Striving for excellence Developing a framework for the Triple C curriculum in family medicine education

Worldwide, the focus of medical education programs is shifting from a rotation-centric to a competency-based approach that helps specific roles and competencies to be achieved. In the United Kingdom, the General Medical Council has described elements of good practice in a model called Good Medical Practice.1 In the United States, core competencies for physicians have been defined by at least 2 key groups: the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties.2 The American Institute of Medicine has recommended the introduction of core skills or competencies and has created a structure for improving, reforming, and enhancing medical education and health care.3 In the 1980s, the 4 principles of family medicine (FM) were introduced by the College of Family Physicians of Canada (CFPC) to provide guidance and direction for FM practitioners and residency programs.4 The 4 principles of FM emphasize the following: the importance of the doctor-patient relationship, the family physician being a skilled clinician, family medicine being a community-based discipline, and the family physician being a resource to a defined practice.5 The 4 principles of FM soon formed the foundation of undergraduate, residency, and continuing professional development medical education program objectives and evaluations.6 They emphasize the important roles that family physicians play in areas beyond biomedical knowledge and expertise.7 The Educating Future Physicians of Ontario Project in the 1980s and 1990s reviewed existing frameworks, including the 4 principles of FM, and defined 8 key roles of physicians (ie, medical expert, communicator, collaborator, health advocate, learner, manager [“gatekeeper”], scholar, and physician as person).8 These 8 roles were ultimately adapted between 1997 and 2002 by a Working Group on Societal Needs from the Royal College of Physicians and Surgeons of Canada (RCPSC) and led to the creation of a framework called CanMEDS. The CanMEDS framework was updated in 2005 to become a more generic competency-based model for health education (from undergraduate to postgraduate and continuing professional development).9 In 2009, a Working Group on Curriculum Review appointed by the CFPC released an adaptation of the original CanMEDS model.10 This model, CanMEDS-FM, aligned with the original CanMEDS released by the RCPSC; however, it focused on the educational needs of medical students and residents learning to become family physicians.7 The CanMEDS-FM model is based on 7 roles that encapsulate the competencies required to become a skilled and well-rounded family physician. Table 110 shows the critical CanMEDS-FM roles as defined by the CFPC. Table 1 The CanMEDS–Family Medicine roles, as defined by the College of Family Physicians of Canada Currently, the CanMEDS-FM model of education is being widely implemented in undergraduate FM programs across Canada. Residency programs are working to incorporate the competency-based model and replace the rotation- or time-based model. The new CanMEDS-FM curriculum will also place more emphasis on learning to be family physicians rather than other specialists and place FM preceptors at the forefront of FM education. Ultimately, this will result in the further legitimization of FM as a discipline and go a long way toward ensuring that future generations of residents become well-rounded physicians who can provide superior care to their patients and society. In addition to embracing the 4 principles of FM and the CanMEDS-FM roles, the CFPC is advancing postgraduate FM education in Canada by promoting the Triple C Competency-based Curriculum (Triple C). This competency-based curriculum is comprehensive, focused on continuity of education and patient care, and centred in FM. The CFPC website describes the goal of the Triple C curriculum as follows: [T]o ensure that all Family Medicine residents develop professional competence to the level of a physician ready to begin practice in the specialty of Family Medicine.11 The curriculum ensures that graduates are 1) competent to provide comprehensive care in any Canadian community; 2) prepared for the evolving needs of society; and 3) educated based upon the best available evidence on patient care and medical education.11 The CFPC website continues to explain: This curriculum addresses accountability, social responsibility, patient safety, and efficiencies in educational programming. It highlights the College’s vision of graduating sufficient numbers of Canadian family physicians who can provide comprehensive, continuing care within traditional family practices and within newer models of inter-professional practice.11 Striving for excellence in FM postgraduate education demands that curriculum designers invest considerable energy in the design, delivery, and evaluation of innovative programs to meet the learning needs of residents. The purpose of this paper is to share the process of developing the University of Ottawa (U of O) Family Medicine Curriculum Framework (FMCF) and exploring the role the framework has played in the delivery of a curriculum that incorporates the 4 principles of FM, the CanMEDS-FM roles, the Triple C curriculum principles, the curriculum content domains, and the pedagogic strategies that support the development of attitudes, knowledge, and skills for postgraduate FM training programs. The FMCF provides a foundation for FM education and sets a quality standard for the design, delivery, and evaluation of effective postgraduate FM programs. The framework is a first step toward guiding what should be included in a comprehensive postgraduate FM curriculum in Canada. For the past 2 years, the Department of Family Medicine (DFM) at the U of O has been developing the educational learning objectives, teaching and learning strategies, and evaluation tools to align with this framework. Future publications will share the experience of how this framework guides the design, implementation, and evaluation of the Triple C curriculum for postgraduate FM education.