What supervisors say in their feedback: construction of CanMEDS roles in workplace settings.
The CanMEDS framework has been widely adopted in residency education and feedback processes are guided by it. It is, however, only one of many influences on what is actually discussed in feedback. The sociohistorical culture of medicine and individual supervisors' contexts, experiences and beliefs are also influential. Our aim was to find how CanMEDS roles are constructed in feedback in a postgraduate curriculum-in-action. We applied a set of discourse analytic tools to written feedback from 591 feedback forms from 7 hospitals, including 3150 feedback comments in which 126 supervisors provided feedback to 120 residents after observing their performance in authentic settings. The role of Collaborator was constructed in two different ways: a cooperative discourse of equality with other workers and patients; and a discourse, which gave residents positions of power-delegating, asserting and 'taking a firm stance'. Efficiency-being fast and to the point emerged as an important attribute of physicians. Patients were seldom part of the discourses and, when they were, they were constructed as objects of communication and collaboration rather than partners. Although some of the discourses are in line with what might be expected, others were in striking contrast to the spirit of CanMEDS. This study's findings suggest that it takes more than a competency framework, evaluation instruments, and supervisor training to change the culture of workplaces. The impact on residents of training in such demanding, efficiency-focused clinical environments is an important topic for future research.
Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands. n.renting@umcg.nl.
Nienke
N
Renting
Centre for Medical Education, Queen's University Belfast, Belfast, UK.|Department of Education Development and Research, Maastricht University, Maastricht, The Netherlands.
Tim
T
Dornan
Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Rijk O B
RO
Gans
Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Jan C C
JC
Borleffs
Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Janke
J
Cohen-Schotanus
Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
A Debbie C
AD
Jaarsma
D002983:Clinical Competence; D003142:Communication; D003299:Cooperative Behavior; D000068156:Formative Feedback; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007400:Interprofessional Relations; D010817:Physician-Patient Relations; D017132:Workplace
CanMEDS; Competency-based medical education; Discourse analysis; Feedback; Patient-centred care; Postgraduate training; Residency; Workplace learning