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Tipwong A, Hall NC, Snell L, Chamnan P, Moreno M, Harley JM. Clinical teaching self-efficacy positively predicts professional fulfillment and negatively predicts burnout amongst Thai physicians: a cross-sectional survey. BMC Med Educ 2024; 24:361. [PMID: 38566108 PMCID: PMC10988928 DOI: 10.1186/s12909-024-05325-1] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinician teachers (physicians who teach in clinical settings) experience considerable psychological challenges in providing both educational training and patient care. This study aimed to determine the prevalence of physician burnout and professional fulfillment, and to identify internal and external factors associated with mental health outcomes among Thai clinician teachers working in non-university teaching hospitals. METHOD A one-time online questionnaire was completed by physicians at 37 governmental, non-university teaching hospitals in Thailand, with 227 respondents being assessed in the main analyses. Four outcomes were evaluated including burnout, professional fulfillment, quality of life, and intentions to quit. RESULTS The observed prevalence of professional fulfillment was 20%, and burnout was 30.7%. Hierarchical regression analysis showed a significant internal, psychological predictor (clinical teaching self-efficacy) and external, structural predictors (multiple roles at work, teaching support), controlling for the background variables of gender, years of teaching experience, family roles, and active chronic disease, with clinical teaching self-efficacy positively predicting professional fulfillment (b = 0.29, p ≤.001) and negatively predicting burnout (b = - 0.21, p =.003). CONCLUSIONS Results highlight the importance of faculty development initiatives to enhance clinical teaching self-efficacy and promote mental health among Thai physicians.
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Affiliation(s)
- Arunee Tipwong
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
- Department of Social Medicine, Surat Thani Hospital, Surat Thani, SNI, Thailand
| | - Nathan C Hall
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Linda Snell
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
- Division of General Internal Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Parinya Chamnan
- Office of the Collaborative Project to Increase Production of Rural Doctor (CPIRD), Ministry of Public Health, Nonthaburi, NBI, Thailand
| | - Matthew Moreno
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jason M Harley
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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Sternszus R, Snell L, Razack S. Critically re-examining professional norms: Medicine's urgent need to look inwards. Med Educ 2024. [PMID: 38380532 DOI: 10.1111/medu.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Robert Sternszus
- Department of Pediatrics and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Linda Snell
- Department of Medicine and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Saleem Razack
- Division of Critical Care, Department of Pediatrics and Scholar in the Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Oswald A, Dubois D, Snell L, Anderson R, Karpinski J, Hall AK, Frank JR, Cheung WJ. Implementing Competence Committees on a National Scale: Design and Lessons Learned. Perspect Med Educ 2024; 13:56-67. [PMID: 38343555 PMCID: PMC10854462 DOI: 10.5334/pme.961] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/03/2023] [Indexed: 02/15/2024]
Abstract
Competence committees (CCs) are a recent innovation to improve assessment decision-making in health professions education. CCs enable a group of trained, dedicated educators to review a portfolio of observations about a learner's progress toward competence and make systematic assessment decisions. CCs are aligned with competency based medical education (CBME) and programmatic assessment. While there is an emerging literature on CCs, little has been published on their system-wide implementation. National-scale implementation of CCs is complex, owing to the culture change that underlies this shift in assessment paradigm and the logistics and skills needed to enable it. We present the Royal College of Physicians and Surgeons of Canada's experience implementing a national CC model, the challenges the Royal College faced, and some strategies to address them. With large scale CC implementation, managing the tension between standardization and flexibility is a fundamental issue that needs to be anticipated and addressed, with careful consideration of individual program needs, resources, and engagement of invested groups. If implementation is to take place in a wide variety of contexts, an approach that uses multiple engagement and communication strategies to allow for local adaptations is needed. Large-scale implementation of CCs, like any transformative initiative, does not occur at a single point but is an evolutionary process requiring both upfront resources and ongoing support. As such, it is important to consider embedding a plan for program evaluation at the outset. We hope these shared lessons will be of value to other educators who are considering a large-scale CBME CC implementation.
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Affiliation(s)
- Anna Oswald
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- 8-130 Clinical Sciences building, 11350-83 Avenue, Edmonton, AB, Canada
| | - Daniel Dubois
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Jolanta Karpinski
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Dept. of Emergency Medicine, University of Ottawa, Canada
| | - Jason R. Frank
- Centre for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
| | - Warren J. Cheung
- Dept. of Emergency Medicine, University of Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, 1053 Carling Avenue, Rm F660, Ottawa, Canada
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Ouellet S, Hamel S, Simard C, Koolian M, Robert A, Wou K, Lam S, Bessissow A, St-Georges S, Tagalakis V, de Pokomandy A, Snell L, Sun NZ, Malhamé I. Exploring pregnant individuals' counseling needs regarding urgent imaging to rule out pulmonary embolism. Res Pract Thromb Haemost 2024; 8:102317. [PMID: 38496711 PMCID: PMC10943056 DOI: 10.1016/j.rpth.2024.102317] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024] Open
Abstract
Background Computed tomography pulmonary angiogram and lung scintigraphy with ventilation/perfusion scan are needed to diagnose pulmonary embolism (PE) in pregnancy. Their associated ionizing radiation doses are considered safe in pregnancy. A standardized patient information tool may improve patient counseling and reduce testing hesitancy. Objectives In this context, we sought to address 1) what patients want to know before undergoing these tests and 2) how they want the information to be provided to them. Methods We used a qualitative descriptive methodology. We recruited pregnant participants at the McGill University Health Center in Montreal, Canada. Structured interviews explored information needs about PE and diagnostic imaging for PE. The interview transcripts' themes were analyzed with a hybrid deductive and inductive approach. Results Of 21 individuals approached, 20 consented to participate. Four had been previously investigated for PE. Participants requested information about the risks associated with PE and radiation and their effects on maternal and fetal health. They preferred for radiation doses to be presented in comparison with known radiation thresholds for fetal harm. They suggested that a written tool should be developed using an accessible language. Participants also indicated that the tool would be integrated into their decision-making process, emphasizing a lower risk tolerance for their fetus than for themselves. Conclusion This single-center group of pregnant patients wished to be informed about the risks of PE and radiation associated with imaging. A written tool could help put information into context and facilitate decision making. These new insights may be used to inform counseling.
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Affiliation(s)
- Suzie Ouellet
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Sandrine Hamel
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Camille Simard
- Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montréal, Québec, Canada
| | - Maral Koolian
- Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada
| | - Antony Robert
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Karen Wou
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, Québec, Canada
| | - Stéphanie Lam
- Department of Diagnostic Radiology, McGill University Health Center, Montréal, Québec, Canada
| | - Amal Bessissow
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Sarah St-Georges
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, Québec, Canada
| | - Vicky Tagalakis
- Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Snell
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Institute for Health Sciences Education, McGill University, Montréal, Québec, Canada
| | - Ning-Zi Sun
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Institute for Health Sciences Education, McGill University, Montréal, Québec, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
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Laverdure M, Gomez-Garibello C, Snell L. Residents as Medical Coaches. J Surg Educ 2023; 80:1067-1074. [PMID: 37271599 DOI: 10.1016/j.jsurg.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES With the recent implementation of Competency-based Medical Education (CBME) and emphasis on direct observation of learners, there is an increased interest in the concept of clinical coaching. While there is considerable literature on the role of attending physicians as coaches, little data is available on the role of residents as coaches, and residents' perceptions about effective coaching. We aimed to identify distinct characteristics of residents' coaching, to examine residents' perceptions on what they valued most in clinical coaches, and to explore trainees' ideas about how to optimize this role. DESIGN We performed an exploratory qualitative study, using 45 minutes semi-structured interviews. We did a thematic analysis of the interview transcripts using both inductive and deductive coding. PARTICIPANTS We invited and interviewed 5 surgical and 5 nonsurgical residents, and 3 surgical and 3 nonsurgical attending staff. Residents were recruited from all post graduate levels and from a variety of programs. SETTING Our study was done in a large tertiary teaching hospital. RESULTS Residents perceived that they have a significant role as coaches for junior learners, different from the attending's role. The proximity between the coach and the coaches leads to a different supervisor-learner rapport. This was of benefit as learners described feeling more comfortable making mistakes and seeking feedback, which potentiates effective coaching. Residents reported feeling that it was easier to coach their recently-acquired skills as the subtleties of the tasks and the troubleshooting were fresher in memory. Residents expressed appreciating a coach who values autonomy and does not intervene except when patient safety is at risk. Strategies identified to further optimize residents' role as coaches include placing coaching as a priority, ensuring dedicated time, and offering teaching sessions on coaching. CONCLUSIONS Residents have distinct roles as coaches, driven by their recent experience being coached and as near peers. More research is needed to evaluate concrete measures to optimize residents' role as coaches and to improve their coaching skills.
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Affiliation(s)
- Morgane Laverdure
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
| | | | - Linda Snell
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
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Thoma B, Fowler N, Maniatis T, Karwowska A, Sonnenberg LK, Snell L, Dagnone D, Bandiera G. In solidarity with anti-racism leaders in Canadian medical education. Can Med Educ J 2023; 14:155. [PMID: 37465737 PMCID: PMC10351645 DOI: 10.36834/cmej.77465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Nancy Fowler
- College of Family Physicians of Canada, Ontario, Canada
| | | | - Anna Karwowska
- Association of Faculties of Medicine of Canada, Ontario, Canada
| | | | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Damon Dagnone
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Glen Bandiera
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
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Yilmaz Y, Chan MK, Richardson D, Atkinson A, Bassilious E, Snell L, Chan TM. Defining new roles and competencies for administrative staff and faculty in the age of competency-based medical education. Med Teach 2023; 45:395-403. [PMID: 36471921 DOI: 10.1080/0142159x.2022.2136517] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE These authors sought to define the new roles and competencies required of administrative staff and faculty in the age of CBME. METHOD A modified Delphi process was used to define the new CBME roles and competencies needed by faculty and administrative staff. We invited international experts in CBME (volunteers from the ICBME Collaborative email list), as well as faculty members and trainees identified via social media to help us determine the new competencies required of faculty and administrative staff in the CBME era. RESULTS Thirteen new roles were identified. The faculty-specific roles were: National Leader/Facilitator in CBME; Institutional/University lead for CBME; Assessment Process & Systems Designer; Local CBME Leads; CBME-specific Faculty Developers or Trainers; Competence Committee Chair; Competence Committee Faculty Member; Faculty Academic Coach/Advisor or Support Person; Frontline Assessor; Frontline Coach. The staff-specific roles were: Information Technology Lead; CBME Analytics/Data Support; Competence Committee Administrative Assistant. CONCLUSIONS The authors present a new set of faculty and staff roles that are relevant to the CBME context. While some of these new roles may be incorporated into existing roles, it may be prudent to examine how best to ensure that all of them are supported within all CBME contexts in some manner.
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Affiliation(s)
- Yusuf Yilmaz
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Denyse Richardson
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adelle Atkinson
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Ereny Bassilious
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Linda Snell
- Medicine and Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Teresa M Chan
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Divisions of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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Abstract
Background Ownership of patient care is a concept that embodies a number of professionalism attributes and involves a feeling of strong commitment and responsibility towards patient care. Little is known about how the embodiment of this concept develops in the earliest stages of clinical training. The goal of this qualitative study is to explore the development of ownership of patient care in clerkship. Methods Using qualitative descriptive methodology, we conducted twelve one-on-one in-depth semi-structured interviews with final-year medical students at one university. Each participant was asked to describe their understanding and beliefs with regards to ownership of patient care and discuss how they acquired these mental models during clerkship, with emphasis on enabling factors. Data were inductively analyzed using qualitative descriptive methodology and with professional identity formation as the sensitizing theoretical framework. Results Ownership of patient care develops in students through a process of professional socialization that includes enabling factors such as role modelling, student self-assessment, learning environment, healthcare and curriculum structures, attitudes of and treatment by others, and growing competence. The resulting ownership of patient care is manifested as understanding patients' needs and values, engaging patients in their care, and maintaining a strong sense of accountability for patients' outcome. Conclusion An understanding of how ownership of patient care develops in early medical training and the associated enabling factors can inform strategies aimed at optimizing this process, such as designing curricula with more opportunities for longitudinal patient contact and fostering a supportive learning environment with positive role modelling, clear attribution of responsibilities, and purposefully granted autonomy.
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Affiliation(s)
| | - Linda Snell
- Department of Medicine, McGill University, Quebec, Canada
- McGill Institute of Health Sciences Education, Quebec, Canada
| | - Ning-Zi Sun
- Department of Medicine, McGill University, Quebec, Canada
- McGill Institute of Health Sciences Education, Quebec, Canada
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Cupido N, Fowler N, Sonnenberg LK, Karwowska A, Richardson D, Snell L, Thoma B, Mylopoulos M. Adaptive Expertise in CanMEDS 2025. Can Med Educ J 2023; 14:18-21. [PMID: 36998497 PMCID: PMC10042796 DOI: 10.36834/cmej.75445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Nathan Cupido
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Nancy Fowler
- College of Family Physicians of Canada, Ontario, Canada
- McMaster University, Ontario, Canada
| | - Lyn K Sonnenberg
- University of Alberta, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta, Canada
;
| | - Anna Karwowska
- University of Ottawa, Ontario, Canada
- Association of Faculties of Medicine of Canada, Ontario, Canada
| | - Denyse Richardson
- University of Toronto, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- McGill University, Quebec, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Saskatchewan, Saskatchewan, Canada
| | - Maria Mylopoulos
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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Thoma B, Karwowska A, Samson L, Labine N, Waters H, Giuliani M, Chan TM, Atkinson A, Constantin E, Hall AK, Gomez-Garibello C, Fowler N, Tourian L, Frank J, Anderson R, Snell L, Van Melle E. Emerging concepts in the CanMEDS physician competency framework. Can Med Educ J 2023; 14:4-12. [PMID: 36998506 PMCID: PMC10042782 DOI: 10.36834/cmej.75591] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies. Methods Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted. Results 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts. Conclusion This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.
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Affiliation(s)
- Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Anna Karwowska
- University of Ottawa, Ontario, Canada
- Association of Faculties of Medicine of Canada, Ontario, Canada
| | - Louise Samson
- Université de Montréal, Quebec, Canada
- Collège des médecins du Québec, Quebec, Canada
| | | | | | | | | | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Toronto, Ontario, Canada
| | | | - Andrew K Hall
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Ottawa, Ontario, Canada
| | | | - Nancy Fowler
- McMaster University, Ontario, Canada
- College of Family Physicians of Canada, Ontario, Canada
| | | | | | - Rob Anderson
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- NOSM University, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- McGill University, Quebec, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- Queen’s University, Ontario, Canada
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Affiliation(s)
- Brent Thoma
- Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Cynthia Abbott
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- Medicine and Health Sciences Education, McGill University, Quebec, Canada
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Hamel S, Ouellet S, Simard C, Robert A, Wou K, St-Georges S, Lam S, Bessissow A, Tagalakis V, Snell L, Malhamé I. Developing a Patient Information Tool for Pregnant People Requiring Diagnostic Imaging for Pulmonary Embolism: A Providers' Needs Assessment. J Obstet Gynaecol Can 2022; 44:1132-1133. [PMID: 35940356 DOI: 10.1016/j.jogc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Sandrine Hamel
- Department of Medicine, McGill University Health Centre, Montréal, QC
| | - Suzie Ouellet
- Department of Medicine, McGill University Health Centre, Montréal, QC
| | - Camille Simard
- Department of Medicine, Jewish General Hospital, Montréal, QC
| | - Antony Robert
- Department of Emergency Medicine, McGill University Health Centre, McGill University, Montréal, QC
| | - Karen Wou
- Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montréal, QC
| | - Sarah St-Georges
- Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montréal, QC
| | - Stephanie Lam
- Department of Radiology, McGill University Health Centre, McGill University, Montréal, QC
| | - Amal Bessissow
- Department of Medicine, McGill University Health Centre, Montréal, QC
| | - Vicky Tagalakis
- Department of Medicine, Jewish General Hospital, Montréal, QC; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC
| | - Linda Snell
- Department of Medicine, McGill University Health Centre, Montréal, QC; Institute of Health Sciences Education, McGill University, Montréal, QC
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montréal, QC; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC.
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Yan L, Niburski K, Snell L. Sonoist: An Innovative Peer Ultrasound Learning Initiative on Canadian Teaching Hospital Wards. Mcgill J Med 2022. [DOI: 10.26443/mjm.v20i2.856] [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: 11/23/2022] Open
Abstract
Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation.
Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4).
Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching.
Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.
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Yan L, Niburski K, Snell L. Sonoist: An Innovative Peer Ultrasound Learning Initiative on Canadian Teaching Hospital Wards. Mcgill J Med 2021. [DOI: 10.26443/mjm.v20i1.856] [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: 11/23/2022] Open
Abstract
Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation.
Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4).
Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching.
Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.
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Amer S, Aboeldalyl S, Snell L, Shawky H, Seyam E, Ibrahim E. P–639 The role of chronic inflammation in polycystic ovarian syndrome – a systematic review and meta-analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is polycystic ovarian syndrome (PCOS) associated with chronic inflammation as determined by elevated serum C-reactive protein (CRP) level independent of obesity? Summary answer: Circulating CRP is moderately elevated in women with PCOS (independent of obesity), which is indicative of low-grade chronic inflammation.
What is known already
Although current literature associates polycystic ovarian syndrome (PCOS) with chronic inflammation, the evidence for this link remains inconclusive and its causal nature remains unclear. A systematic review and meta-analysis involving 31 studies was published on this topic in 2011 providing evidence for increased circulating CRP (96% higher than controls). However, since that review there have been over 100 published studies assessing CRP in PCOS women utilising more advanced CRP assays.
Study design, size, duration
This systematic review involved an extensive search of electronic databases for studies investigating CRP and other inflammatory makers in PCOS women from January 2000 to March 2020. Searched databases included PUBMED, EMBASE and MEDLINE, SCOPUS, DynaMed plus, TRIP, ScienceDirect and Cochrane Library. Inclusion criteria were using Rotterdam criteria for PCOS diagnosis, measuring CRP with high-sensitivity assay, matching/adjusting participants for BMI, and including drug naïve participants who were free from conditions that could affect inflammatory markers.
Participants/materials, setting, methods
The review included all studies comparing circulating CRP between women with and without PCOS. Articles’ quality and risk of bias were assessed using modified Newcastle-Ottawa scale. CRP data were extracted from eligible studies and entered into RevMan software for calculation of standardized mean difference (SMD) and 95% Confidence Interval (CI). Sensitive analysis was performed for high-quality studies providing data for non-obese participants.
Main results and the role of chance
The systematic review included 95 eligible studies (n = 10,074), of which 68 (n = 7991) were included in a meta-analysis. Sixty-two of the 95 studies reported significantly higher circulating CRP in PCOS women (n = 5235) versus controls (n = 4839). The remaining studies showed no statistically significant differences between the two groups after adjusting for BMI. Pooled analysis of 68 studies revealed significantly higher circulating CRP in PCOS women (SMD 1.26, 95%CI, 1.01, 1.52; z = 9.60; p = 0.00001; I²=96%). Sensitivity meta-analysis for non-obese women in 37 high-quality studies showed significantly higher circulating CRP in PCOS women versus controls (SMD 1.84, 95%CI, 1.40, 2.28; z = 8.19; p < 0.00001; I²=97%). Circulating TNF- α was measured in 13 studies, of which seven reported higher levels in PCOS women versus controls and six showed no difference. Circulating IL–6 was measured in 19 articles, of which eight reported significantly higher levels in PCOS women versus controls and 11 found no difference. Four studies (n = 512) reported increased white cell count in PCOS women (n = 323) compared with healthy controls (n = 189).
Nine studies (n = 922) assessed circulating adiponectin, with seven showing significantly lower levels in PCOS women (n = 368) versus controls and one showing no difference. Meta-analysis of four of these studies (n = 355) revealed a SMD –1.48 (95% CI; –2.48,-.14).
Limitations, reasons for caution
High heterogeneity between studies and the small size of several studies are the main limitations. Heterogeneity is due to variation in laboratory methods used to measure CRP and variations between participants e.g. age, BMI and PCOS phenotypes. Sensitivity and sub-group analysis were performed to address this heterogeneity.
Wider implications of the findings: Further research is required to understand the underlying molecular mechanisms and the pathophysiological role of chronic inflammation in PCOS. This could potentially identify targets for new treatments that could improve short- and long-term health problems associated with PCOS.
Trial registration number
N/A
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Affiliation(s)
- S Amer
- University of Nottingham, Gynaecology, Derby, United Kingdom
| | - S Aboeldalyl
- University of Nottingham, Obstetrics and Gynaecology, Derby, United Kingdom
| | - L Snell
- University Hospitals of Derby and Burton NHS Foundation Trust, Library & Knowledge Service, Derby, United Kingdom
| | - H Shawky
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology, Minia, Egypt
| | - E Seyam
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology, Minia, Egypt
| | - E Ibrahim
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology, Minia, Egypt
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Liao KC, Peng CH, Snell L, Wang X, Huang CD, Saroyan A. Understanding the lived experiences of medical learners in a narrative medicine course: a phenomenological study. BMC Med Educ 2021; 21:321. [PMID: 34090423 PMCID: PMC8180022 DOI: 10.1186/s12909-021-02741-5] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Reflection and various approaches to foster reflection have been regarded as an indispensable element in enhancing professional practice across different disciplines. With its inherent potential to engage learners in reflection and improvement, narrative medicine has been adopted in various settings. However, the relevance and effectiveness of reflection remains underexplored in the context of narrative medicine, specifically in regard to the concern about variability of learner acceptance and the way learners really make sense of these reflective activities. This study aimed to explore what medical learners experience through narrative medicine and the meanings they ascribe to the phenomenon of this narrative-based learning. METHODS Using a transcendental phenomenology approach, twenty medical learners were interviewed about their lived experiences of taking a narrative medicine course during their internal medicine clerkship rotation. Moustakas' phenomenological analysis procedures were applied to review the interview data. RESULTS Six themes were identified: feeling hesitation, seeking guidance, shifting roles in narratives, questioning relationships, experiencing transformation, and requesting a safe learning environment. These themes shaped the essence of the phenomenon and illustrated what and how medical learners set out on a reflective journey in narrative medicine. These findings elucidate fundamental elements for educators to consider how narrative approaches can be effectively used to engage learners in reflective learning and practice. CONCLUSION Adopting Moustakas' transcendental phenomenology approach, a better understanding about the lived experiences of medical learners regarding learning in narrative medicine was identified. Learner hesitancy should be tackled with care by educators so as to support learners with strategies that address guidance, relationship, and learning environment. In so doing, medical learners can be facilitated to develop reflective capabilities for professional and personal growth.
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Affiliation(s)
- Kuo-Chen Liao
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Taoyuan, 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chang-Hsuan Peng
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Linda Snell
- Institute of Health Sciences Education and Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Xihui Wang
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Quebec, Canada
| | - Chien-Da Huang
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Chest and Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alenoush Saroyan
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Quebec, Canada
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Marwan Y, Luo L, Toobaie A, Benaroch T, Snell L. Operating Room Educational Environment in Canada: Perceptions of Surgical Residents. J Surg Educ 2021; 78:60-68. [PMID: 32741693 DOI: 10.1016/j.jsurg.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/08/2020] [Revised: 06/18/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The educational experience in operating rooms (OR) plays a central role in the transformation of a trainee into a surgeon. As Canadian residency programs transition to competency-based medical education, and since most surgical competencies are attained in the OR, we investigated the perceptions of Canadian surgical residents about their OR learning environment. DESIGN Cross-sectional, national survey. SETTING An online questionnaire, including the validated 40-item operating room educational environment measure (OREEM) inventory, was sent to residency programs of all surgical specialties in Canada. The OREEM assesses the trainees' perceptions of the "trainer and training," "learning opportunities," "atmosphere in the operating room," "supervision, workload, and support," Each individual item was rated using a 5-point Likert scale ranging from "strongly disagree" (scores 1) to "strongly agree" (scores 5). The mean score of each individual item was measured, and the mean scores of each subscale and an overall score of the questions were also measured. PARTICIPANTS Surgical residents in Canada. RESULTS Four hundred thirty residents were included for final analysis. The overall mean OREEM score was 3.72 ± 0.4. "Atmosphere in the OR" was the subscale with the highest mean score (3.87 ± 0.5), while "supervision, workload, and support" had the lowest subscale mean score (3.49 ± 0.5). The overall OREEM mean score for junior and senior residents was 3.67 ± 0.4 and 3.80 ± 0.4, respectively (p = 0.001). No significant differences were seen in the mean OREEM score between males and females or different surgical programs. Nevertheless, general surgery had the lowest "supervision, workload, and support" subscale score (3.27 ± 0.5; p < 0.001). CONCLUSIONS The overall educational environment in OR may be considered satisfactory as perceived by Canadian surgical residents; however, several areas for potential improvement are identified and suggestions for optimizing the learning environment are described.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Lucy Luo
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Asra Toobaie
- Division of Orthopaedic Surgery, Western University, London, Ontario, Canada
| | - Thierry Benaroch
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Linda Snell
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
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Moore K, Patel H, Razack S, Snell L, Taylor L. Management and Leadership Development Programs for the Medical Community at McGill University. Mcgill J Med 2020. [DOI: 10.26443/mjm.v9i1.606] [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: 11/23/2022] Open
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19
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Masson V, Snell L, Dolmans D, Sun NZ. Exploring the evolving concept of 'patient ownership' in the era of resident duty hour regulations-experience of residents and faculty in an internal medicine night float system. Perspect Med Educ 2019; 8:353-359. [PMID: 31642049 PMCID: PMC6904378 DOI: 10.1007/s40037-019-00540-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Despite the use of 'patient ownership' as an embodiment of professionalism and increasing concerns over its loss among trainees, how its development in residents has been affected by duty hour regulations has not been well described. In this qualitative study, we aim to outline the key features of patient ownership in internal medicine, factors enabling its development, and how these have been affected by the adoption of a night float system to comply with duty hour regulations. METHODS In this qualitative descriptive study, we interviewed 18 residents and 12 faculty internists at one university centre and conducted a thematic analysis of the data focused on the concept of patient ownership. RESULTS We identified three key features of patient ownership: personal concern for patients, professional capacity for autonomous decision-making, and knowledge of patients' issues. Within the context of a night float system, factors that facilitate development of patient ownership include improved fitness for duty and more consistent interactions with patients/families resulting from working the same shift over consecutive days (or nights). Conversely, the increase in patient handovers, if done poorly, is a potential threat to patient ownership development. Trainees often struggle to develop ownership when autonomy is not supported with supervision and when role-modelling by faculty is lacking. DISCUSSION These features of patient ownership can be used to frame discussions when coaching trainees. Residency programs should be mindful of the downstream effects of shift-based scheduling. We propose strategies to optimize factors that enable trainee development of patient ownership.
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Affiliation(s)
- Vanessa Masson
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Ning-Zi Sun
- McGill University, Montreal, Quebec, Canada.
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20
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Burn E, Youde J, Snell L. 54DEVELOPING A CROSS-SPECIALITY CURRICULUM FOR TRAINEES INVOLVED IN THE FALLS AND FRAGILITY FRACTURE AUDIT PROGRAMME. Age Ageing 2019. [DOI: 10.1093/ageing/afz057.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Burn
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust
| | - J Youde
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust
| | - L Snell
- Library Services, University Hospitals of Derby and Burton NHS Foundation Trust
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Affiliation(s)
- Jumanah Karim
- Department of PediatricsMcGill University Health Centre Montreal Quebec Canada
| | - Yousef Marwan
- Division of Orthopaedic SurgeryMcGill University Health Centre Montreal Quebec Canada
- Department of SurgeryFaculty of MedicineHealth Sciences CentreKuwait University Kuwait City Kuwait
| | - Ahmed Dawas
- Department of MedicineMcGill University Health Centre Montreal Quebec Canada
| | - Ali Esmaeel
- Department of SurgeryFaculty of MedicineHealth Sciences CentreKuwait University Kuwait City Kuwait
| | - Linda Snell
- Department of MedicineMcGill University Health Centre Montreal Quebec Canada
- Centre for Medical EducationMcGill University Montreal Quebec Canada
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Abstract
Aim: This perspective is part of a series of articles that are outcomes of a consensus conference, that seek to offer a comprehensive examination of the clinical learning environment (CLE), using different academic disciplines and areas of focus termed "avenues." The education dimensions of the CLE are discussed in detail in this perspective, along with critical linkages to the other avenues. Methods: Using iterative presentations, discussion and small group work, in October 2018, the consensus conference participants explored the education, psychological, sociocultural, diversity and inclusion, digital and architectural aspects of the CLE. Results: The education avenue of the CLE includes elements of teaching and learning such as the curriculum, clinical experiences, the assessment system, educational program governance, trainee selection, faculty development, and program evaluation and improvement. Within the educational domain, we focus on organizational and personal/social aspects of the CLE, including (1) curriculum design and deployment, including placement of trainees in clinical settings, organizational culture, practices and policies, and accreditation and regulatory requirements from the organizational domain (2) the education system, including assessment, program evaluation and organization and governance; and (3) elements from the personal and social domains, including peer-to-peer, trainee-faculty, and trainee-patient relationships that influence how and what postgraduate trainees learn, trainee selection, informal and hidden curricula, and trainees' perceptions of their learning environment. Conclusions: We provide suggestions for further research and recommendations for addressing challenges and facilitating improvement in the educational aspects of the CLE, along with actionable practice points.
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Affiliation(s)
- Ming-Ka Chan
- a Department of Pediatrics and Child Health , University of Manitoba , Winnipeg, Manitoba , Canada
| | - Linda Snell
- b Department of Medicine and Centre for Medical Education , McGill University , Montreal , Quebec , Canada
- c Royal College of Physicians and Surgeons of Canada , Ottawa, Ontario , Canada
| | - Ingrid Philibert
- d Formerly Accreditation Council of Graduate Medical Education , Chicago , IL , USA
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Abstract
Learning in a clinical context is foundational in the training of health professionals; there is simply no alternative. The subject of the clinical learning environment (CLE) is at the forefront of discussions. In this introduction to a themed issue on the CLE, we present an expanded conceptual model that approaches the CLE through six different lenses, termed "avenues:" architectural, digital, diversity and inclusion, education, psychological, and sociocultural, with each avenue represented by a paper. The aim is to facilitate dialog around the contributions of different academic disciplines to research on the CLE. Collectively the papers highlight the overlap between the various "avenues" in how they influence each other, and how they collectively have shaped the work to understand and improve the CLE. The expectation is that the various avenues can add to existing knowledge and create new ideas for interventions to improve the clinical learning environment across nations for learners and teachers with the ultimate aim of improving patient care. Research and efforts to improve the CLE are critical to learning, professional socialization and well-being for trainees as they learn and participate in patient care, and to the quality of care they will deliver over decades of practice after graduation.
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Affiliation(s)
- Jonas Nordquist
- a Department of Medicine (Huddinge) , Karolinska Institutet , Stockholm , Sweden
- b Department of Research and Education , Karolinska University Hospital , Stockholm , Sweden
| | - Jena Hall
- c Department of Obstetrics and Gynecology , Queen's University , Kingston , Canada
| | - Kelly Caverzagie
- d Internal Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - Linda Snell
- e Medicine , McGill University , Montreal , Canada
- f Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
| | | | - Brent Thoma
- h University of Saskatchewan , Saskatoon , Canada
| | | | - Ingrid Philibert
- i Accreditation Council of Graduate Medical Education , Chicago , IL , USA
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Tsuchiya S, Takamiya Y, Saroyan A, Snell L. Do Canadian and Japanese palliative care physicians perceive the concept of resilience differently? IJWPC 2018. [DOI: 10.26443/ijwpc.v5i1.142] [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: 11/23/2022] Open
Abstract
Teaching about resilience is one of the biggest challenges in medical education. One of the problems of currently accepted definitions is that they attribute individualistic notions mainly originating in North American society, such as “endure ongoing hardship,” “thrive on challenges,” “be healthy,” and “be stronger.” In response to this situation, Tsuchiya et al (2017) proposed a description of a broader model of a resilient physician in healthcare that incorporates concepts of self-definition as described in both North American and the East Asian societies; that is, “a person’s capacity to be aware of the aspects of the self differently identified in each context, and to consciously value oneself and others in the context”. However, the concept is still theoretical, and more empirical understanding is needed.This presentation will examine the findings from our exploratory study on physician resilience using semi-structured interviews with 20 palliative care physicians (10 each in Canada and Japan) to answer the following questions:(1) Are there any differences in the way Canadian and Japanese palliative care physician perceive resilience? (2) What factors might affect the similarities or differences of their perceptions of resilience? (3) Are these findings consistent with Tsuchiya’s description? Following qualitative analysis using a grounded theory approach, a schematic representation of resilience in physicians will be offered, to inform a coherent educational program for resilient healthcare professionals.
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Simons R, White S, Topen S, Snell L, Murphy C, Collins R, Davies J, Owen A, Barker J, Green L, Patel I, Ridgway J, Lenchner J, Faerber J, Pearce L, Meanwell H, Kominek N, Janik L, Best H, Stevens T, Hubbard G, Stratton R. A survey of bolus feeding practices in the UK home enteral feeding population. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.019] [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: 11/28/2022]
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Marwan Y, Waly F, Algarni N, Addar A, Saran N, Snell L. The Role of Letters of Recommendation in the Selection Process of Surgical Residents in Canada: A National Survey of Program Directors. J Surg Educ 2017; 74:762-767. [PMID: 28126378 DOI: 10.1016/j.jsurg.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/08/2016] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Letters of recommendation (LOR) provide valuable information that help in selecting new residents. In this study, we aim to investigate the perceptions of surgical residency program directors (PDs) in Canada on the elements that can affect the strength and value of LOR. DESIGN Cross-sectional; survey. SETTING A national survey was conducted using an online questionnaire consisting of 2 main sections to collect data from PDs from all surgical subspecialties. The first section included basic background questions about the participant, such as the specialty and experience in selecting resident candidates, whereas the second section was about the elements and characteristics of LOR. Participants were asked to rate the importance of 34 different variables using a Likert scale. PARTICIPANTS Surgical PDs in Canada. RESULTS Of 122 PDs, 65 (53.3%) participated in the survey. Work ethic (57; 87.7%), interpersonal skills (52; 80.0%), and teamwork (49; 75.4%) were considered very important parts of the LOR by more than three-quarters of the PDs. Thirty-three (50.8%) PDs reported that a familiar author of LOR would always affect their impression regarding the letter. Additionally, 57 (87.7%) and 35 (53.8%) directors thought that LOR are important in evaluating the candidates and can help in predicting the residents' performance during their residency training. CONCLUSIONS LOR are important for the selection of new surgical residents in Canada. Information about the candidate's work ethic, interpersonal skills, and teamwork is essential for a good LOR. Familiarity of PDs with authors of LOR could increase the value of the letter.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
| | - Feras Waly
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, University of Tabuk, Tabuk, Saudi Arabia
| | - Nizar Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Addar
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Neil Saran
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Linda Snell
- Centre for Medical Education, McGill University, Montreal, Quebec, Canada
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Harris P, Bhanji F, Topps M, Ross S, Lieberman S, Frank JR, Snell L, Sherbino J. Evolving concepts of assessment in a competency-based world. Med Teach 2017; 39:603-608. [PMID: 28598736 DOI: 10.1080/0142159x.2017.1315071] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Competency-based medical education (CBME) is an approach to the design of educational systems or curricula that focuses on graduate abilities or competencies. It has been adopted in many jurisdictions, and in recent years an explosion of publications has examined its implementation and provided a critique of the approach. Assessment in a CBME context is often based on observations or judgments about an individual's level of expertise; it emphasizes frequent, direct observation of performance along with constructive and timely feedback to ensure that learners, including clinicians, have the expertise they need to perform entrusted tasks. This paper explores recent developments since the publication in 2010 of Holmboe and colleagues' description of CBME assessment. Seven themes regarding assessment that arose at the second invitational summit on CBME, held in 2013, are described: competency frameworks, the reconceptualization of validity, qualitative methods, milestones, feedback, assessment processes, and assessment across the medical education continuum. Medical educators interested in CBME, or assessment more generally, should consider the implications for their practice of the review of these emerging concepts.
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Affiliation(s)
- Peter Harris
- a Office of Medical Education , University of New South Wales , Sydney , Australia
| | - Farhan Bhanji
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- c Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec, Canada
| | - Maureen Topps
- d Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Shelley Ross
- e Department of Family Medicine , University of Alberta , Edmonton , Canada
| | - Steven Lieberman
- f Office of the Dean of medicine, University of Texas Medical Branch , Galveston , TX , USA
| | - Jason R Frank
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- g Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
| | - Linda Snell
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- c Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec, Canada
| | - Jonathan Sherbino
- h Division of Emergency Medicine, Department of Medicine , McMaster University , Hamilton , Canada
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Ferguson PC, Caverzagie KJ, Nousiainen MT, Snell L. Changing the culture of medical training: An important step toward the implementation of competency-based medical education. Med Teach 2017; 39:599-602. [PMID: 28598749 DOI: 10.1080/0142159x.2017.1315079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education. MATERIALS AND METHODS At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic. RESULTS There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME. CONCLUSIONS The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.
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Affiliation(s)
- Peter C Ferguson
- a Division of Orthopaedic Surgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Kelly J Caverzagie
- b Division of General Internal Medicine, Department of Internal Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - Markku T Nousiainen
- a Division of Orthopaedic Surgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Linda Snell
- c Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec , Canada
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
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Abstract
The paradigm shift brought about by the advent of competency-based medical education (CBME) can be characterized as an adaptive change. Currently, its development and implementation suffer from the lack of a lingua franca. A shared language is needed to support collaboration and dissemination across the world community of medical educators. The International CBME Collaborators held a second summit in 2013 to explore this and other contemporary CBME issues. We present the resulting International CBME Collaborator's glossary of CBME terms. Particular attention is given to the terms competency, entrustable professional activity (EPA), and milestone and their interrelationships. Medical education scholars and enthusiasts of the competency-based approach are encouraged to adopt these terms and definitions, although no doubt the vocabulary of CBME will continue to evolve.
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Affiliation(s)
- Robert Englander
- a School of Medicine, University of Minnesota , Minneapolis , MN , USA
| | - Jason R Frank
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- c Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
| | | | - Jonathan Sherbino
- e Division of Emergency Medicine, Department of Medicine , McMaster University , Hamilton , Canada
| | - Shelley Ross
- f Department of Family Medicine , University of Alberta , Edmonton , Canada
| | - Linda Snell
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- g Centre for Medical and Department of General Internal Medicine , McGill University , Montreal, Quebec , Canada
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Lockyer J, Bursey F, Richardson D, Frank JR, Snell L, Campbell C. Competency-based medical education and continuing professional development: A conceptualization for change. Med Teach 2017; 39:617-622. [PMID: 28598738 DOI: 10.1080/0142159x.2017.1315064] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician's career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD.
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Affiliation(s)
- Jocelyn Lockyer
- a Cumming School of Medicine, University of Calgary , Calgary , Canada
| | - Ford Bursey
- b Faculty of Medicine, Memorial University of Newfoundland , St John's , Canada
| | - Denyse Richardson
- c Department of Medicine , University of Toronto , Toronto , Canada
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
| | - Jason R Frank
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- f Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
| | - Linda Snell
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- e Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Canada
| | - Craig Campbell
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- g Department of Medicine , University of Ottawa , Ottawa , Canada
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Holmboe ES, Sherbino J, Englander R, Snell L, Frank JR. A call to action: The controversy of and rationale for competency-based medical education. Med Teach 2017; 39:574-581. [PMID: 28598742 DOI: 10.1080/0142159x.2017.1315067] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although medical education has enjoyed many successes over the last century, there is a recognition that health care is too often unsafe and of poor quality. Errors in diagnosis and treatment, communication breakdowns, poor care coordination, inappropriate use of tests and procedures, and dysfunctional collaboration harm patients and families around the world. These issues reflect on our current model of medical education and raise the question: Are physicians being adequately prepared for twenty-first century practice? Multiple reports have concluded the answer is "no." Concurrent with this concern is an increasing interest in competency-based medical education (CBME) as an approach to help reform medical education. The principles of CBME are grounded in providing better and safer care. As interest in CBME has increased, so have criticisms of the movement. This article summarizes and addresses objections and challenges related to CBME. These can provide valuable feedback to improve CBME implementation and avoid pitfalls. We strongly believe medical education reform should not be reduced to an "either/or" approach, but should blend theories and approaches to suit the needs and resources of the populations served. The incorporation of milestones and entrustable professional activities within existing competency frameworks speaks to the dynamic evolution of CBME, which should not be viewed as a fixed doctrine, but rather as a set of evolving concepts, principles, tools, and approaches that can enable important reforms in medical education that, in turn, enable the best outcomes for patients.
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Affiliation(s)
- Eric S Holmboe
- a Accreditation Council for Graduate Medical Education , Chicago , IL , USA
| | - Jonathan Sherbino
- b Division of Emergency Medicine, Department of Medicine , McMaster University , Hamilton , Canada
| | - Robert Englander
- c School of Medicine, University of Minnesota , Minneapolis , MN , USA
| | - Linda Snell
- d Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec , Canada
- e Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
| | - Jason R Frank
- e Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- f Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
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Abstract
For more than 60 years, competency-based education has been proposed as an approach to education in many disciplines. In medical education, interest in CBME has grown dramatically in the last decade. This editorial introduces a series of papers that resulted from summits held in 2013 and 2016 by the International CBME Collaborators, a scholarly network whose members are interested in developing competency-based approaches to preparing the next generation of health professionals. An overview of the papers is given, as well as a summary of landmarks in the conceptual evolution and implementation of CBME. This series follows on a first collection of papers published by the International CBME Collaborators in Medical Teacher in 2010.
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Affiliation(s)
- Jason R Frank
- a Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- b Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
| | - Linda Snell
- a Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- c Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec, Canada
| | - Robert Englander
- d School of Medicine, University of Minnesota , Minneapolis , MN , USA
| | - Eric S Holmboe
- e Accreditation Council for Graduate Medical Education , Chicago , IL , USA
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Gruppen L, Frank JR, Lockyer J, Ross S, Bould MD, Harris P, Bhanji F, Hodges BD, Snell L, Ten Cate O. Toward a research agenda for competency-based medical education. Med Teach 2017; 39:623-630. [PMID: 28598741 DOI: 10.1080/0142159x.2017.1315065] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Competency-based medical education (CBME) is both an educational philosophy and an approach to educational design. CBME has already had a broad impact on medical schools, residency programs, and continuing professional development in health professions around the world. As the CBME movement evolves and CBME programs are implemented, a wide range of emerging research questions will warrant scholarly examination. In this paper, we describe a proposed CBME research agenda developed by the International CBME Collaborators. The resulting framework includes questions about the meaning of key concepts of CBME and their implications for learners, faculty members, and institutional structures. Other research questions relate to the learning process, the meaning of entrustment decisions, fundamental measurement issues, and the nature and definition of standards. The exploration of these questions will help to solidify the theoretical foundation of CBME, but many issues related to implementation also need to be addressed. These pertain to, among other things, nurturing independent learning, assembling and using assessment results to make decisions about competence, structuring feedback, supporting remediation, and how best to evaluate the longer-term outcomes of CBME. High-quality research on these questions will require rigorous outcome measures with strong validity evidence. The complexity of CBME necessitates theoretical and methodological diversity. It also requires multi-institutional studies that examine effects at multiple levels, from the learner to the team, the institution, and the health care system. Such a framework of research questions can guide and facilitate scholarly discourse on the theoretical and practical body of knowledge related to competency-based health professions education.
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Affiliation(s)
- Larry Gruppen
- a Department of Learning Health Sciences , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Jason R Frank
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- c Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
| | - Jocelyn Lockyer
- d Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Shelley Ross
- e Department of Family Medicine , University of Alberta , Edmonton , Canada
| | - M Dylan Bould
- f Departments of Innovation in Medical Education , University of Ottawa and of Anesthesiology, University of Ottawa and Children's Hospital of Eastern Ontario , Ontario , Canada
| | - Peter Harris
- g Office of Medical Education, University of New South Wales , Sydney , Australia
| | - Farhan Bhanji
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- h Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec , Canada
| | - Brian D Hodges
- i Department of Psychiatry , University of Toronto, Wilson Centre for Research in Education , Toronto , Canada
- j Centre for Research and Development of Education , University Health Network , Toronto , Canada
| | - Linda Snell
- b Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- h Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec , Canada
| | - Olle Ten Cate
- k Centre for Research and Development of Education, University Medical Center Utrecht , Utrecht , The Netherlands
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Saiki T, Snell L, Bhanji F. Twelve tips for promoting learning during presentations in cross cultural settings. Med Teach 2017; 39:458-462. [PMID: 28440721 DOI: 10.1080/0142159x.2017.1288860] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Educators frequently learn together in cross cultural settings such as at international conferences. Cultural differences should influence how educational programs are designed and delivered to effectively support learning; cultural sensitivity and the competence to deal with such differences are important skills for health professions educators. Teaching without this approach may lead to lost learning opportunities. This article provides twelve tips for educators to consider when planning and delivering formal presentations (e.g. lectures and workshops) in cross cultural settings. The tips were constructed based on a literature review, the authors' experience, and interviews with international educators who frequently deliver and receive education in cross cultural settings. The tips are divided into three phases: (1) preparation for the session to optimize learners' experience (2) interaction when delivering the session and (3) reflection on the experience.
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Affiliation(s)
- Takuya Saiki
- a Medical Education Development Centre , Gifu University , Gifu , Japan
- b Centre for Medical Education , McGill University , Montreal , Québec , Canada
| | - Linda Snell
- a Medical Education Development Centre , Gifu University , Gifu , Japan
- b Centre for Medical Education , McGill University , Montreal , Québec , Canada
| | - Farhan Bhanji
- a Medical Education Development Centre , Gifu University , Gifu , Japan
- b Centre for Medical Education , McGill University , Montreal , Québec , Canada
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Tsuchiya S, Takamiya Y, Snell L. A New Description of a Healthcare Professional’s Resilience, Incorporating an Eastern Philosophical Perspectives of Self-definition. How to Bridge the Gap between Independent and Interdependent Self-definition in Medical Education. IJWPC 2017. [DOI: 10.26443/ijwpc.v4i1.124] [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: 11/23/2022] Open
Abstract
Teaching about resilience is one of the biggest challenges in medical education. One of the problems is that medical educators might still ascribe to the individualistic self-definition mainly promoted in the North American society. This definition includes characteristics such as “enduring ongoing hardship,” “thriving on challenges,” “being healthy,” and “being stronger,” which may raise hidden expectations that a healthcare professional’s personality should be strong enough to bounce back to his or her original condition even in a psychologically demanding situation. Psychological theorists describe two broad modes of self-definition in two different cultures: independent self-definition in North American individualism and interdependent self-definition in East Asian collectivism. Despite this seemingly stereotypical discussion on the characteristics of self-definition, a discussion of the two types of self-definition can still encourage medical educators to propose a broader model of resilience in medical education. More specifically, a person using an independent self-definition may become be a complete, whole, autonomous entity, without others, and thus tends to achieve more and become more productive in a competitive society. In contrast, a person using an interdependent self-definition is more likely to be open to another aspect of the context and thus might be able to find and value the self in different ways even in the same context. However, these two self-definitions may not be dichotomous or mutually exclusive but occur in varying ratios in any one individual, particularly as trends of increased globalization, immigration, and technology call for changes in an individual’s value systems in countries. From this standpoint, this review proposes a new definition of resilience in medical education, which is ‘a person’s capacity to be aware of the aspects of the self differently identified in each context, and to consciously value oneself and others in the context’. This is the first article that incorporates the concept of the two self-definitions into resilience education in healthcare. The proposed definition may provide a broader model of resilience in a healthcare professional for educators as well as trainees in medical education.
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Puschel K, Repetto P, Bernales M, Barros J, Perez I, Snell L. "In our own words": Defining medical professionalism from a Latin American perspective. Educ Health (Abingdon) 2017; 30:11-18. [PMID: 28707631 DOI: 10.4103/efh.efh_4_16] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Latin America has experienced a tremendous growth in a number of medical schools, and there are concerns about their quality of training in critical areas such as professionalism. Medical professionalism is a cultural construct. The aim of the study was to compare published definitions of medical professionalism from Latin American and non-Latin American regions and to design an original and culturally sound definition. METHODS A mixed methods approach was used with three phases. First, a systematic search and thematic analysis of the literature were conducted. Second, a Delphi methodology was used to design a local definition of medical professionalism. Third, we used a qualitative approach that combined focus groups and personal interviews with students and deans from four medical schools in Chile to understand various aspects of professionalism education. The data were analyzed using NVivo software. RESULTS A total of 115 nonrepeated articles were identified in the three databases searched. No original definitions of medical professionalism from Latin America were found. Twenty-six articles met at least one of the three decisional criteria defined and were fully reviewed. Three theoretical perspectives were identified: contractualism, personalism, and deontology. Attributes of medical professionalism were classified in five dimensions: personal, interpersonal, societal, formative, and practical. Participants of the Delphi panel, focus groups, and personal interviews included 36 medical students, 12 faculties, and four deans. They took a personalistic approach to design an original definition of medical professionalism and highlighted the relevance of respecting life, human dignity, and the virtue of prudence in medical practice. Students and scholars differed on the value given to empathy and compassion. DISCUSSION This study provides an original and culturally sound definition of medical professionalism that could be useful in Latin American medical schools. The methodology used in the study could be applied in other regions as a basis to develop culturally appropriate definitions of medical professionalism.
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Affiliation(s)
- Klaus Puschel
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de , Santiago, Chile
| | - Paula Repetto
- Department of Health Psychology, School of Psychology Pontificia Universidad Católica de , Santiago, Chile
| | - Margarita Bernales
- Department of Health Psychology, School of Psychology Pontificia Universidad Católica de , Santiago, Chile
| | - Jorge Barros
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de , Santiago, Chile
| | - Ivan Perez
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de , Santiago, Chile
| | - Linda Snell
- Centre for Medical Education, McGill University, Montreal, Québec, Canada
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dos Santos RA, Snell L, Tenorio Nunes MDP. The link between quality and accreditation of residency programs: the surveyors' perceptions. Med Educ Online 2017; 22:1270093. [PMID: 28178919 PMCID: PMC5328332 DOI: 10.1080/10872981.2016.1270093] [Citation(s) in RCA: 3] [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: 05/24/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 05/29/2023]
Abstract
UNLABELLED Accreditation of medical residency programs has become globally important. Currently it is moving from the goal of attaining minimal standards to a model of continuous improvement. In some countries, the accreditation system engages peers (physicians) to survey residency programs. The surveyors are sometimes volunteers, usually engaged in multiple clinical and education activities. Few studies have investigated the benefits of residency program evaluation and accreditation from the perspective of the surveyors. As peers they both conduct and receive accreditation surveys, which puts them in a privileged position in that it provides the surveyor with an opportunity to share experiences and knowledge and apply what is learned in their own context. The objective of this study is to obtain the perceptions of these surveyors about the impact of an accreditation system on residency programs. Surveyors participated in semi-structured interviews. A thematic analysis was performed on the interview data, and resulting topics were grouped into five themes: Burden (of documentation and of time needed); Efficiency and efficacy of the accreditation process; Training and experience of surveyors; Being a peer; Professional skills and recognition of surveyors. These categories were organized into two major themes: 'Structure and Process' and 'Human Resources'. The study participants proposed ways to improve efficiency including diminish the burden of documentation to the physicians involved in the process and to increase efforts on training programs and payment for surveyors and program directors. Based on the results we propose a conceptual framework to improve accreditation systems. ABBREVIATIONS PD: Program director.
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Affiliation(s)
- Renato Antunes dos Santos
- Department of Education and Health, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
- Mental Health Unit, University Hospital of Brasília, University of Brasília (UnB), Brasília, Brazil
| | - Linda Snell
- McGill’s Centre for Medical Education, Montreal, QC, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
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Maniate J, Dath D, Cooke L, Leslie K, Snell L, Busari J. Supporting clinician educators to achieve "work-work balance". Can Med Educ J 2016; 7:e114-e120. [PMID: 28344698 PMCID: PMC5344049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Clinician Educators (CE) have numerous responsibilities in different professional domains, including clinical, education, research, and administration. Many CEs face tensions trying to manage these often competing professional responsibilities and achieve "work-work balance." Rich discussions of techniques for work-work balance amongst CEs at a medical education conference inspired the authors to gather, analyze, and summarize these techniques to share with others. In this paper we present the CE's "Four Ps"; these are practice points that support both the aspiring and established CE to help improve their performance and productivity as CEs, and allow them to approach work-work balance.
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Affiliation(s)
- Jerry Maniate
- Wilson Centre & Department of Medicine, Faculty of Medicine, University of Toronto, ON
| | - Deepak Dath
- Department of Surgery, McMaster University, QC
| | - Lara Cooke
- Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, AB
| | - Karen Leslie
- Centre for Faculty Development, University of Toronto, ON
| | - Linda Snell
- Centre for Medical Education, McGill University, QC
| | - Jamiu Busari
- Faculty of health, medicine and life sciences, Maastricht University, Netherlands
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dos Santos RA, Snell L, Nunes MDPT. Evaluation of the impact of collaborative work by teams from the National Medical Residency Committee and the Brazilian Society of Neurosurgery. Retrospective and prospective study. SAO PAULO MED J 2016; 134:103-9. [PMID: 26465819 PMCID: PMC10496539 DOI: 10.1590/1516-3180.2015.9603001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/08/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Training for specialist physicians in Brazil can take place in different ways. Closer liaison between institutions providing this training and assessment and health care services may improve qualifications. This article analyzes the impact of closer links and joint work by teams from the National Medical Residency Committee (Comissão Nacional de Residência Médica, CNRM) and the Brazilian Society of Neurosurgery (Sociedade Brasileira de Neurocirurgia, SBN) towards evaluating these programs. DESIGN AND SETTING Retrospective and prospective study, conducted in a public university on a pilot project developed between CNRM and SBN for joint assessment of training programs across Brazil. METHODS The literature in the most relevant databases was reviewed. Documents and legislation produced by official government bodies were evaluated. Training locations were visited. Reports produced about residency programs were analyzed. RESULTS Only 26% of the programs were immediately approved. The joint assessments found problems relating to teaching and to functioning of clinical service in 35% of the programs. The distribution of programs in this country has a strong relationship with the Human Development Index (HDI) of the regions and is very similar to the distribution of specialists. CONCLUSION Closer collaboration between the SBN and CNRM had a positive impact on assessment of neurosurgery medical residency across the country. The low rates of direct approval have produced modifications and improvements to the quality of teaching and care (services). Closer links between the CNRM and other medical specialties have the capability to positively change the structure and function of specialty training in Brazil.
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Affiliation(s)
- Renato Antunes dos Santos
- MD. Doctoral student, Universidade de São Paulo (USP), São Paulo, Brazil. Psychiatrist at the University Hospital of Brasília, Universidade de Brasília (UnB), Brasília, Brazil. Visiting Professor at McGill’s Centre for Medical Education, Montreal-Canada.
| | - Linda Snell
- MD. Professor of Medicine, Core Member of McGill’s Centre for Medical Education and Senior Clinician Educator at the Royal College of Physicians and Surgeons of Canada.
| | - Maria do Patrocínio Tenório Nunes
- MD, PhD. Full and Associate Professor, Discipline of General Practice and Propaedeutics, Department of Internal Medicine, Universidade de São Paulo (USP), São Paulo, Brazil.
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Sun NZ, Gan R, Snell L, Dolmans D. Use of a Night Float System to Comply With Resident Duty Hours Restrictions: Perceptions of Workplace Changes and Their Effects on Professionalism. Acad Med 2016; 91:401-8. [PMID: 26488569 DOI: 10.1097/acm.0000000000000949] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Although some evidence suggests that resident duty hours reforms can lead to shift-worker mentality and loss of patient ownership, other evidence links long hours and fatigue to poor work performance and loss of empathy, suggesting the restrictions could positively affect professionalism. The authors explored perceived impacts of a 16-hour duty restriction, achieved using a night float (NF) system, on the workplace and professionalism. METHOD In 2013, the authors conducted semistructured interviews with 18 residents, 9 staff physicians, and 3 residency program directors in the McGill University core internal medicine residency program regarding their perceptions of the program's 12-hour shift-based NF system. Interviews were transcribed and coded for common themes. The authors used a descriptive qualitative methodology. RESULTS Participants viewed implementation of the NF system as leading to decreased physical and mental exhaustion, more consistent interaction with patients, and more stable team structure within shifts compared with the previous 24-hour call system. These workplace changes were felt to improve teamwork and patient ownership within shifts, quality of work performed, and empathy. Across shifts, however, more frequent sign-overs, stricter application of shift time boundaries, and loose integration between daytime and NF teams were perceived as leading to emergence of shift-worker mentality around sign-over. Perceptions of optimal patient ownership changed from the traditional single-physician-24/7 model to team-based shared ownership. CONCLUSIONS Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.
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Affiliation(s)
- Ning-Zi Sun
- N.-Z. Sun is assistant professor, Department of Medicine, and associate member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada. R. Gan is a community internist, Department of Medicine, Anna-Laberge Hospital, Chateauguay, Quebec, Canada. L. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada, and senior clinician-educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. D. Dolmans is professor and educational psychologist, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Larouche V, Snell L, Morris DV. Latrogenic Myxoedema Madness Following Radioactive Iodine Ablation for Graves’ Disease with a Concurrent Diagnosis of Primary Hyperaldosteronism. Can J Diabetes 2015. [DOI: 10.1016/j.jcjd.2015.09.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Larouche V, Snell L, Morris DV. Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism. Endocrinol Diabetes Metab Case Rep 2015; 2015:150087. [PMID: 26525086 PMCID: PMC4626654 DOI: 10.1530/edm-15-0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 08/11/2015] [Accepted: 09/02/2015] [Indexed: 11/26/2022] Open
Abstract
Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism.
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Affiliation(s)
- V Larouche
- Resident, Internal Medicine Residency Training Program, Department of Medicine, McGill University , Montreal, Quebec , Canada
| | - L Snell
- Division of General Internal Medicine, McGill University Health Centre , Montreal, Quebec, H4A 3J1 , Canada
| | - D V Morris
- Division of Endocrinology, McGill University Health Centre , Montreal, Quebec, H4A 3J1 , Canada
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Ellis J, Brown J, Smith C, Snell L, Capocci S, Ferro F, Ferreira J, Marshall N, Webster D, Johnson M, Lipman M. Influenza immunisation: knowledge and actions taken by UK HIV-positive adults. HIV Med 2015; 17:397-9. [DOI: 10.1111/hiv.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Ellis
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - J Brown
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
- Division of Medicine; University College London; London UK
| | - C Smith
- Department of Infection and Population Health; University College London; London UK
| | - L Snell
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - S Capocci
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - F Ferro
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - J Ferreira
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - N Marshall
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - D Webster
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - M Johnson
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - M Lipman
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
- Division of Medicine; University College London; London UK
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Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med 2015; 90:718-25. [PMID: 25785682 DOI: 10.1097/acm.0000000000000700] [Citation(s) in RCA: 437] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Recent calls to focus on identity formation in medicine propose that educators establish as a goal of medical education the support and guidance of students and residents as they develop their professional identity. Those entering medical school arrive with a personal identity formed since birth. As they proceed through the educational continuum, they successively develop the identity of a medical student, a resident, and a physician. Each individual's journey from layperson to skilled professional is unique and is affected by "who they are" at the beginning and "who they wish to become."Identity formation is a dynamic process achieved through socialization; it results in individuals joining the medical community of practice. Multiple factors within and outside of the educational system affect the formation of an individual's professional identity. Each learner reacts to different factors in her or his own fashion, with the anticipated outcome being the emergence of a professional identity. However, the inherent logic in the related processes of professional identity formation and socialization may be obscured by their complexity and the large number of factors involved.Drawing on the identity formation and socialization literature, as well as experience gained in teaching professionalism, the authors developed schematic representations of these processes. They adapted them to the medical context to guide educators as they initiate educational interventions, which aim to explicitly support professional identity formation and the ultimate goal of medical education-to ensure that medical students and residents come to "think, act, and feel like a physician."
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Affiliation(s)
- Richard L Cruess
- R.L. Cruess is professor of surgery and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S.R. Cruess is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. J.D. Boudreau is associate professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. L. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Y. Steinert is professor of family medicine and director, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Affiliation(s)
- Richard L Cruess
- Professor of surgery and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada; . Professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Associate professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Professor of family medicine and director, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Abstract
Teaching medical professionalism is a fundamental component of medical education. The objective is to ensure that students understand the nature of professionalism and its obligations and internalize the value system of the medical profession. The recent emergence of interest in the medical literature on professional identity formation gives reason to reexamine this objective. The unstated aim of teaching professionalism has been to ensure the development of practitioners who possess a professional identity. The teaching of medical professionalism therefore represents a means to an end.The principles of identity formation that have been articulated in educational psychology and other fields have recently been used to examine the process through which physicians acquire their professional identities. Socialization-with its complex networks of social interaction, role models and mentors, experiential learning, and explicit and tacit knowledge acquisition-influences each learner, causing them to gradually "think, act, and feel like a physician."The authors propose that a principal goal of medical education be the development of a professional identity and that educational strategies be developed to support this new objective. The explicit teaching of professionalism and emphasis on professional behaviors will remain important. However, expanding knowledge of identity formation in medicine and of socialization in the medical environment should lend greater logic and clarity to the educational activities devoted to ensuring that the medical practitioners of the future will possess and demonstrate the qualities of the "good physician."
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Affiliation(s)
- Richard L Cruess
- Dr. Richard Cruess is professor of surgery and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Sylvia Cruess is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Boudreau is associate professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Steinert is professor of family medicine and director, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, Snell L, Mangtani P, Adetifa I, Lalvani A, Abubakar I. Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ 2014; 349:g4643. [PMID: 25097193 PMCID: PMC4122754 DOI: 10.1136/bmj.g4643] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children. DESIGN Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts. SETTING Community congregate settings and households. INCLUSION CRITERIA Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays. DATA EXTRACTION Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis. RESULTS The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). CONCLUSIONS BCG protects against M tuberculosis infection as well as progression from infection to disease.Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- A Roy
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK
| | - M Eisenhut
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - R J Harris
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK
| | - L C Rodrigues
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Sridhar
- Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - S Habermann
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - L Snell
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - P Mangtani
- London School of Hygiene and Tropical Medicine, London, UK
| | - I Adetifa
- Medical Research Council, Fajara, Gambia
| | - A Lalvani
- Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - I Abubakar
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, University College London, London, UK
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Abstract
BACKGROUND Faculty development is often local and international experiences are usually limited to conferences and courses. In 2006, five schools across the globe decided to enhance international faculty experiences through an exciting new collaboration: the International Medical Educators Exchange (IMEX) initiative. METHOD Twice a year, one of the five schools in the Netherlands, Canada, Sweden and the UK organizes a week of faculty development activities for experienced medical educators from each school, including group discussions, short presentations, observations and active engagement in local education, one-on-one meetings with local faculty members, and many opportunities for in-depth discussion. We administered a survey to evaluate the impact of this international exchange. RESULTS By August 2013, 31 IMEX scholars had attended at least one of the 14 site visits held; most of them (29) had attended 3-5 site visits. Responding IMEX alumni (55%, N = 16) felt that their experiences impacted their personal competence and international orientation, and to some extent their career, their daily work and their institution. Most features of the IMEX program were valued as highly important and highly successful. DISCUSSION IMEX has established itself as an important additional faculty development opportunity for those medical educators who wish to develop and pursue a career in education.
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Bandiera G, Leblanc C, Regehr G, Snell L, Frank JR, Sherbino J. Education scholarship in emergency medicine part 2: supporting and developing scholars. CAN J EMERG MED 2014; 16 Suppl 1:S6-S12. [PMID: 25027789 DOI: 10.2310/8000.2014.141455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Emergency medicine (EM) is defined, in part, by clinical excellence across an immense breadth of content and the provision of exemplary bedside teaching to a wide variety of learners. The specialty is also well-suited to a number of emerging areas of education scholarship, particularly in relation to team-based learning, clinical reasoning, acute care response, and simulation-based teaching. The success of EM education scholarship will be predicated on systematic, collective attention to providing the infrastructure for this to occur. Specifically, as a new generation of emergency physicians prepares for education careers, academic organizations need to develop means not only to identify potential scholars but also to mentor, support, and encourage their careers. This paper summarizes the supporting literature and presents related recommendations from a 2013 consensus conference on EM education scholarship led by the Academic Section of the Canadian Association of Emergency Physicians.
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Sherbino J, Frank JR, Snell L. Defining the key roles and competencies of the clinician-educator of the 21st century: a national mixed-methods study. Acad Med 2014; 89:783-789. [PMID: 24667507 DOI: 10.1097/acm.0000000000000217] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine a consensus definition of a clinician-educator and the related domains of competence. METHOD During September 2010 to March 2011, the authors conducted a two-phase mixed-methods national study in Canada using (1) focus groups of deans of medicine and directors of medical education centers to define the attributes, domains of competence, and core competencies of clinician-educators using a grounded theory analysis, and (2) a survey of 1,130 deans, academic chairs, and residency program directors to validate the focus group results. RESULTS The 22 focus group participants described being active in clinical practice, applying theory to practice, and engaging in education scholarship-but not holding a particular administrative position-as essential attributes of clinician-educators. Program directors accounted for 68% of the 350 survey respondents, academic chairs for 19%, and deans for 13% (response rate: 31%). Among respondents, 85% endorsed the need for physicians with advanced training in medical education to serve as educational consultants. Domains of clinician-educator competence endorsed by >85% of respondents as important or very important were assessment, communication, curriculum development, education theory, leadership, scholarship, and teaching. With regard to training requirements, 55% endorsed a master's degree in education as effective preparation, whereas 39% considered faculty development programs effective. CONCLUSIONS On the basis of this study's findings, the authors defined a clinician-educator as a clinician active in health professional practice who applies theory to education practice, engages in education scholarship, and serves as a consultant to other health professionals on education issues.
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Affiliation(s)
- Jonathan Sherbino
- Dr. Sherbino is associate professor of medicine and director of continuing professional education, Division of Emergency Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, and clinician-educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. Dr. Frank is associate professor and director of educational research and development, Department of Emergency Medicine, University of Ottawa, and director, Specialty Education, Strategy, and Standards, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. Dr. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada, and senior clinician-educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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