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Dermatology postgraduate training in Canada: CanMEDS competencies

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Dermatology postgraduate training in Canada: CanMEDS competencies
Anatoli Freiman MD1, Adam Natsheh MD2, Benjamin Barankin MD3, and Neil H Shear MD FRCPC2
Dermatology Online Journal 12 (1): 6

1. Division of Dermatology, McGill University, Montreal,Canada.
2. Division of Dermatology, University of Toronto, Toronto, Canada
3. Division of Dermatology, University of Alberta, Edmonton, Canada


Medical residency education and the development of formalized training objectives in Canada have evolved continuously, especially with the introduction of the Canadian Medical Education Directions for Specialists (CanMEDS) competencies by the Royal College of Physicians and Surgeons of Canada (RCPSC) in 1996. In order to evaluate the effectiveness of implementation of CanMEDS competencies in Canadian postgraduate dermatology training programs from the residents' perspective, a comprehensive national survey of all Canadian core dermatology residents was conducted in June 2004. One hundred percent of core (PGY3-5) dermatology residents across the country (n = 48) completed the survey. Forty eight percent of residents were familiar with the CanMEDS competencies. Within the CanMEDS framework, the competencies were felt to be taught adequately by the following proportion of residents: medical expert (78 %), professional (66 %), communicator (52 %), collaborator (48 %), health advocate (48 %), scholar (48 %), and manager (28 %), with notable differences based on the year of training. This is the first national Canadian survey examining dermatology postgraduate education from the residents' perspective with a focus on CanMEDS competencies. While the RCPSC CanMEDS project implementation is presently in the faculty development phase, further work must be accomplished to enhance awareness of CanMEDS competencies and to incorporate these into dermatology residency programs across the country. Particular targeting of the roles perceived to be poorly taught is needed.


Dermatology education in Canada has continuously evolved over the past few decades. Whereas undergraduate medical school dermatology teaching has been previously reviewed [1, 2, 3, 4] there is little information regarding postgraduate dermatology training in Canada. In 1993 the Royal College of Physicians and Surgeons of Canada (RCPSC) Health and Public Policy Committee established the innovative Canadian Medical Education Directions for Specialists (CanMEDS) project, with the goals to 1) ensure that postgraduate programs are fully responsive to societal needs and 2) encourage the design of new residency training programs, curricula, and evaluation processes that would facilitate these goals. The RCPSC Office of Education has coordinated three phases of the CanMEDS program as follows: Framework Development (1990-96), Pilot Projects (1996-97), and Implementation (1997-2002). The fourth phase, Faculty Development, was formally launched in November 2003 [5].

The shift toward competency and outcome-based medical education now requires residents to achieve proficiency in seven domains of CanMEDS competencies, which include 1) Medical Expert (the central role), 2) Professional, 3) Health Advocate, 4) Scholar, 5) Manager, 6) Collaborator, and 7) Communicator (Fig. 1). These have been adopted as a framework of core competencies for specialists to be incorporated into the objectives of training, evaluation, and accreditation of all Royal College specialty programs [6]. The objective of this survey was to evaluate the effectiveness of implementation of CanMEDS competencies training in Canadian dermatology postgraduate programs from the perspective of dermatology residents. A broad appraisal of dermatology education in Canada from the residents' perspective was published recently [7].

Figure 1
CanMEDs Roles Framework. Copyright© 2001-2005 The Royal College of Physicians and Surgeons of Canada. Reproduced with the permission of the copyright holder.


A national survey of all core Canadian dermatology residents (PGY 3-5) was conducted in June 2004. Seven main dermatology programs were surveyed as follows: University of British Columbia (Vancouver), University of Alberta (Edmonton), University of Toronto (Toronto), University of Ottawa (Ottawa), McGill University (Montreal), University of Montreal (Montreal) and Laval University (Quebec City). The survey was conducted in June (at the end of the academic year) to allow the longest time and fullest experience in the program for each cohort year of residents.

The survey explored the following: 1) demographic information and 2) awareness of the CanMEDS framework, and 3) perceived adequacy of training in the seven CanMEDS competencies in dermatology. The survey was conducted anonymously. The questionnaires were distributed during academic rounds by program representatives and subsequently collected in sealed, unmarked envelopes. All data were subsequently entered into the SAS statistical database and tabulated. Analysis was performed using SPSS statistical software, version 11.5 (SSPS Inc., Chicago, Ill;


One hundred percent of core dermatology residents in Canada (PGY 3-5) responded to the survey; 35 percent of residents were male and 65 percent female. Fourteen residents (29 %) were in PGY-3 year of training, 14 (29 %) in PGY-4 and 20 (42 %) in PGY-5.

Overall, 48 percent of dermatology residents said they were familiar with the RCPSC CanMEDS framework. Table 1 demonstrates the perceived adequacy of training in the specific competencies. Residents became more familiar with these roles as they progressed through training, increasing from 43 percent in PGY-3 and PGY-4 to 60 percent in PGY-5. A decreasing trend was noted in the perceived adequacy of teaching for most of the individual CanMEDS roles in residency.

The Medical Expert role was felt to be adequately taught by 100 percent of PGY-3's, but only 70 percent of PGY-5's; specifically, 77.4 percent of females and 88.2 percent of males felt that this was adequately taught. There was also a decreasing trend of perceived adequacy of teaching observed for the Health Advocate role (57.1 % for PGY-3 to 45 % for PGY-5) and Professional role (78.6 % for PGY-3 to 65.0 % for PGY-5). The perceived effectiveness of the teaching of the Scholar role also declined with progression through training (57.1 % in PGY-3 to 40 % for PGY-5), with a difference noted between males and females (64.7% vs. 41.9% respectively).


The CanMEDS roles form a fundamental framework of core physician abilities. The RCPSC was the first medical assoication in the world to implement a national educational framework of the core competencies for all specialists. This framework has been reviewed in several Canadian postgraduate specialty training fields, including psychiatry [8], surgery [9], and obstetrics and gynecology [10]. To our knowledge, this is the first assessment of the CanMEDS competencies based on the perspective of the learners.

Even though familiarity with CanMEDS competencies increases with the year of training, they are perceived to be less adequately or sufficiently taught in later years. The increased familiarity may be due to residents being increasingly exposed to the CanMEDS framework from the view of rotation goals and objectives, as well as in-training evaluation reports. On the other hand, the perception that individual CanMEDS roles are less adequately taught may be explained by the fact that residents assume greater independence and responsibility for self-learning as they progress through training, and the perceived amount of external instruction is diminished.

The CanMEDS framework now forms the basis for the Royal College's accreditation standards, specialty-specific objectives of training, exam blueprints and in-training evaluations [5]. The challenge remains to develop new methods for teaching, and confirming that trainees acquire the appropriate cognitive knowledge, technical skills, and personal attributes required by their specialty. This will require an enhancement and formalization of competency evaluation tools that adequately document trainee performance in the required domains. Residents should seek opportunities that will enhance their development in the CanMEDS roles. At the same time, program directors and faculty supervisors should work collaboratively with residents to ensure that creative and flexible opportunities exist.

The RCPSC CanMEDS project is presently in the Faculty Development phase. These roles will likely become more evident to trainees as faculty become increasingly aware of them. Prideaux et al. give concrete examples of how faculty development can incorporate the seven CanMEDS roles [11]. These can be applied specifically to each Royal College specialty program, including dermatology. It is hoped that Canadian dermatology residency programs will embrace the available opportunities to incorporate the CanMEDS educational framework. Specific targeting of the areas perceived to be poorest taught should result in improved education of the next generation of Canadian dermatologists.

Acknowledgments We thank Jason R. Frank, MD, FRCPC from RCPSC Office of Education for reviewing the manuscript. We also gratefully acknowledge all Canadian dermatology residents who took the time to participate in the study.

Conflicts of interest: None. Funding: This study was supported by the Canadian Professors of Dermatology. Presented in part at the 80th Annual Canadian Dermatology Association Meeting, Quebec City, July 2, 2005.


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