Evaluation of the Online Component of a Blended Learning Electroconvulsive Therapy Curriculum for Psychiatry Residents to Treat Depression in Older Adults.

OBJECTIVE: The objective of this study was to evaluate the online component of a blended curriculum for psychiatry residents on the use of electroconvulsive therapy (ECT) to treat depression in older adults. METHODS: Second- and third-year general psychiatry residents completed a blended learning curriculum during their core geriatric psychiatry rotation. The curriculum consisted of didactic seminars, hands-on clinical management, and two online clinical cases focused on the management of late-life depression with ECT. Knowledge acquisition following module completion was measured using a nine-question multiple-choice test. The authors adapted the Medical E-Learning Evaluation Survey (MEES) to measure resident satisfaction, clinical relevance, and instructional design. RESULTS: A total of 37 residents completed both online modules. Of these, 35 residents completed the knowledge test and 23 completed the adapted MEES. Almost all participants (96%) agreed or strongly agreed that the modules were relevant to their clinical work, evidence-based, able to be completed in a reasonable amount of time, and a valuable learning experience. The average score on the knowledge test, after removing one outlier, was 83%. CONCLUSION: Psychiatry residents are very satisfied with the content and delivery of the online component of a blended curriculum for understanding the use of ECT for late-life depression. Future work should examine satisfaction with the remainder of the curricula as well as the impact on longer-term knowledge acquisition and patient care.

Commentary on Barradell and Bell (2021)-applying a critical lens to the role of students as partners in health professions education: challenges, risks, and potential.

This commentary is a response to Barradell and Bell's (2021) qualitative research synthesis on the role of students as partners (SaP) in health professions education (HPE), which was recently published in Advances in Health Sciences Education. Through an exploration of some of the challenges and risks of SaP in HPE, the author argues that the uncritical application of SaP carries with it a risk of harm to students and faculty. The commentary ends with suggestions on how the potential of SaP in HPE might be better realized.

The McMaster Narrative Comment Rating Tool: Development and Initial Validity Evidence.

CONSTRUCT: The McMaster Narrative Comment Rating Tool aims to capture critical features reflecting the quality of written narrative comments provided in the medical education context: valence/tone of language, degree of correction versus reinforcement, specificity, actionability, and overall usefulness. BACKGROUND: Despite their role in competency-based medical education, not all narrative comments contribute meaningfully to the development of learners' competence. To develop solutions to mitigate this problem, robust measures of narrative comment quality are needed. While some tools exist, most were created in specialty-specific contexts, have focused on one or two features of feedback, or have focused on faculty perceptions of feedback, excluding learners from the validation process. In this study, we aimed to develop a detailed, broadly applicable narrative comment quality assessment tool that drew upon features of high-quality assessment and feedback and could be used by a variety of raters to inform future research, including applications related to automated analysis of narrative comment quality. APPROACH: In Phase 1, we used the literature to identify five critical features of feedback. We then developed rating scales for each of the features, and collected 670 competency-based assessments completed by first-year surgical residents in the first six-weeks of training. Residents were from nine different programs at a Canadian institution. In Phase 2, we randomly selected 50 assessments with written feedback from the dataset. Two education researchers used the scale to independently score the written comments and refine the rating tool. In Phase 3, 10 raters, including two medical education researchers, two medical students, two residents, two clinical faculty members, and two laypersons from the community, used the tool to independently and blindly rate written comments from another 50 randomly selected assessments from the dataset. We compared scores between and across rater pairs to assess reliability. FINDINGS: Single and average measures intraclass correlation (ICC) scores ranged from moderate to excellent (ICCs = .51-.83 and .91-.98) across all categories and rater pairs. All tool domains were significantly correlated (p's <.05), apart from valence, which was only significantly correlated with degree of correction versus reinforcement. CONCLUSION: Our findings suggest that the McMaster Narrative Comment Rating Tool can reliably be used by multiple raters, across a variety of rater types, and in different surgical contexts. As such, it has the potential to support faculty development initiatives on assessment and feedback, and may be used as a tool to conduct research on different assessment strategies, including automated analysis of narrative comments.

A Qualitative Investigation of Burnout and Well-being Among Faculty and Residents in a Canadian Psychiatry Department.

OBJECTIVE: This study used semi-structured interviews with faculty and residents in psychiatry to inform a qualitative, process-based understanding of well-being and related concepts, as well as to identify and critically explore strategies for maintaining well-being in psychiatry. METHODS: Using interpretive description as a qualitative research methodology, semi-structured phone interviews were conducted with 12 faculty (nine clinical and three non-clinical) and five residents in a Canadian psychiatry department between September and December 2019, prior to the onset of the COVID-19 pandemic. Interviews were transcribed, coded, and subsequently analyzed for themes by the research team. RESULTS: Fourteen women and three men completed the study, consisting of nine faculty members, five psychiatry residents, and three non-clinical PhD scientists. Four themes were developed from the interview data: (1) The nature of working in academic psychiatry, (2) professional identity as a double-edged sword, (3) feelings of isolation and powerlessness in the system, and (4) strategies to support well-being. CONCLUSION: In the absence of many qualitative perspectives on well-being in academic psychiatry, the findings of this study can be used as a first step to inform future interventions and meaningful institutional change around well-being in psychiatry. The findings may help to enable conversations about well-being that embrace humanity and vulnerability as essential components of professional identity in psychiatry and provide opportunities for open discussion and support.

Perspectives on mental health services for medical students at a Ugandan medical school.

BACKGROUND: University-based mental health services for medical students remain a challenge, particularly in low-income countries, due to poor service availability. Prior studies have explored the availability of mental health services in high-income countries but little is known about mental health services in countries in sub-Saharan Africa, such as Uganda. Medical students are at a higher risk of developing mental health challenges during their course of study as compared with other students. Thus, there is a need for well-structured mental health services for this group of students. The aim of this study was to explore perspectives on mental health services for medical students at a public University in Uganda. METHODS: This was a qualitative study where key informant interviews were conducted among purposively selected university administrators (n = 4), student leaders (n = 4), and mental health employees of the university (n = 3), three groups responsible for the mental well-being of medical students at a public university in Uganda. Interviews were audio-recorded, transcribed, and thematically analyzed to identify relevant themes. RESULTS: The working experience of university administrators and mental health providers was between eight months to 20 years, while student leaders had studied at the university for over four years. We identified five broad themes: (1) Burden of medical school: A curriculum of trauma, (2) Negative coping mechanisms and the problem of blame, (3) The promise of services: Mixed Messages, (4) A broken mental health system for students, and (5) Barriers to mental health services. CONCLUSION: Distinguishing between psychological distress that is anticipated because of the subject matter in learning medicine and identifying those students that are suffering from untreated psychiatric disorders is an important conceptual task for universities. This can be done through offering education about mental health and well-being for administrators, giving arm's length support for students, and a proactive, not reactive, approach to mental health. There is also a need to redesign the medical curriculum to change the medical education culture through pedagogical considerations of how trauma informs the learning and the mental health of students.

Patients' perspectives on the experience of absconding from a psychiatric hospital: a qualitative study.

BACKGROUND: Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients' perspectives on the experience of absconding from the psychiatry facility. METHODS: We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes. RESULTS: Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients' engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding. CONCLUSION: Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.

Competence committees: The steep climb from concept to implementation.

INTRODUCTION: Competence committees (CCs) are groups of educators tasked with reviewing resident progress throughout their training, making decisions regarding the achievement of Entrustable Professional Activities and recommendations regarding promotion and remediation. CCs have been mandated as part of competency-based medical education programmes worldwide; however, there has yet to be a thorough examination of the implementation challenges they face and how this impacts their functioning and decision-making processes. This study examined CC implementation at a Canadian institution, documenting the shared and unique challenges that CCs faced and overcame over a 3-year period. METHODS: This study consisted of three phases, which were conceptually and analytically linked using Moran-Ellis and colleagues' notion of 'following a thread.' Phase 1 examined the early perceptions and experiences of 30 key informants using a survey and semi-structured interviews. Phase 2 provided insight into CCs' operations through a survey sent to 35 CC chairs 1-year post-implementation. Phase 3 invited 20 CC members to participate in semi-structured interviews to follow up on initial themes 2 years post-implementation. Detailed observation notes from 16 CC meetings across nine disciplines were used to corroborate the findings from each phase. RESULTS: Response rates in each phase were 83% (n = 25), 43% (n = 15) and 60% (n = 12), respectively. Despite the high degree of support for CCs among faculty and resident members, several ongoing challenges were highlighted: adapting to programme size, optimising membership, engaging residents, maintaining capacity among members, sharing and aggregating data and developing a clear mandate. DISCUSSION: Findings of this study reinforce the importance of resident engagement and information sharing between disciplines. Challenges faced by CCs are discussed in relation to the existing literature to inform a better understanding of group decision-making processes in medical education. Future research could compare implementation practices across sites and explore which adaptations lead to better or worse decision-making outcomes.

Use of the theoretical domains framework and behaviour change wheel to develop a novel intervention to improve the quality of multidisciplinary cancer conference decision-making.

BACKGROUND: Multidisciplinary Cancer Conferences (MCCs) are prospective meetings involving cancer specialists to discuss treatment plans for patients with cancer. Despite reported gaps in MCC quality, there have been few efforts to improve its functioning. The purpose of this study was to use theoretically-rooted knowledge translation (KT) theories and frameworks to inform the development of a strategy to improve MCC decision-making quality. METHODS: A multi-phased approach was used to design an intervention titled the KT-MCC Strategy. First, key informant interviews framed using the Theoretical Domains Framework (TDF) were conducted with MCC participants to identify barriers and facilitators to optimal MCC decision-making. Second, identified TDF domains were mapped to corresponding strategies using the COM-B Behavior Change Wheel to develop the KT-MCC Strategy. Finally, focus groups with MCC participants were held to confirm acceptability of the proposed KT-MCC Strategy. RESULTS: Data saturation was reached at n = 21 interviews. Twenty-seven barrier themes and 13 facilitator themes were ascribed to 11 and 10 TDF domains, respectively. Differences in reported barriers by physician specialty were observed. The resulting KT-MCC Strategy included workshops, chair training, team training, standardized intake forms and a synoptic discussion checklist, and, audit and feedback. Focus groups (n = 3, participants 18) confirmed the acceptability of the identified interventions. CONCLUSION: Myriad factors were found to influence MCC decision making. We present a novel application of the TDF and COM-B to the context of MCCs. We comprehensively describe the barriers and facilitators that impact MCC decision making and propose strategies that may positively impact the quality of MCC decision making.

Attending Emergency Physicians' Perceptions of a Programmatic Workplace-Based Assessment System: The McMaster Modular Assessment Program (McMAP).

Construct: The McMaster Modular Assessment Program (McMAP) is a programmatic workplace-based assessment (WBA) system that provides emergency medicine trainees with competency judgments through frequent task-specific and global daily assessments. Background: The longevity of McMAP relative to other programmatic WBA systems affords a unique view that precedes large-scale transitions to competency-based medical education (CBME), particularly in North America. Although prior work has described the perspective of residents using this system, the in-depth experiences of assessors using the system have yet to be explored. This perspective is important for understanding the validity of the competency judgments the system produces. Approach: We conducted a qualitative study that used semi-structured interviews analyzed using interpretive description (Thorne) to explore 16 attending physicians' experiences using McMAP. Data analysis was completed independently by 2 researchers, who met regularly to discuss codes and resolve any disagreements. Results: Having a structured assessment framework for a range of clinical tasks has helped encourage what attendings perceived to be more frequent and better-quality assessments, with the added advantages of being holistic, flexible, and learner-driven. However, attendings also perceived a number of challenges of McMAP and programmatic WBA more broadly. These included a reluctance to give and to document negative feedback, "gaming" of the system by both attendings and residents, and a variety of logistic and technology-related concerns. Conclusions: Based on our findings, we offer several key recommendations that can help programs maximize the benefits of programmatic WBA as they transition to CBME.

A solution to gender inequity in surgery? Better caregiving policies.

SUMMARY: Attitudes toward women in surgery appear to be shifting in a positive direction. Why, then, do women still represent only 27% of surgeons in Canada? The answer may, at least in part, lie in the field's inability to adequately accommodate caregiving duties, which are still disproportionately "women's responsibilities" in our society. Although most Canadian academic centres now have paid maternity leave policies for trainees and faculty, these do not necessarily apply to surgeons working in the community, nor do they always reflect what occurs in practice. The perceived inability of the field to accommodate both personal and professional duties is often a significant deterrent to young women considering a career in surgery. In this commentary, we explore the need to address the "caregiver problem" as an important step toward achieving gender equity in surgery.

'It's not the form; it's the process': a phenomenological study on the use of creative professional development workshops to improve teamwork and communication skills.

INTRODUCTION: Past research has demonstrated the positive effects of visual and performing arts on health professionals' observational acuity and associated diagnostic skills, well-being and professional identity. However, to date, the use of arts for the development of non-technical skills, such as teamwork and communication, has not been studied thoroughly. METHODS: In partnership with a community print and media arts organisation, Centre[3], we used a phenomenological approach to explore front-line mental health and social service workers' experiences with a creative professional development workshop based on the visual and performing arts. Through preworkshop and postworkshop interviews with participants and postworkshop interviews with their managers, we sought to examine how participants' perceptions of the workshop compared with their preworkshop expectations, specific impacts of the workshop with respect to participants' teamwork and communication skills and changes in their perceptions regarding the use of the arts in professional development. RESULTS: Our workshops were successful in enhancing teamwork skills among participants and showed promise in the development of communication skills, though observable changes in workplace communication could not be confirmed. The workshop facilitated teamwork and collegiality between colleagues, creating a more enjoyable and accepting work environment. The workshops also helped participants identify the strengths and weaknesses of their communication skills, made them more comfortable with different communication styles and provided them with strategies to enhance their communication skills. CONCLUSIONS: Participation in the arts can be beneficial for the development of interpersonal skills such as teamwork and communication among health professionals.

Academic leadership in nursing: A concept analysis.

BACKGROUND: Research on improving academic leadership in nursing is paramount to increase new faculty support, improve retention, and ensure a high academic standard for the next generation of nurses. However, an operational definition of academic leadership in nursing is missing from the literature and a common language is needed to cohere research. AIM: This study aimed to analyze the concept of academic leadership in nursing to inform future research on the factors that affect nursing faculty career development, job satisfaction, and retention. METHODS: A concept analysis using Walker and Avant's eight-step method. DATA SOURCES: Five databases were searched (CINAHL, PubMed, OVID Emcare, ERIC, and Google Scholar), with 16 articles identified for analysis. The term "academic leadership" was used in a title search with "nursing" as a keyword. RESULTS: Three main attributes were found: administrator, mentor, and nurse. The consequences of academic leadership in nursing are improved work environments, increased job satisfaction, and decreased faculty turnover. Capabilities essential for academic leaders in nursing include vision, risk-taking, excellent communication, mentoring, succession planning, advocacy, and education. CONCLUSION: An academic leader in nursing is a transformational leader who encourages, empowers, and motivates team members to grow, develop and thrive.

Learner Experiences of Preceptor Self-Disclosure of Personal Illness in Medical Education.

PURPOSE: The notion of physician invulnerability to illness contributes to the ongoing marginalization of physicians with personal experiences of illness and complicates professional identity development in medical learners. As such, physician self-disclosure of lived experiences as patients has seen an increasing role in medical education. Existing literature, centered on mental health, has characterized the positive effect of physician discussion of experience with mental illness on medical students and residents. However, the ways learners process and understand physician illness stories beyond this context and their use in education remain unclear. This study aimed to explore undergraduate medical students' perspectives on physician illness discussions of both physical and mental illness, including their perceptions of its use as a pedagogical tool. METHOD: This qualitative study followed an interpretive descriptive design using activity theory as a sensitizing concept. Semistructured interviews with medical students were conducted between January and April 2022 at McMaster University in Hamilton, Ontario, Canada. The authors analyzed transcripts using reflexive thematic analysis. RESULTS: Twenty-one medical students participated in interviews. Although rare, self-disclosure conversations occurred across varied settings and addressed diverse aspects of illness experiences. Discussions involved teaching of pathophysiology, career advice, and wellness guidance. Five themes were developed: the opposition of physicianhood, patienthood, and situating the learner identity; invisibility and stigmatization of physician illness; impact of preceptor stories on learners' relationship with medicine; challenging the "rules" of physicianhood; and situating self-disclosure in medical education. CONCLUSIONS: Students strongly appreciated physician self-disclosure conversations. Self-disclosure can act as an effective pedagogical tool by fostering expansive learning among medical students. Further research is necessary to explore physician perspectives and supports for self-disclosure in education.

Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program.

Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.

Shifting paradigms: A collective and structural strategy for addressing healthcare inequity.

Healthcare inequity is a persistent systemic problem, yet many solutions have historically focused on "debiasing" individuals. Individualistic strategies fit within a competency-based medical education and assessment paradigm, whereby professional values of social accountability, patient safety, and healthcare equity are linked to an individual clinician's competence. Unfortunately, efforts to realise the conceptual linkages between medical education curricula and goals to improve healthcare equity fail to address the institutional values, policies, and practices that enable structural racism. In this article, we explore alternative approaches that target collective and structural causes of health inequity. We first describe the structural basis of healthcare inequity by identifying the ways in which institutional culture, power and privilege erode patient-centred care and contribute to epistemic injustice. We then outline some reasons that stereotypes, which are a culturally supported foundation for discrimination, bias and racism in healthcare, cannot be modified effectively through individualistic strategies or education curricula. Finally, we propose a model that centres shared values for leadership by individuals and institutions with consistency in goal setting, knowledge translation, and talent development. Figure 1 summarises the key recommendations. We have provided cases to supplement this work and facilitate discussion about the model's application to practice.

An iterative approach to promoting departmental wellbeing during COVID-19.

RATIONALE, AIMS, AND OBJECTIVES: Addressing wellbeing among learners, faculty, and staff during the COVID-19 pandemic is a challenge for many clinical departments. Continued and systemic supports are needed to combat the pandemic's impact on mental health and wellbeing. This article describes an iterative approach to conducting a needs assessment and implementing a COVID-19-related wellness initiative in a psychiatry department. METHODS: Development of the initiative followed the Plan-Do-Study-Act (PDSA) quality improvement cycle and was informed by Shanafelt and colleagues' framework for supporting healthcare workers during the COVID-19 pandemic. Key features included the establishment of a Wellness Working Group, the curation of relevant resources on the Department's website, and the deployment of regular, monthly surveys that informed the creation of further supports, such as a weekly online drop-in support group. RESULTS: Survey response rates ranged from 22% to 32% (n = 90-127) throughout our initiative. Across multiple surveys, approximately 80% of respondents reported feeling supported or very supported by the Department, and 90% were satisfied or very satisfied with the quantity and quality of information provided. Our support group and resources page were accessed by nearly one-quarter and one-third of respondents, respectively, with satisfaction rates of 81% or higher. Consistent with the Department's mandate, ensuring equity was a key focus of the Working Group throughout its operations. CONCLUSIONS: There is potential for this model to be scaled to create a faculty-wide, institution-wide, or regional approach to addressing wellbeing. Other departments may also wish to adopt similar approaches to supporting their members during this challenging time.

Indigenous Cultural Safety in Recognizing and Responding to Family Violence: A Systematic Scoping Review.

This systematic scoping review synthesizes the recommended approaches for providing culturally safe family violence interventions to Indigenous peoples in health care and social service settings. A total of 3783 sources were identified through our electronic database searches, hand-searching of Indigenous-focused journals, and backward and forward citation chaining. After screening those sources in duplicate, 28 papers were included for synthesis in June 2020. Forward citation chaining of these 28 included articles in June 2022 identified an additional 304 possible articles for inclusion; following the screening of those 304 articles, an additional 6 were retained in the review. Thus, a total of 34 articles were included for data extraction and narrative synthesis. Initial results were presented to members of the Six Nations of the Grand River Youth Mental Wellness Committee, and their feedback was incorporated into our inductive organization of findings. Our findings represent three thematic areas that reflect key recommendations for health care and social service provision to Indigenous families for whom family violence is a concern: (1) creating the conditions for cultural safety; (2) healing at the individual and community level; and (3) system-level change. These findings demonstrate the need to center Indigenous peoples and perspectives in the development and implementation of cultural safety approaches, to acknowledge and address historically contingent causes of past and present family violence including colonization and related state policies, and to transform knowledge and power relationships at the provider, organization, and government level.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response.

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents' understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.