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Li C, Veinot P, Mylopoulos M, Leung FH, Law M. The new mentee: Exploring Gen Z women medical students' mentorship needs and experiences. Clin Teach 2024; 21:e13697. [PMID: 38050710 DOI: 10.1111/tct.13697] [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: 09/17/2022] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE The incoming Canadian cohort of medical students is comprised mainly of individuals from Generation Z (Gen Z; born between 1997 and 2012), with greater than 50% of applicants identifying as female. A gap remains in our understanding of Gen Z women learners in their challenges in navigating medical education, their expectations for their medical careers and the influences that have impacted their worldview. This study explored the needs, values, and experiences of Gen Z women medical students and the impact of these factors on mentorship expectations among this population that will soon be entering the workforce. METHODS Upon receiving ethics approval from the University of Toronto Research Ethics Board, semi-structured interviews were conducted (February-May 2021) with 15 Gen Z women students from 14 English-speaking Canadian medical schools who had given written consent to participate. An iterative constant comparative team approach was utilised in which the interview guide and sampling were adjusted as the data evolved. Transcripts were line by line coded into categories, then grouped into themes using descriptive analysis. RESULTS These socially aware learners described how society had afforded them greater opportunities for expression, which gave them a sense of feeling advantaged over older generations. However, participants paradoxically expressed feelings of powerlessness and commented on tensions they experienced when interacting with older generation physician mentors, especially during conversations on social justice issues. They also highlighted instances of biased mentorship specific to their gender. Participants emphasised a desire for inclusive mentorship that considered the mentee's identity and intersectionality. CONCLUSIONS The growing number of women learners in Canadian medical schools necessitates a re-evaluation of mentorship delivery. Mentors must adapt by integrating Gen Z ideals to overcome mentorship challenges.
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Affiliation(s)
- Calandra Li
- Postgraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Maria Mylopoulos
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
| | - Fok-Han Leung
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marcus Law
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Bhuiya AR, Sutherland J, Boateng R, Bain T, Skidmore B, Perrier L, Makarski J, Munce S, Lewis I, Graham ID, Holroyd-Leduc J, Straus SE, Stelfox HT, Strifler L, Lokker C, Li LC, Leung FH, Dobbins M, Puchalski Ritchie LM, Squires JE, Rac VE, Fahim C, Kastner M. A scoping review reveals candidate quality indicators of knowledge translation and implementation science practice tools. J Clin Epidemiol 2024; 165:111205. [PMID: 37939744 DOI: 10.1016/j.jclinepi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To identify candidate quality indicators from existing tools that provide guidance on how to practice knowledge translation and implemenation science (KT practice tools) across KT domains (dissemination, implementation, sustainability, and scalability). STUDY DESIGN AND SETTING We conducted a scoping review using the Joanna Briggs Institute Manual for Evidence Synthesis. We systematically searched multiple electronic databases and the gray literature. Documents were independently screened, selected, and extracted by pairs of reviewers. Data about the included articles, KT practice tools, and candidate quality indicators were analyzed, categorized, and summarized descriptively. RESULTS Of 43,060 titles and abstracts that were screened from electronic databases and gray literature, 850 potentially relevant full-text articles were identified, and 253 articles were included in the scoping review. Of these, we identified 232 unique KT practice tools from which 27 unique candidate quality indicators were generated. The identified candidate quality indicators were categorized according to the development (n = 17), evaluation (n = 5) and adaptation (n = 3) of the tools, and engagement of knowledge users (n = 2). No tools were identified that appraised the quality of KT practice tools. CONCLUSIONS The development of a quality appraisal instrument of KT practice tools is needed. The results will be further refined and finalized in order to develop a quality appraisal instrument for KT practice tools.
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Affiliation(s)
- Aunima R Bhuiya
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
| | - Justin Sutherland
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Rhonda Boateng
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Téjia Bain
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Becky Skidmore
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Laure Perrier
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Julie Makarski
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Sarah Munce
- University Health Network, Toronto, Ontario, Canada
| | - Iveta Lewis
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and the O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa Strifler
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Ontario, Canada; National Collaborating Centre for Methods and Tools, Hamilton, Ontario, Canada
| | - Lisa M Puchalski Ritchie
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Valeria E Rac
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Christine Fahim
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika Kastner
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Research and Innovation, North York, Ontario, Canada
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Affiliation(s)
- Stephanie Park
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Grace Zhou
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Calvin Ke
- Department of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Fok-Han Leung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Ontario, Canada
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Huang RS, Lu KJQ, Meaney C, Kemppainen J, Punnett A, Leung FH. Assessment of Resident and AI Chatbot Performance on the University of Toronto Family Medicine Residency Progress Test: Comparative Study. JMIR Med Educ 2023; 9:e50514. [PMID: 37725411 PMCID: PMC10548315 DOI: 10.2196/50514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Large language model (LLM)-based chatbots are evolving at an unprecedented pace with the release of ChatGPT, specifically GPT-3.5, and its successor, GPT-4. Their capabilities in general-purpose tasks and language generation have advanced to the point of performing excellently on various educational examination benchmarks, including medical knowledge tests. Comparing the performance of these 2 LLM models to that of Family Medicine residents on a multiple-choice medical knowledge test can provide insights into their potential as medical education tools. OBJECTIVE This study aimed to quantitatively and qualitatively compare the performance of GPT-3.5, GPT-4, and Family Medicine residents in a multiple-choice medical knowledge test appropriate for the level of a Family Medicine resident. METHODS An official University of Toronto Department of Family and Community Medicine Progress Test consisting of multiple-choice questions was inputted into GPT-3.5 and GPT-4. The artificial intelligence chatbot's responses were manually reviewed to determine the selected answer, response length, response time, provision of a rationale for the outputted response, and the root cause of all incorrect responses (classified into arithmetic, logical, and information errors). The performance of the artificial intelligence chatbots were compared against a cohort of Family Medicine residents who concurrently attempted the test. RESULTS GPT-4 performed significantly better compared to GPT-3.5 (difference 25.0%, 95% CI 16.3%-32.8%; McNemar test: P<.001); it correctly answered 89/108 (82.4%) questions, while GPT-3.5 answered 62/108 (57.4%) questions correctly. Further, GPT-4 scored higher across all 11 categories of Family Medicine knowledge. In 86.1% (n=93) of the responses, GPT-4 provided a rationale for why other multiple-choice options were not chosen compared to the 16.7% (n=18) achieved by GPT-3.5. Qualitatively, for both GPT-3.5 and GPT-4 responses, logical errors were the most common, while arithmetic errors were the least common. The average performance of Family Medicine residents was 56.9% (95% CI 56.2%-57.6%). The performance of GPT-3.5 was similar to that of the average Family Medicine resident (P=.16), while the performance of GPT-4 exceeded that of the top-performing Family Medicine resident (P<.001). CONCLUSIONS GPT-4 significantly outperforms both GPT-3.5 and Family Medicine residents on a multiple-choice medical knowledge test designed for Family Medicine residents. GPT-4 provides a logical rationale for its response choice, ruling out other answer choices efficiently and with concise justification. Its high degree of accuracy and advanced reasoning capabilities facilitate its potential applications in medical education, including the creation of exam questions and scenarios as well as serving as a resource for medical knowledge or information on community services.
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Affiliation(s)
- Ryan St Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin Jia Qi Lu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Kemppainen
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Punnett
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Haematology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Lu KJQ, Meaney C, Guo E, Leung FH. Evaluating the Applicability of Existing Lexicon-Based Sentiment Analysis Techniques on Family Medicine Resident Feedback Field Notes: Retrospective Cohort Study. JMIR Med Educ 2023; 9:e41953. [PMID: 37498660 PMCID: PMC10415947 DOI: 10.2196/41953] [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] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Field notes, a form for resident-preceptor clinical encounter feedback, are widely adopted across Canadian medical residency training programs for documenting residents' performance. This process generates a sizeable cumulative collection of feedback text, which is difficult for medical education faculty to navigate. As sentiment analysis is a subfield of text mining that can efficiently synthesize the polarity of a text collection, sentiment analysis may serve as an innovative solution. OBJECTIVE This study aimed to examine the feasibility and utility of sentiment analysis using 3 popular sentiment lexicons on medical resident field notes. METHODS We used a retrospective cohort design, curating text data from University of Toronto medical resident field notes gathered over 2 years (from July 2019 to June 2021). Lexicon-based sentiment analysis was applied using 3 standardized dictionaries, modified by removing ambiguous words as determined by a medical subject matter expert. Our modified lexicons assigned words from the text data a sentiment score, and we aggregated the word-level scores to a document-level polarity score. Agreement between dictionaries was assessed, and the document-level polarity was correlated with the overall preceptor rating of the clinical encounter under assessment. RESULTS Across the 3 original dictionaries, approximately a third of labeled words in our field note corpus were deemed ambiguous and were removed to create modified dictionaries. Across the 3 modified dictionaries, the mean sentiment for the "Strengths" section of the field notes was mildly positive, while it was slightly less positive in the "Areas of Improvement" section. We observed reasonable agreement between dictionaries for sentiment scores in both field note sections. Overall, the proportion of positively labeled documents increased with the overall preceptor rating, and the proportion of negatively labeled documents decreased with the overall preceptor rating. CONCLUSIONS Applying sentiment analysis to systematically analyze field notes is feasible. However, the applicability of existing lexicons is limited in the medical setting, even after the removal of ambiguous words. Limited applicability warrants the need to generate new dictionaries specific to the medical education context. Additionally, aspect-based sentiment analysis may be applied to navigate the more nuanced structure of texts when identifying sentiments. Ultimately, this will allow for more robust inferences to discover opportunities for improving resident teaching curriculums.
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Affiliation(s)
- Kevin Jia Qi Lu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Guo
- Department of Economics, University of Toronto, Toronto, ON, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Ke C, Mohammad E, Chan JCN, Kong APS, Leung FH, Shah BR, Lee D, Luk AO, Ma RCW, Chow E, Wei X. Team-Based Diabetes Care in Ontario and Hong Kong: a Comparative Review. Curr Diab Rep 2023:10.1007/s11892-023-01508-0. [PMID: 37043089 PMCID: PMC10091345 DOI: 10.1007/s11892-023-01508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE OF REVIEW There are gaps in implementing and accessing team-based diabetes care. We reviewed and compared how team-based diabetes care was implemented in the primary care contexts of Ontario and Hong Kong. RECENT FINDINGS Ontario's Diabetes Education Programs (DEPs) were scaled-up incrementally. Hong Kong's Multidisciplinary Risk Assessment and Management Program for Diabetes Mellitus (RAMP-DM) evolved from a research-driven quality improvement program. Each jurisdiction had a mixture of non-team and team-based primary care with variable accessibility. Referral procedures, follow-up processes, and financing models varied. DEPs used a flexible approach, while the RAMP-DM used structured assessment for quality assurance. Each approach depended on adequate infrastructure, processes, and staff. Diabetes care is most accessible and functional when integrated team-based services are automatically initiated upon diabetes diagnosis within a strong primary care system, ideally linked to a register with supports including specialist care. Structured assessment and risk stratification are the basis of a well-studied, evidence-based approach for achieving the standards of team-based diabetes care, although flexibility in care delivery may be needed to meet the unique needs of some individuals. Policymakers and funders should ensure investment in skilled health professionals, infrastructure, and processes to improve care quality.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- ICES, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
- , Toronto, Canada.
| | - Emaad Mohammad
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Douglas Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Andrea O Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Truong J, Sandhu P, Sheng V, Sadeghi Y, Leung FH, Wright R, Suleman S. Advocacy in community-based service learning: perspectives of community partner organizations. Can Med Educ J 2023; 14:90-94. [PMID: 36998499 PMCID: PMC10042788 DOI: 10.36834/cmej.74887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Health advocacy is a core competency for physicians, which can be developed through community-based service-learning (CBSL). This exploratory study investigated the experiences of community partner organizations (CPOs) participating in CBSL in the context of health advocacy. Methods A qualitative study was conducted. Nine CPOs at a medical school participated in interviews on topics pertaining to CBSL and health advocacy. Interviews were recorded, transcribed, and coded. Major themes were identified. Results CPOs perceived a positive impact from CBSL through student activities and connecting with the medical community. There was no unifying definition of health advocacy. Advocacy activities varied depending on the individual's role (i.e., CPO, physician, and student), which encompassed providing patient care or services, raising awareness of healthcare issues, and influencing policy changes. CPOs had different perceptions of their role in CBSL from facilitating service-learning opportunities to teaching students in CBSL, while a few desired to be involved in curriculum development. Conclusion This study provides further insight into health advocacy from the lens of CPOs, which may inform changes to health advocacy training and the CanMEDS Health Advocate Role to better align with the values of community organizations. Engaging CPOs in the broader medical education system may improve health advocacy training and ensure a positive bidirectional impact.
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Affiliation(s)
- Judy Truong
- Department of Internal Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Priya Sandhu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Vanessa Sheng
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Yasamin Sadeghi
- Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Ontario, Canada
| | - Roxanne Wright
- MD program, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Shazeen Suleman
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Ontario, Canada
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Bhuiya AR, Makarski J, Hayden L, Perrier L, Munce S, Lewis I, Graham ID, Holroyd-Leduc J, Straus SE, Stelfox HT, Strifler L, Lokker C, Li LC, Leung FH, Dobbins M, Ritchie LMP, Squires J, Rac V, Fahim C, Kastner M. Identifying candidate quality indicators of tools that support the practice of knowledge translation: a scoping review protocol. JBI Evid Synth 2023; 21:264-278. [PMID: 36111878 DOI: 10.11124/jbies-22-00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and characterize relevant knowledge translation methods tools (those that provide guidance for optimized knowledge translation practice) to uncover candidate quality indicators to inform a future quality assessment tool for knowledge translation strategies. INTRODUCTION Knowledge translation strategies (defined as including knowledge translation interventions, tools, and products) target various knowledge users, including patients, clinicians, researchers, and policy-makers. The development and use of strategies that support knowledge translation practice have been rapidly increasing, making it difficult for knowledge users to decide which to use. There is limited evidence-based guidance or measures to help assess the overall quality of knowledge translation strategies. INCLUSION CRITERIA Empirical and non-empirical documents will be considered if they explicitly describe a knowledge translation methods tool and its development, evaluation or validation, methodological strengths or limitations, and/or use over time. The review will consider a knowledge translation methods tool if it falls within at least one knowledge translation domain (ie, implementation, dissemination, sustainability, scalability, integrated knowledge translation) in the health field. METHODS We will conduct a systematic search of relevant electronic databases and gray literature. The search strategy will be developed iteratively by an experienced medical information specialist and peer-reviewed with the PRESS checklist. The search will be limited to English-only documents published from 2005 onward. Documents will be independently screened, selected, and extracted by 2 researchers. Data will be analyzed and summarized descriptively, including the characteristics of the included documents, knowledge translation methods tools, and candidate quality indicators. SCOPING REVIEW REGISTRATION Open Science Framework ( https://osf.io/chxvq ).
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Affiliation(s)
- Aunima R Bhuiya
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Julie Makarski
- North York General Hospital, Research and Innovation, North York, ON, Canada
| | - Leigh Hayden
- Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- University Health Network, Toronto, ON, Canada
| | - Iveta Lewis
- North York General Hospital, Research and Innovation, North York, ON, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and the O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Lisa Strifler
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Fok-Han Leung
- St Michael's Hospital, Unity Health, Tornoto, ON, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Lisa M Puchalski Ritchie
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Valeria Rac
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Christine Fahim
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Monika Kastner
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,North York General Hospital, Research and Innovation, North York, ON, Canada
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Shachar B, Rubin S, Kazevman G, Leung FH. A Qualitative Evaluation of Medical Students' Perspectives Regarding Collaboration with Physician Assistants. J Physician Assist Educ 2022; 33:279-283. [PMID: 36409235 DOI: 10.1097/jpa.0000000000000471] [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] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Physician assistant (PA) is a burgeoning profession in Canada, with several accredited training programs. Because the scope of practice for PAs in Ontario, as delineated by the province, stipulates that all tasks they perform must be delegated by a supervising physician, it is expected that medical students will increasingly encounter and work alongside PAs in clinical environments. There has been a paucity of research to date investigating how medical students experience this professional relationship. This current study aimed to investigate the attitudes and perspectives that medical students have about working with PAs. METHODS Medical students from the University of Toronto (n = 11) in various stages of training participated in 3 focus groups. The focus groups used a semi-structured interview guide to explore medical students' general opinions of the profession, their understanding of the interprofessional relationship, and their experiences working with PAs. Qualitative methods with a phenomenological underpinning were used to analyze the focus groups. RESULTS The findings show that medical students have observed or collaborated with PAs in clinical environments but are generally unaware of the profession's scope of practice and responsibilities. Medical students also viewed PAs as beneficial to patient care and expressed a desire to discover more about the profession through formal education. DISCUSSION This call for interprofessional education should be heeded by medical faculty to better prepare medical students for future collaboration with PAs.
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Affiliation(s)
- Ben Shachar
- Ben Shachar, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Serena Rubin, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Gill Kazevman, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Fok-Han Leung, MD , is an associate professor for the Department of Family and Community Medicine at the University of Toronto in Toronto, Ontario
| | - Serena Rubin
- Ben Shachar, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Serena Rubin, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Gill Kazevman, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Fok-Han Leung, MD , is an associate professor for the Department of Family and Community Medicine at the University of Toronto in Toronto, Ontario
| | - Gill Kazevman
- Ben Shachar, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Serena Rubin, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Gill Kazevman, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Fok-Han Leung, MD , is an associate professor for the Department of Family and Community Medicine at the University of Toronto in Toronto, Ontario
| | - Fok-Han Leung
- Ben Shachar, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Serena Rubin, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Gill Kazevman, MD, is a family medicine resident at the University of Toronto, Temerty Faculty of Medicine, in Toronto, Ontario
- Fok-Han Leung, MD , is an associate professor for the Department of Family and Community Medicine at the University of Toronto in Toronto, Ontario
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10
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Teitelbaum D, Xie M, Issa M, Nelms M, Wintraub L, Leung FH, Nyhof-Young J, Otremba M, Sirianni G, Prucnal K. Use of wearable point-of-view live streaming technology for virtual physical exam skills training. Can Med Educ J 2022; 13:64-66. [PMID: 35875435 PMCID: PMC9297247 DOI: 10.36834/cmej.73076] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We piloted a virtual teaching tool comprised of a chest-mounted smartphone streaming point-of-view footage over videoconferencing software to deliver a physical exam skills session. Compared to medical students taught via third person view through pre-recorded video followed by preceptor-led discussion, a higher proportion of students taught via point-of-view wearable technology reported improved knowledge of demonstrated skills and feeling engaged, comfortable interacting with their tutor, and better able to visualize demonstrated exam maneuvers. This accessible, affordable, and easily replicable innovation can potentially enhance virtual clinical skills teaching and enable novel distant clinical learning opportunities for healthcare professions students and educators.
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Affiliation(s)
| | - Mary Xie
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Matthew Nelms
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Lauren Wintraub
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- St. Michael’s Hospital, Ontario, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Office of Assessment and Evaluation, MD Program, University of Toronto, Ontario, Canada
| | - Mirek Otremba
- Department of General Internal Medicine, Royal Jubilee Hospital, British Columbia, Canada
| | - Giovanna Sirianni
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Karina Prucnal
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- North York General Hospital, Ontario, Canada
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11
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Lofters AK, Baker NA, Corrado AM, Schuler A, Rau A, Baxter NN, Leung FH, Weyman K, Kiran T. Care in the Community: Opportunities to improve cancer screening uptake for people living with low income. Prev Med Rep 2022; 24:101622. [PMID: 34976677 PMCID: PMC8684029 DOI: 10.1016/j.pmedr.2021.101622] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/11/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Despite organized provincial cancer screening programs, people living with low income consistently have lower rates of screening in Ontario, Canada than their more socioeconomically advantaged peers. We previously published results of a two-phase, exploratory qualitative study involving both interviews and focus groups whose objective was to integrate knowledge of people living with low income on how to improve primary care strategies aimed at increasing cancer screening uptake. In the current paper, we report previously unpublished findings from that study that identify how taking a community outreach approach in primary care may lead to increased cancer screening uptake among people living with low income. Participants told us that they saw value in a community outreach approach to cancer screening. They recommended specific actionable approaches, in particular, mobile community-based screening and community information sessions, and recommended taking an ethno-specific lens depending on the communities being targeted. Participants expressed a desire for primary care providers to go out into the community to learn more about the whole patient, such as could be achieved with home visits, but they simultaneously believed that this may be challenging in urban settings and in the context of perceived physician shortages. Models of primary care that provide support to an entire local community and provide some of their services directly in that community may have a meaningful impact on cancer screening for socially marginalized groups.
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Affiliation(s)
- Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 2B1, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.,Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M7, Canada.,Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Natalie Alex Baker
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M7, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Ann Marie Corrado
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 2B1, Canada
| | - Andree Schuler
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Allison Rau
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Nancy N Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Australia.,Department of Surgery, University of Toronto, Toronto, ON M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M6, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Karen Weyman
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M6, Canada
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12
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Yu CH, Medleg F, Choi D, Spagnuolo CM, Pinnaduwage L, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi S, Stacey D, Telner D. Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial. BMC Med Inform Decis Mak 2021; 21:323. [PMID: 34809626 PMCID: PMC8609876 DOI: 10.1186/s12911-021-01673-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01673-w.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Farid Medleg
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Catherine M Spagnuolo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Lakmini Pinnaduwage
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Paul Cantarutti
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada
| | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada
| | - Amy Hoang-Kim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Noah Ivers
- Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - David Kaplan
- University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.,North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada
| | - Fok-Han Leung
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - John Maxted
- Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada
| | - Jeremy Rezmovitz
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sumeet Sodhi
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada
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13
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Kazevman G, Ng JCY, Marshall JL, Slater M, Leung FH, Guiang CB. Challenges for Family Medicine Residents in Attaining the CanMEDS Professional Role: A Thematic Analysis of Preceptor Field Notes. Acad Med 2021; 96:1598-1602. [PMID: 34039855 DOI: 10.1097/acm.0000000000004184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Among the roles of the competent physician is that of a professional, according to the Canadian Medical Education Directives for Specialists (CanMEDS) framework, which describes the abilities physicians require to effectively meet the health care needs of the people they serve. Through examination of preceptor field notes on resident performance, the authors identified aspects of this role with which family medicine residents struggle. METHOD The authors used a structured thematic analysis in this qualitative study to explore the written feedback postgraduate medical learners receive at the University of Toronto Department of Family and Community Medicine. Seventy field notes written between 2015 and 2017 by clinical educators for residents who scored "below expectation" in the CanMEDS professional role were analyzed. From free-text comments, the authors derived inductive codes, amalgamated the codes into themes, and measured the frequency of the occurrence of the codes. The authors then mapped the themes to the key competencies of the CanMEDS professional role. RESULTS From the field notes, 7 themes emerged that described reasons for poor performance. Lack of collegiality, failure to adhere to standards of practice or legal guidelines, and lack of reflection or self-learning were identified as major issues. Other themes were failure to maintain boundaries, taking actions that could have a negative impact on patient care, failure to maintain patient confidentiality, and failure to engage in self-care. When the themes were mapped to the key competencies in the CanMEDS professional role, most related to the competency "commitment to the profession." CONCLUSIONS This study highlights aspects of professional conduct with which residents struggle and suggests that the way professionalism is taught in residency programs-and at all medical training levels-should be reassessed. Educational interventions that emphasize learners' commitment to the profession could enhance the development of more practitioners who are consummate professionals.
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Affiliation(s)
- Gill Kazevman
- G. Kazevman is a third-year medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jessica C Y Ng
- J.C.Y. Ng is a graduate of the University of Toronto, Scarborough, Ontario, Canada
| | - Jessica L Marshall
- J.L. Marshall is a graduate of the University of Toronto, Scarborough, Ontario, Canada
| | - Morgan Slater
- M. Slater is a postdoctoral fellow, Department of Family Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Fok-Han Leung
- F.-H. Leung is associate professor, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charlie B Guiang
- C.B. Guiang is assistant professor and resident academic project coordinator, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, and physician co-lead, Wellesley-St. James Town Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
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14
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Charalambous A, Pincus D, High S, Leung FH, Aktar S, Paterson JM, Redelmeier DA, Ravi B. Association of Surgical Experience With Risk of Complication in Total Hip Arthroplasty Among Patients With Severe Obesity. JAMA Netw Open 2021; 4:e2123478. [PMID: 34468752 PMCID: PMC8411295 DOI: 10.1001/jamanetworkopen.2021.23478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Severe obesity is a risk factor for major early complications after total hip arthroplasty (THA). OBJECTIVE To determine the association between surgeon experience with THA in patients with severe obesity and risk of complications. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study was performed in Ontario, Canada, from April 1, 2007, to March 31, 2017, with data analysis performed from March 2020 to January 2021. A cohort of patients who received a primary THA for osteoarthritis and who also had severe obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] ≥40) at the time of surgery was defined. These patients were identified using the Canadian Institute for Health Information Discharge Abstract Database and physician claims from the Ontario Health Insurance Plan. Generalized estimating equations were used to determine the association between overall THA and severe obesity-specific THA surgeon volume and the occurrence of complications after controlling for potential confounders. The study hypothesized that surgeon experience specific to patients with severe obesity could further reduce the risk of complications. EXPOSURES Primary THA. MAIN OUTCOMES AND MEASURES Complications were considered as a composite outcome (revision, infection requiring surgery, or dislocation requiring reduction), within 1 year of surgery. This was defined before the study, as was the study hypothesis. RESULTS A total of 4781 eligible patients was identified. The median age was 63 (interquartile range [IQR], 56-69) years, and 3050 patients (63.8%) were women. Overall, 186 patients (3.9%) experienced a surgical complication within 1 year of surgery. The median overall THA surgeon volume was 70 (IQR, 46-106) cases/y, whereas the median obesity-specific surgeon volume was 5 (IQR, 2-9) cases/y. After controlling for patient and hospital factors, greater obesity-specific THA surgeon volume (adjusted odds ratio per additional 10 cases, 0.65 [95% CI, 0.47-0.89]; P = .007), but not greater overall THA surgeon volume (adjusted odds ratio per 10 additional cases, 0.97 [95% CI, 0.93-1.02]; P = .24), was associated with a reduced risk of complication. CONCLUSIONS AND RELEVANCE Increased surgeon experience performing THA in patients with severe obesity was associated with fewer major surgical complications. These findings suggest that surgeon experience is required to mitigate the unique anatomical challenges posed by surgery in patients with severe obesity. Referral pathways for patients with severe obesity to surgeons with high obesity-specific THA volume should be considered.
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Affiliation(s)
- Alexander Charalambous
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sasha High
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suriya Aktar
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - J. Michael Paterson
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donald A. Redelmeier
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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15
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Kastner M, Makarski J, Hayden L, Hamid JS, Holroyd-Leduc J, Twohig M, Macfarlane C, Hynes MT, Prasaud L, Sklar B, Honsberger J, Wang M, Kramer G, Hobden G, Armson H, Ivers N, Leung FH, Liu B, Marr S, Greiver M, Desroches S, Sibley K, Saunders H, Isaranuwatchai W, McArthur E, Harvey S, Manawadu K, Petricca K, Straus SE. Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness-implementation randomised controlled trial. BMJ Open 2021; 11:e048350. [PMID: 33597147 PMCID: PMC7893667 DOI: 10.1136/bmjopen-2020-048350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION In response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called 'KeepWell' that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases. METHODS AND ANALYSIS We will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness-implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability. ETHICS AND DISSEMINATION Ethics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting. TRIAL REGISTRATION NUMBER NCT04437238.
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Affiliation(s)
- Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Research and Innovation, University of Toronto, Toronto, Ontario, Canada
| | - Julie Makarski
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Leigh Hayden
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Margo Twohig
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Charlie Macfarlane
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Mary Trapani Hynes
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Leela Prasaud
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Barb Sklar
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Joan Honsberger
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Marilyn Wang
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Gloria Kramer
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Gerry Hobden
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Heather Armson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Noah Ivers
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fok-Han Leung
- Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Barbara Liu
- Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Marr
- Division of Geriatric Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Desroches
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Kathryn Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hailey Saunders
- Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Sarah Harvey
- Healthcare technologies, QoC Health, Toronto, Ontario, Canada
| | - Kithara Manawadu
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Kadia Petricca
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Sharon E Straus
- Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bellicoso E, Cho SM, Got T, Leung FH, Wright R. Building relationships: reimagining the community placement for medical students. Can Med Educ J 2021; 12:e107-e108. [PMID: 33680243 PMCID: PMC7931479 DOI: 10.36834/cmej.70555] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Sung Min Cho
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Tiffany Got
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Community and Family Medicine, University of Toronto, Ontario, Canada
| | - Roxanne Wright
- Faculty of Medicine, University of Toronto, Ontario, Canada
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Abstract
This article was migrated. The article was marked as recommended. The landscape of postgraduate education in a family medicine residency changed abruptly with the onset of the pandemic in March 2020. The early weeks and months of the pandemic have highlighted some short-fallings in virtual supervision that were not anticipated based upon our previous ways of teaching. In order to support the essential components of family medicine postgraduate teaching, curricular and program structural changes are required (which will likely translate into further iterative improvements). This opinion piece highlights some early changes in our large Canadian Family Medicine Residency Program, combining our early reflections on virtual supervision, the practicalities of on-the-ground teaching, and the existing concepts from the literature supporting effective medical teaching.
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Kazevman G, Marshall JL, Shachar B, Slater M, Leung FH, Guiang CB. Uncovering Hidden Scholar Feedback with Field Notes. MedEdPublish 2021. [DOI: 10.15694/mep.2021.000168.1] [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: 11/06/2022] Open
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Tsang J, Berger I, Kirubarajan A, Park S, Wright R, Leung FH. Evaluating of a pen-pal curriculum innovation: a novel tool to teach medical students empathy for homelessness. MedEdPublish 2021. [DOI: 10.15694/mep.2021.000086.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Jeyakumar Y, Sharma D, Sirianni G, Nyhof-Young J, Otremba M, Leung FH. Limitations in virtual clinical skills education for medical students during COVID-19. Can Med Educ J 2020; 11:e165-e166. [PMID: 33349770 PMCID: PMC7749689 DOI: 10.36834/cmej.70240] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Giovanna Sirianni
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Joyce Nyhof-Young
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Mirek Otremba
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Division of General Internal Medicine, Mount Sinai Hospital, Ontario, Canada
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
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Yu C, Choi D, Bruno BA, Thorpe KE, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi-Helou S, Stacey D, Telner D. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e16984. [PMID: 32996893 PMCID: PMC7557444 DOI: 10.2196/16984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. OBJECTIVE This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. METHODS A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. RESULTS At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). CONCLUSIONS Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078.
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Affiliation(s)
- Catherine Yu
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Dorothy Choi
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Brigida A Bruno
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sharon E Straus
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | | | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), Toronto, ON, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, Toronto, ON, Canada
| | - Amy Hoang-Kim
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Kaplan
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Fok-Han Leung
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - John Maxted
- Markham Stouffville Hospital, Markham, ON, Canada
| | | | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sumeet Sodhi-Helou
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), Toronto, ON, Canada
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Wintraub L, Xie M, Issa M, Jeyakumar Y, Nelms M, Sharma D, Teitelbaum D, Otremba M, Sirianni G, Nyhof-Young J, Leung FH. Wearable technology and live video conferencing: The development of an affordable virtual teaching platform to enhance clinical skills education during the COVID-19 pandemic. Can Med Educ J 2020; 11:e121-e125. [PMID: 33062106 PMCID: PMC7522885 DOI: 10.36834/cmej.70554] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Mary Xie
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mariam Issa
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | - Matthew Nelms
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | | | - Mirek Otremba
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Division of General Internal Medicine, Mount Sinai Hospital, Ontario, Canada
| | - Giovanna Sirianni
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Office of Assessment and Evaluation, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Ontario, Canada
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Lofters AK, Baker NA, Schuler A, Rau A, Baxter A, Baxter NN, Kucharski E, Leung FH, Weyman K, Kiran T. A "Tea and Cookies" Approach: Co-designing Cancer Screening Interventions with Patients Living with Low Income. J Gen Intern Med 2020; 35:255-260. [PMID: 31637642 PMCID: PMC6957607 DOI: 10.1007/s11606-019-05400-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/16/2019] [Accepted: 09/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND In our primary care organization, we have observed income gradients in cancer screening for our patients despite outreach. We hypothesized that outreach strategies could be improved upon to be more compelling for our patients living with low income. OBJECTIVE To use co-design to adapt our current strategies and create new strategies to improve cancer screening uptake for patients living with low income. DESIGN An exploratory, qualitative study in two phases: interviews and focus groups. PARTICIPANTS For interviews, we recruited 25 patient participants who were or had been overdue for cancer screening and had been identified by their provider as potentially living with low income. For subsequent focus groups, we recruited 14 patient participants, 11 of whom had participated in Phase I interviews. APPROACH To analyse written transcripts, we took an iterative, inductive approach using content analysis and drawing on best practices in Grounded Theory methodology. Emergent themes were expanded and clarified to create a derived model of possible strategies to improve the experience of cancer screening and encourage screening uptake for patients living with low income. KEY RESULTS Fear and competing priorities were two key barriers to cancer screening identified by patients. Patients believed that a warm and encouraging outreach approach would work best to increase cancer screening participation. Phone calls and group education were specifically suggested as potentially promising methods. However, these views were not universal; for example, women were more likely to be in favour of group education. CONCLUSIONS We used input from patients living with low income to co-design a new approach to cancer screening in our primary care organization, an approach that could be broadly applicable to other contexts and settings. We learned from our patients that a multi-modal strategy will likely be best to maximize screening uptake.
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Affiliation(s)
- Aisha K Lofters
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada.
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
| | - Natalie A Baker
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Andree Schuler
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Allison Rau
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Alison Baxter
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Nancy N Baxter
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Edward Kucharski
- Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Karen Weyman
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Health Quality Ontario, 130 Bloor Street W, Toronto, ON, M5S 1N5, Canada
- Institute of Health Policy, Management and Evaluation, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
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Broussenko M, Burns S, Leung FH, Toubassi D. Can Teachers Distinguish Competencies From Entrustable Professional Activities? PRiMER 2019; 3:19. [PMID: 32537590 DOI: 10.22454/primer.2019.433736] [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] [Indexed: 10/26/2022]
Abstract
Introduction There has been a recent transition from the use of "competencies" to "entrustable professional activities" (EPAs) in medical education assessment paradigms. Although this transition proceeds apace, few studies have examined these concepts in a practical context. Our study sought to examine how distinct the concepts of competencies and EPAs were to front-line clinical educators. Methods A 20-item survey tool was developed based on the University of Calgary Department of Family Medicine's publicly available lists of competencies and EPAs. This tool required participants to identify given items as either a competency or an EPA, after reading a description of each. The tool was administered to a convenience sample of consenting clinical educators at 5 of the 14 training sites at the University of Toronto Department of Family and Community Medicine in 2018. We also collected information on years in practice, hours spent supervising per week, and direct involvement in medical education. Results We analyzed a total of 60 surveys. The mean rate of correct responses was 45.3% (+/- 21.8%). Subgroup analysis failed to reveal any correlation between any of the secondary characteristics and correct responses. Conclusion Clinical educators in our study were not able to distinguish between competencies and EPAs. Further research is recommended prior to intensive curricular changes.
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Affiliation(s)
- Mark Broussenko
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Burns
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Toubassi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Cohen L, Leung FH, Oriuwa C, Wright R. Service-learning Curriculum Design and Implementation at the University of Toronto Faculty of Medicine. MedEdPublish 2019. [DOI: 10.15694/mep.2019.000141.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was marked as recommended. Community service-learning is an integral component of the undergraduate medical experience, as it provides students with the opportunity to respond to and address societal issues. Students at the University of Toronto, Faculty of Medicine have traditionally participated in a service-learning curriculum that required them to choose placement opportunities from a centrally- developed catalogue of options, with no continuity between the university and the community from year to year. The mandatory service-learning placement was re-designed under the advisement of long-standing community partners, community-engaged physicians, and academics. The new model centralizes the relationship between faculty tutors and community partners, who act as co-educators for the medical students, with tutors serving as the primary link to community organizations. The University of Toronto's Faculty of Medicine is the first Canadian medical institution to implement this innovative curricular model.
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Sharp JR, Maguire JL, Carsley S, Abdullah K, Chen Y, Perrin EM, Parkin PC, Birken CS, Maguire JL, Lau E, Laupacis A, Parkin PC, Salter M, Szatmari P, Weir S, Abdullah K, Aglipay M, Ali Y, Anderson LN, Bayoumi I, Birken CS, Borkhoff CM, Carsley S, Chen S, Chen Y, Dai DW, Darmawikarta D, Dennis CL, Eny K, Erdle S, Furlong K, Kavikondala K, Koroshegyi C, Kowal C, Lee GJ, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, Plumptre L, van den Heuvel M, Vanderhout S, Wong P, Zabih W, Abdurrahman M, Anderson B, Anderson K, Arbess G, Baker J, Barozzino T, Bergeron S, Bhagat D, Blanchette N, Bloch G, Bonifacio J, Bowry A, Brown A, Bugera J, Calpin C, Campbell D, Cheema S, Cheng E, Chisamore B, Constantin E, Culbert E, Danayan K, Das P, Derocher MB, Do A, Dorey M, Doukas K, Egger A, Farber A, Freedman A, Freeman S, Fung K, Gazeley S, Goldenberg D, Guiang C, Ha D, Hafiz S, Handford C, Hanson L, Harrington L, Hatch H, Hughes T, Jacobson S, Jagiello L, Jansz G, Kadar P, Kiran T, Kitney L, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Li A, Li P, Loo J, Louis J, Mahmoud S, Male R, Mascoll V, Moodie R, Morinis J, Nader M, Naymark S, Neelands P, Owen J, Parry J, Peer M, Pena K, Perlmutar M, Persaud N, Pinto A, Pitt T, Porepa M, Qi V, Ramji N, Ramji N, Rana J, Rosenthal A, Rouleau K, Saunderson J, Saxena R, Schiralli V, Sgro M, Shepherd S, Smiltnieks B, Srikanthan C, Taylor C, Turner S, Uddin F, Vaughan J, Weisdorf T, Wijayasinghe S, Wong P, Wormsbecker A, Ying E, Young E, Zajdman M, Bustos M, Camacho C, Dalwadi D, Jegathesan T, Malhi T, Thadani S, Thompson J, Thompson L, Allen C, Boodhoo B, Hall J, Juni P, Lebovic G, Pope K, Shim J, Thorpe K, Azad A. Temperament Is Associated With Outdoor Free Play in Young Children: A TARGet Kids! Study. Acad Pediatr 2018; 18:445-451. [PMID: 28842293 DOI: 10.1016/j.acap.2017.08.006] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/04/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Outdoor free play is important for preschoolers' physical activity, health, and development. Certain temperamental characteristics are associated with obesity, nutrition, and sedentary behaviors in preschoolers, but the relationship between temperament and outdoor play has not been examined. This study examined whether there is an association between temperament and outdoor play in young children. METHODS Healthy children aged 1 to 5 years recruited to The Applied Research Group for Kids (TARGet Kids!), a community-based primary care research network, from July 2008 to September 2013 were included. Parent-reported child temperament was assessed using the Childhood Behavior Questionnaire. Outdoor free play and other potential confounding variables were assessed through validated questionnaires. Multivariable linear regression was used to determine the association between temperament and outdoor play, adjusted for potential confounders. RESULTS There were 3393 children with data on outdoor play. The association between negative affectivity and outdoor play was moderated by sex; in boys, for every 1-point increase in negative affectivity score, mean outdoor play decreased by 4.7 minutes per day. There was no significant association in girls. Surgency was associated with outdoor play; for every 1-point increase in surgency/extraversion, outdoor play increased by 4.6 minutes per day. CONCLUSIONS Young children's temperamental characteristics were associated with their participation in outdoor free play. Consideration of temperament could enhance interventions and strategies to increase outdoor play in young children. Longitudinal studies are needed to elucidate the relationship between children's early temperament and physical activity.
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Affiliation(s)
- Julia R Sharp
- Department of Post-Graduate Medical Education, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Jonathon L Maguire
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Department of Paediatrics, St Michael's Hospital, Toronto, Canada
| | - Sarah Carsley
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Kawsari Abdullah
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Yang Chen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Eliana M Perrin
- Department of Pediatrics, Division of Primary Care, Duke University, Durham, NC
| | - Patricia C Parkin
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Catherine S Birken
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Child Health Evaluative Studies, SickKids Research Institute, Toronto, Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
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Summers A, Ruderman C, Leung FH, Slater M. Examining patterns in medication documentation of trade and generic names in an academic family practice training centre. BMC Med Educ 2017; 17:175. [PMID: 28938883 PMCID: PMC5610475 DOI: 10.1186/s12909-017-1015-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre. METHODS A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed. RESULTS Among 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%. CONCLUSIONS Trade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees' clinical knowledge and decision-making.
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Affiliation(s)
- Alexander Summers
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
| | - Carly Ruderman
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
| | - Morgan Slater
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
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Qureshi A, Kwok Y, Chaudhary Z, Leung FH, Mylopoulos M, Sockalingam S. A Simulation to Teach Integrated Care in Undergraduate Medical Education: The "Getting to Know Patients' System of Care" (GPS-CARE) Experience. Acad Psychiatry 2017; 41:533-537. [PMID: 28058669 DOI: 10.1007/s40596-016-0657-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/14/2016] [Indexed: 05/24/2023]
Affiliation(s)
| | - Yvonne Kwok
- University of Toronto, Toronto, Ontario, Canada
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Anderson LN, Heong SW, Chen Y, Thorpe KE, Adeli K, Howard A, Sochett E, Birken CS, Parkin PC, Maguire JL, Abdullah K, Anderson LN, Birken CS, Borkhoff CM, Carsley S, Chen Y, Katz-Lavigne M, Kavikondala K, Kowal C, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, Heuvel MVD, Baker J, Barozzino T, Bonifacio J, Campbell D, Cheema S, Chisamore B, Danayan K, Das P, Derocher MB, Do A, Dorey M, Freeman S, Fung K, Guiang C, Handford C, Hatch H, Jacobson S, Kiran T, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Loo J, Mahmoud S, Moodie R, Morinis J, Naymark S, Neelands P, Owen J, Peer M, Perlmutar M, Persaud N, Pinto A, Porepa M, Ramji N, Ramji N, Rosenthal A, Saunderson J, Saxena R, Sgro M, Shepherd S, Smiltnieks B, Taylor C, Weisdors T, Wijayasinghe S, Wong P, Ying E, Young E. Vitamin D and Fracture Risk in Early Childhood: A Case-Control Study. Am J Epidemiol 2017; 185:1255-1262. [PMID: 28459987 DOI: 10.1093/aje/kww204] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 01/08/2016] [Accepted: 04/22/2016] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to evaluate the association of vitamin D intake and serum levels with fracture risk in children under 6 years of age. A case-control study was conducted in Toronto, Ontario, Canada. Cases were recruited from the fracture clinic at the Hospital for Sick Children, and matched controls were obtained from the TARGet Kids! primary-care research network. Controls were matched to cases on age, sex, height, and season. Fracture risk was estimated from conditional logistic regression, with adjustment for skin type, fracture history, waist circumference, outdoor free play, neighborhood income, soda consumption, and child's birth weight. A total of 206 cases were recruited during May 2009-April 2013 and matched to 343 controls. Serum 25-hydroxyvitamin D concentration (per 10-nmol/L increment: adjusted odds ratio (aOR) = 0.95, 95% confidence interval (CI): 0.88, 1.03) and intake of cow's milk (<2 cups/day vs. 2 cups/day: aOR = 0.95 (95% CI: 0.60, 1.52); >2 cups/day vs. 2 cups/day: aOR = 1.39 (95% CI: 0.85, 2.23)) were not significantly associated with reduced odds of fracture. A statistically significant association was observed between child use of vitamin D supplements and decreased odds of fracture (yes vs. no: aOR = 0.42, 95% CI: 0.25, 0.69). Vitamin D supplementation, but not serum 25-hydroxyvitamin D level or milk intake, was associated with reduced fracture risk among these healthy young children.
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Affiliation(s)
- Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sze Wing Heong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yang Chen
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Khosrow Adeli
- Clinical Biochemistry Division, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Howard
- Division of Orthopaedics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Etienne Sochett
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Iglar K, Leung FH, Moineddin R, Herold J. FM-MAP: A Novel In-Training Examination Predicts Success on Family Medicine Certification Examination. Fam Med 2017; 49:369-373. [PMID: 28535317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The objective of our study was to assess the correlation between a locally developed In-Training Examination (ITE) and the certification examination in family medicine in Canada. METHODS The ITE was taken twice yearly, which corresponded for most residents to the fifth, ninth, 17th, and 21st month of training. The results for the ITE were correlated to the CFPC certification examination taken in the 23rd month of residency. RESULTS The scores on each of the four iterations of the ITE correlated moderately well with performance relating to problem solving skills and knowledge on the certification examination. The ITE showed a trend to an increased correlation with duration in the training program with a Spearman correlation coefficient increasing from 0.45 on the first test to 0.54 on the fourth test. The correlation of the ITE with performance on the component assessing the doctor- patient relationship on the certification examination was poor (r=0.26 on the last test). CONCLUSION Our in-training examination is a useful predictor of performance in problem solving and knowledge domains of the family medicine expert role on the certification examination.
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Affiliation(s)
- Karl Iglar
- Department of Family and Community Medicine, University of Toronto
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Cox KA, Parkin PC, Anderson LN, Chen Y, Birken CS, Maguire JL, Macarthur C, Borkhoff CM, Anderson LN, Bayoumi I, Birken CS, Borkhoff CM, Carsley S, Chen Y, Katz-Lavigne M, Kavikondala K, Koroshegyi C, Kowal C, Lee GJ, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, van den Heuvel M, Wong P, Zabih W, Baker J, Barozzino T, Bonifacio J, Campbell D, Cheema S, Chisamore B, Danayan K, Das P, Derocher MB, Do A, Dorey M, Freeman S, Fung K, Guiang C, Handford C, Hatch H, Jacobson S, Kiran T, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Loo J, Mahmoud S, Moodie R, Morinis J, Naymark S, Neelands P, Owen J, Peer M, Perlmutar M, Persaud N, Pinto A, Porepa M, Ramji N, Ramji N, Rosenthal A, Saunderson J, Saxena R, Sgro M, Shepherd S, Smiltnieks B, Taylor C, Weisdors T, Wijayasinghe S, Wong P, Ying E, Young E, Barozzino T, Chisamore B, Feldman M, Ipp M, Abreo K, Dalwadi D, Malhi T, Pugliese A, Smith M, Thompson L. Association Between Meat and Meat-Alternative Consumption and Iron Stores in Early Childhood. Acad Pediatr 2016; 16:783-791. [PMID: 26804490 DOI: 10.1016/j.acap.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Received: 03/17/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To prevent iron deficiency, 2014 Canadian recommendations for healthy term infants from 6 to 24 months recommend iron-rich complementary foods such as meat and meat alternatives 2 or more times a day. The purpose of our study was to evaluate the association between meat and meat-alternative consumption and iron status in young children and the association between red meat consumption and iron status among children meeting recommendations. METHODS Healthy children aged 12 to 36 months were recruited. A cross-sectional study was conducted. Meat and meat-alternative consumption was measured using the NutriSTEP questionnaire. Adjusted multivariable regression analyses were used to evaluate an association between meat consumption and serum ferritin, and iron deficiency (serum ferritin <14 μg/L). RESULTS A total of 1043 children were included. Seventy-three percent of children met the recommended daily intake of meat and meat alternatives, and 66% ate red meat in the past 3 days. Eating meat and meat alternatives was not associated with serum ferritin (0.13 μg/L, 95% confidence interval -0.05, 0.31, P = .16), but it was associated with a decreased odds of iron deficiency (odds ratio 0.97, 95% confidence interval 0.94, 0.99, P = .03). Associations between red meat consumption and iron status were not statistically significant. Statistically significant covariates associated with increased odds of iron deficiency included longer breast-feeding duration, daily cow's milk intake of >2 cups, and a higher body mass index z score. CONCLUSIONS Daily cow's milk intake of >2 cups, longer breast-feeding duration, and a higher body mass index z score were modifiable risk factors associated with iron deficiency. Eating meat according to recommendations may be a promising additional target for the prevention of iron deficiency in early childhood.
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Affiliation(s)
- Kelly Anne Cox
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Laura N Anderson
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada
| | - Yang Chen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada; Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada.
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Abstract
Student-run free clinics (SRFCs) are becoming increasingly popular programmes in schools for promoting interprofessional education and service learning. Despite their prevalence, little research has been done surrounding SRFCs and wait-times. SRFCs may experience long wait-times because patients are often seen on a drop-in basis and time has to be allotted for interprofessional case discussion and teaching. The purpose of this study was to evaluate the wait-times for patients being seen at an interprofessional SRFC and determine potential improvements. Wait-times, total treatment room times, total time per patient, and whether a referral and/or prescription was given were tracked from May 2014 to July 2015 at an SRFC. A total of 268 patients were seen in 52 clinics. On average, five patients were seen per clinic. Patients waited for an average time of 21 minutes before they were seen by the team. Average treatment time per patient was 69 minutes. Patients were generally at the clinic for a total of 91 minutes before being discharged. Several improvements for managing client flow at interprofessional SRFCs are discussed.
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Affiliation(s)
- Tina Hu
- a Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada
| | - Fok-Han Leung
- b Department of Family and Community Medicine , St. Michael's Hospital , Toronto , Ontario , Canada
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Lofters AK, Slater MB, Nicholas Angl E, Leung FH. Facebook as a tool for communication, collaboration, and informal knowledge exchange among members of a multisite family health team. J Multidiscip Healthc 2016; 9:29-34. [PMID: 26869796 PMCID: PMC4734793 DOI: 10.2147/jmdh.s94676] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To implement and evaluate a private Facebook group for members of a large Ontario multisite Family Health Team (FHT) to facilitate improved communication and collaboration. DESIGN Program implementation and subsequent survey of team members. SETTING A large multisite FHT in Toronto, Ontario. PARTICIPANTS Health professionals of the FHT. MAIN OUTCOME MEASURES Usage patterns and self-reported perceptions of the Facebook group by team members. RESULTS At the time of the evaluation survey, the Facebook group had 43 members (37.4% of all FHT members). Activity in the group was never high, and posts by team members who were not among the researchers were infrequent throughout the study period. The content of posts fell into two broad categories: 1) information that might be useful to various team members and 2) questions posed by team members that others might be able to answer. Of the 26 team members (22.6%) who completed the evaluation survey, many reported that they never logged into the Facebook page (16 respondents), and never used it to communicate with team members outside of their own site of practice (19 respondents). Only six respondents reported no concerns with using Facebook as a professional communication tool; the most frequent concerns were regarding personal and patient privacy. CONCLUSION The use of social media by health care practitioners is becoming ubiquitous. However, the issues of privacy concerns and determining how to use social media without adding to provider workload must be addressed to make it a useful tool in health care.
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Affiliation(s)
- Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Morgan B Slater
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Nicholas Angl
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Leung FH. Texture and approach: technique for consistent cervical examinations. Can Fam Physician 2014; 60:823-825. [PMID: 25217679 PMCID: PMC4162699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Fok-Han Leung
- Staff physician in the Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont
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Abstract
The advent of social networking as a major platform for human interaction has introduced a new dimension into the physician–patient relationship, known as Health 2.0. The concept of Health 2.0 is young and evolving; so far, it has meant the use of social media by health professionals and patients to personalize health care and promote health education. Social networking sites like Facebook and Twitter offer promising platforms for health care providers to engage patients. Despite the vast potential of Health 2.0, usage by health providers remains relatively low. Using a pilot study as an example, this commentary reviews the ways in which physicians can effectively harness the power of social networking to meaningfully engage their patients in primary prevention.
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Affiliation(s)
| | | | - Fok-Han Leung
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
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Yu CH, Stacey D, Sale J, Hall S, Kaplan DM, Ivers N, Rezmovitz J, Leung FH, Shah BR, Straus SE. Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care--systematic decision aid development and study protocol. Implement Sci 2014; 9:16. [PMID: 24450385 PMCID: PMC3937124 DOI: 10.1186/1748-5908-9-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/15/2014] [Indexed: 11/21/2022] Open
Abstract
Background Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. Objectives To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. Methods 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice. 2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness. 3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity. 4. Usability testing: This will be done using cognitive task analysis. 5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Discussion Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.
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Affiliation(s)
- Catherine H Yu
- Keenan Research Centre, Li Ka Shing Knowledge Institute of St, Michael's Hospital, Toronto, Canada.
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Haq R, Heus L, Baker NA, Dastur D, Leung FH, Leung E, Li B, Vu K, Parsons JA. Designing a multifaceted survivorship care plan to meet the information and communication needs of breast cancer patients and their family physicians: results of a qualitative pilot study. BMC Med Inform Decis Mak 2013; 13:76. [PMID: 23883430 PMCID: PMC3733735 DOI: 10.1186/1472-6947-13-76] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 07/19/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Following the completion of treatment and as they enter the follow-up phase, breast cancer patients (BCPs) often recount feeling 'lost in transition', and are left with many questions concerning how their ongoing care and monitoring for recurrence will be managed. Family physicians (FPs) also frequently report feeling ill-equipped to provide follow-up care to BCPs. In this three-phase qualitative pilot study we designed, implemented and evaluated a multi-faceted survivorship care plan (SCP) to address the information needs of BCPs at our facility and of their FPs. METHODS In Phase 1 focus groups and individual interviews were conducted with 35 participants from three stakeholder groups (BCPs, FPs and oncology specialist health care providers (OHCPs)), to identify specific information needs. An SCP was then designed based on these findings, consisting of both web-based and paper-based tools (Phase 2). For Phase 3, both sets of tools were subsequently evaluated via focus groups and interviews with 26 participants. Interviews and focus groups were audio taped, transcribed and content analysed for emergent themes and patterns. RESULTS In Phase 1 patients commented that web-based, paper-based and human resources components were desirable in any SCP. Patients did not focus exclusively on the post-treatment period, but instead spoke of evolving needs throughout their cancer journey. FPs indicated that any tools to support them must distill important information in a user-friendly format. In Phase 2, a pilot SCP was subsequently designed, consisting of both web-based and paper-based materials tailored specifically to the needs of BCPs as well as FPs. During Phase 3 (evaluation) BCPs indicated that the SCP was effective at addressing many of their needs, and offered suggestions for future improvements. Both patients and FPs found the pilot SCP to be an improvement from the previous standard of care. Patients perceived the quality of the BCP-FP relationship as integral to their comfort with FPs assuming follow-up responsibilities. CONCLUSIONS This pilot multi-component SCP shows promise in addressing the information needs of BCPs and the FPs who care for them. Next steps include refinement of the different SCP components, further evaluation (including usability testing), and planning for more extensive implementation.
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Affiliation(s)
- Rashida Haq
- Division of Hematology & Oncology, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lineke Heus
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St., Toronto, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Natalie A Baker
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St., Toronto, ON, Canada
| | - Daisy Dastur
- Oncology Clinical Research Group, St. Michael’s Hospital, Toronto, ON, Canada
| | - Fok-Han Leung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family Medicine, St. Michael’s Hospital, Toronto, ON, Canada
| | - Eman Leung
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Benjamin Li
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Janet A Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St., Toronto, ON, Canada
- Department of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada
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Bunn S, Fleming P, Rzeznikiewiz D, Leung FH. Understanding the demographic characteristics and health of medically uninsured patients. Can Fam Physician 2013; 59:e276-e281. [PMID: 23766066 PMCID: PMC3681470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine demographic and diagnostic information about the medically uninsured patient population and compare it with that of the medically insured patient population at a primary care centre. DESIGN Medical chart audit. SETTING Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont. PARTICIPANTS Medically uninsured patients who were treated in the Department of Family and Community Medicine at St Michael's Hospital from 2005 to 2009, as well as randomly selected patients who were insured through the Ontario Health Insurance Program. MAIN OUTCOME MEASURES The following information was obtained from patients' medical charts: patient's age, sex, and household income; if the patient had a specific diagnosis (ie, hypertension, type 2 diabetes mellitus, HIV, tuberculosis, substance addiction, or mental health disorder); if the patient accessed a specific category of primary care (ie, prenatal care or routine pediatric care); and the reason for the patient's uninsured status. RESULTS There was no significant difference in the mean age and sex distribution of insured and uninsured patients. The uninsured group had a significantly lower mean household income (P = .02). With the exception of HIV, there was no significant difference in the prevalence of the specific diagnoses studied or in the prevalence of accessing specific categories of primary care between insured and uninsured patients (P > .05). The prevalence of HIV was significantly greater in the uninsured group (24%) than in the insured group (4%) (P = .004). The largest proportion of uninsured patients lacked health insurance owing to the landed immigrant health insurance waiting period (27%), followed by individuals without permanent resident status in Canada (22%). A subgroup analysis of the uninsured, HIV-positive population revealed that the largest proportion of individuals (36%) lacked health insurance because they had no permanent resident status in Canada. CONCLUSION Uninsured and insured patients at the primary care centre did not differ significantly with respect to age and sex distribution; prevalence of hypertension, type 2 diabetes mellitus, tuberculosis, substance addiction, or mental health disorder; or the proportion who sought prenatal or routine pediatric care. The landed immigrant 3-month waiting period was the most common reason that uninsured patients lacked health insurance. Uninsured patients in this study lived in lower-income areas than insured patients did. This, combined with the increased prevalence of HIV in the uninsured group, might lead to a large number of uninsured, HIV-positive patients delaying seeking treatment and might have negative implications for public health.
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Affiliation(s)
- Shannon Bunn
- St Michael's Department of Family and Community Medicine, Health Centre at 80 Bond, 80 Bond St, Toronto ON M5B 1X2, Canada.
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Zarghom S, Di Fonzo D, Leung FH. Does Socioeconomic Status Affect Patients' Ease of Use of a Touch-Screen (iPad) Patient Survey? Interact J Med Res 2013; 2:e1. [PMID: 23612116 PMCID: PMC3628116 DOI: 10.2196/ijmr.2314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/14/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022] Open
Abstract
Socioeconomic disparities influence the usage rate of advanced communication technologies in Canada. It is important to assess all patient interactions with computers and electronic devices based on these socioeconomic differences. This project studied the ease of use of a touch-screen interface program for collecting patient feedback. The interface collected feedback on physicians’ communication skills, an important health concern that has been garnering more and more attention. A concurrent paper survey was used to gather information on the socioeconomic status and the usability of the touchscreen device. As expected, patients who were older, had lower annual household income, and had lower educational attainment were associated with more difficulty using the devices. Surprisingly, 94% of all users (representing a wide range of socioeconomic status backgrounds) rated the device as easy to use.
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Affiliation(s)
- Saman Zarghom
- University of Toronto, Faculty of Medicine, Toronto, ON, Canada
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Kopansky-Giles D, Leung FH. 29B. Enhancing Primary Healthcare Delivery in the Inner City through Interprofessional Team-based Care. Glob Adv Health Med 2013. [PMCID: PMC3875096 DOI: 10.7453/gahmj.2013.097cp.s29b] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Focus Area: Sustainable Business Models This session will describe the evolution of an integrative model of primary healthcare delivery within a hospital-based setting. Over the past decade, the Academic Family Health Team (AFHT) in the Department of Family and Community Medicine at St Michael's Hospital in Toronto has been in the business of transforming primary healthcare. The AFHT provides services to the inner-city community of Toronto through 5 clinical sites located conveniently in the downtown east core. Our model of care incorporates patient- and family-centered values; interprofessional collaboration; and accessible evidence-based care and research. Evaluation of our efforts has proved emancipating for both clinicians and patients—with the delivery of integrative healthcare services, improved coordination of care, enhanced patient outcomes and satisfaction, improved quality of work life for our health professional team, and patient/family empowerment in self-help strategies. This model of care was identified by the Council of the Federation Health Care Innovation Working Group as one of 4 innovative models of primary care delivery to be emulated in Canada. The session will describe our experiences in building our integrative healthcare team. Facilitators and barriers to the development of successful integrative models of primary care will be described. Specific strategies that have facilitated success in our experience also will be shared.
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Leung FH, Watson W. The parasite that wasn't: a case of mistaken identity. Can Fam Physician 2011; 57:1145-1147. [PMID: 21998230 PMCID: PMC3192079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Fok-Han Leung
- Health Centre, St Michael's Hospital, Toronto, ON, Canada.
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Leung FH, Frankford R. The born identity: prescription drug coverage by eligibility group. Can Fam Physician 2011; 57:1016-1018. [PMID: 21918145 PMCID: PMC3173422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Fok-Han Leung
- Family Practice Unit, St Michael's Hospital, Toronto, ON M5B 1W8, Canada.
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Abstract
BACKGROUND Regardless of the area of deficiency, be it in knowledge, skills or attitudes, residents requiring remediation are rarely self-identified. This illustrates a diminished ability for self-reflection. Self-reflection is a cornerstone of adult education. During the remediation process, the remediation curriculum needs to emphasize self-reflection. AIMS How can one structure self-reflection in a remediation curriculum? METHODS This article describes how to adapt and apply environmental scanning for remedial residents. RESULTS Environmental scanning is a rigorous and well-developed business approach that can be adapted for personal continuous quality improvement to foster self-reflection in medical trainees. There are often already existing tools which can form the foundation for regular reflection in medical education using an environmental scanning structure. CONCLUSIONS Environmental scanning can be thought of as a structured approach to internal and external reflections.
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Affiliation(s)
- Fok-Han Leung
- St. Michael's Hospital, Department of Family and Community Medicine, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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Abstract
PROBLEM Residents requiring remediation are often deficient in communication skills, namely clinical interviewing skills. Residents have to digest large amounts of knowledge, and then apply it in a clinical interview. The patient-centered approach, as demonstrated in the Calgary-Cambridge model and Martin's Map, can be difficult to teach. Before implementing a remediation curriculum, the theoretical educational underpinnings must be sound; curriculum evaluation is often expensive. Before establishing metrics for curriculum evaluation, a starting point is to perform a mental experiment to test theoretical adherence. METHODS This article describes an experiential remedial curriculum for communication skills. Educational theories of Kolb, Knowles, Bandura, and Bloom are used to design the curriculum into theory-based design components. CONCLUSIONS Kolb's experiential cycle models the natural sequence of experiencing, teaching, and learning interviewing skills. A curriculum structured around this cycle has multiple intercalations with the above educational theories. The design is strengthened by appropriately timed use of education strategies such as learning contracts, taped interviews, simulations, structured reflection, and teacher role modeling. Importantly, it also models the form of the clinical interview format desired. Through understanding and application of contemporary educational theories, a program to remediate interviewing skills can increase its potential for success.
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Affiliation(s)
- Fok-Han Leung
- St Michael's Hospital, Family Practice Unit, Toronto, ON, Canada.
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Leung FH, Savithiri R. Spotlight on focus groups. Can Fam Physician 2009; 55:218-219. [PMID: 19221085 PMCID: PMC2642503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Fok-Han Leung
- Family and Community Medicine, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8.
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Leung FH, Leung A. Bless me, for I have sinned ...: Behaviour change and the confessional. Can Fam Physician 2009; 55:17-18. [PMID: 19155355 PMCID: PMC2628844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Fok-Han Leung
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario.
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Leung FH, Thompson K, Weaver DF. Evaluating Spousal Abuse as a Potential Risk Factor for Alzheimer’s Disease: Rationale, Needs and Challenges. Neuroepidemiology 2006; 27:13-6. [PMID: 16770080 DOI: 10.1159/000093894] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Repetitive head trauma is an identified risk factor for Alzheimer's disease (AD). The violence in wife assault is repetitive and targets the head. This association provides a rationale for studying the relationship between spousal abuse and AD. DESIGN To preliminarily evaluate the possibility of an increased susceptibility for AD in women subjected to spousal abuse and to identify challenges associated with such a study, we performed a pilot case-control study involving women with AD and compared the incidence of spousal abuse against two control groups. Forty consecutive women with AD referred to a Memory Disorders Clinic were enrolled. Individuals were evaluated at three visits (0, 3, 9 months) and were followed for an additional 12 months to ensure that no other diagnosis emerged. Two control groups were likewise assessed. RESULTS 17.5% (7/40) of the women (average age 71 years) with AD reported spousal abuse with head trauma. In control group 1, 5.0% (2/40) and in control group 2, 7.5% (3/40) of the women reported spousal abuse with head trauma. CONCLUSIONS The development of AD may be a potential long-term consequence of wife assault. Our study suggests spousal abuse as a possible risk factor for AD, and supports the need for larger studies. However, there are practical challenges associated with the successful execution of such a study.
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Affiliation(s)
- Fok-Han Leung
- School of Medicine, University of Toronto, Toronto, Canada
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