A Curriculum History of Postgraduate Medical Education in Canada, 1990-2020

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Kettaneh, Hasan
Change Leadership , Glocalization , Competency-Based Medical Education , CanMEDS Roles Framework , Modified CanMEDS , CanMEDS-2025 , GLOCALS , Leadership , Leadership in Medical Education , Postgraduate Medical Education , Leadership in Postgraduate Medical Education , PGME , CBME , CBD , Longue Durée framework , Braudel’s Longue Durée , exploratory sequential multi-manuscript mixed methods , Multi-Manuscript , Configurations , Ideological factors , Skinner , hermeneutic approach , theory of intentionality , Curriculum History , Historical research , Archives , Arksey and O’Malley Scoping Review , Modified Delphi Study , Pan-Canadian , Consensus , Curriculum Change , Inclusive Governance , EDII , Indigenization - Equity, Diversity, Inclusion, Anti-Racism, and Accessibility (I-EDIAA) , Digital Health Literacy , Expert Panel , think globally
Curricular reforms and change initiatives in PGME are often reactive responses to global or local crises, risks, and opportunities. This reality renders our understanding of PGME curriculum incomplete. To better design and understand curricular change in a complex adaptive human system such as PGME, it is necessary to “think globally, act locally,” concomitantly looking back while thinking forward. Since 1990, PGME curricula in Canada has undergone many reform iterations including the EFPO project, the CanMEDS Roles framework, the CBME/CBD initiative, and the recent emergency response to the ongoing COVID-19 pandemic. To unpack these curricular transformations, contextualize drivers behind change, and examine change leadership, this multi-manuscript dissertation employed a curriculum-history approach using Braudel’s (1960) interdisciplinary Longue Durée framework in an exploratory sequential mixed methods design. This dissertation contributes to the body of knowledge in PGME by documenting national and international social, cultural, political, and ideological configurations and lived experiences that shaped PGME curricula between 1990 and 2020, providing an understanding of how the current system of training residents has evolved in Canada, and why PGME curricula is the way it is today. In Study 1, Skinner's (2002) hermeneutic approach and theory of intentionality were utilized to thematically analyze archival collections going back to 1970. In Study 2, Arksey’s and O’Malley’s (2005) framework for scoping reviews was employed to map the literature relevant to the CBME paradigmatic shift in Canada since 1990. In Study 3, a modified Delphi study of three rounds was conducted to gain consensus from 30 pan-Canadian CBME experts about the role of change leadership and driving forces behind curricular changes in PGME over the last 30 years. The findings of the three studies suggest that change in PGME is a learning process involving stakeholders’ co-creation, contextualization, and actualization of curricular change to meet the needs of local population served. The resultant GLOCALS model calls for a distributed and participatory change leadership approach, as well as an inclusive and engaging PGME governance at the global and local levels to guide successful curricular reforms. The results further recommend the addition of digital health literacy and equity, diversity, inclusion, and indigeneity (EDII) to the CanMEDS-2025 version.
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