Recruiting the next generation of rural healthcare practitioners: the impact of an online mentoring program on career and educational goals in rural youth.

INTRODUCTION: There is increasing recognition that encouraging and supporting rural youth to pursue healthcare careers could be a promising strategy for addressing shortages of rural healthcare practitioners. Although rural students in health science programs often return to their home communities to practice, they continue to be underrepresented in these programs. Geographic isolation and small community sizes create barriers to entry for rural students, including a lack of educational and outreach services and a smaller pool of role models with experience in pursuing health science careers. Online mentoring has the potential to overcome these barriers by connecting rural youth with experienced role models from outside their communities; therefore, we tested whether this type of intervention could be used to increase interest in and guide rural youth towards rural healthcare careers. METHODS: From 2016 to 2020, our intervention, Rural eMentoring BC, matched 364 youth in rural British Columbia to near-peer mentors enrolled in health science programs. Through an online platform, dyads discussed career and educational options and pathways through a semistructured curriculum consisting of eight units. To determine the likelihood of mentees pursuing a career in rural health care after participating in the program, we deployed pre- and post-unit surveys that evaluated their interest in the following areas: healthcare careers, post-secondary education, working rurally, and finding allies. After completing the program, 209 mentees were invited to complete a program evaluation, which consisted of short-answer questions intended to capture their overall impressions of the program. RESULTS: After completing the career exploration unit, 63 students (out of the 103 who completed the unit) indicated that they were interested in healthcare careers, compared to 37 before. However, students' attitudes towards post-secondary education and finding allies did not change after completing those units, nor did their opinion of working rurally (although there was no unit dedicated to this topic). Encouragingly though, most already held positive opinions of these areas before entering the program. Of the 41 students who took our program evaluation, most viewed the program and their mentors favorably; discussion topics they found most useful included career exploration, learning life skills, and learning how to prepare for, and what to expect from, post-secondary education. CONCLUSION: This study suggests that online mentoring can direct rural youths' career interests toward, and provide a refreshing approach to imparting information about, healthcare professions. Although its longitudinal impacts need to be studied, the changes in attitudes and gains in knowledge observed while participating in this program put these students on the right track for eventually transitioning to health science programs. Arming rural youth with the knowledge and motivation to pursue healthcare careers through near-peer mentorship could be a unique strategy for increasing rural student representation in health science programs, and ultimately the number of rural healthcare professionals.

PHArmacy Students as Educators (PHASE): Implementation and evaluation of an educator's curriculum for pharmacy students.

BACKGROUND AND PURPOSE: Designed to address the Association of Faculties of Pharmacy of Canada's competency "teach pharmacy team members, the public, and other health care professionals," the PHArmacy Students as Educators (PHASE) program was developed by the institute's entry-to-practice doctor of pharmacy program. The program's objective was to support students in developing the necessary skills to fulfill their role as pharmacist-educators. EDUCATIONAL ACTIVITY AND SETTING: We performed a two-year pilot (2017-2019) of the PHASE program which consists of a large-group didactic session followed by an academic half-day (AHD) session. Evaluation was conducted using Likert-scale and qualitative student survey data collected pre- and post-sessions to determine: (1) how the PHASE program supported students as future educators, and (2) students' perceptions and experiences related to teaching and learning. FINDINGS: All students in the 2020 and 2021 graduating cohorts were included in the study following consent. We determined that while respondents agreed to the statement, "A role of a pharmacist includes being an educator" (93.7% and 98.2% for 2020 and 2021 cohorts) at baseline, the proportion of strongly agree responses increased following the didactic session (P < .005). Of note, average Likert-score for respondents' confidence in educating increased following the AHD session (P < .001). Qualitative analysis identified an increase in students' self-rated ability for determining learners' needs, developing and conducting educational sessions, and confidence related to educating others. SUMMARY: Overall, the PHASE program showed positive impact during the first two years of implementation and lessons learned from the pilot are discussed.

The More Things Change, the More They Stay the Same: Residents Perspectives on Learning to Teach Over 7 Years.

Despite increasing emphasis on the development and implementation of Residents-as-Teachers programs, resident perspectives on their roles as teachers have rarely been explored. This paper explores trends across 7 years of data collected from resident leaders across North American orthopaedic residency programs. Methods: Data were collected during the American Orthopaedic Association's resident-only engagement activity known as the C. McCollister Evarts Resident Leadership Forum (RLF). A total of 997 of 1,050 RLF participants responded from 2015 to 2021. Results: Residents perceived themselves as having a strong influence on medical students' education more so than any other teacher. However, less than one third are provided with any formal instruction from their institutions to support their teaching, and nearly 3 quarters of participants felt there was room for improvement in their teaching effectiveness. For the most part, resident perspectives have stayed relatively consistent over time. Discussion: Residents are keen and willing to invest time into developing their teaching effectiveness. There may be a need for improved advocacy to program directors to increase the presence and availability of formal Residents-as-Teachers programs to support residents in their roles as teachers. We offer suggestions for the composition of such programs for consideration.

COVID as a catalyst: medical student perspectives on professional identity formation during the COVID-19 pandemic.

Background: As a result of the COVID-19 pandemic, a national decision was made to remove all medical students from clinical environments resulting in a major disruption to traditional medical education. Our study aimed to explore medical student perspectives of professional identity formation (PIF) during a nationally unique period in which there was no clinical training in medical undergraduate programs. Methods: We interviewed fifteen UBC medical students (years 1-4) regarding their perspectives on PIF and the student role in the setting of the COVID-19 pandemic. Data were analysed iteratively and continuously to create a codebook and identify themes of PIF based on interview transcripts. Results: We identified three key themes: (1) Medical students as learners vs contributing team members (2) Decreased competency as a threat to identity and (3) Doctors as heroes. Conclusions: The impact of disruptions due to COVID-19 catalyzed student reflections on their role within the healthcare system, as well as the role of self-sacrifice in physician identity. Simultaneously, students worried that disruptions to clinical training would prevent them from actualizing the identities they envisioned for themselves in the future. Ultimately, our study provides insight into student perspectives during a novel period in medical training, and highlights the unique ways in which PIF can occur in the absence of clinical exposure.

Contexte: En réponse à la pandémie de la COVID-19, la décision a été prise de retirer les étudiants en médecine des milieux cliniques à l'échelle nationale, ce qui a entraîné une perturbation majeure de l'enseignement médical traditionnel. Notre étude visait à explorer les opinions des étudiants en médecine sur la formation de l'identité professionnelle (FIP) au cours de cette période unique marquée par l'absence de formation clinique dans les programmes d'études médicales pré-doctorales. Méthodes: Nous avons sondé quinze étudiants en médecine de l'Université de Colombie-Britannique (1re à 4e année) pour recueillir leur point de vue sur la FIP et sur le rôle des étudiants dans le contexte de la pandémie. Les données ont été analysées de manière itérative et continue afin de créer une liste de codes et de dégager les thèmes en rapport avec la FIP à partir des transcriptions de ces entretiens. Résultats: Nous avons identifié trois thèmes clés : (1) les étudiants en médecine, en tant qu'apprenants versus en tant que membres actifs d'une équipe (2), la diminution des compétences comme menace pour l'identité et (3) les médecins comme héros. Conclusions: L'impact des perturbations dues à la COVID-19 a suscité chez les étudiants une réflexion sur leur rôle au sein du système de santé, ainsi que sur le rôle de l'abnégation dans l'identité du médecin. Parallèlement, les étudiants craignaient que les bouleversements de la formation clinique les empêchent de concrétiser leur identité professionnelle telle qu'ils l'envisageaient. En somme, notre étude donne un aperçu des réflexions des étudiants au cours d'une période inédite de la formation médicale et met en évidence les façons uniques dont l'identité professionnelle peut se construire en l'absence d'exposition clinique.

Understanding Professional Identity Formation in Early Clerkship: A Novel Framework.

PURPOSE: Medical educators should foster students' professional attitudes because individuals are more likely to act in accordance with medicine's professional values if these values have been internalized. Still, there is much to be learned about how students examine and negotiate their emerging identities. This study examined third-year medical students' experiences of professional identity formation (PIF) during clinical clerkship. METHOD: The authors relied on an interpretivist perspective, informed by a grounded theory approach, to analyze data, which were collected from a pilot course designed to support medical students' efforts to "unhide" the hidden curriculum in relation to their development as medical students and emerging professionals. RESULTS: Twelve third-year medical students engaged in 10 collaborative discussions with 3 faculty members, a resident, and a fourth-year student (2015-2016). Discussions facilitated students' reflection on their professional journeys. Analysis of transcribed discussions resulted in a conceptual framework useful for exploring and understanding students' reflections on their PIF. Through analyzing students' experiences, the authors identified 4 components that constituted PIF stories: context, focus, catalyst, process. CONCLUSIONS: The analysis resulted in the development of a conceptual framework and distinct identity formation themes. Discrete reflections focused on either students' current identity (being) or their sense of future self (becoming). The study identified catalysts that sparked participants' introspection about, or their processing of, identity. The moments that generate profound feelings of awareness in students are often moments that would not be recognizable (even post hoc) as remarkable by others.

A Systems-Based Practice Curriculum in Orthopaedics: Successes and Challenges Moving Forward.

BACKGROUND: Teaching and assessment of the systems-based practice competency have been a challenge for many educators in graduate medical education. Previous research done at our institution demonstrated a marked inconsistency across institutions in educational content, methods of delivery, and performance assessment. As a result, we developed a 2-week health systems curriculum for orthopaedic surgery residents. METHODS: A 2-week health systems rotation was developed during which postgraduate year (PGY)-1 residents were excused from their normal clinical duties. Residents followed patients as observers of the health-care system, challenged to view health care through the eyes of the patient and to identify what could be done individually and collectively to provide a better and safer experience. Additional learning experiences were designed on the basis of our literature review. At the end of the rotation, residents discussed and provided a written summary of their experiences and completed an anonymous evaluation. Using a Likert scale (1 to 10), residents were asked if the experience was educational and whether it was it additive to their undergraduate medical education for each of the 9 educational areas. RESULTS: The mean responses for all 9 educational areas were 8.2 for whether the experience was educational and 8.3 for whether it was it additive to participants' undergraduate medical education. Feedback from residents indicated that they found the course very helpful and that it inspired them to consider how they could "create overdue and necessary changes in our health-care system." CONCLUSIONS: Our health systems rotation in PGY-1 has been a valuable learning experience for the residents and has created a foundation on which to build in subsequent years of residency.

The Matrix: Moving From Principles to Pragmatics in Medical School Curriculum Renewal.

Many medical programs embarking on curriculum renewal begin with overarching goals and principles, but struggle with how to translate these into an implementable curriculum and assessment practices. This article describes the Matrix, a tool developed as a means of transforming high-level pedagogic principles into a concrete curriculum while addressing the complexities of curriculum content, context, people, and places. Using a known framework as an analytic lens, the authors explore the Matrix's intended and unintended impacts on the University of British Columbia Medical Doctor Undergraduate Program (MDUP).The Matrix is a graphical representation of the 130 weeks of the renewed MDUP curriculum. Its focus is on week-level objectives, which are mapped to year-level milestones and deconstructed into individual session objectives via virtual course books.The Matrix had several predictable outcomes. It served as a tool for translating principles into a pragmatic curriculum. It created a curriculum map that reflected the original vision for renewal, enabled curriculum drift monitoring, and provided a high-level yet detailed visual representation. However, this innovation had unexpected system impacts with respect to multiple levels of governance, and it enabled realignment of the MDUP's governance structure with the functionality required to administer the renewed curriculum.The Matrix created a foundation for curriculum mapping at the MDUP. It has transitioned from the curriculum development and renewal phase into a useful implementation framework. The authors propose that it could be adapted by others for local use.

Sustaining health education research programs in Aboriginal communities.

Despite evidence supporting the ongoing provision of health education interventions in First Nations communities, there is a paucity of research that specifically addresses how these programs should be designed to ensure sustainability and long-term effects. Using a Community-Based Research approach, a collective case study was completed with three Canadian First Nations communities to address the following research question: What factors are related to sustainable health education programs, and how do they contribute to and/or inhibit program success in an Aboriginal context? Semi-structured interviews and a sharing circle were completed with 19 participants, including members of community leadership, external partners, and program staff and users. Seven factors were identified to either promote or inhibit program sustainability, including: 1) community uptake; 2) environmental factors; 3) stakeholder awareness and support; 4) presence of a champion; 5) availability of funding; 6) fit and flexibility; and 7) capacity and capacity building. Each factor is provided with a working definition, influential moderators, and key evaluation questions. This study is grounded in, and builds on existing research, and can be used by First Nations communities and universities to support effective sustainability planning for community-based health education interventions.

Residents' views of the role of classroom-based learning in graduate medical education through the lens of academic half days.

PURPOSE: To examine the role of classroom-based learning in graduate medical education through the lens of academic half days (AHDs) by exploring residents' perceptions of AHDs' purpose and relevance and the effectiveness of teaching and learning in AHDs. METHOD: The authors invited a total of 186 residents in three programs (internal medicine, orthopedic surgery, and hematology) at the University of British Columbia Faculty of Medicine to participate in semistructured focus groups from October 2010 to February 2011. Verbatim transcripts of the interviews underwent inductive analysis. RESULTS: Twenty-seven residents across the three programs volunteered to participate. Two major findings emerged. Purpose and relevance of AHDs: Residents believed that AHDs are primarily for knowledge acquisition and should complement clinical learning. Classroom learning facilitated consolidation of clinical experiences with expert clinical reasoning. Social aspects of AHDs were highly valued as an important secondary purpose. Perceived effectiveness of teaching and learning: Case-based teaching engaged residents in critical thinking; active learning was valued. Knowledge retention was considered suboptimal. Perspectives on the concept of AHDs as "protected time" varied in the three programs. CONCLUSIONS: Findings suggest that (1) engagement in classroom learning occurs through participation in clinically oriented discussions that highlight expert reasoning processes; (2) formal classroom teaching, which focuses on knowledge acquisition, can enhance informal learning occurring during clinical activity; and (3) social aspects of AHDs, including their role in creating communities of practice in residency programs and in professional identity formation, are an important, underappreciated asset for residency programs.

Community-based research in action: tales from the Ktunaxa community learning centres project.

BACKGROUND: Rural communities, particularly Aboriginal communities, often have limited access to health information, a situation that can have significant negative consequences. To address the lack of culturally and geographically relevant health information, a community-university partnership was formed to develop, implement, and evaluate Aboriginal Community Learning Centres (CLCs). OBJECTIVES: The objective of this paper is to evaluate the community-based research process used in the development of the CLCs. It focuses on the process of building relationships among partners and the CLC's value and sustainability. METHODS: Semistructured interviews were conducted with key stakeholders, including principal investigators, community research leads, and supervisors. The interview transcripts were analyzed using an open-coding process to identify themes. RESULTS: Key challenges included enacting shared project governance, negotiating different working styles, and hiring practices based on commitment to project objectives rather than skill set. Technological access provided by the CLCs increased capacity for learning and collective community initiatives, as well as building community leads' skills, knowledge, and self-efficacy. An important lesson was to meet all partners "where they are" in building trusting relationships and adapting research methods to fit the project's context and strengths. CONCLUSIONS: Successful results were dependent upon persistence and patience in working through differences, and breaking the project into achievable goals, which collectively contributed to trust and capacity building. The process of building these partnerships resulted in increased capacity of communities to facilitate learning and change initiatives, and the capacity of the university to engage in successful research partnerships with Aboriginal communities in the future.

Hiring your next partner: AOA critical issues.

Hiring a new partner into an orthopaedic department or group can be a daunting task. A recent American Orthopedic Association symposium sought to address three major aspects of hiring that affect orthopaedic leaders: (1) when to hire-the chairperson's role; (2) generational issues that affect hiring; and (3) the development of an initial compensation package.How does the chairperson recruit new physicians? Hiring a new partner into the academic setting requires a good deal of foresight. There must be an established game plan. Advertising and interviews need to be orchestrated. Chairpersons can find information about candidates from many unique sources. Fit within the department and community is important and must be cultivated. Spouses and families need special attention. Research candidates have individual needs. Perhaps the most important aspect of recruitment is the development of a realistic business plan. This paper provides an overview of factors to consider in managing a new hire.Generational issues are intriguing. Should they affect our hiring practices? It seems clear to established physicians that the new generation of graduates is different from their predecessors. Is this really true? Most everyone is familiar with the terms "Silent Generation," "Baby Boomers," "Generation X," and "Generation Y." Is there anything to be gained by categorizing an applicant? Is it important to hire a replica of one's self? This paper provides a thoughtful overview of generational issues as they apply to hiring new partners.Most department chairpersons are not trained as negotiators. Some preparation and experience are helpful in guiding the process of making an initial offer to a candidate. It is not all about pay. The package includes the guarantee period, expectations for the new hire, mentorship, and resources. How much should new orthopaedic academic hires be paid? Recent benchmark data from the Academic Orthopaedic Consortium suggest a mean income of $282,667 for physicians who have just finished a fellowship. New hires are concerned about call frequency and available time free from work. How much work should be expected from an academic surgeon? Recent survey data from the American Orthopaedic Consortium suggest a mean of 9200 relative value units per year. This article offers some guidelines for the chairperson who needs to formulate an initial offer for a new hire.There is a lot involved in hiring a new partner, as times are changing. This paper offers considerable food for thought about hiring.

Home telehealth for chronic disease management: selected findings of a narrative synthesis.

BACKGROUND: Chronic disease has become an increasingly important issue for individuals and healthcare organizations across Canada. Home telehealth may have the potential to alleviate the economic and social challenges associated with rising rates of chronic disease. An aim of this review was to gather and synthesize the evidence on the effectiveness of home telehealth in chronic disease management. MATERIALS AND METHODS: We searched the Medline, EMBASE, Web of Science, CINAHL, and PAIS databases for studies published in English from January 1, 2005, and December 31, 2010. Academic publications, white papers, and gray literature were all considered eligible for inclusion, provided an original research element was present. Articles were screened for relevance. RESULTS: One hundred one articles on quantitative or mixed-methods studies reported the effects of home telehealth on disease state, symptoms, and quality of life in chronic disease patients. Studies were consistent in finding that home telehealth was equivalent or superior to usual care. CONCLUSIONS: The literature strongly supports the use of home telehealth as an equally effective alternative to usual care. The circumstances under which home telehealth emerges as significantly better than usual care have not been extensively researched. Further research into factors affecting the effectiveness of home telehealth would support more widespread realization of telehealth's potential benefits.

Technology-enabled academic detailing: computer-mediated education between pharmacists and physicians for evidence-based prescribing.

BACKGROUND: Academic detailing (AD) is the practice of specially trained pharmacists with detailed medication knowledge meeting with physicians to share best practices of prescribing. AD has demonstrated efficacy in positively influencing physicians' prescribing behavior. Nevertheless, a key challenge has been that physicians in rural and remote locations, or physicians who are time challenged, have limited ability to participate in face-to-face meetings with academic detailers, as these specially trained academic detailers are primarily urban-based and limited in numbers. OBJECTIVE: To determine the feasibility of using information technologies to facilitate communication between academic detailers and physicians (known as Technology-Enabled Academic Detailing or TEAD) through a comparison to traditional face-to-face academic detailing (AD). Specifically, TEAD is compared to AD in terms of the ability to aid physicians in acquiring evidence-informed prescribing information on diabetes-related medications, measured in terms of time efficiency, satisfaction of both physicians and pharmacists, and quality of knowledge exchange. METHODS: General Practitioner Physicians (n=105) and pharmacists (n=12) were recruited from across British Columbia. Pharmacists were trained to be academic detailers on diabetes medication usage. Physicians were assigned to one of four intervention groups to receive four academic detailing sessions from trained pharmacists. Intervention groups included: (1) AD only, (2) TEAD only, (3) TEAD crossed over to AD at midpoint, and (4) AD crossed over to TEAD at midpoint. Evaluation included physician-completed surveys before and after each session, pharmacist logs after each detailing session, interviews and focus groups with physicians and pharmacists at study completion, as well as a technical support log to record all phone calls and emails from physicians and pharmacists regarding any technical challenges during the TEAD sessions, or usage of the web portal. RESULTS: Because recruitment was very low for the cross over groups, we analyzed the results in two groups instead: AD only and TEAD only. 354 sessions were conducted (AD=161, TEAD=193). Of these, complete data were available for 300 sessions, which were included in analysis (AD=133, TEAD=167). On average, TEAD sessions were 49min long, and AD sessions 81min long. Overall, physicians enjoyed both modalities of academic detailing (AD and TEAD) because they received information that both reinforced their existing diabetes knowledge and also provided new prescribing insights and approaches. CONCLUSION: The results suggest that TEAD is an acceptable alternative to AD for providing physicians advice about prescribing. TEAD is more time efficient, facilitates effective knowledge exchange and interprofessional collaboration, and can reach those physicians virtually where face-to-face AD is not possible or practical. LIMITATIONS: Due to logistics, physicians were allocated, rather than randomized, to receive AD and/or TEAD.

Implementation and evaluation of a novel research education rotation for Royal College of Physicians and Surgeons emergency medicine residents.

Royal College of Physicians and Surgeons (RCPS) emergency medicine (EM) residents must complete a scholarly project; however, significant variation exists in Canadian EM resident research education and facilitation. We developed and implemented a novel mandatory research education rotation for RCPS EM residents intended to increase knowledge, faculty/resident collaborations, and, ultimately, scholarly output. This 4-week rotation took place in the fall of 2011 and consisted of 37 faculty-led didactic, critical appraisal, and workshop seminars. Exposure to faculty research and resulting opportunities and the development of resident research projects were integrated into the rotation. Twelve participating residents completed daily evaluations and took part in an exit focus group analyzed using a constant comparative method. Knowledge acquisition was assessed with a pre/post comprehensive examination instrument evaluated by a paired t-test. Evaluations indicated generally high satisfaction throughout the rotation. Focus group analysis indicated that residents felt two important but competing goals existed: developing a research project and developing critical appraisal skills. The research knowledge of all participants improved significantly (mean/SD examination change +35.4%/+10.4%, range +20.0% to +53.6%, p < 0.001), and several new resident/faculty research collaborations arose from the rotation. A rotation of this nature is an efficient and effective means to increase research and critical appraisal knowledge and faculty/resident collaborations. As a result of our positive experience, the rotation will continue annually and has been expanded to include pediatric EM fellows. Longitudinal tracking of the participating trainee cohort will remain ongoing to assess the scholarly output impact of the rotation.

Resident education in the systems-based practice competency.

More than 10 years after the establishment of the six core competencies by the Accreditation Council for Graduate Medical Education, systems-based practice remains an elusive subject to teach, measure, and document. A wide variety of methods have been reported that address teaching and assessing performance for the discrete parts of systems-based practice; however, no single approach has been described that encompasses the competency in its entirety. To better understand the current state of this competency, orthopaedic residents and educators from around the country were surveyed to determine which systems-based practice topics were being taught at their institutions, how these topics were being taught, and how resident performance was assessed. Seven focus group sessions were held with members involved in the care of musculoskeletal patients to determine what they believed were essential skills for residents to learn relative to the healthcare system. Using this information, a health systems rotation was created for first-year residents that incorporated several different teaching and assessment methods. This rotation has received positive feedback from residents, patients, and health professionals. Its effect on resident development will be tracked over the next 5 years.

I feel disconnected: learning technologies in resident education.

With the rapid development of technology in medical education, orthopaedic educators are recognizing that the way residents learn and access information is profoundly changing. Residency programs are faced with the challenging problem that current educational methods are not designed to take full advantage of the information explosion and rapid technologic changes. This disconnection is often seen in the potentially separate approaches to education preferred by residents and orthopaedic educators. Becoming connected with residents requires understanding the possible learning technologies available and the learners' abilities, needs, and expectations. It is often assumed that approaches to strategic lifelong learning are developed by residents during their training; however, without the incorporation of technology into the learning environment, residents will not be taught the digital literacy and information management strategies that will be needed in the future. To improve learning, it is important to highlight and discuss current technologic trends in education, the possible technologic disconnection between educators and learners, the types of learning technologies available, and the potential opportunities for getting connected.

Reshaping orthopaedic resident education in systems-based practice.

BACKGROUND: Despite advances in understanding the "systems-based practice" competency in resident education, this topic has remained difficult to teach, assess, and document. The goal of this study was to perform a needs assessment and an analysis of the current state of systems-based practice education in orthopaedic residency programs across the U.S. and within our own institution. METHODS: A sample of orthopaedic educators and residents from across the U.S. who were attending the 2010 American Orthopaedic Association (AOA) Effective Orthopaedic Educator Course, AOA Resident Leadership Forum, and AOA Council of Residency Directors meeting were surveyed to determine (1) which aspects of systems-based practice, if any, were being taught; (2) how systems-based practice is being taught; and (3) how residency programs are assessing systems-based practice. In addition, an in-depth case study of these issues was performed by means of seven semi-structured focus group sessions with diverse stakeholders who participated in the care of musculoskeletal patients at the authors' institution. A quantitative approach was used to analyze the survey data. The focus group data were analyzed with procedures associated with grounded theory, relying on a constant comparative method to develop salient themes arising from the discussion. RESULTS: "Clinical observation" (33%) and "didactic case-based learning" (23%) were reported by the survey respondents as the most commonly used teaching methods, but specific topics were taught inconsistently. Competency assessment was reported to occur infrequently, and 36% of respondents reported that systems-based practice areas were not being assessed by any methods. The focus group discussions emphasized the need for standardized experiential learning that was closely linked to the patient's perspective. Orthopaedic faculty members were uncomfortable with their knowledge of this competency and their ability to teach and assess it. CONCLUSIONS: Teaching the systems-based practice competency occurs inconsistently, and formal assessment occurs infrequently. In addition to formal teaching, learning systems-based practice will be best achieved experientially and from the patient's perspective.

Competency is not enough: integrating identity formation into the medical education discourse.

Despite the widespread implementation of competency-based medical education, there are growing concerns that generally focus on the translation of physician roles into "measurable competencies." By breaking medical training into small, discrete, measurable tasks, it is argued, the medical education community may have emphasized too heavily questions of assessment, thereby missing the underlying meaning and interconnectedness of how physician roles shape future physicians. To address these concerns, the authors argue that an expanded approach be taken that includes a focus on professional identity development. The authors provide a conceptual analysis of the issues and language related to a broader focus on understanding the relationship between the development of competency and the formation of identities during medical training. Including identity alongside competency allows a reframing of approaches to medical education away from an exclusive focus on "doing the work of a physician" toward a broader focus that also includes "being a physician." The authors consider the salient literature on identity that can inform this expanded perspective about medical education and training.

Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis.

Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed articles and five IECPCP project reports were included in the review. We found that IP interventions at the post-licensure level improved provider satisfaction and workplace quality. Including IP learning opportunities into practice education in rural communities or in less popular healthcare specialties attracted a higher number of students and therefore may increase employment rates. This area requires more high quality studies to firmly establish the effectiveness of IP interventions in recruiting and retaining future healthcare professionals. There is strong evidence that IP interventions at the post-licensure level reduced patient care costs. The knowledge synthesis has enhanced our understanding of the relationships between IP interventions, IP collaboration and HHR outcomes. Gaps remain in the knowledge of staff retention and determination of staffing costs associated with IP interventions vis-à-vis patient care costs. None of the studies reported long-term data on graduate employment choice, which is essential to fully establish the effectiveness of IP interventions as a HHR recruitment strategy.

A collaborative quality improvement model and electronic community of practice to support sepsis management in emergency departments: investigating care harmonization for provincial knowledge translation.

Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and national level to establish a template for policy makers from other jurisdictions to translate knowledge into action for EDs. This research study will employ the IHI model for improvement, incorporate the principles of participatory action research, and use the E2E online CoP to engage ED practitioners (eg, physicians, nurses, and administrators, exchanging ideas, engaging in discussions, sharing resources, and amalgamating knowledge) from across BC to (1) share the evidence of early intervention in sepsis, (2) adapt the evidence to their patterns of practice, (3) develop a common set of orders for implementing the sepsis pathway, and (4) agree on common indicators to measure clinical outcomes. Our hypothesis is that combining the social networking ability of an electronic CoP and its inherent knowledge translation capacity with the structured project management of the IHI model will result in widespread and sustained improvement in the emergency and overall care of patients with severe sepsis presenting to EDs throughout BC.