should mean better integration of physicians within the health care system and, ultimately, physicians who are better able to meet the health care needs of the population. Taking an earlier and more systematic approach to lifelong learning and regarding it as a foundational skill will benefit physicians as they transition from residency to practice and as their practices evolve. Preparing residents for transition into practice can reduce the stress associated with the first few years of practice when several other life events also occur (e.g., choosing a life partner, buying a house, beginning a family). Conceptualizing transitions within the career of a physician can provide medical schools, medical associations and specialty societies with a framework for providing supports for physicians, particularly around issues related to work–life balance. Breaking down some of the artificial boundaries between undergraduate, postgraduate and continuing education allows for more flexible training options for students and physicians. In an ideal world, there should be many more opportunities for practising physicians to return to residency-type training to learn new skills and knowledge in concentrated, intense study periods. Raising
the profile and importance of transitions in training and practice can stimulate innovations in training to address these issues. We should be considering graduated fellowships and licensing to more directly address the phenomena of transitioning into practice.
reCoMMenDAtIonS
1. Provide opportunities for the acquisition of lifelong learning skills early during the education program. This will permit the practise and development of the generic and applied skills necessary for independent practice, including, but not limited to, information literacy, raising and answering questions, continuous practice improvement techniques, feedback-seeking behaviour, self-monitoring of practice, and comparison to recognized standards of care.
2. Develop systems to provide feedback data to practising physicians and assist them in interpreting and using those data to create individualized learning plans that can be implemented and can potentially have an impact on patient care.
3. Identify the appropriate structures and expectations for transitional periods. This may require new courses that are common to all. Mentorship and other supervised training may also be needed. Additional attention to the role of the manager toward the end of training (i.e., after the certification examinations) would facilitate the assumption of duties as an independent practitioner.
4. Standardize “transitions” training within clerkship and residency programs.
5. Stimulate innovations in transitions training within the clerkship and residency programs. The Royal College specialty certification examinations should be completed sooner (e.g., six months before the training program finishes). This would allow for a formal junior staff period at the end of training, with supervision and mentoring that would enable a more graduated transition into practice.
6. Call for more research to understand professional practice transitions and develop and test transitional support systems.
7. The Royal College needs to ensure that MAINPORT and CPD requirements support evidence-based learning and assessment activities across the CanMEDS roles.
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