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Objective Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individuals with early psychosis.Method We conducted semistructured qualitative interviews with 19 service users (cisgender and transgender women, nonbinary individuals) receiving care in 2 early psychosis programs in Ontario, Canada. We also conducted semistructured interviews and focus groups with 36 clinicians providing SRH or mental health care to this population. Participants were asked about SRH care access/provision experiences and the interplay with psychosis. Using a social interactionist orientation, a thematic analysis described and explained service user and clinician perspectives regarding SRH care.Results Amongst both service users and clinician groups, common themes developed: (a) diversity of settings: SRH services are accessed in a large range of spaces across the health care system, (b) barriers in nonpsychiatric SRH care settings: psychosis impacts the ability to engage with existing SRH services, (c) invisibility of SRH in psychiatric settings: SRH is rarely addressed in psychiatric care, (d) variability of informal SRH-related conversations and supports, and cutting across all of the above themes, (e) intersecting social and cultural factors impacted SRH services access.Conclusions SRH is important for health and wellbeing; improvements are urgently needed across the healthcare system and within early psychosis programs to meet this population's multifaceted SRH needs.

To examine how project Extension for Community Healthcare Outcomes–Integrated Mental and Physical Health (ECHO-IMPH) influences the attitudes and approaches of primary care providers and other participants towards patients.

Purpose: The purpose of this co-produced research project was to conduct interviews with people working in, volunteering with and accessing Canadian recovery colleges (RCs) to explore their perspectives on what an evaluation strategy for RCs could look like. Design/methodology/approach: This study used a participatory action research approach and involved semistructured interviews with 29 people involved with RCs across Canada. Findings: In this paper, the authors share insights from participants about the purposes of RC evaluation; key elements of evaluation; and the most applicable and effective approaches to evaluation. Participants indicated that RC evaluations should use a personalized, humanistic and accessible approach. The findings suggest that evaluations can serve multiple purposes and have the potential to support both organizational and personal-recovery goals if they are developed with meaningful input from people who access and work in RCs. Practical implications: The findings can be used to guide evaluations in which aspects that are most important to those involved in RCs could inform choices, decisions, priorities, developments and adaptations in RC evaluation processes and, ultimately, in programming. Originality/value: A recent scoping review revealed that although coproduction is a central feature of the RC model, coproduction principles are rarely acknowledged in descriptions of how RC evaluation strategies are developed. Exploring coproduction processes in all aspects of the RC model, including evaluation, can further the mission of RCs, which is to create spaces where people can come together and engage in mutual capacity-building and collaboration.

Trauma patients and surgery residents can feel disconnected due to differences in background and a lack of time for adequate communication, yet they understand each other's stressors and share a desire for increased communication and connection.

This article describes the authors’ personal experiences of collaborating across international borders in academic research. International collaboration in academic medicine is one of the most important ways by which research and innovation develop globally. However, the intersections among colonialism, academic medicine, and global health research have created a neocolonial narrative that perpetuates inequalities in global health partnerships. The authors critically examine the visa process as an example of a racist practice to show how the challenges of blocked mobility increase inequality and thwart research endeavors. Visas are used to limit mobility across certain borders, and this limitation hinders international collaborations in academic medicine. The authors discuss the concept of social closure and how limits to global mobility for scholars from low- and middle-income countries perpetuate a cycle of dependence on scholars who have virtually barrier-free global mobility—these scholars being mainly from high-income countries. Given the current sociopolitical milieu of increasing border controls and fears of illegal immigration, the authors’ experiences expose what is at stake for academic medicine when the political sphere, focused on tightening border security, and the medical realm, striving to build international research collaborations, intersect. Creating more equitable global partnerships in research requires a shift from the current paradigm that dominates most international partnerships and causes injury to African scholars.

The rapid rise of cases of coronavirus disease 2019 (COVID-19) has led to the implementation of public health measures on an unprecedented scale. These measures have significantly affected the training environment and the mental health of health care providers and learners. Design thinking offers creative and innovative solutions to emergent complex problems, including those related to training and patient care that have arisen as a result of the COVID-19 pandemic. Design thinking can accelerate the development and implementation of solution prototypes through a process of inspiration, ideation, and implementation. Digital technology can be leveraged as part of this process to provide care and education in new or enhanced ways. Online knowledge hubs, videoconference-based interactive sessions, virtual simulations, and technology-enhanced coaching for health care providers are potential solutions to address identified issues. Limitations of this model include inherent bias toward utilitarian instead of egalitarian principles and the subsequent threat to diversity, equity, and inclusion in solutions. Although medical educators have embraced digital transformation during the COVID-19 pandemic, there is a need to ensure that these changes are sustained.

Supplemental Digital Content is available in the text

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Objective: The study explored knowledge, attitude, and practices of Canadian Medical Education Directions for Specialists (CanMEDS) “‘Leader” role in faculty psychiatrists in a university setting. Methods: This is a qualitative study using a thematic analysis approach. Participants were identified by purposive, convenience, and snowball sampling. Telephone interviews were conducted to explore participants’ perceptions of leadership. Qualitative analysis was carried out using a constant comparative analysis approach to identify themes across the interview data. Data was transcribed and coded into themes and categories to form an analysis of physicians’ knowledge, attitude, and practices of the CanMEDS “Leader” role. Results: Twenty-eight faculty psychiatrists participated in the study. The following themes and subthemes emerged from analysis: (a) characteristics of leadership and lack of clarity regarding CanMEDS “Leader” role (subthemes: differences between manager and leader, lack of specificity and practicality, relevance to practice) and (b) the meaning of leadership (subthemes: “positional leadership” and “everyday leadership,” physician as team leader, developing leadership skills, getting beyond “occupational adolescence”). Conclusion: Participants perceived CanMEDS “Leader” role description as a high-level vision, which needs practice-oriented guidance. Participants conceptualized the dual nature of physician leadership at an individual level and at an organizational level. Leadership training is important both in residency as well as lifelong learning.

Objective: Co-production involves service providers and service users collaborating to design and deliver services together and is gaining attention as a means to improve provision of care. Aiming to extend this model to an educational context, the authors assembled a diverse group to develop co-produced education for psychiatry residents and medical students at the University of Toronto over several years. The authors describe the dynamics involved in co-producing psychiatric education as experienced in their work. Methods: A collaborative autobiographical case study approach provides a snapshot of the collective experiences of working to write a manuscript about paying service users for their contributions to co-produced education. Data were collected from two in-person meetings, personal communications, emails, and online comments to capture the fullest possible range of perspectives from the group about payment. Results: The juxtaposition of the vision for an inclusive process against the budgetary constraints that the authors faced led them to reflect deeply on the many meanings of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had implications at personal, organizational, and social levels. Conclusion: Paying mental health service user educators for their contributions is an ethical imperative for the authors. However, unless payment is accompanied by other forms of demonstrating respect, it aligns with organizational structures and practices, and it is connected to a larger goal of achieving social justice, the role of service users as legitimate knowers and educators and ultimately their impact on learners will be limited.

This article explores conceptual and methodological challenges surrounding the recovery of patients’ voices in the history of medicine. We examine the debate that followed Roy Porter’s seminal article, ‘The Patient’s View: Doing Medical History from Below’ (1985). Porter argued that patients should be given a central role in medical history, aiming to restore to patients a voice and agency that is often lost in ‘physician-centered’ historical narratives. His work carried significant influence but also sparked an ongoing debate about the possibility of conducting ‘patient-centered’ history of medicine. The growth of the medical humanities has afforded renewed attention to patient narratives, supporting the need to recognise patients’ voices in contemporary healthcare and medical education. However, several barriers complicate and problematise the expansion of a patient-centred epistemology across historical periods. Postmodern critics have expressed scepticism that ‘the patient’s view’ can be recovered from history, with some claiming that ‘the patient’ is a construct of the ‘medical gaze’ whose subjectivity cannot be reconstituted outside of sociohistorical discourses of knowledge and power. Psychiatry in the mid-20th century presents a particular challenge for patient-centred history. We discuss the influence of postmodern theorists, especially Michel Foucault, whose work is seen as undermining the possibility of a patient-centred epistemology. We argue against Foucault’s erasure of the patient, and instead explore alternate constructivist epistemologies, focusing on the hermeneutics of Hans-Georg Gadamer and dialogism of Mikhail Bakhtin, to help address historiographical challenges in recovering ‘the patient’s view’. To illustrate the value of Gadamerian and Bakhtinian approaches, we apply them to a case study from the Verdun Protestant Hospital (Québec, Canada) from 1941 to 1956, which sheds light on the introduction of the first antipsychotic, chlorpromazine, into clinical practice. We highlight how Gadamer’s hermeneutics and Bakhtin’s dialogism together offer insights into patient perspectives during this liminal period in the history of psychiatry.

Objective: Individuals with severe mental illness (SMI) are disproportionally affected by medical comorbidities, resulting in poor physical health and premature death. Despite this, care for chronic medical conditions is suboptimal, and there is limited research that explores this phenomenon from the patient’s perspective. The aim of this study was to identify barriers and facilitators of engagement with a physical health service experienced by individuals with SMI.Methods: Adults with SMI were recruited from a large psychiatric hospital and offered referral to a physical health service focused on the prevention and treatment of obesity and diabetes. Interviews were conducted at referral, 3, and 6 months. Data from 56 interviews of 24 participants were analyzed using the framework method to identify factors influencing engagement.Results: Barriers to engagement were identified at individual, medical program, and health system levels. Factors influencing the individual experience included difficulty in care coordination, affective symptomatology, and ability to bond with providers. Factors at the program level included difficulty adjusting to the clinic environment and the inability to achieve treatment goals. Factors at the system level included challenges in attending multiple appointments in a fragmented health system, lack of social support, and financial constraints.Conclusions: This qualitative study suggests that traditional models of medical care for chronic conditions pose challenges for many individuals with SMI and contribute to health disparities. Adaptation of medical care to populations with SMI and close collaboration between medical and mental health services are necessary to improve medical care and, subsequently, health outcomes.

IntroductionDespite the known negative health outcomes of concussions in minor level boys’ hockey, there has been significant resistance to creating a safer game with less body checking.MethodsTo better understand cultural barriers that prevent making the sport safer for youth and adolescents, semistructured interviews, with 20 ice hockey stakeholders, were conducted and analysed using thematic analysis.ResultsThrough this analysis, two primary concepts arose from respondents. The first concept is that body checking, despite the harm it can cause, should be done in a respectful sportsmanlike fashion. The second concept is the contradiction that the game of ice hockey is both dynamic and unchangeable.DiscussionUsing structural functionalist theory, we propose an argument that the unfortunate perpetuation of violence and body checking in youth ice hockey serves to maintain the social order of the game and its culture. Any strategies aimed at modifying and promoting healthy behaviour in the game should take these concepts into account.

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With 40 to 65% of mental health patients being cared for by family members, nearly 500,000 Canadians are serving as caregivers. Yet family members are often excluded from daily clinical interactions and the development of mental health continuing medical education (CME). This qualitative study aimed to understand how best to involve families in mental health CME and how to advance their meaningful and equitable engagement in such initiatives. Semi-structured interviews were conducted with two samples: mental health care providers (n= 8) and family members of individuals diagnosed with a co-occurring addiction and mental health problems (n= 12) to explore barriers, facilitators, and strategies for family engagement. Several themes related to the perception of expertise emerged from the interviews, including the tension between the validity of knowledge based on education/credentials and knowledge based on lived experience, as well as expressions of “voice.” Participants also identified barriers to, and ethical considerations related to, family engagement, including stigma and confidentiality, and recommended strategies and supports to meaningfully include the family perspective within mental health CME. Aligning with the movement to improve collaboration between mental health professionals and service users requires developing relationships with family members. Identifying strategies to involve families in the development of CME is crucial to initiating and maintaining family engagement.

The authors describe a novel course that pairs service users as advisors to senior psychiatry residents with the goals of improving the residents’ understanding of recovery, reducing negative stereotypes about people in recovery, and empowering the service users who participated. Service users who had experience working as peer support workers and/or system advocates were selected for a broad and deep understanding of recovery and an ability to engage learners in constructive dialogue. They met monthly with resident advisees over a period of 6 months. They were supported with monthly group supervision meetings and were paid an honorarium. Quantitative evaluations and qualitative feedback from the first two cohorts of the course, comprising 34 pairs, are reported here. The first cohort of residents responded with a wide range of global ratings and reactions. In response to their suggestions, changes were made to the structure of the course to create opportunities for small group learning and reflective writing and to protect time for residents to participate. The second cohort of residents and both cohorts of service users gave acceptably high global ratings. Residents in the second cohort described gaining a number of benefits from the course, including an enhanced understanding of the lived experience of recovery and a greater sense of shared humanity with service users. Advisors described an appreciation for being part of something that has the potential for changing the practice of psychiatry and enhancing the lives of their peers. Positioning service users as advisors to psychiatry residents holds promise as a powerful way of reducing distance between future psychiatrists and service users and facilitating system reform toward person-centered recovery-oriented care.

Introduction:Women who are younger in age are more likely to smoke during pregnancy and postpartum and tend to have less success with cessation/reduction. There is an unmet need for interventions targeted to pregnant and postpartum young women that provide them with support to quit/reduce long-term into the postpartum period and beyond.Aims:Our study aimed to gain an in-depth understanding of the perspectives of young pregnant and postpartum women of text messaging (TM) as a conduit for smoking cessation/reduction, and to determine the appropriate content, frequency, duration and unique features needed for an effective cessation/reduction TM programme.Methods:Six focus groups and six telephone interviews were convened with 36 pregnant and postpartum women 16–30 years of age.Results:Three main themes were identified: 1) topic areas that women would like TM to focus on; 2) the need for messages to be tailored; and 3) the importance for the programme to take a woman-centered approach.Conclusions:Respondents supported the idea of a TM cessation/reduction intervention and had clear programme recommendations. A personalised, woman-centered TM programme that meets a young woman's unique needs and addresses her concerns through her participation and direction is likely to empower and support her to quit/reduce.

The authors sought to evaluate a formal mentorship program for second-year psychiatry residents at the University of Toronto after the program’s first year of implementation. Ten mentees and ten faculty mentors were interviewed by fellow second-year residents and an independent researcher, respectively, about their experiences in the program. Interview data were thematically coded and analyzed using a grounded theory approach. Three major themes were identified. First, participants emphasized the importance of a natural, flexible, and engaging matching process for mentors and mentees. Many experienced the random assignment approach to matching and the mandatory nature of the program as barriers to developing a meaningful relationship with their mentors. Second, participants expressed a preference for geographic proximity between mentor and mentee workplaces and for meetings to take place in informal settings in order to improve the quality and quantity of their interactions. Lastly, participants felt that clear directions and expectations about the program’s goals should be communicated, and that a forum for information sharing among mentors was needed. Overall, the majority of participants believed that the program facilitated growth and development and provided positive opportunities for both mentors and mentees. While challenges were present in the program, participants provided tangible recommendations to improve the process.

A Correction to this paper has been published: https://doi.org/10.1007/s40596-021-01471-6