Developing a learner-focused and competency-based educational model on pain management and substance use

Between January 2016 and June 2020, the Government of Canada reported 17,602 apparent opioid toxicity deaths. As a response to this national public health crisis, it provided funding to the Association of Faculties of Medicine of Canada (AFMC) to develop, in partnership with the 17 Canadian Faculties of Medicine and several collaborators, a learner-focused and competency-based educational model for undergraduate medical students focused on pain management and substance use.

The Medical Council of Canada (MCC)’s mission is to develop, validate and implement tools and strategies to assess physicians’ competence and ensure physicians meet national requirements and standards. Findings from a recent longitudinal study, focused on a cohort of 3,404 physicians who were registered with the College of Physicians & Surgeons of Alberta (CPSA) and who completed the Medical Council of Canada Qualifying Examination (MCCQE) Part I and the MCCQE Part II between 1992 and 2017, confirmed that the performance on the MCCQE Part II was “significantly associated with potentially dangerous opioid and benzodiazepine prescribing behavior. […] Candidates who failed the Medical Council of Canada Qualifying Examination (MCCQE) Part II on their first attempt, on average, prescribed [2+ Opioids and 2+ Benzodiazepines] to 30% more patients than passing candidates.”¹ These results not only reinforce the importance of medical licensing exams for patient safety, but also confirm the necessity to adjust the curriculum and the exam objectives accordingly.

As one of the AFMC project collaborators, the MCC was tasked with developing content to incorporate into the MCCQE Part I and the MCCQE Part II. To this end, in January 2020, we hosted two examination development workshops focused on developing content related to pain management (including appropriate opioid prescribing) and opioid use disorder.

In the first workshop, the group, composed of seven subject matter experts, a representative from the Queen’s University Curriculum Committee, a content expert from the AFMC Response to the Opioid Crisis Working Group, and MCC staff, worked on developing Objective Structured Clinical Examination (OSCE) cases to reflect the topics and subtopics of the curriculum being developed by the AFMC Response to the Opioid Crisis Working Group. This productive two-day meeting resulted in seven new OSCE cases.

The second two-day workshop consisted of developing Multiple-Choice Questions (MCQs) that aligned with the AFMC curriculum being elaborated. Six subject matter experts, a representative from the Queen’s Curriculum Committee, a content expert from the AFMC Response to the Opioid Crisis Working Group, and MCC staff, came together to produce 44 new MCQs and reviewed an additional nine items that had previously been developed.

In parallel, the AFMC and numerous contributors developed a bilingual curriculum of 10 modules and an introduction module about the Canadian opioid crisis to address gaps in the current undergraduate medical education curriculum. Launched in January 2021, the online courses are available for free to undergraduate medical students and any stakeholders interested in continuous professional development on this website.

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1 De Champlain, A. F., Ashworth, N., Kain, N., Qin, S., Wiebe, D., & Tian, F. (2020). Does Pass/Fail on Medical Licensing Exams Predict Future Physician Performance in Practice? A Longitudinal Cohort Study of Alberta Physicians. Journal of Medical Regulation, 106 (4): 17–26. doi.org/10.30770/2572-1852-106.4.17