Competency-structured case discussion in the morning meeting: enhancing CanMEDS integration in daily practice

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Abstract

Outcome-focused, competency-based educational curricula have become the norm in residency training programs. The Canadian Medical Education Directives for Specialists (CanMEDS) framework is one example of such a curriculum. However, models for incorporating all the competencies in everyday clinical practice have been difficult to accomplish. In this manuscript, a CanMEDS, competency-structured, acute case discussion in a regular morning meeting was undertaken. All the diagnostic and therapeutic interventions were explicitly organized and discussed under their respective CanMEDS competency headings. Post exercise, the majority of residents felt that they were more competent in all the competencies and indicated their willingness to continue having similarly structured acute case discussions in the future.

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Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.

Amir Qaseem, Timothy Wilt, Steven E Weinberger … (2011)

This guideline is an official statement of the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS). It represents an update of the 2007 ACP clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD) and is intended for clinicians who manage patients with COPD. This guideline addresses the value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies (anticholinergics, long-acting β-agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy. This guideline is based on a targeted literature update from March 2007 to December 2009 to evaluate the evidence and update the 2007 ACP clinical practice guideline on diagnosis and management of stable COPD. RECOMMENDATION 1: ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). RECOMMENDATION 2: For stable COPD patients with respiratory symptoms and FEV(1) between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used (Grade: weak recommendation, low-quality evidence). RECOMMENDATION 3: For stable COPD patients with respiratory symptoms and FEV(1) 50% predicted. (Grade: weak recommendation, moderate-quality evidence). RECOMMENDATION 7: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (Pao(2) ≤55 mm Hg or Spo(2) ≤88%) (Grade: strong recommendation, moderate-quality evidence).

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Does this dyspneic patient in the emergency department have congestive heart failure?

Charlie Wang, J. FitzGerald, Michael Schulzer … (2005)

Dyspnea is a common complaint in the emergency department where physicians must accurately make a rapid diagnosis. To assess the usefulness of history, symptoms, and signs along with routine diagnostic studies (chest radiograph, electrocardiogram, and serum B-type natriuretic peptide [BNP]) that differentiate heart failure from other causes of dyspnea in the emergency department. We searched MEDLINE (1966-July 2005) and the reference lists from retrieved articles, previous reviews, and physical examination textbooks. We retained 22 studies of various findings for diagnosing heart failure in adult patients presenting with dyspnea to the emergency department. Two authors independently abstracted data (sensitivity, specificity, and likelihood ratios [LRs]) and assessed methodological quality. Many features increased the probability of heart failure, with the best feature for each category being the presence of (1) past history of heart failure (positive LR = 5.8; 95% confidence interval [CI], 4.1-8.0); (2) the symptom of paroxysmal nocturnal dyspnea (positive LR = 2.6; 95% CI, 1.5-4.5); (3) the sign of the third heart sound (S(3)) gallop (positive LR = 11; 95% CI, 4.9-25.0); (4) the chest radiograph showing pulmonary venous congestion (positive LR = 12.0; 95% CI, 6.8-21.0); and (5) electrocardiogram showing atrial fibrillation (positive LR = 3.8; 95% CI, 1.7-8.8). The features that best decreased the probability of heart failure were the absence of (1) past history of heart failure (negative LR = 0.45; 95% CI, 0.38-0.53); (2) the symptom of dyspnea on exertion (negative LR = 0.48; 95% CI, 0.35-0.67); (3) rales (negative LR = 0.51; 95% CI, 0.37-0.70); (4) the chest radiograph showing cardiomegaly (negative LR = 0.33; 95% CI, 0.23-0.48); and (5) any electrocardiogram abnormality (negative LR = 0.64; 95% CI, 0.47-0.88). A low serum BNP proved to be the most useful test (serum B-type natriuretic peptide <100 pg/mL; negative LR = 0.11; 95% CI, 0.07-0.16). For dyspneic adult emergency department patients, a directed history, physical examination, chest radiograph, and electrocardiography should be performed. If the suspicion of heart failure remains, obtaining a serum BNP level may be helpful, especially for excluding heart failure.

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Collaboration, communication, management, and advocacy: teaching surgeons new skills through the CanMEDS Project.

Lawrence R. Frank, Bernard Langer (2003)

The training of future surgeons must evolve in such a way that it ensures that surgical practice meets the needs of modern societies. Many surgical educators and organizations are considering which abilities are critical elements of the education of surgeons for the new millennium. We describe the approach employed by the Royal College of Physicians and Surgeons of Canada (RCPSC), called the Canadian Medical Education Directions for Specialists (CanMEDS) Project. Through this endeavor the RCPSC has adopted a framework of core competencies organized around seven physician "Roles": Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional. We present the development and rationale for this framework and the progress of its implementation in postgraduate surgical training programs across Canada.

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Author and article information

Journal

Journal ID (nlm-ta): Adv Med Educ Pract

Journal ID (iso-abbrev): Adv Med Educ Pract

Journal ID (publisher-id): Advances in Medical Education and Practice

Title: Advances in Medical Education and Practice

Publisher: Dove Medical Press

ISSN (Electronic): 1179-7258

Publication date Collection: 2015

Publication date (Electronic): 20 May 2015

Volume: 6

Pages: 353-358

Affiliations

Department of Medicine 1443, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia

Author notes

Correspondence: Imad Salah Hassan, Department of Medicine 1443, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, PO Box 22490, Riyadh 11426, Kingdom of Saudi Arabia, Tel +966 56 089 4530, Fax +966 11 801 4229, Email imadsahassan@ 123456yahoo.co.uk

Article

Publisher ID: amep-6-353

DOI: 10.2147/AMEP.S79521

PMC ID: 4445311

PubMed ID: 26056510

SO-VID: 61cb07b5-775b-4d91-9c75-c55f2c45733d

License:

The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Competency-structured case discussion in the morning meeting: enhancing CanMEDS integration in daily practice

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Most cited references 11

Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.

Does this dyspneic patient in the emergency department have congestive heart failure?

Collaboration, communication, management, and advocacy: teaching surgeons new skills through the CanMEDS Project.

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