Employee Drug Testing: Orwellian Vision or Pragmatic Approach to Problems in the Workforce

Until very recently, there has been no case law considering the legitimacy of employee drug testing under Human Rights legislation or the permissibility of drug testing policies and what they should stipulate. In light of two relatively recent cases, Entrop v. Imperial Oil and Toronto-Dominion Bank v. Canadian Human Rights Commission and Canadian Civil Liberties Association, a re-examination of the legitimacy of employee drug testing is warranted, along with the arguments concerning what the policies should target and how they should be implemented. Furthermore, the EDT jurisprudence exemplifies the discrepancies in the human rights framework, as articulated by the Supreme Court in British Columbia Government [Public Service Employee Relations Commission] v. BCGSEU. The Ontario Court of Appeal heard Entrop prior to the release of the recent Supreme Court pronouncements on a revised human rights analytical framework, thus providing a further impetus to examine how EDT can justifiably be implemented according to traditional human rights principles embraced in the new unified approach. Courts should consider employee drug testing to be a practicable and legitimate employment rule that strives to maintain workplace safety and integrity. This conclusion is reached after examining the viable concerns over substance abuse, the various issues that are raised by employee drug testing, the role of human rights and Charter jurisprudence, and the preciseness of the polices\u27 language. The present pending appeal before the Ontario Court of Appeal in Entrop presents a unique opportunity for the judiciary to set out guidelines as to the permissible means of drug testing, the responsibilities of employers and employees, and how testing can be legally upheld under statutory and common law. Employee drug testing is unquestionably an invasion of employees\u27 privacy. But it is also a proactive approach to a pressing issue that confronts the workplace and society at large. Employee assistance programs are a valuable component in an employer\u27s strategy to maintaining a healthy workforce and a safe work environment. But these programs alone are simply not sufficient to combat the danger of substance abuse in the workplace. Unions and management must work together to implement testing policies that meet the changing virtues and vices of contemporary Canadian society in order to accommodate employees\u27 needs

Employee Drug Testing: Orwellian Vision or Pragmatic Approach to Problems in the Workforce

Until very recently, there has been no case law considering the legitimacy of employee drug testing under Human Rights legislation or the permissibility of drug testing policies and what they should stipulate. In light of two relatively recent cases, Entrop v. Imperial Oil and Toronto-Dominion Bank v. Canadian Human Rights Commission and Canadian Civil Liberties Association, a re-examination of the legitimacy of employee drug testing is warranted, along with the arguments concerning what the policies should target and how they should be implemented. Furthermore, the EDT jurisprudence exemplifies the discrepancies in the human rights framework, as articulated by the Supreme Court in British Columbia Government [Public Service Employee Relations Commission] v. BCGSEU. The Ontario Court of Appeal heard Entrop prior to the release of the recent Supreme Court pronouncements on a revised human rights analytical framework, thus providing a further impetus to examine how EDT can justifiably be implemented according to traditional human rights principles embraced in the new unified approach. Courts should consider employee drug testing to be a practicable and legitimate employment rule that strives to maintain workplace safety and integrity. This conclusion is reached after examining the viable concerns over substance abuse, the various issues that are raised by employee drug testing, the role of human rights and Charter jurisprudence, and the preciseness of the polices\u27 language. The present pending appeal before the Ontario Court of Appeal in Entrop presents a unique opportunity for the judiciary to set out guidelines as to the permissible means of drug testing, the responsibilities of employers and employees, and how testing can be legally upheld under statutory and common law. Employee drug testing is unquestionably an invasion of employees\u27 privacy. But it is also a proactive approach to a pressing issue that confronts the workplace and society at large. Employee assistance programs are a valuable component in an employer\u27s strategy to maintaining a healthy workforce and a safe work environment. But these programs alone are simply not sufficient to combat the danger of substance abuse in the workplace. Unions and management must work together to implement testing policies that meet the changing virtues and vices of contemporary Canadian society in order to accommodate employees\u27 needs

The effect of a global multiculturalism track on cultural competence of preclinical medical students

BACKGROUND: We evaluated the effect of an elective (the Global Multiculturalism Track), including international and domestic immersion experiences, on the cultural competence of preclinical medical students. METHODS: A self-assessment instrument was used to measure cultural competence, and it was administered to Track participants and nonparticipating class cohorts at the beginning and the end of the preclinical years. RESULTS: Track participants (n=26) had a higher level of cultural competence both at the beginning and at the end of the program. At the end of their second year, students participating in the Track had, for the first time, greater knowledge of certain aspects of local cultures, more tolerance of people of other cultures not speaking English, and more comfort with patients of these cultures, compared with non-Track participants. CONCLUSIONS: The results are based on a small sample size, but the suggestion that a multiculturalism track could provide a model for development of cultural competence warrants further research

The effect of medical students\u27 international experiences on attitudes toward serving underserved multicultural populations

BACKGROUND: We evaluated the effect of international electives on the attitudes of preclinical and clinical-year medical students with respect to serving underserved multicultural populations. METHODS: A self-assessment instrument was used to measure attitudes of 146 students before and after participating in international electives. The same attitudinal items were also analyzed at two time intervals for 18 students who completed international electives as preclinical students and 76 class cohorts who did not. RESULTS: Analyses show that the effect of international experiences is different for preclinical students and clinical students. For both groups, however, these experiences can develop and support perceptions and values conducive to serving underserved multicultural populations. These include reported increases in cultural competence and important personal attributes like idealism and enthusiasm. In addition, these experiences can heighten clarity about career roles, including those involving underserved multicultural patients. CONCLUSIONS: This study provides support for the hypothesis that international electives develop attributes that could benefit underserved multicultural populations

A longitudinal study of multicultural curriculum in medical education

OBJECTIVE: To evaluate impact a multicultural interclerkship had on students\u27 perception of knowledge, interview skills, and empathy towards serving culturally diverse populations and role student demographics played in learning. METHODS: Data extracted from students\u27 self-reported course evaluations and pre/post questionnaires during multiculturalism interclerkship across 11 academic years. Inquired students\u27 opinion about four areas: effectiveness, small group leaders, usefulness, and overall experience. Subscale and item ratings were compared using trend tests including multivariate analyses. RESULTS: During studied years, 883 students completed course evaluation with high overall mean rating of 3.08 (S = 0.45) and subscale mean scores ranging from 3.03 to 3.30. Trends in three of four subscales demonstrated clear uptrend (p \u3c 0.0001). Positive correlations between ratings of leaders and usefulness were observed (p \u3c 0.0001). Pre/post matched dataset (n = 967) indicated majority of items (19/23) had statistically significant higher post interclerkship ratings compared to pre scores with nine of 19 having statistically significant magnitudes of change. Questionnaire had high overall reliability (Cronbach alpha = 0.8), and item-to-group correlations ranged from 0.40 to 0.68 (p \u3c 0.0001). CONCLUSIONS: By increasing students\u27 exposure and interaction with diverse patients, their knowledge, attitude, and skills were increased and expanded in positive manner. These findings might inform those who are interested in enhancing this important competence. This is especially true given increasing scrutiny this global topic is receiving within and across healthcare professions around the world

Assessing Patient-Provider Collaboration in Subjects with Type 2 Diabetes in Jamaica and Effects on Glycemic Control

Background: Type 2 Diabetes Mellitus is a growing health problem worldwide that places patients at increased risk of morbidity and mortality from microvascular and macrovascular complications. Research suggests that a patient-centered approach which focuses on patient-physician communication and collaboration in the management of chronic diseases such as diabetes may improve clinical outcomes in a glycemic parameter such as HbA1c. We measured the degree of this patient-centered approach in a sample population of subjects with Type 2 Diabetes in Jamaica with the use of the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire and assessed the relationship between patient-centered care and glycemic control. Purpose: To compare PACIC scores to hemoglobin A1C values in subjects with Type 2 Diabetes and to determine the correlation between patient-physician collaboration and glycemic control. Methods: Participants were selected from the Diabetes Clinic at the University Hospital of the West Indies in Kingston, Jamaica, in August 2011. A total of 40 patients were screened, but only 19 met eligibility requirements and agreed to participate in the study. Informed consent was obtained. The patients were assigned a study number and then self-administered the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire in a private examination room. The PACIC is a validated instrument consisting of a total of 20 multiple choice questions. It measures five subjective categories: 1) Patient activation; 2) Delivery system design and decision support; 3) Goal setting; 4) Problem solving/contextual counseling; and 5) Follow-up/ coordination. Each category can be averaged individually with scores ranging from 1-5. The overall PACIC score measures patient-physician collaboration with a score ranging from a low of 1.0 to a high of 5.0. Additional study data was collected by one of the authors (PD) for both characterization of the study population and for analysis of potential confounders. These additional independent variables included: patient age, type of treatment (i.e., lifestyle modification), and years diagnosed with diabetes mellitus. Results: There were 19 subjects who were eligible for study and completed the PACIC questionnaire. There were more women than men (78.9%, 15 women and 4 men). The age range was 33-78 years with a mean age of 55. The range for years diagnosed with diabetes was 0.03 – 32 years with a mean of 14 years. Eight of the subjects (42.1%) were on combination therapy with insulin and oral hypoglycemic agents. Hemoglobin A1c values ranged from 5.4% – 15.5% with a mean of 10.8%. The PACIC scores ranged from 1.85 – 4.80 with a mean of 3.15. No statistically significant correlations were found between PACIC scores and HbA1c (r=.184). HbA1c did not significantly correlate with patient age (r=-.408), nor with years diagnosed with diabetes (r=-.244). Further statistical analysis using non-parametric correlation coefficients to take small sample sizes into account did not reveal any significant relationship either. Conclusion: There was no statistically significant trends between our main variables of the patient-physician collaboration (PACIC score) and glycemic control (HbA1c). Analysis of potential confounders also failed to elicit any correlations with HbA1c. The major limitation in this study is the small sample size. An important next step would be to repeat this study with a larger clinic sample

Herd characteristics and cow-level factors associated with Prototheca mastitis on dairy farms in Ontario, Canada

Prototheca spp. are algae that cause incurable acute or chronic mastitis in dairy cows. The aim of this case-control study was the identification of cow- and herd-level risk factors for this unusual mastitis pathogen. Aseptically collected composite milk samples from 2,428 milking cows in 23 case and 23 control herds were collected between January and May 2011. A questionnaire was administered to the producers, and cow-level production and demographic data were gathered. In 58 of 64 isolates, Prototheca spp. and Prototheca zopfii genotypes were differentiated using PCR and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. All isolates were identified as Prototheca zopfii genotype 2. The mean within-herd prevalence for Prototheca spp. was 5.1% (range 0.0-12.5%). Case herds had a significantly lower herd-level prevalence of Staphylococcus aureus and a higher prevalence of yeasts than did control herds. The final logistic regression model for herd-level risk factors included use of intramammary injections of a non- intramammary drug [odds ratio (OR) = 136.8], the number of different injectable antibiotic products being used (OR = 2.82), the use of any dry cow teat sealant (external OR = 80.0; internal OR = 34.2), and having treated 3 or more displaced abomasums in the last 12 mo OR = 44.7). The final logistic regression model for cow-level risk factors included second or greater lactation (OR = 4.40) and the logarithm of the lactation-average somatic cell count (OR = 2.99). Unsanitary or repeated intramammary infusions, antibiotic treatment, and off-label use of injectable drugs in the udder might promote Prototheca udder infection

Weaving The Threads of Multiculturalism Throughout Medical Education

How do medical students learn about the healthcare impact of essential multiculturalism issues in an increasingly diverse population? This study gauges student participation in a variety of multiculturalism curricula and student assessment of curriculum time devoted to multiculturalism at school versus national levels