Developing the Change Agent Competencies of Occupational Therapy University Students: Using a Scholarship of Teaching and Learning Approach in a Canadian Program

Canadian occupational therapy (OT) university programs must teach change agent competencies. These include promoting social justice and empowering clients, which United States occupational therapists also do. Change agent competency requirements are challenging to teach and involve multidisciplinary knowledge and non-traditional skills. As few occupational therapists feel competent to act as change agents, university programs must engage in a scholarship of teaching and learning (SoTL) approach and identify areas of improvement. The aim of this study, informed by SoTL, was to document, as described by participants, the pedagogical activities related to teaching the change agent role in an OT program in Canada and explore possible curricular improvements. Two online 90-minute focus group meetings were held: one with ten teaching team members, the other with six current and past students. Participants were questioned regarding current formal and informal curricular activities, barriers that influenced competency development, and activities that could help improve it. Data were analyzed thematically. Actual informative teaching activities, such as ethics and multicultural courses, were deemed helpful but insufficient, with only one transformative course in the curriculum. Barriers such as a rigid, biomedical-based program structure also affected competency acquisition. Solutions to improve acquisition included mentorship and recognition of relevant extracurricular projects by the programs. SoTL offers a reflective lens to learn from collective experiences. This study showed the importance of involving students and faculty in program development and delivery improvements in order to better support educators and program administrators in their mission to meet the needs of vulnerable populations

Resetting the compass: exploring the implicit messages of orientation to a community-engaged medical school

Background: Although students’ transition into medical school is a critical step in their professional journey, orientation has been relatively under-researched, particularly with regard to its intersections with schools’ social missions. This paper reports on a study looking at the implicit messages of orientation to the Northern Ontario School of Medicine’s undergraduate program.Methods: An extended mixed methods study was conducted to look at different aspects of the School’s Orientation Week. The term “hidden curriculum” was used to shape inquiry, both in its broad sense of implicit educational experiences and messages and in its more specific sense of the educational messages sent by a medical school’s culture and activities. Data were collected using participant surveys, focus groups, and interviews. Transcripts and free-text survey responses were analyzed to identify underlying themes.Results: Orientation Week was generally well received and was generally perceived by different stakeholders (such as students, school leaders, and community members) as a positive and necessary undertaking. However, there were points of contention and confusion that created a hidden curriculum with respect to participants’ identities, both as students and as future health professionals.Conclusion: Orientation to undergraduate medical training can be successfully linked to a school’s social mission, but in doing so it can send complex and unintended messages to the participants that may be perceived quite differently based on their circumstances and expectations

Explorer les perspectives des partie prenantes concernant la mise en œuvre de la formation médicale axée sur les compétences: une étude descriptive qualitative

Introduction: Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices. Methods: We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College’s Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results. Results: The participants’ perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes. Conclusion: By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts.Introduction: La formation médicale axée sur les compétences (FMAC) offre des avantages et des bénéfices perçus pour les études médicales postdoctorales et la formation de médecins compétents. Le but de notre étude était d’apprendre des personnes impliquées dans l’implantation de la FMAC dans deux programmes de résidence afin d'informer les pratiques de mise en œuvre en cours. Méthodes: Nous avons réalisé une étude qualitative descriptive pour explorer les perspectives de plusieurs parties prenantes impliquées dans la mise en œuvre de la FMAC dans deux programmes de résidence (la première cohorte) visant à mettre en place le modèle Compétence par conception du Collège royal dans une université canadienne. Des entrevues semi-structurés ont été menés auprès de 17 participants issus de six groupes de parties prenantes, notamment des résidents, des chefs de département, des directeurs de programme, des membres de la faculté, des éducateurs médicaux et des administrateurs de programme. La collecte et l'analyse des données étaient itératives et réflexives afin d’enrichir l'authenticité des résultats. Résultats: Les perspectives des participants se sont organisées autour de trois thèmes clés, à savoir : a) contextualiser les pratiques de curriculum et d'évaluation avec les objectifs d'apprentissage de la FMAC, b) coordonner les nouvelles exigences administratives pour soutenir la mise en œuvre, et c) s'adapter à une structure de programme axée sur les compétences, chacun avec des sous-thèmes. Conclusion: En recueillant les perspectives des différents groupes de parties prenantes ayant vécu les processus de mise en œuvre, nous avons développé une compréhension commune des facilitateurs et des défis pour les directeurs de programme, les administrateurs de programme et les leaders éducatifs dans la formation médicale postdoctorale. Les résultats de notre étude contribuent à la conversation savante concernant les aspects clés liés à la mise en œuvre de la FMAC et servent à informer son développement et son application en cours dans différents contextes éducatifs

Exploring stakeholder perspectives regarding the implementation of competency-based medical education: a qualitative descriptive study

Introduction: Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices. Methods: We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College’s Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results. Results: The participants’ perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes. Conclusion: By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts

Community engagement: A central feature of NOSM’s socially accountable distributed medical education

Background: Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM’s distinctive model, Distributed Community Engaged Learning (DCEL).Methods: Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies.Results: Community engagement contributes throughout the lifecycle stages of preadmission, admission, and undergraduate medical education. High school students from 70 Northern Ontario communities participate in NOSM’s week-long Health Sciences Summer Camps. The MD admissions process involves approximately 128 volunteers assessing written applications and over 100 volunteer interviewers. Thirty-six Indigenous communities host first year students and third-year students learn their core clinical medicine in 15 communities, throughout Northern Ontario. In general, learners and communities report net benefits from participation in NOSM programs.Conclusion: Community engagement makes a key contribution to the success of NOSM’s socially accountable distributed medical education

Causes of death in people with coeliac disease in England compared with the general population: a competing risk analysis.

INTRODUCTION: Quantifying excess cause-specific mortality among people with coeliac disease (CD) compared with the general population accounting for competing risks will allow accurate information to be given on risk of death from specific causes. METHOD: We identified from the Clinical Practice Research Datalink all patients with CD linked to Office for National Statistics between 1998 and 2012. We selected controls by frequency matching from the registered general practice population within 10-year age bands. We calculated the adjusted cumulative incidence (including adjustment for competing risks) and excess cumulative incidence for different causes of death up to 10 years from diagnosis. RESULTS: Of the 10 825 patients with CD, 773 died within the study period. The overall mortality rate among patients with CD was 128/10 000 person years compared with 153/10 000 in controls (HR=0.94 95% CI 0.84 to 1.01). We found no overall difference in the cumulative incidence of respiratory disease, digestive disease or cancer related death among cases and controls. The adjusted cumulative incidence of death from cardiovascular deaths was slightly lower compared with those without CD diagnosis (CD 0.32% vs controls 0.41%) with a corresponding excess cumulative incidence of -0.08% (95% CI -0.13 to -0.04). However, patients with CD had 0.15% excess risk (95% CI 0.03 to 0.27) of deaths from non-Hodgkin's lymphoma from the general population baseline risk. CONCLUSIONS: Overall, people with CD have no major excess risk of cancer, digestive disease or respiratory disease related or cardiovascular mortality compared with the general population. These findings should be reassuring to patients with CD and clinicians managing their care

Discourses of student orientation to medical education programs

Background: Although medical students’ initial orientation is an important point of transition in medical education, there is a paucity of literature on the subject and major variations in the ways that different institutions orient incoming medical students to their programs. Methods: We conducted a discourse analysis of medical education orientation in the literature and on data from a survey of peer institutions’ approaches to orientation. Results: These two discourses of orientation had clear similarities, in particular, the critical role of ceremony and symbols, and the focus on developing professionalism and physician identities. There were also differences between them, in particular, in the way that the discourse in the literature focused on the symbolic and professional aspects of orientation; something we have called ‘cultural orientation’. Meanwhile, those who were responsible for orientation in their own institutions tended to focus on the practical and social dimensions. Conclusion: By examining how orientation has been described and discussed, we identify three domains of orientation: cultural, social, and practical. These domains are relatively distinct in terms of the activities associated with them, and in terms of who is involved in organizing and running these activities. We also describe orientation as a liminal activity system on the threshold of medical school where incoming students initially cross into the profession. Interestingly, this state of ambiguity also extends to the scholarship of orientation with only some of its aspects attracting formal enquiry, even though there is a growing interest in transitions in medical education as a whole. We hope, therefore, that this study can help to legitimize enquiry into orientation in all its forms and that it can begin to situate the role of orientation more firmly within the firmament of medical education practice and research

Glycemic control during consecutive days with prolonged walking exercise in individuals with type 1 diabetes mellitus

Aims: Despite its general benefits for health, exercise complicates the maintenance of stable blood glucose concentrations in individuals with type 1 diabetes. The aim of the current study was to examine changes in food intake, insulin administration, and 24-h glycemic control in response to consecutive days with prolonged walking exercise (~8 h daily) in individuals with type 1 diabetes. Methods: Ten individuals with type 1 diabetes participating in the worlds' largest walking event were recruited for this observational study. Simultaneous measurements of 24-h glycemic control (continuous glucose monitoring), insulin administration and food intake were performed during a non-walking day (control) and during three subsequent days with prolonged walking exercise (daily distance 40 or 50 km). Results: Despite an increase in daily energy (31 ± 18%; p 10 mmol/L) and hypoglycemia (blood glucose 0.05 for all variables). The prolonged walking exercise was associated with a modest increase in glycemic variability compared with the control day (p < 0.05). Conclusion: Prolonged walking exercise allows for profound reductions in daily insulin administration in persons with type 1 diabetes, despite large increments in energy and carbohydrate intake. When taking such adjustments into account, prolonged moderate-intensity exercise does not necessarily impair 24-h glycemic control. © 2016 Elsevier Ireland Ltd

Adaptation during a longitudinal integrated clerkship: the lived experiences of third-year medical students at the Northern Ontario School of Medicine.

There are three interrelated concepts of what medical students learn, which include the formal, informal, and hidden curriculum. Several researchers who have investigated notions of the hidden curriculum have demonstrated how the experiences of medical training entrenched in the hidden curriculum can have a profound impact on medical student adaptation. The most influential transitional stage in undergraduate medical education is the third-year clinical clerkship, when medical students transition from classroom learners into clinicians. The Northern Ontario School of Medicine’s (NOSM) clinical clerkship year consists of a mandatory eightmonths of living and working in rural and northern communities throughout Northern Ontario, and learning in the context of rural family practice. Informed by a social constructivist research paradigm, I explored how 12 third-year students described the challenges they had to manage and, in response, the strategies they employed to adapt to their clerkship. I elicited their experiences and perspectives to contribute to a rich understanding of how students at the NOSM describe developing processes of adaptation during the Comprehensive Community Clerkship. Data were collected between August 2011 and April 2012, including: a) pre-clerkship interviews and a demographic questionnaire, b) mobile methods in the form of ‘guided walks’ in the communities, and c) post-clerkship interviews. The quality of the data collection and analysis were enhanced through processes of methodological and interpretive rigour, representativeness and authenticity, rich description and contextual relevance, audit trail, and reflexivity. Through an inductive thematic analysis of the data, the findings provide a rich description of events experienced such as medical training in one’s hometown or a familiar community, iv transitions including adaptation to the clinical setting and to the medical profession, and the influence of the clerkship on career path, personal well-being, and empathy for patients. The findings serve to advance our understanding of how medical students describe developing processes of adaptation throughout a longitudinal integrated clerkship. Implications are considered for medical students, the NOSM, the clerkship communities, and medical schools nationally and internationally. I propose recommendations regarding the suitability of authentic methods in medical education research, and discuss the implications for rural and northern health research.Doctor of Philosophy (PhD) in Rural and Northern Healt