We rely upon formal accreditation and curricular standards to articulate the priorities of professional training. The language used in standards affords value to certain constructs and makes others less apparent. Leveraging standards can be a useful way for educators to incorporate certain elements into training. This research was designed to look for ways to embed the teaching and practice of compassionate care into Canadian family medicine residency training.We conducted a Foucauldian critical discourse analysis of compassionate care in recent formal family medicine residency training documents. Critical discourse analysis is premised on the notion that language is connected to practices and to what is accorded value and power. We assembled an archive of texts and examined them to analyse how compassionate care is constructed, how notions of compassionate care relate to other key ideas in the texts, and the implications of these framings.There were very few words, metaphors or statements that related to concepts of compassionate care in our archive. Even potential proxies, notably the doctor-patient relationship and patient-centred care, were not primarily depicted in ways that linked them to ideas of compassion or caring. There was a reduction in language related to compassionate care in the 2013 standards compared with the standards published in 2006.Our research revealed negative findings and a relative absence of the construct of compassionate care in our archival documents. This work demonstrates how a shift in curricular focus can have the unintended consequence of making values that are taken for granted less visible. Given that standards shape training, we must pay attention not only to what we include, but also to what we leave out of formal documents. We risk losing important professional values from training programmes if they are not explicitly highlighted in our standards.
Introduction: In response to a government request to address physician shortages in underserved communities, the University of Toronto (U of T) established the Family Medicine Residency Program (FMRP) at the Royal Victoria Regional Health Centre (RVH) in Barrie, Ontario, Canada. Prior to establishing the FMRP, approximately 21% of Barrie residents did not have a family physician. This study investigated residents’ training experiences, strengths and opportunities for improvement of a community FMRP, reasons why graduates choose to work in Barrie after graduation, and graduates’ practice setting and location. Methods: RVH graduates from 2011-2016 (N=45) were invited to participate. Semistructured one-on-one interviews sought insight into graduates’ experience in the program. We collected online survey data to gather demographic information. We determined current practice location using a government-funded data set and the public registry of the provincial licensing body. Results: Analysis of qualitative data provided insights into an overwhelmingly positive educational experience that contributed to graduates choosing to stay and work in Barrie. Participants noted the wide range of hands-on training opportunities as a strength of the program. They perceived that the program added value to the local community by increasing capacity to provide care to an underserved patient population. Tracking data demonstrated that two-thirds of graduates continued to work in the RVH region after graduation. Conclusions: The successful establishment of a new university-affiliated FMRP in an underserved community provides a strong mechanism to recruit physicians. Training in this setting provided excellent educational experiences to residents, who felt prepared to enter independent practice upon completion of training.
Purpose This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians’ experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform. Design/methodology/approach A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively. Findings Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations. Research limitations/implications Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders’ decision-making about system reform. Originality/value This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.
Le dialogue entre les enseignants cliniciens et les stagiaires à propos des préjugés dont font l’objet certaines populations dans les soins de santé peut se révéler difficile. En tant que médecins, en plus d’avoir nos propres identités, différents antécédents et diverses expériences
Abstract Background The aim of this educational study was to investigate the use of interactive case-based modules relating to the screening and identification of early-stage inflammatory arthritis in both online technology (OLT) and paper (PF) formats with identical content. Methods Forty learners from family medicine or rheumatology residency programs were recruited. Content pertaining to a “Sore Hands, Sore Feet” (SHSF) and Gait Arms Legs Spine (GALS) screening tool modules were selected, reviewed and developed based on a validated curriculum from the World Health Organization and Canadian Curriculum for MSK conditions. Both the SHSF module and GALS screening tool were assessed via a randomized control trial. Assessments were completed during an orientation with all learners; then prior to the intervention (T1); at the end of the module (T2) and 3 months following the modules (T3) to assess retention. Focus groups were conducted to determine learners’ satisfaction with the different learning formats. Baseline data was collated, and analysis performed after randomization into the PF (control) and OLT (experimental) groups. Repeated measures ANOVA was used for statistical analyses. Results Forty participants were recruited and randomized into the PF or OLT group ( n = 20 each). At 3 months, there were n = 31 participants for SHSF (PF n = 19, OLT n = 12) and n = 32 for GALS (PF n = 19, OLT n = 13). There was no significant difference between the OLT and PF groups in both analyses. A significant increase in scores from Pre- to Post-Module in SHSF (F (1, 18) = 24.62. p < .0001) and GALS (F (1, 30) = 40.08, p < .0001) were identified to suggest learning occurred with both formats. The repeated measures ANOVA to assess retention revealed a significant decrease in scores from Post-Module to Follow-up for both learning format groups for SHSF (F (1, 29) = 4.68. p = .039), and GALS (F (1, 30) = 18.27. p < .0001) suggesting 3 months may be too long to retain this educational information. Conclusions Both formats led to residents’ ability to screen, identify and initially manage inflammatory arthritis. The hypothesis is rejected because both OLT and PF groups demonstrated significant learning during the process regardless of format. It is important to emphasize that from T1 (pre-module) to T2 (post-module), the residents demonstrated learning regardless of group to which they were assigned. However, learning retention declined from T2 (post-module) to T3 (three-month follow-up). Regular review of knowledge may be required earlier than 3 months to retain information learned. This study may impact educational strategies in MSK health. Trial registration This study did not involve “patients” rather learners and as such it was not registered.
In commentaries, research papers, and policy reports published across Canada, there exists considerable variation in the ways the discipline of family medicine is perceived. Some scholars describe family physicians as the consummate medical experts: physicians able to respond to patient needs across
Strong verbal communication skills are essential for physicians. Despite a wealth of medical education research exploring communication skills training, learners struggle to become strong communicators. Integrating basic science into the curriculum provides students with conceptual knowledge that improves learning outcomes and facilitates the development of adaptive expertise, but the conceptual knowledge, or "basic science," of patient-provider communication is currently unknown. This review sought to address that gap and identify conceptual knowledge that would support improved communication skills training for medical trainees.Combining the search methodology of Arksey and O'Malley with a critical analytical lens, the authors conducted a critical scoping review of literature in linguistics, cognitive psychology, and communications to determine: what is known about verbal communication at the level of word choice in physician-patient interactions? Studies were independently screened by 3 researchers during 2 rounds of review. Data extraction focused on theoretical contributions associated with language use and variation. Analysis linked patterns of language use to broader theoretical constructs across disciplines.The initial search returned 15,851 unique studies, and 271 studies were included in the review. The dominant conceptual groupings reflected in the results were: (1) clear and explicit language, (2) patient participation and activation, (3) negotiating epistemic knowledge, (4) affiliative language and emotional bonds, (5) role and identity, and (6) managing transactional and relational goals.This in-depth exploration supports and contextualizes theory-driven research of physician-patient communication. The findings may be used to support future communications research in this field and educational innovations based on a solid theoretical foundation.
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. These two limits are usually quite independent of each other, so that no single number, such as a one-hour rating, can fully describe the usability of the apparatus. The proposed service factor rating gives both of these limits, and therefore gives the user the data for applying the apparatus to a variety of duty cycles. In conclusion, it is suggested that welding generators and transformers be designed for a service-factor rating of 75 per cent, since this corresponds best to typical welding duty cycles. It is also proposed that the standard AIEE values of temperature rise by resistance for continuous rated machines, 60 degrees centigrade for class A, or 80 degrees centigrade for class B insulation, be recognized as the limiting values in continuous operation at the service-factor rating. Rating for Welding Service Before proposing a method of rating, it is advisable to consider the purpose of rating. "The rating of a machine or other equipment is a set of performance characteristics which are subject to verification by test under specified conditions and which by mutual agreement between buyer and seller may serve as a basis of specifications and contracts covering the purchase and sale of the machine or other equipment. The rating is used by the manufacturer in the design and fabrication of the equipment and is used by the purchaser as the basis for application; therefore, the terms in which the rating is stated should be definite, easily verified, of such a nature as to permit intelligent use of the equipment, and as far as possible inclusive of usual conditions as found in practice." 1
Medical schools aim to integrate the values of generalism into their undergraduate programs. However, currently no program has been described to measure the degree to which formal curricular materials represent generalist principles.
Objective of program
To quantify the generalism principles present in undergraduate medical education learning materials and to provide recommendations to enhance generalism content.
Program description
A review of the literature and accreditation documents was conducted to identify key elements of medical generalism. An evidence-informed tool, the Toronto Generalism Assessment Tool, was developed and applied to the new preclerkship undergraduate cases at the University of Toronto in Ontario. The findings regarding the presence of generalism principles and recommendations to enhance generalism content were provided to case developers. The recommendations were valued and were incorporated into subsequent iterations of the cases.
Conclusion
This is the first report of a successful evidence-informed program to assess the degree of generalism reflected in undergraduate medical education curricular documents. This program can be used by other institutions wishing to review their curricula through a generalist lens.
Background Continuity of care (CoC) is integral to the practice of comprehensive primary care, yet research in the area of CoC training in residency programs is limited. In light of distributed medical education and evolving accreditation standards, a rigorous understanding of the context and enablers contributing to CoC education must be considered in the design and delivery of residency training programs.
Approach At our preceptor-based community academic site, we developed a system—resident—preceptor (SRP) framework to explore factors that influence a resident’s perception regarding CoC, and established variables in each area to enhance learning. We then implemented a two-year educational SRP intervention (SRPI) to one cohort of residents and their preceptors to integrate critical education factors and align teaching of continuity of care within curricular goals.
Evaluation Evaluation of the intervention was based on resident interviews and faculty focus groups, and a qualitative phenomenological approach was used to analyze the data. While some factors identified are inherent to family medicine, the opportunity for reflection is a unique component to inculcate CoC learning.
Reflection The SRP innovation provides a unique framework to facilitate residents’ understanding and development of CoC competency. Our model can be applied to all residency programs, including traditional academic sites as well as distributed training sites, to enhance CoC education.
