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Huang D, Whitehead C, Kuper A. Competing discourses, contested roles: Electronic health records in medical education. Med Educ 2024. [PMID: 38764398 DOI: 10.1111/medu.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/06/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION The integration of electronic health records (EHRs) into medical education remains contested despite their widespread use in clinical practice. For medical trainees, this has resulted in idiosyncratic and often ad hoc methods of instruction on EHR use. The purpose of this study was to understand the currently fragmented nature of EHR instruction by examining discourses of EHR use within the medical education literature. METHODS We conducted a Foucauldian critical discourse analysis to identify discourses of EHRs in the medical education literature. We found our texts through a systematic search of widely cited medical education journals from 2013-2023. Each text was analysed for recurring truth statements-claims framed as self-evidently true and thus not needing supporting evidence-about the role of EHRs in medical education. RESULTS We identified three major discourses: (1) EHRs as a clinical skill and competency, emphasising training of physical interactions between learners, patients and computers; (2) EHRs as a system, emphasising the creation and facilitation of networks of people, technologies, institutions and standards; and (3) EHRs as a cognitive process, framed as a method to shape processes like clinical reasoning and bias. Each discourse privileged certain stakeholders over others and served to rationalise educational interventions that could be seen as beneficial in isolation yet were often disjointed in combination. CONCLUSIONS Competing discourses of EHR use in medical education produce divergent interventions that exacerbate their contested role in contemporary medical education. Identifying different claims for the benefits of EHR use in these settings allows educators to make rational choices between competing educational directions.
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Affiliation(s)
- Daniel Huang
- St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia Whitehead
- Women's College Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Ayelet Kuper
- Sunnybrook Health Sciences Centre, Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University Health Network and University of Toronto, Toronto, Canada
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Gray J, Cartmill C, Whitehead C. Playing well with others: lessons from theatre for the health professions about collaboration, creativity and community. Adv Health Sci Educ Theory Pract 2024:10.1007/s10459-024-10314-6. [PMID: 38411869 DOI: 10.1007/s10459-024-10314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/28/2024] [Indexed: 02/28/2024]
Abstract
Despite collaboration among different professions being recognized as fundamentally important to contemporary and future healthcare practice, the concept is woefully undertheorized. This has implications for how health professions educators might best introduce students to interprofessional collaboration and support their transition into interprofessional, collaborative workplaces. To address this, we engage in a conceptual analysis of published collaborative, interprofessional practices and conceptual understandings in theatre, as a highly collaborative art form and industry, to advance thinking in the health professions, specifically to inform interprofessional education. Our analysis advances a conceptualization of collaboration that takes place within a work culture of creativity and community, that includes four modes of collaboration, or the ways theatre practitioners collaborate, by: (1) paying attention to and traversing roles and hierarchies; (2) engaging in reciprocal listening and challenging of others; (3) developing trust and communication, and; (4) navigating uncertainty, risk and failure. We conclude by inviting those working in the health professions to consider what might be gleaned from our conceptualization, where the embodied and human-centred aspects of working together are attended to alongside structural and organizational aspects.
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Affiliation(s)
- Julia Gray
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada.
| | - Carrie Cartmill
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, and University Health Network, 200 Elizabeth Street, 1ES-559, Toronto, ON, M5G 2C4, Canada
| | - Cynthia Whitehead
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, and University Health Network, 200 Elizabeth Street, 1ES-559, Toronto, ON, M5G 2C4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
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Melka D, Baheretibeb Y, Whitehead C. Perceptions of readiness for interprofessional learning among Ethiopian medical residents at Addis Ababa University: a mixed methods study. BMC Med Educ 2024; 24:89. [PMID: 38273302 PMCID: PMC10811800 DOI: 10.1186/s12909-024-05055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Interprofessional learning is an important approach to preparing residents for collaborative practice. Limited knowledge and readiness of residents for interprofessional learning is considered one of the barriers and challenges for applying Interprofessional learning. We aimed to assess the perceptions of readiness of medical residents for interprofessional learning in Ethiopia. METHODS We conducted a parallel mixed-methods study design to assess the perceptions of readiness for interprofessional learning among internal medicine and neurology residents of Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, from May 1 to June 30, 2021. One hundred one residents were included in the quantitative arm of the study, using the Readiness for Interprofessional Learning Scale (RIPLS) tool. All internal medicine and neurology residents who consented and were available during the study period were included. SPSS/PC version 25 software packages for statistical analysis (SPSS) was used for statistical analysis. Descriptive statistics were summarized as mean and standard deviation for continuous data as well as frequencies and percentages to describe categorical variables. Data were presented in tables. In addition, qualitative interviews were undertaken with six residents to further explore residents' knowledge and readiness for IPL. Data were analyzed using a six-step thematic analysis. RESULTS Of the 101 residents surveyed, the majority of the study participants were male (74.3%). The total mean score of RIPLS was 96.7 ± 8.9. The teamwork and collaboration plus patient-centeredness sub-category of RIPLS got a higher score (total mean score: 59.3 ± 6.6 and 23.5 ± 2.5 respectively), whereas the professional identity sub-category got the lowest score (total mean score: 13.8 ± 4.7). Medical residents' perceptions of readiness for interprofessional learning did not appear to be significantly influenced by their gender, age, year of professional experience before the postgraduate study, and department. Additionally, the qualitative interviews also revealed that interprofessional learning is generally understood as a relevant platform of learning by neurology and internal medicine residents. CONCLUSIONS We found high scores on RIPLS for internal medicine and neurology postgraduate residents, and interprofessional learning is generally accepted as an appropriate platform for learning by the participants, which both suggest readiness for interprofessional learning. This may facilitate the implementation of interprofessional learning in the postgraduate medical curriculum in our setting. We recommend medical education developers in Ethiopia consider incorporating interprofessional learning models into future curriculum design.
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Affiliation(s)
- Dereje Melka
- Department of Neurology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
| | - Yonas Baheretibeb
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, Director and Scientist at the Wilson Centre, Temerty Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada
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Cartmill C, Rowland P, Rojas D, Cameron E, Whitehead C. Power/knowledge: A sociomaterial perspective on a new accreditation process during COVID-19. Med Educ 2023; 57:1210-1218. [PMID: 37264487 DOI: 10.1111/medu.15143] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/30/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic had significant impacts on many aspects of health care and education, including the accreditation of medical education programmes. As a community of international educators, it is important that we study changes that resulted from the pandemic to help us understand educational processes more broadly. As COVID-19 unfolded in Canada, a revised format of undergraduate medical accreditation was implemented, including a shift to virtual site visits, a two-stage visit schedule, a focused approach to reviewing standards and the addition of a field secretary to the visit team. Our case study research aimed to evaluate the sociomaterial implications of these changes in format on the process of accreditation at two schools. METHODS We interviewed key informants to understand the impacts, strengths and limitations of changes made to the accreditation format. We used an abductive approach to analyse transcripts and applied a sociomaterial lens in looking for interconnections between the material and social changes that were experienced within the accreditation system. RESULTS Stakeholders within the accreditation system did not anticipate that changes to the accreditation format would have significant impacts on how accreditation functioned or on its overall outcomes. However, key informants described how the revised format of accreditation reconstructed how power was distributed and how knowledge was produced. The revised format contributed to changes in who held power within each of the programmes, within each of the visiting teams and between site members and visiting team members. As power shifted across stakeholders in response to material changes to the accreditation format, key informants described changes in how knowledge was produced. CONCLUSIONS Our findings suggest that the most powerful knowledge about any given programme might best be obtained through individualised tools, technologies and voices that are most meaningful to the unique context of each programme. Deliberate attention to how knowledge and power are influenced by the interactions between material and social processes within accreditation may help educators and leaders see the effects of change.
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Affiliation(s)
- Carrie Cartmill
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Rowland
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Rojas
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erin Cameron
- Centre for Social Accountability, Northern Ontario School of Medicine University, Human Sciences Division, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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Naidu T, Wondimagegn D, Whitehead C, Rashid MA. Can the medical educator speak? The next frontier of globalisation research in medical education. Med Educ 2023; 57:900-902. [PMID: 37029473 DOI: 10.1111/medu.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Thirusha Naidu
- Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, 4000, South Africa
| | | | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Ahmed Rashid
- Faculty of Medical Sciences, UCL Medical School, University College London, London, UK
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Rashid MA, Naidu T, Wondimagegn D, Whitehead C. Reconsidering a Global Agency for Medical Education: Back to the Drawing Board? Teach Learn Med 2023:1-8. [PMID: 37724805 DOI: 10.1080/10401334.2023.2259363] [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: 03/17/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
Issue: The World Federation for Medical Education (WFME) was established in 1972 and in the five decades that followed, has been the de facto global agency for medical education. Despite this apparently formidable remit, it has received little analysis in the academic literature. Evidence: In this article, we examine the historical context at the time WFME was established and summarize the key decisions it has taken in its history to date, highlighting particularly how it has adopted positions and programmes that have seemingly given precedence to the values and priorities of countries in the Global North. In doing so, we challenge the inevitability of the path that it has taken and consider other possible avenues that such a global agency in medical education could have taken, including to advocate for, and to develop policies that would support countries in the Global South. Implications: This article proposes a more democratic and equitable means by which a global organization for medical education might choose its priority areas, and a more inclusive method by which it could engage the medical education community worldwide. It concludes by hypothesizing about the future of global representation and priority-setting, and outlines a series of principles that could form the basis for a reimagined agency that would have the potential to become a force for empowerment and global justice in medical education.
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Affiliation(s)
- Mohammed Ahmed Rashid
- UCL Medical School, Faculty of Medical Sciences, University College London, London, UK
| | - Thirusha Naidu
- Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Dagnone JD, Glover-Takahashi S, Spadafora S, Whitehead C. Time's up for prioritizing Physician Humanism into CanMEDS. Can Med Educ J 2023; 14:123-124. [PMID: 36998484 PMCID: PMC10042780 DOI: 10.36834/cmej.75106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- JD Dagnone
- Department of Emergency Medicine, Queen's University, Ontario, Canada
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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González Martín R, Palomar A, Zuckerman C, Whitehead C, Quiñonero A, Scott R, Domínguez F. P-670 Phytoestrogen concentration in women’s urine and follicular fluid are associated with better IVF outcomes in euploid single embryo transfer cycles. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
What is phytoestrogen exposure impact on the reproductive outcomes of women undergoing IVF treatment?
Summary answer
Increased urinary and follicular fluid phytoestrogen concentration were associated with better IVF outcomes.
What is known already
The impact and safety of phytoestrogens, plant-derived isoflavones with estrogenic activity predominantly present in soy, on female reproductive health and on IVF outcomes continues to be hotly debated. Numerous studies suggest healthy benefits of phytoestrogen consumption: protection against reprotoxic substances, reductions in breast and other cancers, fibroids, menopausal symptoms, cardiovascular disease, inflammation, and metabolic syndrome and obesity. However, many studies suggest a harmful effect due to the endocrine-disruptor properties of phytoestrogens in both male and female reproductive tissues. Its impact on IVF treatments success is still understudied.
Study design, size, duration
60 women attending IVI-RMA New Jersey undergoing IVF with single-embryo transfer (SET) of euploid good-quality blastocyst after PGT analysis were recruited. Patients underwent PGT-SET cycles following standard protocols. Concentrations of two phytoestrogens (daidzein and genistein) were measured in follicular fluid (FF) and urine collected at oocyte pick-up (UOP) and urine collected at transfer day (UT). These measurements were correlated with IVF clinical outcomes.
Participants/materials, setting, methods
Participants were aged 18-42 years old 18.5-29.9 kg/m2 BMI. Measure of both phytoestrogens’ concentration in follicular fluid and urine samples collected at two different time-points was performed by UPLC-MSMS, with internal standards. Urine phytoestrogen concentrations were normalized by creatinine, measured by Jaffe reaction. Generalized linear models were employed to explore IVF outcomes association, estimated as percentile 20th to 80th increase (95% confidence intervals), among log-transformed phytoestrogen concentration. Both unadjusted and age-BMI-adjusted models were applied.
Main results and the role of chance
In fully adjusted models, higher sum of phytoestrogen concentration in follicular fluid (FF) were significantly associated with higher estradiol at hCG [1.31 (1.04, 1.65), p = 0.023]; whereas the sum of creatinine-corrected phytoestrogens measured in oocyte pick-up urine (UOP) were significantly associated with higher MII oocytes number [1.29 (1.07, 1.56), p = 0.008] and higher fertilized oocytes number [1.34 (1.10, 1.64), p = 0. 004]. Regarding clinical IVF outcomes, in fully adjusted models a higher follicular fluid and oocyte pick-up urine phytoestrogens concentration was significantly associated with higher implantation ratio [8.60 (1.09, 68.03), p = 0. 023] for FF, and [5.01 (0.96, 26.21), p = 0. 05] for UOP; higher clinical pregnancies ratio [5.58 (1.31, 23.73), p = 0.017] for FF, and [3.25 (0.99, 10.63), p = 0.045] for UOP; higher live newborns ratio [5.58 (1.31, 23.73), p = 0.017] for FF, and [3.25 (0.99, 10.63), p = 0.045] for UOP; and higher number of women with live newborns among those who started treatment [4.29 (1.28, 14.38), p = 0.016] for FF, and [2.83 (0.99, 8.07), p = 0.047] for UOP.
Limitations, reasons for caution
Further studies are needed to confirm this association in other populations, including the measurement of other estrogenic isoflavones and its metabolites.
Wider implications of the findings
This is the first work evaluating the association between phytoestrogens concentrations in different biofluids and IVF reproductive outcomes. Our results, using an euploid SET, suggest a beneficial effect of phytoestrogen consumption in women undergoing IVF treatment, further studies are needed to assess the benefit of phytoestrogen supplementation on IVF outcomes.
Trial registration number
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Affiliation(s)
| | - A Palomar
- IVI Foundation-RMA Global , Research, Valencia, Spain
- IIS La Fe, Reproductive Medicine , Valencia, Spain
| | - C Zuckerman
- IVI/RMA New Jersey, Center for Clinical Research , Basking Ridge, U.S.A
| | - C Whitehead
- IVI/RMA New Jersey, Center for Clinical Research , Basking Ridge, U.S.A
| | - A Quiñonero
- IVI Foundation-RMA Global , Research, Valencia, Spain
| | - R Scott
- IVI/RMA New Jersey, Center for Clinical Research , Basking Ridge, U.S.A
- Thomas Jefferson University, Sidney Kimmel College of Medicine , Philadelphia, U.S.A
| | - F Domínguez
- IVI Foundation-RMA Global , Research, Valencia, Spain
- IIS La Fe, Reproductive Medicine , Valencia, Spain
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Cartmill C, Whitehead C, Ihekwoaba E, Goel R, Green S, Haidar M, Harriott D, Wright S. Teaching poverty and health: importing transformative learning into the structures and paradigms of medical education. Can Med Educ J 2022; 13:5-12. [PMID: 35572013 PMCID: PMC9099171 DOI: 10.36834/cmej.72841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND As a paradigm of education that emphasizes equity and social justice, transformative education aims to improve societal structures by inspiring learners to become agents of social change. In an attempt to contribute to transformative education, the University of Toronto MD program implemented a workshop on poverty and health that included tutors with lived experience of poverty. This research aimed to examine how tutors, as members of a group that faces structural oppression, understood their participation in the workshop. METHODS This research drew on qualitative case study methodology and interview data, using the concept of transformative education to direct data analysis and interpretation. RESULTS Our findings centred around two broad themes: misalignments between transformative learning and the structures of medical education; and unintended consequences of transformative education within the dominant paradigms of medical education. These misalignments and unintended consequences provided insight into how courses operating within the structures, hierarchies and paradigms of medical education may be limited in their potential to contribute to transformative education. CONCLUSIONS To be truly transformative, medical education must be willing to try to modify structures that reinforce oppression rather than integrating marginalized persons into educational processes that maintain social inequity.
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Affiliation(s)
- Carrie Cartmill
- The Wilson Centre, University Health Network and University of Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network and University of Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Esther Ihekwoaba
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Ritika Goel
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Samantha Green
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | | | - Dawnmarie Harriott
- Voices from the Street speakers bureau, Working for Change, Ontario, Canada
| | - Sarah Wright
- The Wilson Centre, University Health Network and University of Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
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Affiliation(s)
- Ahmed Rashid
- UCL Medical School, Royal Free Hospital, London, NW3 2PR, UK
| | - Cynthia Whitehead
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada.,Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street, 1ES-565 Toronto, Ontario, Canada M5G 2C4
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White D, Carroll JC, Crann S, Shapiro M, Whitehead C, Freeman R, Glazier RH, Martin D, Kidd M. A Master Class in Family Doctor Leadership: Evaluating an Innovative Program. Fam Med 2021; 53:701-707. [PMID: 34587266 DOI: 10.22454/fammed.2021.512946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES In family medicine, leadership is critical for health care delivery, advancing curricula, research, and quality improvement. Systematic reviews of leadership development programs in health care identify limitations, calling for innovative designs and rigorous assessment. Our objective was to evaluate the impact of applying master class principles to leadership development in academic family medicine. METHODS We used mixed methods to assess the impact of an innovative master class program on 15 emerging leaders in a large academic department of family medicine. The program consisted of five sessions where family physician masters shared their wisdom, techniques, and feedback with promising leaders. Quantitative evaluation involved participants' ratings of each session's content and delivery using a 5-point Likert scale. We assessed postcourse semistructured interviews with participants qualitatively using descriptive thematic content analysis. RESULTS Individual sessions were highly evaluated, with a combined mean of 4.82/5. Qualitative thematic analysis identified self-perceived increased effectiveness in leadership activities; increased confidence as a leader; increased motivation to be a leader; and perceptions of value from the program, contributing to what participants described as unexpected potential change within themselves. Themes related to effectiveness of the program were practical advice; networking; diverse topics; accessible speakers sharing personal stories; and small-group, informal, early-evening format. CONCLUSIONS Master class concepts can be adapted to leadership development in academic family medicine, with evidence of early positive impact on participants' self-perception of leadership skills and confidence. Further research is warranted to assess organizational impact and applicability to other settings.
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Affiliation(s)
- David White
- Department of Family & Community Medicine, University of Toronto, Canada.,and North York General Hospital
| | - June C Carroll
- Department of Family & Community Medicine, University of Toronto, Canada
| | - Sara Crann
- Department of Family & Community Medicine, University of Toronto, Canada
| | - Marla Shapiro
- Department of Family & Community Medicine, University of Toronto, Canada.,and North York General Hospital, Toronto, Canada
| | - Cynthia Whitehead
- Department of Family & Community Medicine, University of Toronto, Canada.,Women's College Hospital, Toronto, Canada.,Wilson Centre, University Health Network, Faculty of Medicine, University of Toronto, Canada.,and University Health Network, Toronto, Canada
| | - Risa Freeman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,and Wilson Centre, University Health Network, Faculty of Medicine, University of Toronto, Canada
| | - Richard H Glazier
- Department of Family & Community Medicine, University of Toronto, Canada.,St. Michael's Hospital, Toronto, Canada.,and ICES, Toronto, Canada
| | - Danielle Martin
- Department of Family & Community Medicine, University of Toronto, Canada.,and Women's College Hospital, Toronto, Canada
| | - Michael Kidd
- College of Health and Medicine, Australian National University, Australia
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Goldman J, Kuper A, Whitehead C, Baker GR, Bulmer B, Coffey M, Shea C, Jeffs L, Shojania K, Wong B. Interprofessional and multiprofessional approaches in quality improvement education. Adv Health Sci Educ Theory Pract 2021; 26:615-636. [PMID: 33113055 DOI: 10.1007/s10459-020-10004-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
The imperative for all healthcare professionals to partake in quality improvement (QI) has resulted in the development of QI education programs with participants from different professional backgrounds. However, there is limited empirical and theoretical examination as to why, when and how interprofessional and multiprofessional education occurs in QI and the outcomes of these approaches. This paper reports on a qualitative collective case study of interprofessional and multiprofessional education in three longitudinal QI education programs. We conducted 58 interviews with learners, QI project coaches, program directors and institutional leads and 135 h of observations of in-class education sessions, and collected relevant documents such as course syllabi and handouts. We used an interpretive thematic analysis using a conventional and directed content analysis approach. In the directed content approach, we used sociology of professions theory with particular attention to professional socialization, hierarchies and boundaries in QI, to understand the ways in which individuals' professional backgrounds informed the planning and experiences of the QI education programs. Findings demonstrated that both interprofessional and multiprofessional education approaches were being used to achieve different education objectives. While each approach demonstrated positive learning and practice outcomes, tensions related to the different ways in which professional groups are engaging in QI, power dynamics between professional groups, and disconnects between curricula and practice existed. Further conceptual clarity is essential for a more informed discussion about interprofessional and multiprofessional education approaches in QI and explicit attention is needed to professional processes and tensions, to optimize the impact of education on practice.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada.
| | - Ayelet Kuper
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cynthia Whitehead
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Beverly Bulmer
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maitreya Coffey
- Department of Paediatrics, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
- Children's Hospitals Solutions for Patient Safety, Cincinnati, OH, USA
| | - Christine Shea
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kaveh Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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14
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Wondimagegn D, Soklaridis S, Yifter H, Cartmill C, Yeshak MY, Whitehead C. Passing the microphone: broadening perspectives by amplifying underrepresented voices. Adv Health Sci Educ Theory Pract 2020; 25:1139-1147. [PMID: 33175325 PMCID: PMC7656220 DOI: 10.1007/s10459-020-10012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/30/2020] [Indexed: 05/17/2023]
Affiliation(s)
- Dawit Wondimagegn
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Sophie Soklaridis
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Helen Yifter
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada
| | - Mariamawit Yonathan Yeshak
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Wondimagegn D, Petros A, Asrat Y, Aklilu T, Estifanos AS, Addissie A, Amogne W, Gebremariam TH, Cartmill C, Whitehead C, Soklaridis S, Yifter H. COVID-19 in Ethiopia: A contextual approach to explaining its slow growth. J Glob Health 2020; 10:020369. [PMID: 33110563 PMCID: PMC7568527 DOI: 10.7189/jogh.10.020369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dawit Wondimagegn
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adane Petros
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yidnekachew Asrat
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfamariam Aklilu
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Haile Gebremariam
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Helen Yifter
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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16
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Goldman J, Kuper A, Baker GR, Bulmer B, Coffey M, Jeffs L, Shea C, Whitehead C, Shojania KG, Wong B. Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions. Acad Med 2020; 95:1745-1754. [PMID: 32079957 DOI: 10.1097/acm.0000000000003203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Project-based experiential learning is a defining element of quality improvement (QI) education despite ongoing challenges and uncertainties. The authors examined stakeholders' perceptions and experiences of QI project-based learning to increase understanding of factors that influence learning and project experiences. METHOD The authors used a case study approach to examine QI project-based learning in 3 advanced longitudinal QI programs, 2 at the University of Toronto and 1 at an academic tertiary-care hospital. From March 2016 to June 2017, they undertook 135 hours of education program observation and 58 interviews with learners, program directors, project coaches, and institutional leaders and reviewed relevant documents. They analyzed data using a conventional and directed data analysis approach. RESULTS The findings provide insight into 5 key factors that influenced participants' project-based learning experiences and outcomes: (1) variable emphasis on learning versus project objectives and resulting benefits, tensions, and consequences; (2) challenges integrating the QI project into the curriculum timeline; (3) project coaching factors (e.g., ability, capacity, role clarity); (4) participants' differing access to resources and ability to direct a QI project given their professional roles; and (5) workplace environment influence on project success. CONCLUSIONS The findings contribute to an empirical basis toward more effective experiential learning in QI by identifying factors to target and optimize. Expanding conceptualizations of project-based learning for QI education beyond learner-initiated, time-bound projects, which are at the core of many QI educational initiatives, may be necessary to improve learning and project outcomes.
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Affiliation(s)
- Joanne Goldman
- J. Goldman is assistant professor, Department of Medicine, scientist, Centre for Quality Improvement and Patient Safety, and cross-appointed researcher, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-1589-4070
| | - Ayelet Kuper
- A. Kuper is associate professor, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - G Ross Baker
- G.R. Baker is professor and program lead, Quality Improvement and Patient Safety, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Bulmer
- B. Bulmer is vice president, Education, St. Michael's Hospital, Unity Health Toronto, and lecturer, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maitreya Coffey
- M. Coffey is associate professor, Department of Paediatrics, University of Toronto, medical officer for patient safety, Hospital for Sick Children, Toronto, Ontario, Canada, and associate clinical director, Children's Hospitals Solutions for Patient Safety, Cincinnati, Ohio
| | - Lianne Jeffs
- L. Jeffs is research and innovation lead scholar in residence and senior clinician scientist, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, associate professor, Lawrence S. Bloomberg Faculty of Nursing, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, and affiliate scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christine Shea
- C. Shea is program director and lecturer, Quality Improvement and Patient Safety, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is professor, Department of Family and Community Medicine, director and scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, and vice president of education, Women's College Hospital, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- K.G. Shojania is professor and vice chair, Department of Medicine, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-9942-0130
| | - Brian Wong
- B. Wong is associate professor, Department of Medicine, University of Toronto, director, Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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17
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Tavares W, Kuper A, Kulasegaram K, Whitehead C. The compatibility principle: on philosophies in the assessment of clinical competence. Adv Health Sci Educ Theory Pract 2020; 25:1003-1018. [PMID: 31677146 DOI: 10.1007/s10459-019-09939-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
The array of different philosophical positions underlying contemporary views on competence, assessment strategies and justification have led to advances in assessment science. Challenges may arise when these philosophical positions are not considered in assessment design. These can include (a) a logical incompatibility leading to varied or difficult interpretations of assessment results, (b) an "anything goes" approach, and (c) uncertainty regarding when and in what context various philosophical positions are appropriate. We propose a compatibility principle that recognizes that different philosophical positions commit assessors/assessment researchers to particular ideas, assumptions and commitments, and applies ta logic of philosophically-informed, assessment-based inquiry. Assessment is optimized when its underlying philosophical position produces congruent, aligned and coherent views on constructs, assessment strategies, justification and their interpretations. As a way forward we argue that (a) there can and should be variability in the philosophical positions used in assessment, and these should be clearly articulated to promote understanding of assumptions and make sense of justifications; (b) we focus on developing the merits, boundaries and relationships within and/or between philosophical positions in assessment; (c) we examine a core set of principles related to the role and relevance of philosophical positions; (d) we elaborate strategies and criteria to delineate compatible from incompatible; and (f) we articulate a need to broaden knowledge/competencies related to these issues. The broadened use of philosophical positions in assessment in the health professions affect the "state of play" and can undermine assessment programs. This may be overcome with attention to the alignment between underlying assumptions/commitments.
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Affiliation(s)
- Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada.
- Post-MD Education (Post-Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, ON, Canada.
| | - Ayelet Kuper
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kulamakan Kulasegaram
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
- Department of Family and Community Medicine, Women's College Hospital, Faculty of Medicine, University of Toronto, Toronto, Canada
- MD Program, University of Toronto, Toronto, Canada
| | - Cynthia Whitehead
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
- Department of Family and Community Medicine, Women's College Hospital, Faculty of Medicine, University of Toronto, Toronto, Canada
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Abstract
Abstract
Thesis Statement
Men experience poorer health outcomes than females and gender specific targeted health promotion needs to adequately address this gender bias.
Methodology
This prospective observational study audited all printed health promotional materials in all health facility waiting rooms within a defined geographic region. A total of 24 sites were surveyed which included general practice centres, community health centres and hospitals. The surveyed health literature included posters, brochures, and booklets.
Results
There were 1143 health materials audited across the sites. Of these, 3.15% (n = 36) were male-specific literature, 15.31% (n = 175) were female specific health literature and 81.54% (n = 932) were gender neutral. Literature which had a gendered focus was overwhelmingly female to male with a ratio of approximately 5:1.
Conclusions and Implications
This research highlighted that despite the known outcomes of lower male life expectancy and higher burden of disease, male specific literature is significantly under-represented within health facility waiting spaces. There remains potential for health clinicians to provide targeted male health education and thereby improve male health literacy.
Key messages
Men's health both within Australia and globally remains under-represented despite lower health expectancy and higher burden of disease. Health facilities ought to actively control the health promotion messaging to vulnerable population groups.
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Affiliation(s)
- M Whitehead
- South Eastern Sydney Local Health District, Sydney, Australia
| | - H Ng Chok
- Western Sydney University, Sydney, Australia
| | - C Whitehead
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - L Luck
- Nepean Blue Mountains Local Health District, Sydney, Australia
- Western Sydney University, Sydney, Australia
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19
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Javidan AP, Raveendran L, Rai Y, Tackett S, Kulasegaram KM, Whitehead C, Rosenfield J, Houston P. Fostering trust, collaboration, and a culture of continuous quality improvement: A call for transparency in medical school accreditation. Can Med Educ J 2020; 11:e102-e108. [PMID: 33062101 PMCID: PMC7522879 DOI: 10.36834/cmej.70061] [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: 06/11/2023]
Abstract
Medical schools provide the foundation for a physician's growth and lifelong learning. They also require a large share of government resources. As such, they should seek opportunities to maintain trust from the public, their students, faculty, universities, regulatory colleges, and each other. The accreditation of medical schools attempts to assure stakeholders that the educational process conforms to appropriate standards and thus can be trusted. However, accreditation processes are poorly understood and the basis for accrediting authorities' decisions are often opaque. We propose that increasing transparency in accreditation could enhance trust in the institutions that produce society's physicians. While public reporting of accreditation results has been established in other jurisdictions, such as Australia and the United Kingdom, North American accrediting bodies have not yet embraced this more transparent approach. Public reporting can enhance public trust and engagement, hold medical schools accountable for continuous quality improvement, and can catalyze a culture of collaboration within the broader medical education ecosystem. Inviting patients and the public to peer into one of the most formative and fundamental parts of their physicians' professional training is a powerful tool for stakeholder and public engagement that the North American medical education community at large has yet to use.
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Affiliation(s)
- Arshia Pedram Javidan
- Faculty of Medicine, University of Toronto, Ontario
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Lucshman Raveendran
- Faculty of Medicine, University of Toronto, Ontario
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Yeshith Rai
- Faculty of Medicine, University of Toronto, Ontario
| | - Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, MD, USA
| | - Kulamakan Mahan Kulasegaram
- The Wilson Centre for Research in Education, University Health Network, University of Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre for Research in Education, University Health Network, University of Toronto, Ontario, Canada
- Women’s College Hospital, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Jay Rosenfield
- Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Patricia Houston
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Unity Health, Ontario, Canada
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20
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Rowland P, Boyd V, Lising D, Goldman J, Whitehead C, Ng SL. When logics of learning conflict: an analysis of two workplace-based continuing education programs. Adv Health Sci Educ Theory Pract 2020; 25:673-689. [PMID: 31897922 DOI: 10.1007/s10459-019-09952-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
Educators, practitioners, and policy makers are calling for stronger connections between continuing education (CE) for professionals and the concerns of workplaces where these professionals work. This call for greater alignment is not unique to the health professions. Researchers within the field of higher education have long wrestled with the complexities of aligning professional learning and workplace concerns. In this study, we extend this critical line of inquiry to explore the possible conceptual intersections between two CE programs acting within a single healthcare organization. Both programs are concerned with improving patient care, primarily by changing the ways professionals think and talk with one another. However, the two programs have different historical origins: one in a workplace, the other within a university setting. Introducing the concept of "modes of ordering" as a way to analyze the curricula, we argue the programs are operating through separate logics of learning. We label these two modes of ordering: (1) learning as standardization and (2) learning as identification. Through our discussion, we explore how these different modes demand different roles for educators and participants. Ultimately, we argue that both have value. However, we also argue that educators require conceptual tools to sensitize them to the possibility of competing logics of learning and the subsequent implications for their practice as educators. In conclusion, we offer the metaphor of CE educator as choreographer, connecting concepts and practices within these logics in productive ways while continually navigating the various learning imperatives acting on professionals at any given time.
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Affiliation(s)
- Paula Rowland
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, ON, Canada.
- Wilson Centre for Research in Education, Toronto, ON, Canada.
- Toronto General Hospital, University Health Network, 200 Elizabeth Ave, Eaton South, 1- 565, Toronto, ON, M5G 2C4, Canada.
| | - Victoria Boyd
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Dean Lising
- BOOST! (Building Optimal Outcomes from Successful Teamwork) Program, IPE Scholar-in-Residence (Centennial College), Centre for Interprofessional Education, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Toronto, ON, Canada
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia Whitehead
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stella L Ng
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Centre for Faculty Development, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
- Centre for Ambulatory Care Education, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Deborah Gill
- University College London Medical School, University College London, London WC1E 6BT, UK.
| | | | - Dawit Wondimagegn
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Whitehead C, Paradis E. One Size Does Not Fit All: Balancing Individual and System Needs in Primary Care and Beyond. Acad Med 2019; 94:940-942. [PMID: 30973367 DOI: 10.1097/acm.0000000000002749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this issue, Dewan and Norcini invite readers to reconsider the basic minimum standards for independent primary care practice. Their willingness to push boundaries, question turf wars, and suggest innovative ways forward is laudable. Although their piece is timely and provocative, it does not fully consider the interplay between individual and system factors that influence people to pursue different kinds of degrees and practice in this context. In this Invited Commentary, the authors discuss imperatives that are underacknowledged by Dewan and Norcini: the importance of diversity in health system planning; status, power, and privilege; the extension of their argument beyond primary care; the conflation of time in training with competence; and important issues of distribution of health care resources. Ultimately, the authors argue that there may be strength in diversity, one that should not be obscured by attempts to normalize training time.
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Affiliation(s)
- Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, BMO Financial Group Chair in Health Professions Research, University Health Network, vice president of education, Women's College Hospital, and associate professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. E. Paradis holds the Canada Research Chair in Collaborative Healthcare Practice and is assistant professor, Leslie Dan Faculty of Pharmacy, Department of Anesthesia and Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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23
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24
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Affiliation(s)
- Sophie Soklaridis
- From the Centre for Addiction and Mental Health (S.S., C.Z., D.G.), the Departments of Psychiatry (S.S., C.Z., V.H.T.), Family and Community Medicine (S.S., C.W.), and Medicine (C.Z., A.K.), University of Toronto, the Wilson Centre for Research in Education (S.S., A.K., C.W.), Sunnybrook Health Sciences Centre (A.K.), Women's College Hospital (V.H.T., C.W.), and University Health Network (C.W.), Toronto, and University of Calgary, Calgary, AB (V.H.T.) - all in Canada; and Catalyst, New York (D.G.)
| | - Catherine Zahn
- From the Centre for Addiction and Mental Health (S.S., C.Z., D.G.), the Departments of Psychiatry (S.S., C.Z., V.H.T.), Family and Community Medicine (S.S., C.W.), and Medicine (C.Z., A.K.), University of Toronto, the Wilson Centre for Research in Education (S.S., A.K., C.W.), Sunnybrook Health Sciences Centre (A.K.), Women's College Hospital (V.H.T., C.W.), and University Health Network (C.W.), Toronto, and University of Calgary, Calgary, AB (V.H.T.) - all in Canada; and Catalyst, New York (D.G.)
| | - Ayelet Kuper
- From the Centre for Addiction and Mental Health (S.S., C.Z., D.G.), the Departments of Psychiatry (S.S., C.Z., V.H.T.), Family and Community Medicine (S.S., C.W.), and Medicine (C.Z., A.K.), University of Toronto, the Wilson Centre for Research in Education (S.S., A.K., C.W.), Sunnybrook Health Sciences Centre (A.K.), Women's College Hospital (V.H.T., C.W.), and University Health Network (C.W.), Toronto, and University of Calgary, Calgary, AB (V.H.T.) - all in Canada; and Catalyst, New York (D.G.)
| | - Deborah Gillis
- From the Centre for Addiction and Mental Health (S.S., C.Z., D.G.), the Departments of Psychiatry (S.S., C.Z., V.H.T.), Family and Community Medicine (S.S., C.W.), and Medicine (C.Z., A.K.), University of Toronto, the Wilson Centre for Research in Education (S.S., A.K., C.W.), Sunnybrook Health Sciences Centre (A.K.), Women's College Hospital (V.H.T., C.W.), and University Health Network (C.W.), Toronto, and University of Calgary, Calgary, AB (V.H.T.) - all in Canada; and Catalyst, New York (D.G.)
| | - Valerie H Taylor
- From the Centre for Addiction and Mental Health (S.S., C.Z., D.G.), the Departments of Psychiatry (S.S., C.Z., V.H.T.), Family and Community Medicine (S.S., C.W.), and Medicine (C.Z., A.K.), University of Toronto, the Wilson Centre for Research in Education (S.S., A.K., C.W.), Sunnybrook Health Sciences Centre (A.K.), Women's College Hospital (V.H.T., C.W.), and University Health Network (C.W.), Toronto, and University of Calgary, Calgary, AB (V.H.T.) - all in Canada; and Catalyst, New York (D.G.)
| | - Cynthia Whitehead
- From the Centre for Addiction and Mental Health (S.S., C.Z., D.G.), the Departments of Psychiatry (S.S., C.Z., V.H.T.), Family and Community Medicine (S.S., C.W.), and Medicine (C.Z., A.K.), University of Toronto, the Wilson Centre for Research in Education (S.S., A.K., C.W.), Sunnybrook Health Sciences Centre (A.K.), Women's College Hospital (V.H.T., C.W.), and University Health Network (C.W.), Toronto, and University of Calgary, Calgary, AB (V.H.T.) - all in Canada; and Catalyst, New York (D.G.)
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Whitehead C, Wondimagegn D, Baheretibeb Y, Hodges B. The International Partner as Invited Guest: Beyond Colonial and Import-Export Models of Medical Education. Acad Med 2018; 93:1760-1763. [PMID: 29727317 DOI: 10.1097/acm.0000000000002268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The dominant model of international collaboration in medical education, both currently and in the past two centuries, is one of foreign (i.e., Euro-American) ownership and control. In this Invited Commentary, the authors provide a brief selected history of such international partnerships. They then focus on recent partnership models that have alternative structures. One of these is the collaborative partnership between Addis Ababa University (AAU) and the University of Toronto. This partnership is known as the Toronto Addis Ababa Academic Collaboration (TAAAC). From the inception of this partnership, the TAAAC has aimed to be relational and has firmly placed ownership of the codeveloped curriculum at AAU. Other explicit aims of the TAAAC are to help AAU develop culturally appropriate programming that is sustainable with local resources and to develop capacity-building, coteaching models. In seeking potential precedents to the TAAAC, the authors have explored archives in Ethiopia, Canada, and the United Kingdom. They found that invited foreign guests have played a role in the development of educational systems in Ethiopia since the 1940s. The authors believe that by paying close attention to the language used to describe the nature of a relationship, medical educators may be able to move toward more collaborative, capacity-building international partnerships.
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Affiliation(s)
- Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, BMO Financial Group Chair in Health Professions Education Research, University Health Network, vice president of education, Women's College Hospital, and associate professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. D. Wondimagegn is chief executive director, College of Health Sciences, and vice president and associate professor, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia. Y. Baheretibeb is associate professor, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. B. Hodges is executive vice president of education, University Health Network, professor, Department of Psychiatry, University of Toronto, scientist, Wilson Centre, and Richard and Elizabeth Currie Chair in Health Professions Education Research, University of Toronto, Toronto, Ontario, Canada
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Feilchenfeld Z, Kuper A, Whitehead C. Stethoscope of the 21st century: dominant discourses of ultrasound in medical education. Med Educ 2018; 52:1271-1287. [PMID: 30334276 DOI: 10.1111/medu.13714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/11/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education. METHODS We conducted a Foucauldian critical discourse analysis (CDA) to identify and analyse discourses that legitimise and privilege the use of POCUS in medical education. We assembled an archive of 473 texts published between 1980 and 2017. Each article in the archive was analysed to identify frequently occurring truth statements (expressing concepts whose truths are unquestioned within particular discourses) that we used to characterise the major discourses that construct representations of POCUS in medical education. RESULTS We identified three dominant discourses: (i) a visuo-centric discourse prioritising the visual information as truth over other clinical data; (ii) a utilitarian discourse emphasising improvements in patient care; and (iii) a modernist discourse highlighting the current and future needs of clinicians in our technological world. These discourses overlap and converge; the core discursive effect makes the further elevation of POCUS in medical education, and the resulting attenuation of other curricular priorities, appear inevitable. CONCLUSIONS The three dominant discourses identified in this paper engender ideal conditions for the proliferation of POCUS in medical education through curricular guidelines, surveys of adherence to these guidelines and authoritative position statements. By identifying and analysing these dominant discourses, we can ask questions that do not take for granted the assumed truths underpinning the discourses, highlight potential pitfalls of proposed curricular changes and ensure these changes truly improve medical education.
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Affiliation(s)
- Zac Feilchenfeld
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- The Wilson Centre, Toronto, ON, Canada
| | - Cynthia Whitehead
- The Wilson Centre, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
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Wondimagegn D, Pain C, Baheretibeb Y, Hodges B, Wakma M, Rose M, Sherif A, Piliotis G, Tsegaye A, Whitehead C. Toronto Addis Ababa Academic Collaboration: A Relational, Partnership Model for Building Educational Capacity Between a High- and Low-Income University. Acad Med 2018; 93:1795-1801. [PMID: 29995668 PMCID: PMC6282678 DOI: 10.1097/acm.0000000000002352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Educational partnerships between academic health sciences centers in high- and low-resource settings are often formed as attempts to address health care disparities. In this Perspective, the authors describe the Toronto Addis Ababa Academic Collaboration (TAAAC), an educational partnership between the University of Toronto and Addis Ababa University. The TAAAC model was designed to help address an urgent need for increased university faculty to teach in the massive expansion of universities in Ethiopia. As TAAAC has developed and expanded, faculty at both institutions have recognized that the need to understand contextual factors and to have clarity about funding, ownership, expertise, and control are essential elements of these types of collaborative initiatives. In describing the TAAAC model, the authors aim to contribute to wider conversations and deeper theoretical understandings about these issues.
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Affiliation(s)
- Dawit Wondimagegn
- D. Wondimagegn is chief executive director, College of Health Sciences, and vice president and associate professor, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clare Pain
- C. Pain is associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yonas Baheretibeb
- Y. Baheretibeb is associate professor, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brian Hodges
- B. Hodges is executive vice president of education, University Health Network, professor, Department of Psychiatry, University of Toronto, and scientist and Richard and Elizabeth Currie Chair in Health Professions Education Research, Wilson Centre, Toronto, Ontario, Canada
| | - Melaku Wakma
- M. Wakma is former director of graduate programs and current assistant professor, Department of Foreign Languages and Literature, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marci Rose
- M. Rose is program coordinator, Toronto Addis Ababa Academic Collaboration, University Health Network, Toronto, Ontario, Canada
| | - Abdulaziz Sherif
- A. Sherif is former chair of internal medicine and assistant professor, Department of Medicine, Addis Ababa University, Addis Ababa, Ethiopia, and current fellow of autologous stem cell transplantation, University of Toronto, Toronto, Ontario, Canada
| | - Gena Piliotis
- G. Piliotis is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Admasu Tsegaye
- A. Tsegaye is former president, Addis Ababa University, and current Ethiopian Ambassador to Indonesia, Addis Ababa, Ethiopia
| | - Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, BMO Financial Group Chair in Health Professions Research, University Health Network, vice president of education, Women’s College Hospital, and associate professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Kulasegaram KM, Tonin P, Houston P, Whitehead C. Accreditation drives medical education. Does evidence drive accreditation? Med Educ 2018; 52:772-773. [PMID: 29879306 DOI: 10.1111/medu.13584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Kulamakan M Kulasegaram
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Tonin
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Houston
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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McIlwain C, Prince V, Tan L, Whitehead C, Leopold J, McLean K. PI3K/AKT/mTOR pathway inhibition sensitizes ovarian cancer cells to anti-estrogen therapy. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.160] [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: 11/29/2022]
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Rice K, Ryu JE, Whitehead C, Katz J, Webster F. Medical Trainees' Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education. Acad Med 2018; 93:775-780. [PMID: 29140917 PMCID: PMC5929494 DOI: 10.1097/acm.0000000000002053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Evidence suggests that physicians' opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula. METHOD This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015. RESULTS Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value. CONCLUSIONS Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients.
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Affiliation(s)
- Kathleen Rice
- K. Rice is a postdoctoral fellow, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jae Eun Ryu
- J.E. Ryu is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, University Health Network, associate professor, Department of Family and Community Medicine, University of Toronto, vice president for education, Women’s College Hospital, and BMO Financial Group Chair, Health Professions Research, University Health Network, Toronto, Ontario, Canada
| | - Joel Katz
- J. Katz is professor and Canada Research Chair in Health Psychology, Department of Psychology, York University, Toronto, Ontario, Canada
| | - Fiona Webster
- F. Webster is associate professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, scientist, Wilson Centre, University Health Network, and academic fellow, Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
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Bandiera G, Kuper A, Mylopoulos M, Whitehead C, Ruetalo M, Kulasegaram K, Woods NN. Back from basics: integration of science and practice in medical education. Med Educ 2018; 52:78-85. [PMID: 28994457 DOI: 10.1111/medu.13386] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT In 1988, the Edinburgh Declaration challenged medical teachers, curriculum designers and leaders to make an organised effort to change medical education for the better. Among a series of recommendations was a call to integrate training in science and clinical practice across a breadth of clinical contexts. The aim was to create physicians who could serve the needs of all people and provide care in a multitude of contexts. In the years since, in the numerous efforts towards integration, new models of curricula have been proposed and implemented with varying levels of success. SCOPE OF REVIEW In this paper, we examine the evolution of curricular integration since the Edinburgh Declaration, and discuss theoretical advances and practical solutions. In doing so, we draw on recent consensus reports on the state of medical education, emblematic initiatives reported in the literature, and developments in education theory pertinent to the role of integrated curricula. CONCLUSIONS Interest in integration persists despite 30 years of efforts to respond to the Edinburgh Declaration. We argue, however, that a critical shift has taken place with respect to the conception of integration, whereby empirical models support a view of integration as pertaining to both cognitive activity and curricular structure. In addition, we describe a broader definition of 'basic science' relevant to clinical practice that encompasses social and behavioural sciences, as well as knowledge derived from biomedical science.
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Affiliation(s)
- Glen Bandiera
- PostMD Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Mariela Ruetalo
- PostMD Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kulamakan Kulasegaram
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole N Woods
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Kulamakan Kulasegaram
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada.
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Douglas Buller
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Cations M, Laver K, Whitehead C, Ratcliffe J, Kurrle S, Shulver W, Crotty M. FACILITATING CONSUMER-DIRECTED DECISION MAKING IN LONG-TERM CARE: RESULTS FROM A CITIZENS’ JURY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Cations
- Flinders University, Adelaide, South Australia, Australia,
- UNSW Australia, Sydney, South Australia, Australia,
| | - K. Laver
- Flinders University, Adelaide, South Australia, Australia,
| | - C. Whitehead
- Flinders University, Adelaide, South Australia, Australia,
| | - J. Ratcliffe
- Flinders University, Adelaide, South Australia, Australia,
| | - S. Kurrle
- University of Sydney, Sydney, South Australia, Australia
| | - W. Shulver
- Flinders University, Adelaide, South Australia, Australia,
| | - M. Crotty
- Flinders University, Adelaide, South Australia, Australia,
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Harrison S, Dyer S, Laver K, Whitehead C, Crotty M. INTERVENTIONS FOR THE TREATMENT OF BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: AN OVERVIEW. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Harrison
- NHMRC Cognitive Decline Partnership Centre, Syndey University, Syndey, New South Wales, Australia,
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - S. Dyer
- NHMRC Cognitive Decline Partnership Centre, Syndey University, Syndey, New South Wales, Australia,
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - K. Laver
- NHMRC Cognitive Decline Partnership Centre, Syndey University, Syndey, New South Wales, Australia,
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - C. Whitehead
- NHMRC Cognitive Decline Partnership Centre, Syndey University, Syndey, New South Wales, Australia,
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - M. Crotty
- NHMRC Cognitive Decline Partnership Centre, Syndey University, Syndey, New South Wales, Australia,
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
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Feilchenfeld Z, Dornan T, Whitehead C, Kuper A. Ultrasound in undergraduate medical education: a systematic and critical review. Med Educ 2017; 51:366-378. [PMID: 28118684 DOI: 10.1111/medu.13211] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/26/2016] [Accepted: 08/15/2016] [Indexed: 05/18/2023]
Abstract
CONTEXT The use of point-of-care ultrasound (POCUS) in clinical care is growing rapidly and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. OBJECTIVES We conducted a critical and systematic review framed by the rationales enumerated in academic publications by advocates of ultrasound in UME. METHODS This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified from an archive of 403 academic publications using techniques from Foucauldian critical discourse analysis (CDA). We then sought empirical evidence in support of these rationales, using a critical synthesis methodology also adapted from CDA. RESULTS We identified four dominant discursive rationales with different levels of evidentiary support. The use of ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve the quality of patient care was difficult to evaluate. CONCLUSIONS Our analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimises them and may preclude further primary research. As the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.
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Affiliation(s)
- Zac Feilchenfeld
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
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Affiliation(s)
- C Whitehead
- Nuclear Physics Division, Atomic Energy Research Establishment Harwell, Didcot, Berkshire, OXI1 ORA
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Wong R, Kitto S, Whitehead C. Other ways of knowing: Using critical discourse analysis to reexamine intraprofessional collaboration. Can Fam Physician 2016; 62:701-703. [PMID: 27629658 PMCID: PMC5023333] [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: 06/06/2023]
Affiliation(s)
- Rene Wong
- Assistant Professor in the Department of Medicine at the University of Toronto in Ontario, Research Fellow at the Wilson Centre for Research in Education, and a doctoral candidate in the Institute of Medical Sciences at the University of Toronto.
| | - Simon Kitto
- Associate Professor and Director of Research in the Office of Continuing Professional Development in the Department of Innovation in Medical Education at the University of Ottawa in Ontario
| | - Cynthia Whitehead
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Director of the Wilson Centre for Research in Education
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Hong K, Forman E, Werner M, Franasiak J, Juneau C, Morin S, Whitehead C, Treff N, Scott R. Natural is not better: gonadotropin stimulation does not increase aneuploidy or diminish implantation rates of euploid embryos. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wong R, Kitto S, Whitehead C. [D'autres façons de savoir: L'analyse critique du discours pour réexaminer la collaboration intraprofessionnelle]. Can Fam Physician 2016; 62:e501-e503. [PMID: 27629678 PMCID: PMC5023353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Rene Wong
- Professeur adjoint au Département de médecine de l'Université de Toronto, en Ontario, boursier de recherche au Wilson Centre for Research in Education et candidat au doctorat à l'Institute of Medical Sciences de l'Université de Toronto.
| | - Simon Kitto
- Professeur agrégé et directeur de la recherche au Bureau du développement professionnel continu du Département de l'innovation en éducation médicale de l'Université d'Ottawa, en Ontario
| | - Cynthia Whitehead
- Professeure agrégée au Département de médecine familiale et communautaire de l'Université de Toronto et directrice du Wilson Centre for Research in Education
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Milte R, Miller M, Crotty M, Mackintosh S, Thomas S, Cameron I, Whitehead C, Kurrle S, Ratcliffe J. Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture. J Rehabil Med 2016; 48:378-85. [DOI: 10.2340/16501977-2070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wong R, Kitto S, Whitehead C. How a Social Sciences Informed Examination of Diabetes Guidelines Can Reveal Inefficiencies in Knowledge Translation. Can J Diabetes 2015. [DOI: 10.1016/j.jcjd.2015.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee A, Gaekwad A, Bronca M, Cheruvu L, Davies O, Whitehead C, Agzarian M, Chen C. Author reply. Intern Med J 2015; 45:988. [DOI: 10.1111/imj.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Lee
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - A. Gaekwad
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - M. Bronca
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - L. Cheruvu
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
- Department of Rehabilitation and Aged Care; Repatriation General Hospital; Adelaide South Australia Australia
| | - O. Davies
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
- Department of Rehabilitation and Aged Care; Repatriation General Hospital; Adelaide South Australia Australia
- Flinders Clinical Effectiveness; Flinders University; Adelaide South Australia Australia
| | - C. Whitehead
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - M. Agzarian
- Radiology; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - C. Chen
- Department of Ophthalmology; Flinders University and Medical Centre; Adelaide South Australia Australia
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Sarhan O, Nakshabandi Z, Alghanbar M, Alotay A, Sherif I, Whitehead C, El-Husseini A. Posterior urethral valves: Metabolic consequences in a cohort of patients. J Pediatr Urol 2015; 11:216.e1-6. [PMID: 26096436 DOI: 10.1016/j.jpurol.2015.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/22/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite the improvements in diagnosis and management of posterior urethral valves (PUVs), about one third of patients develop chronic kidney disease (CKD). Children with PUVs might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels, which could affect their bone growth and overall health. OBJECTIVE The aim was to determine the relationship between kidney function, vitamin D deficiency and secondary hyperparathyroidism in children with PUVs. PATIENTS AND METHODS Sixty-four children with PUVs were followed for a period of 3.64 ± 2.50 years after their initial presentation and management. Their laboratory parameters were compared with 20 age-, gender- and race-matched children in a control group, including: serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D levels, and kidney function. RESULTS Children with PUVs had significantly lower estimated kidney function (P = 0.006) and vitamin D levels (P < 0.001) and higher iPTH levels (P = 0.042). There were no significant between-group differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, and bicarbonate levels. There was a strong correlation between the degree of vitamin D deficiency and hyperparathyroidism and the degree of kidney dysfunction (r = 0.52 and -0.52, respectively) in the PUV group. On a multivariate analysis, the kidney dysfunction was the only independent predictor of vitamin D deficiency (ρ = 0.271, P < 0.001), while kidney dysfunction, serum calcium and alkaline phosphatase were independent predictors for hyperparathyroidism (ρ = 0.925, P<0.001, ρ = 0.933, P<0.001 and ρ = 0.913, P < 0.001, respectively). DISCUSSION The prevalence of CKD in children with PUVs ranges from 30 to 60%. Patients with CKD are more likely to have vitamin D deficiency and display more-prominent hyperparathyroidism. Compared with a control group with normal kidney function, the present cohort had lower 25-hydroxyvitamin D and higher iPTH serum levels. Abnormal kidney function was a major predictor for both serum levels. In this cohort, there were no significant differences in serum calcium and phosphorus between children with PUVs and the control group, and also between those with and without CKD. On the contrary, vitamin D level decreased early in the disease and progressively declined thereafter, while iPTH was the opposite. These findings were comparable to previous studies. This study had some limitations because it was a single center cross-sectional non-randomized study. However, the findings in this study can be extrapolated to children with PUVs and CKD from other origins because the unit is considered as a referral center in the Middle East region. CONCLUSION Abnormal kidney function, vitamin D deficiency, and secondary hyperparathyroidism are prevalent in children with PUVs. Kidney function is the main determinant of vitamin D and parathyroid hormone levels. Efforts should be directed toward managing CKD, and controlling vitamin D deficiency and hyperparathyroidism in children after ablation of PUV.
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Affiliation(s)
- O Sarhan
- Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Z Nakshabandi
- Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - M Alghanbar
- Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - A Alotay
- Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - I Sherif
- Biochemistry Department, Mansoura University, Mansoura, Egypt.
| | - C Whitehead
- Division of Nephrology, University of Kentucky, Lexington, KY, USA.
| | - A El-Husseini
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Division of Nephrology, University of Kentucky, Lexington, KY, USA.
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Webster F, Krueger P, MacDonald H, Archibald D, Telner D, Bytautas J, Whitehead C. A scoping review of medical education research in family medicine. BMC Med Educ 2015; 15:79. [PMID: 25903055 PMCID: PMC4407512 DOI: 10.1186/s12909-015-0350-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/26/2015] [Indexed: 05/10/2023]
Abstract
BACKGROUND Little is known about the state of education research within family medicine. As family medicine education models develop, it is important to develop an understanding of the current state of this research and develop ways to advance the field. METHODS We conducted a scoping review of family medicine education research to describe 1) research topic areas and 2) the methodologies and methods used to study these topics. MEDLINE, Social Sciences Abstracts and ERIC electronic databases were searched. 817 full text articles from 2002 to 2012 were screened; 624 articles were included in the review. RESULTS The following research topic areas were identified: continuing education, curriculum development, undergraduate education, teaching methods, assessment techniques, selection of entrants, non-clinical skills, professional and faculty development, clinical decision-making and resident well-being. Quantitative studies comprised the large majority of research approaches; overall minimal methodological details were provided. CONCLUSIONS Our review highlights an overall need for increased sophisticated in methodological approaches to education research in family medicine, a problem that could be ameliorated by multiple strategies including better engagement of methodologists throughout the research process. The results provide guidance for future family medicine education research programs.
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Affiliation(s)
- Fiona Webster
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, M5G 1V7, Toronto, ON, Canada.
| | - Paul Krueger
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, M5G 1V7, Toronto, ON, Canada.
| | - Heather MacDonald
- Health and BioSciences, Reference Services, Carlton University, 1125 Colonel By Drive, K1S 5B6, Ottawa, ON, Canada.
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, 43 Bruyere Street, Floor 3JB, K1N 5C8, Ottawa, ON, Canada.
| | - Deanna Telner
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, M5G 1V7, Toronto, ON, Canada.
| | - Jessica Bytautas
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, M5T 3M6, Toronto, ON, Canada.
| | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, M5G 1V7, Toronto, ON, Canada.
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Ash A, Whitehead C, Hughes B, Williams D, Nayyar V. Impact of a transport checklist on adverse events during intra-hospital transport of critically ill patients. Aust Crit Care 2015. [DOI: 10.1016/j.aucc.2014.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Whitehead C. What ails medical education?
Let Me Heal The Opportunity to Preserve Excellence in American Medicine
Kenneth M. Ludmerer
Oxford University Press, 2014. 451 pp. Science 2015. [DOI: 10.1126/science.aaa0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Lee A, Gaekwad A, Bronca M, Cheruvu L, Davies O, Whitehead C, Agzarian M, Chen C. Stroke physician versus stroke neurologist: can anyone thrombolyse? Intern Med J 2014; 45:305-9. [PMID: 25533873 DOI: 10.1111/imj.12673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM The aim of this study is to compare the outcomes of thrombolysis under standard clinical settings between subjects treated by a stroke neurologist versus those treated by a non-neurologist stroke physician. METHODS Single-centre, observational cohort study of subjects thrombolysed in a calendar year, stratified according to the physician type authorising thrombolysis. Endpoints measured include proportion of subjects with symptomatic intracranial haemorrhage, door-to-needle time, change in National Institute of Health Stroke Scale and discharge destination. RESULTS Forty-nine subjects with a mean age 76 ± 16 years underwent thrombolysis, 21 were under the care of a stroke neurologist and 28 by a non-neurologist stroke physician. No symptomatic intracranial haemorrhages were observed. There was no difference in terms of door-to-needle time, proportion of individuals with haemorrhagic transformation, mortality or discharge destination between the two groups. CONCLUSION Due to the single-centre, observational nature of this study, the equivalent outcomes between those thrombolysed by a stroke neurologist versus those thrombolysed by a stroke physician must be interpreted with caution pending further studies. Nevertheless, in the current setting, no signal for harm has been detected. This study is unique as it is the first to our knowledge comparing outcomes between a neurologist and non-neurologist following thrombolysis.
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Affiliation(s)
- A Lee
- Flinders Comprehensive Stroke Centre, Flinders University of South Australia and Flinders Medical Centre, Adelaide, South Australia, Australia
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Hubinette M, Dobson S, Towle A, Whitehead C. Shifts in the interpretation of health advocacy: a textual analysis. Med Educ 2014; 48:1235-43. [PMID: 25413916 DOI: 10.1111/medu.12584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/13/2014] [Accepted: 07/28/2014] [Indexed: 05/12/2023]
Abstract
CONTEXT Health advocacy is widely accepted as a key element of competency-based education. We examined shifts in the language and description of the role of the health advocate and what these reveal about its interpretation and enactment within the context of medical education. METHODS We conducted a textual analysis of three key documents that provide sequential depictions of the role of the health advocate in medical education frameworks: Educating Future Physicians for Ontario (1993), CanMEDS 2000 and CanMEDS 2005. We used a series of questions to examine shifts in the emphasis, focus and application of the role between documents. Theoretically, we drew upon Carlisle's conceptual framework to identify different approaches to advocacy. RESULTS We identified three major shifts in the language associated with the role of health advocate across our textual documents. Firstly, activities and behaviours that were initially positioned as being the responsibility of the profession as a whole came to be described instead as competencies required of every physician. Secondly, the initial focus on health advocacy as representing collective action towards public policy and systems-level change was altered to a primary focus on individual patients and doctors. Thirdly, we observed a progression away from descriptions of concrete actions and behaviours. CONCLUSIONS This study uncovers shifts in the language of physician advocacy that affect the discourse of health advocacy and expectations placed on physicians and trainees. Being explicit about expectations of the medical profession and individual practitioners may require renewed examination of societal needs. Although this study uses the CanMEDS role of Health Advocate as a specific example, it has implications for the conceptualisation of health advocacy in medicine and medical education globally.
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Affiliation(s)
- Maria Hubinette
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Whitehead C, Selleger V, van de Kreeke J, Hodges B. The 'missing person' in roles-based competency models: a historical, cross-national, contrastive case study. Med Educ 2014; 48:785-795. [PMID: 25039735 DOI: 10.1111/medu.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/13/2013] [Accepted: 02/24/2014] [Indexed: 05/28/2023]
Abstract
CONTEXT The use of roles such as medical expert, advocate or communicator to define competencies is currently popular in health professions education. CanMEDS is one framework that has been subject to great uptake across multiple countries and professions. The examination of the historical and cultural choices of names for roles generates insight into the nature and construction of roles. One role that has appeared in and disappeared from roles-based frameworks is that of the 'person'. METHODS In order to examine the implications of explicitly including or excluding the role of the 'physician as person' in a competency framework, we conducted a contrastive analysis of the development of frameworks in Canada and the Netherlands. We drew upon critical social science theoretical understandings of the power of language in our analysis. RESULTS In Canada, the 'person' role was a late addition to the precursory work that informed CanMEDS, and was then excluded from the final set of CanMEDS role names. In the Netherlands, a 'reflector' role was added in some Dutch schools and programmes when CanMEDS was adopted. This was done in order to explicitly emphasise the importance of the 'person' of the trainee. CONCLUSIONS In analysing choices of names for roles, we have the opportunity to see how cultural and historical contexts affect conceptions of the roles of doctors. The taking up and discarding of the 'person' role in Canada and the Netherlands suggest that as medical educators we may need to further consider the ways in which we wish the trainee as a person to be made visible in the curriculum and in assessment tools.
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Affiliation(s)
- Cynthia Whitehead
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada
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