Closing the research gap at the interface of learning and clinical practice Article de synthèse : Combler le déficit en recherche à l ’ interface entre apprentissage et pratique clinique

Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents’ acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ‘‘research gap’’ where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions. Résumé Objectif Le dialogue à l’interface de la formation et de la pratique clinique met en lumière des domaines ayant une importance fondamentale pour le développement de nouvelles approches pour la formation clinique en anesthésiologie. L’objectif de cet article est d’examiner la littérature sur l’éducation et l’acquisition des compétences dans trois domaines pertinents pour l’interface entre apprentissage et la pratique clinique dans le but de suggérer un programme de recherche qui viendra enrichir les données probantes quant à la formation du médecin pour l’acquisition de compétences pour un exercice indépendant. Les trois domaines à examiner sont les suivants: 1) les transitions dans la poursuite de la formation; 2) l’effet de la réduction des heures de formation clinique sur la compétence; et 3) les efforts faits pour incorporer les compétences et les rôles CanMEDS dans l’enseignement et l’évaluation. Constatations principales Cinquante-six articles pertinents pour un ou plusieurs de ces thèmes ont été identifiés dans cette synthèse, y compris 21 études sur les transitions (sur, pendant et après la formation postgraduée), 19 études I. Philibert, PhD (&) Department of Field Activities, Accreditation Council for Graduate Medical Education and the Journal of Graduate Medical Education, 515 North State Street, Suite 2000, Chicago, IL 60654, USA e-mail: Iphilibert@acgme.org 123 Can J Anesth/J Can Anesth (2012) 59:203–212 DOI 10.1007/s12630-011-9639-7