Impact of a professional development session based on learner evaluations within a preceptor community of practice.

BACKGROUND: Physician preceptors play key roles in teaching medical professional trainees but receive little formal teacher training. One proposed way to improve teaching is by providing preceptors with learner feedback. The feedback from learner evaluations often has a limited impact with changes to teaching practice difficult to implement. This study explores the effect of using learner feedback to create a professional development session on teaching within a preceptor community of practice. METHODS: In this case study, 15 preceptors agreed to release their learner evaluations, and ten participated in the professional development session. Immediately and 2-3 months after the session, participants completed surveys on their intention to change and the changes made. The community of practice lead was interviewed to discuss the professional development session's impact. Qualitative approaches were used to analyze the data. RESULTS: From the learner evaluations, nine areas of improvement were identified and discussed. All attendees made changes to their teaching practices, which the community of practice lead confirmed. Fewer changes were identified at the community of practice group level. CONCLUSION: Using learner evaluations to structure a professional development session within a community of practice can help identify areas of improvement and create strategies to address these challenges.

A Novel, Combined Student and Preceptor Professional Development Session for Optimizing Feedback: Protocol for a Multimethod, Multisite, and Multiyear Intervention.

BACKGROUND: Providing feedback to medical learners is a critical educational activity. Despite the recognition of its importance, most research has focused on training preceptors to give feedback, which neglects the role of learners in receiving feedback. Delivering a combined professional development session for both preceptors and students may facilitate more effective feedback communication and improve both the quality and quantity of feedback. OBJECTIVE: The objective of our research project is to examine the impact of a relational feedback intervention on both preceptors and students during a longitudinal integrated clerkship. METHODS: Students and preceptors will attend a 2.5-hour combined professional development session, wherein they will be provided with educational tools for giving and receiving feedback within a coaching relationship and practice feedback giving and receiving skills together. Before the combined professional development session, students will be asked to participate in a 1-hour preparation session that will provide an orientation on their role in receiving feedback and their participation in the combined professional development session. Students and preceptors will be asked to complete a precombined professional development session survey and an immediate postcombined professional development session survey. Preceptors will be asked to complete a follow-up assessment survey, and students will be asked to participate in a follow-up, student-only focus group. Anonymized clinical faculty teaching evaluations and longitudinal integrated clerkship program evaluations will also be used to assess the impact of the intervention. RESULTS: As of March 1, 2022, a total of 66 preceptors and 29 students have completed the baseline and follow-up measures. Data collection is expected to conclude in December 2023. CONCLUSIONS: Our study is designed to contribute to the literature on the feedback process between preceptors and students within a clinical setting. Including both the preceptors and the students in the same session will improve on the work that has already been conducted in this area, as the students and preceptors can further develop their relationships and coconstruct feedback conversations. We will use social learning theory to interpret the results of our study, which will help us explain the results and potentially make the work generalizable to other fields. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32829.

Currencies of recognition: What rewards and recognition do Canadian distributed medical education preceptors value?

Background: Medical schools spend considerable time, effort, and money on recognition initiatives for rural and distributed medical education (DME) faculty. Previous literature has focused on intrinsic motivation to teach and there is little in the literature to guide institutional recognition efforts or to predict which items or types of recognition will be most appreciated. Methods: To better understand how rural and DME faculty in Canada value different forms of recognition, we asked faculty members from all Canadian medical schools to complete a bilingual, national online survey evaluating their perceptions of currently offered rewards and recognition. The survey received a robust response in both English and French, across nine Canadian provinces and one territory. Results: Our results indicated that there were three distinct ways that preceptors looked at recognition; these perspectives were consistent across geographic and demographic variables. These "clusters" or "currencies of recognition" included: i) Formal institutional recognition, ii) connections, growth and development, and iii) tokens of gratitude. Financial recognition was also found to be important but separate from the three clusters. Some preceptors did value support of intrinsic motivation most important, and for others extrinsic motivators, or a mix of both was most valued. Conclusions: Study results will help medical schools make effective choices in efforts to find impactful ways to recognize rural and DME faculty.

A model for faculty engagement in distributed medical education: Crafting a paddle.

Distributed medical education initiatives are now a key component of all Canadian medical schools. The success of these initiatives requires engaged community-based faculty who are able to successfully balance both their clinical and educational responsibilities. Present understanding of faculty engagement within distributed medical education is limited. Faculty engagement is a complex and multifaceted construct that includes a reciprocal relationship between a Faculty of Medicine and their faculty. Clarification of both the extrinsic and intrinsic motivators of distributed faculty provide opportunities for Faculties of Medicine to more fully engage their faculty and sustain distributed medical education programs.

Patient satisfaction with care for urgent health problems: a survey of family practice patients.

PURPOSE: Patient satisfaction is an important health care outcome. This study compared patients' satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services. METHODS: We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied). RESULTS: The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8-6.4) compared with all other services (all P <.004, adjusted for multiple comparisons), with the exception of patients who used the after-hours clinic affiliated with their physician, whose satisfaction was not significantly different (mean 5.6; 95% CI, 5.2-6.0). CONCLUSIONS: Satisfaction was highest for patients receiving care from their own family physician or their physician's after-hours clinic. These results are important for new primary care models that emphasize continuity and after-hours availability of family physicians.

Big cities and bright lights: rural- and northern-trained physicians in urban practice.

INTRODUCTION: Rural medical education is increasing in popularity in Canada. This study examines why some family physicians who completed their residency training in northern Ontario decided to practise in urban centres. METHODS: We used a qualitative research method. We interviewed 14 graduates of the Family Medicine North program and the Northeastern Ontario Family Medicine program. The interview transcripts were content-analyzed. RESULTS: There were different pathways leading to urban practice. While some pathways were straightforward, others were more complicated. Most participants offered multiple reasons for choosing to work in urban areas, suggesting that the decision-making processes could be quite complex. Family and personal factors were most frequently mentioned as reasons for choosing the urban option. The needs of the spouse and the children were especially important. Most of the participants had no plans to return to rural medical practice, but even these physicians retained some vestiges of rural practice. CONCLUSION: Most Canadian medical schools now offer some rural medical training opportunities. The findings of this study provide some useful insights that could help medical educators and decision-makers know what to expect and understand how practice location decisions are made by doctors.

Graduates of northern Ontario family medicine residency programs practise where they train.

OBJECTIVE: To examine where graduates of the Northeastern Ontario Family Medicine (NOFM) residency program in Sudbury and the Family Medicine North (FMN) program in Thunder Bay practise after graduation, using cross-sectional and longitudinal analyses. METHODS: Data from the Scott's Medical Database were examined. All physicians who graduated from NOFM and FMN between 1993 and 2002 were included in this analysis. Differences in the location of first practice between NOFM and FMN graduates were tested using chi-squared tests. Logistic regression analyses were used to examine the impact of the training program on a physician's first, as well as continuing, practice location. RESULTS: Between 1993 and 2002, FMN graduates were 4.56 times more likely (95% confidence interval [CI] 2.34-8.90) to practise in rural areas, compared with NOFM graduates, but NOFM graduates were 2.50 times more likely than FMN graduates (95% CI 1.35-4.76) to practise in northern Ontario. There was no statistically significant difference between the graduates of the 2 programs in the likelihood of working in either northern Ontario or a rural area. About two-thirds (67.5%) of all person-years of medical practice provided by NOFM and FMN graduates took place in northern Ontario or rural areas outside the north. CONCLUSION: NOFM and FMN have been successful in producing family physicians to work in northern Ontario and rural areas. Results from this study add to the growing evidence from Canada and abroad that rural or northern medical education and training increases the likelihood that the graduates will practise in rural or northern communities.

Does a one-day workshop improve clinical faculty's comfort and behaviour in practising and teaching evidence-based medicine? A Canadian mixed methods study.

OBJECTIVE: The purpose of this study was to determine the impact of a 1-day evidence-based medicine (EBM) workshop on physician attitudes and behaviours around teaching and practicing EBM. DESIGN: A mixed methods study using a before/after cohort. SETTING: A medical school delivering continuing professional development to 1250 clinical faculty over a large geographic area in Canada. PARTICIPANTS: 105 physician clinical faculty members. INTERVENTION: A 1-day workshop presented at 11 different sites over an 18-month period focusing on EBM skills for teaching and clinical practice. OUTCOME MEASURES: (1) A quantitative survey administered immediately before and after the workshop, and 3-6 months later, to assess the hypothesis that comfort with teaching and practising EBM can be improved.(2) A qualitative survey of the expectations for, and impact of the workshop on, participant behaviours and attitudes using a combination of pre, post and 3 to 6-month follow-up questionnaires, and telephone interviews completed 10-14 months after the workshop. RESULTS: Physician comfort with their EBM clinical skills improved on average by 0.93 points on a 5-point Likert scale, and comfort with EBM teaching skills by 0.97 points (p values 0.001). Most of this improvement was sustained 3-6 months later. Three to fourteen months after the workshop, half of responding participants reported that they were using the Population Intervention Comparator Outcome (PICO) methodology of question framing for teaching, clinical practice or both. CONCLUSIONS: Comfort in teaching and practicing EBM can be improved by a 1-day workshop, with most of this improvement sustained 3-6 months later. PICO question framing can be learnt at a 1-day workshop, and is associated with a self-reported change in clinical and teaching practice 3-14 months later. This represents both level 2 (attitudes) and level 3 (behaviours) change using the Kirkpatrick model of evaluation.

Emergency Department and Walk-in Clinic Use in Models of Primary Care Practice with Different After-Hours Accessibility in Ontario.

INTRODUCTION: New models of primary healthcare delivery recently implemented in Ontario are designed to improve after-hours accessibility. This study examined whether the six-month prevalence of emergency department and walk-in clinic use differed among patients of eight Family Health Network (FHN), 16 Family Health Group (FHG) and 12 fee-for-service (FFS) physicians in one city. METHODS: Patients over one year of age who had visited their family doctor in the previous 12 months (n=9,373) were randomly selected from computerized records. A mailed survey asked about urgent health problems in the previous six months and use of health services for those problems. A generalized estimating equation approach was used to compare the proportions of patients using the emergency department and walk-in clinic in the FHN versus other practice types, adjusting for clustering of patients within practices. Multiple imputation was used to impute data for non-respondents and missing items on the surveys. RESULTS: The response rate was 62.3% (5,884/9,373). Six-month prevalence of emergency department use was 11.4% (199/1,753) among the FHN practices, 15.7% (347/2,236) among the FHG practices (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.21-1.80) and 14.3% (252/1,779) among the FFS practices (OR=1.33; 95% CI=1.12-1.59). Six-month prevalence of walk-in clinic use was 1.7% (30/1,723) among the FHN practices versus 1.9% (41/2,236) in the FHG practices (OR=1.07; 95% CI=0.68-1.68) and 3.4% (59/1,779) among the FFS practices (OR=2.08; 95% CI=1.41-3.08). The statistical significance of results was unchanged using multiple imputation. CONCLUSIONS: Patients' use of the emergency department and walk-in clinics differs across primary care practice models with different after-hours accessibility arrangements and incentives.

Learning procedural skills in family medicine residency: comparison of rural and urban programs.

OBJECTIVE: To determine whether family medicine residents graduating from rural programs assess themselves as more experienced and competent in a range of procedural skills than graduates of urban programs do. DESIGN: Self-administered written survey. SETTING: Ontario. PARTICIPANTS: Residents from 5 Ontario family medicine programs in 2000 and 2001; a total of 535 surveys were available for analysis (response rate of 78%). MAIN OUTCOME MEASURES: Mean self-assessed experience and competence scores for 53 procedures at residency entry, end of year 1, and graduation. RESULTS: Upon entry, there was no difference in mean procedural experience (2.89 vs 2.85, P = .54) or mean competence (2.34 vs 2.36, P = .88) scores between rural residents and their urban counterparts. There was a significant increase in procedural experience (P < .001) and competence (P < .001) scores during residency training. At graduation, mean experience (3.98 vs 3.70, P < .001) and competence (3.67 vs 3.39, P = .004) scores were significantly higher for rural residents than for their urban colleagues. A statistically larger proportion of residents graduating from rural programs assessed themselves as competent in 16 procedures. These included skills necessary for treating patients in emergency settings (establish intravenous lines for adults and infants, obtain arterial blood gas measurements, intubate adults and neonates, perform cautery for epistaxis, remove corneal foreign body, aspirate or inject knee and shoulder joints, and apply forearm or walking casts), for diagnostic procedures (endometrial biopsy and bone marrow aspiration), and for management of labour and delivery (vaginal delivery; vacuum extraction; and repair of first-, second-, and third-degree tears). CONCLUSION: Graduates of rural programs who have had a substantial component of training in communities of fewer than 10,000 people report greater self-assessed experience and competence in procedural skills than graduates of urban programs do. The difference likely reflects the unique aspects of rural training sites, including preceptors' competence in performing procedures.

Duration of rural training during residency: rural family physicians prefer 6 months.

OBJECTIVE: To determine whether rural family physicians thought they had received enough months of rural exposure during family medicine residency, how many months of rural exposure those who were satisfied with their training had had, and how many months of rural exposure those who were not satisfied with their training wanted. DESIGN: Mailed survey. SETTING: Rural Canada. PARTICIPANTS: Rural family physicians who had graduated between 1991 and 2000 from a Canadian medical school. MAIN OUTCOME MEASURES: Respondents' opinions about whether their exposure to rural medicine during training had been adequate. RESULTS: Response rate was 59% (382/651). After excluding physicians who had not had Canadian family medicine residency training, 348 physicians remained, and of those, 58% thought they had had adequate rural exposure during residency. Median duration of rural training among those who thought they had had enough rural exposure was 6 months; median duration of rural exposure among those who thought they had not had enough was 2 months. Median duration of rural exposure desired by those who thought they had not had enough rural training was 6 months. Some physicians wanted much more than 6 months of rural training; for example, one quarter of those satisfied with their rural training had had 10 or more months of rural rotations. Fewer than 1% of respondents thought they had received too much rural training. There was no significant difference in number of months of rural training preferred by men and women (P = .94). One third of respondents had graduated from rural-focused family practice residency programs. Rural program graduates were more likely than non-rural program graduates to report that the duration of their rural training was adequate (84% vs 46%, P < .0001) and to report more mean months of rural exposure (8.9 vs 3.4; P < .0001). CONCLUSION: Typical rural family physicians prefer to have 6 months of rural exposure during residency. This finding is consistent with the recommendation of a College of Family Physicians of Canada committee that rural family medicine training programs offer at least 6 months of rural rotations. Almost half of rural family physicians wished they had had more rural training. Both rural-focused and non-rural-focused programs should consider providing opportunities for pursuing elective rotations in rural areas in addition to mandatory rotations if they want to respond to these preferences for training.

Factors influencing family physicians to enter rural practice: does rural or urban background make a difference?

OBJECTIVE: To examine where rural physicians grew up, when during their training they became interested in rural medicine, factors influencing their decision to practise rural medicine, and differences in these measures according to rural or urban upbringing. DESIGN: Mailed survey. SETTING: Rural Canada. PARTICIPANTS: Rural family physicians who graduated between 1991 and 2000 from a Canadian medical school. MAIN OUTCOME MEASURES: Backgrounds of recently graduated rural physicians, when physicians first became interested in rural practice during training, and most influential factors in decisions to practise rural medicine. RESULTS: Response rate was 59% (382/651). About 33% of rural physicians grew up in communities of less than 10 000 people, 44% in cities of 10 000 to 499 999 people, and 23% in cities of more than 500 000 people. Physicians raised in rural areas were more likely than those raised in urban areas to have some interest in rural family practice at the start and end of medical school (90% vs 67% at the start, 98% vs 91% at the end, respectively, P < .0001). Physicians raised in urban areas were more likely to state that rural medical training was the most influential factor in their choice of rural practice (19% vs 9%, P = .015). Other factors cited as influential were the challenge of rural practice (24% for both urban and rural upbringing), rural lifestyle (14% for urban and 18% for rural upbringing) and, for physicians raised in rural areas, having grown up or spent time in a rural area (27% for rural and 4.1% for urban upbringing, P < .001). Financial incentives were least frequently cited as the most influential factor (7.5% for urban and 4.9% for rural upbringing, P = .35). CONCLUSION: Although other studies have suggested that physicians with a rural upbringing are more likely to practise rural medicine and policy makers might still wish to target students raised in rural areas as candidates for rural medicine, this study shows that physicians raised in urban areas remain the main source of human resources for rural communities. They account for two thirds of new physicians in rural areas. Education in rural medicine during medical training has a stronger influence on physicians raised in urban areas than on physicians raised in rural areas. Undergraduate and postgraduate training periods, therefore, offer an important opportunity for recruiting physicians raised in urban areas to rural practice.