Professional identity formation: linking meaning to well-being.

Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.

Anticoagulation management: an interdisciplinary curriculum for family medicine residents.

Anticoagulants are high-risk medications with the potential to cause significant patient harm if inappropriately managed. Medical trainees and practicing physicians often report inadequate education and uncertainty in decision-making related to anticoagulation therapy. To address this gap, an interdisciplinary Anticoagulation Management Training Program was developed for family medicine residents at the Toronto Western Family Health Team. Evaluation data demonstrated both improved knowledge and confidence in prescribing, monitoring, and adjusting anticoagulation therapy. This suggests that similar dedicated curricula be considered in other family medicine programs in order to optimize patient safety by enhancing the knowledge and self-efficacy of future practising physicians.

Les anticoagulants sont des médicaments à haut risque qui, mal gérés, peuvent causer des dommages importants aux patients. De nombreux étudiants en médecine et médecins en exercice déclarent que leur formation est inadéquate et qu'ils ont des doutes lorsqu'ils prescrivent un traitement anticoagulant. Pour combler cette lacune, une formation interdisciplinaire en gestion des anticoagulants a été élaborée pour les résidents en médecine familiale au sein de la Toronto Western Family Health Team. Les données d'évaluation de la formation indiquent une amélioration sur le plan des connaissances et de la confiance lors de la prescription, ainsi que sur celui du suivi et de l'ajustement de l'anticoagulothérapie. Ces résultats suggèrent qu'il serait donc pertinent d'envisager l'introduction de formations spécialisées de ce type dans les programmes de médecine familiale pour mieux assurer la sécurité des patients par le développement des connaissances et de l'auto-efficacité des futurs praticiens.

Can Teachers Distinguish Competencies From Entrustable Professional Activities?

INTRODUCTION: There has been a recent transition from the use of "competencies" to "entrustable professional activities" (EPAs) in medical education assessment paradigms. Although this transition proceeds apace, few studies have examined these concepts in a practical context. Our study sought to examine how distinct the concepts of competencies and EPAs were to front-line clinical educators. METHODS: A 20-item survey tool was developed based on the University of Calgary Department of Family Medicine's publicly available lists of competencies and EPAs. This tool required participants to identify given items as either a competency or an EPA, after reading a description of each. The tool was administered to a convenience sample of consenting clinical educators at 5 of the 14 training sites at the University of Toronto Department of Family and Community Medicine in 2018. We also collected information on years in practice, hours spent supervising per week, and direct involvement in medical education. RESULTS: We analyzed a total of 60 surveys. The mean rate of correct responses was 45.3% (+/- 21.8%). Subgroup analysis failed to reveal any correlation between any of the secondary characteristics and correct responses. CONCLUSION: Clinical educators in our study were not able to distinguish between competencies and EPAs. Further research is recommended prior to intensive curricular changes.

Instruction using a high-fidelity cardiopulmonary simulator improves examination skills and resource allocation in family medicine trainees.

INTRODUCTION: High-fidelity cardiopulmonary simulators have proven promising in various areas of medical education but have yet to be studied in Family Medicine training. METHODS: A 2-hour curriculum, combining didactic and simulator exposure, and addressing common valvular pathologies, was offered to post-graduate year 1 and 2 Family Medicine residents. Residents' abilities to describe and diagnose four simulated murmurs were assessed before the teaching sessions and 2 to 4 weeks after. Confidence in physical examination skills, as well as the use of echocardiography, was also measured. RESULTS: Twenty residents participated. Mean composite murmur description scores improved in 95% of residents (P < 0.001), as did mean diagnostic accuracy (from 43.8% to 85.0%; P < 0.001). For pathologic murmurs, the number of echocardiograms recommended did not change, whereas for the nonpathologic murmur, 16 residents who recommended echocardiography presession no longer did postsession (P < 0.001). Mean confidence significantly increased (P < 0.001). The mean satisfaction score for the session was 4.9/5, and all residents recommended that the session be repeated in future years. CONCLUSION: A didactic and simulator-based session is very well received by Family Medicine residents. It significantly improves description and diagnosis of murmurs and reduces unnecessary echocardiogram use without affecting appropriate use.

The informational needs of newly diagnosed cervical cancer patients who will be receiving combined chemoradiation treatment.

BACKGROUND: Cervical cancer patients experience a range of psychosocial sequelae, secondary to both disease and treatment (1, 2). Prevalence studies estimate that in the first 3 months following a gynecological cancer diagnosis, 47-70% of women experience symptoms of sufficient severity to merit a diagnosis of moderate/severe depression or anxiety (3, 4). Psycho-educational interventions appear to help in this regard (5). Consequently, Princess Margaret Hospital is initiating a psycho-educational group for newly diagnosed cervical cancer patients who will be receiving combined chemoradiation. PURPOSE: To offer the most effective program possible, this study aimed to define patients' informational preferences. METHOD: A retrospective needs assessment was conducted, involving women (n = 14) who had completed combined chemoradiation for a new cervical cancer diagnosis in the past 5 years. Patients were interviewed using a new measure based on previous literature (6, 7), which included both open-ended and Likert-type questions spanning a variety of topics. RESULTS: Analyses revealed treatment-related information to be most important to these women, with practical, emotional/social and sexual issues rated as somewhat less important. Further, the vast majority of patients stated that having the information they wanted when they were preparing for treatment would have reduced anxiety or stress, enhanced quality of life, and improved treatment and side effect management. Thus, the study's results will guide development of the psycho-educational group, employing an evidence-based approach to ameliorate patient care.