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PURPOSE Physician shortages and maldistribution, particularly within family medicine, have led many medical schools worldwide to create regional medical campuses (RMCs) for clerkship training. However, Canadian medical schools have developed a number of RMCs in which all years of training (i.e., a combined model that includes both preclerkship and clinical training) are provided geographically separate from the main campus. This study addresses the question: Are combined model RMC graduates more likely to enter postgraduate training in family medicine and rural-focused programs relative to main campus graduates? METHOD The authors used a quasi-experimental research design and analyzed 2006-2016 data from the Canadian Resident Matching Service (CaRMS). Graduating students (N = 26,525) from 16 Canadian medical schools who applied for the CaRMS match in their year of medical school graduation were eligible for inclusion. The proportions of graduates who matched to postgraduate training in (1) family medicine and (2) rural-focused programs were compared for combined model RMCs and main campuses. RESULTS Of RMC graduates, 48.4% matched to family medicine (95% confidence interval [CI] = 46.1-50.7) compared with 37.1% of main campus graduates (95% CI = 36.5-37.7; P < .001). Of RMC graduates, 23.9% matched to rural-focused training programs (95% CI = 21.8-25.9) compared with 10.4% of main campus graduates (95% CI = 10.0-10.8; P < .001). Subanalyses ruled out a variety of potentially confounding variables. CONCLUSIONS Combined model RMCs, in which all years of training take place away from the medical school's main campus, are associated with greater proportions of medical students entering family medicine postgraduate training and rural-focused training programs. These findings should encourage policymakers, health services agencies, and medical schools to continue seeking complements to academic medical center-based medical education.

Background and Objectives: There is a limited evidentiary base on the development of family medicine in different contexts and countries. The lack of evidence impedes our ability to compare and characterize family medicine models and identify areas of success that have led to the effective provision of care. This paper offers a comparative compilation and analysis of the development of family medicine training programs in seven countries: Brazil, Canada, Ethiopia, Haiti, Indonesia, Kenya, and Mali. Methods: Using qualitative case studies, this paper examines the process of developing family medicine programs, including enabling strategies and barriers, and shared lessons. An appreciative inquiry framework and complex adaptive systems thinking inform our qualitative study. Results: Committed partnerships, the contribution of champions, health policy, and adaptability were identified as key enablers in all seven case studies. The case studies further reveal that some enablers were more salient in certain contexts as compared to others, and that it is the interaction of enablers that is crucial for understanding how and why initiatives succeeded. The barriers that emerged across the seven case studies include: (1) resistance from other medical specialties, (2) lack of resources and capabilities, (3) difficulty in sustaining support of champions, and (4) challenges in brokering effective partnerships. Conclusions: A key insight from this study is that the implementation of family medicine is nonlinear, dynamic, and complex. The findings of this comparative analysis offer insights and strategies that can inform the design and development of family medicine programs elsewhere.

Contexte et objectif : L’objectif general du projet de recherche-action international francophone sur la responsabilite sociale des facultes de medecine a ete d’experimenter et d’evaluer la pertinence, l’applicabilite et la mise en œuvre d’une demarche de qualite inspiree des principes de responsabilite sociale (RS) et d’en demontrer l’utilite comme une strategie de choix pour ameliorer la sante. Description : Au 1er novembre 2015, 56 facultes de medecine dans 18 pays francophones ont adhere au projet de recherche-action. La phase d’evaluation de la perception des differents acteurs a montre que la sensibilisation devait etre poursuivie aupres des acteurs « intra muros » et « extra-muros ». La participation forte des etudiants signe un vif interet de ces derniers pour la RS. Des experimentations d’actions pragmatiques de RS ont ete choisies par les facultes : le contrat faculte-territoire, la premiere ligne de sante, l’adaptation de la formation et les populations vulnerables. Resultats : Le regroupement de facultes dans un meme pays montre une dynamique nationale forte, une mutualisation des projets d’intervention et une visibilite accentuee. En Tunisie et en Haiti, les quatre facultes nationales sont partenaires du projet autour d’une thematique commune. Les six facultes de medecine de Madagascar se sont engagees dans un partenariat national prometteur. Conclusion : L’experience du projet de recherche action sur la RS des facultes de medecine est une experience d’envergure originale dans le monde francophone. En raison de la diversite des engagements, le projet illustre de maniere evidente la possibilite d’engager des actions pragmatiques de RS a l’echelle d’une communaute, d’une institution academique ou d’un pays.

Contexte : Les facultes de medecine francophones au niveau mondial (139), conscientes de leurs obligations, s’engagent pleinement envers leur responsabilite sociale avec l’objectif de repondre au mieux aux besoins des populations qu’elles ont le mandat de servir. En 2012, elles ont mis sur pied un projet international de recherche-action sur la responsabilite sociale. Apres quelques annees de travaux, elles ont recemment elabore un plan strategique pour la periode 2015-2020 pour confirmer leurs engagements, mieux coordonner les actions, en faire un suivi plus rigoureux et en augmenter l’impact. Exegese : Le plan se fonde sur trois axes specifiques d’intervention : l’impact, l’accreditation, les partenariats/collaborations. Ceux-ci sont renforces par trois axes transversaux de soutien : plaidoyer/formation/expertise, dissemination/leadership, organisation/ressources. Les objectifs de chacun des axes ainsi qu’une serie d’actions prioritaires pour la periode 2015-2017 sont presentes. Conclusion : Ce plan strategique confirme l’engagement concret des facultes de medecine francophones envers leur responsabilite sociale pour les prochaines annees.

Background: Globalization results in a rapidly diversifying population, increased inequities, and more complex health problems affecting populations. This forces medical schools to integrate global health (GH) into the training of health-care professionals from curriculum development to practical learning activities, here and abroad.Approach: The approach aims at enriching existing programs in GH competencies in an interdisciplinary context. The goal is to ensure that all health-science students develop a certain level of GH competency. The main actions are the mobilization of key stakeholders, the development of a competency framework (CF) to perform gap analysis, tool formalization, and monitoring and evaluation activities. Subsequent to scoping review and stakeholder consultations, ten principles are identified and used to guide the enrichment process.Results: Actual outputs cover a broad scope, from key decision-makers’ support and endorsement to the formalization of tools and the consolidation and creation of activities such as service-learning activities, rotations among underserved populations, and training for international rotations.Conclusion: While this unique approach is proving to be a major challenge, the preliminary results are well worth the effort. The project’s tangible impacts on health-sciences teaching, the GH competence of graduates, and care delivery are topics of interest for future investigation.

Contexte : Etre socialement responsable, c'est etre comptable devant la societe des actions que l'on entend mener en sa faveur. En matiere de sante, la responsabilite sociale est l'engagement a repondre de facon aussi performante que possible aux besoins de sante prioritaires du citoyen et de la societe, notamment en erigeant comme principes fondateurs les valeurs de qualite, equite, pertinence et efficience, et la participation active a l'evolution du systeme de sante. Exegese : Pour l'institution de formation, la responsabilite sociale devrait etre appreciee a l'aide de normes relevant de trois domaines interdependants : la conception, la production et l'utilisabilite des personnels de sante. L'institution qui forme et qui verifie son impact sur la societe merite un label d'excellence, en ce qu'elle assume pleinement son role d'acteur responsable dans le systeme de sante et se pose en garante de l'interet general. Conclusion : Dans un monde plus enclin a la recherche d'efficience et de transparence, cette nouvelle posture de l'institution de formation s'imposera a l'avenir. Un cadre general de normes illustrant la responsabilite sociale est propose pour une reactualisation de l'evaluation et l'accreditation.

Contexte : Bien que l'Examen Clinique Objectif Structure (ECOS) soit considere comme le meilleur instrument pour l'evaluation de la competence clinique, l'experience de ce type d'examen est encore limitee en France. But : Evaluer la faisabilite et l'acceptabilite d'un ECOS destine aux internes en Urologie. Materiel et Methodes : 20 internes d'urologie ont passe un circuit de 5 stations de 10 minutes chacune avec patients simules. La selection des problemes a ete effectuee en fonction des objectifs d'apprentissage des programmes d'enseignement de l'urologie. Un questionnaire ecrit avec echelle de Likert a ete utilise pour evaluer l'acceptabilite de l'ECOS. Les performances des internes juniors et seniors ont ete comparees avec un test t de Student. Resultats : La performance des internes seniors a ete globalement superieure a celle des juniors, mais sans difference significative. Les internes seniors ont ete significativement meilleurs concernant les problemes de consultation et la majorite d'entre eux ont obtenu une note superieure a la moyenne totale du groupe. Malgre notre manque d'experience et les difficultes logistiques, nous n'avons pas rencontre de difficulte dans le developpement et l'organisation de l'examen. Tous les participants ont confirme que les situations cliniques presentees etaient realistes et que les patients simules etaient credibles. Conclusions : Les resultats de cette experience pilote d'ECOS en urologie prouvent la faisabilite d'un tel instrument pour evaluer la performance des internes et les deficiences eventuelles de l'enseignement, notamment l'activite de consultation. Cette experience doit etre developpee afin d'explorer ses qualites psychometriques.

Background: Bridging the theory of psychometric assessment to an evaluation instrument is a challenging and continuous task. Such a task was completed for the SP-based OSCE licensing examination used in Quebec since 1990.Purpose: To review the comprehensive series of psychometric studies undertaken on the examination based on the theory of psychometric assessment. Methods: The examination is a 5.5 hour-long OSCE composed of 26 clinical cases of7, 10 or 15 minutes' duration. Candidates' total scores and case scores are used for licensing decisions. Reliability coefficients were obtained as well as generalizability studies to assess the impact of examination sites (4), tracks (14) and languages(French and English) on candidates' results. Its content validity was assessed by experts as well as by practicing family physicians, examiners and exam coordinators. Concurrent validity was assessed. Through differential item functioning (DIF)statistical approach, possible gender biases were analyzed. The predictive validity of the examination scores on selected aspects of practice was analyzed as well as the impact of the examination on the teaching and learning process.Results: These studies confirmed the validity, reliability and generalizability of the examination scores. No biases were demonstrated. Examination scores predicted elements of practice. Educational impact was present.Conclusion: This study confirmed the quality of the examination, ensured its continuous improvement and supported the inferences made from the examination results.

> I do not know where my road is taking me, but I walk better when my hand holds yours. > > — Alfred de Musset “Lie beside me. Hold my hand.” Nicole’s words during her last days. She was 60 and had been my wife for 38 years. The disease plagued her for almost 10 years. Mutilating surgery

Medical examinations translated into two or more languages may discriminate against one or more of the linguistic groups involved if the quality of the translations is poor or if the “medical cultures”; of the different linguistic groups are not identical. The most striking aspect of a literature review of the subject is the paucity of published reports. Over the past 3 years, the authors have gained considerable experience in translating large‐scale objective structured clinical examinations into French and English. Analysis of the examination results is described and leads to the conclusion that the translation does not discriminate against either linguistic group. The translation process developed for these examinations is presented, and hypotheses to explain the scarcity of literature on the subject are developed.

INTRODUCTION An understanding of the contextual, professional, and personal factors that affect choice of practice location for physicians is needed to support successful strategies in addressing geographic maldistribution of physicians. This study compared two categories of predictors of family practice location in non-metropolitan areas among undergraduate medical students: individual characteristics (nature), and the rural program component of their training program (nurture). The study aimed to identify factors that predict the location of practice 2 years post-residency training and determine the predictive value of combining nature and nurture variables using administrative data from two undergraduate medical education programs. METHODS Databases were developed from available administrative sources for a retrospective analysis of two undergraduate medical education programs in Canada: Universite de Sherbrooke (UdeS) and University of British Columbia (UBC). Both schools have a strong mandate to evaluate the impact of their programs on physician distribution. The dependent variable was location of practice 2 years after completing postgraduate training in family medicine. Independent variables included individual and program characteristics. Separate analyses were conducted for each program using multiple logistic regression. RESULTS The nature and nurture variables considered in the models explained only 21% to 27% of the variance in the eventual location of practice of family physician graduates. For UdeS, having an address in a rural/small-town environment at application to medical school (OR=2.61, 95% CI: 1.24-6.06) and for UBC, location of high school in a rural/small town (OR=4.03, 95% CI: 1.05-15.41), both increased the chances of practicing in a non-metropolitan area. For UdeS the nurture variable (ie length of clerkship in a non-metropolitan area) was the most significant predictor (OR=1.14, 95% CI: 1.067-1.22). For both medical schools, adding a single nurture variable to the model using only nature variables significantly increased the amount of variation accounted for in predicting location of practice in non-metropolitan areas. CONCLUSIONS Aspects of graduates' rural background increase the chances of practicing in a non-metropolitan area. A third-year clerkship experience in a rural area may increase the chances of non-metropolitan practice. Although the total variation predicted by both nature and nurture variables in this study was small, adding a nurture variable significantly improves the prediction of individuals who will practice in a non-metropolitan area. The fact that total variation predicted was small is likely to be due to the limitations of the administrative databases used. Different strategies are being implemented in each university to improve the quality of existing administrative databases, as well as to collect relevant data about intent-to-practice, training characteristics, and the attitudes, beliefs and backgrounds of students.

The Sherbrooke-Estrie integrated cardiovascular health program (SEICHP) was developed in the Canadian province of Quebec. It was among the 12 field projects selected in 2001 around the world by the World Health Organization (WHO) to implement the TUFH (Towards Unity for Health) strategy as a way to improve health development responding to people's needs through integration of health services and partnership among key stakeholders. SEICHP tailored and applied the TUFH approach. It developed comprehensive and integrated services for people suffering or being at risk of cardiovascular problems in its region of influence. It emphasized complementarity, efficiency of resource use, interprofessional collaboration and partnership. In this, SEICHP complied with TUFH criteria. Information on how it adapted and applied these with relative success is reported.Even though difficulties in evaluation represent a limitation, major lessons learned linked to TUFH criteria include: the necessity to involve the public health and individual health people at all phases of program development and implementation, including the identification of information to be collected; an emphasis on integration brings health professionals to realize the importance of interdisciplinary work and academic institutions to modify their educational programs; restraining and supporting factors to partnership must be considered purposefully to optimize the partnership process; and optimal assessment of impact is difficult to attain.TUFH gave SEICHP a comprehensive conceptual framework for health development to work with. It had a highly significant impact on its development and provides direction for its future actions.

ContextStandards for licensure are designed to provide assurance to the public of a physician's competence to practice. However, there has been little assessment of the relationship between examination scores and subsequent practice performance.ObjectiveTo determine if there is a sustained relationship between certification examination scores and practice performance and if licensing examinations taken at the end of medical school are predictive of future practice in primary care.Design, Setting, and ParticipantsA total of 912 family physicians, who passed the Quebec family medicine certification examination (QLEX) between 1990 and 1993 and entered practice. Linked databases were used to assess physicians' practice performance for 3.4 million patients in the universal health care system in Quebec, Canada. Patients were seen during the follow-up period for the first 4 years (1993 cohort of physicians) to 7 years (1990 cohort of physicians) of practice from July 1 of the certification examination to December 31, 1996.Main Outcome MeasuresMammography screening rate, continuity of care index, disease-specific and symptom-relief prescribing rate, contraindicated prescribing rate, and consultation rate.ResultsPhysicians achieving higher scores on both examinations had higher rates (rate increase per SD increase in score per 1000 persons per year) of mammography screening (β for QLEX, 16.8 [95% confidence interval {CI}, 8.7-24.9]; β for Medical Council of Canada Qualifying Examination [MCCQE], 17.4 [95% CI, 10.6-24.1]) and consultation (β for QLEX, 4.9 [95% CI, 2.1-7.8]; β for MCCQE, 2.9 [95% CI, 0.4-5.4]). Higher subscores in diagnosis were predictive of higher rates in the difference between disease-specific and symptom-relief prescribing (β for QLEX, 3.9 [95% CI, 0.9-7.0]; β for MCCQE, 3.8 [95% CI, 0.3-7.3]). Higher scores of drug knowledge were predictive of a lower rate (relative risk per SD increase in score) of contraindicated prescribing for MCCQE (relative risk, 0.88; 95% CI, 0.77-1.00). Relationships between examination scores and practice performance were sustained through the first 4 to 7 years in practice.ConclusionScores achieved on certification examinations and licensure examinations taken at the end of medical school show a sustained relationship, over 4 to 7 years, with indices of preventive care and acute and chronic disease management in primary care practice.

Background: Bridging the theory of psychometric assessment to an evaluation instrument is a challenging and continuous task. Such a task was completed for the SP-based OSCE licensing examination used in Quebec since 1990. Purpose: To review the comprehensive series of psychometric studies undertaken on the examination based on the theory of psychometric assessment. Methods: The examination is a 5.5 hour-long OSCE composed of 26 clinical cases of 7, 10 or 15 minutes' duration. Candidates' total scores and case scores are used for licensing decisions. Reliability coefficients were obtained as well as generalizability studies to assess the impact of examination sites (4), tracks (14) and languages (French and English) on candidates' results. Its content validity was assessed by experts as well as by practicing family physicians, examiners and exam coordinators. Concurrent validity was assessed. Through differential item functioning (DIF) statistical approach, possible gender biases were analyzed. The predictive validity of the examination scores on selected aspects of practice was analyzed as well as the impact of the examination on the teaching and learning process. Results: These studies confirmed the validity, reliability and generalizability of the examination scores. No biases were demonstrated. Examination scores predicted elements of practice. Educational impact was present. Conclusion: This study confirmed the quality of the examination, ensured its continuous improvement and supported the inferences made from the examination results.

Background : The World Health Organization advocates for faculties of medicine to orient health professional education toward the needs of the populations graduates are to serve and to include a greater emphasis on primary health care. It was in this framework that in 2007, the Faculty of Medicine and Health Sciences at the Universite de Sherbrooke (FMHS-UdeS) in Canada and the Facultad de Medicina de la Universidad de la Republica (FMUdelaR) in Montevideo, Uruguay developed a comprehensive collaboration to sustain the development of family medicine in both universities through education, practice and research. Activities and Outcomes : In addition to information sharing through email and teleconferencing, this five year collaboration has included 28 bilateral visits by the two institutions' teachers and leaders. During these visits, Uruguayan members participated in workshops and benefited from exchanges during educational and clinical activities. Interactions led to the improvement of their skills as teachers of family medicine with an emphasis on clinical teaching, supervision, feedback to learners in clinical evaluations, use of various educational methods, use of standardized patients for teaching and evaluation, and research. FMHS-UdeS members learned about the community aspects of family medicine in Uruguay and reflected on how these could be implemented to the benefit of Canadians. Conclusions : The international collaboration forged between the FMHS-UdeS and the FMUdelaR represents a socially responsible endeavor that has been highly rewarding for all involved. It represents a significant learning opportunity for each group aiming to better prepare physicians to serve as primary health care providers in their communities.

Objective Structured Clinical Examination (OSCE) is now generally considered as the new gold standard for evaluating clinical competence. The objective of this study was to assess the feasibility of OSCE in evaluating urology residents.20 urology residents rotated through a circuit of five standardized patient-based OSCE stations of 10 min duration. The selection of problems was based on educational objectives of urology residency programs. Written questionnaires based on Likert-type scales were used to measure OSCE feasibility. The mean score was arbitrarily used as a passing score. Student t test was only used to compare the performance between junior and senior residents.Senior residents performed globally better, but without significant differences (51.3+/-7.8 vs. 45.03+/-5.1, p0.05). Senior resident scores regarding outpatient problems were significantly higher (p = 0.04), more senior residents reached the passing score (75 vs. 16% junior residents). All the participants agreed that the clinical situations were realistic and that the simulated patients were believable. Most participants agreed that the sampling of cases were representative of urology practice.This is the first reported OSCE applied to urology residency. The results of this pilot study support the feasibility of an OSCE in assessing the performance of urology residents. Our data raises questions regarding the training of outpatient consultation skills to residents. This experiment warrants further series to explore the study's psychometrics features.

Context.—Clinical competence is a determinant of the quality of care delivered, and may be associated with use of health care resources by primary care physicians. Clinical competence is assumed to be assessed by licensing examinations, yet there is a paucity of information on whether scores achieved predict subsequent practice.Objective.—To determine if licensing examination scores were associated with selected aspects of quality of care and resource use in initial primary care practice.Design.—Prospective cohort study of recently licensed family physicians, followed up for the first 18 months of practice.Setting.—The Quebec health care system.Participants.—A total of 614 family physicians who passed the licensing examination between 1991 and 1993 and entered fee-for-service practice in Quebec.Main Outcome Measures.—All patients seen by physicians were identified by the universal health insurance board and all health services provided to these patients were retrieved for the 18 months prior to (baseline) and after (follow-up) the physicians' entry into practice. Medical service and prescription claims files were used to measure rates of resource use (specialty consultation, symptom-relief prescribing compared with disease-specific prescribing) and quality of care (inappropriate prescribing, mammography screening). Baseline data were used to adjust for differences in practice population.Results.—Study physicians saw a total of 1116389 patients, of whom 113535 (10.2%) were elderly and 83391 (7.5%) were women aged 50 to 69 years. Physicians with higher licensing examination scores referred more of their patients for consultation (3.8/1000 patients per SD increase in score; 95% confidence interval [CI], 1.2-7.0; P=.005), prescribed to elderly patients fewer inappropriate medications (−2.7/1000 patients per SD increase in score; 95% CI, −4.8 to −0.7; P =.009) and more disease-specific medications relative to symptom-relief medications (3.9/1000 patients per SD increase in score; 95% CI, 0.3 to 7.4; P=.03), and referred more women aged 50 to 69 years (6.6/1000 patients per SD increase in score; 95% CI, 1.2-11.9; P=.02) for mammography screening. If patients of physicians with the lowest scores had experienced the same rates of consultation, prescribing, and screening as patients of physicians with the highest scores, an additional 3027 patients would have been referred, 179 fewer elderly patients would have been prescribed symptom-relief medication, 912 more elderly patients would have been prescribed disease-specific medication, 189 fewer patients would have received inappropriate medication, and 121 more women would have received mammography screening.Conclusions.—Licensing examination scores are significant predictors of consultation, prescribing, and mammography screening rates in initial primary care practice.

Female candidates have been shown to repeatedly outperform male candidates in examinations measuring their medical competence. This study explored differences in the results of both groups on the 1993, 1994 and 1995 Quebec licensing examinations which used two SP-based instruments and one paper and pencil instrument. ANOVA and ANCOVA analyses confirmed that female candidates obtained higher results on all instruments year after year, and that these results were not biased by the content of the examination.

The large scale standardized patient-based objective structured clinical examination used in Quebec licensing examination was held for the first time in 1990 and was the 1st OSCE in the world used for high-stakes purposes such as licensure. As of June 1996, 13 examination sessions have been implemented and more than 1500 candidates assessed. Major changes have been implemented through the years in order to improve the examination. The length of the cases has been progressively increased from 7 minutes duration to 7, 10, 14 or 20 minutes duration according to the complexity of the clinical situations. More weight has been given to the assessment of integrative problem solving skills such as diagnosis and treatment. A multiple key feature approach to weighting the assessment items in the cases is progressively used. Sophisticated psychometric analysis of the results, that confirmed the quality of the examination, have been implemented.

To look at how well residency directors in family medicine predict the performances of their candidates on the Quebec Licensing Examination (QLEx) for family physicians.The four family medicine program directors in Quebec were asked in the spring of 1992 to identify the ten residents from their own programs who would get the highest marks on the QLEx and the ten who would get the lowest marks. From the results of these candidates, and those of the intermediate groups defined by default, the prediction abilities of the program directors were assessed.Descriptive statistics showed that the program directors had difficulties discriminating among the different groups and tended to collapse the predicted scores toward the total mean. Analysis-of-variance studies confirmed the absence of difference between the predicted weak and intermediate groups as well as between the predicted intermediate and strong groups for each program and for each QLEx component. Regression analysis as well as eta 2 studies showed that the program directors' prediction abilities were low for all components and represented less than 25% of the explained variance of the QLEx scores.The residency directors did not accurately categorize their residents' performances on the QLEx. Both the evaluations of program directors and terminal examination results are complementary approaches to clinical competence assessment and should be used for licensure.

Objective To assess whether the transition from a traditional curriculum to a community oriented problem based learning curriculum at Sherbrooke University is associated with the expected improvements in preventive care and continuity of care without a decline in diagnosis and management of disease. Design Historical cohort comparison study. Setting Sherbrooke University and three traditional medical schools in Quebec, Canada. Participants 751 doctors from four graduation cohorts (1988-91); three before the transition to community based problem based learning (n = 600) and one after the transition (n = 151). Outcome measures Annual performance in preventive care (mammography screening rate), continuity of care, diagnosis (difference in prescribing rates for specific diseases and relief of symptoms), and management (prescribing rate for contraindicated drugs) assessed using provincial health databases for the first 4-7 years of practice. Results After transition to a community oriented problem based learning curriculum, graduates of Sherbrooke University showed a statistically significant improvement in mammography screening rates (55 more women screened per 1000, 95% confidence interval 10.6 to 99.3) and continuity of care (3.3% more visits coordinated by the doctor, 0.9% to 5.8%) compared with graduates of a traditional medical curriculum. Indicators of diagnostic and management performance did not show the hypothesised decline. Sherbrooke graduates showed a significant fourfold increase in disease specific prescribing rates compared with prescribing for symptom relief after the transition. Conclusion Transition to a community oriented problem based learning curriculum was associated with significant improvements in preventive care and continuity of care and an improvement in indicators of diagnostic performance.

Toute profession est organisée autour d'un corpus global de connaissances, de savoir-faire, d'applications pratiques et de règles qui imposent qu'il y ait une formation et un entraînement particuliers des individus qui en font partie. La compétence professionnelle, définie comme la capacité d'un professionnel à utiliser son jugement, de même que les connaissances, les habiletés et les attitudes associées à sa profession pour résoudre des problèmes complexes, est un construit non observable directement. Pour l'évaluer, il faut faire des inferences à partir d'éléments observables et mesurables. Mais comment faire?Le présent article explique pourquoi on doit évaluer la compétence professionnelle et comment l'évaluer. Les auteurs décrivent l'expertise du Centre d'évaluation des sciences de la santé de l'Université Laval qui, depuis plus de dix ans, utilise l'examen clinique objectif structuré, ECOS, pour la certification des candidats à la pratique de la médecine de famille au Québec, un instrument qui a largement démontré sa validité et sa fidélité., Every profession is organized around a body of knowledge, expertise, practical applications and rules which impose a particular kind of education and training for members of that profession. The professional competency, defined as the degree to which one uses knowledge, skills and judgment in situations that arise in the course of professional practice, is a construct not directly observable. Hence, we have to draw inferences from observable and measurable elements. But how?This article explains why must professional competency be evaluated and how to evaluate. Authors describe the Centre for Evaluation in the Health Sciences expertise, which has been using for 10 years the Objective Clinical Structured Examination (OSCE) for the certification of family medicine candidates. The validityand the reliability of this toolhave been widely demonstrated.