Professionalism lapses in health professions training: Navigating the 'Yellow Card' moments for transformative learning.

INTRODUCTION: Health professions training programmes face increasing reports of professionalism lapses, which can delay, or end, trainee progression. How programmes respond to professionalism lapses to facilitate professional identity development has not been clarified. The objective of this study is to identify factors that facilitate and impair transformations around professionalism lapses in health professions training programmes. METHODS: We conducted a qualitative study interviewing 5 faculty and 20 trainees with firsthand or secondhand experience with professionalism lapses from a range of health professions training programmes at McMaster University. Using reflexive thematic analysis, we coded verbatim transcripts informed by the lenses of social and transformative learning theories. We constructed themes through iterative and comparative analysis, seeking meaningful variation across professions and triangulating faculty and trainee perspectives. RESULTS: Four themes were constructed. First, lapses are in the eye of the beholder with personal definitions intersecting with institutional and situation norms. Difficulties exist in recognising and convincing trainees to respond to lapses that are perceived to be minor or subject to interpretation. Second, responses to professionalism lapses occurred within power hierarchies, which impacted how trainees reacted to the remediation process, risked superficial trainee responses to concerns and led to concerns around inequitable treatment in how standards were applied. Third, fostering transformation involves building trainee confidence, agency, trust and engagement. Focused support and advocacy for trainees can empower and promote agency in tackling disorienting lapses. Fourth, perspective shifts involve deep engagement over time, including but not limited to self-reflection, structured discussion and seeking support. DISCUSSION: Identifying and addressing professionalism lapses is complex and requires nuanced and contextual exploration of personal, institutional and situational dynamics at play. By fostering environments that promote genuine reflection and dialogue and focus on building trainee confidence, agency, trust and engagement, health professions training programmes can better support trainees in navigating these complex situations and contribute to the broader goal of socialising to a professional culture and practice.

Associations between education policies and the geographic disposition of family physicians: a retrospective observational study of McMaster University education data.

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.

Medical education interventions influencing physician distribution into underserved communities: a scoping review.

BACKGROUND AND OBJECTIVE: Physician maldistribution is a global problem that hinders patients' abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities. METHODS: A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians' decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations. RESULTS: There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness. CONCLUSIONS: Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.

An Examination of Myers-Briggs Type Indicator Personality, Gender, and Career Interests of Ontario Veterinary College Students.

The objectives of this study were to describe the Myers-Briggs Type Indicator (MBTI) distribution of Ontario Veterinary College (OVC) veterinary students (n = 1,249), and to evaluate its associations with gender and career interests. This was achieved by collecting pre-matriculation data from 11 graduating classes. Overall, OVC veterinary students were diverse in their MBTI types and preferences, as well as career interests. Extraversion, Sensing, Thinking, and Judging were the most prevalent preferences. Female veterinary students were 2.96 (95% CI = 2.11-4.17) times more likely to demonstrate the Feeling preference and 1.89 (95% CI = 1.41-2.56) more likely to prefer Judging, compared to male students (who were more likely to prefer the Thinking and Perceiving preferences, respectively). At entry to the veterinary program, students who preferred Intuition (vs. Sensing) were 2.08 (95% CI = 1.33-3.33) times more likely to be interested in a veterinary career other than practice, and 1.92 (95% CI = 1.43-2.56) times more likely to be undecided about their future veterinary career path. Both at entry to the program and in their final-year stream choice, students of the Thinking preference were more likely to select equine or food animal, rather than small animal practice, compared to students of the Feeling preference. There were additional significant associations regarding MBTI preferences and career interests. This study highlights the diversity of veterinary students, and provides an opportunity for educators to potentially expand their teaching methods and career guidance resources to better reach students of all MBTI preferences.

An Exploration of the Relationship between Psychological Capital and Depression among First-Year Doctor of Veterinary Medicine Students.

This study examined the impact of psychological capital on depressive symptoms among Doctor of Veterinary Medicine (DVM) students (n=84) over their first two semesters of studies. Our results indicated elevated rates of depression in both the first and second semesters relative to published norms. Using the typology developed by Hafen, Reisbig, White, and Rush (2008), students were classified as either "adaptive" (i.e., improving depressive symptomatology from semester to semester) or "struggling" (i.e., worsening depressive symptomatology from semester to semester). All four components of psychological capital (i.e., self-esteem, optimism, hope, and resilience) were positively associated with adaptive response to depression. These results are significant, as the components of psychological capital can be learned and strengthened through deliberate interventions, providing tangible guidance for students, faculty, and health professionals in their efforts to improve student wellness.

Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada.

RATIONALE: Primary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system-level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges. AIMS AND OBJECTIVES: This study investigates the medical education experiences that influence FP's decisions about practice locations in Canada. METHODS: We conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach. RESULTS: FPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions. CONCLUSION: Medical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.

The relationship between regional medical campus enrollment and rates of matching to family medicine residency.

BACKGROUND: The Michael G. DeGroote School of Medicine expanded its medical education across three campus sites (Hamilton, Niagara Regional and Waterloo Regional) in 2007. Ensuring the efficacy and equivalency of the quality of training are important accreditation considerations in distributed medical education. In addition, given the social accountability mission implicit to distributed medical education, the proportion of learners at each campus that match to family medicine residency programs upon graduation is of particular interest. METHODS: By way of between campus comparisons of Canadian Residency Matching Service (CaRMS) match rates, this study investigates the family medicine match proportion of medical students from McMaster's three medical education campuses. These analyses are further supported by between campus comparisons of Personal Progress Index (PPI), Objective Structured Clinical Examination (OSCE), Medical Council of Canada Qualifying Examination-Part 1 (MCCQE1) performances that offer insight into the equivalency and efficacy of the educational outcomes at each campus. RESULTS: The Niagara Regional Campus (NRC) demonstrated a significantly greater proportion of students matched to family medicine. With respect to education equivalency, the proportion of students' PPI scores that were more than two SD below the mean was comparable across campuses. OSCE analysis yielded less than 2% differences across campuses with no differences in the last year of training. The MCCQE1 pass rates were not statistically significant between campuses and there were no differences in CaRMS match rates. With respect to education efficacy, there were no differences among the three campuses' pass rates on the MCCQE1 and CaRMS match rates with the national rates. CONCLUSIONS: Students in all campuses received equivalent educational experiences and were efficacious when compared to national metrics, while residency matches to family medicine were greater in the NRC. The reasons for this difference may be a factor of resident and leadership role-models as well as the local hospital and community environment.

CONTEXTE: Le campus Michael G. DeGroote School of Medicine a élargi ses programmes pré-doctoraux sur trois campus (Hamilton, Niagara Regional, et Waterloo Regional) en 2007. Aux fins de l'agrément, il est important de s'assurer de l'efficacité et de l'équivalence dans la qualité des formations dans les programmes décentralisés. De plus, vu la mission de responsabilité sociale implicite à l'éducation médicale décentralisée, la proportion de gradués jumelés à un programme de résidence en médecine familiale sur chaque campus est d'un intérêt certain. MÉTHODES: En comparant les taux de jumelage du Service canadien de jumelage des résidents (CaRMS) des différents campus, cette étude analyse la proportion des jumelages en médecine familiale des étudiants des des trois campus de l'Université McMaster offrant un programme de formation en médecine. Ces analyses s'appuient aussi sur les comparaisons entre ces trois campus de l'indice de progrès personnel (PPI), de l'examen clinique objectif structuré (ECOS), de l'examen d'aptitude du Conseil médical du Canada, partie I (EACMC1) qui offrent un aperçu de l'équivalence et de l'efficacité des résultats d'apprentissage à chacun de ces campus. RÉSULTATS: Le Campus de la région de Niagara (NRC) a compté une plus grande proportion d'étudiants jumelés en médecine familiale. Pour ce qui est de l'équivalence des formations, la proportion des scores PPI se trouvant à deux écarts-types sous la moyenne était comparable sur les trois campus. L'ECOS a obtenu des différences de moins de 2 % entre les campus, mais aucune dans la dernière année de formation. Les taux de réussite à l'EACMC1 de chaque campus ne présentaient pas de différence significative, et aucune différence n'a été notée dans les taux de jumelage du CaRMS. Quant à l'efficacité de la formation, il n'y a eu aucune différence entre les taux de réussite aux trois campus obtenus à l'EACMC1 et entre les taux de jumelage du CaRMS et les taux nationaux. CONCLUSIONS: Les étudiants des trois campus ont vécu des expériences d'apprentissage équivalentes et ils se sont avérés compétents lorsque comparés aux mesures nationales. Cependant, les jumelages de résidence en médecine familiale étaient plus nombreux sur le campus de la région de Niagara. On pourrait imputer cette différence aux modèles de rôle des résidents et dirigeants ainsi qu'à l'hôpital régional et au milieu communautaire.