Exploring Family Physician Training Needs to Improve Cancer Patient Care.

Family physicians have multifaceted roles in cancer patient care and oncology education among this group is unfortunately inadequate. This study explored the needs and perspectives of family physicians regarding their oncology training and experiences. As well, physician cancer care experiences, knowledge use, and continuing education practices were elucidated. The authors employed a qualitative approach with family physicians participating in semi-structured interviews. General practitioners in oncology were excluded. Purposeful sampling was used, with recruitment through Ontario regional primary cancer care leads and social media. Interviews were transcribed, and thematic analysis was conducted. Thirteen participants were interviewed-1.6:1 female: male, ages 30-39, practicing for an average of 9 years (0.5-30 years), with urban and suburban practices. Most trained in Canada as undergraduates and completed their residency in Ontario; 62% had participated in at least one oncology continuing medical education session. Three major themes emerged: delineation of roles, oncology knowledge and education, and palliative care. Participants reported role uncertainty after cancer diagnosis, with oncology teaching at all levels described as lacking relevance. Palliative care rotations were an avenue for oncology education and where participants returned to cancer care. Changing existing teaching, information access, and avenues of oncology experiences may be the next step to supporting successful cancer care by family physicians.

Clinical Objectives of the Canadian Licensing Examination: Exploring the Representation of Oncology.

Every physician should be comfortable caring for cancer patients, yet medical education in oncology is known as inadequate. Our study explored this issue from an assessment perspective, by determining the representation of oncology and other health priorities in the clinical learning objectives for the Medical Council of Canada Qualifying Examination Part 1 (MCCQE Part 1). The Medical Council of Canada lists objectives for the MCCQE Part 1, based on CanMEDS roles for medical graduate competency. These objectives guide exam question development and can be used as a study guide for learners. Our study focused on the Medical Expert role and mapped the clinical objectives for oncologic, cardiovascular, cerebrovascular and chronic lower respiratory disease. The clinical objectives contained 190 topics under the Medical Expert role. Oncology content was found in 57 (30%), cardiovascular disease in 56 (29.5%), cerebrovascular disease in 21 (11%) and chronic lower respiratory disease in 7 (3.7%). In objectives with oncology content, gastrointestinal cancer (16, 28%), non-specific indicators of cancer (7, 12%) and genitourinary/musculoskeletal cancers (6, 10.5%) were most frequent. Content coding had inter-rater agreement greater than 99%, with kappas from 0.73 to 1.00. Oncology was highly represented in the clinical objectives listed for the MCCQE Part 1. With existing research showing limited oncology content on examinations and in medical curricula, our results were unexpected. This finding could signal the efficacy of initiatives seeking to improve oncology education and emphasizes the importance of continuing improvements in oncology education to meet patient and healthcare system needs.

Fake It 'Til You Make It: Pressures to Measure Up in Surgical Training.

PURPOSE: Expectations of certainty and confidence in surgical culture are a source of internal conflict for surgeons and learners, with surgeons describing a pressure to project an image that is, at times, inconsistent with how they feel internally. The authors explored surgical residents' perceptions of "impression management" and its effects on surgical judgment and decision making. METHOD: The authors used a constructivist grounded theory approach to conduct and analyze 15 semistructured interviews with general surgery trainees at an urban Canadian academic health center between 2012 and 2014. Interviews explored impression management in the context of resident learning and performance. Analysis was inductive, whereby emergent themes contributed to a developing conceptual framework, and deductive, using an existing theory of impression management. RESULTS: Residents described sensing an "expectation" to portray an image aligned with the ideal surgical stereotype of confidence and certainty, and shared strategies used to mirror this image. Impression management strategies were used to portray an image of competence, with the aim to improve access to teaching and evaluations. Unintended consequences of impression management on decision making, patient safety, and resident wellness were identified. CONCLUSIONS: These findings contribute to a deeper understanding of the potential impact of the sociocultural context on residency training, and provide a language allowing for more explicit discussions about the impact of surgical culture on trainee behaviors. Translation includes formal instruction of these concepts in the curriculum so that trainees better recognize, reflect on, and cope with the pressures to perform in front of others.