[Teaching in a pandemic: the transformation of teaching and clinical supervision]. / Enseigner en situation de pandémie : La transformation de l'enseignement et de la supervision clinique.

Introduction: The COVID-19 pandemic is an event that deeply impacts our personal, professional, and collective lives. How do we teach in these times of great upheaval? What are the main changes that have occurred? Method: Using the Cartel logic, four professors and a qualitative researcher carried out an autoethnographic research aimed at documenting the main changes that have occurred in the teaching of family medicine in their respective practices located in four different academic family medicine groups at the University of Sherbrooke. Results: Five key moments in teaching that occurred during a pandemic were identified: a) the declaration of a pandemic, b) the approach with the graduating/advanced cohort of residents, c) the anticipation and preparation for the arrival of new residents, d) arrival of first year residents and e) adaptation to the second wave. For each moment, we present the issues encountered in our care and teaching practices under three transversal relational axes: the relationship of humans to their cultural context, the patient-doctor relationship, and the teacher-resident relationship. Conclusion: Our analysis shows that the transmission of medical knowledge and the art of medicine cannot take place without specific attention to the overall cultural context, the contextual relationship of clinical care, and the teaching relationship. Our study also makes it possible to recommend the opening of spaces for reflection and dialogue in our teaching environments.

Family Medicine Supervisors' Preferences for Improving Their Teaching Skills in Senior Care.

BACKGROUND AND OBJECTIVES: Many clinical supervisors in family medicine feel ill-equipped to teach senior care to their family medicine residents (trainees). We therefore sought to explore their preferred learning strategies for improving their clinical and teaching skills with regard to senior care. METHODS: In this qualitative study, we conducted focus groups and interviews with supervisors from four family medicine clinics, to explore their preferred educational strategies. We selected four clinics using a maximum-variation strategy, based on a survey assessing continuing professional development (CPD) needs. The qualitative thematic analysis followed an inductive/deductive approach based on McGuire's attributes of persuasive communication. RESULTS: The four focus groups and nine interviews with 53 supervisors (37 physicians, 9 nurses, 4 psychologists, 1 social worker, 1 nutritionist, 1 sexologist) revealed that supervisors preferred being trained by experienced trainers specialized in senior care, from various professional backgrounds, and knowledgeable about local community resources. They valued practical training the most, such as clinical case discussions based on real cases, clinical tools, and mentoring. The findings also suggest that training in senior care should be adapted to the supervisors' experience, profession, workload, and scope of intervention. Supervisors valued repeated CPD with longitudinal follow-up and easy access to trainers and to up-to-date training content. CONCLUSIONS: The findings of this project will allow those who design CPD activities to adapt such activities to the preferences of supervisors, so as to improve their clinical and teaching skills in senior care. This, in turn, may help supervisors to embody an appealing professional role model for learners.

Implementing advanced access to primary care in an academic family medicine network: Participatory action research.

OBJECTIVE: To support the implementation of the advanced access model in a network of family medicine academic settings, and to identify solutions to teaching advanced access to family medicine residents. DESIGN: Participatory action research study using descriptive methods. SETTING: A network of 11 academic family medicine settings, mostly located in the province of Quebec. PARTICIPANTS: Eighteen academic-setting directors and deputy directors and 125 clinical preceptors. METHODS: The study was carried out from August 2015 through January 2017. Settings were represented by a "community of practice" of academic-setting directors and deputy directors. Data were collected via questionnaires, online surveys, and 4, 60-minute focus groups. Data were analyzed using descriptive statistics or thematic analysis. Findings were validated with the community of practice. MAIN FINDINGS: Nearly all of the academic family medicine settings implemented advanced access for their clinical preceptors (90.9%). Four main solutions to teaching advanced access were identified: establishing an optimal panel of patients; ensuring continuity of care during absences and away rotations; optimizing team collaboration; and creating a positive experience of immersion in advanced access. CONCLUSION: An academic-setting community of practice contributed to sharing solutions that were instrumental in broadly implementing the advanced access model and that also paved the way for the integration of advanced access for future family physicians, further supporting timely access to primary care.

What Do Clinical Supervisors Require to Teach Residents in Family Medicine How to Care for Seniors?

We assessed clinicians' continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol.

BACKGROUND: Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty. Our objectives are twofold: 1) to identify actions required to promote the adoption of professional practices oriented toward social competence in primary care teams; and 2) to examine factors that would encourage the inclusion of people living in poverty in the process of developing social competence in healthcare organizations. METHODS/DESIGN: This study will use a participatory action research design applied in healthcare organizations. Participatory research is an increasingly recognized approach that is helpful for involving the people for whom the research results are intended. Our research team consists of 19 non-academic researchers, 11 academic researchers and six partners. A steering committee composed of academic researchers and stakeholders will have a decision-making role at each step, including knowledge dissemination and recommendations for new interventions. In this project we will adopt a multiphase approach and will use a variety of methods, including photovoice, group discussions and interviews. DISCUSSION: The proposed study will be one of only a few using participatory research in primary care to foster changes aimed at enhancing quality and access to care for people living in poverty. To our knowledge this will be the first study to use photovoice in healthcare organizations to promote new interventions. Our project includes partners who are targeted for practice changes and improvements in delivering primary care to persons living in poverty. By involving knowledge users, including service recipients, our study is more likely to produce a transformation of professional practices and encourage healthcare organizations to take into account the needs of persons living in poverty.