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Abstract
Inequitable variation in physician effort and resource use is revealed.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Canada
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Ellaway RH, O'Brien BC, Sherbino J, Maggio LA, Artino AR, Nimmon L, Park YS, Young M, Thomas A. Is There a Problem With Evidence in Health Professions Education? Acad Med 2024:00001888-990000000-00830. [PMID: 38574241 DOI: 10.1097/acm.0000000000005730] [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: 04/06/2024]
Abstract
ABSTRACT What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume the knowledge produced as evidence might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris' learning loops framework.From a single-loop perspective ("How are we doing?"), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective ("Could we do better?") suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more systemwide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective ("Are we asking the right questions?") highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations, as well as influencing decisions.
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Affiliation(s)
- Rachel H Ellaway
- R.H. Ellaway is professor, Department of Community Health Sciences, and director, Office of Health and Medical Education Scholarship, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: orcid.org/0000-0002-3759-6624
| | - Bridget C O'Brien
- B.C. O'Brien is professor, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: orcid.org/0000-0001-9591-5243
| | - Jonathan Sherbino
- J. Sherbino is professor, Department of Medicine, and assistant dean of health professions education research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lauren A Maggio
- L.A. Maggio is professor, Department of Medicine and Health Professions Education, Uniformed Services University, Bethesda, Maryland; ORCID: orcid.org/0000-0002-2997-6133
| | - Anthony R Artino
- A.R. Artino Jr is professor, Department of Health, Human Function, and Rehabilitation Sciences, and associate dean for educational research, School of Medicine and Health Sciences, George Washington University, Washington, DC; ORCID: orcid.org/0000-0003-2661-7853
| | - Laura Nimmon
- L. Nimmon is scientist, Centre for Health Education Scholarship, and associate professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: orcid.org/0000-0002-7291-603X
| | - Yoon Soo Park
- Y.S. Park is Ilene B. Harris Endowed Professor and head, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: orcid.org/0000-0001-8583-4335
| | - Meredith Young
- M. Young is associate professor, Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; ORCID: orcid.org/0000-0002-2036-2119
| | - Aliki Thomas
- A. Thomas is associate professor, School of Physical and Occupational Therapy and Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; ORCID: orcid.org/0000-0001-9807-6609
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Jain NR, Nimmon L, Bulk LY. How to … bring a JEDI (justice, equity, diversity and inclusion) lens to your research. Clin Teach 2024; 21:e13660. [PMID: 37874114 DOI: 10.1111/tct.13660] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Neera R Jain
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
| | - Laura Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Laura Y Bulk
- Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Nimmon L, Stenlund S. Interpersonal energy: New and bold directions in palliative care health professions education research. Palliat Med 2024; 38:166-169. [PMID: 38268060 PMCID: PMC10865756 DOI: 10.1177/02692163231219949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Laura Nimmon
- The University of British Columbia, Faculty of Medicine, Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Vancouver, BC, Canada
| | - Säde Stenlund
- The University of British Columbia, Faculty of Medicine, School of Population and Public Health, Vancouver, BC, Canada
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Macdonald GG, Leese J, Hoens AM, Kerr S, Lum W, Gulka L, Nimmon L, Li LC. A patienthood that transcends the patient: An analysis of patient research partners' narratives of involvement in a Canadian arthritis patient advisory board. J Health Serv Res Policy 2024; 29:22-30. [PMID: 37632271 PMCID: PMC10729530 DOI: 10.1177/13558196231197288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Incorporating the perspectives of patients and public into the conduct of research has the potential to make scientific research more democratic. This paper explores how being a patient partner on an arthritis patient advisory board shapes the patienthood of a person living with arthritis. METHODS An analysis was undertaken of the narratives of 22 patient research partners interviewed about their experiences on the Arthritis Patient Advisory Board (APAB), based in Vancouver, Canada. RESULTS Participants' motivations to become involved in APAB stemmed largely from their desire to change their relationship with their condition. APAB was a living collective project in which participants invested their hope, both for their own lives as patients and for others with the disease. CONCLUSIONS Our findings highlight how the journeys of patient partners connect and integrate seemingly disparate conceptions of what it means to be a patient. One's experience as a clinical 'patient' transforms into the broader notion of civic patienthood.
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Affiliation(s)
- Graham G Macdonald
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila Kerr
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Wendy Lum
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Lianne Gulka
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Mortaz Hejri S, Yousefi-Nooraie R, Young M, Nimmon L. Social Network Analysis in Medical Education. Acad Med 2023; 98:1454. [PMID: 36972125 DOI: 10.1097/acm.0000000000005218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
| | - Reza Yousefi-Nooraie
- assistant professor, Department of Public Health Sciences, University of Rochester
| | - Meredith Young
- associate professor, Institute of Health Sciences Education, McGill University
| | - Laura Nimmon
- scientist, Center for Health Education Scholarship, University of British Columbia
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Mortaz Hejri S, Yousefi-Nooraie R, Young M, Nimmon L. Social Network Analysis in Medical Education. Acad Med 2023; 98:1454. [PMID: 38029312 DOI: 10.1097/01.acm.0000997316.37970.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Sara Mortaz Hejri
- assistant professor, Department of Public Health Sciences, University of Rochester
| | - Reza Yousefi-Nooraie
- assistant professor, Department of Public Health Sciences, University of Rochester
| | - Meredith Young
- associate professor, Institute of Health Sciences Education, McGill University
| | - Laura Nimmon
- scientist, Center for Health Education Scholarship, University of British Columbia
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Abstract
Background While immigrant international medical graduates (I-IMGs) contribute significantly to the physician workforce in North America, researchers have highlighted the myriad of ways sociocultural challenges can negatively impact their success. Conceptual understanding that unpacks the complex processes of how I-IMGs effectively manage sociocultural challenges is relatively sparse. In addressing this critical knowledge gap, this study explored how I-IMGs successfully manage sociocultural differences as postgraduate residents. Methods We interviewed eleven I-IMGs from diverse backgrounds who are in training or recently trained in a distributed multi-site postgraduate medical training program in Canada. We used the lens of sociocultural learning theory to gain insights into the processes of how I-IMGs describe successful management of sociocultural challenges. Results The overarching storyline of participants emphasized that their experiences were humbling as they grappled with inner struggles, emotions, and vulnerabilities while embracing the ambiguity of not knowing what was expected of them. The following dominant themes from their narratives encapsulate the salient processes for how I-IMGs conceptualize and successfully manage sociocultural challenges: 1) successfully navigating transitions; 2) resisting or altering elements of prior sociocultural norms while embracing the new; 3) living and being in community and having supportive social networks; 4) risk taking to self-advocate and actively seek help. Conclusion Understanding the strengths and positive strategies for how I-IMGs interface with complex sociocultural challenges has application for medical training institutions. Our insights suggest the need for practical, effective, and continuous assistance within I-IMG training programs to better support future trainees dealing with sociocultural challenges.
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Affiliation(s)
- Azaria Marthyman
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
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Hu A, MacDonald G, Jain NR, Nimmon L. Exploring Mistreatment of Medical Students by Patients: A Qualitative Study. Acad Med 2023; 98:1164-1172. [PMID: 37343166 DOI: 10.1097/acm.0000000000005304] [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: 06/23/2023]
Abstract
PURPOSE Mistreatment of medical students by patients has not been qualitatively explored in the literature. The authors sought to develop a rich understanding of the impact and consequences of medical students' experiences of mistreatment by patients. METHOD This exploratory descriptive qualitative study was conducted at a large Canadian medical school from April-November 2020. Fourteen medical students were recruited for semistructured interviews. Students were asked about their experiences of mistreatment by patients and how they responded to these experiences. Transcripts were thematically analyzed using an inductive approach, and the authors interwove critical theory into their conceptual interpretation of the data. RESULTS Fourteen medical students (median age = 25.5; 10, 71.4% self-reported male; 12, 85.7% self-identified visible minority) participated in this study. Twelve (85.7%) participants had personally experienced patient mistreatment and 2 (14.3%) had witnessed mistreatment of another learner. Medical students described being mistreated by patients based on their gender and race/ethnicity. Although all participants were aware of the institution's official mechanism for reporting mistreatment, none filed an official report. Some participants described turning to their formal (faculty members and residents) and informal (family and friends) social supports to cope with mistreatment by patients. Participants described resenting and avoiding patients who mistreated them and struggling to maintain empathy for, openness to, and overall ethical engagement with discriminatory patients. Students often described a need to be stoic toward their experiences of mistreatment by patients, often seeing it as their "professional duty" to overcome and thus suppress the negative emotions associated with mistreatment. CONCLUSIONS Medical schools must proactively develop multifaceted mechanisms to support medical students who experience mistreatment by patients. Future research can further uncover this neglected dimension of the hidden curriculum to better develop responses to incidents of mistreatment that commit to antiracism, antisexism, patient care, and learner care.
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Affiliation(s)
- Amanda Hu
- A. Hu is clinical associate professor, Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-1292-1582
| | - Graham MacDonald
- G. MacDonald is a PhD candidate, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neera R Jain
- N.R. Jain is senior lecturer, Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; ORCID: https://orcid.org/0000-0002-2931-2740
| | - Laura Nimmon
- L. Nimmon is a scientist, Centre for Health Education Scholarship, and associate professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ghanouni P, Inouye K, Gowan C, Hartford W, McKinnon A, McQuitty S, Backman CL, Li LC, Nimmon L. Beyond dyadic communication: Network of communication in inflammatory arthritis teams. Chronic Illn 2023; 19:591-604. [PMID: 35635126 DOI: 10.1177/17423953221102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore how communication is perceived and care is negotiated amongst IA healthcare teams by drawing on the perspectives of each team member. METHOD This analysis drew on data from an ongoing three-year study exploring team-based IA care. We interviewed 11 participants including two men with IA and their family care providers and healthcare providers. We used a three-staged analytic process and integrated broad tenets of social network theory to understand the relational dimensions of team members experiences. RESULT Analysis revealed three themes regarding communication and care: (1) seeking/sharing information, (2) striving to coordinate unified care, and (3) providing patients a voice. DISCUSSION This study emphasizes the importance of understanding team dynamics beyond the dyad of patient and care provider. Negotiating power and decision-making in IA care is a dynamic process involving shifting levels of responsibility amongst a care team. Communication-based strategies that extend dyadic interactions may enhance teamwork and health outcomes in chronic conditions.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Kristy Inouye
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Chelsey Gowan
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Wendy Hartford
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Annette McKinnon
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, Canada
| | - Shanon McQuitty
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, Canada
| | - Catherine L Backman
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupation Science and Occupational Therapy, University of British Columbia, Canada
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Steinert Y, Nimmon L, Buckley H. When I Don't Say … 'Patients'. Med Educ 2023; 57:792-794. [PMID: 37132341 DOI: 10.1111/medu.15107] [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] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023]
Abstract
In the latest "When I Say…" paper, Steinert et al. outline the consequences of not saying "patients"
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Affiliation(s)
- Yvonne Steinert
- Institute of Health Sciences Education and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship and Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Buckley
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Jarus T, Krupa T, Mayer Y, Battalova A, Bulk L, Lee M, Nimmon L, Roberts E. Negotiating legitimacy and belonging: Disabled students' and practitioners' experience. Med Educ 2023; 57:535-547. [PMID: 36516022 DOI: 10.1111/medu.15002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 05/12/2023]
Abstract
INTRODUCTION People with disabilities are underrepresented in health professions education and practice. Barriers for inclusion include stigma, disabling discourses, discriminatory programme design and oppressive interactions. Current understandings of this topic remain descriptive and fragmented. Existing research often includes only one profession, excludes particular types of disability and focuses on one aspect of the career journey. To expand understanding, we examined the recurrent forms of social relations that underlie the participation of disabled individuals in learning and practice contexts across five health professions. METHOD We analysed 124 interviews with 56 disabled health practitioners and students. Participants were interviewed up to three times over 1.5 years. Using constructivist grounded theory, authors used a staged analytic approach that resulted in higher level conceptual categories that advance interpretations of social processes. Finally, the authors compared and integrated findings among students and practitioners. RESULTS Participants experience challenges to their sense of legitimacy and belonging as health providers. They describe tensions within the health education and practice between the commitment to inclusion and the day-to-day realities experienced by disabled participants. We identified six distinct, but related, conditions underlying these tensions: (i) validity and transparency of competencies' evaluation; (ii) the social and physical contexts; (iii) integration of inclusive practices; (iv) boundaries between personal and professional identities; (v) vulnerability to authority figures; and (vi) dynamic person-level factors. DISCUSSION If we are to commit to health practitioners and students with disabilities experiencing an overall sense of legitimacy and belonging, priority needs to be given to system-level practices and policies to support inclusion. Attention to the day-to-day marginalisation of students and practitioners with disabilities in the health professions is also needed. Additionally, inclusive and transparent delineation of competency requirements is needed. Finally, educational actions are needed to increase understanding of disability in the health professions, with particular attention to promoting social relations that foster collective responsibility for supporting inclusion.
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Affiliation(s)
- Tal Jarus
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Terry Krupa
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Yael Mayer
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Alfiya Battalova
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laura Bulk
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- The Centre for Accessibility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Lee
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Health Education Scholarship, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Earllene Roberts
- Disability Resource Centre and AVP Students, University of British Columbia, Kelowna, British Columbia, Canada
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Macdonald G, Asgarova S, Hartford W, Berger M, Cristancho S, Nimmon L. What do you mean, 'negotiating?': Patient, physician, and healthcare professional experiences of navigating hierarchy in networks of interprofessional care. J Interprof Care 2023:1-12. [PMID: 37161739 DOI: 10.1080/13561820.2023.2203722] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one's perspective is heavily influenced by one's position in the workplace division of labor and professional hierarchy. We conclude that "negotiation" is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of "negotiation" may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.
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Affiliation(s)
- Graham Macdonald
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Sevinj Asgarova
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Wendy Hartford
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Mary Berger
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Sayra Cristancho
- Centre for Education Research & Innovation, University of Western Ontario, London, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
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Mayer Y, Shalev M, Nimmon L, Krupa T, Bulk LY, Battalova A, Lee M, Jarus T. Social support experiences of students and clinicians with disabilities in health professions. Adv Health Sci Educ Theory Pract 2023; 28:477-497. [PMID: 36315305 DOI: 10.1007/s10459-022-10169-9] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Social support is vital in promoting the health, well-being, and performance of students and clinicians in health professions. Health settings' demanding and competitive nature imposes unique challenges on students and clinicians with disabilities. This paper aims to explore the trajectories and experiences of social support interactions amongst students and clinicians with disabilities in health professions. In a qualitative longitudinal study, 124 in-depth semi-structured interviews were conducted with 27 health students and 29 health clinicians with disabilities. Data analysis was informed by grounded theory as an adapted analytic approach involving constant comparisons. A few main characteristics of social support and trajectories in which social support is negotiated emerged from the data: (1) The need to be accepted and not questioned when asking for support, (2) Support interactions that do not heighten otherness, (3) Failure to acknowledge the challenges, (4) Interactions that support the process of disclosure (5) Interactions that allow mobilization of social support without strain or an extra effort. These findings have important implications for designing more supportive health professions, educational programs, and workplaces for people living with disabilities.
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Affiliation(s)
- Yael Mayer
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Michal Shalev
- Department of Occupational Therapy, Ono Academic College, Kiryat Ono, Israel
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Terry Krupa
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Laura Yvonne Bulk
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alfiya Battalova
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Lee
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tal Jarus
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Chin-Yee B, Nimmon L, Veen M. Technical Difficulties: Teaching Critical Philosophical Orientations toward Technology. Teach Learn Med 2023; 35:240-249. [PMID: 36286229 DOI: 10.1080/10401334.2022.2130334] [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: 03/05/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Issue: Technological innovation is accelerating, creating less time to reflect on the impact new technologies will have on the medical profession. Modern technologies are becoming increasingly embedded in routine medical practice with far-reaching impacts on the patient-physician relationship and the very essence of the health professions. These impacts are often difficult to predict and can create unintended consequences for medical education. This article is driven by a main question: How do we prepare trainees to critically assess technologies that we cannot foresee and effectively use technology to support equitable and compassionate care? Evidence: We translate insights from the philosophy of technology into a proposal for integrating critical technical consciousness in medical curricula. We identify three areas required to develop critical consciousness with regard to emerging technologies. The first area is technical literacy, which involves not just knowing how to use technology, but also understanding its limitations and appropriate contexts for use. The second area is the ability to assess the social impact of technology. This practice requires understanding that while technification creates new possibilities it can also have adverse, unintended consequences. The third area is critical reflection on the relationship between 'the human' and 'the technical' as it relates to the values of the medical profession and professional identity formation. Human and technology are two sides of the same coin; therefore, thinking critically about technology also forces us to think about what we consider 'the human side of medicine'. Implications: Critical technical consciousness can be fostered through an educational program underpinned by the recognition that, although technological innovation can create new possibilities for healing, technology is never neutral. Rather, it is imperative to emphasize that technology is interwoven with the social fabric that is essential to healing. Like medication, technology can be both potion and poison.
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Affiliation(s)
- Benjamin Chin-Yee
- Schulich School of Medicine and Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario Veen
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
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Singh G, Sawatzky B, Nimmon L, Mortenson WB. Perceived eHealth literacy and health literacy among people with spinal cord injury: A cross-sectional study. J Spinal Cord Med 2023; 46:118-125. [PMID: 35254229 PMCID: PMC9897799 DOI: 10.1080/10790268.2021.1963140] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This purpose of this research was to (1) to evaluate eHealth and general health literacy levels among individuals with spinal cord injury (SCI) and (2) to identify relationships between eHealth literacy, general health literacy, and various sociodemographic factors. DESIGN Cross-sectional. SETTING The study was conducted in the community setting. PARTICIPANTS As part of a larger study, a total of 50 community-dwelling individuals with SCI were recruited. INTERVENTIONS n/a. OUTCOME MEASURES Quantitative online survey data were collected on participants' sociodemographic characteristics, eHealth literacy (using the eHealth Literacy Scale), general health literacy (using the Brief Health Literacy Screening Tool). RESULTS The average age of participants was 49 years old; 25 participants were male and 25 were female. A total of 39 participants experienced traumatic SCI and 11 participants experienced non-traumatic SCI. Participants demonstrated moderate levels of eHealth literacy (31.6 out of 40) and general health literacy (17.6 out of 20). A significant, positive correlation was found between eHealth literacy and general health literacy. Significant, positive correlations were found between general health literacy and sociodemographic factors, including income and education. A significant, negative correlation was found between general health literacy and time since injury. CONCLUSION No previous studies we are aware of have evaluated perceived eHealth literacy and general health literacy among people with SCI. This study demonstrated the diverse range of eHealth literacy levels in SCI populations and how this, and other factors, may impact an individual's ability to self-manage and adopt to eHealth technologies.
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Affiliation(s)
- Gurkaran Singh
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, Canada
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Nazerali-Maitland A, Nimmon L, Douglas C. Challenges with international medical graduate selection: finding positive attributes predictive of success in family medicine residency. BMC Prim Care 2022; 23:256. [PMID: 36175829 PMCID: PMC9520825 DOI: 10.1186/s12875-022-01861-1] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
Background Criteria to select residents most likely to succeed, other than proficiency of their medical knowledge, is a challenge facing preceptors. International Medical Graduates (IMGs) play an integral role in mitigating the high demand for family medicine physicians across Canada. Thus, selecting IMG candidates that have a high probability of succeeding in Canadian educational settings is important. The purpose of this study is to elucidate qualitative attributes that positively correspond to success in residency, to ultimately assist in the selection of IMG residents most likely to achieve family medicine residency. Methods Interviews of 13 family medicine preceptors from some of the largest IMG training sites in Canada were performed to collect original data. The data was coded in tandem sequences using standardized coding techniques to increase robustness of results. Results The identified positive predictors of an IMG residents’ success are: presence of a positive attitude, proficient communication skills, high level of clinical knowledge, trainability. Conclusions The results provide adequate guidelines to assist in selection of IMG residents. Canada is a unique sociocultural setting where standardized selection methods of IMGs have not been employed. By selecting IMG residents who possess these attributes upon inception of residency, benefits of instruction will be maximized and result in residents developing increased aptitudes for patient care.
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Stasiuk S, Hubinette M, Nimmon L. The ways social networks shape reflection on early significant clinical experiences in medical school. Can Med Educ J 2022; 13:28-38. [PMID: 36310907 PMCID: PMC9588180 DOI: 10.36834/cmej.73422] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical curricula are increasingly providing opportunities to guide reflection for medical students. However, educational approaches are often limited to formalized classroom initiatives where reflection is prescriptive and measurable. There is paucity of literature that explores the personal ways students may experience authentic reflection outside of curricular time. The purpose of this study was to understand how social networks might shape dimensions of reflection. METHODS This study employed a qualitative social network analysis approach with a core sample of seven first year undergraduate medical students who described their relationships with 61 individuals in their networks. Data consisted of participant generated sociograms and individual semi-structured interviews. RESULTS Many learners struggled to find significant ways to involve their social networks outside of medicine in their new educational experiences. It appeared that some medical students began in-grouping, becoming more socially exclusive. Interestingly, participants emphasized how curricular opportunities such as reflective portfolio sessions were useful for capturing a diversity of perspectives. CONCLUSIONS Our study is one of the first to characterize the social networks inside and outside of medical school that students utilize to discuss and reflect on early significant clinical experiences. Recent commentary in the literature has suggested reflection is diverse and personal in nature and our study offers empirical evidence to demonstrate this. Our insights emphasize the importance of moving from an instrumental approach to an authentic socially situated approach if we wish to cultivate reflective lifelong learning.
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Affiliation(s)
- Samantha Stasiuk
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Maria Hubinette
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
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van Enk A, Nimmon L, Buckley H, Cuncic C, Canfield C, Veerapen K, Holmes C. Presenting cases in front of patients: implications for a key medical education genre. Adv Health Sci Educ Theory Pract 2022; 27:621-643. [PMID: 35366717 DOI: 10.1007/s10459-022-10105-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
Case presentations have been researched as both an important form of intra/inter-professional communication, where a patient's clinical information is shared among health professionals involved in their care, and an equally key discursive tool in education, where learners independently assess a patient and present the case to their preceptor and/or care team. But what happens to the case presentation, a genre that governs physician (and learner) talk about patients, when it is used in patients' presence? While they were commonly used at the bedside in the past, case presentations today are more commonly performed in hallways or conference rooms, out of patient earshot. This paper draws on interview data from a study involving patient-present case presentations in a medical education setting. Our analysis asks what participants' metageneric comments about the encounter can teach us about the genre, about patient involvement in medical education, and about linguistic adaptations to the genre that the profession might make to support patient involvement.
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Affiliation(s)
- Anneke van Enk
- Department of Innovation in Medical Education (DIME), Faculty of Medicine, University of Ottawa, 850 ch. Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Laura Nimmon
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Heather Buckley
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cary Cuncic
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carolyn Canfield
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kiran Veerapen
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cheryl Holmes
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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20
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Leese J, Zhu S, Townsend AF, Backman CL, Nimmon L, Li LC. Ethical issues experienced by persons with rheumatoid arthritis in a wearable-enabled physical activity intervention study. Health Expect 2022; 25:1418-1431. [PMID: 35303379 PMCID: PMC9327860 DOI: 10.1111/hex.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Using wearables to self‐monitor physical activity is a promising approach to support arthritis self‐management. Little is known, however, about the context in which ethical issues may be experienced when using a wearable in self‐management. We used a relational ethics lens to better understand how persons with rheumatoid arthritis (RA) experience their use of a wearable as part of a physical activity counselling intervention study involving a physiotherapist (PT). Methods Constructivist grounded theory and a relational ethics lens guided the study design. This conceptual framework drew attention to benefits, downsides and tensions experienced in a context of relational settings (micro and macro) in which participants live. Fourteen initial and eleven follow‐up interviews took place with persons with RA in British Columbia, Canada, following participation in a wearable‐enabled intervention study. Results We created three main categories, exploring how experiences of benefits, downsides and tensions when using the intervention intertwined with shared moral values placed on self‐control, trustworthiness, independence and productivity: (1) For some, using a wearable helped to ‘do something right’ by taking more control over reaching physical activity goals. Some, however, felt ambivalent, believing both there was nothing more they could do and that they had not done enough to reach their goal; (2) Some participants described how sharing wearable data supported and challenged mutual trustworthiness in their relationship with the PT; (3) For some, using a wearable affirmed or challenged their sense of self‐respect as an independent and productive person. Conclusion Participants in this study reported that using a wearable could support and challenge their arthritis self‐management. Constructing moral identity, with qualities of self‐control, trustworthiness, independence and productivity, within the relational settings in which participants live, was integral to ethical issues encountered. This study is a key step to advance understanding of ethical issues of using a wearable as an adjunct for engaging in physical activity from a patient's perspective. Patient or Public Contribution Perspectives of persons with arthritis (mostly members of Arthritis Research Canada's Arthritis Patient Advisory Board) were sought to shape the research question and interpretations throughout data analysis.
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Affiliation(s)
- Jenny Leese
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Siyi Zhu
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Rehabilitation Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anne F Townsend
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Health Research, Health Innovation One, Lancaster University, Lancaster, UK
| | - Catherine L Backman
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Centre for Health Education Scholarship, P.A. Woodward Instructional Resources Centre (IRC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Cheema B, Li M, Ho D, Amari E, Buckley H, Canfield C, Cuncic C, Nimmon L, Van Enk A, Veerapen K, Wisener KM, Holmes CL. Patient-present teaching in the clinic: Effect on agency and professional behaviour. Med Educ 2022; 56:270-279. [PMID: 34433224 PMCID: PMC9292717 DOI: 10.1111/medu.14623] [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] [Received: 05/11/2021] [Revised: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND/PURPOSE Although much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient-centred and respectful behaviours in a patient-present learning environment. METHODS We conducted this study in an ambulatory internal medicine clinic using 'patient-present' clinic visits. All case presentations occurred in examination rooms with the patient. We invited participants (attending physicians, undergraduate and postgraduate learners, patients and family members) to participate in semistructured interviews after each clinic visit to explore the impact of the patient-present learning environment. We recruited 34 participants in the study; 10 attending physicians, 12 learners, 10 patients and 2 family members. We analysed the data deductively using a conceptual framework of agency. SUMMARY/RESULTS We identified three major insights: (1) Patients felt engaged and valued opportunities to be heard; (2) Attending physicians and learners reported a more respectful learning environment and a positive though challenging teaching and learning experience; and (3) A hidden curriculum emerged in a performance-based view of professional behaviour. CONCLUSIONS Patient-present teaching engaged patients and enhanced their agency by recasting the patient as the central focus within the healthcare encounter. We identified a tension between performing and learning. This study adds new insights to the concept of patient centredness and professionalism from the perspectives of all participants in the medical teaching and learning environment.
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Affiliation(s)
- Bavenjit Cheema
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Meredith Li
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Daniel Ho
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Erica Amari
- Office of Faculty Development, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Heather Buckley
- Department of Family Practice, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Carolyn Canfield
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cary Cuncic
- Division of General Internal Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Nimmon
- Centre for Health Education Scholarship and Department of Occupational Science and Occupational TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Anneke Van Enk
- Department for Innovation in Medical EducationUniversity of OttawaOttawaOntarioCanada
| | - Kiran Veerapen
- Office of Faculty Development and Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Katherine M. Wisener
- Office of Faculty Development, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cheryl Lynn Holmes
- Undergraduate Medical Education and the Division of Critical Care, Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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22
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Gupta S, Panchal P, Sadatsafavi M, Ghanouni P, Sin D, Pakhale S, To T, Zafari Z, Nimmon L. A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study. Addict Sci Clin Pract 2022; 17:1. [PMID: 34991699 PMCID: PMC8734321 DOI: 10.1186/s13722-021-00283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/03/2021] [Indexed: 01/24/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit. Methods We recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis. Results Stopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire. Conclusions We developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00283-1.
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Affiliation(s)
- Samir Gupta
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Division of Respirology, Department of Medicine, St. Michael's Hospital, Suite 6044, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Puru Panchal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Parisa Ghanouni
- Faculty of Health, School of Occupational Therapy, Halifax, NS, Canada
| | - Don Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Smita Pakhale
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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23
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Singh G, Nimmon L, Sawatzky B, Ben Mortenson W. Barriers and Facilitators to eHealth Technology Use Among Community-Dwelling Individuals With Spinal Cord Injury: A Qualitative Study. Top Spinal Cord Inj Rehabil 2022; 28:196-204. [PMID: 35521060 PMCID: PMC9009201 DOI: 10.46292/sci21-00016] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background As eHealth technologies become a more prevalent means to access care and self-manage health, it is important to identify the unique facilitators and barriers to their use. Few studies have evaluated the use or potential use of eHealth technologies in spinal cord injury (SCI) populations. Objectives The primary objective of this study was to explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with SCI. Methods A qualitative descriptive study was conducted. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis. Results Our analysis identified three barriers to engagement with eHealth technologies, including (1) overcoming a digital divide to comprehending and utilizing eHealth technologies, (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Our analysis also identified three facilitators to using eHealth technologies, including (1) having previous successful experiences with eHealth technologies, (2) being able to use voice activation features, and (3) being able to interact in an online community network. Conclusion By exploring barriers and facilitators to eHealth technology use, these findings may have a short-term impact on informing researchers and clinicians on important factors affecting engagement of individuals with SCI with telemedicine, mobile, and web applications (apps) and a long-term impact on informing future development of eHealth interventions and tools among chronic disease populations.
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Affiliation(s)
- Gurkaran Singh
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,International Collaboration on Repair Discoveries, Vancouver, Canada
,G.F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, Canada
,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - W. Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,International Collaboration on Repair Discoveries, Vancouver, Canada
,G.F. Strong Rehabilitation Centre, Vancouver, Canada
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24
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Hartford W, Backman CL, Li LC, McQuitty S, McKinnon A, Kherani R, Nimmon L. Networks of Care: A Social Network Perspective of Distributed Multidisciplinary Care for People With Inflammatory Arthritis. ACR Open Rheumatol 2022; 4:40-56. [PMID: 34687173 PMCID: PMC8754010 DOI: 10.1002/acr2.11349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore how multidisciplinary inflammatory arthritis (IA) care is accessed from the perspectives of people with IA and their health care network members. METHODS In this phenomenological study, we used purposive sampling to recruit patients with IA for less than 5 years and age of more than 18 years who spoke English and reported two or more health care network members. We conducted one-to-one interviews with patients and their health care network members. Data were analysed using a social network perspective. RESULTS We interviewed 14 patient participants and 19 health care network members comprising health care providers and informal caregivers. An overarching theme of whole person (holistic) IA care was identified, with the following two broad multifaceted subthemes: 1) connected networks and whole person care and 2) network disconnect and disrupted access to care. The first subtheme notes how access to health care providers and social support was fundamental to holistic care and how care was facilitated by communication pathways that promoted care. The second subtheme illustrates impediments to access, including appointment time pressures, inadequacies in communication delivery modes, and family physicians' unfamiliarity with rheumatology care. Inequities in care were also reported. CONCLUSION Participants shared a goal of whole person care. Although health care networks included multiple disciplines, they did not always provide coordinated multidisciplinary care. Communication modes, linkages between network actors, and organizational structures governed the flow of information and resources through networks and influenced access to equitable whole person care. The development of health care system structures to support the flow of information and resource transfer is needed to promote network collaboration and equitable access to resources.
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Affiliation(s)
- Wendy Hartford
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Linda C. Li
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | | | - Raheem Kherani
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Nimmon
- University of British ColumbiaVancouverBritish ColumbiaCanada
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25
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Nimmon L, Atherley A. Qualitative ego networks in health professions education: Capturing the self in relation to others. Med Educ 2022; 56:71-81. [PMID: 34490649 DOI: 10.1111/medu.14663] [Citation(s) in RCA: 4] [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] [Received: 02/14/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Our very sense of self emerges through interactions with others. As part of this State of the Science series on Self, Society, and Situation, we introduce a qualitative ego network research approach. This research approach offers insights into the self's (the ego's) interpretation of and relation to named others in the social network in question. PURPOSE Visual mapping of participants' social networks is gaining traction, yet this research approach has received no focused attention in the health professions education (HPE) literature. A qualitative ego network approach is a compelling research approach because it uniquely maps participants' perceptions of the complex social world they are embedded in. Although many methodologies can explore participants' social world, ego networks can enhance expression of tacit knowledge of one's social environment and encourage reflection. This approach, combined with other qualitative data, can also reveal hidden relational data that the researcher may not observe or consider. To demonstrate its value as a visual methodology, we will showcase two examples of qualitative ego network studies. We then balance the paper with some critical reflections of this research approach. CONCLUSIONS A qualitative ego network approach holds potential for deepening understanding of the self in relation to society and situation in future HPE research. We look forward to intentional, impactful and invigorated research using a qualitative ego network approach as we tackle unknowns about how self and society in specific HPE situations interact.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Anique Atherley
- Academy of Teaching and Learning, Ross University School of Medicine, Barbados Campus, Bridgetown, Barbados
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26
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Davis AM, Wong R, Steinhart K, Cruz L, Cudmore D, Dwyer T, Li L, Marks P, McGlasson R, Urquhart N, Wilson JA, Nimmon L, Ogilvie-Harris D, Chahal J. Development of an intervention to manage knee osteoarthritis risk and symptoms following anterior cruciate ligament injury. Osteoarthritis Cartilage 2021; 29:1654-1665. [PMID: 34597801 DOI: 10.1016/j.joca.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/28/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injury is a risk factor for developing knee osteoarthritis (OA). We developed an intervention to support people manage risk factors for OA. METHODS We conducted one-on-one interviews with 20 individuals with OA symptoms 6-15 years post ACL injury and used a nominal group process during a workshop with 40 patients and healthcare professionals (HCPs) to elicit information on the intervention content and delivery characteristics (timing, HCPs, and methods). Interview data were analyzed using content analysis. Nominal group ideas with importance ratings ≥5 of 7 met criteria for inclusion. Results were integrated, considering similarities and differences. RESULTS Eight content categories were identified: 1. understanding knee injury and expectations about recovery; 2. understanding OA risk; 3. understanding OA signs and symptoms; 4. managing OA risk; 5. managing knee OA symptoms; 6. information for influencers; 7. credible sources; and, 8. updates on new evidence and treatments. Delivery timing reflected a lifespan approach from time of injury through symptomatic knee OA management. Although multiple media for delivery were identified, introductory face-to-face discussions and opportunity for re-accessing HCPs were critical. All HCPs who treat people with ACL should be familiar with and able to deliver the intervention. CONCLUSIONS This co-development approach identified that an intervention to support people with ACL injury to limit and manage knee OA requires content embedded within an easily accessible, multi-media delivery model with capacity for check-back with HCPs that is appealing to different age groups and personal preferences over the lifespan post injury.
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Affiliation(s)
- A M Davis
- Institute of Health Policy, Management and Evaluation and Department of Physical Therapy, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada.
| | - R Wong
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
| | - K Steinhart
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
| | - L Cruz
- LiveActive Sport Medicine and Women's College Hospital, University of Toronto, Toronto, Canada.
| | - D Cudmore
- Family and Sport Medicine, St. Francis Xavier University, Antigonish, and Department of Family Medicine, Dalhousie University, Halifax, Canada.
| | - T Dwyer
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital College and Mount Sinai Hospital, University of Toronto, Toronto, Canada.
| | - L Li
- Arthritis Research Canada, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | - P Marks
- University of Toronto Orthopaedic Sports Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | | | - N Urquhart
- Dartmouth General Hospital, Orthopaedic Surgery, Dalhousie University, Halifax, Canada.
| | - J A Wilson
- Department of Surgery, McMaster University, Hamilton, Canada.
| | - L Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - D Ogilvie-Harris
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, Toronto, Canada.
| | - J Chahal
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Schroeder Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.
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Leese J, MacDonald G, Backman CL, Townsend A, Nimmon L, Li LC. Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counseling Intervention: Qualitative Study Using a Relational Ethics Lens. JMIR Mhealth Uhealth 2021; 9:e30332. [PMID: 34766912 PMCID: PMC8663466 DOI: 10.2196/30332] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/27/2021] [Accepted: 09/19/2021] [Indexed: 12/27/2022] Open
Abstract
Background Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. However, recent evidence also identifies some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ethically aware ways. Objective Using an ethics lens, we aimed to describe a range of experiences from persons with knee OA who used a wearable during a physical activity counseling intervention study. Methods This is a secondary analysis of qualitative interviews nested within a randomized controlled trial. Guided by phenomenography, we explored the experiences of persons with knee OA following participation in a physical activity counseling intervention that involved using a Fitbit Flex and biweekly phone calls with a study physiotherapist (PT) in an 8-week period. Benefits or downsides experienced in participants’ relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens. Results Interviews with 21 participants (12 females and 9 males) aged 40 to 82 years were analyzed. Education levels ranged from high school graduates (4/21, 19%) to bachelor’s degrees or above (11/21, 52%). We identified 3 categories of description: (1) participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; (2) some participants felt a sense of accomplishment from seeing progress in their wearable data, which fueled their motivation; (3) for some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. However, they also expressed there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate. Conclusions Findings provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in a randomized controlled trial to support physical activity. To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation.
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Affiliation(s)
- Jenny Leese
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Graham MacDonald
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Catherine L Backman
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
| | - Anne Townsend
- Arthritis Research Canada, Vancouver, BC, Canada.,Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Laura Nimmon
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Vancouver, BC, Canada
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Dalinghaus K, Regehr G, Nimmon L. Intersections of power: videoconferenced debriefing of a rural interprofessional simulation team by an urban interprofessional debriefing team. Perspect Med Educ 2021; 10:286-292. [PMID: 34106435 PMCID: PMC8505583 DOI: 10.1007/s40037-021-00669-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Simulation as an educational tool is known to have benefits. Moreover, the use of simulation in continuing interprofessional development is vital in rural and remote communities with limited case volumes and resources. This study explored power dynamics between rural simulation participants and urban expert co-debriefers during a simulated operating room crisis and debriefing. The aim is to gain a rich understanding of rural/urban relational dynamics embedded within the constraints and affordances of videoconferencing technology. METHODS In situ observations of a videoconference-enabled simulation and debriefing were conducted, followed by seven semi-structured interviews, in this qualitative case study. A sociomateriality lens with additional sensitizing concepts of power from critical theory was employed to explore human and nonhuman interactions between rural learners, urban co-debriefers, and videoconferencing technology. RESULTS The interviews exposed subtle expressions of power dynamics at play that were curiously not observable in the enactment of the exercise. Rural learners appreciated the objectivity of the urban debriefers as well as the nurse/physician dyad. However, rural participants appeared to quietly dismiss feedback when it was incongruent with their context. Videoconference technology added both benefits and constraints to these relational dynamics. DISCUSSION Awareness of power relationships, and insights into affordances and constraints of videoconferencing may enhance operationalization of interprofessional simulation-based education (SBE) in rural and remote contexts.
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Affiliation(s)
| | - Glenn Regehr
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Singh G, Sawatzky B, Nimmon L, Ben Mortenson W. Perceived eHealth Literacy and Health Literacy among People with Spinal Cord Injury. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Singh G, Sawatzky B, Nimmon L, Ben Mortenson W. Experiences of Individuals with Spinal Cord Injury with Internet-based Health Resources. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.766] [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: 11/25/2022]
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Hartford W, Asgarova S, MacDonald G, Berger M, Cristancho S, Nimmon L. Macro and meso level influences on distributed integrated COPD care delivery: a social network perspective. BMC Health Serv Res 2021; 21:491. [PMID: 34024272 PMCID: PMC8141100 DOI: 10.1186/s12913-021-06532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Care guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions. Continuity of care is also emphasised. However, many patients with COPD experience fragmented care. Discontinuities in healthcare and related social services are likely to result in disjointed rather than integrated care which can negatively affect patient health outcomes. The purpose of this qualitative study was to improve our understanding of, and how, contextual features pertaining to structures and processes of COPD integrated care influence delivery of care within patients’ healthcare networks. Methods We conducted individual interviews with 28 participants (9 patients, 16 healthcare professionals, and 3 spousal caregivers). Participants were recruited through the lung clinic at a city hospital in western Canada. We employed a social network paradigm to analyse and interpret the data. Results The analysis revealed an overarching theme of fragmented COPD care with two sub-themes: (1) Funding shortfalls and availability of resources, and (2) Dis(mis)connected communication pathways. The overarching theme depicts variations, delays, and discontinuities in patient care. The sub-themes describe how macro level influences and meso level shortfalls were perceived to influence the availability of respiratory care resources that contributed to fragmented COPD care. Conclusions Employing a social network lens drew particular attention to family physicians’ pivotal role in delivering community-based COPD care. While an integrated approach to care is recommended by care guidelines, institutional and organizational structures and processes, such as financial and communication structures, may inhibit delivery of integrated care. Thus, macro and meso level structures and processes have the potential to shape patient care by constraining family physicians’ purposive and communication actions necessary for facilitating an integrated distributed approach to care. We propose a context of care which fosters a context for family physicians’ delivery of patient-centered care. Integrated care delivery may improve patients’ wellbeing and alleviate financial constraints on the healthcare system.
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Affiliation(s)
- Wendy Hartford
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.
| | - Sevinj Asgarova
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,University of British Columbia, Vancouver, Canada.,Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, 429-2194, Health Sciences Mall, V6T 1Z3, Vancouver, Canada
| | - Graham MacDonald
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Mary Berger
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,Dalhousie University, Halifax, Canada
| | - Sayra Cristancho
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario Canada, Medical Sciences Building, Suite 100, N6G 2V4, London, Ontario, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, 429-2194, Health Sciences Mall, V6T 1Z3, Vancouver, Canada
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Glegg SMN, Ryce A, Miller KJ, Nimmon L, Kothari A, Holsti L. Organizational supports for knowledge translation in paediatric health centres and research institutes: insights from a Canadian environmental scan. Implement Sci Commun 2021; 2:49. [PMID: 33985591 PMCID: PMC8117660 DOI: 10.1186/s43058-021-00152-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational supports are thought to help address wide-ranging barriers to evidence-informed health care (EIHC) and knowledge translation (KT). However, little is known about the nature of the resources and services that exist within paediatric health care and research settings across Canada to facilitate evidence use in health care delivery. This survey examined existing supports for EIHC/KT within these organizations to inform the design of similar EIHC/KT support programmes. METHODS A national environmental scan was conducted using a bilingual online survey distributed to leaders at Canadian paediatric academic health science centres and their affiliated research institutes. Participants were invited through email, social media and webinar invitations and snowball sampling. Supports of interest included personnel, resources, services, organizational structures or processes, and partnerships or collaborations; barriers and successes were also probed. Data were compiled by site, reported using descriptive statistics, or grouped thematically. Supports were described using the AIMD (Aims, Ingredients, Mechanism, Delivery) framework. RESULTS Thirty-one respondents from 17 sites across seven provinces represented a 49% site response rate. Eleven (65%) sites reported an on-site library with variable staffing and services. Ten (59%) sites reported a dedicated KT support unit or staff person. Supports ranged from education, resource development and consultation to protocol development, funded initiatives and collaborations. Organizations leveraged internal and external supports, with the majority also employing supports for clinical research integration. Supports perceived as most effective included personnel, targeted initiatives, leadership, interdepartmental expertise, external drivers and logistical support. Barriers included operational constraints, individual-level factors and lack of infrastructure. CONCLUSIONS This first survey of organizational supports for EIHC/KT identified the range of supports in place in paediatric research and health care organizations across Canada. The diversity of supports reported across sites may reflect differences in resource capacity and objectives. Similarities in EIHC/KT and research integration supports suggest common infrastructure may be feasible. Moreover, stakeholder engagement in research was common, but not pervasive. Tailored support programmes can target multi-faceted barriers. Findings can inform the development, refinement and evaluation of EIHC/KT support programmes and guide the study of the effectiveness and sustainability of these strategies.
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Affiliation(s)
- Stephanie Miranda Nadine Glegg
- Rehabilitation Sciences, The University of British Columbia, T325 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Sunny Hill Health Centre at BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. .,BC Children's Hospital Research Institute, 938 W. 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
| | - Andrea Ryce
- Sunny Hill Health Centre at BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Kimberly J Miller
- Sunny Hill Health Centre at BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.,BC Children's Hospital Research Institute, 938 W. 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, T325 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Anita Kothari
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Liisa Holsti
- BC Children's Hospital Research Institute, 938 W. 28th Ave, Vancouver, BC, V5Z 4H4, Canada.,Department of Occupational Science and Occupational Therapy, The University of British Columbia, T325 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Leese J, Li LC, Nimmon L, Townsend AF, Backman CL. Moving Beyond "Until Saturation Was Reached": Critically Examining How Saturation Is Used and Reported in Qualitative Research. Arthritis Care Res (Hoboken) 2021; 73:1225-1227. [PMID: 33756068 DOI: 10.1002/acr.24600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Jenny Leese
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Linda C Li
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne F Townsend
- Arthritis Research Canada, Vancouver, British Columbia, Canada, and Lancaster University, Lancaster, UK
| | - Catherine L Backman
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
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Atherley AEN, Nimmon L, Teunissen PW, Dolmans D, Hegazi I, Hu W. Students' social networks are diverse, dynamic and deliberate when transitioning to clinical training. Med Educ 2021; 55:376-386. [PMID: 32955741 PMCID: PMC7984257 DOI: 10.1111/medu.14382] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 05/15/2023]
Abstract
CONTEXT Transitions in medical education are dynamic, emotional and complex yet, unavoidable. Relationships matter, especially in times of transition. Using qualitative, social network research methods, we explored social relationships and social support as medical students transitioned from pre-clinical to clinical training. METHODS Eight medical students completed a social network map during a semi-structured interview within two weeks of beginning their clinical clerkships (T0 ) and then again four months later (T1 ). They indicated meaningful interactions that influenced their transition from pre-clinical to clinical training and discussed how these relationshipsimpacted their transition. We conducted mixed-methods analysis on this data. RESULTS At T0 , eight participants described the influence of 128 people in their social support networks; this marginally increased to 134 at T1 . People from within and beyond the clinical space made up participants' social networks. As new relationships were created (eg with peers and doctors), old relationships were kept (eg with doctors and family) or dissolved over time (eg with near-peers and nurses). Participants deliberately created, kept or dissolved relationships over time dependent on whether they provided emotional support (eg they could trust them) or instrumental support (eg they provided academic guidance). CONCLUSIONS This is the first social networks analysis paper to explore social networks in transitioning students in medicine. We found that undergraduate medical students' social support networks were diverse, dynamic and deliberate as they transitioned to clerkships. Participants created and kept relationships with those they trusted and who provided emotional or instrumental support and dissolved relationships that did not provide these functions.
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Affiliation(s)
- Anique E. N. Atherley
- Faculty of Health, Medicine and Life SciencesSchool of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
- School of MedicineUniversity of Western SydneyPenrithNSWAustralia
| | - Laura Nimmon
- Faculty of MedicineCentre for Health Education Scholarship (CHES)University of British ColumbiaVancouverBCCanada
| | - Pim W. Teunissen
- Faculty of Health, Medicine and Life SciencesSchool of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
- Department of Obstetrics and GynaecologyVU University Medical CentreAmsterdamThe Netherlands
| | - Diana Dolmans
- Faculty of Health, Medicine and Life SciencesSchool of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Iman Hegazi
- School of MedicineUniversity of Western SydneyPenrithNSWAustralia
| | - Wendy Hu
- School of MedicineUniversity of Western SydneyPenrithNSWAustralia
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Leese J, Geldmanc J, Zhu S, Macdonald GG, Pourrahmat MM, Townsend AF, Backman CL, Nimmon L, Li LC. The Perspectives of Persons with Arthritis on the Use of Wearable Technology to Self-Monitor Physical Activity: A Qualitative Evidence Synthesis. Arthritis Care Res (Hoboken) 2021; 74:1520-1532. [PMID: 33644994 DOI: 10.1002/acr.24585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/07/2020] [Accepted: 02/23/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aim to broaden understanding of the perspectives of persons with arthritis on their use of wearables to self-monitor physical activity, through a synthesis of evidence from qualitative studies. METHODS We conducted a systematic search of 5 databases (including Medline, CINAHL, and Embase) from inception to 2018. Eligible studies qualitatively examined the use of wearables from the perspectives of persons with arthritis. All relevant data were extracted and coded inductively in a thematic synthesis. RESULTS Of 4358 records retrieved, 7 articles were included. Participants used a wearable during research participation in 3 studies and as part of usual self-management in 2 studies. In remaining studies, participants were shown a prototype they did not use. Themes identified were: 1) Potential to change dynamics in patient-health professional communication: Articles reported a common opinion that sharing wearable data could possibly enable them to improve communication with health professionals; 2) Wearable-enabled self-awareness; a benefit or downside?: There was agreement that wearables could increase self-awareness of physical activity levels, but perspectives were mixed on whether this motivated more physical activity; 3) Designing a wearable for everyday life: Participants generally felt the technology was not obtrusive in their everyday lives, but it was speculated certain prototypes may embarrass or stigmatize persons with arthritis. CONCLUSION Themes hint toward an ethical dimension, as participants perceive their use of wearables may positively or negatively influence their capacity to shape their everyday self-management. We suggest ethical questions pertinent to the use of wearables in arthritis self-management for further exploration.
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Affiliation(s)
- Jenny Leese
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Jasmina Geldmanc
- Arthritis Research Canada, Vancouver, Canada.,Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Siyi Zhu
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Vancouver, Canada.,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Rehabilitation Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Graham G Macdonald
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Vancouver, Canada
| | | | - Anne F Townsend
- Arthritis Research Canada, Vancouver, Canada.,Division of Health Research, Health Innovation One, Lancaster University, Lancaster, UK
| | - Catherine L Backman
- Arthritis Research Canada, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Vancouver, Canada
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Abstract
PURPOSE Faculty development is increasingly acknowledged as an important aspect of health professions education. Its conceptualization has evolved from an individual skills training activity to contemporary notions that draw on an organizational model. This organizational model recognizes relationships and networks as important mediators of knowledge mobilization. Although such conceptual advancements are critical, we lack empirical evidence and robust insights into how social networks function to shape learning in faculty development. The purpose of this study was to understand how informal professional social networks influence faculty development learning in the health professions. METHOD This study used a qualitative social network approach to explore how teaching faculty's relationships influenced their learning about teaching. The study was conducted in 2018 in an undergraduate course at a Canadian medical school. Eleven faculty participants were recruited, and 3 methods of data collection were employed: semistructured interviews, participant-drawn sociograms, and demographic questionnaires. RESULTS The social networks of faculty participants influenced their learning about teaching in the following 4 dimensions: enabling and mobilizing knowledge acquisition, shaping identity formation, expressing vulnerability, and scaffolding learning. CONCLUSIONS Faculty developers should consider faculty's degree of social embeddedness in their professional social networks, as our study suggests this may influence their learning about teaching. The findings align with recent calls to conceptually reorient faculty development in the health professions as a dynamic social enterprise.
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Affiliation(s)
- Heather Buckley
- H. Buckley is clinical assistant professor, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- L. Nimmon is scientist, Center for Health Education Scholarship, and associate professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Battalova A, Bulk L, Nimmon L, Hole R, Krupa T, Lee M, Mayer Y, Jarus T. "I Can Understand Where They're Coming From": How Clinicians' Disability Experiences Shape Their Interaction With Clients. Qual Health Res 2020; 30:2064-2076. [PMID: 32449447 DOI: 10.1177/1049732320922193] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Students and clinicians with disabilities are underrepresented in the academic health programs and professional clinical settings. Disability studies foregrounds the unique ways of knowing and being that clinicians with disabilities can offer. Based on a larger grounded theory study of the experiences of students and clinicians with disabilities, this article examines the role that clinicians' abilities to draw on their personal experiences of living with a disability have on their interactions with clients. The analysis of semistructured interviews with 55 students and clinicians with disabilities from different fields contributes to the development of a theory of epistemic connection. The theory is informed by the following three themes: (a) building rapport through understanding, (b) from understanding to advocacy and creative approaches, and (c) between professionalism and disability. The findings emphasize not only the importance of diversifying the health care workforce but also incorporating disability epistemology into the health care culture.
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Affiliation(s)
- Alfiya Battalova
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Bulk
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachelle Hole
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Terry Krupa
- Queens University, Kingston, Ontario, Canada
| | - Michael Lee
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yael Mayer
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tal Jarus
- The University of British Columbia, Vancouver, British Columbia, Canada
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Buckley H, Nimmon L. Social connectedness in virtual learning contexts. Clin Teach 2020; 18:208-209. [DOI: 10.1111/tct.13281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Heather Buckley
- Clinical associate professor, Department of Family Practice Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Laura Nimmon
- Scientist, Center for Health Education Scholarship, and associate professor Department of Occupational Science and Occupational Therapy Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
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Bulk LY, Kimel G, King N, Nimmon L. Understanding Experiences in Hospice: Exploring Temporal, Occupational, and Relational Dimensions Using Pictor Technique. Qual Health Res 2020; 30:1965-1977. [PMID: 32564687 DOI: 10.1177/1049732320926134] [Citation(s) in RCA: 3] [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: 06/11/2023]
Abstract
Temporality, occupation, and relationships are identified as discrete factors that impact quality of life for individuals at the end of life and those around them. However, scholars, practitioners, and educators require insights regarding whether and how interactions between these factors shape this quality of life. This study is framed by an understanding that meaning is negotiated between people through social interaction and occupational engagement in temporal contexts. We conducted in-depth interviews with 9 patients and 10 family members, incorporating the Pictor visual elicitation technique. Analysis was conducted through an iterative process involving open and selective coding. Findings are described as three main processes: (a) experiences of temporal rupture, (b) diminished significance of clock time, and (c) shifts in occupational priorities. Participants' perspectives may help carers understand how to foster positive temporal experiences and quality of life for patients and those who love them.
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Affiliation(s)
- Laura Yvonne Bulk
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gil Kimel
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nigel King
- University of Huddersfield, Huddersfield, United Kingdom
| | - Laura Nimmon
- The University of British Columbia, Vancouver, British Columbia, Canada
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Davis AM, Chahal J, Wong R, Steinhart K, Dwyer T, Li L, Marks P, Cruz L, Urquhart N, Wilson JA, Cudmore D, Nimmon L, Ogilvie-Harris D. Limiting the Risk of Osteoarthritis After Anterior Cruciate Ligament Injury: Are Health Care Providers Missing the Opportunity to Intervene? Arthritis Care Res (Hoboken) 2020; 73:1754-1762. [PMID: 32937005 DOI: 10.1002/acr.24419] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/11/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To understand what sports orthopedic surgeons (OS), primary care physicians (PCPs) with sports medicine training, and physical therapists (PTs) managing nonelite athletes with anterior cruciate ligament (ACL) injury tell their patients about their osteoarthritis (OA) risk. METHODS An electronic survey was distributed by the Canadian Academy of Sport and Exercise Medicine (PCPs, OS), the Sports and Orthopedic Divisions of the Canadian Physiotherapy Association (PTs), and to OS identified through the Royal College of Physicians and Surgeons and the Canadian Orthopaedic Association. The survey included 4 sections: demographics, factors discussed, timing of discussions, and discussion of risk factors and their management. Proportions or means with 95% confidence intervals were calculated. RESULTS A total of 501 health care professionals (HCPs) responded (98 PCPs, 263 PTs, and 140 OS). Of those responding, 70-77% of physicians reported always discussing OA risk, but only 35% of PTs did. All HCPs reported that patient activities perceived as detrimental to knee health, ACL reinjury, and simultaneous injury to other structures in the knee were most often the reason for discussing OA risk. OA risk was discussed at initial management post-injury (65-94%), with few discussing risk subsequently. Eighty percent of physicians and 99% of PTs indicated that PTs were suited to provide OA risk and management information. CONCLUSION HCPs routinely managing people with ACL injury do not consistently discuss OA risk post-injury with them. Educational strategies for HCPs are urgently needed to develop care pathways inclusive of support for OA risk management following ACL injury.
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Affiliation(s)
| | - Jas Chahal
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tim Dwyer
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Li
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Marks
- University of Toronto, Toronto, Ontario, Canada
| | - Laura Cruz
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Urquhart
- Dartmouth General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - David Cudmore
- St. Francis Xavier University and Dalhousie University, Nova Scotia, Antigonish and Halifax, Canada
| | - Laura Nimmon
- University of British Columbia, Vancouver, British Columbia, Canada
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Paradis E, Nimmon L, Wondimagegn D, Whitehead CR. Critical Theory: Broadening Our Thinking to Explore the Structural Factors at Play in Health Professions Education. Acad Med 2020; 95:842-845. [PMID: 31809292 DOI: 10.1097/acm.0000000000003108] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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
As part of the Philosophy of Science series of Invited Commentaries, this article on critical theory describes the origins of this research paradigm and its key concepts and orientations (ontology, epistemology, axiology, methodology, and rigor). The authors frame critical theory as an umbrella term for different theories, including feminism, antiracism, and anticolonialism. They emphasize the structural analysis that critical scholars conduct to uncover and sometimes address the role that social, political, cultural, economic, ethnic, and gender factors play in health professions education. They note the importance of acknowledging one's social location when doing critical research and highlight the core values of democracy and egalitarianism that underpin critical research. Methodologically, the authors stress how critical scholars reject singular truths in favor of more nuanced portraits of concepts and events, mobilize inductive approaches over deductive ones, and use critical theory to develop their projects and analyze their data. Following upon this elucidation of critical theory, the authors apply this paradigm to analyze the sample case of Lee, a medical resident who was involved in a medication error. The authors conclude that research conducted in the critical tradition has the potential to transcend individualistic accounts by revealing underlying structural forces that constrain or support individual agency.
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Affiliation(s)
- Elise Paradis
- E. Paradis is assistant professor, status only, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-9103-4721. L. Nimmon is a scientist, Centre for Health Education Scholarship, and assistant professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-7291-603X. D. Wondimagegn is associate professor of psychiatry and chief executive director, College of Health Sciences, Addis Ababa University, and a consultant psychiatrist, Tikur Anbessa Hospital, Addis Ababa, Ethiopia. C.R. Whitehead is vice president, education, Women's College Hospital, director and scientist, Wilson Centre for Research in Education, and professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-0134-9074
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Nimmon L. Expanding medical expertise: The role of healer. Med Educ 2020; 54:380-381. [PMID: 32078169 DOI: 10.1111/medu.14134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Bulk LY, Smith A, Nimmon L, Jarus T. A closer look at opportunities for blind adults: Impacts of stigmatization and ocularcentrism. British Journal of Visual Impairment 2020. [DOI: 10.1177/0264619620911424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Blind Canadians experience higher rates of unemployment, social isolation, and poverty than sighted Canadians. Examining what influences opportunities can help to identify the factors that disable blind people. During initial analysis, stigma and ocularcentrism emerged as important factors. Thus, this article examines how stigma operates culturally, socially, politically, and economically to shape opportunities among blind adults. Data were collected through in-depth, semi-structured interviews with six legally blind participants (visual acuity of 20/200 or below), aged 19–65 years. Thematic analysis was employed to understand the common and diverging narratives of participants. Within participant narratives, ocularcentrism is found to contribute to stigmatization at societal, interpersonal, and internalized levels. Opportunities are experienced within this context, and the stigmatization experienced both shaped and was shaped by participation in activities. It is imperative that a closer look is given to how stigma shapes the opportunities for blind people, so that individuals, teachers, practitioners, and policy makers can develop relevant and effective interventions and can challenge stigmatization.
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Affiliation(s)
| | | | | | - Tal Jarus
- The University of British Columbia, Canada
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Hartford W, Backman C, Li LC, McKinnon A, Nimmon L. Appropriating and asserting power on inflammatory arthritis teams: A social network perspective. Health Expect 2020; 23:813-824. [PMID: 32185848 PMCID: PMC7495070 DOI: 10.1111/hex.13051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background Therapeutic interventions for people with inflammatory arthritis (IA) increasingly involve multidisciplinary teams and strive to foster patient‐centred care and shared decision making. Participation in health‐care decisions requires patients to assert themselves and negotiate power in encounters with clinicians; however, clinical contexts often afford less authority for patients than clinicians. This disadvantage may inhibit patients' involvement in their own health care. Objective To identify communication attributes, IA patients use to influence and negotiate their treatment with members of their health‐care network. Method A qualitative social network approach was used to analyse data from a larger study that investigated IA patients' overall experiences of multidisciplinary care. Fourteen patients with IA attended individual semi‐structured interviews. Researchers used thematic analysis to identify patterns of assertiveness and influence in the data. Results Participants experienced loss of identity, control and agency in addition to the physical symptoms of IA. However, they had a sense of personal responsibility for managing their health care. Perceptions of health‐care team support enhanced patients' influence in treatment negotiations. Notably, there appeared to be an underlying tension between being empowered or disempowered. Discussion and conclusions The findings have significant implications for treatment decision communication approaches to IA care. A social network perspective may provide a pathway for clinicians to better understand the complexities of communication with their patients. This approach may reduce unequal power dynamics that occur within clinician/patient interactions and afford people with IA agency, control and affirmation of identity within their health‐care network.
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Affiliation(s)
- Wendy Hartford
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Backman
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annette McKinnon
- Arthritis Research Canada's Patient Advisory Board, Vancouver, BC, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Bulk LY, Tikhonova J, Gagnon JM, Battalova A, Mayer Y, Krupa T, Lee M, Nimmon L, Jarus T. Disabled healthcare professionals' diverse, embodied, and socially embedded experiences. Adv Health Sci Educ Theory Pract 2020; 25:111-129. [PMID: 31538268 DOI: 10.1007/s10459-019-09912-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Disabled people are underrepresented within healthcare professions, although their participation has potential benefits for them personally, and for broader society. Disabled peoples' participation in healthcare professions is limited by assumptions about disability. Little research explores how healthcare professions can be organized to support disabled peoples' employment. Within a critical realist paradigm influenced by grounded theory, this study used interviews to explore the experiences of 56 disabled healthcare clinicians and students, and advance a conceptual taxonomy of disability experience within healthcare professions. Participants describe their experiences of disability in the healthcare professional context in terms of characteristics and dimensions of disability-how characteristics interact with factors within healthcare training and practice environments. We profile two particularly salient dimensions of the disability experience: visibility and onset of disability. These are developed to describe complexity and specificity of the experiences of individuals negotiating the healthcare context. Among participants there is extensive heterogeneity related to the experience of disability in healthcare professional contexts. Despite some having similar disability characteristics, no two individuals experience the same combination of characteristics and dimensions of disability. Given the complexity of experiences for disabled healthcare professionals/students, a taxonomy for conceptualizing this experience is presented. Readers are encouraged to consider the taxonomy through which they might conceptualize individual, embodied, and socially embedded experiences of disabled healthcare professionals and students. Stakeholders involved in healthcare professions and education should consider this shift in perspective, with a view to increasing access of disabled people to health professional practice.
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Affiliation(s)
| | | | | | | | - Yael Mayer
- University of British Columbia, Vancouver, Canada
| | | | - Michael Lee
- University of British Columbia, Vancouver, Canada
| | - Laura Nimmon
- University of British Columbia, Vancouver, Canada
| | - Tal Jarus
- University of British Columbia, Vancouver, Canada
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Rawal S, Strahlendorf C, Nimmon L. Challenging the myth of the attrition of empathy in paediatrics residents. Med Educ 2020; 54:82-87. [PMID: 31475381 DOI: 10.1111/medu.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 01/18/2019] [Accepted: 02/12/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Empathy is vital to the physician-patient relationship. It promotes patient compliance and increases treatment efficacy. Studies evaluating the loss of empathy as residents advance through training curricula have generated inconsistent claims. Those considering diverse resident populations have supported a decline, whereas the few studies focused on paediatrics note stable empathy scores during training, which, indeed, exceed those of the general population. To better understand the issue as it pertains to paediatrics trainees, this study aimed to explore the state, and map a trajectory, of empathy in paediatrics residents, to identify factors influencing the learning and retention of empathy. METHODS This qualitative descriptive study was conducted at an urban children's hospital in Canada. A total of 10 participants were recruited for semi-structured interviews via a purposeful sampling strategy. The institutional research ethics board approved the project. RESULTS Senior residents (R3 and R4) reported increased empathy, attributable to greater knowledge regarding paediatric illnesses, according them a fuller sense of the impact on families. Challenges to sustained empathy correlated with published literature: time constraints, compassion fatigue and burnout with poor coping, and the hidden curriculum. Empathy was learned from peers, preceptors and other health care providers. Resident resilience, borne out of personal adversity, was protective against the loss of empathy. Residents advocated for increased autonomy and responsibility for patient care, and increased exposure to longitudinal care, including the patient's social context and home life, to increase resident empathy. CONCLUSIONS Curriculum development committees could consider the inclusion of these encounters and experiences in residency training, although similar descriptive research in other specialty contexts would be needed to refine understanding.
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Affiliation(s)
- Surabhi Rawal
- Pediatric Hematology/Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Caron Strahlendorf
- Pediatric Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Nimmon L, Kimel G, Lingard L, Bates J. Can a complex adaptive systems perspective support the resiliency of the heart failure patient - informal caregiver dyad? Curr Opin Support Palliat Care 2019; 13:9-13. [PMID: 30507631 DOI: 10.1097/spc.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers' well being, and in turn heart failure patients' health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient - informal caregiver dyad. RECENT FINDINGS Heart failure care is enacted within a complex system composed of patients, their informal caregivers and a variety of health professionals. In a national study, we employed a CAS perspective to explore how all parts of the heart failure team function interdependently in emergent and adaptive ways. Salient in our data were the severe vulnerability of elderly heart failure patients and their long-term partners who suffered from a chronic illness. Novel approaches are needed that can quickly adapt and reorganize care when unpredictable disturbances occur in the couples' functional capacity. SUMMARY The linear protocol-driven care models that shape heart failure guidelines, training and care delivery initiatives do not adequately capture heart failure patients' social environment. CAS is a powerful theoretical tool that can render visible the most vulnerable members of the heart failure team, and incite robust specialized holistic palliative heart failure care models.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy
| | - Gil Kimel
- St. Paul's Hospital, Palliative Care Program, Division of Internal Medicine, Department of Medicine
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
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Abstract
PURPOSE Psychological safety (PS) is recognized as key in health professions education. However, most studies exploring PS in medical education have focused on mistreatment, thus focusing on what PS is not. The authors set out to explicitly explore learners' concept of PS in the context of medical education to better understand and define PS and its educational consequences for medical students. METHOD This descriptive exploratory study was conducted in the context of a pilot peer-assisted learning (PAL) program. The program brought together residents and medical students for 16 semiformal learning sessions. Eight medical students from a PAL program were recruited for semistructured interviews to explore their experiences of PS. Transcripts were thematically analyzed using an inductive approach, and social ecological theory was integrated in the later stages of analysis. RESULTS Students described PS as not feeling judged. Having supportive relationships with peers and mentors improved PS. Students' sense of PS appeared to free them to focus on learning in the present moment without considering the consequences for their image in the eyes of others. Feeling safe also seemed to facilitate relationship building with the mentors. CONCLUSIONS A sense of PS appears to free learners from constantly being self-conscious about projecting an image of competence. This enables learners to be present in the moment and concentrate on engaging with the learning task at hand. The authors propose that the term "educational safety" be used to describe a relational construct that can capture the essence of what constitutes PS for learners.
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Affiliation(s)
- Sian Hsiang-Te Tsuei
- S.H.-T. Tsuei is a doctoral student, Population Health Sciences, Global Health and Populations Field, Health Systems Specialization, Harvard University, Boston, Massachusetts, and affiliate member, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. D. Lee is a medical student, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. C. Ho is a pediatric psychiatry fellow, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. G. Regehr is senior scientist and associate director of research, Centre for Health Education Scholarship, and professor, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. L. Nimmon is scientist, Centre for Health Education Scholarship, and assistant professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Hartford W, Lear S, Nimmon L. Stroke survivors' experiences of team support along their recovery continuum. BMC Health Serv Res 2019; 19:723. [PMID: 31638959 PMCID: PMC6805495 DOI: 10.1186/s12913-019-4533-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 09/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background A coordinated stroke rehabilitation care team is considered optimal for supporting stroke survivors from diagnosis to recovery. Despite this recognition, many stroke survivors cannot access essential rehabilitation services. Furthermore, there is a lack of understanding of stroke patients’ and their caregivers’ rehabilitation needs and wishes. We sought to gain insight into healthcare and social structures from the perspective of patients and caregivers that can better support long-term stroke recovery. Methods We conducted individual interviews with 24 participants comprised of stroke survivors, spousal caregivers, stroke support group coordinators, and speech pathologist. Participants were recruited through three stroke survivor support groups. An empowerment lens was integrated into data analysis and data interpretation. Results Two dominant themes captured participants’ experiences through stroke survivors’ trajectory of care. 1) Experiences of managing stroke. This theme identified stroke survivors and spousal caregivers’ experiences with stroke recovery, rehabilitation, and fulfilling unmet needs. 2) Resources of support. This theme described the social and financial support structures drawn upon to assist with stroke rehabilitation. Conclusions The study highlighted a lack of teamwork between stroke survivors, spousal caregivers, and health professionals. This fragmented care was compounded by inequities in rehabilitation programs and health services resulting in what appeared to be a disempowering rehabilitation process. Although stroke recovery groups were a significant source of support for stroke survivors and spousal caregivers, participants perceived they were overlooked, by stroke recovery healthcare providers, as a site for stroke recovery healthcare services. An empowerment approach to stroke rehabilitation involves collaboration between stroke survivors, caregivers, healthcare providers, health services, and existing community stroke support structures. Framing stroke based care through an empowerment lens may serve to address stroke rehabilitation inadequacies and inequities.
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Affiliation(s)
- W Hartford
- Centre for Health Education Scholarship, Faculty of Medicine, P. A. Woodward Instructional Resources Centre (IRC), University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, B.C, V6T 1Z3, Canada.
| | - S Lear
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
| | - L Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, P. A. Woodward Instructional Resources Centre (IRC), University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, B.C, V6T 1Z3, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, Vancouver, B.C, V6T 2B5, Canada
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Chan M, Nimmon L. Spinning the lens on physician power: narratives of humanism and healing. Perspect Med Educ 2019; 8:305-308. [PMID: 31562636 PMCID: PMC6820609 DOI: 10.1007/s40037-019-00537-4] [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] [Indexed: 05/04/2023]
Abstract
Divisive, disabling and dangerous power has featured heavily in health professions literature, social media and medical education. Negative accounts of the wielding of power have discoloured the lens through which the public sees medicine and distorted the view of a profession long associated with healing, humanism and heart. What has been buried in the midst of this discourse are positive accounts of power where the yielding of power is encouraging, empathetic and empowering. This article offers three personal vignettes illustrating the ability of power to positively affect lives in the practice of medicine, for patients and doctors alike. More of these stories are needed to uplift and rebalance the conversation on physician power and how it can be used for good. It is necessary to provide a narrative framework of what it looks like to be a healer and a humanistic doctor to satisfy the general public through a commitment to cultivate multidimensional future healthcare providers.
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Affiliation(s)
- Mercedes Chan
- Department of Paediatrics, Division of Paediatric Rheumatology, University of British Columbia, Vancouver, BC, Canada.
- BC Children's Hospital, Vancouver, BC, Canada.
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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