Teaching Opportunities for Postgraduate Trainees in Primary Care.

ABSTRACT: The purpose of this AM Last Page is to help faculty and postgraduate medical trainees (residents) identify resident teaching opportunities and foster teaching skill development. The Fundamental Teaching Activities (FTA) framework includes three domains in which physicians teach: Clinical Preceptor; Teacher Outside the Clinical Setting; and Educational Leader. Based on interviews with faculty and residents as well as our collective and diverse teaching experience, we adapted the FTA framework to be more applicable to resident teaching. The resultant domains are: Clinical Teacher; Teacher in Nonclinical Settings; and Educational Collaborator.

Competency-based faculty development: applying transformations from lessons learned in competency-based medical education.

Faculty development in medical education is often delivered in an ad hoc manner instead of being a deliberately sequenced program matched to data-informed individual needs. In this article, the authors, all with extensive experience in Faculty Development (FD), present a competency-based faculty development (CBFD) framework envisioned to enhance the impact of FD. Steps and principles in the CBFD framework reflect the lessons learned from competency-based medical education (CBME) with its foundational goal to better train physicians to meet societal needs. The authors see CBFD as a similar framework, this one to better train faculty to meet educational needs. CBFD core elements include articulated competencies for the varied educational roles faculty fulfill, deliberately designed curricula structured to build those competencies, and an assessment program and process to support individualized faculty learning and professional growth. The framework incorporates ideas about where and how CBFD should be delivered, the use of coaching to promote reflection and identity formation and the creation of communities of learning. As with CBME, the CBFD framework has included the important considerations of change management, including broad stakeholder engagement, continuous quality improvement and scholarship. The authors have provided examples from the literature as well as challenges and considerations for each step.

Dans l'enseignement médical, le perfectionnement du corps professoral se fait souvent de façon ad hoc et non dans le cadre d'un programme structuré en fonction des besoins individuels définis sur la base de données. Dans cet article, les autrices, qui ont toutes une vaste expérience en matière de perfectionnement du corps professoral (PCP), présentent un cadre pour le perfectionnement fondé sur les compétences (PCPFC) visant à renforcer les effets du PCP. Les étapes et les principes de ce cadre reflètent les enseignements tirés de la formation médicale fondée sur les compétences (FMFC), dont l'objectif fondamental est de former les médecins de façon à ce qu'ils puissent répondre aux besoins de la société. De manière analogue, le cadre PCPFC viserait à mieux former le corps professoral pour qu'il puisse répondre aux besoins éducatifs. Les éléments centraux du cadre comprennent la définition des compétences pour chacun des rôles que les enseignants remplissent, la création de programmes de formation structurés et axés sur le développement de ces compétences et l'élaboration d'un programme d'évaluation ainsi qu'un processus pour soutenir de manière individualisée l'apprentissage et la croissance professionnelle des enseignants. Le cadre présente des idées sur les modalités des formations de PCPFC, sur l'environnement dans lequel elles interviennent, sur l'utilisation du coaching pour promouvoir la réflexion et la construction d'identité et sur la création de communautés d'apprentissage. Tout comme la FMFC, le cadre du PCPFC répond aux importants enjeux liés à la gestion du changement, y compris l'engagement des parties prenantes, l'amélioration continue de la qualité et la recherche. Les autrices proposent des exemples tirés de la littérature scientifique et passent en revue les défis et les points importants à considérer pour chaque étape.

Longitudinal Study of Family Medicine Residents' Clinical Teaching After Participation in the Residents-as-Teachers Program.

BACKGROUND AND OBJECTIVE: Residents-as-teachers (RAT) programs provide opportunities for residents to gain teaching skills. Published studies have assessed RAT programs largely at a single point in time rather than longitudinally. To address this gap, we examined (a) longitudinal trends in RAT participants' interest, comfort, confidence, skill, and familiarity with aspects of clinical teaching; and (b) subsequent involvement in clinical teaching. METHODS: We conducted a longitudinal survey of one cohort of family medicine residents (N=56) who participated in the RAT program during residency. We collected data before and after the RAT program and at one and three years into practice (2016-2020). We measured outcomes including interest, comfort, confidence, skill, familiarity with aspects of clinical teaching and involvement in clinical teaching. We performed longitudinal analysis using repeated measures analysis of variance. RESULTS: Response rates at four data collections were 63% (n=35), 66% (n=37), 55% (n=31), and 34% (n=19), respectively. We observed consistent trends in interest, comfort, confidence, skill, and familiarity with aspects of clinical teaching; mean scores increased from before to after the RAT program and subsequently decreased in the early years in practice. At 1 and 3 years in practice, 71% and 74% of respondents, respectively, reported being involved in teaching, primarily teaching medical students. CONCLUSIONS: The RAT program appears to be a positive contributing influence on family medicine graduates' perceived preparedness to teach and their involvement in teaching after graduation from residency. A relatively high proportion of residents are involved in teaching in the early years in practice.

International medical graduates' experiences with caring for cross-cultural patient populations: Qualitative study in Alberta.

OBJECTIVE: To explore experiences of international medical graduate (IMG) FPs in providing cross-cultural patient care and to identify rewards and challenges they experienced when caring for patients of cultural backgrounds different from their own. DESIGN: Descriptive qualitative study. SETTING: Family medicine primary care practices in Alberta. PARTICIPANTS: Eighteen IMG FPs practising in the metropolitan areas of Edmonton or Calgary in Alberta as of May 2013. METHODS: Individual face-to-face or telephone interviews were conducted using a semistructured interview guide. Seventeen interviews occurred between July and August 2013 and 1 took place in August 2014. All interviews were audiorecorded and transcribed verbatim. Transcribed data were subject to thematic analysis. MAIN FINDINGS: International medical graduates identified several rewarding aspects of caring for patients with cultural backgrounds different from their own, including learning about different cultures, perceiving that appointments are more succinct, and advocating for patients whom they perceive to be at a disadvantage. Family physicians also identified several challenges associated with caring for patients of different cultural backgrounds, including encountering language barriers, perceiving that visits take longer, and experiencing patients' lack of acceptance of FPs with cultural backgrounds different from their own. CONCLUSION: Cultural differences between FPs and patients can enhance or undermine doctor-patient relationships. The results of this study speak to the need for cultural competency training for FPs practising in culturally diverse settings.

Psychological need fulfillment in virtual teaching: insights of residents and faculty.

Objective: To explore benefits and challenges experienced by residents and faculty when teaching in virtual settings. Methods: This was a qualitative descriptive study employing one-on-one semi-structured interviews with 10 residents and 12 faculty in the Department of Family Medicine at the University of Alberta, Canada, from May 2021 to May 2022. Participants were recruited via social media, resident and department events and email lists. Interview transcripts were analyzed descriptively and thematically employing the Self-Determination Theory (SDT) framework to map the identified benefits and challenges as facilitators and barriers to fulfilling teacher's basic psychological needs for autonomy, competence, and relatedness in virtual settings. Results: Resident and faculty participants used virtual technology not only to deliver education, but also leveraged various platform features to support their needs in virtual settings. The emerging themes within benefits and challenges of virtual teaching were amenable to mapping onto three basic psychological needs of the SDT framework - autonomy (e.g., increased accessibility; lack of control over teaching environment), competence (e.g., increased self-confidence; technological limitations hindering skill development), and relatedness (e.g., timely exchange of information; difficulty with professional identity formation). Conclusions: Despite the inherent challenges, teaching in virtual settings can support teachers' psychological needs. Recommendations for the future delivery and facilitation of virtual learning include: giving high priority to engagement and active participation; nurturing autonomy and greater individual responsibility for learning; and creating an environment of emotional support. The SDT-informed strategies shown to be effective in in-person teaching need to be examined for their applicability in virtual settings.

Mindsets of Early-Career Family Physicians Trained in Competency-Based Education.

INTRODUCTION: The objective of this study was to examine the mindsets (mastery, performance approach, performance avoidance) of early-career family physicians following graduation from a competency-based education residency program. METHODS: This was a longitudinal, cohort, survey study of family medicine residents at a large Canadian university. The 2015-2017 cohort of family medicine residents was surveyed at three time points: (1) at the end of residency training; (2) at 1 year in clinical practice; and (3) at 3 years in clinical practice. We used Baranik et al's instrument to measure three types of mindsets. We performed descriptive and multivariate analyses using SPSS 26.0 software. RESULTS: Irrespective of the time in practice, mean scores were the highest on the mastery mindset and the lowest on the performance avoidance mindset measures (P<.001). Over time, the mastery mindset scores tended to decrease (P=.04). CONCLUSION: Family physicians trained in competency-based education continued to be mastery-oriented in the first 3 years of clinical practice. This finding is reassuring given that the mastery mindset is associated with professional well-being and long-term success. Nonetheless, because mastery mindset scores appeared to decrease over time, residency programs need to ensure graduating residents are equipped with knowledge and tools to remain mastery-oriented throughout the course of their professional careers.

Association of Physicians' Self-Compassion with Work Engagement, Exhaustion, and Professional Life Satisfaction.

Self-compassion has shown promise as an adaptive resource for coping with uncertainties and challenges. This study examined the relationship between self-compassion and professional wellbeing (work engagement, exhaustion, and professional life satisfaction) of physicians, who frequently face uncertainties and challenges in their clinical practice. Fifty-seven practicing physicians in Canada participated in the study. Overall, 65% of the participants were female; 47% were in the early-career stage; 49% were family medicine (FM) physicians, with the rest being non-FM specialists. It was hypothesized that (a) self-compassionate physicians would experience greater work engagement and less exhaustion from work than physicians reporting lower self-compassion and (b) self-compassionate physicians would experience greater professional life satisfaction through their greater work engagement and less exhaustion than physicians reporting lower self-compassion. Sequential regression analyses were performed. The results confirmed the hypothesized associations, indicating that self-compassionate physicians experienced more positive work engagement, felt less emotionally, physically, and cognitively exhausted due to work demands, and were more satisfied with their professional life than physicians who exhibited less compassion toward themselves in uncertain and challenging times. Future studies are needed to determine optimal ways to support practicing physicians and medical trainees in becoming more self-compassionate for their enhanced wellbeing and, ultimately, for the provision of effective patient care.

Lifelong learning practices and leisure-time exercise habits of academic and community-based physicians.

This article was migrated. The article was marked as recommended. Objective: Physicians are required to be lifelong learners for the provision of quality patient care. At the same time, physician wellbeing is a critical component in the delivery of such care. This study was designed to examine: (1) lifelong learning practices and leisure-time exercise habits of academic and community-based physicians; and (2) associations of leisure-time exercise with work engagement, exhaustion, and professional life satisfaction. Methods: Using an online survey, quantitative data were collected from physicians practicing in Canada. The survey contained validated scales of physician lifelong learning, leisure-time exercise, work engagement, work exhaustion, and professional life satisfaction. Descriptive, chi-square, t-test, and correlational analyses were performed. Results: Physicians (n=57) reported moderately high levels of lifelong learning, with no significant difference between academic and community-based physicians. To stay current in their practice, the majority of physicians reported exchanging ideas/asking colleagues and searching databases as questions arise (>90%), followed by engaging in clinical teaching and attending conferences and meetings of professional organizations (>80%). Watching podcasts and webinars was the least preferred lifelong learning activity (<50%). With respect to leisure-time exercise habits, more community-based physicians reported engaging in mild and/or moderate forms of exercising, whereas more academic physicians reported engaging in strenuous exercising in a typical week. Correlational analyses revealed that physicians' leisure-time exercise scores were positively correlated with professional life satisfaction (r = 0.25; p = 0.058) and work engagement (r = 0.29; p = 0.028) and negatively correlated with work exhaustion (r = -0.34; p = 0.01). Conclusions: Irrespective of the practice type, physicians tend to engage in lifelong learning activities that offer in-person interactions with colleagues and trainees. Regular participation in leisure-time exercise appears to enhance physicians' professional wellbeing. As such, these activities and habits should be encouraged, supported, and promoted within institutional culture and health systems in general.

Physicians as Teachers and Lifelong Learners.

INTRODUCTION: Lifelong learning requires sustained motivation for learning. Employing a motivational theory framework, we investigated the relationships of psychological need satisfaction, clinical teaching involvement, and lifelong learning of physicians at different career stages and in various medical specialties. We also examined the associations of physician lifelong learning with stress, burnout, teaching enjoyment, and life satisfaction, all of which are essential for physician well-being and, ultimately, for the provision of quality patient care. METHODS: This was a cross-sectional study. Using survey methodology, quantitative data were collected from 202 practicing physicians in Canada. The questionnaire contained validated scales of physician lifelong learning and psychological need satisfaction, measures of clinical teaching (involvement and enjoyment), stress level, burnout frequency, and life satisfaction. Analysis of covariance and correlational analysis were performed. RESULTS: On average, participants reported moderate to moderately high levels of lifelong learning, psychological need satisfaction, teaching enjoyment, and life satisfaction. Irrespective of career stage and specialty, physicians' psychological need satisfaction and involvement in clinical teaching were significant in relation to lifelong learning. That is, physicians who experienced greater psychological need satisfaction at work and those who were involved in clinical teaching had, on average, higher lifelong learning scores. Physician lifelong learning had significant associations with life satisfaction and teaching enjoyment but not with stress level and burnout frequency. DISCUSSION: Fulfilling physicians' basic psychological needs at work and supporting them in their teaching roles is likely to enhance physician lifelong learning and, ultimately, quality of patient care.

Transitioning to academia: Exploring the experience of new family medicine faculty members at the beginning of their academic careers.

OBJECTIVE: To explore the experience of new family medicine faculty members at the beginning of their academic careers and determine what factors might facilitate their transition to an academic role in family medicine. DESIGN: Qualitative, phenomenologic study of new academic family physicians. SETTING: Eight Canadian departments of family medicine. PARTICIPANTS: English-speaking, full-time academic family physicians who had been in their first faculty position in a Canadian department of family medicine for 1 to 5 years. METHODS: Data were collected using semistructured, in-depth interviews that were audiotaped and transcribed verbatim. Data analysis employed an immersion and crystallization technique. The transcriptions were reviewed in an iterative and interpretive manner. Thirteen interviews were performed before saturation was reached. MAIN FINDINGS: The following 3 key themes were identified in relation to the experience of being a new academic family medicine faculty member: lack of or inadequate orientation; the challenges associated with transitioning to academia; and balancing the demands of the role. Orientation was often lacking or suboptimal, with participants left to navigate the transition process alone. The challenges associated with the transition to academia included the realities of clinical work and uncertainties about how to incorporate the various aspects of the new role into members' reality (eg, research). Trying to balance the demands of the academic role (eg, committee involvement, manual reviews), as well as finding work-life balance, was overwhelming. CONCLUSION: This study highlights the factors that might help recruit and retain academic faculty members in family medicine, as well as help them build successful academic careers. Orientation for these new members is an area that requires more attention. Clear parameters around division of time, support, and expectations for advancement should be explained at the beginning of new faculty members' academic appointments. Effective mentoring might help new faculty members have a more successful transition and reduce the risk of feeling overwhelmed and considering leaving academia.

Motivations for learning of family medicine residents trained in competency-based education.

BACKGROUND AND OBJECTIVE: Family physicians regularly encounter clinical uncertainty and ambiguity and thus, are expected to engage in on-going learning to respond to changing needs of family practice. Using Achievement Goal Theory, the objective of this study was to examine motivations for learning of family medicine residents in a competency-based program. METHOD: This was a cross-sectional study, employing a survey methodology with family medicine residents at the mid-point of training at a Canadian university. Multivariate analyses of variance and covariance were used to examine residents' goal orientations (performance approach, mastery approach, performance avoidance, mastery avoidance) for the group as a whole and to test for the effects of residents' gender and program stream (urban/rural), respectively. RESULTS: A total of 52 (67%) residents completed the survey. Overall, residents scored highest on mastery approach and lowest on performance avoidance, thus, exhibiting adaptive motivations for learning. Male residents demonstrated higher levels of performance approach, performance avoidance, and mastery avoidance than female residents. No significant differences in goal orientations were found between urban and rural residents. CONCLUSIONS: Family medicine residents trained in the culture of competency-based education appear to be mastery approach oriented. This motivation orientation is critical in the dynamic practice of family medicine and is consistent with the life-long learning mandate of the medical profession.

Preparing teachers for competency-based medical education: Fundamental teaching activities.

INTRODUCTION: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers. METHODS: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development. RESULTS: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools. CONCLUSIONS: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.

Lifelong learning along the education and career continuum: meta-analysis of studies in health professions.

INTRODUCTION: Lifelong learning is an integral part of health professionals' maintenance of competence. Several studies have examined the orientation toward lifelong learning at various stages of the education and career continuum; however, none has looked at changes throughout training and practice. The objective of the present study was to determine if there are differences between groups defined by their places on the education and career continuum. METHODS: The authors performed a group-level meta-analysis on studies that used the 14-item Jefferson Scale of Physician Lifelong Learning or its variants. Eleven published articles, which reported on studies with post-secondary health professions students, residents, and practicing health professionals met the inclusion criteria. In total, there were 12 independent data sets, with four data sets per group. RESULTS: In total, over seven thousand students, residents, and practicing health professionals responded to the Jefferson Scale (N=7.269). Individual study means tendency to be high, suggesting a high orientation toward lifelong learning among the trainees (students and residents) and practicing health professionals. Meta-analysis results indicated that the orientation toward lifelong learning tended to increase gradually along the education and career continuum. Significant differences in the group means were found between the trainees and practicing health professionals. CONCLUSION: In the reviewed studies, the orientation toward lifelong learning among students, residents, and practicing professionals was high. Nonetheless, although based on separate cohorts, it appears that the orientation toward lifelong learning continues to develop even after the completion of formal training.

Engaging Patients and Clinicians in Establishing Research Priorities for Gestational Diabetes Mellitus.

OBJECTIVES: We involved patients and clinicians in Alberta, Canada, to establish research priorities in gestational diabetes mellitus (GDM), using an approach based on a model proposed by the James Lind Alliance (JLA). METHODS: We adapted the 4-step JLA process to engage women with GDM and clinicians to identify uncertainties about the management of GDM. Uncertainties were identified through a survey and a review of the clinical practice guidelines (CPG). Uncertainties were short-listed by a steering committee, followed by a 1-day facilitated workshop using a nominal group format and involving a similar number of patients and clinicians, who identified the top 10 research priorities. RESULTS: Across the various survey formats, 75 individuals submitted 389 uncertainties, the majority (44; 59%) coming from patients. We removed 9 questions as being out of scope or unclear, and 41 were identified on a review of CPG, resulting in a total of 421 uncertainties. After the priority setting process, the final top 10 research priorities included questions about a simpler, more accurate and convenient screening test; risk factors for GDM; improving postpartum diabetes screening; the impact of GDM on the future health of the children; lifestyle challenges and mental health issues; safety, effectiveness and/or impact of diet and/or medication treatments; appropriate timing for delivery; and how care is provided, organized or communicated. CONCLUSIONS: These top 10 research priorities were informed through a comprehensive and transparent process involving women who have experienced GDM as well as clinicians, and they may be regarded as research priorities for GDM.

Ginger for nausea and vomiting of pregnancy.

Clinical questionCan ginger treat nausea and vomiting of pregnancy?Bottom lineIn the first trimester ginger might improve nausea and vomiting by about 4 points on a 40-point scale or stop vomiting for 1 in 3 women at 6 days. The largest study suggests no increase in fetal malformations or stillbirths, but smaller studies suggest otherwise.