Do deficiencies in CanMEDS competencies of dismissed residents differ according to specialty?

Introduction: Program directors dismiss a small percentage of residents from residency training programs, presumably due to underperformance or lack of progress. Whether underperformance in competency domains differs by residents’ specialty is unknown. Methods: In 2021, we analysed the case law of Dutch residents who were dismissed from training by the program director, and who challenged this dismissal before the national conciliation board between 2011 and 2020. Across medical specialties we compared which of the CanMEDS competency domains these residents failed to meet. Results: We found 116 cases of residents dismissed from their training programmes who challenged the decision of the program director before the board. In general, most residents were unable to meet the requirements of several CanMEDS competency domains (usually: medical expert, communicator, and professional). In surgery, all dismissed residents failed to meet the competency domain of the medical expert, while most of the dismissed psychiatry residents met this domain. In specialties with a primarily diagnostic task, more dismissed residents failed to meet the competency domain of the scholar, while dismissed general medicine residents (for example family medicine and nursing homecare) were less likely to do so. Residents in general medicine, more often than other specialties, however, failed to meet the competency domain of the professional. Conclusion: Residents dismissed from training, who challenged their dismissal, failed to meet the requirements of multiple CanMEDS competency domains. Competency domain failures differ by specialty.