Barriers and facilitators to program directors' use of the medical education literature: a qualitative study.

BACKGROUND: It is unclear how often frontline clinical teachers are using this literature and its evidence base in teaching and assessment. Our study purpose was to examine postgraduate program director perspectives on the utilization and integration of evidence-based medical education literature in their teaching and assessment practices. METHODS: The authors conducted semi-structured telephone interviews with a convenience sample of current and former program directors from across Canada. Interviews were transcribed and analyzed inductively to distil pertinent themes. RESULTS: In 2017, 11 former and current program directors participated in interviews. Major themes uncovered included the desire for time-efficient and easily adaptable teaching and assessment tools. Participants reported insufficient time to examine the medical education literature, and preferred that it be 'synthesized for them'. (i.e., Best evidence guidelines). Participants recognised continuing professional development and peer to peer sharing as useful means of education about evidence-based tools. Barriers to the integration of the literature in practice included inadequate time, lack of financial compensation for teaching and assessment, and the perception that teaching and assessment of trainees was not valued in academic promotion. DISCUSSION: Faculty development offices should consider the time constraints of clinical teachers when planning programming on teaching and assessment. To enhance uptake, medical education publications need to consider approaches that best meet the needs of a targeted audiences, including frontline clinical teachers. This may involve novel methods and formats that render evidence and findings from their studies more easily 'digestible' by clinical teachers to narrow the knowledge to practice gap.

Impact of prolonged PPE use on Canadian health professionals.

AIM: To explore the impact that prolonged use of personal protective equipment (PPE) has on the skin integrity of Canadian health professionals. METHOD: A descriptive, pan-Canadian, cross-sectional, online survey was carried out to explore the type and prevalence of PPE-related skin injury among Canadian health professionals. Convenience sampling was used to disseminate the online survey link to health professionals. RESULTS: There were responses from 757 health professionals. Masks worn included surgical masks (90%), a combination of surgical or N95/KN95 masks (7.7%) and an N95/KN95 mask alone (2.7%). Responses showed 84.6% of providers always wear a mask while at work with 38.5% wearing the same mask all shift; 90% of participants wore protective eye wear. Complications included soreness or pressure injuries behind the ears (70%), new or worsening acne (52%), a runny nose or sneezing (45%), itching (39%), and dry skin (37%). Hand issues included dry skin (53%), red skin (30%), itching (26%), broken skin (20%), rash (16%), and dermatitis (11%) - 51% of respondents did not moisturise their hands. Complications related to gown use included itching (6%), moisture-associated skin damage (5.5%), feeling claustrophobic (4.5%), and new or worsening acne (3%). Increased perspiration due to PPE was experienced in 87.5% of respondents. Some 43% of respondents noted their mental health became worse due to wearing PPE for prolonged periods. CONCLUSION: These findings should be used in the development of guidelines to prevent and manage PPE-related skin injuries among health professionals. Education for professionals should focus on skin protection, prevention of PPE-related skin complications and support for mental health issues.

Designing faculty development to support the evaluation of resident competency in the intrinsic CanMEDS roles: practical outcomes of an assessment of program director needs.

BACKGROUND: The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada mandate that faculty members demonstrate they are evaluating residents on all CanMEDS (Canadian Medical Education Directions for Specialists) roles as part of the accreditation process. Postgraduate Medical Education at the University of Ottawa initiated a 5-year project to develop and implement a comprehensive system to assess the full spectrum of CanMEDS roles. This paper presents the findings from a needs assessment with Program Directors, in order to determine how postgraduate medical faculty can be motivated and supported to evaluate residents on the intrinsic CanMEDS roles. METHODS: Semi-structured individual interviews were conducted with 60 Postgraduate Program Directors in the Faculty of Medicine. Transcribed interviews were analyzed using qualitative analysis. Once the researchers were satisfied the identified themes reflected the views of the participants, the data was assigned to categories to provide rich, detailed, and comprehensive information that would indicate what faculty need in order to effectively evaluate their residents on the intrinsic roles. RESULTS: Findings indicated faculty members need faculty development and shared point of care resources to support them with how to not only evaluate, but also teach, the intrinsic roles. Program Directors expressed the need to collaborate and share resources across departments and national specialty programs. Based on our findings, we designed and delivered workshops with companion eBooks to teach and evaluate residents at the point of care (Developing the Professional, Health Advocate and Scholar). CONCLUSIONS: Identifying stakeholder needs is essential for designing effective faculty development. By sharing resources, faculties can prevent 'reinventing the wheel' and collaborate to meet the Colleges' accreditation requirements more efficiently.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review.

Background: Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards. Methods: We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature. Results: We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers. Conclusions: The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Contexte: Depuis 31 ans, nous sommes témoins d'efforts institutionnels visant à offrir aux cliniciens enseignants une plus grande reconnaissance et à récompenser leur travail. Cependant, d'après leur perception, la valorisation de leurs réalisations en matière d'enseignement clinique demeure insuffisante. Cette revue narrative a un double objectif : d'une part, repérer les qualités qui sont prises en considération en vue de l'octroi d'une reconnaissance officielle ou de l'attribution de récompenses (prix) aux cliniciens enseignants et d'autre part recenser les éléments qui empêchent certains candidats de se voir accorder une telle reconnaissance ou récompense. Méthodes: Nous avons effectué des recherches dans OVID Medline, Embase, Education Source et Web of Science pour repérer les articles pertinents publiés entre 1990 et 2020. Le contenu des résultats des 43 articles sélectionnés a ensuite été analysé pour dégager les principales tendances et questions abordées. Résultats: La plupart des articles pertinents se rapportaient au contexte des États-Unis. En revanche, peu d'articles pertinents concernaient celui du Canada. Sur le plan international, la question des qualités des cliniciens enseignants et des éléments qui peuvent les empêcher d'obtenir la reconnaissance ou une récompense suscite moins d'intérêt depuis 2010. Le fait « d'offrir de la rétroaction ¼, d'avoir « d'excellentes habiletés de communication ¼, d'assurer une « bonne supervision ¼, et un bon « sens de l'organisation ¼ sont des compétences cognitives souvent considérées pour l'octroi de la reconnaissance et l'attribution de récompenses. Parmi les compétences non cognitives, on note le fait d'être « stimulant ¼, d'être « passionné et enthousiaste ¼ et de « créer un environnement offrant du soutien ¼. La dévalorisation de l'enseignement, le manque de critères clairs et l'utilisation de mesures d'évaluation peu fiables sont les principaux obstacles à l'octroi de la reconnaissance ou à l'attribution d'une récompense aux cliniciens enseignants. Conclusions: Les résultats de notre revue narrative mettent en évidence la nécessité de mener des recherches empiriques localement en matière de reconnaissance et de récompense afin d'éclairer les réformes locales des politiques et des pratiques dans le milieu spécifique où elles sont appliquées.

Utilization of evidence-based tools and medical education literature by Canadian postgraduate program directors in the teaching and assessment of the CanMEDS roles.

BACKGROUND: Researchers have shown that clinical educators feel insufficiently informed about how to teach and assess the CanMEDS roles. Thus, our objective was to examine the extent to which program directors utilize evidence-based tools and the medical education literature in teaching and assessing the CanMEDS roles. METHODS: In 2016, the authors utilized an online questionnaire to survey 747 Canadian residency program directors (PD's) of Royal College of Physicians and Surgeons of Canada (RCPSC) accredited programs. RESULTS: Overall, 186 PD's participated (24.9%). 36.6% did not know whether the teaching strategies they used were evidence-based and another third (31.9%) believed they were "not at all" or "to a small extent" evidence-based. Similarly, 31.8% did not know whether the assessment tools they used were evidence-based and another third (39.7%) believed they were "not at all" or "to a small extent" evidence-based. PD's were aware of research on teaching strategies (62.4%) and assessment tools (51.9%), but felt they did not have sufficient time to review relevant literature (72.1% for teaching and 64.1% for assessment). CONCLUSIONS: Canadian PD's reported low awareness of evidence-based tools for teaching and assessment, implying a potential knowledge translation gap in medical education research.

CONTEXTE: La recherche montre que les éducateurs en médecine se sentent insuffisamment informés sur la façon d'enseigner et d'évaluer les rôles CanMEDS. Notre objectif était donc d'examiner dans quelle mesure les directeurs de programmes utilisent des outils fondés sur les données probantes et la littérature en éducation médicale pour enseigner et évaluer les rôles CanMEDS. MÉTHODES: En 2016, les auteurs ont utilisé un questionnaire en ligne pour interroger 747 directeurs de programmes de résidence (DP) agréés par le Collège royal des médecins et chirurgiens du Canada (CRMCC). RÉSULTATS: Parmi les 186 (24,9 %) DP qui ont participé au sondage, 36,6 % ne savaient pas si les stratégies d'enseignement qu'ils utilisaient étaient fondées sur des données probantes et un tiers (31,9 %) estimaient qu'elles n'étaient « pas du tout ¼ fondées sur des données probantes ou qu'elles ne l'étaient que « dans une faible mesure ¼. De surcroît, 31,8 % ne savaient pas si les outils d'évaluation qu'ils utilisaient étaient fondés sur des données probantes et un tiers (39,7 %) estimait qu'ils l'étaient « dans une faible mesure ¼ ou qu'ils ne l'étaient « pas du tout ¼. Les DP ont déclaré qu'ils étaient au courant de l'existence d'études sur les stratégies d'enseignement (62,4 %) et sur les outils d'évaluation (51,9 %), mais qu'ils manquaient de temps pour se familiariser avec la documentation pertinente (72,1 % pour l'enseignement et 64,1 % pour l'évaluation). CONCLUSIONS: Les DP au Canada sont peu familiers avec les outils d'enseignement et d'évaluation fondés sur les données probantes, ce qui suggère un transfert des connaissances lacunaire de la recherche à l'éducation médicale.

Support of supervised injection facilities by emergency physicians in Canada.

BACKGROUND: Despite evidence supporting the implementation of supervised injection facilities (SIFs) by multiple stakeholders, no evaluation of emergency physicians' attitudes has ever been documented towards such facilities in Canada or internationally. The primary goal of our study was to determine the opinions and perceptions of emergency physicians regarding the implementation of SIFs in Canada. METHODS: We conducted a national electronic survey of staff and resident emergency physicians in Canada using an iteratively designed survey tool in consultation with content experts. Invitations to complete the survey were sent via email by the Canadian Association of Emergency Physicians. Inclusion criteria required respondents to have treated an adult patient in a Canadian emergency department within the preceding 6 months. The primary measure was the proportion of respondents who would support, not support or were unsure of supporting SIFs in their community with the secondary measure being the likelihood of respondents to refer patients to a SIF if available. RESULTS: We received 280 responses out of 1353 eligible physicians (20.7%), with the analysis conducted on 250 responses that met inclusion criteria (18.5%). The majority of respondents stated they would support the implementation of SIFs in their community (N=172; 74.5%) while 10.8% (N=25) would not and 14.7% (N=34) did not know. The majority of respondents said they would refer their patients to SIFs (N=198; 84.6%), with 4.3% (N=10) who would not and 11.1% (N=26) who were unsure. CONCLUSION: The findings from our study demonstrate that the majority of emergency physician respondents in Canada support the implementation of such sites (74.5%) while 84.6% of respondents would refer patients from the emergency department to such sites if they did exist. Given that many Canadian cities are actively pursuing the creation of SIFs or imminently opening such sites, it appears that our sample population of emergency physicians would both support this approach and would utilize such facilities in an effort to improve patient-centered outcomes for this often marginalized population.