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1
BLUEPRINT PROJECT
Blueprint Project Team September 2013
Defining the New MCC Blueprint
Consultation with Council
Defining the New Blueprint
• Background and Context• Process• Information sources overview• Candidates, the Blueprint & Test
Specifications• Next Steps
2
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:
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
Item Development Scoring
Fairness
Standard SettingLongitudinal Outcomes
Test Content/ Blueprinting
R&D Validity Agenda
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
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, Patient Interaction
7
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
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
Defining the New Blueprint
Claire Touchie, MD, FRCPC
for the Blueprint Project team
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
Purpose & Format
1. To engage Council members in a consultation about the proposed Blueprint and Test Specifications
2. Formata. 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
Defining the Blueprint
15
Documents used
Current Issues in Health Professional and Health
Professional Trainee Assessment
Supervising PGY-1 Residents
Incidence and Prevalence
National Survey
16
Supervising New PGY-1 Residents: A Case Study of Supervisors expectations vs. Residents’ perceptions
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
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
PGY1 CS PGY1 CS PGY1 CSIVF Informed consent Goals of care
No supervisionIndirect supervisionDirect supervisionNot performed
EPAs that varied betweenSUPERVISORS and RESIDENTS
20
EPAs Resident Responses: DAYTIME vs. NIGHTTIME
Day Night Day Night Day NightCritically ill Critically ill Handover Handover Patient D/C Patient D/C
No supervision
Indirect supervision
Direct supervision
Not performed
21
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
Incidence and Prevalence ofDiseases and other Health Related Issues in Canada
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
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
3Fracture 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
6Excessive and Irregular Menstruation
Urinary Tract Infection Abdominal Pain
7 Convalescence Sore Throat Upper Respiratory Infection
8Mental/ Behavioural DisorderDue 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
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
National Survey of the Physicians, Pharmacists, Nurses and Public in Canada: 2013
• 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
• 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
unsupervised
Overlap between supervised and unsupervised decision points
n = 327
n = 122
30
Importance of Roles
31
Supervised Unsupervised0
10
20
30
40
50
60
70
80
Medical ExpertNon Medical Expert
Pe
rce
nta
ge
of
Ve
ry/E
xtr
em
ely
Imp
or-
tan
t q
ue
sti
on
s
Medical Expert Questions
32
Determine Cause Initiate Management0
20
40
60
80
100
120
140
SupervisedUnsupervised
Nu
mb
er
of Q
ue
stio
ns
Non Medical Expert
Collabora
tor
Comm
unicato
r
Health A
dvocate
Manager
Profe
ssional
Scholar
0
10
20
30
40
50
60
70
80
90
100
SupervisedUnsupervised
Pe
rce
nt
of
tota
l su
rve
y q
ue
sti
on
s
33
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
Public Survey
Concerns around time
Centered on the patient
Knowledge/Credibility
Doctor Characteristics
0 200 400 600 800 1000 1200 1400
Public Survey
35
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
MCC Blueprint SME Consultation
Defining the Blueprint
38
Who were the SMEs?
Blueprint
39
SME Panel Meeting – Defining the Proposal
Candidate Descriptions
(D1 & D2)Blueprint
Test Specifications (D1 & D2)
40
Blueprint
Undifferentiated physician at 2 decision points
Decision Point 1Entering supervised practice
Decision Point 2Entering unsupervised practice
41
MCC Common Blueprint
Proposed Common Blueprint
43
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Physician
Activities
Assessment/Diagnosis
Management
Communication
Professional Behaviors
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
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
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
Refreshment Break
47
MCC Blueprint: Building Consensus
Practice Poll
• Übermeetings tool– Web: mcc.ubermeetings.com– Text: 613-519-1313
• Who would you have liked to meet?
49
Proposed Common Blueprint
50
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Physician
Activities
Assessment/Diagnosis
Management
Communication
Professional Behaviors
Consultation
• What was your first reaction to the Blueprint?– One word….
51
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
Consultation
• When you think of being a physician, what key words are missing in the definitions?
53
Test Specifications
Proposed Common Blueprint
55
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Physician
Activities
Assessment/Diagnosis
Management
Communication
Professional Behaviors
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Row Percent
Physician Activities
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
ConstraintsDecision 1 – Entry into Supervised Practice
Specification 1 – Constraints
CONSTRAINT CATEGORY DESCRIPTION CONDITION
Complexity multiple morbidities at least 10%
AgeNeonate, 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
SettingIncluded but not limited to rural or remote settings, long term care institutions and home visits
sample across categories
57
Consultation
For Decision 1 (supervised practice)• Do you agree with the weightings?
58
Dimensions of Care
Health Promotion and
Illness Prevention
Acute Chronic Psychosocial Aspects
Row Percent
Physician Activities
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
Dimensions of Care
Health Promotion and
Illness Prevention
Acute Chronic Psychosocial Aspects
Row Percent
Physician Activities
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
ConstraintsDecision 2 – Entry into Unsupervised Practice
Specification 2 – Constraints
CONSTRAINT CATEGORY DESCRIPTION CONDITION
Complexity multiple morbidities at least 20%
AgeNeonate, 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
SettingIncluded but not limited to rural or remote settings, long term care institutions and home visits
sample across categories
61
Consultation
For Decision 2 (unsupervised practice):• Do you agree with the weightings?
62
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Row Percent
Physician
Activities
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
Comparison between Two Decision points – Dimensions of Care
Health Promotion & Illness Prevention
Acute Chronic Pyschosocial Aspects0
5
10
15
20
25
30
35
40
20
30 30
2020
25
35
20
Test Specification Weightings between Decision 1 and 2
D1-Entry into Supervised Practice D2-Entry into Unsupervised PracticeDimensions of Care
Wei
gh
tin
g %
64
Comparison between Two Decision points – Physician Activities
Assessment/Diagnosis Management Communication Professional Behaviors0
5
10
15
20
25
30
35
40
30
20
30
20
25
35
20 20
Test Specification Weightings between Decision 1 and 2
D1-Entry into Supervised Practice D2-Entry into Unsupervised PracticePhysician Activities
Wei
gh
tin
g %
65
Consultation
• Do the differences between the two specifications make sense?
66
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
Next Steps
Next Steps for MCCBlueprint & 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
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
Tra
nsi
tio
n Q
EI
& Q
EII
to
BP
- C
on
ten
tT
ran
siti
on
QE
I &
QE
II t
o B
P -
Ass
ess
me
nt
To
ols
Tim
eli
ne
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
Asse
ssm
en
t E
vo
luti
on
Tim
eli
ne
TBD
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
Identify options, needs assessments, scope of
opportunities & prioritizeEstablish/foster relationships
Design, develop, implement assessment strategies
Establish timeframe targets (i.e. years)
Establish supporting business model
Opportunities would span relationships, needs assessment, potential solutions, design/development, business modeling/delivery and implementation / monitoring activities:· E-Portfolio (University Assessment Tool support) could include
· accrediting school OSCEs at graduation (i.e. survey / needs assessment)· Mini-CEX as an assessment for leading up to decision 1· Technical skills/procedure assessment tools (DOPS)· ITER & FITER
· Harmonize with the RCPSC
Timeline to be established
Assessment Evolution through Partnerships
72
Assessment Evolution Opportunities
73
Consultation
• As we continue discussion tomorrow, what could be better?
74
Until Tomorrow
Day 2 – Workshop Consultations
Proposed Common Blueprint
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Physician
Activities
Assessment/Diagnosis
Management
Communication
Professional Behaviors
77
Assessment leading up to Decision 1: Entry into Supervised Practice
Dimensions of Care
Health Promotion and
Illness Prevention
Acute Chronic Psychosocial Aspects
Row Percent
Physician Activities
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
Assessment leading up to Decision 2: Entry into Unsupervised Practice
Dimensions of Care
Health Promotion and
Illness Prevention
Acute Chronic Psychosocial Aspects
Row Percent
Physician Activities
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
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
Proposed Common Blueprint
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Physician
Activities
Assessment/Diagnosis
Management
Communication
Professional Behaviors
81
Mapping CanMEDs Roles
• For the specific dimension select all the CanMEDS roles that can be mapped
82
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
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
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
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
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
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
Dimensions of Care
Focus of care for the patient, family, community and/or population.
ChronicIllness of long duration that includes but is not limited to illnesses with slow progression.
Mapping CanMEDs
89
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
Mapping CanMEDs Roles
• Discussion…
91
Practice Poll Prep
• What is the best thing to do in Ottawa?– Brainstorm– Vote
92
Workshop #1Gaps and Issues: Dimensions, Definitions and Specifications
Workshop #1Gaps & Issues
• Explore in more detail feedback from yesterday’s initial consultation to establish key take-aways in consultation with Council members
94
Proposed Common Blueprint
Dimensions of Care
Health Promotion and Illness Prevention
Acute Chronic Psychosocial Aspects
Physician
Activities
Assessment/Diagnosis
Management
Communication
Professional Behaviors
95
Overall Blueprint - Feedback
• What key words are missing?
– Add key words on Sunday pm
96
Overall Blueprint - Feedback
• Insert responses from Consensus scale if not all 3-5’s
97
Overall Blueprint
• What are the critical take-aways we need to consider as part of this consultation from your perspective?
98
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.
AcuteBrief 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
Blueprint – Dimensions of Care
• What are the critical take-aways we need to consider as part of this consultation?
100
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
Blueprint – Physician Activities
• What are the critical take-aways we need to consider as part of this consultation?
102
Comparison between Two Decision points – Dimensions of Care
Health Promotion & Illness Prevention
Acute Chronic Pyschosocial Aspects0
5
10
15
20
25
30
35
40
20
30 30
2020
25
35
20
Test Specification Weightings between Decision 1 and 2
D1-Entry into Supervised Practice D2-Entry into Unsupervised Practice
Dimensions of Care
Wei
gh
tin
g %
103
Comparison between Two Decision points – Physician Activities
Assessment/Diagnosis Management Communication Professional Behaviors0
5
10
15
20
25
30
35
40
30
20
30
20
25
35
20 20
Test Specification Weightings between Decision 1 and 2
D1-Entry into Supervised Practice D2-Entry into Unsupervised Practice
Physician Activities
Wei
gh
tin
g %
104
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
Blueprint – Test Specifications
• What are the critical take-aways we need to consider as part of this consultation?
106
Workshop #2Blueprint Impacts, Challenges and Opportunities
DRAFT - for discussion only
Workshop #2Challenges & Opportunities
• To explore the impacts, challenges and opportunities of the proposed Blueprint and Test Specifications for an undifferentiated physician
108
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
Blueprint – Challenges
110
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
Assessment Evolution Opportunities
112
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…
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Blueprint – Opportunities
• What would you consider to be your personal “top 3” collaboration opportunities for what ever reason?
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Thank You