Journal articles on the topic 'Cmet Theses'
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Sensekerci, Erkan. "Metaphor-Themed Studies in Social Studies Education in Turkey and Their Evaluations in Terms of Conceptual Metaphor Theory (CMT)." World Journal of Education 12, no. 6 (December 12, 2022): 24. http://dx.doi.org/10.5430/wje.v12n6p24.
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The aim of the present study is to examine postgraduate theses and published articles on "analysis of metaphorically used words in discourse" in the field of social studies education in Turkey by document analysis method. Within the scope of the research, The National Thesis Center and Dergipark databases were surveyed. The survey revealed 22 completed theses and 39 published articles between the years of 2010 and 2022. First, the studies were analysed in terms of the study/publication year of the works, the universities where they were conducted, their sample/study groups, the methodological framework they were based on, their data collection tool, the expertise of the researchers and thesis advisors, and the metaphors that were the subject of the research. The works were subsequently evaluated in terms of CMT (Conceptual Metaphor Theory) and were subjected to five research questions. This evaluation revealed that the studies examined: (i) do not establish a relationship between their research findings and the theoretical framework of CMT although they view metaphors as products of conceptual thinking; (ii) do not benefit adequately from the essential references or seminal works of CMT; (iii) do not align themselves with a particular theory of metaphor or an approach, and, therefore, lack criteria for how they associate metaphor with thought; (iv) do not make explicit the criteria according to which they classified the statement of participants as metaphorical; and (v) try to reach the data suited to their research purpose with a data collection tool coded as "A is X like or as B", which is a coding scheme that is conventionally identified as a simile rather than a conceptual metaphor among CMT adherents.
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MacPherson, Peter, and Julie Emberley. "Evaluating pediatrics residents’ ethics learning needs using multisource interprofessional feedback." Canadian Medical Education Journal 8, no. 4 (December 16, 2017): e86-91. http://dx.doi.org/10.36834/cmej.36931.
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Background: Ethics education is a required component of pediatric residency training. Limited instructional time requires educators to identify and prioritize learning needs. This is the first study to identify pediatric residents’ ethics learning needs using a multisource (360 degree) assessment. We hypothesized that pediatricians or allied health care professionals would identify unperceived ethics learning needs.Methods: Pediatric residents, pediatricians, respiratory therapists (RTs), and registered nurses (RNs) working at a university children's hospital rated the importance of twelve ethics themes as learning needs for trainees using a Likert-type scale. One-way ANOVA was used to determine differences between the groups, followed by post-hoc testing.Results: Response rates were 65%, 70%, 57%, and 47% for residents, pediatricians, RTs, and RNs, respectively. Themes were categorized into three priority groupings based on mean importance ratings. Where significant differences existed between residents and other respondent groups, pediatric residents rated the theme as being more important. Conclusion: This study provides an interprofessional assessment of pediatric residents’ perceived ethics learning needs. High priority ethics topics were identified, allowing for targeted teaching. Pediatricians and allied HCPs did not rate any ethics themes higher than residents. Medical educators may consider using methods inspired by multisource feedback for program evaluation.
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Harms, Sheila, Bryce Bogie, Anne Lizius, Karen Saperson, Susan Jack, and Meghan McConnell. "From good to great: learners’ perceptions of the qualities of effective medical teachers and clinical supervisors in psychiatry." Canadian Medical Education Journal 10, no. 3 (July 21, 2019): e17-26. http://dx.doi.org/10.36834/cmej.53156.
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Background: The shift in postgraduate medical training towards a competency-based medical education framework has inspired research focused on medical educator competencies. This research has rarely considered the importance of the learning environment in terms of both setting and specialty-specific factors. The current study attempted to fill this gap by examining narrative comments from psychiatry faculty evaluations to understand learners’ perceptions of educator effectiveness.
Methods: Data consisted of psychiatry faculty evaluations completed in 2015-2016 by undergraduate and postgraduate learners (N= 324) from McMaster University. Evaluations were provided for medical teachers and clinical supervisors in classroom and clinical settings. Narrative comments were analyzed using descriptive qualitative methodology by three independent reviewers to answer: “What do undergraduate and postgraduate medical learners perceive about educator effectiveness in psychiatry?”
Results: Narrative comments were provided on 270/324 (83%) faculty evaluation forms. Four themes and two sub-themes emerged from the qualitative analysis. Effective psychiatry educators demonstrated specific personal characteristics that aligned with previous research on educator effectiveness. Novel themes included the importance of relationships and affective factors, including learner security and inspiration through role modeling
Conclusion: Contemporary discussions about educator effectiveness in psychiatry have excluded the dynamic, relational and affective components of the educational exchange highlighted in the current study. This may be an important focus for future educational research.
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Switzer, Fiona, Sean Harper, and David Peck. "Exploring the barriers to the implementation of cognitive behavioural therapy for psychosis (CBTp)." Mental Health Review Journal 24, no. 1 (May 3, 2019): 30–43. http://dx.doi.org/10.1108/mhrj-06-2018-0017.
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Purpose The purpose of this paper is to identify barriers for people with psychotic spectrum disorders accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be explored and if completion of this training effects referral behaviours and attitudes to CBTp. Design/methodology/approach This study is a quantitative service evaluation project which uses a questionnaire design to explore the factors that influence a clinician’s decision to refer a patient for CBTp. Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental health in NHS Lothian were invited to participate in the study. Findings CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates. Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and knowledge in CBTp. Originality/value This is the first paper of its kind to investigate the potential barriers to access to CBTp in Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers identified will be discussed.
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Suryo Ediyono, Ro Hani,. "TERAPI MUSIK MENURUT AL-FARABI PADA MASA DINASTI ABBASIYAH." Jurnal CMES 12, no. 1 (October 9, 2019): 65. http://dx.doi.org/10.20961/cmes.12.1.34872.
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This study was intended to describe the functions and instruments of music during the Abbasid Dynasty and to describe music therapy according to Al-Farabi. The research method used is the descriptive qualitative method, where the data were technically collected using the library technique, then the data were analyzed based on the formulated problem, following after it describes the analysis results in the form of a written report. The data sources are the reference books related to Al-Farabi. The data of this study used Mūsīq Al-Kabīr, books, theses, journals related to the research. Based on this research, it can be concluded that the art of music began to develop rapidly during the Abbasid caliphate, and music can be used as a therapy for the soul, spiritual, and psychosomatic.
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Karras, Beverley, Saumya Selvaraj, Athena McConnell, Deirdre Andres, Krista Trinder, and Meredith McKague. "Student perceptions of the care of children: impacts of pre-clerkship pediatric and primary care clinical teaching." Canadian Medical Education Journal 5, no. 1 (December 17, 2014): e38-e49. http://dx.doi.org/10.36834/cmej.36624.
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Background: Pediatric clinical skills teaching sessions provide an early opportunity for students to be exposed to the medical care of children. This report describes second and third year medical students’ perceptions of and attitudes towards working with children before and after the pediatric clinical skills teaching sessions, and the experiences of those students precepted by pediatricians only compared to those students working with a combination of pediatricians and family physicians.Method: A 13 question survey was voluntarily completed before and after teaching sessions. Written reflective assignments were qualitatively analyzed for key themes. Response rate averaged 68% with class sizes of 84 and 85 students.Results: Students’ perceptions of the care of children were generally very positive. Some differences were found based on gender, phase of study and prior clinical exposure to pediatric care. Pre and post responses were similar, regardless of preceptor specialty. Students with family physician preceptors identified the themes of prevention, health promotion and multidisciplinary care in their reflections. Conclusions: Students had already formed positive attitudes toward the medical care of children and intended to care for children in their future practice. Further research is needed into the effects of pre-clerkship experiences in the care of children on choice of medical specialty.
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Clark, Marcia, Jonathan White, Sharla King, and Mike Carbonaro. "Exploring Surgeons' Perceptions of the Role of Simulation in Surgical Education: A Needs Assessment." Canadian Medical Education Journal 2, no. 2 (November 22, 2011): e44-e52. http://dx.doi.org/10.36834/cmej.36547.
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Introduction: The last two decades have seen the adoption of simulation-based surgical education in various disciplines. The current study’s goal was to perform a needs assessment using the results to inform future curricular planning and needs of surgeons and learners.Methods: A survey was distributed to 26 surgeon educators and interviews were conducted with 8 of these surgeons. Analysis of survey results included reliability and descriptive statistics. Interviews were analyzed for thematic content with a constant comparison technique, developing coding and categorization of themes.Results: The survey response rate was 81%. The inter-item reliability, according to Cronbach’s alpha was 0.81 with strongest agreement for statements related to learning new skills, training new residents and the positive impact on patient safety and learning. There was less strong agreement for maintenance of skills, improving team functioning and reducing teaching in the operating room. Interview results confirmed those themes from the survey and highlighted inconsistencies for identified perceived barriers and a focus on acquisition of skills only. Interview responses specified concerns with integrating simulation into existing curricula and the need for more evaluation as a robust educational strategy.Conclusion: The findings were summarized in four themes: 1) use of simulation, 2) integration into curriculum, 3) leadership, and 4) understanding gaps in simulation use. This study exemplifies a mixed-methods approach to planning a surgical simulation program through a general needs assessment.
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Fiddick, Lucy, Emily Neale, Falguni Nathwani, Kristina Bennert, and James Gregory. "Referring to psychological therapy services in secondary NHS mental health services – how do mental health care professionals decide?" Mental Health Review Journal 25, no. 2 (April 6, 2020): 185–96. http://dx.doi.org/10.1108/mhrj-04-2019-0013.
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Purpose Evidence-based psychological therapies are available for severe and enduring mental health problems, but resources and access to these are limited within England. Practitioners in community mental health teams (CMHTs) can act as gatekeepers for access to psychological therapies for those in secondary care, but little is known about how they make referral decisions. This paper aims to understand how CMHT practitioners make decisions about who to refer or not, to secondary care psychological therapy services (PTS). Design/methodology/approach A total of 11 CMHT practitioners were interviewed to understand the decision making processes underpinning their referrals or otherwise, to a PTS within NHS England. The data were analysed qualitatively using thematic analysis. Findings Thematic analysis resulted in 11 sub-themes under three main themes of the self, the organisation and wider structure and the service user. Results indicated that some participants were referred automatically for psychological therapy if a service user asked or if there was external pressure to refer, while others’ decisions were informed by contextual information such as the service user’s ability to engage or change, risk status and limited organisational resources. Originality/value This study explores the decision making of multi-disciplinary professionals referring to PTS. The findings have important implications for understanding some of the factors that can influence patient access to psychological treatment in secondary care.
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Riva, John J., Radwa Elsharawi, Julian Daza, Augustin Toma, Robert Whyte, Gina Agarwal, and Jason W. Busse. "Medical students’ challenges and suggestions regarding research training: a synthesis of comments from a cross-sectional survey." Canadian Medical Education Journal 10, no. 3 (July 21, 2019): e91-100. http://dx.doi.org/10.36834/cmej.52997.
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Background: We previously reported on a cross-sectional study of students from the Michael G. DeGroote School of Medicine at McMaster University that found most respondents wanted more opportunities to participate in research. Students provided additional comments that we synthesized to enrich the findings of our quantitative analysis.
Methods: From our previously administered 13-item, online questionnaire, run across three campuses in Ontario, Canada, 498 of 618 medical students completed our survey and 360 (72%) provided optional written comments, which we synthesized using thematic analysis in this current study.
Results: Major themes that emerged were: (1) Active student participation to identify research opportunities and interested mentors are needed; (2) Types of research involvement; (3) Uncertainty whether research training translates into useable skills; (4) Desire for a formalized research curriculum and centralization of research opportunities across campuses.
Conclusion: Programs should stress to interested students the importance of actively looking for research opportunities and consider both large and small-group educational sessions.
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Kidd, Monica, Lara Nixon, Tom Rosenal, Roberta Jackson, Laurie Pereles, Ian Mitchell, Glenda Bendiak, and Lisa Hughes. "Using visual art and collaborative reflection to explore medical attitudes toward vulnerable persons." Canadian Medical Education Journal 7, no. 1 (April 2, 2016): e22-e30. http://dx.doi.org/10.36834/cmej.36680.
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Background: Vulnerable persons often face stigma-related barriers while seeking health care. Innovative education and professional development methods are needed to help change this.Method: We describe an interdisciplinary group workshop designed around a discomfiting oil portrait, intended to trigger provocative conversations among health care students and practitioners, and we present our mixed methods analysis of participant reflections.Results: After the workshop, participants were significantly more likely to endorse the statements that the observation and interpretive skills involved in viewing visual art are relevant to patient care and that visual art should be used in medical education to improve students’ observational skills, narrative skills, and empathy with their patients. Subsequent to the workshop, significantly more participants agreed that art interpretation should be required curriculum for health care students. Qualitative comments from two groups from two different education and professional contexts were examined for themes; conversations focused on issues of power, body image/self-esteem, and lessons for clinical practice. Conclusions: We argue that difficult conversations about affective responses to vulnerable persons are possible in a collaborative context using well-chosen works of visual art that can stand in for a patient.
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Gibson, Christine, Madawa Chandratilake, and Andrea Hull. "Use of portfolios for assessment of global health residents: qualitative evaluation of design and implementation." Canadian Medical Education Journal 9, no. 2 (June 1, 2018): e20-32. http://dx.doi.org/10.36834/cmej.36642.
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Background: When the Global Health training program was created at the University of Calgary, residents were encouraged to seek learning experiences that met their career goals and individualized objectives. An assessment tool was sought that could be reliable, valid, yet flexible. A portfolio process was chosen, but research was necessary to determine whether it was robust.Methods: A qualitative study was conducted with academic experts in Canadian residency training, as well as directors and residents involved in Global Health study in order to assess the validity and benefit of such a tool. Through an online survey, interviews, and focus groups, views on the portfolio and intended content were collected and coded thematically.Results: Multiple themes emerged from the content analysis. Overall, all stakeholders (residents and faculty) were supportive of the use of portfolios for summative assessment, mentioning authentic and varying assessments, reflective and narrative components, and mentor interaction as positive attributes, but they did have many recommendations.Conclusion: This qualitative evaluation validated the use of portfolios for this cohort of students while yielding comments and suggestions that will further enhance the interactive and flexible nature of this seldom used assessment tool. These findings contribute to the understanding of how Global Health assessment can remain individualized yet rigorous.
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Piggott, Thomas, Cathy Morris, and Michael Lee-Poy. "Preceptor engagement in distributed medical school campuses." Canadian Medical Education Journal 6, no. 2 (December 11, 2015): e21-e28. http://dx.doi.org/10.36834/cmej.36726.
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Background: There is increasing interest in distributed medical campuses and engagement of physicians in these communities. To date, there has been suboptimal recruitment of physicians to participate in medical education at distributed campuses. The purpose of this project was to identify barriers to engagement in medical education by community physicians in the geographical catchment of the Waterloo Regional Campus of McMaster.Method: In-depth, semi-structured, qualitative interviews were conducted with physicians not involved in teaching. Interview recordings were transcribed and analyzed using a closed-loop, iterative coding methodology and thematic analysis was performed. Interviews were conducted until thematic saturation was achieved.Results: Six interviews were conducted and coded. Nine key themes emerged: academic centre versus distributed sites, interest in teaching, financial considerations, administrative barriers, medical experience and knowledge currency, practice environment and schedule, training on teaching, setting up systems for learners in distributed campus settings, and student engagement and medical learner level.Conclusions: Barriers to engagement in teaching primarily focused on differences in job structure in the community, administrative barriers both at the hospital and through the medical school, and lack of knowledge on how to teach. As medical schools look to expand the capacity of distributed campuses, misperceptions should be addressed and opportunities to improve engagement should be further explored.
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Lubitz, Rebecca, Joseph Lee, and Loretta Hillier. "Residents’ perceptions of an integrated longitudinal curriculum: a qualitative study." Canadian Medical Education Journal 6, no. 2 (December 11, 2015): e29-e40. http://dx.doi.org/10.36834/cmej.36727.
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Background: The purpose of this study was to explore family medicine residents’ perceptions of a newly restructured integrated longitudinal curriculum.Method: A purposeful sample of 16 family medicine residents participated in focus group interviews conducted from a grounded theory perspective to identify the characteristics of this training model that contribute to and that challenge learning.Results: Eight key themes were identified: continuity of care, relevance to family medicine, autonomy, program-focused preparation, professional development as facilitated by role modeling, patient volume, clarity of expectations for learners, and logistics. Positive learning experiences were marked by high levels of autonomy, continuity, and relevance to family medicine. Less favorable learning experiences were characterized by limited opportunities for continuity of care, limited relevance to family medicine practice and unclear expectations for the resident’s role. Family physician-led learning experiences contributed to residents’ understanding of the full scope of family medicine practice, more so than specialist-led experiences. The logistics of implementing the integrated block were challenging and negatively impacted continuity and learning.Conclusions: This study suggests that an integrated longitudinalized family medicine block training model has the potential to support the principles of a longitudinal integrated competency-based curriculum to effectively prepare residents for family medicine practice.
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Kwok, Jason, Vincent Wu, Anthony Sanfilippo, Kathryn Bowes, and Sheila Pinchin. "Examining the impact of early longitudinal patient exposure on medical students’ career choices." Canadian Medical Education Journal 8, no. 1 (February 24, 2017): e101-105. http://dx.doi.org/10.36834/cmej.36752.
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Background: Medical schools include career direction experiences to help students make informed career decisions. Most experiences are short, precluding students from attaining adequate exposure to long-term encounters within medicine. We investigated the impact of the First Patient Program (FPP), which fosters longitudinal patient exposure by pairing junior medical students with chronically ill patients through their healthcare journey, in instilling career direction. Methods: Medical students who completed at least 6-months in the FPP participated in a cross-sectional survey. Students’ answers were analyzed with respect to the number of FPP appointments attended. Thematic analysis was conducted to explore qualitative responses.Results: One hundred and forty-eight students participated in the survey. Only 28 (19%) students stated that the FPP informed their career decisions. Thirty-nine percent of students who attended four or more appointments indicated that the FPP informed their career decisions, compared to 16% of students who attended less (p=0.021). Thematic analysis revealed two themes: 1) Students focused mainly on patient encounters within FPP; and 2) Students sought career directions from other experiences.Conclusion: The majority of students did not attain career guidance from the FPP, but rather used the program to understand the impact of chronic illness from the patient’s perspective.
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Kuipers, Meredith Jane, Amira Eapen, Joel Lockwood, Sara Berman, Samuel Vaillancourt, James Maskalyk, Aklilu Azazh, and Megan Landes. "Examining critical factors affecting graduate retention from an emergency medicine training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives." Canadian Medical Education Journal 8, no. 2 (April 20, 2017): e61-74. http://dx.doi.org/10.36834/cmej.36827.
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Background: In Ethiopia, improvement and innovation of the emergency care system is hindered by lack of specialist doctors trained in emergency medicine, underdeveloped emergency care infrastructure, and consumable resource limitations. Our aim was to examine the critical factors affecting retention of graduates from the Addis Ababa University (AAU) post-graduate emergency medicine (EM) training program within the Ethiopian health care system. Methods: Qualitative interviews were conducted with current AAU EM residents and stakeholders in Ethiopian EM. Mixed-methods inductive thematic analysis was performed.Results: Resident and stakeholder participants identified critical factors in three domains: the individual condition, the occupational environment, and the national context. Within each domain, priority themes emerged from the responses, including the importance of career satisfaction over the career continuum (individual condition), the opportunity to be involved in the developing EM program and challenges associated with resource, economic, and employment constraints (occupational environment), and perceptions regarding the state of awareness of EM and the capacity for change at the societal level (national context). Conclusions: This work underscores the need to resolve multiple systemic and cultural issues within the Ethiopian health care landscape in order to address EM graduate retention. It also highlights the potential success of a retention strategy focused on the career ambitions of keen EM doctors.
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Klowak, Jennifer, Radwa Elsharawi, Robert Whyte, Andrew Costa, and John Riva. "Predictors of medical student interest and confidence in research during training: a cross-sectional study." Canadian Medical Education Journal 9, no. 3 (July 29, 2018): e4-13. http://dx.doi.org/10.36834/cmej.42084.
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Purpose: Research education and opportunities are an important part of undergraduate medical education. This study’s objectives were to determine students’ interest in research, student self-rated research skills and to assess potential predictors of research interest and confidence. Method: Stakeholder consultation and literature informed a 13-item cross-sectional survey. In 2014, all students enrolled in McMaster University’s School of Medicine in Ontario, Canada were sent three waves of an electronic survey. Results: The response rate was 81% (498 of 618). Most (n=445, 89%) endorsed prior research experiences. The majority of students (n=383, 86%) wanted more research education and opportunities. Higher rating of their supervisors’ understanding of research was associated with greater interest in research (OR=2.08; 95% CI=1.27–3.41). Home campus (distributed vs. main) was not a significant predictor of research interest. In our adjusted linear regression model, significant predictors of higher self-rated research ability included prior thesis work and higher self-rated knowledge gained in MD program. Conclusions: In a survey of a three-year medical school, medical student interest in further research education and opportunities was high and positively predicted by student-rated supervisors’ understanding of research, but not campus location. This study also identified several predictors of student self-rated research ability.
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Beagan, Brenda, Erin Fredericks, and Mary Bryson. "Family physician perceptions of working with LGBTQ patients: physician training needs." Canadian Medical Education Journal 6, no. 1 (April 20, 2015): e14-e22. http://dx.doi.org/10.36834/cmej.36647.
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Background: Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education.Method: In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software.Results: Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.
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Karim, Safiya, and Maryana Duchcherer. "Intimidation and harassment in residency: a review of the literature and results of the 2012 Canadian Association of Interns and Residents National Survey." Canadian Medical Education Journal 5, no. 1 (December 17, 2014): e50-e57. http://dx.doi.org/10.36834/cmej.36667.
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Background: Intimidation and harassment (I&H) have been longstanding problems in residency training. These behaviours continue to be prevalent, as evidenced by the 2012 Canadian Association of Interns and Residents (CAIR) National Resident Survey. More than seven in ten (72.9%) residents reported behaviour from others that made them feel diminished during their residency. We conducted a literature review to identify other surveys to determine the prevalence, key themes, and solutions to I&H across residency programs.Method: PubMed and MEDLINE searches were performed using the key words “intimidation,” “harassment,” “inappropriate behaviour,” “abuse,” “mistreatment,” “discrimination,” and “residency.” The search was limited to English language articles published between 1996 and 2013, and to papers where ten or more residents were surveyed or interviewed.Results: A total of ten articles were reviewed. Our findings showed that I&H continue to be highly prevalent with 45-93% of residents reporting this behaviour on at least one occasion. Verbal abuse was the most predominant form; staff physicians and nurses tended to be the dominant source. Residents reported that I&H caused significant emotional impact; however, very few incidents of inappropriate behaviour were reported. Very few solutions to I&H were proposed.Conclusions: I&H in residency education continue to be common problems that are under-reported and under-discussed. The opportunity exists to improve efforts in this area. Definitions of what incorporates I&H should be revisited and various educational and structural initiatives should be implemented.
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Levesque, Mylene, Sharon Hatcher, Denis Savard, Reine Victoire Kamyap, Pauline Jean, and Catherine Larouche. "Physician perceptions of recruitment and retention factors in an area with a regional medical campus." Canadian Medical Education Journal 9, no. 1 (March 28, 2018): e74-83. http://dx.doi.org/10.36834/cmej.42937.
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Background: The factors that influence physicians to establish and maintain their practice in a region are variable. The presence of a regional medical campus (RMC) could influence physicians’ choice. The objective of this study was to explore the factors influencing physician recruitment and retention, and in particular the role of a RMC, in a region of Quebec.Methods: A literature review of factors influencing physicians to stay in a rural area was conducted in order to create an interview guide. Questions were divided into sections: general information, family situation, medical training, career choice, current practice, intent to stay in the region, and impact of the RMC. Thirteen semi-structured individual interviews were conducted with practicing physicians. Data were analyzed using QDAMiner. Results: Recruitment factors were divided into six major themes: type of practice, spousal interest, opportunity for teaching, training in a region, workforce planning, and quality of life. Participants identified positive and negative factors associated with retention. In both cases, family and quality of work environment were mentioned. The RMC was perceived as having important impacts on the quality of professional life, research, medical practice, and regional development.Conclusion: This study highlights the role of RMCs in physician recruitment and retention via multiple impacts on the quality of practice of physicians working in the same area._______Contexte: Les facteurs influençant les médecins à s’établir et à rester dans une région sont variables. La présence d’un campus médical régional (CMR) pourrait influencer ce choix. L’objectif de cette étude était d’explorer les facteurs de recrutement et de rétention influençant les médecins ayant choisi de pratiquer dans la région du Saguenay-Lac-Saint-Jean au Québec, en particulier le rôle du CMR.Méthodes: Une synthèse de la littérature a permis d’identifier différents facteurs influençant les médecins dans leur choix de lieu de pratique. Un guide d’entrevue a été élaboré à partir de ces facteurs. Les questions étaient séparées selon les sections suivantes: informations générales, situation familiale, études médicales, choix de carrière, pratique actuelle, intention de rester dans la région, impact du CMR. Treize entrevues semi-dirigées individuelles ont été réalisées avec des médecins en pratique. Les données ont été analysées avec QDA Miner.Résultats: Les facteurs influençant le recrutement étaient séparés en six thèmes majeurs : type de pratique, intérêt du conjoint, opportunité d’enseigner, formation en région, planification gouvernementale des effectifs médicaux et qualité de vie. Les participants ont identifié des facteurs de rétention négatifs et positifs. Ceux-ci concernaient la famille et la qualité de l’environnement de travail. D’après les participants, le CMR avait un impact direct sur la qualité de la vie professionnelle, la recherche, la pratique médicale et le développement régional.Conclusion: Cette étude a permis de mettre en évidence le rôle des CMRs dans le recrutement et la rétention via de multiples impacts sur la qualité de pratique des médecins exerçant dans la même région.
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McKenna-Lawlor, S. M. P., M. Dryer, Z. Smith, K. Kecskemety, C. D. Fry, W. Sun, C. S. Deehr, D. Berdichevsky, K. Kudela, and G. Zastenker. "Arrival times of Flare/Halo CME associated shocks at the Earth: comparison of the predictions of three numerical models with these observations." Annales Geophysicae 20, no. 7 (July 31, 2002): 917–35. http://dx.doi.org/10.5194/angeo-20-917-2002.
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Abstract. The arrival times at L1 of eleven travelling shocks associated both with X-ray flaring and with halo CMEs recorded aboard SOHO/LASCO have been considered. Close to the Sun the velocities of these events were estimated using either Type II radio records or CME speeds. Close to the Earth the shocks were detected in the data of various solar wind plasma, interplanetary magnetic field (IMF) and energetic particle experiments aboard SOHO, ACE, WIND, INTERBALL-1 and IMP-8. The real-time shock arrival predictions of three numerical models, namely the Shock Time of Arrival Model (STOA), the Interplanetary Shock Propagation Model (ISPM) and the Hakamada-Akasofu-Fry Solar Wind Model (HAFv.2) were tested against these observations. This is the first time that energetic protons (tens of keV to a few MeV) have been used to complement plasma and IMF data in validating shock propagation models. The models were all generally successful in predicting shock arrivals. STOA provided the smallest values of the "predicted minus measured" arrival times and displayed a typical predictive precision better than about 8 h. The ratio of the calculated standard deviation of the transit times to Earth to the standard deviation of the measurements was estimated for each model (treating interacting events as composite shocks) and these ratios turned out to be 0.60, 1.15 and 1.02 for STOA, ISPM and HAFv.2, respectively. If an event in the sample for which the shock velocity was not well known is omitted from consideration, these ratios become 0.36, 0.76 and 0.81, respectively. Larger statistical samples should now be tested. The ratio of the in situ shock velocity and the "Sun to L1" transit velocity (Vsh /Vtr) was in the range of 0.7–0.9 for individual, non-interacting, shock events. HAFv.2 uniquely provided information on those changes in the COBpoint (the moving Connection point on the shock along the IMF to the OBserver) which directly influenced energetic particle rise times. This model also illustrated the non-uniform upstream conditions through which the various shocks propagated; furthermore it simulated shock deformation on a scale of fractions of an AU. On the spatial scale (300 RE ), where near-Earth spacecraft are located, the passing shocks, in conformity with the models, were found to be locally planar. The shocks also showed tilting relative to the Sun-Earth line, probably reflecting the inherent directionality associated with their solar origin. Key words. Interplanetary physics (energetic particles; interplanetary shocks; solar wind plasma)
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Willis, Lauren, Emily S. Van Laar, Tristin Abair, Megan Whitney, Caitlin Costello, Amrita Y. Krishnan, Sagar Lonial, Sandra Kurtin, Joseph Mikhael, and Ola Landgren. "Evidence of Improved Knowledge and Skills Among Hematologists/Oncologists Participating in Online CME-Certified Activities." Blood 138, Supplement 1 (November 5, 2021): 4958. http://dx.doi.org/10.1182/blood-2021-145375.
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Abstract Background: Several regimens are currently available for the treatment of newly diagnosed or relapsed/refractory multiple myeloma (R/R MM). This has subsequently led to the development of a variety of novel management strategies. Because of the rapidly changing treatment landscape, it is challenging for hematologists/oncologists (hem/oncs), particularly those in community-based settings, to stay current on recent data and clinical practice guidelines. Aim: The objective of this study was to determine if a curriculum of online continuing medical education (CME) activities could improve the knowledge, skills, and confidence of hem/oncs as it relates to the treatment of patients with MM. Methods: The curriculum contained online CME-certified activities for clinicians that focused on personalizing treatment, managing adverse events (AEs), and integrating new data and agents into clinical practice for the treatment of MM. All activities were developed with input from a steering committee of expert myeloma physicians and a nurse practitioner. There were 10 activities included in this analysis. The impact of education was examined using a repeated-pair design with a pre-/post-assessment. Questions from all activities were grouped into learning topics. Mean knowledge/skill was calculated across all activities, and included questions designed for longitudinal analysis. Statistical significance was assessed using a McNemar's test (5% significance level, P <.05). Data was collected from when the first activity posted on November 11, 2020 through July 8, 2021. Results: A total of 570 hem/oncs were included in this analysis. A majority practiced in community-based settings (51%), specialized in hematologic malignancies (specialists, 51%), and cared for 1 to 10 patients with MM in a typical month (70%). The percentage of correct responses pre- and post-education across multiple curriculum activities are displayed by subgroup in the Table. Confidence was assessed for various topics on the scale of 1-not confident to 5-very confident. Hem/oncs were considered confident if they rated their confidence a 4 or 5. The pre-/post-education percentage of hem/oncs who were confident (4 or 5 on a scale of 1 to 5) personalizing treatment: 18%/23% academic (P <.01, relative percentage improvement, RI +56%), 17%/31% community (P <.001, RI +82%), 18%/30% specialists (P <.001, RI +67%), 13%/25% average 10 or fewer patients with MM per month (P <.001, RI +91%). Conclusions: The series of CME-certified activities had a significant, positive impact on knowledge, skills, and confidence across all learning themes for all hem/oncs, but especially community-based hem/oncs and specialists in hematologic malignancies. For almost all learning themes, community-based hem/oncs demonstrated similar or higher knowledge/skills post-education than their academic-based counterparts. Community-based hem/oncs also demonstrated larger relative improvements in knowledge/skills than academic-based hem/oncs. Hem/oncs who saw fewer patients with MM on average per month demonstrated a larger relative percentage improvement with these learning themes: foundational knowledge, knowledge of clinical trial data, knowledge of treatment regimens, knowledge of SDM. Hem/oncs who saw a higher number of patients with MM on average per month demonstrated larger relative percentage improvement with these learning themes: knowledge of MRD, skills personalizing treatment, knowledge of AEs, skills managing AEs, skills using SDM. This analysis shows that online CME using multimedia formats can significantly improve the knowledge, skills, and confidence of hem/oncs in multiple areas related to best practices for treating patients with newly diagnosed or R/R MM. The impact on community-based hem/oncs was significant and closed large knowledge and skill gaps compared to their academic peers. Results also suggest the following areas warrant further education: case-based application of treatment options and AE management as well as best practices for individualizing treatment. Acknowledgements: Sukhbir Bahra contributed to data analysis for this research. These CME activities were supported by an independent educational grant from AbbVie, Bristol Myers Squibb, GlaxoSmithKline, Karyopharm Therapeutics, Oncopeptides, and Sanofi Genzyme. Reference: https://www.medscape.org/sites/advances/multiple-myeloma Figure 1 Figure 1. Disclosures Krishnan: BMS: Consultancy, Current equity holder in publicly-traded company, Speakers Bureau; MAGENTA: Consultancy; REGENERON: Consultancy; SANOFI: Consultancy; GSK: Consultancy; JANSSEN: Consultancy, Research Funding; City of Hope Cancer Center: Current Employment; Amgen: Speakers Bureau. Lonial: Takeda: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; BMS/Celgene: Consultancy, Honoraria, Research Funding; AMGEN: Consultancy, Honoraria; GlaxoSmithKline: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Merck: Honoraria. Kurtin: Abbvie, Amgen, BMS, Incyte, Pharmacyclics, GSK, AstraZeneca, Takeda: Consultancy, Speakers Bureau. Mikhael: Janssen: Consultancy; Takeda: Consultancy; Sanofi: Consultancy; Karyopharm: Consultancy; Amgen: Consultancy; BMS: Consultancy; Oncopeptides: Consultancy; GSK: Consultancy. Landgren: Amgen: Honoraria; Janssen: Honoraria; Janssen: Research Funding; Janssen: Other: IDMC; Celgene: Research Funding; Amgen: Research Funding; Takeda: Other: IDMC; GSK: Honoraria.
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Dermer, Shari, Briana Betz, Piyali Chatterjee-Shin, Vishal Patel, and Nikhil I. Khushalani. "Online CME closes gaps in CSCC management revealed in a virtual patient simulation." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e23013-e23013. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e23013.
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e23013 Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer type. Although highly curable in its early stages, advanced or metastatic CSCC has been associated with mortality rates as high as 70%. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of oncologists on the assessment and management of CSCC. Methods: The educational series consisted of 4 online, CME-certified activities in multiple delivery formats, including an initial virtual patient simulation, followed by a clinical practice assessment (CPA) and 2 video discussions with synchronized slides. For the video discussions, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test ( P <.05) assessed educational effect. The first activity launched June 2019 and the last launched August 2020; data were collected until December 2020. Results: Following education oncologists had significant improvements in knowledge and competence compared with responses from the CPA. Improvement in knowledge and competence measured as relative % change in correct responses pre/post education across the learning themes identified in the virtual patient simulation are reported: Identifying patients who are not candidates for surgical intervention: 9% increase (56% CPA/ 77% pre/ 84% post; n=123-314; P <.05). Tailoring treatment: 30% increase (41% CPA/ 56% pre/ 73% post; n=119-314; P <.05). Tailoring treatment–cemiplimab: 22% increase (32% CPA/ 55% pre/ 67% post; n=123-314; P <.05). Tailoring treatment–cetuximab: 16% increase (15% CPA/ 37% pre/ 43% post; n=123-314; P <.05). New and emerging immunotherapies for CSCC: 47% increase (28% CPA/ 30% pre/ 44% post; n=119-314; P <.05). Conclusions: These results demonstrate the effectiveness of curriculum-based education for oncologists to address specific gaps in care as identified in a virtual patient simulation. This series of CME-certified online educational activities resulted in significant improvements in knowledge and competence in the assessment and treatment of patients with CSCC.
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Worst, Michelle Arielle, Rich Caracio, Katie Lucero, and Jacob Cohen. "CME curriculum improves clinician knowledge, competence, and confidence in managing patients with NF1-related tumors." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e23009-e23009. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e23009.
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e23009 Background: Neurofibromatosis type 1 (NF1) is an uncommon complex autosomal dominant disorder caused by germline mutations in the NF1 tumor suppressor gene. Therapeutic options have historically been limited with surgical debulking being the preferred treatment modality. However, recent clinical data have shown improved outcomes with the use of MEK inhibitors. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of physician learners with respect to the treatment of NF1-related tumors. Methods: The educational series consisted of four online, CME-certified activities. For each activity, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities, stratified by learning theme, and evaluated by target specialty. A repeated pairs pre-/post-assessment study design was used and McNemar’s test or paired samples t-test (P < .05) assessed educational effect. The first activity in the series launched Dec. 2019 and the last launched June 2020; data were collected until Dec. 2020. Results: Overall significant improvements were seen after education for oncologists (N = 258, P < .001), neurologists (N = 474, P < .001), surgeons (N = 427, P < .001), neurosurgeons (N = 93, P < .05), and pediatricians (N = 56, P < .001), regardless of practice setting. A sub-analysis of community specialists also showed significant improvements after education: oncologists (N = 117, P < .01), neurologists (N = 188, P < .001), and surgeons (N = 206, P < .001). Outcomes assessed by learning themes and specialty showed relative percent increases, with the majority being statistically significant. Conclusions: This analysis demonstrates that oncologists’ and other specialists’ knowledge, competence, and confidence regarding the treatment of NF1-related tumors improved after education, as measured through a comprehensive analysis of CME outcomes data from a variety of activities designed to achieve these ends. These results have the ability to translate to improvements in clinical care. Despite the improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.
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Armagan, Allison, Elaine Bell, Maria B. Uravich, and Shanthi Voorn. "959. Online CME Successful at Improving Knowledge, Competence and Confidence on Incorporating mAbs for COVID-19 Among a Global Audience." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S572. http://dx.doi.org/10.1093/ofid/ofab466.1154.
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Abstract Background The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19. Methods 10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P< .05) assessed educational effect. The activities launched between November 2020 and May 2021; data were collected through May 2021. Results To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P < .001). (ii) 70% improvement/reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P < .001). (iii) 52% improvement/reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P < .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P < .001). Conclusion This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care. Disclosures All Authors: No reported disclosures
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Saleem, Fatima, and Hector Blott. "Barriers to the Use of the Mental Health Treatment Requirement as Part of a Community-Based Criminal Sentence for Mentally Disordered Offenders." BJPsych Open 8, S1 (June 2022): S17—S18. http://dx.doi.org/10.1192/bjo.2022.111.
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AimsDue to the high rates of mental disorder in prison there have been a number of initiatives to divert mentally disordered offenders out of custody. One of these is the Mental Health Treatment Requirement (MHTR): a criminal sentence available as part of a Community Order, offered as an alternative to short-term custodial sentences in an attempt to address recidivism and encourage concordance with community psychiatric treatment. In spite of the prevalence of mental disorder amongst offenders, MHTRs represent less than 1% of all community sentences. Here we aim to identify obstacles to the use of the MHTR at sentencing and to suggest ways of overcoming them.MethodsA literature review and brief case series will be used to identify and illustrate what may be obstructing or limiting the use of the MHTR. The terms ‘MHTR’ and ‘Mental Health Treatment Requirement’ were searched on Google, Google Scholar, Athens, and PubMed, and results analysed for recurrent themes. The issues encountered clinically by one of the authors who referred three defendants for MHTRs in psychiatric sentencing reports in 2021 were reviewed with the same purpose.ResultsThe main barriers to the use of the MHTR which were identified were issues related to a lack of clinician awareness and experience, homelessness and housing, and service structure and provision. There may be a reluctance for Community Mental Health Teams (CMHTs) to accept offenders onto their caseloads, and there are challenges in obtaining assessments and recommendations for MHTRs. There are difficulties in securing an MHTR for homeless defendants on remand for whom identifying housing prior to sentencing, and thus a CMHT to supervise the MHTR, can be challenging. The MHTR assessment and referral process is more lengthy and cumbersome than that for most other disposals, leaving the defendant awaiting sentencing (potentially in custody) while the referral is processed.ConclusionSuggested solutions to improve access to the MHTR include increasing clinician awareness and confidence by providing teaching and training, and multi-agency meetings to enhance communication and create an understanding amongst professionals of duties, roles, and responsibilities. Initiatives to identify housing for homeless remand prisoners before their release, as well as ensuring the availability of community services to supervise treatment, would overcome some of the obstacles identified and increase availability of the MHTR. Funding for additional staff to conduct the assessment and referrals process would also be likely to improve uptake.
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Evans, F., R. Deslandes, P. Deslandes, and S. Young. "Opinions of stakeholders about integrating pharmacists into Community Mental Health Teams." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i43. http://dx.doi.org/10.1093/ijpp/riac019.060.
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Abstract Introduction Pharmacists are routinely involved in optimising medicines for mental health patients during inpatient admissions through attending ward rounds and providing a clinical pharmacy service. (1) Despite literature demonstrating the benefits, specialist pharmacists are not routinely integrated in Community Mental Health Teams (CMHTs) (2) and there is little research to identify the barriers to pharmacists’ integration. The opinions of stakeholder who influence the design of community mental health services, are key to understanding these issues. Aim To explore the views of relevant stakeholders in one health board (HB) in Wales, regarding integration of pharmacists into CMHTs, and to make recommendations to overcome identified barriers to integration. Methods Semi-structured interviews using open questions with key stakeholders within two CMHTs and the HB’s adult mental health clinical board. Participants were selected purposively to allow recruitment of individuals who would provide insight into the proposed question(s). Written, informed consent was obtained. A deductive approach was used to define interview questions. Interviews were transcribed and analysed thematically using an inductive approach to explore the data without any pre-conceived ideas and identify additional key themes. The study was registered with the HB. Results Interviews (3 pharmacists, 2 consultant psychiatrists, 1 integrated manager, 2 clinical nurse leads and 2 general managers) lasted between 30-45 minutes. Analysis revealed five main themes; relationship with the pharmacist, including previous experiences and individual pharmacist’s personal attributes; CMHT workload relevant to pharmacists’ skills; workforce and financial pressures; the need for ongoing support for and from pharmacists; and pharmacists’ expertise including non-medical prescribing. Previous experience of working with specialist mental health pharmacist influenced participants’ views, those with limited experience were less clear about what a pharmacist’s role would be in CMHTs“…we haven’t had specialist pharmacist linked to us ………“Always can get in touch with pharmacy by e-mail or phone. Can see advantage of a pharmacist in the building, the medics would really like that it wouldn’t need to be every week maybe a morning every two weeks. We know where pharmacy are, not a dire need. Others identified a clear role for pharmacists, “running clinic for us especially when we have referrals from GP purely asking for medication reviews having [pharmacist] here the benefit surpasses most of the options we can offer through medic”. Participants believed pharmacists needed training in risk assessment and consultation skills and they should be prescribers to contribute effectively. Nine participants had worked previously with pharmacists, all advocated their integration into CMHTs. Conclusion This small-scale study suggests there is a desire to integrate pharmacists into CMHTs with a strong emphasis on their role in addressing medicine-related workload pressures. Positive relationships formed from prior experience of working with pharmacists strongly influenced support for integration. There are potential roles for pharmacists that would improve timeliness and quality of care for people supported by CMHTs. Resource constraints such as lack of funding and availability of appropriately trained pharmacists need to be resolved. Further work is necessary to investigate how these barriers can be addressed and to evaluate the cost-effectiveness of any pharmacy service delivered. References (1) Royal Pharmaceutical Society England (2018). No health without mental health: How can pharmacy support people with mental health problems? London. Royal Pharmaceutical Society England (2) Robinson, J. (2017). Challenging the Stigma. The Pharmaceutical Journal, November 2017, Vol 299, No 7907, [online] | DOI: 10.1211/PJ.2017.20203915 [Accessed 1 Mar. 2019]
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Mador, Brett, Michael Kim, Jonathan White, Ilene Harris, and Ara Tekian. "Development of a novel conceptual framework for curriculum design in Canadian postgraduate trauma training." Canadian Medical Education Journal, December 5, 2019. http://dx.doi.org/10.36834/cmej.68621.
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Background: Recent changes in practice patterns and training paradigms in trauma care have resulted in a critical review of postgraduate curricula. Specifically, a shift towards non-operative management of traumatic injuries, and reduced resident work-hours, has led to a significant decrease in trainees' surgical exposure to trauma. The purpose of our study is to perform an exploratory review and needs assessment of trauma curricula for general surgery residents in Canada.
Methods: Our study design includes semi-structured interviews with trauma education experts across Canada and focus groups with various stakeholder groups. We performed qualitative analysis of comments, with two independent reviewers, using inductive thematic analysis to identify themes and sub-themes.
Results: We interviewed four trauma education experts and conducted four focus groups. We formulated two main themes: institutional context and transferability of curricular components. We further broke down institutional context into sub-themes of culture, resources, trauma system, and trauma volume. We developed a new conceptual framework to guide ongoing curricular reform for trauma care within the context of general surgery training.
Conclusions: Our exploratory curriculum review of trauma care training in Canada has provided valuable data to guide a national curriculum development process.
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Szafran, Olga, Douglas Myhre, Jacqueline Torti, and Shirley Schipper. "Factors perceived to influence rural career choice of urban background family physicians: a qualitative analysis." Canadian Medical Education Journal, November 21, 2019. http://dx.doi.org/10.36834/cmej.56976.
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Background: Urban background physicians are the main source of physician supply for rural areas across Canada. The purpose of this study was to describe factors that influence rural career choice and practice location of urban background family medicine graduates.
Methods: We conducted a qualitative, descriptive study employing telephone interviews with 9 urban background family medicine graduates. Those who completed residency training between 2006 and 2011 and were in rural practice, but who had an urban upbringing were asked about: when the decision for rural practice was made; factors that influenced rural career choice; and factors that influenced choice of a particular rural location. Emerging themes were identified through content analysis of interview data.
Results: We identified four themes as factors influencing rural career choice - variety/broad scope of rural practice, rural lifestyle, personal relationships, and positive rural experience/physician role models. We also identified factors in four theme areas as influencing the choice of a particular rural practice location - having lived in the rural community, spousal influence, personal lifestyle, and comfort with practice expectations.
Conclusion: Decisions for rural career choice and rural practice location by urban background family medicine graduates are based on clinical practice considerations, training experience, as well as personal and lifestyle factors.
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Landriault, Angele, and Angus McMurtry. "The perceived contributions of non-physician team members to residents’ interprofessional education during a critical care rotation." Canadian Medical Education Journal, November 18, 2020. http://dx.doi.org/10.36834/cmej.68905.
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Background: During rotations, post-graduate medical residents must learn about interprofessional teamwork and collaboration. Our study examined the role of non-physician healthcare team members in such education, from the perspectives of both residents and team members themselves.
Methods: This qualitative study took place in the intensive care unit (ICU) of a teaching hospital in a Canadian city. We conducted semi-structured individual and focus group interviews with both residents (n = 6) and the team members with whom they collaborated: pharmacists, nurses, respiratory therapists, and a social worker (n = 19).
Results: We developed a number of themes about interprofessional education (IPE) in this context from the data, including the presence of planned, unplanned, and tacit teaching; the influence of contextual factors like ICU culture, work demands, resident motivation, power hierarchies, and perceptions of ‘good’ and ‘bad’ residents; the gap between team member perceptions of their contribution to residents’ IP education and residents’ own perceptions; and concerns about the transferability of IPE to other contexts.
Conclusions: The influence of non-physician team members on residents’ IPE in the clinical environment is an understudied topic. While our study was limited to one ICU, the themes that emerged may be of interest to others in similar contexts.
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Sud, Shama, Laila Premji, Jonathan P. Wong, and Angela Punnett. "Career decision making in undergraduate medical education." Canadian Medical Education Journal, April 13, 2020. http://dx.doi.org/10.36834/cmej.69220.
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Background: It is unclear how medical students prioritize different factors when selecting a specialty. With rising under and unemployment rates a novel approach to career counselling is becoming increasingly important. A better understanding of specialty selection could lead to improved career satisfaction amongst graduates while also meeting the health care needs of Canadians.
Methods: Medical students from the University of Toronto participated in a two-phase study looking at factors impacting specialty selection. Phase I consisted of focus groups, conducted independently for each year, and Phase II was a 21-question electronic survey sent to all students.
Results: Twenty-one students participated in the focus group phase and 95 in the survey phase. Primary themes related to career selection identified in Phase I in order of frequency included personal life factors (36), professional life factors (36), passion/interest (20), changing interests (19) and hidden curriculum (15). The survey phase had similar results with passion (83), lifestyle (79), flexibility (75), employment opportunities (60) and family (50) being ranked as the factors most important in specialty selection.
Conclusion: Personal factors, professional factors and passion/interest may be key themes for medical students when deciding which specialty to pursue. Targeting career counselling around these areas may be important.
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Bass, Adam, Heather Armson, Kevin McLaughlin, and Jocelyn Lockyer. "Physician engagement in regularly scheduled rounds." Canadian Medical Education Journal, November 25, 2020. http://dx.doi.org/10.36834/cmej.69750.
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Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS.
Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS.
Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS.
Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designs
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Williams-Yuen, Jordan, Mahesh Shunmugam, Haley Smith, Sandra Jarvis-Selinger, and Maria Hubinette. "COVID as a catalyst: medical student perspectives on professional identity formation during the COVID-19 pandemic." Canadian Medical Education Journal, March 16, 2022. http://dx.doi.org/10.36834/cmej.73444.
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Background: As a result of the COVID-19 pandemic, a national decision was made to remove all medical students from clinical environments resulting in a major disruption to traditional medical education. Our study aimed to explore medical student perspectives of professional identity formation (PIF) during a nationally unique period in which there was no clinical training in medical undergraduate programs.
Methods: We interviewed fifteen UBC medical students (years 1-4) regarding their perspectives on PIF and the student role in the setting of the COVID-19 pandemic. Data were analysed iteratively and continuously to create a codebook and identify themes of PIF based on interview transcripts.
Results: We identified three key themes: (1) Medical students as learners vs contributing team members (2) Decreased competency as a threat to identity and (3) Doctors as heroes.
Conclusions: The impact of disruptions due to COVID-19 catalyzed student reflections on their role within the healthcare system, as well as the role of self-sacrifice in physician identity. Simultaneously, students worried that disruptions to clinical training would prevent them from actualizing the identities they envisioned for themselves in the future. Ultimately, our study provides insight into student perspectives during a novel period in medical training, and highlights the unique ways in which PIF can occur in the absence of clinical exposure.
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Dore, Kelly, Bryce James Mack Bogie, Karen Saperson, Karen Finlay, and Parveen Wasi. "Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework." Canadian Medical Education Journal, March 19, 2021. http://dx.doi.org/10.36834/cmej.70434.
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Background: Outcomes of national policy change impact all levels of the organizational hierarchy. The medical education literature is sparse on how reflections from program directors (PDs) on past large-scale policy changes can inform future policy initiatives. To fill this gap, we conducted a national survey on PDs’ perceptions of, and reflections on, decision-making in medical education, accreditation procedures, and the CanMEDS framework implementation.
Methods: The survey was distributed to former Canadian specialty medicine PDs (N = 684). Descriptive analysis was performed on quantitative data, thematic analysis was performed on qualitative comments, and comparisons between the quantitative and qualitative findings were performed to identify areas of convergence and/or divergence.
Results: A total of 265 (38.7%) former PDs participated. Quantitative analysis revealed that 52.8% of respondents did not feel involved in decision-making regarding policy changes, 45.1% of respondents did not feel prepared to assess the CanMEDS Roles, and PDs were divided on the reasonableness of accreditation documentation. Qualitative analysis produced four themes: communication, resources, expectations of outcomes, and buy-in. Nine sub-themes were also identified. A high level of convergence was identified across the content, with only four areas of divergence identified.
Conclusions: Our findings have the potential to inform future policy and/or accreditation changes. Without the lens of those charged with overseeing the implementation, policy evaluation and quality improvement will remain uninformed. PDs, therefore, bring unique insights into our understanding of national policy changes, and without the voices of these frontline implementers, the true success of policy change implementation will be hindered.
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Chaplin, Timothy, Heather Braund, Adam Szulewski, Nancy Dalgarno, Rylan Egan, and Brent Thoma. "Multi-source feedback following simulated resuscitation scenarios: a qualitative study." Canadian Medical Education Journal, January 4, 2022. http://dx.doi.org/10.36834/cmej.72387.
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Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.
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Lieffers, Jessica, Erin Wolfson, Gabilan Sivapatham, Astrid Lang, Alexa McEwen, Marcel D'Eon, and Carol Henry. "Interprofessional culinary education workshops at the University of Saskatchewan." Canadian Medical Education Journal, February 16, 2021. http://dx.doi.org/10.36834/cmej.70611.
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Implication Statement
If you want to offer your students an enjoyable and worthwhile interprofessional activity to learn about issues in community nutrition, your university can cook up these interprofessional culinary education workshops. Start with a few enthusiastic students from various health professional programs who can organize, promote, and lead. Include faculty and/or staff to support the students and apply for internal funding. Find workshop facilitators (e.g., chefs), and arrange for program evaluation. It is best to choose workshop topics and themes relevant to your local situation. Ensure workshops are structured to facilitate cooperative and experiential learning. Students will find these sessions informative, practical, and enjoyable.
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Thoma, Brent, Anna Karwowska, Louise Samson, Nicole Labine, Heather Waters, Meredith Giuliani, Teresa M. Chan, et al. "Emerging concepts in the CanMEDS physician competency framework." Canadian Medical Education Journal, September 26, 2022. http://dx.doi.org/10.36834/cmej.75591.
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Background: The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies. Methods: Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted. Results: 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanity; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts. Conclusion: This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.
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Gray, Serajaddin, Mohammad Effatpanah, Sara Salehi, Siamand Anvari Savojbalaghi, Leila Momeni, Roghayeh Abedi Gilavandani, and Alireza Abbasi Chaleshtari. "Medication Errors and Reducing Interventions: A Mixed Study in a Teaching Hospital." Journal of Pharmaceutical Care, April 19, 2021. http://dx.doi.org/10.18502/jpc.v9i1.6030.
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Background: Given the special importance of preventing from medication, the present study aimed to investigate the determining Causes of Medication Errors (CMEs) and their Priorities for reducing interventions in a hospital.
Methods: The present mixed, sequential and cross-sectional study was conducted in a teaching hospital (2016). For data collection, Fishbone Diagrams, interviews, note taking and checklists were used, and qualitative data were analyzed though the thematic approach. Moreover, the Maxqda Software v.14.0, Excel, Edraw Max v.9.0 were employed for data analysis and reporting.
Results: Seventy-five CMEs were classified under two main themes (human and non-human) and four sub-themes (personal, network, organizational, and meta-organizational). Weakness of professionalism and low experience as the personal causes; Actions of pharmacy colleagues, physicians and other nurses as the network causes; Management of nurses and unit specialty as the organizational causes and the quality of academic education, drug features and macro policies of medication as meta-organizational causes were classified. Six causes were given priority for reducing interventions.
Conclusion: In the short term, human factors should be considered with the aim of reducing medication errors. It is also recommended that teaching how to deal with nurses’ stress and psychological pressure (especially beginner nurse), resulting from critically ill patients and high workload, be paid special attention. Besides, it is suggested that professionalism be given priority to reduce personal neglects and to create safe environments for reporting personal neglects. In addition, more emphasis should be placed on the right route in the process of medication administration.
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Beavers, Lindsay, Voula Christofilos, Christinne Duclos, Kelly McMillen, Jasmine Sheehan, Laura Tomat, Lianne Jeffs, Rebecca Kelsey, and Beverly Bulmer. "Perceptions of preparedness: How hospital-based orientation can enhance the transition from academic to clinical learning." Canadian Medical Education Journal, April 23, 2020. http://dx.doi.org/10.36834/cmej.61649.
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Background: Clinical placements are essential for applied learning experiences in health professions education. Unfortunately, there is little consensus on how best to prepare learners for the transition between academic and clinical learning. We explored learners’ perceptions of hospital-based orientation and resulting preparedness for clinical placement.
Methods: Sixty-three learners participated in a total of 18 semi-structured focus groups, during their clinical placements. Data were analyzed thematically.
Results: We organized learners’ perceptions of hospital-based orientation that support their preparedness for placement into three themes: (1) adequate site orientation for learner acquisition of organization acumen and (2) clinical preceptor training to support unit/service and (3) individual components.
Conclusion: Thoughtful attention to hospital-based orientation can support learners in transitioning from academic to clinical learning. Hospital organizations should attend to all three components during orientation to better support learners’ preparedness for clinical learning.
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Keren, Daniela, Martina Kelly, Adrienne Wakabayashi, and Susan McNair. "“Figuring it out on our own”: exploring family medicine residents’ sexual assault and domestic violence training." Canadian Medical Education Journal, November 28, 2022. http://dx.doi.org/10.36834/cmej.74964.
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Background: Family physicians are uniquely able to provide comprehensive and longitudinal care to those experiencing sexual assault and domestic violence (SADV). To date, we know little about how Canadian family medicine (FM) residents learn about SADV. This study explored SADV teaching in residency from the perspectives of FM residents. Methods: This qualitative study took place in the Western University FM residency program. We conducted semi-structured interviews with first- and second-year FM residents (n=8). We analyzed data using thematic analysis. Results: We identified three inter-related themes: (1) Inconsistent training for SADV, (2) Attitudes towards SADV and (3) Learner hesitancy. Quality and quantity of SADV learning opportunities were inconsistent across learners, fuelling feelings of incompetence and lack of confidence around providing SADV care. This led to hesitant behaviours by learners when encountering SADV clinically. Conclusions: Understanding FM residents’ experiences and ideas regarding SADV education is critical in order to graduate physicians equipped to care for this vulnerable population. This research highlights the relationship among learners’ and teachers’ experiences, attitudes and behaviours; targeting this behavioural cycle may improve SADV learning.
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Polle, Emma, and Jane Gair. "Mindfulness-based stress reduction for medical students: a narrative review." Canadian Medical Education Journal, March 31, 2021. http://dx.doi.org/10.36834/cmej.68406.
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Background: Medical students are at high risk of depression, distress and burnout, which may adversely affect patient safety. There has been growing interest in mindfulness in medical education to improve medical student well-being. Mindfulness-based stress reduction (MBSR) is a commonly used, standardized format for teaching mindfulness skills. Previous research has suggested that MBSR may be of particular benefit for medical students. This narrative review aims to further investigate the benefits of MBSR for undergraduate medical students.
Methods: A search of the literature was performed using MedLine, Embase, ERIC, PSYCInfo, and CINAHL to identify relevant studies. A total of 102 papers were identified with this search. After review and application of inclusion and exclusion criteria, 9 papers were included in the study.
Results: MBSR training for medical students was associated with increased measures of psychological well-being and self-compassion, as well as improvements in stress, psychological distress and mood. Evidence for effect on empathy was mixed, and the single paper measuring burnout showed no effect. Two studies identified qualitative themes which provided context for the quantitative results.
Conclusions: MBSR benefits medical student well-being and decreases medical student psychological distress and depression.
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Azzi, Elise, Edward Seale, and Douglas Archibald. "Exploring resident perspectives on family medicine enhanced skills training." Canadian Medical Education Journal, August 22, 2022. http://dx.doi.org/10.36834/cmej.72657.
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Background: Third-year enhanced skills programs, also known as family medicine (FM) PGY3 programs, have always been an area of debate. Their exponential growth does not stem from a strong body of academic evidence or public health needs assessment. This qualitative descriptive study explores the current perspectives of second-year FM residents at the University of Ottawa on extended training programs through semi-structured interviews. Results: Of the fifteen participants, eight were applying to PGY3 FM programs, six were not and one was unsure. Themes generated included: developing generalist niches within primary care, increasing confidence of FM graduates, allowing generalists to fill in healthcare gaps to meet community needs, meeting the pressures of workplace competition and employability requirements, and creating alternate paths to five-year specialties. 80% would extend their core FM training, with self-design and options of shorter time frames as preconditions. Conclusion: FM residents are interested in furthering their training, whether through extending core residency period or via enhanced skills programs. The demand for these programs will continue rising. Capitalizing on residents’ interests to catapult the profession forward and optimize the quality of healthcare should be the priority for licensing bodies and medical educators.
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Cartmill, Carrie, Cynthia Whitehead, Esther Ihekwoaba, Ritika Goel, Samantha Green, Mona Haidar, Dawnmarie Harriott, and Sarah Wright. "Teaching poverty and health: importing transformative learning into the structures and paradigms of medical education." Canadian Medical Education Journal, December 20, 2021. http://dx.doi.org/10.36834/cmej.72841.
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Background: As a paradigm of education that emphasizes equity and social justice, transformative education aims to improve societal structures by inspiring learners to become agents of social change. In an attempt to contribute to transformative education, the University of Toronto MD program implemented a workshop on poverty and health that included tutors with lived experience of poverty. This research aimed to examine how tutors, as members of a group that faces structural oppression, understood their participation in the workshop. Methods: This research drew on qualitative case study methodology and interview data, using the concept of transformative education to direct data analysis and interpretation. Results: Our findings centred around two broad themes: misalignments between transformative learning and the structures of medical education; and unintended consequences of transformative education within the dominant paradigms of medical education. These misalignments and unintended consequences provided insight into how courses operating within the structures, hierarchies and paradigms of medical education may be limited in their potential to contribute to transformative education. Conclusions: To be truly transformative, medical education must be willing to try to modify structures that reinforce oppression rather than integrating marginalized persons into educational processes that maintain social inequity.
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Mathews, Maria, Ivy Bourgeault, and Dana Ryan. "Perceptions of bias in the selection of international medical graduate residency applicants in Canada." Canadian Medical Education Journal, September 20, 2022. http://dx.doi.org/10.36834/cmej.73320.
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Background: In Canada, international medical graduates (IMG) consist of immigrant-IMG and previous Canadian citizens/permanent residents who attended medical school abroad (CSA). CSA are more likely to obtain a post-graduate residency position than immigrant-IMG and previous studies have suggested that the residency selection process favours CSA over immigrant-IMG. This study explored potential sources of bias in the residency program selection process. Methods: We conducted semi-structured interviews with senior administrators of clinical assessment and post-graduate programs across Canada. We asked about perceptions of the background and preparation of CSA and immigrant-IMG, methods applicants use to improve likelihood of obtaining residency positions, and practices that may favour/discourage applicants. Interviews were transcribed and a constant comparative method was employed to identify recurring themes. Results: Of a potential 22 administrators, 12 (54.5%) completed interviews. Five key factors that may provide CSA with an advantage were: reputation of the applicant’s medical school, recency of graduation, ability to complete undergraduate clinical placement in Canada, familiarity with Canadian culture, and interview performance. Conclusions: Although residency programs prioritize equitable selection, they may be constrained by policies designed to promote efficiencies and mitigate medico-legal risks that inadvertently advantage CSA. Identifying the factors behind these potential biases is needed to promote an equitable selection process.
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Yilmaz, Yusuf, Robert Carey, Teresa Chan, Venkat Bandi, Shisong Wang, Robert A. Woods, Debajyoti Mondal, and Brent Thoma. "Developing a dashboard for program evaluation in competency-based training programs: a design-based research project." Canadian Medical Education Journal, April 27, 2022. http://dx.doi.org/10.36834/cmej.73554.
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Background: Canadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires the assessment of entrustable professional activities (EPAs). Dashboards could be used to track the completion of EPAs to support program evaluation. Methods: Using a design-based research process, we identified program evaluation needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. We interviewed leaders from the emergency medicine program and postgraduate medical education office at the University of Saskatchewan. Two investigators thematically analyzed interview transcripts to identify program evaluation needs that were audited by two additional investigators. Identified needs were described using quotes, analytics, and visualizations. Results: Between July 1, 2019 and April 6, 2021 we conducted 17 interviews with six participants (two program leaders and four institutional leaders). Four needs emerged as themes: tracking changes in overall assessment metrics, comparing metrics to the assessment plan, evaluating rotation performance, and engagement with the assessment metrics. We addressed these needs by presenting analytics and visualizations within a dashboard. Conclusions: We identified program evaluation needs related to EPA assessments and designed dashboard elements to meet them. This work will inform the development of other CBME assessment dashboards designed to support program evaluation.
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Arja, Sateesh Babu, Sireesha Bala Arja, Samir Fatteh, Krishna Teja Challa, Manoj Kumar Reddy Somagutta, and Danielle Blouin. "Impact of accreditation on Caribbean medical schools’ processes." Canadian Medical Education Journal, June 4, 2021. http://dx.doi.org/10.36834/cmej.71333.
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Background: Caribbean graduates contribute significantly to the US healthcare workforce. The accreditation requirements of local governments vary from one Caribbean island to another island. The Educational Commission for Foreign Medical Graduates (ECFMG) requirement that all future applicants be graduates from accredited medical schools drove Caribbean medical schools to seek accreditation. Accreditation has been found to significantly impact the educational processes of Canadian medical schools. Our study aims at investigating Caribbean medical school leaders’ perceptions of the impact of accreditation on their school’s processes.
Methods: This qualitative study and data analysis were done using a framework analysis. Academic leaders and faculty members from three different types of Caribbean medical schools (accredited, denied-accreditation schools, never applied for accreditation) were interviewed using semi-structured interviews.
Results: A total of 12 participants from six different Caribbean medical schools participated in the interview process. Themes of processes influenced by accreditation at Caribbean medical schools were similar to those found in the Canadian context and align with best practices of Continuous Quality Improvement (CQI).
Conclusions: Caribbean medical schools are changing their educational processes as a result of accreditation requirements. Some processes are not maintained in a continuous manner, raising questions about the development of a true CQI culture.
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Berrington, Roger, Nina Condo, Felicien Rubayita, Karen Cook, and Chelsea Jalloh. "Community organization feedback about an undergraduate medical education service learning program." Canadian Medical Education Journal, June 14, 2021. http://dx.doi.org/10.36834/cmej.71420.
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Background: In 2016, Service Learning (SL) became a curricular requirement for undergraduate medical education (UGME) students at the University of Manitoba. Students partner with a community-based organization for two years to engage in non-clinical activities in community settings. Significant feedback has been collected from students re: their SL experiences. This project specifically collected feedback from community organizations involved with SL.
Methods: In June 2019, an electronic survey was distributed to the 36 community organizations involved with SL.
Results: Twenty-seven organizations completed the survey. Feedback was grouped into two main themes: 1) Logistics and 2) The SL Experience. About half (52%) of respondents indicated it was “easy” to schedule students for SL; however, students’ busy schedules and differences between hours of organization programming and students’ availability were highlighted. Most respondents described students as “engaged” (70%); respondents indicated SL raised students’ understanding of power and privilege (56%) and systemic oppression (63%).
Conclusions: Community organizations shared valuable insights to inform the SL program. Results identified specific aspects of the SL program to address moving forward, such as sharing learning objectives with community partners. Ensuring processes are in place to obtain feedback from community partners is an essential step to improve SL programs, and to strengthen reciprocal community-university partnerships.
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Wang, Aaron, Allison Meiwald, Robert Harper, Kristine Van Aarsen, and Justin Yan. "Health research methodology education in Canadian emergency medicine residency programs: A national environmental scan." Canadian Medical Education Journal, May 20, 2020. http://dx.doi.org/10.36834/cmej.68753.
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Objectives: Our objective was to describe the variability of research methodology teaching among English-speaking Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) residency programs. We also aimed to identify barriers to teaching research methodology curricula.
Methods: An electronic survey was sent by email to program directors and residents of English-speaking RCPSC-EM training programs countrywide. Reminder emails were sent after 2, 4, and 8 weeks. Quantitative, descriptive statistics were prepared, and qualitative data and themes were identified.
Results: We received a total of 7 responses from the possible 12 program directors (response rate = 58.3%). Out of 354 potential resident respondents, 82 (23.2%) completed the survey. There was disparity between resident and program director responses with respect to the existence of curricula, preparation for Royal College exams, and usefulness for future practice. Barriers to teaching a research methodologies curriculum included lack of time, support, educated faculty, and finances.
Conclusion: This survey demonstrates that Canadian EM residency programs vary with respect to research methodology curriculum, and discrepancies exist between residents’ and program directors’ perceptions of the curriculum. Given the lack of a standardized research methodology curriculum for these programs, there is an opportunity to improve training in research methodology.
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Okoniewska, Basia, Malika A. Ladha, and Irene W. Y. Ma. "Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): A phenomenological study." Canadian Medical Education Journal, June 5, 2020. http://dx.doi.org/10.36834/cmej.69318.
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Background: Each year, a number of medical students are unmatched in the Canadian Residency Matching Service (CaRMs) match. There is little information on the experiences of unmatched candidates. This study seeks to explore the experiences of applicants who were unmatched in the first iteration of their CaRMS applications
Methods: We interviewed 15 participants who were previously unmatched, using a semi-structured interview guide to ask them of their experiences on the following domains: the overall unmatched experience; circumstances leading to their unmatched status; resources employed; barriers experienced; recommendations; and, their eventual career outcomes. We independently identified major themes from field notes to code the data using a phenomenology approach.
Results: Our participants universally reported negative emotions, concerns regarding privacy and confidentiality breaches, and stigma faced (real or perceived). Systemic challenges included: lack of information, pressures faced from undergraduate medical education, and logistical issues such as financial challenges, licensing and scheduling issues. The utility of peer support differed for individual participants, but all those who had support from other unmatched candidates felt that to be useful.
Conclusions: Our participants reported significant challenges faced after being unmatched. Based on these experiences, we identified four major recommendations to support candidates through their unmatched journey.
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Axelrod, Charlotte, Connor TA Brenna, Ariel Gershon, Allan Peterkin, and Joyce Nyhof-Young. "The Companion Curriculum: medical students’ perceptions of the integration of humanities within medical education." Canadian Medical Education Journal, October 31, 2022. http://dx.doi.org/10.36834/cmej.72907.
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Background: The contributions of arts and humanities to medical education are known in the medical education community, but medical schools’ offerings vary. The Companion Curriculum (CC) is a student-curated set of optional humanities content for medical students at the University of Toronto. This study evaluates integration of the CC to identify key enabling conditions for medical humanities engagement. Methods: A mixed-methods evaluation gauged usage and perceptions of integration of the CC among medical students using an online survey and focus groups. Narrative data underwent thematic analysis, supported by summary statistics of quantitative data. Results: Half of survey respondents were aware of the CC (n = 67/130; 52%), and, once prompted with a description, 14% had discussed it in their tutorial groups. Of students using the CC, 80% reported learning something new regarding their roles as communicators and health advocates. Themes were the perceived value of the humanities, internal student barriers, institutional neglect of the humanities, and student critiques and recommendations. Conclusion: Despite participants’ interest in medical humanities, our CC remains underused. To improve humanities’ visibility in the MD curriculum, our results indicate that greater institutional support, including faculty development and early curricular integration, is required. Further study should explore reasons for gaps between interest and participation.
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Li, Ming K., Grace Xu, Paula Veinot, Maria Mylopoulos, and Marcus Law. "Overshadowed by shadowing: exploring how Canadian medical students experience shadowing." Canadian Medical Education Journal, September 19, 2022. http://dx.doi.org/10.36834/cmej.74348.
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Background: Preclinical medical students commonly perceive shadowing as beneficial for career exploration. However, research is sparse on the broader impact of shadowing as a learning strategy. We explored students’ perceptions and lived experiences of shadowing to understand its role and impact on their personal and professional lives. Methods: Between 2020-2021, individual semi-structured video interviews were conducted with 15 Canadian medical students in this qualitative descriptive study. Inductive analysis proceeded concurrently with data collection until no new dominant concepts were identified. Data were iteratively coded and grouped into themes. Results: Participants described internal and external factors that moulded shadowing experiences, arising tensions between intended and perceived experiences, and how these lived experiences impacted their wellness. Internal factors associated with shadowing behaviour included: 1) aspiring to be the best and shadowing to demonstrate excellence, 2) shadowing for career exploration, 3) shadowing as learning opportunities for early clinical exposure and career preparedness, and 4) reaffirming and redefining professional identity through shadowing. External factors were: 1) unclear residency match processes which position shadowing as competitive leverage, 2) faculty messaging that perpetuates student confusion around the intended value of shadowing, and 3) social comparison in peer discourse, fuelling a competitive shadowing culture. Conclusions: The tension between balancing wellness with career ambitions and the unintended consequences of unclear messaging regarding shadowing in a competitive medical culture highlights issues inherent in shadowing culture.