Background and Objectives: The onset of the COVID-19 pandemic severely threatened all aspects of academic family medicine, constituting a crisis. Multiple publications have identified recommendations and documented the creative responses of primary care and academic organizations to address these challenges, but there is little research on how decisions came about. Our objective was to gain insight into the context, process, and nature of family medicine leaders’ discussions in pivoting to address a crisis. Methods: We used a qualitative descriptive design to explore new dimensions of existing concepts. The setting was the academic family medicine department at the University of Toronto. To identify leadership themes, we used the constant comparative method to analyze transcripts of monthly meetings of the departmental executive: three meetings immediately before and three following the declaration of a state emergency in Ontario. Results: Six themes were evident before and after the onset of the pandemic: building capacity in academic family medicine; developing leadership; advancing equity, diversity, and inclusion; learner safety and wellness; striving for excellence; and promoting a supportive and collegial environment. Five themes emerged as specific responses to the crisis: situational awareness; increased multidirectional communication; emotional awareness; innovation in education and patient care; and proactive planning for extended adaptation to the pandemic. Conclusion: Existing cultural and organizational approaches formed the foundation for the crisis response, while crisis-specific themes reflected skills and attitudes that are essential in clinical family medicine, including adapting to community needs, communication, and emotional awareness.
Le rôle des programmes de formation en compétences avancées (CA) au Canada a fait l’objet de vastes débats. Ces programmes étaient conçus pour offrir aux résidents et aux médecins en pratique active des possibilités de parfaire leurs compétences dans des domaines ciblés afin de soutenir
Background Referral and consultation letters ferry patients among providers, negotiating co-operative care. Our study examined how 'relevance' is signalled and decoded in these letters, from the perspective of both experts and trainees in three clinical specialties. Methods 104 letters were collected from 16 physicians representing family medicine, psychiatry and surgery. Interviews were conducted with 14 of these physicians and 13 residents from the three specialties. All documents and transcripts were analysed for emergent themes. Results Six rhetorical factors influenced expert physicians' decisions about what material is relevant: educational, professional, audience, system-institutional, medical-legal, and evaluative. Each specialty placed different emphasis on these factors. Trainees reported having no instruction regarding how to construct rhetorically relevant letters, and they demonstrated awareness of only three of the factors identified by experts − professional, audience and evaluative. Experts and trainees differed in their understanding and application of these three factors. Conclusions This research demonstrates that six rhetorical factors influence relevance decisions in letter writing, and that experts address these factors in tacit, dynamic and discipline-specific ways. Trainees share with experts an appreciation of the rhetorical functions of referral and consultation letters, but lack a comprehensive understanding of the influential factors and do not receive instruction in them. These findings provide a framework for instruction in this domain to equip novices to meet the expectations of their professional audiences successfully.
Teaching medical students to spontaneously identify biopsychosocial issues (e.g. family violence) remains a challenge. We examined the extent to which using unannounced standardised patients (SPs) presenting in a clerk's clinical setting could assist with this teaching challenge.All clerks attended a family violence seminar in their family medicine rotation. Intervention students additionally saw an unannounced SP portraying 1 of 2 scenarios in their preceptor's office during the rotation, and received immediate feedback about their performance. An end of rotation objective structured clinical examination (OSCE) included an SP presentation similar to that seen by the intervention students.Clerks who received the intervention demonstrated increased questioning about family violence, from 0% (0 of 29 students) to 19% (5 of 26 students) in 1 OSCE scenario (P = 0.019), and from 40% (12 of 30 students) to 76% (19 of 25 students) in the other (P = 0.007).Seeing unannounced SPs had a dramatic effect on later student performance. This potentially powerful intervention could be applied to a range of clinical issues.
In family medicine, leadership is critical for health care delivery, advancing curricula, research, and quality improvement. Systematic reviews of leadership development programs in health care identify limitations, calling for innovative designs and rigorous assessment. Our objective was to evaluate the impact of applying master class principles to leadership development in academic family medicine.We used mixed methods to assess the impact of an innovative master class program on 15 emerging leaders in a large academic department of family medicine. The program consisted of five sessions where family physician masters shared their wisdom, techniques, and feedback with promising leaders. Quantitative evaluation involved participants' ratings of each session's content and delivery using a 5-point Likert scale. We assessed postcourse semistructured interviews with participants qualitatively using descriptive thematic content analysis.Individual sessions were highly evaluated, with a combined mean of 4.82/5. Qualitative thematic analysis identified self-perceived increased effectiveness in leadership activities; increased confidence as a leader; increased motivation to be a leader; and perceptions of value from the program, contributing to what participants described as unexpected potential change within themselves. Themes related to effectiveness of the program were practical advice; networking; diverse topics; accessible speakers sharing personal stories; and small-group, informal, early-evening format.Master class concepts can be adapted to leadership development in academic family medicine, with evidence of early positive impact on participants' self-perception of leadership skills and confidence. Further research is warranted to assess organizational impact and applicability to other settings.
The primary purpose of rating an electrical machine is to give the user an idea of what he may expect from the unit which he purchases. It is the purpose of this paper to propose a method of rating arc-welding generators and transformers which will give a truer picture of their working ability than is afforded by the present one-hour rating. Such a method of rating will be beneficial both to the customer who buys and uses arc welders and to the manufacturers who produce and market the units. The user will be better able to select a machine which will do the job to be performed, and at the same time he will be assured that he is not purchasing a machine unduly large for his requirements. The present custom is to give welding transformers and generators a one-hour rating, specifying the current they can deliver for a one-hour period, starting cold, without exceeding the permissible temperature rise. The plan here proposed is to give them a current rating indicative of their normal operating capacity, or short-time welding ability; and an additional service factor rating, indicative of their continuous current capacity, as limited by thermal considerations. All electric apparatus has these two major limitations on its output, one a ``size'' limit expressed by breakdown torque, commutation limit, or voltage drop; and the other a thermal limit expressed by the degrees temperature rise permissible for the type of insulation used.
The role of enhanced skills (ES) training programs in Canada has been the subject of extensive debate. These programs were designed to provide both residents and physicians in practice with opportunities to extend their competence in a focused area to support the delivery of comprehensive care that
