Perceptions de partialité dans la sélection des diplômés internationaux en médecine aux programmes de résidence au Canada

Background: In Canada, international medical graduates (IMG) consist of immigrant-IMG and previous Canadian citizens/permanent residents who attended medical school abroad (CSA). CSA are more likely to obtain a post-graduate residency position than immigrant-IMG and previous studies have suggested that the residency selection process favours CSA over immigrant-IMG. This study explored potential sources of bias in the residency program selection process. Methods: We conducted semi-structured interviews with senior administrators of clinical assessment and post-graduate programs across Canada. We asked about perceptions of the background and preparation of CSA and immigrant-IMG, methods applicants use to improve likelihood of obtaining residency positions, and practices that may favour/discourage applicants. Interviews were transcribed and a constant comparative method was employed to identify recurring themes.  Results: Of a potential 22 administrators, 12 (54.5%) completed interviews. Five key factors that may provide CSA with an advantage were: reputation of the applicant’s medical school, recency of graduation, ability to complete undergraduate clinical placement in Canada, familiarity with Canadian culture, and interview performance.  Conclusions: Although residency programs prioritize equitable selection, they may be constrained by policies designed to promote efficiencies and mitigate medico-legal risks that inadvertently advantage CSA. Identifying the factors behind these potential biases is needed to promote an equitable selection process.Contexte :Parmi les diplômés internationaux en médecine (DIM) au Canada, il y a des diplômés immigrants et des citoyens ou des résidents canadiens qui ont fait leurs études de médecine à l’étranger (CEE). Ces derniers ont plus de chances d’obtenir un poste de résidence postdoctorale que les DIM immigrants. Des études montrent que le processus de sélection des résidents favorise les CEE au détriment des DIM immigrants. La présente étude explore les sources potentielles de biais dans le processus d’attribution des postes de résidence. Méthodes : Nous avons mené des entrevues semi-structurées avec des gestionnaires principaux de programmes d’évaluation clinique et de programmes de formation postdoctorale de tout le Canada. Nous les avons interrogés sur leurs perceptions quant au parcours et au niveau de préparation des CEE et des DIM immigrants, quant aux méthodes utilisées par les candidats pour augmenter leurs chances d’obtenir un poste de résidence et quant aux pratiques qui peuvent encourager ou décourager les candidats. Les entretiens ont été transcrits et une méthode comparative constante a été employée pour identifier les thèmes récurrents. Résultats : Douze (54,5 %) des 22 gestionnaires sollicités ont participé aux entrevues. Les cinq facteurs clés susceptibles de procurer un avantage aux CEE sont : la réputation de la faculté de médecine où le candidat a obtenu son diplôme, la date récente d’obtention de ce dernier, la possibilité d’effectuer un stage clinique de premier cycle au Canada, la familiarité avec la culture canadienne et la performance à l’entrevue. Conclusions : Bien que la sélection équitable soit une priorité pour les programmes de résidence, ils doivent également respecter des politiques visant l’efficacité et l’atténuation des risques médico-légaux qui avantagent involontairement les CEE. Il faut déceler les facteurs qui sous-tendent ces biais potentiels pour renforcer le caractère équitable du processus de sélection

Higher Education Exchange: 2009

This annual publication serves as a forum for new ideas and dialogue between scholars and the larger public. Essays explore ways that students, administrators, and faculty can initiate and sustain an ongoing conversation about the public life they share.The Higher Education Exchange is founded on a thought articulated by Thomas Jefferson in 1820: "I know no safe depository of the ultimate powers of the society but the people themselves; and if we think them not enlightened enough to exercise their control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."In the tradition of Jefferson, the Higher Education Exchange agrees that a central goal of higher education is to help make democracy possible by preparing citizens for public life. The Higher Education Exchange is part of a movement to strengthen higher education's democratic mission and foster a more democratic culture throughout American society.Working in this tradition, the Higher Education Exchange publishes interviews, case studies, analyses, news, and ideas about efforts within higher education to develop more democratic societies

Family physicians’ roles in long-term care homes and other congregate residential care settings during the COVID-19 pandemic: a qualitative study

Context: The COVID-19 pandemic disproportionally affected long-term care (LTC) homes and other community-based congregate residential care settings. Although family physicians (FPs) play important roles in the care of residents in LTC homes, provincial pandemic plans make few references to their specific roles in LTC. Objective: To examine the experiences of FPs providing care in LTC homes and other congregate care settings in Canada during the first year of the COVID-19 pandemic (2020–2021). Methods: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four Canadian regions. Interviews were transcribed, and a thematic analysis approach was employed. Findings: Twenty-one of the 68 FPs interviewed discussed providing care in congregate residential settings, including LTC. We identified three major themes: 1) the roles of FPs in community-based congregate residential care settings during a pandemic, 2) modification of the delivery of routine care, and 3) special workforce considerations in pandemic response for community-based congregate residential care settings. Limitations: We interviewed FPs in four Canadian jurisdictions between October 2020 and June 2021; findings may not be generalisable to later pandemic stages or to other provinces. Our recruitment strategy did not specifically target FPs who worked in different types of congregate residential care facilities; further research is needed to examine these settings in greater depth. Implications: FPs have a unique understanding of the populations they serve and are well suited to plan and implement community-adaptive procedures. Future pandemic plans should implement LTC-related FP roles during the pre-pandemic stage of a pandemic response

Family physicians\u27 responses to personal protective equipment shortages in four regions in Canada: a qualitative study.

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians\u27 (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic

Development of a primary care pandemic plan informed by in-depth policy analysis and interviews with family physicians across Canada during COVID-19: A qualitative case study protocol

Introduction Given the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians\u27 roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. Methods and analysis We will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians\u27 proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses. Ethics and dissemination Approval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care

Family physician leadership during the COVID-19 pandemic: roles, functions and key supports.

PURPOSE: Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. DESIGN/METHODOLOGY/APPROACH: This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. FINDINGS: Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. PRACTICAL IMPLICATIONS: Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. ORIGINALITY/VALUE: The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study\u27s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care

Quantitative principles of cis-translational control by general mRNA sequence features in eukaryotes.

BackgroundGeneral translational cis-elements are present in the mRNAs of all genes and affect the recruitment, assembly, and progress of preinitiation complexes and the ribosome under many physiological states. These elements include mRNA folding, upstream open reading frames, specific nucleotides flanking the initiating AUG codon, protein coding sequence length, and codon usage. The quantitative contributions of these sequence features and how and why they coordinate to control translation rates are not well understood.ResultsHere, we show that these sequence features specify 42-81% of the variance in translation rates in Saccharomyces cerevisiae, Schizosaccharomyces pombe, Arabidopsis thaliana, Mus musculus, and Homo sapiens. We establish that control by RNA secondary structure is chiefly mediated by highly folded 25-60 nucleotide segments within mRNA 5' regions, that changes in tri-nucleotide frequencies between highly and poorly translated 5' regions are correlated between all species, and that control by distinct biochemical processes is extensively correlated as is regulation by a single process acting in different parts of the same mRNA.ConclusionsOur work shows that general features control a much larger fraction of the variance in translation rates than previously realized. We provide a more detailed and accurate understanding of the aspects of RNA structure that directs translation in diverse eukaryotes. In addition, we note that the strongly correlated regulation between and within cis-control features will cause more even densities of translational complexes along each mRNA and therefore more efficient use of the translation machinery by the cell

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. Results Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). Conclusions The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. Protocol registration ID PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767