The CanMEDS role of Collaborator: How is it taught and assessed according to faculty and residents?

Collaboration is an important aspect of providing comprehensive medical care, avoiding medical error (1) and ensuring job satisfaction among health care providers (2,3). The area of collaboration has been highlighted as an area of focus within physician training by The Royal College of Physicians and Surgeons of Canada (RCPSC), who developed the Canadian Medical Education Directives for Specialists (CanMEDS) roles in 1996 and subsequently revised them in 2005 (4). CanMEDS is only one of several frameworks of essential physician competencies for guiding medical education (5), but it is the most widely used, having been adopted by 16 countries to date (6). It includes seven areas of competency expected for physicians: Medical Expert, Communicator, Collaborator, Health Advocate, Manager, Scholar and Professional. The RCPSC defines a Collaborator as one who can “effectively work within a healthcare team to achieve optimal patient care” (4). This is critically important because physicians work in partnership with others who are involved in the care of their patients, including other physicians, allied health professionals and the patients’ family. The RCPSC stipulates that physicians who achieve competency in this role are able to participate effectively and appropriately in an interprofessional health care team, and effectively work with other health professionals to prevent, negotiate and resolve interprofessional conflict (4). There are some roles, such as Medical Expert, that can be more easily assessed using traditional, psychometric methods (7). In contrast, some of the other roles, such as Health Advocate, Collaborator and Manager, are more difficult to assess (8–10). For example, in a survey conducted by the RCPSC, faculty reported that the most difficult roles to teach and assess were Manager and Health Advocate (11). A study by Verma et al (8) explored resident and faculty perceptions of the Health Advocate role and found many barriers to the teaching and assessment of residents in this role. There have been national faculty development workshops and a RCPSC ‘Train-the-Trainer’ course on the Collaborator to educate faculty about how to teach this role. Interprofessional care and education in some ways overlap with the Collaborator role and there is robust literature in those areas (12–15). From these studies, we can learn that health care professional students value interprofessional education (IPE) and that students prefer it to be offered in a small-group, interactive format (12). It has been reported that teachers often feel unprepared for facilitating inter-professional groups of medical, nursing and dental students in seminar discussions (16). Finally, there are key factors to be aware of in organizing the format in which IPE is offered and the training of instructors who are providing the IPE to maximize the chance for success (14). Physicians in training may also learn about collaboration from staff physicians and in other non-IPE venues. Currently, there are no studies that specifically explore the CanMEDS role of Collaborator in physician training. Given this paucity of research, the aim of the present study was to explore the perspectives of paediatric residents and faculty about how the Collaborator role is taught and assessed.