Five years of screaming in the desert of a bloodless health system is a long time. The radio silence of the Legault government about the disastrous reform of the training of medical residents is all the more inexplicable. He is so quick to defend the Quebec exception, how can he rely without complaining on the ways of doing things of pan-Canadian groups in medical education, such as the Royal College of Physicians and Surgeons of Canada, to whom we owe this revolution? based on a model pompously baptized Competence by Design (CPC)?
It will be said that Quebec is blandly relying on the judgment of our faculties of medicine and the College of Physicians. It would be too easy, especially since we cannot say that they shone by their listening in this file. The latter have indeed welcomed the latest alarming report from the Federation of Resident Physicians of Quebec (FMRQ) with a distance that borders on non-assistance.
We grant them this: changing culture takes time, and the objectives underlying this reform are not to be thrown away. Fostering feedback and reinforcing learner learning and confidence are laudable goals. But their hasty implementation in an overloaded network has opened a royal road to a detestable “feedback market” between learners and supervisors.
From this new competency-based learning model, the FMRQ has so far only retained “an absent pedagogical benefit” and “an increased cognitive and emotional load”, despite readjustments that are as numerous as they are unproductive. To the point where resident doctors have become, she says, “the guinea pigs of a failed educational experiment”.
The word “guinea pig” is not too strong. The break detailed by the reporter of the To have to Marco Fortier, who also reviewed an analysis made by independent experts, is profound. Launched without safeguards and in haste, the CBD is “not based on the evidence of scientific research, neither in general pedagogy nor in medical pedagogy”, explains this committee.
Reading this, one cannot help but observe that one seems to have lost sight of the primary objective of medicine: Primum non nocere. How indeed “first, do no harm” by allowing such haggling of the medical act to continue? Energy-intensive beyond reason, the process itself is nonsense in the current state of the health network.
Our hospitals are overflowing, waiting lists are exploding, what benefits can patients expect from this botched reform? None, at least for now. For supervisors, the task is no picnic either. It is added to an increasingly cumbersome list of administrative paperwork. For medical residents, it is a factor of unnecessary stress and anxiety, which becomes detrimental in an environment that already puts them heavily to the test on a daily basis.
Does this partly explain it? Unveiled last month, the Canadian Medical Association’s most recent survey shows an increase in burnout (53% report a high level) in addition to an increased administrative burden for physicians and residents alike.
Building an airplane in midair always comes with its share of risk. It’s been five years that we struggle to tinker in vain a reform while all the indicators are red. The solutions will not come from the Royal College, which has nothing to do with the Quebec exception and which often misunderstands it. Let’s take back the controls.