Reclaiming physician identity: It’s time to integrate ‘Doctor as Person’ into the CanMEDS framework

In 1996, the Royal College of Physicians & Surgeons of Canada (RCPSC) adopted the CanMEDS framework with seven key roles: medical expert, communicator, collaborator, health advocate, manager, professional, and scholar. For many years, CanMEDS has been recognized around the world for defining what patients need from their physicians. From the start, the RCPSC acknowledged that these roles should  evolve over time to continue to meet patient and societal needs (updates in 2005 & 2015).  We propose that  an 8th role is now needed in the framework: “Doctor as Person”. Interestingly, this role was present in the foundational work through the Educating Future Physicians for Ontario (EFPO) project that the RCPSC drew upon in creating CanMEDS more than 20 years ago. Given today’s challenges of providing care in an increasingly stressed Canadian healthcare system, physicians are struggling more than ever with health and wellness, burnout, and the deterioration of the clinical environment. From the patient perspective, there is growing concern that physician-patient interactions are becoming increasingly impersonal and decreasingly patient-centered. The crack emerging in the foundation of physician identity needs to be remedied. We need to pay close attention to how we define ourselves as physicians, by better identifying the competencies required to navigate the personal and professional challenges we face. Only in so doing can we ward off the threat that exists in losing authentic human to human care interactions. Formalizing Doctor as Person as an 8th role in the CanMEDS framework will help patients and physicians create the space to have essential conversations about the humanity of medical care.&nbsp

Harmonious Healthcare Teams: What Healthcare Professionals Can and Cannot Learn from Chamber Musicians

Background: As healthcare becomes increasingly team based, we need new ways of educating trainees to be collaborative team members. One approach is to look to other professions that have developed highly effective ways of collaborating. Doctors have already turned to musicians for specific lessons; however, as of yet, there has been little empirical study of the ways that musicians interact in ensembles, or analysis of how this might provide insights for healthcare. Our hypothesis is that healthcare teams might learn from understanding collaborative practices of chamber musicians.Methods and Findings: We undertook an exploratory study of professional musicians playing in non-conducted ensembles. We used semi-structured interviews to explore factors the musicians considered important for effective group function. The interviews were transcribed and coded thematically. We identified three prominent themes that have relevance for healthcare teams.Conclusions: The highly individual nature of each musical group’s identity suggests that a focus on generic interprofessional education skills development may be insufficient. Furthermore, musicians’ understanding of the fundamental role of non-melodic parts provides the possibility of more nuanced leadership models. Finally, essential differences between musicians’ interactions in rehearsals and performances highlight the importance of varied forms of group interactions

Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

"This is the peer reviewed version of the following article: [Milte CM, Ratcliffe J, Davies O, Whitehead C, Masters S, Crotty M. Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making. Health Expectations. 2015 Oct;18(5):1030-40. ], which has been published in final form at [http://dx.doi.org/10.1111/hex.12076]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms"BACKGROUND: Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared-decision-making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings. OBJECTIVE: To describe meetings between older adults, caregivers and geriatricians in intermediate care and explore patient and meeting characteristics associated with a SDM communication style. METHODS: Fifty-nine family meetings involving geriatricians, patients in an intermediate care setting following an acute hospital admission and their caregivers were rated using the OPTION system for measuring clinician SDM behaviour. The geriatric depression scale and multidimensional HLC scale were completed by patients. The mini-mental state exam (MMSE) assessed patient's level of cognitive impairment. RESULTS: Meetings lasted 38 min (SD 13) and scored 41 (SD 17) of 100 on the OPTION scale. Nine (SD 2.2) topics were discussed during each meeting, and most were initiated by the geriatrician. Meeting length was an important determinant of OPTION score, with higher SDM competency displayed in longer meetings. Patient characteristics, including MMSE, HLC and depression did not explain SDM competency. CONCLUSION: Whilst SDM can be achieved during consultations frail older patients and their caregivers, an increased consultation time is a consequence of this approach

Santé et pauvreté: introduction de l'apprentissage transformateur dans les structures et les paradigmes de l’éducation médicale

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.Contexte : En tant que paradigme favorisant l’équité et la justice sociale, l’éducation axée sur la transformation vise à améliorer les structures sociétales en inspirant les apprenants à devenir des agents du changement social. Dans une visée d’éducation transformatrice, le programme de doctorat en médecine de l’Université de Toronto a mis en place un atelier sur le thème de la santé et la pauvreté auquel participaient des tuteurs ayant une expérience vécue de la pauvreté. Notre recherche visait à examiner comment les tuteurs, en tant que membres d’un groupe confronté à l’oppression structurelle, ont compris leur participation à l’atelier. Méthodes : Cette recherche qualitative s’est appuyée sur une méthodologie d’étude de cas et sur des données d’entrevue, en utilisant le concept d’éducation transformatrice comme prisme pour l’analyse et l’interprétation des données. Résultats : Nos résultats s’articulent autour de deux grands thèmes : les décalages entre l’apprentissage transformateur et les structures de l’éducation médicale, et les conséquences inattendues de l’éducation transformatrice au sein des paradigmes dominants de l’éducation médicale. Ces divergences et ces conséquences non voulues ont permis de constater que les cours qui sont ancrés dans les structures, les hiérarchies et les paradigmes contribueront peu à l’éducation transformatrice. Conclusions : Pour que l’éducation médicale soit véritablement transformatrice, il faut qu’il y ait une volonté de modifier les structures qui renforcent l’oppression plutôt que de faire entrer les personnes marginalisées dans des processus éducatifs qui perpétuent l’inégalité sociale.

Promouvoir la confiance, la collaboration et une culture d'amélioration continue de la qualité : appel à la transparence dans l’agrément des facultés de médecine

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

Racial discrepancies in the association between paternal vs. maternal educational level and risk of low birthweight in Washington State

BACKGROUND: The role of paternal factors in determining the risk of adverse pregnancy outcomes has received less attention than maternal factors. Similarly, the interaction between the effects of race and socioeconomic status (SES) on pregnancy outcomes is not well known. Our objective was to assess the relative importance of paternal vs. maternal education in relation to risk of low birth weight (LBW) across different racial groups. METHODS: We conducted a retrospective population-based cohort study using Washington state birth certificate data from 1992 to 1996 (n = 264,789). We assessed the associations between maternal or paternal education and LBW, adjusting for demographic variables, health services factors, and maternal behavioral and obstetrical factors. RESULTS: Paternal educational level was independently associated with LBW after adjustment for race, maternal education, demographic characteristics, health services factors; and other maternal factors. We found an interaction between the race and maternal education on risk of LBW. In whites, maternal education was independently associated with LBW. However, in the remainder of the sample, maternal education had a minimal effect on LBW. CONCLUSIONS: The degree of association between maternal education and LBW delivery was different in whites than in members of other racial groups. Paternal education was associated with LBW in both whites and non-whites. Further studies are needed to understand why maternal education may impact pregnancy outcomes differently depending on race and why paternal education may play a more important role than maternal education in some racial categories