Development, Implementation, and Meta-Evaluation of a National Approach to Programmatic Assessment in Canadian Family Medicine Residency Training.

The growing international adoption of competency-based medical education has created a desire for descriptions of innovative assessment approaches that generate appropriate and sufficient information to allow for informed, defensible decisions about learner progress. In this article, the authors provide an overview of the development and implementation of the approach to programmatic assessment in postgraduate family medicine training programs in Canada, called Continuous Reflective Assessment for Training (CRAFT). CRAFT is a principles-guided, high-level approach to workplace-based assessment that was intentionally designed to be adaptable to local contexts, including size of program, resources available, and structural enablers and barriers.

Excessive daytime sleepiness after traumatic brain injury.

Study Objectives: To identify the prevalence of excessive daytime sleepiness (EDS) in a prospectively recruited patient population with traumatic brain injury (TBI) of mixed severity. Furthermore, the study aimed to assess the relationship between patient factors and EDS.

Method: One-hundred and eighteen patients with TBI were assessed in a neurorehabilitation clinic after discharge from the emergency department.

Defining competency-based evaluation objectives in family medicine: professionalism.

Objective: To develop and describe observable evaluation objectives for assessing competence in professionalism, which are grounded in the experience of practising physicians.

Design: Modified nominal group technique.

Setting: The College of Family Physicians of Canada in Mississauga, Ont.

Defining competency-based evaluation objectives in family medicine: procedure skills.

Objective: To develop evaluation objectives for assessing competence in procedure skills using a key-features approach. This was part of a multiyear project to develop competency-based evaluation objectives for Certification in Family Medicine.

Design: Nominal group technique.

Defining competency-based evaluation objectives in family medicine: communication skills.

Objective: To provide a pragmatic approach to the evaluation of communication skills using observable behaviours, as part of a multiyear project to develop competency-based evaluation objectives for Certification in family medicine.

Design: A nominal group technique was used to develop themes and subthemes and to identify positive and negative observable behaviours that demonstrate competence in communication in family medicine.

Setting: The College of Family Physicians of Canada in Mississauga, Ont.

Defining competency-based evaluation objectives in family medicine: key-feature approach.

Objective: To develop key features for priority topics previously identified by the College of Family Physicians of Canada that, together with skill dimensions and phases of the clinical encounter, broadly describe competence in family medicine.

Design: Modified nominal group methodology, which was used to develop key features for each priority topic through an iterative process.

Setting: The College of Family Physicians of Canada.

Defining competency-based evaluation objectives in family medicine: dimensions of competence and priority topics for assessment.

Objective: To develop a definition of competence in family medicine sufficient to guide a review of Certification examinations by the Board of Examiners of the College of Family Physicians of Canada.

Design: Delphi analysis of responses to a 4-question postal survey.

Setting: Canadian family practice.

Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial.

We evaluated whether telehealth counseling augments lifestyle change and risk factor decrease in subjects at high risk for primary or secondary cardiovascular events compared to a recommended guideline for brief preventive counseling. Subjects at high risk or with coronary heart disease (35 to 74 years of age, n = 680) were randomized to active control (risk factor feedback, brief advice, handouts) or telehealth lifestyle counseling (active control plus 6 weekly 1-hour teleconferenced sessions to groups of 4 to 8 subjects). Primary outcome was questionnaire assessment of adherence to daily exercise/physical activity and diet (daily vegetable and fruit intake and restriction of fat and salt) after treatment and at 6-month follow-up.

Big cities and bright lights: rural- and northern-trained physicians in urban practice.

Introduction: Rural medical education is increasing in popularity in Canada. This study examines why some family physicians who completed their residency training in northern Ontario decided to practise in urban centres.

Methods: We used a qualitative research method.

Graduates of northern Ontario family medicine residency programs practise where they train.

Objective: To examine where graduates of the Northeastern Ontario Family Medicine (NOFM) residency program in Sudbury and the Family Medicine North (FMN) program in Thunder Bay practise after graduation, using cross-sectional and longitudinal analyses.

Methods: Data from the Scott's Medical Database were examined. All physicians who graduated from NOFM and FMN between 1993 and 2002 were included in this analysis.

Duration of rural training during residency: rural family physicians prefer 6 months.

Objective: To determine whether rural family physicians thought they had received enough months of rural exposure during family medicine residency, how many months of rural exposure those who were satisfied with their training had had, and how many months of rural exposure those who were not satisfied with their training wanted.

Design: Mailed survey.

Setting: Rural Canada.

Factors influencing family physicians to enter rural practice: does rural or urban background make a difference?

Objective: To examine where rural physicians grew up, when during their training they became interested in rural medicine, factors influencing their decision to practise rural medicine, and differences in these measures according to rural or urban upbringing.

Design: Mailed survey.

Setting: Rural Canada.

Evidence-based risk factors for postoperative deep vein thrombosis.

Background: Deep vein thrombosis (DVT) is a common postoperative complication that is associated with significant morbidity and mortality. Thromboprophylaxis has been shown to be underused. In the absence of prophylaxis, rates as high as 50% have been reported following orthopaedic surgery, and 25% following general surgery.