A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities.

OBJECTIVES: The COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises. METHODS: Using Walt & Gilson's Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response. RESULTS: Available documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration. CONCLUSION: The pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.

RéSUMé: OBJECTIFS: La pandémie et la riposte au COVID-19 ont mis en évidence les forces existantes au sein du système de soins pour les populations urbaines mal desservies, mais aussi de nombreuses faillites, en particulier lors des transitions de soins. Les objectifs de cette étude étaient de décrire les politiques de réponse au COVID-19 pour les populations urbaines mal desservies dans trois villes canadiennes; examiner l'impact de ces politiques sur la continuité des soins pour les populations urbaines mal desservies; déterminer si et comment les membres de la communauté urbaine mal desservie ont été impliqués dans les processus politiques; et développer des recommandations politiques et opérationnelles pour optimiser la continuité des soins pour les populations urbaines mal desservies pendant les crises de santé publique. MéTHODES: Utilisant le cadre Policy Triangle de Walt et Gilson comme guide conceptuel, 237 documents politiques et des médias ont été récupérés. Cinq séances d'entrevues de groupe virtuelles complémentaires ont été organisées avec 22 informateurs clés de première ligne et d'expérience vécue pour saisir des réponses et des expériences politiques moins bien documentées. Les documents et les transcriptions des entrevues ont été analysés de manière inductive pour le contenu politique, le contexte, les acteurs et les processus impliqués dans la riposte à la pandémie. RéSULTATS: Les documents disponibles suggèrent que l'accent est peu mis sur la continuité des soins pour les populations urbaines mal desservies pendant la pandémie, malgré les mesures de santé publique ayant des impacts négatifs disproportionnés sur leurs soins. Les réponses politiques étaient en grande partie réactives et temporaires, et les membres de la communauté étaient rarement impliqués. Cependant, un certain nombre d'initiatives communautaires ont été élaborées en réponse aux lacunes des politiques. Des pratiques prometteuses ont émergé, y compris des exemples de nouvelles collaborations multiniveaux et multisectorielles. CONCLUSION: La réponse à la pandémie a révélé des inégalités pour les populations urbaines mal desservies qui subissent des transitions de soins, mais elle a également exposé les forces du système et les possibilités d'amélioration pour éclairer l'orientation future des politiques.

Patient values and preferences on polypharmacy and deprescribing: a scoping review.

Background Understanding how patient values and preferences towards polypharmacy and deprescribing have been studied is important to gain insight on current knowledge in this area and to identify knowledge gaps. Aim To describe methods and outcomes for studying patient values and preferences towards polypharmacy and deprescribing, and to identify gaps in the existing literature. Method A scoping review was conducted on English-language studies that examined patient preferences and values related to polypharmacy and/or deprescribing among community-dwelling adults. MEDLINE, Embase, PubMed, PsycINFO, EconLit, Social Science Citation Index, Science Citation Index Expanded, International Pharmaceutical Abstracts, and CINAHL/AgeLine were searched. Results Thirty articles were included. Surveys (n = 17, 56.7%), interviews/focus groups (n = 9, 30.0%), and mixed methods (n = 3, 10.0%), were commonly used methods. Patients Attitudes Towards Deprescribing (PATD) was the most common tool used (n = 9, 30.0%). Twelve themes related to attitudes, social pressure, and control of polypharmacy/deprescribing were identified. The most frequently-encountered themes included desire or willingness to reduce medication load and influence of healthcare provider on medication use. Conclusion PATD was commonly used to assess preferences and values towards polypharmacy and limited knowledge on patient-important outcomes were addressed. Future research should focus on shared decision-making and communicating risk versus benefit of medications.

Field note use in family medicine residency training: learning needs revealed or avoided?

BACKGROUND: Field notes (FNs) are used in Family Medicine residency programs to foster reflective learning and facilitate formative assessment. Residents assess their strengths and weaknesses and develop action plans for further improvement. This study explored the use of FNs in the University of Manitoba's Family Medicine residency program 5 years after their implementation. METHODS: This multi-method study examined 520 FNs from 16 recent graduates from the University of Manitoba Family Medicine residency program. Quantitative analysis (frequencies and means) enabled descriptions and comparisons between training sites. Four themes emerged from inductive content analysis highlighting common ideas reflected upon. RESULTS: Residents displayed cyclical variation in the FN generation over 2 years. Eight of the 99 Priority Topics (addressing complex psychosocial issues) were not captured in this data set. The domains of Care of First Nations, Inuit, and Metis; Care of the Vulnerable and Underserved; and Behavioural Medicine and the CanMEDS-FM roles of FM - Procedural Skill, Leader/Manager, and Professional were less frequently reflected upon. Four themes (Patient-Centered Care, Patient Safety, Achieving Balance, and Confidence) were identified from qualitative analysis of residents' narrative notes. CONCLUSIONS: Vygotsky's Sociocultural Theory of Cognitive Development was proposed as a lens through which to examine factors influencing resident learning. Residents' discomfort with certain topics may lead to avoidance in reflecting upon certain competencies in FNs, impacting skill acquisition. Further research should explore factors influencing residents' perceptions FNs and how to best assist residents in becoming competent, confident practitioners.

Preparing teachers for competency-based medical education: Fundamental teaching activities.

INTRODUCTION: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers. METHODS: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development. RESULTS: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools. CONCLUSIONS: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.