Listening to Cancer Patients' Narratives During Residency: A Pilot Study on a Communication Skills' Workshop Involving Patients-Partners.

The field of cancer care still lacks best practices in communication. Few postgraduate training programs offer formal training to develop such skills. The patient partnership has been used in medical education to increase the sensitivity of the subjective experiences of patients. In our Canadian center, residents and patient-partners participated in an educational workshop on communication focusing on patient's narrative. The aim of this pilot qualitative study was to explore the experiences of participants in the workshop. Using theoretical sampling, we recruited 6 residents and 6 patient-partners. Semi-structured interviews were conducted and transcribed. A thematic analysis was performed. From analysis, 4 themes emerged: (1) lack of communication skills training; (2) barriers to effective communication in cancer care; (3) the empathy of patient-partners towards the communication challenges faced by residents; and (4) the participants' reactions to the workshop. Based on our findings, our communication skills workshop centered on narrative medicine and involving patient-partners appears feasible. Future research could study its pedagogical value and the optimal learning environment required.

Changing relationships: how does patient involvement transform professional identity? An ethnographic study.

OBJECTIVES: To understand identity tensions experienced by health professionals when patient partners join a quality improvement committee. DESIGN: Qualitative ethnographic study based on participatory observation. SETTING: An interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership. PARTICIPANTS: Two patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team. DATA COLLECTION: Data collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019. DATA ANALYSIS: Ghadiri's identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0). RESULTS: All professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the 'caregiver-patient' relationship into a 'colleague-colleague' relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the 'good professional', challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague. CONCLUSION: This research provides a new perspective on understanding how working in partnership with patients transform health professionals' identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals' resistance to working with patients, patients' status and remuneration, professionals' concerns toward patient 'representativeness'). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

Assessing and promoting partnership between patients and health-care professionals: Co-construction of the CADICEE tool for patients and their relatives.

CONTEXT: Partnership between patients and health-care professionals (HCPs) is a concept that needs a valid, practical measure to facilitate its use by patients and HCPs. OBJECTIVE: To co-construct a tool for measuring the degree of partnership between patients and HCPs. DESIGN: The CADICEE tool was developed in four steps: (1) generate key dimensions of patient partnership in clinical care; (2) co-construct the tool; (3) assess face and content validity from patients' and HCPs' viewpoints; and (4) assess the usability of the tool and explore its measurement performance. RESULTS: The CADICEE tool comprises 24 items under 7 dimensions: 1) relationship of Confidence or trust between the patient and the HCPs; 2) patient Autonomy; 3) patient participation in Decisions related to care; 4) shared Information on patient health status or care; 5) patient personal Context; 6) Empathy; and 7) recognition of Expertise. Assessment of the tool's usability and measurement performance showed, in a convenience sample of 246 patients and relatives, high face validity, acceptability and relevance for both patients and HCPs, as well as good construct validity. CONCLUSIONS: The CADICEE tool is developed in co-construction with patients to evaluate the degree of partnership in care desired by patients in their relationship with HCPs. The tool can be used in various clinical contexts and in different health-care settings. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in determining the importance of constructing this questionnaire. They co-constructed it, pre-tested it and were part of the entire questionnaire development process. Three patients participated in the writing of the article.

Perceptions of Emergency Medicine Residents of Multisource Feedback: Different, Relevant, and Useful Information.

STUDY OBJECTIVE: Multisource feedback is a process through which different members of the care team assess and provide feedback on residents' competencies, usually those that are less often addressed by traditional assessment methods (ie, communication, collaboration, and professionalism). Feasibility and reliability of multisource feedback have been addressed in previous research. The present study explores emergency residents' perceptions of multisource feedback provided by teaching physicians, nurses, and patients they have worked with during a rotation in an emergency department (ED). METHODS: A multisource feedback intervention was proposed to residents during 9 months in the ED of a tertiary care university hospital. Residents distributed feedback questionnaires to physicians, nurses, and patients that focused on competencies (collaboration, communication, and professionalism) from the CanMEDS framework. Responses were compiled and reported to participating residents. To assess residents' perceptions of multisource feedback, semistructured group and individual interviews were held 3 months after the intervention. Transcripts were analyzed qualitatively, following Miles and Huberman's method for intrasite case analysis. RESULTS: According to residents (n=10), each source (physicians, nurses, and patients) provided relevant comments that differed significantly in their content. Physicians focused primarily on medical expertise; nurses addressed competencies related to leadership, collaboration, and communication; and patients commented on the competencies of professionalism and communication. Residents concluded that obtaining feedback from nurses and patients was acceptable and useful. They reported modifying certain behaviors after receiving the multisource feedback. CONCLUSION: Residents perceived the multisource feedback to be acceptable and useful for the assessment of medical competencies such as communication, collaboration, professionalism, and leadership.

What Do Clinical Supervisors Require to Teach Residents in Family Medicine How to Care for Seniors?

We assessed clinicians' continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

[Mental health in primary care: applying psychiatric knowledge to primary care or a whole different practice?] / Les médecins de famille et la santé mentale : une expertise en mal de reconnaissance ou une pratique différente de celle des psychiatres ?

BACKGROUND: In Canada and several other countries, large cohorts of patients who used to be followed in psychiatric clinics are now steered toward primary care. To support this new reality, measures have been taken and investments made in service organization, collaborative work arrangements, and teaching geared toward primary care clinicians. However, these initiatives were implemented when little was known about GPs' needs. METHODS: Using a qualitative approach, we analyzed the content of GPs' statements to explore when, why, and for what concerns GPs are inclined to collaborate with or seek advice from psychiatrists. RESULTS: The results provide an innovative understanding of their practice and its boundaries and suggest that the management of patients with mental health problems in primary care is actually very different from what is done in psychiatry. CONCLUSION: Uncertainty about the broad spectrum of what is normal, the longitudinal aspect of the relationship, and the proximity of the soma are among the specificities we found that could be helpful in organizing care and educating primary care clinicians and medical students more coherently and efficiently.

[THE APPLICATION OF AN INTEGRATED MODEL OF PARTNERSHIP- PATIENT IN THE PROFESSIONALS OF THE HEALTH TRAINING: TOWARDS NEW ONE HUMANIST PARADIGM AND ETHICS OF CO-CONSTRUCTION KNOWLEDGES IN HEALTH]. / L'APPLICATION D'UN MODÈLE INTÉGRE DE PARTENARIAT-PATIENT DANS LA FORMATION DES PROFESSIONNELS DE LA SANTÉ: VERS UN NOUVEAU PARADIGME HUMANISTE ET ÉTHIQUE DE CO-CONSTRUCTION DES SAVOIRS EN SANTÉ.

This article presents the "Montreal model", offering the patient, if he wishes, to become a patient partner for all the decisions that concerns him. We are presently witnessing, presently, major transformations in western societies. Chronic diseases affect a growing proportion of the population, leading a transition from the ascendancy of acute care to an ascendancy of chronic care. Other societal factors such as the consumerism, the individualism, the democratization of the medical information (accelerated by the advent of Internet) and the casualization of a growing part of citizens influence this evolution. In this context, where the nature and the level of patients and their families needs are changing as their expectations towards healthcare systems, one of the promising ways to answer these stakes is a greater participation of patients in their own care. Since 2010, a new relational model, based on the partnership of care between patients and healthcare professionals, was developed in the medicine Faculty of the University of Montreal. This model leans on the recognition of the experiential knowledge of the patients in complementarity with the scientific knowledge of the healthcare professionals. It's the continuity of the participation and the engagement of patients which can be applied to the whole healthcare system, in individual or collective relationship in interdisciplinary. This model is presently in implementation phase in Quebec in the training of the healthcare professionals, in healthcare organisations, as well as in the medical education and in research.

[The Montreal model: the challenges of a partnership relationship between patients and healthcare professionals]. / Le <> : enjeux du partenariat relationnel entre patients et professionnels de la santé.

A promising approach to improve the population's health and the quality of care and services provided by the health system consists of patient engagement at all levels of the health system together with training of health professionals. Since 2010, a new rational model based on the partnership between patients and healthcare professionals has been developed at the University of Montreal's Faculty of Medicine. This patient partnership model is based on the recognition of the patient's experiential knowledge gained from living with a disease, which is complementary to the healthcare professional's scientific knowledge. This partnership is part of a continuum of patient engagement and can be applied in healthcare, professional training, education and research settings. This article describes the theoretical basisfor patient partnerships and how this new model can be implemented in clinical, organizational and systemic levels, as well as the success factors in both patients and healthcare professionals. The Montreal Model provides relevant outlooks for chronic disease management by making patients essential partners in all decisions affecting them and by treating them as experts in the organisation of care. This model should have a significant impact on the population's health by improving physical, psychological health, as well as the patient's well-being. As part of this new framework, several research programs are currently underway to evaluate the impact of this model.

Patients as partners: a qualitative study of patients' engagement in their health care.

To advocate for patients to be more actively involved with the healthcare services they receive, particularly patients living with chronic illness, the Faculty of Medicine of the University of Montreal and its affiliated hospitals developed the Patients as Partners concept where the patient is considered a full-fledged partner of the health care delivery team and the patient's experiential knowledge is recognized. This study aims to show how patients view their engagement with healthcare professionals regarding their direct care. Using theoretical sampling, 16 semi-structured interviews were conducted with patients with chronic illness who were familiar with the concept of Patients as Partners. Data analysis followed a constructivist grounded theory approach. Patients describe themselves as proactively engaging in three types of practice, regardless of health professionals' openness to their role as partners. The first is a process of continuous learning that allows them to acquire experiential knowledge about their health, as well as scientific information and technical know-how. The second involves their assessment of the healthcare they receive, in terms of its quality and how it aligns with their personal preferences. It includes their assessment of the quality of their relationship with the health professional and of the latter's scientific knowledge and technical know-how. The third type, adaptation practices, builds on patients' learning and assessments to compensate for and adapt to what has been perceived as optimal or non-optimal health or healthcare circumstances. Patients appear to play a more active and less docile role in their own direct care than suggested so far in the literature, regardless of the degree of reciprocity of the partnership or the degree to which the health professional seeks to encourage patient engagement.

The patient-as-partner approach in health care: a conceptual framework for a necessary transition.

The prevalence of chronic diseases today calls for new ways of working with patients to manage their care. Although patient-centered approaches have contributed to significant advances in care and to treatments that more fully respect patients' preferences, values, and personal experiences, the reality is that health care professionals still hold a monopoly on the role of healer. Patients live with their conditions every day and are experts when it comes to their own experiences of illness; this expertise should be welcomed, valued, and fostered by other members of the care team. The patient-as-partner approach embodies the ideal of making the patient a bona fide member of the health care team, a true partner in his or her care. Since 2010, the University of Montreal, through the Direction of Collaboration and Patient Partnership, has embraced this approach. Patients are not only active members of their own health care team but also are involved in research and provide valuable training to health sciences students. Including patients as full partners in the health care team entails a significant shift in both the medical practice and medical education cultures. In this perspective, the authors describe this innovative approach to patient care, including the conceptual framework used in its development and the main achievements of patient partners in education, health care, and research.

The future of medical education: a Canadian environmental scan.

OBJECTIVES: One hundred years after the Flexner report remade medical education in North America, many countries are reviewing the purpose and organisation of medical education. In Canada, a national study is being undertaken to define important issues and challenges for the future of medical education. The objectives of this paper are to describe the process of conducting an empirical environmental scan at a national level, and to present the research findings of this scan. METHODS: Thirty national key informant interviews were conducted, transcribed and coded to identify key themes. Interview data were triangulated with data sourced from 34 commissioned literature reviews and a series of national focus groups. RESULTS: Ten key issues or priorities were identified and used to generate detailed review papers used by the Association of Faculties of Medicine of Canada to create a blueprint for the evolution of medical education. The new priorities have major implications for areas ranging from admissions, curriculum content, educational process and the need to articulate the purpose and responsibilities of medical schools in society. DISCUSSION: This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries.