Les répercussions de l’agrément sur les processus des facultés de médecine aux Caraïbes

Background: Caribbean graduates contribute significantly to the US healthcare workforce. The accreditation requirements of local governments vary from one Caribbean island to another island. The Educational Commission for Foreign Medical Graduates (ECFMG) requirement that all future applicants be graduates from accredited medical schools drove Caribbean medical schools to seek accreditation. Accreditation has been found to significantly impact the educational processes of Canadian medical schools. Our study aims at investigating Caribbean medical school leaders’ perceptions of the impact of accreditation on their school’s processes. Methods: This qualitative study and data analysis were done using a framework analysis. Academic leaders and faculty members from three different types of Caribbean medical schools (accredited, denied-accreditation schools, never applied for accreditation) were interviewed using semi-structured interviews. Results: A total of 12 participants from six different Caribbean medical schools participated in the interview process. Themes of processes influenced by accreditation at Caribbean medical schools were similar to those found in the Canadian context and align with best practices of Continuous Quality Improvement (CQI). Conclusions: Caribbean medical schools are changing their educational processes as a result of accreditation requirements. Some processes are not maintained in a continuous manner, raising questions about the development of a true CQI culture.Contexte : Les diplômés des Caraïbes contribuent de manière significative au personnel de santé Américain. Les exigences des gouvernements Caraïbes en matière d’agrément varient d’une île à l’autre. L’Educational Commission for Foreign Medical Graduates, ECFMG (Commission de l’éducation pour les diplômés en médecine étrangers), exige que les candidats soient diplômés de facultés de médecine agréées, ce qui a incité les facultés de médecine des Caraïbes à solliciter l’agrément. Il a été démontré que l’agrément affectait de manière importante les processus éducatifs des écoles de médecine canadiennes. Notre étude vise à examiner les perceptions des directions des facultés de médecine des Caraïbes quant aux répercussions de l’agrément sur leurs processus. Méthodes : La présente étude qualitative et l’analyse des données ont été réalisées selon la méthodologie du cadre logique. Les responsables universitaires et les membres du corps professoral de facultés de médecine des Caraïbes se trouvant dans trois cas de figure différents (facultés agrées, facultés auxquelles l’agrément a été refusé et facultés n’ayant jamais sollicité l’agrément) ont été interrogés par le biais d’entretiens semi-structurées. Résultats : Douze participants de six facultés de médecine de la région des Caraïbes ont participé aux entretiens. Des thèmes similaires se dégagent en ce qui concerne les processus influencés par l’agrément dans les facultés de médecine caribéennes et canadiennes, en particulier l’adoption des pratiques exemplaires en matière d’amélioration continue de la qualité (ACQ). Conclusions : Les facultés de médecine des Caraïbes modifient leurs processus éducatifs afin de remplir les exigences d’agrément. Certains processus ne sont pas maintenus de manière continue, ce qui soulève des interrogations quant à l’implantation d’une véritable culture de l’ACQ

Emergency medicine residents' beliefs about contributing to a Google DocsTM presentation: a survey protocol

Background Web 2.0 collaborative writing technologies have shown positive effects on medical education. One such technology, Google DocsTM, offers collaborative writing applications that improve healthcare students' sharing of information. Since 2008, all graduating residents in emergency medicine in Canada have had access to an online Google DocsTM slideshow designed to help them share summaries of landmark articles in preparation for their Royal College of Physicians and Surgeons of Canada certification exam. A recent evaluation showed that contributions to the presentation were low. Objective This study will identify the factors that influence residents' decision to contribute or not to contribute to this online collaborative project. Methods Using the Theory of Planned Behaviour, semistructured interviews will be conducted with 25 graduating emergency medicine residents in Canada. Content from the interviews will be analysed to determine the most important beliefs in relation to the defined behaviour. Conclusion To our knowledge, this study will be the first to use a theory based framework to identify healthcare trainees' salient beliefs concerning their decision whether to contribute to an online collaborative writing project using Google DocsTM

A value-based comparison of the management of ambulatory respiratory diseases in walk-in clinics, primary care practices, and emergency departments : protocol for a multicenter prospective cohort study

Background: In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. Results: Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. Conclusions: The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative

The proteome of cytosolic lipid droplets isolated from differentiated Caco-2/TC7 enterocytes reveals cell-specific characteristics

Background information. Intestinal absorption of alimentary lipids is a complex process ensured by enterocytes and leading to TRL [TAG (triacylglycerol)-rich lipoprotein] assembly and secretion. The accumulation of circulating intestine-derived TRL is associated with atherosclerosis, stressing the importance of the control of postprandial hypertriglyceridaemia. During the postprandial period, TAGs are also transiently stored as CLDs (cytosolic lipid droplets) in enterocytes. As a first step for determining whether CLDs could play a role in the control of enterocyte TRL secretion, we analysed the protein endowment of CLDs isolated by sucrose-gradient centrifugation from differentiated Caco-2/TC7 enterocytes, the only human model able to secrete TRL in culture and to store transiently TAGs as CLDs when supplied with lipids. Cells were analysed after a 24 h incubation with lipid micelles and thus in a state of CLD-associated TAG mobilization

« Ceci est mon livre » : quelques stratégies opératoires du livre d’artiste au Québec

Le Livre au corps, le titre m’a fait sourire. Devant ce jeu d’associations et de détournements, je ne pouvais que réagir, surenchérir de manière ludique et un brin iconoclaste ; après tout, il y a bien du diable qui dort là-dessous. « Ceci est mon livre », me suis-je dit, puisque de ce jeu de citations, le livre est bien l’objet central – que de cette substitution, tant l’artiste, l’auteur et le lecteur reconnaissent l’adéquation dans l’objet-livre comme médiateur, si bien que sa terminologie..

The Impact of Accreditation on Medical Schools' Processes

This study was carried out to determine the impact of accreditation on medical schools’ processes and to examine whether processes developed as a result of accreditation align with those associated with best practices of continuous quality improvement. In addition, at each school, the predominant organizational culture was assessed as well as the perceived extent of implementation of continuing quality improvement. Sixteen (16) of the 17 medical schools in Canada were invited to participate; one (1) medical school was excluded, as the timing of the study would have significantly interfered with the regular accreditation activities taking place at that school. Thirteen (13) medical schools agreed to contribute to the study. Mixed methods were used. Individual and focus group interviews were held with leaders of the undergraduate medical education program at each school. In addition, all faculty members with either a leadership role or a teaching role within their undergraduate medical education program were invited to complete an electronic survey about the culture of their organization and the implementation of continuing quality improvement. Results showed that accreditation impacts several processes of medical schools, namely their governance structure, their data collection and analysis systems, their monitoring and documentation procedures, and the creation and revision of policies. It also encourages continuing quality improvement exercises and faculty engagement in the affairs of the medical education program. In some cases, it triggers a complete overhaul of the curriculum and of the academic accountability scheme. Most medical education programs in Canada have an Empirical culture, one that favors stability and conservatism. A Clan culture dominated at two medical education programs and was strong in two additional programs; this culture emphasizes organizational relationships, loyalty and commitment. Programs with a Clan culture tended to demonstrate a higher degree of implementation of quality improvement. Several of the processes developed or strengthened in response to accreditation align with best practices of continuing quality improvement. Programs with a Clan culture might better perceive accreditation-related processes as an integral component of their continuous quality improvement activities

Accréditation des programmes d’éducation médicale canadiens

Contexte et problématique : Les programmes d’éducation médicale canadiens sont accrédités de façon conjointe par le Comité d’agrément des facultés de médecine du Canada (CAFMC) et par le Liaison Committee on Medical Education (LCME). De nouvelles dispositions confèrent désormais une autonomie au CAFMC dans le processus décisionnel des statuts d’accréditation des programmes d’éducation médicale canadiens. Exégèse : Cet article présente un bref aperçu du processus d’accréditation des programmes d’éducation médicale canadiens et du contexte d’élaboration des nouvelles normes canadiennes. Les nouvelles normes canadiennes sont disponibles par le lien électronique fourni