Do deficiencies in CanMEDS competencies of dismissed residents differ according to specialty?

Program directors dismiss a small percentage of residents from residency training programs, presumably due to underperformance or lack of progress. Whether underperformance in competency domains differs by residents’ specialty is unknown. In 2021, we analysed the case law of Dutch residents who were dismissed from training by the program director, and who challenged this dismissal before the national conciliation board between 2011 and 2020. Across medical specialties we compared which of the CanMEDS competency domains these residents failed to meet. We found 116 cases of residents dismissed from their training programmes who challenged the decision of the program director before the board. In general, most residents were unable to meet the requirements of several CanMEDS competency domains (usually: medical expert, communicator, and professional). In surgery, all dismissed residents failed to meet the competency domain of the medical expert, while most of the dismissed psychiatry residents met this domain. In specialties with a primarily diagnostic task, more dismissed residents failed to meet the competency domain of the scholar, while dismissed general medicine residents (for example family medicine and nursing homecare) were less likely to do so. Residents in general medicine, more often than other specialties, however, failed to meet the competency domain of the professional. Residents dismissed from training, who challenged their dismissal, failed to meet the requirements of multiple CanMEDS competency domains. Competency domain failures differ by specialty.

住院医师培训项目负责人会将小比例的住院医师从培训项目中解聘，推测其原因为表现不佳或培训进展迟缓。目前尚不明确不同专科住院医师在能力领域的表现不佳情况是否存在差异。2021年，我们分析了2011至2020年间，被项目负责人解聘培训资格且向荷兰国家调解委员会提出申诉的住院医师的相关判例。我们针对各医学专科，对比分析了这些住院医师未达到的加拿大医学专家能力框架（CanMEDS）能力领域。本次研究共纳入116例被解聘培训资格且向该委员会提出申诉的住院医师案例。总体而言，多数住院医师未能达到多项加拿大医学专家能力框架能力领域的要求，通常涉及医学专家、沟通者与从业者三大领域。在外科专科中，所有被解聘的住院医师均未达到医学专家领域的要求，而大部分被解聘的精神科住院医师则达标。在以诊断工作为主的专科中，更多被解聘的住院医师未达到学者领域的要求；而全科医学（如家庭医学与养老院护理）方向的被解聘住院医师则较少出现此类情况。不过，全科医学方向的住院医师相较于其他专科，更常未达到从业者领域的要求。提出申诉的被解聘住院医师，普遍未达到多项加拿大医学专家能力框架能力领域的要求。能力领域未达标情况因专科不同存在显著差异。