control over their health and its determinants, and thereby improve their health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor reduction but also to arrest its progress and reduce its consequences once established. This includes but is not limited to screening, periodic health exam, health maintenance, patient education and advocacy, and community and population health. Acute Brief episode of illness, within the time span defined by initial presentation through to transition of care. This dimension includes but is not limited to urgent, emergent, and life-threatening conditions, new conditions, and exacerbation of underlying conditions. Chronic Illness of long duration that includes but is not limited to illnesses with slow progression. Psychosocial Aspects Presentations rooted in the social and psychological determinants of health that include but are not limited to life challenges, income, culture, and the impact of the patient’s social and physical environment. 99
    98. 98. Blueprint – Dimensions of Care • What are the critical take-aways we need to consider as part of this consultation? 100
    99. 99. Definitions Physician Activities Reflects the scope of practice and behaviors of a physician practicing in Canada Assessment/ Diagnosis Exploration of illness and disease through gathering, interpreting and synthesizing relevant information that includes but is not limited to history taking, physical examination and investigation. Management Process that includes but is not limited to generating, planning, organizing care in collaboration with patients, families, communities, populations, and health care professionals (e.g., finding common ground, agreeing on problems and goals of care, time and resource management, roles to arrive at mutual decisions for treatment). Communication Interactions with patients, families, caregivers, other professionals, communities and populations. Elements include but are not limited to active listening, relationship development, education, verbal, non-verbal and written communication (e.g. patient centered interview, disclosure of error, informed consent). Professional Behaviors Attitudes, knowledge, and skills based on clinical and/or medical administrative competence, communication skills, ethics, societal, and legal duties resulting in the wise application of behaviors that demonstrate a commitment to excellence, respect, integrity, empathy, accountability and altruism. (e.g., self- awareness, reflection, life-long learning, scholarly habits and physician health for sustainable practice). 101
    100. 100. Blueprint – Physician Activities • What are the critical take-aways we need to consider as part of this consultation? 102
    101. 101. Comparison between Two Decision points – Dimensions of Care 20 30 30 2020 25 35 20 0 5 10 15 20 25 30 35 40 Health Promotion & Illness Prevention Acute Chronic Pyschosocial Aspects Weighting% Dimensions of Care Test Specification Weightings between Decision 1 and 2 D1-Entry into Supervised Practice D2-Entry into Unsupervised Practice 103
    102. 102. Comparison between Two Decision points – Physician Activities 30 20 30 20 25 35 20 20 0 5 10 15 20 25 30 35 40 Assessment/Diagnosis Management Communication Professional Behaviors Weighting% Physician Activities Test Specification Weightings between Decision 1 and 2 D1-Entry into Supervised Practice D2-Entry into Unsupervised Practice 104
    103. 103. Blueprint – Test Specifications • Do the differences between the two specifications make sense? – Why did it resonate? Or why not? – If you where unsure has anything to date changed your mind? 105
    104. 104. Blueprint – Test Specifications • What are the critical take-aways we need to consider as part of this consultation? 106
    105. 105. Workshop #2 Blueprint Impacts, Challenges and Opportunities DRAFT - for discussion only
    106. 106. Workshop #2 Challenges & Opportunities • To explore the impacts, challenges and opportunities of the proposed Blueprint and Test Specifications for an undifferentiated physician 108
    107. 107. Blueprint – Challenges • Based on your understanding of MCC qualifying examinations what will be some of the challenges for MCC to implement this proposed blueprint? – Is it possible to meet the proposed blueprint with the tools we have for Decision Point 1 and Decision point 2? – No challenges? How do you propose that we fulfill 50% communication/professional behavior blueprint requirement for decision point 1 with a written exam? Can we cover the entire BP with our present OSCE for decision point 2? 109
    108. 108. Blueprint – Challenges 110
    109. 109. Blueprint – Challenges • Can you see the BP fit along the Assessment Continuum? What are the challenges for using this Blueprint in the Assessment Continuum? 111
    110. 110. Assessment Evolution Opportunities 112
    111. 111. Blueprint – Opportunities • What other opportunities exist to collaborate in assessment leading to the two decision points? – Standardize faculty of medicine OSCEs – Standardize mini-CEX across schools – Common technical skills assessment tools – Harmonize with specialty exams of RC – Standardize ITER/FITER to include as assessment tool – Other suggestions… 113
    112. 112. Blueprint – Opportunities • What would you consider to be your personal “top 3” collaboration opportunities for what ever reason? 114
    113. 113. Thank You

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