Le choix ! Les défis à relever pour améliorer la satisfaction des étudiants en médecine quant à leur choix de spécialité

The authors describe the residency match as a two-step process. The first step, the Choice, is where students use a combination of intuitive and analytic information processing to select the specialty that they believe will provide fulfilment and work-life balance over their entire career. The second step, the Match, uses a “deferred-acceptance” algorithm to optimize pairing of students and their specialty choices. Despite being the rate-limiting step, outcomes of the Choice have typically been eclipsed by the outcomes of the Match. A recently published study found that during their second year of residency training, 1 in 14 physicians reported specialty choice regret, which associates with symptoms of burnout in residents. While the obvious solution is to design interventions that improve the specialty choices of students, this approach faces significant challenges, including the fact that: 1) satisfaction with specialty choice is a difficult-to-define construct; 2) specialty choice regret may be misattributed to a poor choice; and 3) choosing is a more complicated process than matching. The authors end by suggesting that if we hope to improve satisfaction with specialty choice then we should begin by defining this, deciding when to assess it, and then creating assessment tools for which there is validity evidence and that can identify the underlying causes of specialty choice regret. Les auteurs décrivent le jumelage des résidents comme un processus en deux étapes. La première étape, le choix, est celle où les étudiants utilisent une combinaison de traitement intuitif et analytique de l'information pour sélectionner la spécialité qui, selon eux, leur apportera l'épanouissement et l'équilibre entre leur vie professionnelle et leur vie privée tout au long de leur carrière. La deuxième étape, l'appariement, utilise un algorithme "d'acceptation différée" pour optimiser l'appariement des étudiants et de leurs choix de spécialité. Bien qu'il s'agisse de l'étape limitant le taux de réussite, les résultats du choix ont généralement été éclipsés par ceux du jumelage. Une étude récemment publiée a révélé que, durant leur deuxième année de résidence, un médecin sur quatorze regrette d'avoir choisi une spécialité, ce qui est associé à des symptômes d'épuisement professionnel chez les résidents. Bien que la solution évidente soit de concevoir des interventions qui améliorent les choix de spécialité des étudiants, cette approche est confrontée à des défis importants, notamment le fait que : 1) la satisfaction à l'égard du choix de la spécialité est un concept difficile à définir ; 2) le regret du choix de la spécialité peut être attribué à tort à un mauvais choix ; et 3) le choix est un processus plus compliqué que l'appariement. Les auteurs concluent en suggérant que si nous espérons améliorer la satisfaction à l'égard du choix de la spécialité, nous devrions commencer par définir ce concept, décider quand l'évaluer, puis créer des outils d'évaluation pour lesquels il existe des preuves de validité et qui peuvent identifier les causes sous-jacentes des regrets à l'égard du choix de la spécialité

Assessing the scholar CanMEDS role in residents using critical appraisal techniques

Background: In this brief report, we describe two ways in which we assessed the Scholar CanMEDS role using a method to measure residents’ ability to complete a critical appraisal.  These were incorporated into a modified OSCE format where two stations consisted of 1) critically appraising an article and 2) critiquing an abstract.Method: Residents were invited to participate in the CanMEDS In-Training Exam (CITE) through the Office of Postgraduate Medical Education. Mean scores for the two Scholar stations were calculated using the number of correct responses out of 10. The global score represented the examiner’s overall impression of the resident’s knowledge and effort.  Correlations between scores are also presented between the two Scholar stations and a paired sample t-test comparing the global mean scores of the two stations was also performed.Results: Sixty-three of the 64 residents registered to complete the CanMEDS In-Training Exam including the two Scholar stations.  There were no significant differences between the global scores of the Scholar stations showing that the overall knowledge and effort of the residents was similar across both stations (3.8 vs. 3.5, p = 0.13).  The correlation between the total mean scores of both stations (inter-station reliability) was also non-significant (r = 0.05, p = 0.67).  No significant differences between senior residents and junior residents were detected or between internal medicine residents and non-internal medicine residents.Conclusion: Further testing of these stations is needed and other novel ways of assessing the Scholar role competencies should also be investigated

Reducing stigma and discrimination: Candidate interventions

This paper proposes that stigma in relation to people with mental illness can be understood as a combination of problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). From a literature review, a series of candidate interventions are identified which may be effective in reducing stigmatisation and discrimination at the following levels: individuals with mental illness and their family members; the workplace; and local, national and international. The strongest evidence for effective interventions at present is for (i) direct social contact with people with mental illness at the individual level, and (ii) social marketing at the population level

L’enseignement de techniques de gestion du stress basées sur la pleine conscience aux étudiants en médecine par le biais de simulations

Implication Statement Acutely traumatic clinical events can exacerbate stress and burnout amongst healthcare providers.  The Simulated Training for Resilience in Various Environments (STRIVE) course may provide a useful framework for medical educators to teach stress management skills to promote resilience amongst physician trainees. The course introduces the Big Four+ techniques (goal setting, visualization, self-talk, progressive muscular relaxation, attention control and tactical breathing) created by the Canadian Armed Forces using clinical scenarios. This framework can be easily adapted across other training contexts to equip future clinicians with a foundational skill set to optimize their response and recovery following critically stressful incidents.Énoncé des implications de la recherche Un événement clinique très traumatisant peut exacerber le stress et l'épuisement professionnel vécus par les soignants. Le cours « Simulated Training for Resilience in Various Environments » ou STRIVE (formation par simulation pour développer la résilience dans divers environnements) offre un cadre utile aux enseignants en médecine pour initier les apprenants aux stratégies de gestion du stress afin de renforcer leur résilience. Le cours présente, à l'aide de scénarios cliniques, les principales techniques (les « Big Four+ ») créées par les Forces armées canadiennes, à savoir la fixation d'objectifs, la visualisation, le dialogue intérieur, la relaxation musculaire progressive, le contrôle de l'attention et la respiration tactique. Ce cadre peut être facilement adapté à d'autres contextes de formation afin de doter les futurs cliniciens d'un ensemble de compétences fondamentales pour optimiser leur capacité de réaction et de rétablissement face à un incident particulièrement stressant

Explorer l'impact de la pandémie de la COVID-19 sur le bien-être des étudiants en médecine : une évaluation des besoins en vue de la du développement d'interventions en faveur du bien-être de l’apprenant

Background: On March 11, 2020 the World Health Organization declared the novel coronavirus SARS-CoV-2 disease (COVID-19) a global pandemic. We sought to understand impact of COVID-19 on learner wellness at a large tertiary care academic institution to inform the future development of learner wellness interventions during the COVID-19 pandemic. Methods: A cross-sectional, internet-based survey collected quantitative and qualitative data from learners April-June 2020. Descriptive statistics and univariate analyses were reported for quantitative data. Open-ended, qualitative responses were analyzed deductively using thematic analysis. Results: Twenty percent of enrolled learners in that faculty of medicine (540/2741) participated including undergraduate [Bachelor’s] students (25.7%), graduate [science] students (27.5%), undergraduate medical students (22.8%), and postgraduate resident physicians (23.5%). We found that learner wellness across all stages of training was negatively impacted and the ways in which learners were impacted varied as a result of their program's response to the COVID-19 pandemic. Conclusions: Learners in health sciences and medical education report worsening well-being because of the programs and the systems in which they function with the added burden of the COVID-19 pandemic. Future interventions would benefit from a holistic framework of learner wellness while engaging in systems thinking to understand how individuals, programs and respective systems intersect. The importance of acknowledging equity, diversity and inclusion, fostering psychological safety and engaging learners as active participants in their journey during a pandemic and beyond are key elements in developing wellness interventions.Contexte : Le 11 mars 2020, l’Organisation mondiale de la santé a déclaré que le nouveau coronavirus SRAS-CoV-2 (COVID-19) était pandémique. Nous avons tenté de cerner l’impact de la COVID-19 sur le bien-être des apprenants dans un grand centre universitaire de soins tertiaires afin d’étayer le développement futur d’interventions en faveur du bien-être des apprenants en contexte de pandémie. Méthodes : Une enquête transversale par sondage en ligne, menée entre les mois d’avril et juin 2020, a permis de recueillir des données quantitatives et qualitatives auprès des apprenants. Des statistiques descriptives et des analyses univariées ont été présentées comme données quantitatives. Les réponses ouvertes, qualitatives, ont été analysées de manière déductive par le biais d’une analyse thématique. Résultats : Vingt pour cent des étudiants de la faculté de médecine (540/2741) ont participé, dont 25,7 % étaient inscrits au premier cycle (baccalauréat), 27,5 % au deuxième cycle (sciences), 22,8 % au premier cycle en médecine et 23,5 % étaient résidents. Nous avons constaté que la pandémie a négativement affecté le bien-être des apprenants à tous les niveaux de formation et que les effets précis sur les étudiants pouvaient varier en fonction de la réponse de leur programme à la situation sanitaire. Conclusions : Les étudiants en médecine et en sciences de la santé signalent une détérioration de leur bien-être liée aux programmes et aux systèmes dans lesquels ils évoluent, auxquels s’ajoute le fardeau supplémentaire de la pandémie de la COVID-19. Il conviendrait de définir les interventions futures sur la base d’un cadre holistique du bien-être des apprenants tout en adoptant une réflexion systémique pour appréhender l’entrecroisement entre individus, programmes et systèmes.  Reconnaître l’importance de l’équité, de la diversité et de l’inclusion, favoriser la sécurité psychologique et assurer la participation active des apprenants dans leur parcours pendant la pandémie et au-delà, constituent des éléments clés dans l’élaboration d’interventions au profit de leur bien-être

Competence committees decision-making; an interplay of data, group orientation, and intangible impressions

Abstract Background The implementation of competency-based medical education and utilization of competence committees (CC) represents a paradigm shift in residency education. This qualitative study aimed to explore the methods used by two operational CC and their members to make decisions about progression and competence of their residents. Methods An instrumental case study methodology was used to study the CC of two postgraduate training programs. Transcripts from observed CC meetings, member interviews, and guiding documents were analyzed using a constructivist grounded theory approach to reveal themes explaining the decision-making process. Results Our study found that the CC followed a process that began within a social decision schema model and evolved to a discussion that invoked social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. We identified that the CC decision-making was at risk of bias, primarily influenced by the group composition, the group orientation and individual members’ mindset, as well as their personal experiences with the trainees. Conclusions Increased awareness of the sources of bias in CC functioning and familiarity with the CC role in competency-based medical education would enable committees to provide valuable feedback to all trainees regardless of their trajectory

Long-Term Medical Conditions and Major Depression: Strength of Association for Specific Conditions in the General Population

Background: The prevalence of major depression (MD) in persons with nonpsychiatric medical conditions is an indicator of clinical need in those groups, an indicator of the feasibility of screening and case-finding efforts, and a source of etiologic hypotheses. This analysis explores the prevalence of MD in the general population in relation to various long-term medical conditions. Methods: We used a dataset from a large-scale Canadian national health survey, the Canadian Community Health Survey (CCHS). The sample consisted of 115 071 subjects aged 18 years and over, randomly sampled from the Canadian population. The survey interview recorded self-reported diagnoses of various long-term medical conditions and employed a brief predictive interview for MD, the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression was used to adjust estimates of association for age and sex. Results: The conditions most strongly associated with MD were chronic fatigue syndrome (adjusted odds ratio [AOR] 7.2) and fibromyalgia (AOR 3.4). The conditions least strongly associated were hypertension (AOR 1.2), diabetes, heart disease, and thyroid disease (AOR 1.4 in each case). We found associations with various gastrointestinal, neurologic, and respiratory conditions. Conclusions: A diverse set of long-term medical conditions are associated with MD, although previous studies might have lacked power to detect some of these associations. The strength of association in prevalence data, however, varies across specific conditions

A controlled trial of mental illness related stigma training for medical students

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund