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.

住院医师规范化培训项目主管会将少量住院医师从培训项目中除名，此举通常归因于其表现不佳或培训进度滞后。目前尚不明确不同专科住院医师在能力维度上的表现不佳情况是否存在差异。2021年，我们对2011至2020年间因被项目主管除名而向国家调解委员会提出申诉的荷兰住院医师的相关判例进行了分析。我们针对各医学专科，对比了这些住院医师未能达到的CanMEDS能力维度（CanMEDS competency domains）。本次研究共纳入116起住院医师被除名后向委员会提出申诉的案例。总体而言，多数住院医师未能满足多项CanMEDS能力维度的要求，常见未达标的维度包括医疗专家（medical expert）、沟通者（communicator）与专业从业者（professional）。在外科专科中，所有被除名的住院医师均未达到医疗专家维度的要求，而多数被除名的精神科住院医师则达标。对于以诊断工作为核心的专科，更多被除名的住院医师未达到学术研究者（scholar）维度的要求；而全科医学专科（如家庭医学与养老院照护）的被除名住院医师则较少出现此类情况。不过，全科医学专科的住院医师相较于其他专科，更常未达到专业从业者维度的要求。提出申诉的被除名住院医师普遍未能满足多项CanMEDS能力维度的要求，且不同专科的住院医师在能力维度未达标情况上存在显著差异。