The initial development of the LOs based on a literature review and discussions among researchers resulted in a draft list of nine LOs (Table 2), which were presented during the first phase of the Delphi process.
The first round of the Delphi process achieved a 100% response rate (6 out of 6 participants) and a 66.7% completion rate (4 out of 6 participants). This resulted in a consensus for 8 of the 9 OL with 75% agreement. After thought and discussion, the research team modified an additional LO which reached 75% consensus based on the comments written in the Delphi survey. Round 2 included two LOs and had a response rate of 66.7% (4/6) and a completion rate of 100%. This resulted in 75% consensus for the last two LOs, and only two cycles of the Delphi process were required.
The focus group further refined four of the nine LOs (3, 5, 7, and 9) to ensure that the LOs were achievable given the current assessment process. Analysis of the discussion led to three broad themes: competency assessment, curriculum content and delivery, and curriculum modifications. Table 3 lists the final LOs.
Participants agreed that it was not possible to assess every goal for every resident: “We don’t have an assessment score for every goal we have. We have thousands of lenses. It was noted that as long as LOs can be mapped to an EPA, general proficiency would be assessed one way or another.
Program content and delivery
In terms of overall goals and what they should encompass, participants agreed that residents should be able to identify a simple MAID case and a complex MAID case. In addition, residents need to know when and how to get help if needed. Additionally, participants agreed on the importance of defining what depth of knowledge about MAID would be useful for a generalist (i.e., primary care provider) versus an evaluator and provider of MAID. ‘MA. In terms of delivery, participants suggested that the MAID program could be presented in a self-assessment module within the end-of-life unit.
Make Curricular Changes
Participants agreed that curriculum changes should occur at the CCA level and are largely outside of local control. They agreed that the thematic area of “end-of-life care” would be the most appropriate area of study for these discussions to take place.
Each LO was mapped to Areas of Clinical Care (DOCC) and Entrustable Professional Activities (EPA) under the existing DFM program, as well as the CFPC’s 105 Priority Topics . This analysis revealed that while all LOs could be mapped to DOCC, LOs mapped inconsistently with APEs and priority topics (Table 1). Specifically, LOs 5, 6 and 8 have been mapped to priority topics and LOs 5 and 8 have been mapped to APEs. LOs focused on patient education and identification of patient goals (LO 5, 6 and 8) are more easily mapped to the program, while LOs with content exclusive to the WMA (LO 1, 2, 3, 4, 7, 9) revealed shortcomings in the program.