Table 1

Inventory and description of all study variables and of the risks to competence and supports to competence identified in the literature

AreaRisk/support categoryDescription
A. Type of health professionPhysicianOne of four health professions in study. Other words for this profession include ‘doctor’ and ‘medical doctor’. Refers to individuals at any stage of the physician competence life-cycle (eg, medical student, resident, practising physician)
Other health professions (eg, dentists and nurses)Other health professions were only included when the study also discussed one or more of the four professions of primary interest.
PharmacistOne of four health professions in study
Occupational therapistOne of four health professions in study
Physical therapistOne of four health professions in study Another word for this profession is ‘physiotherapist’.
B. Competence life cyclePracticeWorking in the health field as an autonomous practitioner
ResidentPostprofessional education of physicians, called residency education or graduate medical education, leading towards a certification or specialty designation; If education of another profession was not postprofessional, it was considered field- based education.
Field-based educationThe practical education of one or more of the health professions of interest; includes clinical-based training for physiotherapists and clerkship or internship education for physicians
OtherArticles where the competence life-cycle was not specifically mentioned
C. CanMEDS roles15 Medical expertDemonstrating clinical knowledge, skills and abilities required for effective patient care.
CommunicatorCommunicating with patients and providing appropriate written documentation.
ProfessionalDemonstrating ethical practice, high personal standards of behaviour, accountability to the profession and society, profession-led regulation and maintenance of personal health.
ScholarDemonstrating commitment to life-long learning, utilising evidence-informed decision-making, teaching and research
CollaboratorWorking effectively with other health professions including teamwork, managing differences and resolving conflict
ManagerManaging time, resources and priorities, including supervision of learners
Health advocateAdvocating for care or services for individual patients, the community or the patient population
D. Risks to competenceTransitionsDyscompetence or differences in performance associated with change(s) in work or professional status, in focus of practice and/or as experienced by new graduates
International graduateDyscompetence or differences in performance associated with health professionals that were educated in a different country than where the study took place
Lack of clinical exposure/experienceDyscompetence or differences in performance associated with knowledge/competence gaps in certain clinical areas arising from insufficient volume of procedures and patients with a particular condition to attain or maintain competence
AgeDyscompetence or differences in performance associated with the person’s age including youth and older age
GenderDyscompetence or differences in performance between men and women
Practice featuresDyscompetence or differences in performance associated with geographical or office features of the practice
No certificationDyscompetence or differences in performance associated with presence/absence of specific specialty certification
WellnessDyscompetence or differences in performance associated with physical or mental health related issues
ResourcesDyscompetence or differences in performance associated with resources, including people, money and time
Adequacy of practice or educationDyscompetence or differences in performance associated with a previous educational programme that did not adequately prepare learners with particular skills or with specific knowledge due to brevity or low quality
Area of specialty/certificationSpecialty or certification-based variations in dyscompetence; certification and specialty are often used interchangeably
Previous disciplinary activityImpact of previous complaint or discipline matter by a regulatory authority, specialty organisation or health facility on dyscompetence
OtherDifferences related to risks to competence not included in the higher-volume defined topics
E. Supports to competenceContinuing education participationInvolvement in an educational activity such as a course, workshop or conference during the practice competence life-cycle (ie, postspecialty/programme-specific training)
Educational information/programme featuresActions or interventions included in a pre-existing educational programme that are designed to improve the learning, knowledge translation and application of the material
Personal support and feedbackMentorship and feedback provided or available to individuals to inform or improve clinical skills and/or knowledge
Adequate clinical exposure/experienceTime spent in specific rotations or at specific clinical sites, with a particular patient/client population.
Quality assurance participationFormal activities within a structured organisational quality assurance programme, in the workplace
Support through structure or organisationEmployer or site-specific structures or processes that develop or maintain individual or professional competence
Professional organisation participation/systemsMandatory participation in formal personal activities to develop or maintain competence as established through regulatory, association or specialisation requirements
TechnologyMechanical or electronic means to develop or maintain competence via simulation, eLearning opportunities and electronic decision support rules
Reflection and self- assessmentApproaches to developing or maintaining competence that include introspection, personal analysis and consideration of adequacy of competence or demonstration of competence
Assessment and feedback through toolsApproaches that employed a specific tool to measure professional competencies to determine the adequacy of performance and/or to provide information and motivation for improvement
Performance reviewA formal or structured work-based process whereby a practitioner is provided with information on the adequacy of performance and/or provided with information and motivation for improvement; This information is generally formative and intended to assist in performance improvement.
OtherApproaches to developing or maintaining competence not included in other high-volume defined topics.