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Acad Med. 2018 Jul 31. doi: 10.1097/ACM.0000000000002387. [Epub ahead of print]

The Impact of a National Competency-Based Medical Education Initiative in Family Medicine.

Author information

1
R.H. Ellaway is professor, Department of Community Health Sciences, and director, Office of Health and Medical Education Scholarship, Cumming School of Medicine, University of Calgary, Alberta, Canada. ORCID: http://orcid.org/0000-0002-3759-6624 M. Palacios Mackay is assistant professor, Departments of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. S. Lee is assistant professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. M.L. Hofmeister is adjunct assistant professor, Department of Community Health Sciences, and team lead, Undergraduate Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. G. Malin is assistant professor, Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Canada. D. Archibald is assistant professor, Department of Family Medicine, Faculty of Medicine, University of Ottawa, and investigator, Bruyère Research Institute, Ottawa, Ontario, Canada. K. Lawrence is associate professor, Department of Family Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Canada. J. Dogba is assistant professor, Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, Canada. L. Côté is professor, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, Canada. S. Ross is associate professor, Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada.

Abstract

PURPOSE:

Triple C is the Canadian competency-based medical education (CBME) initiative for family medicine. The authors report on a study exploring the impacts Triple C has had across Canada.

METHOD:

A multi-institutional team conducted a realist study to explore the current view of the impact Triple C implementation had in different programs across Canada. Data were collected between March and June 2016 from interviews and focus groups with key medical school stakeholders. Data were analyzed using thematic and template analysis techniques.

RESULTS:

Data were acquired from 16 of the 17 Canadian medical schools from a combination of program leaders, educators, and trainees. Triple C was implemented in different ways and to different extents depending on context. Newer sites tended to have a more comprehensive implementation than established sites. Urban sites afforded different opportunities to implement Triple C from those afforded by rural sites. While it was too early to assess its impact on the quality of graduating residents, Triple C has had a positive impact on identifying and remediating failing learners and on energizing and legitimizing the educational mission in family medicine. Negative impacts included greater costs and tensions in the relationships with other specialties. A principles-based approach to CBME offered flexibility to programs to incorporate variation in their interpretation and implementation of Triple C. While there was a degree of normalization of practice, it was not standardized across sites or programs.

CONCLUSIONS:

Triple C has been successfully implemented across Canada but in differing ways and with different impacts.

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