Extending social accountability mandates to biomedical research in Canadian faculties of medicine.

Background: Social accountability (SA), as defined by Boelen and Heck, is the obligation of medical schools to address the needs of communities through education, research and service activities. While SA is embedded within health profession education frameworks in medicine, they are rarely taught within graduate-level (MSc/PhD) education. Methods: As these programs train future medical researchers, we invited first-year graduate students enrolled in a mandatory professionalism class at our institution (n = 111) to complete a survey on their perceptions of the importance of SA in their research, training, and future careers. Results: Over 80% (n = 87) of respondents agreed that SA is relevant and felt committed to integrating it into their future research activities, only a limited number of students felt confident and/or supported in their abilities to integrate SA into their research. Conclusions: Specific SA training in graduate education is necessary for students to effectively incorporate elements of SA into their research, and as such support the SA mandates of their training institutions. We posit that awareness of SA principles formalizes the professional standards for biomedical researchers and is thus foundational for developing a professionalism curriculum in graduate education programs in medicine. We propose an expansion of the World Health Organization (WHO) partnership pentagon to include partners within the research ecosystem (funding partners, certification bodies) that collaborate with biomedical researchers to make research socially accountable.

Contexte: La responsabilité sociale (RS), telle que définie par Boelen et Heck, est l'obligation pour les facultés de médecine de répondre aux besoins des communautés par l'entremise de l'éducation, de la recherche et des activités de service. Bien que la responsabilité sociale soit intégrée dans les cadres de formation des professionnels de santé en médecine, elle est rarement enseignée au niveau des études supérieures (MSc/PhD). Méthodes: Étant donné que ces programmes forment les futurs chercheurs médicaux, nous avons invité les étudiants de première année inscrits à un cours obligatoire sur le professionnalisme dans notre établissement (n = 111) à participer à une enquête sur leurs perceptions de l'importance de la RS dans leur recherche, leur formation et leur future carrière. Résultats: Plus de 80 % (n = 87) des répondants ont reconnu la pertinence de la RS et se sont engagés à l'intégrer dans leurs futures activités de recherche, mais seul un nombre limité d'étudiants se sont sentis confiants et/ou soutenus dans leurs capacités à intégrer la RS dans leur recherche. Conclusions: Une formation propre à la RS dans le cadre des études supérieures est nécessaire pour que les étudiants puissent intégrer efficacement des éléments de la RS dans leur recherche, et ainsi promouvoir les mandats de RS de leurs établissements de formation. Nous estimons que la sensibilisation aux principes de la RS formalise les normes professionnelles des chercheurs biomédicaux et qu'elle est donc fondamentale pour l'élaboration d'un programme de professionnalisme dans les programmes d'études supérieures en médecine. Nous proposons d'élargir le pentagone du partenariat de l'Organisation mondiale de la santé (OMS) pour y inclure les partenaires de l'écosystème de la recherche (partenaires financiers, organismes de certification) qui collaborent avec les chercheurs biomédicaux pour rendre la recherche socialement responsable.

A Medical Education Research Library: key research topics and associated experts.

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.

Patient references in the 2005 and 2015 CanMEDS frameworks.

Background: Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks. Methods: We used document analysis to examine how the term 'patient(s)' is referenced in the 2005 and 2015 CanMEDS Frameworks. Results: Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME. Conclusion: There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

Contexte: La participation des patients dans la formation médicale postdoctorale (FMPD) peut aider les résidents à améliorer leur professionnalisme et leurs compétences en matière de communication et de collaboration. Le référentiel CanMEDS définit les compétences des médecins et oriente les activités d'enseignement et d'évaluation dans la formation médicale postdoctorale. Cependant, la manière dont les patients sont décrits dans le référentiel CanMEDS n'est pas claire et il n'est pas certain que cette description encourage la participation active des patients dans la FMPD. Pour éclairer la description des patients dans les révisions du référentiel CanMEDS, dont la publication est prévue en 2025, notre objectif était d'examiner comment ils sont présentés dans les référentiels CanMEDS de 2005 et 2015. Méthodes: Nous avons utilisé l'analyse de documents pour examiner les références au terme « patient(s) ¼ dans les référentiels CanMEDS 2005 et 2015. Résultats: Dans les référentiels CanMEDS de 2005 et 2015, les patients sont mentionnés dans la description de certains rôles, mais ils ne le sont pas dans la description des compétences qui y sont associées. Dans d'autres cas, ni la description du rôle ni celle des compétences correspondantes ne font référence aux patients, ce qui peut minimiser l'importance de la participation de ces derniers. Actuellement, le rôle de promoteur de la santé dans le référentiel de 2015 est le seul qui comprend une description et une référence aux patients comme travaillant avec le médecin à titre de partenaires de soins, et qui favorise ainsi la possibilité de faire participer les patients dans la FMPD. Conclusion: Les référentiels CanMEDS passés et présents contiennent des incohérences quant à la description des patients comme partenaires potentiels dans la FMPD. La compréhension de ces incohérences peut éclairer la révision de CanMEDS, dont la publication est prévue en 2025.

Nursing students' use of social media in their learning: a case study of a Canadian School of Nursing.

BACKGROUND: Social media has diverse applications for nursing education. Current literature focuses on how nursing faculty use social media in their courses and teaching; less is known about how and why nursing students use social media in support of their learning. OBJECTIVES: The purpose of this study was to explore how nursing students use social media in their learning formally and informally. METHODS: This exploratory qualitative case study of a Canadian School of Nursing reports on the findings of interviews (n = 9) with nursing students to explore how they use social media in their learning. Data were analyzed using a combined deductive and inductive coding approach, using three cycles of coding to facilitate category identification. RESULTS AND CONCLUSIONS: The findings demonstrate that participants use social media for formal and informal learning and specifically, as a third space to support their learning outside of formal institutional structures. Social media plays a role in the learning activities of nursing students studying both face-to-face and by distance. Accordingly, social media use has implications for learning theory and course design, particularly regarding creating space for student learning communities.

A Qualitative Exploration of the Teaching- and Learning-Related Content Nursing Students Share to Social Media.

Background: Social media have many applications in health professions education. The current literature focuses on how faculty members use social media to supplement their teaching; less is known about how the students themselves use social media to support their educational activities. In this study, this digital artifact collection qualitatively explored what educational content nursing students shared with their social media accounts. Methods: A total of 24 nursing students' Facebook, Twitter, and Instagram accounts were followed over 5 months. A modified directed content analysis was conducted weekly and at the end of the data collection period, using two cycles of inductive and deductive coding. Results: This study demonstrated that nursing students used social media to combat isolation, to consolidate course content, to share resources, and to better anticipate the transition to practice as a new nurse. Conclusions: Faculty members can capitalize on social media platforms to help nursing students explore nursing roles and identities while learning about and enacting professional online behaviours.

A qualitative study of patients' and caregivers' perspectives on educating healthcare providers.

BACKGROUND: Patients/caregivers can be actively involved in the education of healthcare providers (HCPs). The purpose of this study was to explore patients'/caregivers' perspectives on their involvement and roles in the education of HCPs. METHODS: We invited patients/caregivers to participate in one-on-one semi-structured interviews. We analyzed the interview data using conventional content analysis to identify themes. RESULTS: In terms of patient/caregiver involvement in the education of HCPs, we identified that patients/caregivers perceive that it: (a) is challenging because of power-differentials between themselves and HCPs; (b) requires patient training; (c) needs to start early in HCPs' education processes; (d) can improve patient-HCP partnerships; and (e) requires compensation for patients. With regards to the roles that patients can play in educating HCPs, we found that patients/caregivers want to: (a) teach HCPs about patients' expectations, experiences and perspectives through case studies, storytelling, and educational research; (b) provide direct feedback to HCPs; and (c) advise on curricula development and admission boards for HCPs. CONCLUSIONS: Understanding patients'/caregivers' perspectives on this topic can help educational leaders and HCPs improve active patient/caregiver involvement in the education of HCPs. We need to listen to patients'/caregivers' voices in order to make effective changes in current and future health professions education.

CONTEXTE: Les patients et les aidants peuvent participer activement à la formation des prestataires de soins de santé (PSS). L'objectif de cette étude était d'explorer le point de vue des patients et des aidants sur leur participation et leur rôle dans la formation des professionnels de la santé. MÉTHODES: Nous avons invité des patients et des aidants à participer à des entretiens individuels semi-structurés. Nous avons dégagé les thèmes à l'aide d'une analyse de contenu classique des données des entretiens. RÉSULTATS: D'après les patients et les aidants, leur implication dans l'éducation des professionnels de la santé : (a) est un défi en raison du déséquilibre de pouvoir entre eux et les professionnels de la santé; (b) nécessite une formation des patients; (c) doit commencer tôt dans le processus de formation des professionnels de la santé; (d) peut améliorer les partenariats entre les patients et les professionnels de la santé; et (e) suppose que les patients soient indemnisés. En ce qui concerne les rôles que les patients peuvent jouer dans l'éducation des professionnels de la santé, nous avons constaté que les patients et les aidants veulent : (a) enseigner aux professionnels de la santé les attentes, les expériences et les points de vue des patients par le biais d'études de cas, de récits et de recherche en éducation; (b) fournir une rétroaction directe aux professionnels de la santé; et (c) donner des conseils pour le développement decursus et les comités d'admission pour les professionnels de la santé. CONCLUSIONS: Comprendre le point de vue des patients et des aidants sur ce sujet peut aider les éducateurs en poste de gestion et les professionnels de la santé à mieux intégrer la participation active des patients à la formation des soignants. En écoutant la voix des patients et des aidants, nous serons en mesure d'apporter des changements efficaces à la formation actuelle et future des professions de la santé.

Patient Involvement in Medical Education Research: Results From an International Survey of Medical Education Researchers.

There are demands to involve patients in medical education research (MER). This study surveyed researchers to examine the extent and nature of patient involvement in MER. It obtained 283 completed surveys (response rate of 5%). Of the respondents, 153 (54.1%) indicated that they involve patients in MER. Of these respondents, 102 (66.7%) stated that patients are data sources in MER, 41 (26.8%) noted that patients are involved as advisors and/or reviewers, and/or 22 (14.4%) indicated that patients are involved as team members. These respondents reported that they involve patients to improve the relevance of their MER to patients (n = 99; 64.7%), connect MER to patient outcomes (n = 98; 64.1%), and improve the appropriateness of MER (n = 92; 60.1%). The 130 respondents who do not involve patients in MER do not involve them because they believe that their research topic(s) are irrelevant to patients (n = 68; 52.3%), they have limited resources for patient involvement (n = 40; 30.8%), and/or they do not know how to involve patients (n = 28; 21.5%). Researchers need to consider how they can conduct their MER with patients.

Exploring the connections between programmatic assessment and program evaluation within competency-based medical education programs.

Programmatic assessment and program evaluation are both important within competency-based medical education (CBME) programs. Given this importance, there is value in evaluating programmatic assessment as well as using the information collected in programmatic assessment for the evaluation of CBME programs. In order to help facilitate these two activities, this paper distinguishes between programmatic assessment and program evaluation as well as highlights the connections between them. In doing so, it shows that programmatic assessment and program evaluation, when employed appropriately, can complement each other and contribute to the overall effectiveness of CBME programs.

Leveraging social media for medical education: Learning from patients in online spaces.

Social media has applications for teaching, learning, and patient involvement in medical education. It has the potential to eliminate hierarchies in educational interactions, thereby allowing patients to communicate, collaborate, and share information with learners. This commentary suggests that we should consider patients as experts who are available on social media platforms and can therefore play a role in medical education. Specifically, it highlights how patients can serve as teachers in social media-based medical education and how patients' narratives and experiences volunteered in online spaces can help cultivate patient-centred care practices. This article aims to explore how medical students, residents, and practicing physicians can learn from patients on social media and the implications of this learning on medical education more broadly.

Exploring residents' reactions to and use of parent feedback in a pediatric emergency department: A grounded theory study.

BACKGROUND: Competency-based medical education (CBME) involves workplace-based assessment. In pediatrics, patients' parents can participate in this assessment and generate feedback for residents. Prior to routinely collecting parent feedback, it is important to investigate residents' perspectives on it. AIM: To explore residents' reactions to and use of written parent feedback. METHODS: Using a grounded theory approach, we interviewed residents who received written parent feedback at the mid- and end-points of a pediatric emergency training rotation. RESULTS: Twenty-five residents participated. The residents reacted positively to the feedback. They thought that it complements educators' feedback, can elucidate parents' perspectives and needs, and is something that residents want and need. Although the residents thought that non-specific negative parent feedback is not useful, they believed non-specific positive and constructive parent feedback to be encouraging and useful. They delineated how they use non-specific positive parent feedback to boost their self-confidence and reassure themselves that parents perceive their clinical practices as appropriate. They also elucidated how they use constructive parent feedback to understand what is important to parents, become aware of their own behaviors, and modify their clinical practices. CONCLUSIONS: The findings encourage educators in pediatrics to include parents in resident assessment, especially in the CBME era.

The Benefits and Challenges of Involving Adolescents in Medical Education: A Qualitative Study.

OBJECTIVE: To explore the potential benefits and challenges of involving adolescents in the education of medical students and residents from the perspectives of adolescents who are hospitalized with chronic health conditions. METHODS: We conducted qualitative interviews with adolescents at a Canadian pediatric hospital. Eligible participants were those between 13 and 18 years of age who had chronic health conditions lasting more than 3 months and were feeling well enough to participate in an interview. We used conventional content analysis to analyze the data. RESULTS: Sixteen adolescents participated in the study. In terms of benefits, the participants described how involving adolescents in the education of medical students and residents would improve patient-physician interactions, increase patients' confidence and self-worth, encourage patients to self-reflect and gain knowledge about their health conditions and themselves, and enable patients to socialize with other patients. When asked about the challenges, the participants discussed how it might be difficult to include diverse patient perspectives, manage adolescents' negativity, and ensure that learners are nonjudgmental toward adolescents and take them seriously. CONCLUSIONS: Although many of the reported benefits and challenges correspond with those featured in the literature on adult patient involvement in medical education, our findings underscore the distinctive benefits and challenges that medical educators may experience in designing and implementing educational initiatives that involve adolescents. Future design and implementation of educational initiatives should further explore the benefits and challenges of such adolescent involvement, because we know that adolescents can be valuable contributors to medical education.

Observing the influence of the physical environment on family involvement in a rehabilitation setting.

INTRODUCTION: Health professionals and institutions need to understand how to facilitate family involvement within settings designed prior to the adoption of patient- and family-centered philosophies. This study sought to explore how the physical environment of an inpatient rehabilitation setting influenced family involvement in health care delivery. METHOD: We conducted this study on the inpatient acquired brain injury ward of a Canadian adult rehabilitation center. This study used a basic interpretive qualitative approach. We conducted observations of how the physical environment influenced the conversations, interactions, and activities, which were central to family involvement, in this setting. We used a systematic qualitative analysis method. This study received research ethics board approval prior to commencing. RESULTS: We conducted 26 2-hr observation sessions. Five sessions occurred in the morning, 17 in early and late afternoon, and 4 in the evening. Eighteen sessions occurred on a weekday and 8 on a weekend day. The following 6 categories emerged from the field data: (a) accessing health professionals, (b) awareness of family presence, (c) facilitating family presence, (d) facilitating patient-family activities, (e) providing information for families, and (f) facilitating family involvement in therapy. DISCUSSION: This study provided information to inform future discussions and strategies for facilitating family involvement within the existing physical environments of health care institutions. Initial steps should consider ways to help families feel welcomed, such as including additional seating in spaces, posting signage inviting families into spaces, having resources tailored to families readily available, and creating a visible sign-in/sign-out board for families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Digital storytelling in health professions education: a systematic review.

BACKGROUND: Digital stories are short videos that combine stand-alone and first-person narratives with multimedia. This systematic review examined the contexts and purposes for using digital storytelling in health professions education (HPE) as well as its impact on health professionals' learning and behaviours. METHODS: We focused on the results of HPE studies gleaned from a larger systematic review that explored digital storytelling in healthcare and HPE. In December 2016, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, and ERIC. We included all English-language studies on digital storytelling that reported at least one outcome from Levels 2 (learning) or 3 (behaviour) of The New World Kirkpatrick Model. Two reviewers independently screened articles for inclusion and extracted data. RESULTS: The comprehensive search (i.e., digital storytelling in healthcare and HPE) resulted in 1486 unique titles/abstracts. Of these, 153 were eligible for full review and 42 pertained to HPE. Sixteen HPE articles were suitable for data extraction; 14 focused on health professionals' learning and two investigated health professionals' learning as well as their behaviour changes. Half represented the undergraduate nursing context. The purposes for using digital storytelling were eclectic. The co-creation of patients' digital stories with health professionals as well as the creation and use of health professionals' own digital stories enhanced learning. Patients' digital stories alone had minimal impact on health professionals' learning. CONCLUSIONS: This review highlights the need for high-quality research on the impact of digital storytelling in HPE, especially on health professionals' behaviours. PROSPERO REGISTRATION NUMBER: CRD42016050271 .

Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey.

BACKGROUND: Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits. METHODS: We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services. Parents presenting with a neonate to the emergency department in 5 large academic hospitals in Ontario were surveyed between December 2013 and June 2015. We used descriptive statistics to report survey data and explored correlations between factors. RESULTS: A total of 1533 surveys were completed. The most common reasons for presenting were jaundice (441 [28.8%]) and feeding issues (251 [16.4%]). The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department. Although most parents (86.8% [1280/1475]) reported high confidence in caring for a sick or injured child, 42.3% (643/1519) were unsure of the severity, and most (90.4% [578/639]) of these parents felt that the infant required assessment immediately or the same day. Of parents who felt the condition was not serious, 83.2% (198/238) thought that same-day evaluation was required. Nearly half of respondents (44.4% [621/1400]) said they would have gone to their health care provider with a same-day appointment, and 28.1% (344/1225) would have gone to their care provider with a next-day appointment. INTERPRETATION: Parents' reported confidence in caring for sick or injured infants does not match the perceived urgency of neonatal conditions, which likely contributes to emergency department overuse. Any system to decrease nonurgent emergency department use by neonates would need to be immediately responsive, providing same-day help.

Using parent feedback: A qualitative study of residents' and physician-educators' perspectives.

INTRODUCTION: Patients and family members can contribute to resident assessment in competency-based medical education. However, few studies have examined the use of patient/family member feedback generated from questionnaire-based assessments. To implement appropriate assessment strategies and optimize feedback use, we need to understand how residents and physician-educators would use feedback from these stakeholders. This study aimed to understand how paediatric residents and physician-educators would use parent feedback generated from questionnaire-based assessments. METHODS: This study was conducted at a paediatric academic health science centre. We held dyadic interviews with six residents and six physician-educators. A three-step approach was used to analyze the data: data reduction, data display, and conclusions/verifications. We developed an initial coding scheme, conducted an in-depth review of the data and coded it, finalized our coding scheme, and identified categories. RESULTS: Participants described that they would use parent feedback to: (a) provide additional direct observations of residents' performances, (b) teach and coach residents, (c) assess residents' overall performance and progression, and (d) encourage resident self-assessment and behaviour change. DISCUSSION: Parents directly observe residents as they interact with them and their children and, therefore, can provide feedback on residents' performances. Residency programs should include parent feedback and promote and facilitate its use by residents and physician-educators. CONCLUSION: This study provides an initial understanding of how paediatric residents and physician-educators would use parent feedback if they were to receive it. This information, combined with future research, can inform the development and implementation of parent feedback strategies in competency-based medical education.

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments.

BACKGROUND: Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. METHODS: We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. RESULTS: Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. CONCLUSIONS: The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and