Narrative means to professional ends: new strategies for teaching CanMEDS roles in Canadian medical schools.

PROBLEM ADDRESSED: Medical students in training are rarely encouraged to engage in reflective thinking around clinical encounters. Writing exercises can be an effective route for encouraging student reflection. OBJECTIVE OF PROGRAM: The purpose of this pilot project was to determine if using reflective writing in teaching the CanMEDS roles helps to increase students' understanding of the roles in the clinical context. PROGRAM DESCRIPTION: A pilot project was undertaken with 10 third-year medical students at the University of Toronto in Ontario. Students wrote about a different CanMEDS role for each session based on supplied writing prompts. Students also completed a Narrative Reflection Tool at the end of each group session. A selection of writing samples was assessed for reflection and for an understanding of the CanMEDS roles. Students were also given an opportunity to provide feedback on the program. CONCLUSION: Students demonstrated a good grasp of the CanMEDS roles, strong reflective capacity, and engagement in the learning process. Results suggest reflective writing has an important role in encouraging personal reflection and reflective thinking in the clinical context.

Use of alternative medicines by patients with OA that adversely interact with commonly prescribed medications.

UNLABELLED: Owing to the increasing prevalence, patient interest, and high risk of adverse effects associated with use of complementary and alternative medicine (CAM), investigation of this issue in an orthopaedic population is warranted. The objectives of this study were to (1) identify the prevalence of CAM use, (2) assess the level of communication between patients and physicians regarding CAMs, (3) uncover reasons for nondisclosure, and (4) identify potentially harmful interactions between CAMs and conventional therapy. We conducted a cross-sectional observational study among patients being treated in orthopaedic surgical clinics for osteoarthritis (OA). Of the 373 participants, 42.9% reported taking one or more CAMs, and 40.6% admitted their surgeons were unaware of their alternative therapy use. Reasons for nondisclosure included, the patient thought: (1) it was not important (29.7%); (2) the surgeon would not be interested (13.5%); and (3) their surgeon would not know about CAMs (8.2%). Twenty-two of 281 patients (7.8%) were taking alternative medicines that could interact with their blood pressure medication, 28.6% were taking anticoagulant/antiplatelet medication and also taking a CAM that could interact, and 5.9% were taking conventional pain medications along with a CAM that potentially could interact. Orthopaedic surgeons should make it part of their consultation to inquire about CAM use. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.