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INTRODUCTION: The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS: In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS: This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION: The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.
RESUMEN
This study examined older driver engagement in distracting behaviours (secondary activities) at intersections using naturalistic driving data from a larger study based in Melbourne, Australia. Of interest was whether engagement in secondary activities at intersections was influenced by factors such as driver gender and situational variables, in particular, those relating to the complexity of the driving environment. Specifically we expected that when making left/right turns, older drivers would reduce the proportion of time engaged in secondary behaviours at intersections which required gap judgements (partly controlled or uncontrolled) compared with intersections that were fully controlled by traffic signals. Consideration was given to engagement in secondary activity with hands off the wheel and when the vehicle was moving versus stationary. Older drivers aged between 65 and 83 years drove an instrumented vehicle (IV) on their regular trips for approximately two weeks. The IV was equipped with a video camera system, enabling recording of the road environment and driver and a data acquisition unit, enabling recording of trip distance, vehicle speed, braking, accelerating, steering and indicator use. Driving experience and demographics were collected and functional abilities were assessed using the Useful Field of View (UFOV), Trail Making Test B, Mini Mental Status Examination (MMSE), visual acuity and contrast sensitivity. The study yielded a total of 371 trips with 4493 km (99.8 h) of naturalistic driving data including 1396 left and right turns. Trips were randomly selected from the dataset and in-depth analysis was conducted on 200 intersection manoeuvres (approximately 50% left turns, 50% right turns). The most frequently observed secondary activities were scratching/grooming (42.5%), talking/singing (30.2%) and manipulating the vehicle control panel (12.2%). Glances "off road" 2s or longer were associated with reading, reaching and manipulation of the vehicle control panel. Hands off the wheel was associated with reading. Key parameters associated with the percent of intersection time that drivers engaged in secondary activities were intersection complexity, vehicle status (moving vs. stationary) and traffic density. In conclusion, older drivers appeared to engage selectively in secondary activities according to roadway/driving situations, supporting the notion that drivers self-regulate by engaging in secondary tasks less frequently when the driving task is more challenging compared with less challenging manoeuvres.
