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Ventres WB, Stone LA, Akhtar R, Ring JM, Candib LM, Messias E, Epstein RM, Tunzi M, Lee AL, Morley CP, Brown CM, Slawson D, Konkin J, Campbell DG, Couper I, Williams S, Brooks R, Walters L. Storylines of family medicine IV: perspectives on practice-lenses of appreciation. Fam Med Community Health 2024; 12:e002791. [PMID: 38609092 PMCID: PMC11029283 DOI: 10.1136/fmch-2024-002791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IV: perspectives on practice-lenses of appreciation', authors address the following themes: 'Relational connections in the doctor-patient partnership', 'Feminism and family medicine', 'Positive family medicine', 'Mindful practice', 'The new, old ethics of family medicine', 'Public health, prevention and populations', 'Information mastery in family medicine' and 'Clinical courage.' May readers nurture their curiosity through these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Radeeb Akhtar
- Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey M Ring
- Independent Health Psychologist, Los Angeles, California, USA
| | - Lucy M Candib
- Family Medicine and Community Health, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Erick Messias
- Psychiatry and Behavioral Neurosciences, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ronald M Epstein
- Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Marc Tunzi
- Family Medicine Residency Program, Natividad Medical Center, Salinas, California, USA
| | - Amy L Lee
- Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christopher P Morley
- Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Carina M Brown
- Cone Health Family Medicine Residency, The University of North Carolina School of Medicine, Greensboro, North Carolina, USA
| | - David Slawson
- Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Jill Konkin
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - David G Campbell
- Cunninghame Arm Medical Centre, Australian College of Rural and Remote Medicine, Lakes Entrance, Queensland, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Susan Williams
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Brooks
- Department of Rural Health, Broken Hill University, Broken Hill, New South Wales, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide Faculty of Health and Medical Sciences, Mount Gambier, South Australia, Australia
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Nichols D, Cockell J, Lemoine D, Konkin J. The Rural Integrated Community Clerkship: a vital stretch in the Alberta rural physician workforce pipeline. Can Med Educ J 2023; 14:59-63. [PMID: 38045073 PMCID: PMC10689994 DOI: 10.36834/cmej.73944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Longitudinal integrated clerkships are thought to operate synergistically with factors such as rural background and practice intent to determine medical graduates' practice types and locations-sometimes known as the pipeline effect. We examined the influence of the rural integrated community clerkship (ICC) at the University of Alberta on students choosing family medicine and rural practice. Methods We completed a retrospective cohort analysis of graduates from 2009-2016. The cohort was cross-referenced by background, type of clerkship, practice type and practice location. We used χ2 analyses and risk ratios to measure the relative likelihood that ICC students would settle on rural practice and/or family medicine. Results ICC participation had more influence than rural background on students' choice of rural and/or family practice, and both factors were synergistic. Rotation-based clerkship students were least likely to enter family medicine or rural practice. Conclusions The ICC is a clerkship model that influences students to become rural and/or family physicians, regardless of their rural/urban origins. The ICC diverts rural-interested students into rural practice and protects rural-origin students from ending up in urban practice. Expanding ICC infrastructure, including sustaining the rural physician workforce, will benefit rural Alberta communities by increasing the numbers of UA graduates in rural practice.
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Affiliation(s)
- Darren Nichols
- Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Jim Cockell
- Office of Rural & Regional Health, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Daniel Lemoine
- Office of Rural & Regional Health, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Jill Konkin
- Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
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Campbell D, Williams S, Konkin J, White I, Couper I, Stewart R, Walters L. New insights on rural doctors' clinical courage in the context of the unfolding COVID-19 pandemic. Can J Rural Med 2023; 28:163-169. [PMID: 37861600 DOI: 10.4103/cjrm.cjrm_67_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Introduction Rural doctors typically work in low-resource settings and with limited professional support. They are sometimes pushed to the limits of their usual scope of practice to provide the medical care needed by their community. In a previous phenomenological study, we described the concept of clinical courage as underpinning rural doctors' work in this context. In this paper, we draw on rural doctors' experiences during the unfolding COVID pandemic to re-examine our understanding of the attributes of clinical courage. Methods Semi-structured interviews were conducted with rural doctors from 11 countries who had experience preparing for or managing patients with COVID-19. Interviews were transcribed verbatim and coded using NVivo. A deductive thematic analysis was undertaken to identify common ideas and responses related to the features of clinical courage. Results Thirteen interviews from rural doctors during the unfolding COVID-19 pandemic affirmed and enriched our understanding of the attributes of clinical courage, particularly the leadership role rural doctors can have within their communities. Conclusion This study extended our understanding that rural doctors' experience of clinical courage is consistent amongst participants in many parts of the world, including developing countries.
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Affiliation(s)
- David Campbell
- Australian College of Rural and Remote Medicine, Cunninghame Arm Medical Centre, Lakes Entrance, Victoria, Australia
| | - Susan Williams
- Adelaide Rural Clinical School, The University of Adelaide, Nairne, Australia
| | - Jill Konkin
- Department of Family Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada, Canada
| | - Isabella White
- Adelaide Rural Clinical School, The University of Adelaide, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa
| | - Ruth Stewart
- College of Medicine and Dentistry, James Cook University, Thursday Island, Queensland, Australia, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, University of Adelaide, Mount Gambier, Australia, Australia
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Shah P, Ross S, Konkin J, Au L, Lee A. Rubric invites discussions of social determinants of health. Med Educ 2023; 57:487. [PMID: 36852678 DOI: 10.1111/medu.15058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
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Brooks R, White IA, Walters L, Williams S, Couper I, Konkin J, Campbell DG. Developing conceptually sound items for a clinical courage questionnaire. Rural Remote Health 2023; 23:7592. [PMID: 37149725 DOI: 10.22605/rrh7592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Clinical courage can be described as a rural doctor's adaptability and willingness to undertake clinical work at the limits of their training and experience to meet the needs of their patients. This article describes the in-house development of survey items to include in a quantitative measure of clinical courage. METHODS The questionnaire development involved two key concepts: a second-order latent factor model structure and a nominal group technique, used to develop consensus among the research team members. RESULTS The steps taken to develop a sound clinical courage questionnaire are described in detail. The resulting initial questionnaire is presented, ready for testing with rural clinicians and refinement. CONCLUSION This article outlines the psychometric process of questionnaire design and presents the resultant clinical courage questionnaire.
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Affiliation(s)
- Robert Brooks
- Department of Rural Health, Broken Hill University, Broken Hill, NSW 2880, Australia
| | - Isabella A White
- Adelaide Rural Clinical School, The University of Adelaide, Nairne, SA 5252, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, The University of Adelaide, Mount Gambier, SA 5290, Australia
| | - Susan Williams
- Department of Rural Health, University of Sydney, Broken Hill, NSW 2880, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Jill Konkin
- Office of Rural & Regional Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - David G Campbell
- Australian College of Rural and Remoter Medicine, Cunninghame Arm Medical Centre, Lakes Entrance, Vic. 3909, Australia
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Maltais LaPointe G, Lemky K, Gagne P, Konkin J, Stobbe K, Fearon G. Step-by-Step Process for Assessing the Economic Impact of Regional Medical Campuses in Canada. JRMC 2023. [DOI: 10.24926/jrmc.v6i1.4554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Regional medical campuses (RMCs) create positive economic impacts in communities and small cities. RMCs increase educational capacity, medical services, and address the shortage or maldistribution of physicians in rural areas. Our paper answers the question: How do you assess the economic impact of a RMC?
Methods: The Canadian Input-Output (I-O) model and the Simplified American Council on Education (ACE) model are adapted to assess the economic impact of an individual RMC using a step-by-step process. The models are tested using data from three Canadian RMCs.
Results: A comparison of the two models found similarities with data requirements and spreadsheet calculations. However, the Canadian I-O model spreadsheet is linked to Statistics Canada multipliers and calculations are more complex. Outputs are calculated for multiple economic variables. The Simplified ACE model, in contrast, uses a single multiplier and provides a single number by input category and a cumulative total of all impacts.
Conclusion: Both models successfully assess economic impacts of RMC. The step-by-step process allows RMC administrators and others to understand the limitations of each model, but also facilitates an in-house economic assessment of RMC. The authors provide guidance on choosing the best model.
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Couper I, Walters L, Williams S, Campbell D, White I, Stewart R, Konkin J. Exploring rural doctors’ early experiences of coping with the emerging COVID‐19 pandemic. J Rural Health 2022; 38:923-931. [PMID: 35191080 PMCID: PMC9115214 DOI: 10.1111/jrh.12654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose To understand how rural doctors (physicians) responded to the emerging COVID‐19 pandemic and their strategies for coping. Methods Early in the pandemic doctors (physicians) who practise rural and remote medicine were invited to participate through existing rural doctors’ networks. Thirteen semi‐structured interviews were conducted with rural doctors from 11 countries. Interviews were transcribed verbatim and coded using NVivo. A thematic analysis was used to identify common ideas and narratives. Findings Participants’ accounts described highly adaptable and resourceful responses to address the crisis. Rapid changes to organizational and clinical practices were implemented, at a time of uncertainty, anxiety, and fear, and with limited information and resources. Strong relationships and commitment to their colleagues and communities were integral to shaping and sustaining these doctors’ responses. We identified five common themes underpinning rural doctors’ shared experiences: (1) caring for patients in a context of uncertainty, fear, and anxiety; (2) practical solutions through improvising and being resourceful; (3) gaining community trust and cooperation; (4) adapting to unrelenting pressures; and (5) reaffirming commitments. These themes are discussed in relation to the Lazarus and Folkman stress and coping model. Conclusions With limited resources and support, these rural doctors’ practical responses to the COVID‐19 crisis underscore strong problem‐focused coping strategies and shared commitments to their communities, patients, and colleagues. They drew support from sharing experiences with peers (emotion‐focused coping) and finding positive meanings in their experiences (meaning‐based coping). The psychosocial impact on rural doctors working at the limits of their adaptive resources is an ongoing concern.
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Affiliation(s)
- Ian Couper
- Ukwanda Centre for Rural Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa
| | - Lucie Walters
- Adelaide Rural Clinical School Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - Susan Williams
- Adelaide Rural Clinical School Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - David Campbell
- Australian College of Rural and Remote Medicine Brisbane Queensland Australia
- Cunninghame Arm Medical Centre Lakes Entrance Victoria Australia
| | - Isabella White
- Adelaide Rural Clinical School Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - Ruth Stewart
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Jill Konkin
- Department of Family Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
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Walters L, Couper I, Stewart RA, Campbell DG, Konkin J. The impact of interpersonal relationships on rural doctors' clinical courage. Rural Remote Health 2021; 21:6668. [PMID: 34560821 DOI: 10.22605/rrh6668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinical courage occurs when rural doctors push themselves to the limits of their scope of practice to provide the medical care needed by patients in their community. This mental strength to venture, persevere and act out of concern for one's patient, despite a lack of formally recognised expertise, becomes necessary for doctors who work in relative professional isolation. Previous research by the authors suggested that the clinical courage of rural doctors relies on the relationships around them. This article explores in more depth how relationships with others can impact on clinical courage. METHODS At an international rural medicine conference in 2017, doctors who practised rural/remote medicine were invited to participate in the study. Twenty-seven semistructured interviews were conducted exploring experiences of clinical courage. Initial analysis of the material, using a hermeneutic phenomenological frame, sought to understand the meaning of clinical courage. In the original analysis, an emic question arose: 'How do interpersonal relationships impact on clinical courage'. The material was re-analysed to explore this question, using Wenger's community of practice as a theoretical framework. RESULTS This study found that clinical courage was affected by the relationships rural doctors had with their communities and patients, with each other, with the local members of their healthcare team and with other colleagues and health leaders outside their immediate community of practice. CONCLUSION As a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors' way of working.
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Affiliation(s)
- Lucie Walters
- Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, University of Adelaide, Mount Gambier, SA 5290, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ruth A Stewart
- Rural Medicine, College of Medicine and Dentistry, James Cook University, Thursday Island, Qld 4875, Australia
| | - David G Campbell
- Australian College of Rural and Remote Medicine, Cunninghame Arm Medical Centre, Lakes Entrance, Vic. 3909, Australia
| | - Jill Konkin
- Office of Rural & Regional Health, Faculty of Medicine & Dentistry and University of Alberta, Edmonton AB T6G 2C8 Canada
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Jackman D, Konkin J, Yonge O, Myrick F, Cockell J. Crisis and continuity: Rural health care students respond to the COVID-19 outbreak. Nurse Educ Pract 2020; 48:102892. [PMID: 32980557 PMCID: PMC7505875 DOI: 10.1016/j.nepr.2020.102892] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
The COVID-19 outbreak in Winter (2020) has caused widespread disruption for health sciences students undergoing clinical placements-vital periods of experiential learning that cannot be substituted with distance alternatives. For students placed in rural areas, already coping with isolation, precarious supply chains and shortages of essential personnel, the effects of the COVID-19 outbreak may have far-reaching implications for psychosocial wellness, self-efficacy and clinical judgment. Four nursing and eight medical students (n = 12) supplied photographs and commentary documenting the experience of withdrawing suddenly from clinical sites in rural Alberta. Collaborative, thematic analysis revealed continuities between pre- and post-outbreak life, both for the students and their rural hosts. Social determinants of health such as seclusion, environmental hazards, and health-seeking behaviors carried over and compounded the effects of the outbreak on the placement communities and clinical sites. Other continuities included the reliance on technology for clinical and social connectivity, and capitalizing on natural settings to cope with isolation and confinement. Prolonged liminality, lack of closure, and the loss of team identity were the greatest stressors brought on by the suspension of clinical activities. However, the participants felt well equipped to deal with these circumstances through the resilience, adaptability, and community ethos acquired during their placements.
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Affiliation(s)
- Deirdre Jackman
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Jill Konkin
- Faculty of Medicine & Dentistry, Department of Family Medicine, 2-115A Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Olive Yonge
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Florence Myrick
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
| | - Jim Cockell
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
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Konkin J, Grave L, Cockburn E, Couper I, Stewart RA, Campbell D, Walters L. Exploration of rural physicians' lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study. BMJ Open 2020; 10:e037705. [PMID: 32847915 PMCID: PMC7451271 DOI: 10.1136/bmjopen-2020-037705] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Rural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of practice to provide medical care for people who would otherwise not have access to essential clinical services. DESIGN A hermeneutic phenomenological study. SETTING An international rural medicine conference. PARTICIPANTS All doctors attending the conference who practised medicine in rural/remote areas in a predominantly English-speaking community were eligible to participate; 27 doctors were recruited. INTERVENTIONS Semi-structured interviews were conducted. The transcripts were initially read and analysed by individual researchers before they were read aloud to the group to explore meanings more fully. Two researchers then reviewed the transcripts to develop the results section which was then rechecked by the broader group. PRIMARY OUTCOME MEASURE An understanding of the lived experiences of clinical courage. RESULTS Participants provided in-depth descriptions of experiences we have termed clinical courage. This phenomenon included the following features: Standing up to serve anybody and everybody in the community; Accepting uncertainty and persistently seeking to prepare; Deliberately understanding and marshalling resources in the context; Humbly seeking to know one's own limits; Clearing the cognitive hurdle when something needs to be done for your patient; Collegial support to stand up again. CONCLUSION This study elucidated six features of the phenomenon of clinical courage through the narratives of the lived experience of rural generalist doctors.
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Affiliation(s)
- Jill Konkin
- Office of Rural and Regional Health, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Grave
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
| | - Ella Cockburn
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ruth Alison Stewart
- Rural Medicine, College or Medicine and Dentistry, James Cook University Faculty of Medicine Health and Molecular Sciences, Thursday Island, Queensland, Australia
| | - David Campbell
- Australian College of Rural and Remote Medicine, Lakes Entrance, Victoria, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide Faculty of Health and Medical Sciences, Mount Gambier, South Australia, Australia
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Danhoundo G, Whistance-Smith D, Lemoine D, Konkin J. Provision of consumer health information in Alberta's Rural Public Libraries. Health Info Libr J 2019; 36:41-59. [PMID: 30701664 DOI: 10.1111/hir.12248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Access to health services is a major challenge in many rural communities within Canada. Rural public libraries can serve as centres for health resources. OBJECTIVE The aim of this exploratory study was to analyse the manner in which Alberta's rural libraries provide health information to their patrons. METHODS A questionnaire including closed ended and open ended questions was sent to the 285 rural libraries across the Canadian province of Alberta. Descriptive statistics and thematic analysis techniques were used for the data analysis. RESULTS The findings indicate that in three quarters of Alberta's rural libraries, about 10% of requests for assistance were related to health issues. The provision of health information in these libraries is hampered by the lack of Internet, private space for reference interviews, and staff and volunteer training. Library staff members were inexperienced in conducting reference transactions and reported lacking confidence in meeting patrons' needs and ethical standards. DISCUSSION Addressing these challenges will require the recruitment of more qualified librarians in rural library systems, possibly through incentive measures, and a comprehensive education and training programme for both staff and volunteers combined with the necessary resource support for the rural libraries. CONCLUSION When human and material resources are adequate, rural libraries can contribute to improving the health literacy of their communities.
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Affiliation(s)
- Georges Danhoundo
- Division of Community Engagement, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Daniel Lemoine
- Division of Community Engagement, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jill Konkin
- Division of Community Engagement, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Simone K, Ahmed RA, Konkin J, Campbell S, Hartling L, Oswald AE. What are the features of targeted or system-wide initiatives that affect diversity in health professions trainees? A BEME systematic review: BEME Guide No. 50. Med Teach 2018; 40:762-780. [PMID: 30033789 DOI: 10.1080/0142159x.2018.1473562] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/PURPOSE There is interest to increase diversity among health professions trainees. This study aims to determine the features/effects of interventions to promote recruitment/admission of under-represented minority (URM) students to health professions programs. METHODOLOGY This registered BEME review applied systematic methods to: title/full-text inclusion review, data extraction, and quality assessment (QA). Included studies reported outcomes for interventions designed to increase diversity of health professions education (HPE) programs' recruitment and admissions. RESULTS Of 7225 studies identified 86 met inclusion criteria. Interventions addressed: admissions (34%), enrichment (19%), outreach (15%), curriculum (3%), and mixed (29%). They were mostly single center (76%), from the United States (81%), in medicine (45%) or dentistry (22%). URM definition was stated in only 24%. The dimension most commonly considered was ethnicity/race (88%). The majority of studies (81%) found positive effects. Heterogeneity precluded meta-analysis. Qualitative analysis identified key features: admissions studies points systems and altered weightings; enrichment studies highlighted academic, application and exam preparation, and workplace exposure. DISCUSSION/CONCLUSIONS Several intervention types may increase diversity. Limited applicant pools were a rate-limiting feature, suggesting efforts earlier in the continuum are needed to broaden applicant pools. There is a need to examine underlying cultural and external pressures that limit programs' acceptance of initiatives to increase diversity.
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Affiliation(s)
- Kristen Simone
- a Department of Medicine, Faculty of Medicine and Dentistry , University of Alberta , Edmonton , Canada
| | - Rabia A Ahmed
- b Division of Infectious Diseases , University of Alberta , Edmonton , Canada
| | - Jill Konkin
- c Department of Family Medicine, Division of Community Engagement , University of Alberta , Edmonton , Canada
| | - Sandra Campbell
- d John W. Scott Health Sciences Library, University of Alberta , Edmonton , Canada
| | - Lisa Hartling
- e Department of Pediatrics , University of Alberta , Edmonton , Canada
| | - Anna E Oswald
- f Department of Medicine, Division of Rheumatology , University of Alberta , Edmonton , Canada
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Lemky K, Gagne P, Konkin J, Stobbe K, Fearon G, Blom S, Lapointe GM. A review of methods to assess the economic impact of distributed medical education (DME) in Canada. Can Med Educ J 2018; 9:e87-e99. [PMID: 30140340 PMCID: PMC6104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Canadian distributed medical education (DME) increased substantially in the last decade, resulting in positive economic impacts to local communities. A reliable and simple method to estimate economic contributions is essential to provide managers with information on the extent of these impacts. This review paper fills a gap in the literature by answering the question: What are the most applicable quantitative methods to assess the economic impact of Canadian DME programs? METHODS The literature is reviewed to identify economic assessment methods. These are evaluated and compared based on the benefits, challenges, data needs, outputs and potential for use in the DME context. RESULTS We identified five economic impact methods used in similar contexts. Two of these methods have the potential for Canadian DME programs: the Canadian Input-Output (I-O) model and the Simplified American Council on Education (ACE) method. CONCLUSION Choice of a method is contingent on the ability to measure the salient economic impacts, and provide an output that facilitates sustainable decision making. This paper thus fills a gap by identifying methods applicable to DME. These methods will assist stakeholders to calculate economic impacts, resulting in both the advancement and sustainability of these programs over short-and long-term time frames.
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Affiliation(s)
- Kim Lemky
- Brandon University, Manitoba, Canada
| | - Pierre Gagne
- Campus de l’Université de Montréal en Mauricie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Jill Konkin
- Divison of Community Engagement, Edmonton Clinic Health Academy, University of Alberta, Alberta, Canada
| | - Karl Stobbe
- Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | | | - Sylvia Blom
- Charles H. Dyson School of Applied Economics and Management, Cornell University, New York, United States
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Pijl-Zieber EM, Barton S, Awosoga O, Konkin J. Disconnects in pedagogy and practice in community health nursing clinical experiences: Qualitative findings of a mixed method study. Nurse Educ Today 2015; 35:e43-e48. [PMID: 26346374 DOI: 10.1016/j.nedt.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/28/2015] [Accepted: 08/19/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many baccalaureate schools of nursing are using non-traditional placements for undergraduate community health clinical rotations. These placements occur at agencies not organizationally affiliated with the health care system and they typically do not employ registered nurses (RNs). OBJECTIVES AND DESIGN In this paper, we describe the qualitative findings of a mixed method study that explored these gaps as they relate to pre-registration nursing students' preparation for community health roles. RESULTS While non-traditional community health placements offer unique opportunities for learning through carefully crafted service learning pedagogy, these placements also present challenges for student preparation for practice in community health roles. The theory-practice gap and the gap between the expected and actual performance of new graduates are accentuated through the use of non-traditional community clinical experiences. These gaps are not necessarily due to poor pedagogy, but rather due to the perceptions and values of the stakeholders involved: nursing students, community health nursing faculty, and community health nurses. CONCLUSIONS New ways must be developed between academe and community health practice areas to provide students with opportunities to develop competence for practice.
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Affiliation(s)
- Em M Pijl-Zieber
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada, T1K 3M4.
| | - Sylvia Barton
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Olu Awosoga
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
| | - Jill Konkin
- The Division of Community Engagement, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Pijl-Zieber EM, Barton S, Awosoga OA, Konkin J. Nursing Students Achieving Community Health Competencies through Undergraduate Clinical Experiences: A Gap Analysis. Int J Nurs Educ Scholarsh 2015; 12:143-54. [DOI: 10.1515/ijnes-2015-0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractIn Canada, it is widely believed that nursing practice and health care will move from acute care into the community. At the same time, increasing numbers of nursing students are engaged in non-traditional clinical experiences for their community health rotation. These clinical experiences occur at agencies not organizationally affiliated with the health care system and typically do not employ registered nurses (RNs). What has yet to be established is the degree to which nursing students are actually being prepared for community health nursing roles through their community health clinical rotations. In this paper we report the findings of a mixed method study that explored the gap between desired and observed levels of competence in community health of senior nursing students and new graduates. The gap was quantified and then the nature of the gap further explored through focus groups.
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Affiliation(s)
- Em M. Pijl-Zieber
- 1Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4, Canada
| | - Sylvia Barton
- 2Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Oluwagbohunmi A. Awosoga
- 1Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4, Canada
| | - Jill Konkin
- 3Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Pijl-Zieber EM, Barton S, Konkin J, Awosoga O, Caine V. Competence and competency-based nursing education: finding our way through the issues. Nurse Educ Today 2014; 34:676-678. [PMID: 24090616 DOI: 10.1016/j.nedt.2013.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/05/2013] [Accepted: 09/10/2013] [Indexed: 06/02/2023]
Abstract
The language of competence is widely utilized in both the regulation of nursing practice and curricular design in nursing education. The notion of competence defines what it means to be a professional, although it is not the only way of describing nursing practice. Unfortunately, there is much confusion about the concepts of competence, competency, and competency-based education. As well, the notion of competence, despite its global popularity, has flaws. In this paper we will disentangle these terms and critique the use of competence frameworks in nursing education.
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Affiliation(s)
- Em M Pijl-Zieber
- University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada.
| | - Sylvia Barton
- University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Jill Konkin
- University of Alberta, WC Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7 Canada
| | - Olu Awosoga
- University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada
| | - Vera Caine
- University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
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Pijl-Zieber EM, Barton S, Konkin J, Awosoga O, Caine V. Mind the gap: quantifying the performance gap between observed and required clinical competencies in undergraduate nursing students. Nurse Educ Today 2014; 34:667-669. [PMID: 24698306 DOI: 10.1016/j.nedt.2013.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/15/2013] [Accepted: 09/30/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Em M Pijl-Zieber
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada.
| | - Sylvia Barton
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Jill Konkin
- Faculty of Medicine, University of Alberta, WC Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7 Canada
| | - Olu Awosoga
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
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Abstract
Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs.
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Affiliation(s)
| | | | - Sue Berry
- Northern Ontario School of Medicine, Canada
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Bates J, Konkin J, Suddards C, Dobson S, Pratt D. Student perceptions of assessment and feedback in longitudinal integrated clerkships. Med Educ 2013; 47:362-74. [PMID: 23488756 DOI: 10.1111/medu.12087] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES This study was conducted to elucidate how the learning environment and the student-preceptor relationship influence student experiences of being assessed and receiving feedback on performance. Thus, we examined how long-term clinical clerkship placements influence students' experiences of and views about assessment and feedback. METHODS We took a constructivist grounded approach, using authentic assessment and communities of practice as sensitising concepts. We recruited and interviewed 13 students studying in longitudinal integrated clerkships across two medical schools and six settings, using a semi-structured interview framework. We used an iterative coding process to code the data and arrive at a coding framework and themes. RESULTS Students valued the unstructured assessment and informal feedback that arose from clinical supervision, and the sense of progress derived from their increasing responsibility for patients and acceptance into the health care community. Three themes emerged from the data. Firstly, students characterised their assessment and feedback as integrated, developmental and longitudinal. They reported authenticity in the monitoring and feedback that arose from the day-to-day delivery of patient care with their preceptors. Secondly, students described supportive and caring relationships and a sense of safety. These enabled them to reflect on their strengths and weaknesses and to interpret critical feedback as supportive. Students developed similar relationships across the health care team. Thirdly, the long-term placement provided for multiple indicators of progress for students. Patient outcomes were perceived as representing direct feedback about students' development as doctors. Taking increasing responsibility for patients over time is an indicator to students of their increasing competence and contributes to the developing of a doctor identity. CONCLUSIONS Clerkship students studying for extended periods in one environment with one preceptor perceive assessment and feedback as authentic because they are embedded in daily patient care, useful because they are developmental and longitudinal, and constructive because they occur in the context of a supportive learning environment and relationship.
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Affiliation(s)
- Joanna Bates
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Konkin J, Suddards C. Response to R. Ellaway. Adv Health Sci Educ Theory Pract 2013; 18:139-140. [PMID: 23114459 DOI: 10.1007/s10459-012-9425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/15/2012] [Indexed: 06/01/2023]
Affiliation(s)
- Jill Konkin
- Division of Community Engagement, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Szafran O, Crutcher RA, Woloschuk W, Myhre DL, Konkin J. Perceived preparedness for family practice: does rural background matter? Can J Rural Med 2013; 18:47-55. [PMID: 23566862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Rural background and the ability to adjust to rural practice are strong predictors of recruitment and retention of rural physicians. The degree to which rural background and being prepared for practice interrelate may provide insight into efforts aimed at increasing the supply of rural physicians. The purpose of this study was to examine the association between family medicine graduates' rural or urban background and their self-reported preparedness for practice. METHODS This was a retrospective, cross-sectional survey of family medicine graduates who completed the 2-year family medicine residency program at the University of Alberta or University of Calgary from 2001 to 2005. Self-rated preparedness was examined on a 4-point Likert scale for 18 elements of clinical family practice, 8 interdisciplinary issues, 10 practice management issues and 8 nonclinical aspects of family practice. Rural background was defined as having been brought up mainly in a rural community (population < 25 000), and urban background was defined as having been brought up mainly in an urban community (population ≥ 25 000). RESULTS A significantly greater proportion of rural-than urban-background graduates felt prepared for 3 nonclinical aspects of rural practice: time demands of rural practice (95.0% v. 79.3%, p = 0.03), understanding rural culture (92.5% v. 70.2%, p = 0.005) and small-community living (92.5% v. 70.2%, p = 0.003). CONCLUSION Rural background was associated with physicians feeling prepared for the nonclinical and cultural aspects of rural family practice, which suggests that focused rural exposure facilitates an understanding of rural culture. Urban-background physicians were reportedly less prepared for the nonclinical aspects of rural practice. Increased exposure of urban-background residents to the cultural aspects of rural practice may improve recruitment and retention of rural family physicians.
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Affiliation(s)
- Olga Szafran
- Department of Family Medicine, University of Alberta, Edmonton, Alta, Canada.
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Konkin J, Suddards C. Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship. Adv Health Sci Educ Theory Pract 2012; 17:585-96. [PMID: 22052211 DOI: 10.1007/s10459-011-9335-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 10/24/2011] [Indexed: 05/13/2023]
Abstract
Building on other models of longitudinal integrated clerkships (LIC), the University of Alberta developed its Integrated Community Clerkship with guiding principles of continuity of care, preceptor and learning environment. Professionalism is an important theme in medical education. Caring is important in professional identity formation and an ethic of caring is a moral framework for caring. This study explored the development of an ethic of caring in an LIC using empathy, compassion and taking responsibility as descriptors of caring. Through a hermeneutic phenomenological study, the authors focused on students' accounts of being with patients. Following an iterative process of successive analyses and explorations of the relevant literature, sensitizing concepts related to physician identity, and an ethic of caring were used to make sense of these accounts following the principles of constructivist grounded theory methodology. Continuity afforded by the LIC results in a safe environment in which students can meaningfully engage with patients and take responsibility for their care under the supervision of a physician teacher. Together these attributes foster an emerging physician identity born at the site of patient-student interaction and grounded in an ethic of caring. A medical student's evolving professional identity in the clerkship includes the emergence of an ethic of caring. Student accounts of being with patients demonstrate that the LIC at the University of Alberta affords opportunities for students be receptive to and responsible for their patients. This ethic of caring is part of an emerging physician identity for the study participants.
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Affiliation(s)
- Jill Konkin
- Division of Community Engagement, Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-115 Edmonton Clinic Health Academy, Edmonton, AB T6G 2C9, Canada.
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Solez K, Karki A, Rana S, Bjerland H, Cujec B, Aaron S, Morrish D, Walker M, Gowrishankar M, Bamforth F, Satkunam L, Glick N, Stevenson T, Ross S, Dhakal S, Allain D, Konkin J, Zakus D, Nichols D. Multifaceted support for a new medical school in Nepal devoted to rural health by a Canadian Faculty of Medicine and Dentistry. Glob J Health Sci 2012; 4:109-18. [PMID: 23121747 PMCID: PMC4777003 DOI: 10.5539/gjhs.v4n6p109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/22/2012] [Indexed: 11/24/2022] Open
Abstract
Nepal and Alberta are literally a world apart. Yet they share a common problem of restricted access to health services in remote and rural areas. In Nepal, urban-rural disparities were one of the main issues in the recent civil war, which ended in 2006. In response to the need for improved health equity in Nepal a dedicated group of Nepali physicians began planning the Patan Academy of Health Sciences (PAHS), a new health sciences university dedicated to the education of rural health providers in the early 2000s. Beginning with a medical school the Patan Academy of Health Sciences uses international help to plan, deliver and assess its curriculum. PAHS developed an International Advisory Board (IAB) attracting international help using a model of broad, intentional recruitment and then on individuals’ natural attraction to a clear mission of peace-making through health equity. Such a model provides for flexible recruitment of globally diverse experts, though it risks a lack of coordination. Until recently, the PAHS IAB has not enjoyed significant or formal support from any single international institution. However, an increasing number of the international consultants recruited by PAHS to its International Advisory Board are from the University of Alberta in Edmonton, Alberta, Canada (UAlberta). The number of UAlberta Faculty of Medicine and Dentistry members involved in the project has risen to fifteen, providing a critical mass for a coordinated effort to leverage institutional support for this partnership. This paper describes the organic growth of the UAlberta group supporting PAHS, and the ways in which it supports a sister institution in a developing nation.
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Affiliation(s)
- Kim Solez
- University of Alberta, Alberta, Canada.
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Saucier D, Shaw E, Kerr J, Konkin J, Oandasan I, Organek AJ, Parsons E, Tannenbaum D, Walsh AE. Competency-based curriculum for family medicine. Can Fam Physician 2012; 58:707-e361. [PMID: 22700736 PMCID: PMC3374694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Danielle Saucier
- Department of Family Medicine and Emergency Medicine at Laval University in Quebec
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Shaw E, Walsh AE, Saucier D, Tannenbaum D, Kerr J, Parsons E, Konkin J, Organek AJ, Oandasan I. The last C: centred in family medicine. Can Fam Physician 2012; 58:346-e181. [PMID: 22423025 PMCID: PMC3303659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario
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Organek AJ, Tannenbaum D, Kerr J, Konkin J, Parsons E, Saucier D, Shaw E, Walsh A. Redesigning family medicine residency in Canada: the triple C curriculum. Fam Med 2012; 44:90-97. [PMID: 22328474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite a record of excellence, Canadian family medicine residency programs must respond to the changing face of health care and the needs of the population. A working group was established by the College of Family Physicians of Canada to review the current curriculum and make recommendations for change. METHODS Literature reviews of current evidence regarding strategies in postgraduate medical education were carried out, and recent developments in medical education internationally were studied. After recommendations for curriculum change were drafted, workshops, presentations, and peer consultations were conducted over a 4-year period to test ideas and obtain stakeholder feedback. RESULTS The core recommendation of the working group is: Residency programs in family medicine are to establish a competency-based curriculum that is comprehensive, focused on continuity, and centered in family medicine--The Triple C Competency-based Curriculum. The working group developed a new framework for family medicine competency in Canada, CanMEDS-FM, to support the transition. CONCLUSIONS The Triple C Competency-based Curriculum was developed to redesign Canadian family medicine residencies based on a solid rationale. Recommendations for curricular change, as well as the competency framework, CanMEDS-FM, have been accepted enthusiastically by stakeholders. Implementation and evaluation phases are underway.
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Affiliation(s)
- Andrew J Organek
- Department of Family and Community Medicine, University of Toronto.
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Walsh AE, Konkin J, Tannenbaum D, Kerr J, Organek AJ, Parsons E, Saucier D, Shaw E, Oandasan I. Comprehensive care and education. Can Fam Physician 2011; 57:1475-e493. [PMID: 22170205 PMCID: PMC3237527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Allyn E Walsh
- Department of Family Medicine, McMaster University, Hamilton, Ont
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Kerr J, Walsh AE, Konkin J, Tannenbaum D, Organek AJ, Parsons E, Saucier D, Shaw E, Oandasan I. Continuity: middle C--a very good place to start. Can Fam Physician 2011; 57:1355-e459. [PMID: 22084467 PMCID: PMC3215616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jonathan Kerr
- Department of Family Medicine, Queen's University, Kingston, Ont
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Désilets V, Oligny LL, Wilson RD, Allen VM, Audibert F, Blight C, Brock JA, Cartier L, Carroll J, Désilets V, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Gilmour D, Bell D, Carson G, Hughes O, Le Jour C, Leduc D, Leyland N, Martyn P, Masse A, Wolfman W, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C. Archivée: Autopsies foetales et périnatales dans les cas d’anomalies foetales diagnostiquées avant la naissance en présence d’un caryotype normal. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)35056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Désilets V, Oligny LL, Wilson RD, Allen VM, Audibert F, Blight C, Brock JA, Carroll J, Cartier L, Désilets V, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Gilmour D, Bell D, Carson G, Hughes O, Le Jour C, Leduc D, Leyland N, Martyn P, Masse A, Wolfman W, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C. Fetal and Perinatal Autopsy in Prenatally Diagnosed Fetal Abnormalities With Normal Karyotype. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)35055-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McLaughlin K, Bates J, Konkin J, Woloschuk W, Suddards CA, Regehr G. A comparison of performance evaluations of students on longitudinal integrated clerkships and rotation-based clerkships. Acad Med 2011; 86:S25-S29. [PMID: 21955763 DOI: 10.1097/acm.0b013e31822a6eb6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Longitudinal integrated clerkship (LIC) students typically perform as well as, if not better than, rotation-based clerkship (RBC) students on objective evaluations, yet few studies have compared performance in the clinical setting. This study compared in-training evaluation report (ITER) ratings of LIC and RBC students, including their correlation with more objective evaluations. METHOD On the basis of prior academic performance, LIC students (n = 27) at Universities of Alberta, British Columbia, and Calgary were matched with four RBC students from their center. The authors compared reliability of ITER ratings, ITER ratings of clinical skills and professional attributes, and the correlation between ITER ratings and objective evaluations of clinical skills and professional attributes on the Medical Council of Canada Qualifying Examination (MCCQE) Part I. RESULTS ITER ratings of LIC students were more reliable and significantly higher than those of RBC students for both clinical skills and professional attributes. However, LIC students had lower objective structured clinical examination scores and weaker correlations between subjective and objective evaluations of clinical skills. By comparison, LIC students scored higher on a particular component of the MCCQE and had stronger correlations between subjective and objective evaluations of professionalism. CONCLUSIONS The discrepancy between ratings of LIC students' clinical skills on ITER and other evaluation formats may be due to differences between the content of training and objective evaluations, or systematic rater biases. Further studies are needed to confirm and explain these findings. Promisingly, our data suggest that the LIC model may allow for a more predictive evaluation of professional competencies.
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Affiliation(s)
- Kevin McLaughlin
- Office of Undergraduate Medical Education, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
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Leduc D, Leduc D, Gill GH, Biringer A, Duperron L, Ezzat AM, Jones D, Lee L, Muise S, Parish BM, Regush L, Senikas V, Wilson K, Yeung G, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C. Congé de maternité dans le cadre d’une grossesse normale. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)34993-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Burnett M, Aggarwal A, Davis V, Dempster J, Fisher W, MacKinnon K, Pellizzari R, Polomeno V, Rutherford M, Senikas V, Wagner MS, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C, Leyland N, Wolfman W, Allaire C, Awadalla A, Best C, Dunn S, Heywood M, Lemyre M, Marcoux V, Menard C, Potestio F, Rittenberg D, Singh S. Counseling sur la santé sexuelle et génésique offert par les professionnels de la santé. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)34995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burnett M, Aggarwal A, Davis V, Dempster J, Fisher W, MacKinnon K, Pellizzari R, Polomeno V, Rutherford M, Senikas V, Wagner MS, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C, Leyland N, Wolfman W, Allaire C, Awadalla A, Best C, Dunn S, Heywood M, Lemyre M, Marcoux V, Menard C, Potestio F, Rittenberg D, Singh S. Sexual and Reproductive Health Counselling by Health Care Professionals. Journal of Obstetrics and Gynaecology Canada 2011; 33:870-1. [DOI: 10.1016/s1701-2163(16)34994-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kerr J, Walsh AE, Konkin J, Tannenbaum D, Organek AJ, Parsons E, Saucier D, Shaw E, Oandasan I. Renewing postgraduate family medicine education: the rationale for Triple C. Can Fam Physician 2011; 57:963-e312. [PMID: 21841118 PMCID: PMC3155452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jonathan Kerr
- Department of Family Medicine at Queen's University in Kingston, Ont
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Lim K, Butt K, Crane JM, Morin L, Bly S, Butt K, Cargill Y, Davies G, Denis N, Lim K, Ouellet A, Salem S, Senikas V, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C, Gagnon R, Hudon L, Basso M, Bos H, Crane JM, Davies G, Delisle MF, Menticoglou S, Mundle W, Ouellet A, Pressey T, Pylypjuk C, Roggensack A, Sanderson F. Recours à l’évaluation échographique de la longueur cervicale pour prédire l’accouchement préterme dans le cadre de grossesses monofœtales. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)34885-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wong S, Ordean A, Kahan M, Gagnon R, Hudon L, Basso M, Bos H, Crane J, Davies G, Delisle MF, Farine D, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A, Sanderson F, Ehman W, Biringer A, Gagnon A, Graves L, Hey J, Konkin J, Léger F, Marshall C, Robertson D, Bell D, Carson G, Gilmour D, Hughes O, Le Jour C, Leduc D, Leyland N, Martyn P, Masse A, Abrahams R, Avdic S, Berger H, Franklyn M, Harper S, Hunt G, Mousmanis P, Murphy K, Payne S, Midmer D, de la Ronde S. Consommation de substances psychoactives pendant la grossesse. Journal of Obstetrics and Gynaecology Canada 2011. [DOI: 10.1016/s1701-2163(16)34856-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Myhre DL, Konkin J, Woloschuk W, Szafran O, Hansen C, Crutcher R. Locum practice by recent family medicine graduates. Can Fam Physician 2010; 56:e183-e190. [PMID: 20463259 PMCID: PMC2868629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To explore the demographic characteristics of recent Alberta family medicine residency graduates choosing locum practice, as well as their reasons for choosing and leaving locum practice and the frustrations and rewards of locum placements. DESIGN Web-based and mailed cross-sectional survey and interviews. SETTING The family medicine residency training programs at the University of Calgary and the University of Alberta. PARTICIPANTS A total of 152 graduates who had completed family medicine training between 2001 and 2005, inclusive, and who had either done locums in the past or were doing locums at the time of the survey. Interviews were conducted with a subsample of this group (n = 10). MAIN OUTCOME MEASURES Duration of locum practice, reasons for choosing and leaving locum practice, and frustrations and rewards of locum practice. RESULTS Of the 377 graduates surveyed, 242 (64.2%) responded. Among the respondents, 155 (64.0%) had in the past practised or were at the time practising as locum physicians (complete data were available for 152 respondents). Most (71.7%) had arranged locum placements independently. The average duration of a locum placement was 9.1 months. Female and younger family physicians were more likely to practise as locum tenentes. The most common reason for doing a locum placement was as a practice exploration to increase experience or competence (46.7%). The primary reason for leaving locum practice was to settle into permanent practice (52.1%); interview data revealed that this reflected a desire for stability, a desire for continuity with patients, personal life changes, financial considerations, and the end of a perceived need for exploration. Locum tenentes were frustrated with negotiating locum contracts, low patient volumes, lack of patient continuity, and working with difficult staff. Rewards of locum practice included flexibility and freedom in practice, gaining experience, and the rewards that come from seeing patients. In total, 44.6% of family medicine graduates joined practices in which they had done locum placements. CONCLUSION Locum practice is a common early career choice for Alberta family medicine graduates. The most common reason for doing a locum placement was to gain experience, not to delay commitment. Locum practice tends to appeal more to female and younger family physicians. Rewards of locum practice were also cited as reasons for participation. Locum tenentes tend to be frustrated with the business aspects of arranging placements and with the generally low patient volumes. Long-term recruitment efforts by community physicians should be initiated within the first week of locum engagement.
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Affiliation(s)
- Douglas L Myhre
- Department of Family Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Dr NW, Calgary, AB T2N 4N1.
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Rourke J, Dewar D, Harris K, Hutten-Czapski P, Johnston M, Klassen D, Konkin J, Morwood C, Rowntree C, Stobbe K, Young T. Strategies to increase the enrollment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada. CMAJ 2005; 172:62-5. [PMID: 15632407 PMCID: PMC543947 DOI: 10.1503/cmaj.1040879] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- James Rourke
- Health Sciences Centre, Memorial University of Newfoundland, St. John's NL A1B 3V6.
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Konkin J. President's message: Change is afoot! Can J Rural Med 2004; 9:7-8. [PMID: 15603669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Konkin J, Howe D, Soles TL. SRPC policy paper on regionalization, spring 2004. Can J Rural Med 2004; 9:257-9. [PMID: 15603699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Jill Konkin
- SRPC Ad-hoc Committee on Regionalizaton, Shawville, QC
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Konkin J. President's message: Regionalization woes. Can J Rural Med 2004; 9:77-78. [PMID: 15603679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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