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Background. Unsafe sexual practices, substance abuse, and domestic violence impact women's health. This study examined whether lifestyle risk assessment during a general medical examination and counseling about sexually transmitted disease during consultations for adolescent contraception and treatment of a sexually transmitted disease were more frequently done by recently trained obstetricians–gynecologists compared to those of obstetrician–gynecologists licensed before 1990. It also documented obstetrician–gynecologists' evaluations of their medical training in that area. Methods. A pretested anonymous mail survey was conducted in 1995 with all 241 obstetrician–gynecologists practicing in Quebec, Canada; 66% responded ( N = 158). Results. Compared to less recently trained obstetrician–gynecologists, recently trained obstetrician–gynecologists reported routinely assessing tobacco use (77 vs 51%, P = 0.01), alcohol use (50 vs 23%, P = 0.004), and illicit drug use (33 vs 17%, P = 0.05) more frequently during a patient's general medical evaluation. However, they did not assess condom use (50%), number of sexual partners, sexual partners' sexually transmitted disease risk (30%), or experiences of sexual abuse or domestic violence (3%) more frequently than less recently trained obstetrician–gynecologists. They were also not more likely to counsel teenagers about sexually transmitted disease prevention during a contraceptive consultation (30–60%) or to discuss human immunodeficiency virus infection (29%) and hepatitis B immunization (13%) during a sexually transmitted disease consultation. Conclusion. Although evaluation of substance use was better among recently trained OB-Gyn physicians, little or no improvement has been noted regarding STD prevention or the evaluation of sexual abuse or domestic violence, all important lifestyle risks that directly affect women's health and well-being.

Les ergothérapeutes ayant une pratique communautaire ont adapté leurs savoirs aux particularités et aux attentes de leurs milieux. Ce faisant, par leur réflexion dans l'agir et sur l'agir professionnel, ils ont développé des savoirs spécifiques bien ancrés dans la réalité de la pratique. Une enquête sur l'ergothérapie dans les Centres locaux de services communautaires du Québec (CLSC) a révélé trois théories que les ergothérapeutes ont développées au quotidien de leur pratique. La première se rapporte principalement au mode de traitement des demandes de services alors que les deux autres réfèrent plus directement au rôle de l'ergothérapeute au sein de l'équipe d'intervention. Elles reflètent les pressions organisationnelles que vivent les ergothérapeutes qui travaillent en milieux communautaires et les stratégies qu'ils ont élaborées pour y faire face. Cet article présente d'abord brièvement les résultats de l'enquête, les théories qui en émergent et les éléments de congruence avec les théories de référence en ergothérapie. Quelques pistes de réflexion sont proposées pour harmoniser les contraintes actuelles vécues dans le réseau communautaire des services de santé et les valeurs professionnelles en ergothérapie.

To determine whether graduating family physicians are exposed to collaboration between family physicians and nurse clinicians during their training, as well as their opinions about shared care between doctors and nurse clinicians in the delivery of patient care.Anonymous online survey.Two French-Canadian university family medicine residency programs.The 2010 and 2011 graduating family physicians (N = 343) from the University of Montreal and Laval University in Quebec.The extent to which nurse clinicians in graduating family physicians' training milieu were involved in preventive and curative patient care activities, and graduates' opinions about nurse clinicians sharing care with physicians.Of 343 graduates, 186 (54.2%) participated in the survey. Although as residents in family medicine their exposure to shared care with nurse clinicians was somewhat limited, respondents indicated that they were generally quite open to the idea of sharing care with nurse clinicians. More than 70% of respondents agreed or strongly agreed that nurse clinicians could adjust, according to protocols of clinical guidelines, the treatment of patients with diabetes, hypertension, and asthma, as well as regulate medication for pain control in terminally ill patients. By contrast, respondents were less favourable to nurse clinicians adjusting the treatment of patients with depression. More than 80% of respondents agreed or strongly agreed that nurse clinicians could initiate treatment via a medical directive for routine hormonal contraception, acne, uncomplicated cystitis, and sexually transmitted infections. Respondents' opinions on nurse clinicians initiating treatment for pharyngitis and otitis were more divided.Graduating family physicians are quite open to collaborating with nurse clinicians. Although they have observed some collaboration between physicians and nurses, there are areas of shared clinical activities in which they would benefit from further exposure and training.

The objective of this study was to identify the characteristics of physicians practicing obstetrics in the province of Quebec, Canada and relate these to their opinions about midwifery practice. A self-administered questionnaire was sent to a systematic random sample of 844 physicians; 597 physicians answered (response rate = 71%). Results show that physicians who were more open to midwives had a more client-centered approach to maternity care. They had attended premed school outside Canada but received their specialty training in Canada. They also had often collaborated with midwives since they had begun practicing. Physicians who were more open to midwives were less demanding in terms of level of midwife training. They agreed that midwives should be self-regulating. It is concluded that greater knowledge of midwives’ practice, gained through collaboration in the workplace and interdisciplinary education, could help physicians to better understand the significant contributions that midwives can make to the health care system.

Background Until recently, Canada was the only industrialized country that had not legalized midwifery. In the province of Quebec the government adopted a law to evaluate midwifery in eight pilot projects before generalizing the practice. This study examined the similarities and differences among midwives in Quebec. Methods Using data from a 1991 mail survey, we compared 31 nurse-midwives, 12 professional midwives, and 27 lay midwives to assess professional background and opinions about selected maternity care issues and aspects of future midwifery practice, such as midwife training options, responsibilities, setting for midwifery care, relationship to other maternity caregivers, autonomy, and control over their profession. Results Midwives largely shared the same philosophy of care but had different viewpoints on two main professional aspects: compared with professional midwives and nurse-midwives, lay midwives preferred to deliver antepartum, intrapartum, and postpartum care at a client's home or an independent birthing center; like professional midwives, they rejected nursing as a prerequisite to midwifery training. Other interrelated personal, social, political, and legal factors were also associated with different beliefs. Conclusions Despite the differences among the three groups, the process under way in Canada is to recognize a single profession of midwife. Creating a unified profession is a challenge that Canadian midwives with different backgrounds face in the 1990s.

Through a mail survey in 1991, we compared the opinions of 597 physicians practicing obstetrics, 723 maternity care nurses, and 70 midwives from the province of Quebec, Canada, about selected maternity care issues, including the practice of midwifery. Results showed that divergent points of view existed between and within the three groups on many maternity care issues. Physicians were more divided over the routine use of obstetric intervention than the approach to care or their opinion about midwives. Midwives held more client-centered and less interventionist attitudes than nurses or physicians. Nurses were much more open to midwives than physicians, but 20 to 30 percent of physicians saw some advantages in legalizing the practice of midwifery. Physicians and nurses generally considered midwives as a greater professional threat to the other group than to themselves. The fact that many physicians were critical of current maternity care is difjcult to reconcile with their general opposition to midwives. How and to what extent physicians will respond to women's desire for more humanized and less interventionist care remains an open question. Given the problems facing maternity care in North America, expanding midwifery services is an alternative to examine seriously. (BIRTH 21:2, June 1994)

Nonrecognition and mismanagement of work-related diseases is often linked to inadequate medical training. However, undergraduate training in occupational medicine faces many challenges, including lack of student interest and limited curriculum time. The purpose of this article is to present an undergraduate training program developed in one medical school to ensure that all medical students acquire the basic knowledge to recognize work-related health conditions and understand the fundamental principles of workers' comprehensive care. The program involves various learning methods including case studies, small-group learning, interactive large-group teaching, field activities, and e-learning. It has resulted in improving students' attitudes and competencies in occupational medicine and requires little curriculum time.

Past studies have shown in many instances that elderly people are represented in the hospital emergency room in proportion to their distribution in the population. It is possible, though, that elderly patients in the emergency room are using different types of resources than individuals of a younger age. Samples of two hospital emergency room users were selected in 1981 and in 1986. Patients aged 25 years or older were included in the study. The dependent variable was the extent to which patients used resources available at the hospital emergency room only or at alternative emergency medical services in the community. The effect of age on the use of resources in the hospital emergency rooms was estimated separately for those who were transported to the emergency room by ambulance and for those who were not. Age had an effect on use of resources under both conditions, regardless of the patients' gender, time of the visits, availability of alternative sources of emergency care, and diagnostic categories. The role of the hospital emergency room is to address medical care needs of specific segments of the population in special circumstances. Elderly emergency room patients are indeed one of these specific segments with very special needs.

Since the early 1970s, there have been two primary care networks in Quebec: the traditional one characterized by private practice remunerated on a fee-for-service basis, and the public one comprising 15 percent of physicians and characterized by salaried practice within publicly funded local community health service centers (CLSCs). Using data collected on 616 Quebec generalists, 333 in private practice and 283 in CLSCs, we compared physicians' profiles in both networks. In contrast to their colleagues in private practice, CLSC physicians are younger, more often women, and more often graduates of innovative primary care training programs. They are more sensitive to the biopsychosocial nature of health problems and to giving patients an active role in their care. Significant differences were also observed in physicians' self-reported clinical practices, more so for women than for men. The study suggests that alternative primary care settings attract physicians that are more preventive and socially oriented. As a result, they may contribute to the emergence of a more comprehensive type of medical practice in health care delivery systems.

Attitudes of medical caregivers toward treating the elderly were defined in reference to two aspects of quality of care: the technical and the psychosocial aspects. The correlation between these aspects was assessed using samples of first-year and third-year students, interns, and MDs who had graduated two or four years previously. Socioeconomic background and orientational characteristics were also entered in an elementary structural model predicting attitudes toward treating elderly patients. The results clearly indicated that the two aspects of attitudes toward treating elderly persons were so highly correlated that only one dimension defined these attitudes, except in the case of first-year students. Furthermore, only two orientational characteristics consistently explained these attitudes throughout the five groups, while background characteristics were excluded from the model in the graduate MD group. These results suggest that studies of the determinants of medical student attitudes toward treating the elderly should test for the number of dimensions before estimating the effect of a set of predictors.

To investigate how often family physicians see adolescents with mental health problems and how they manage these problems.Mailed survey completed anonymously.Province of Quebec.All 358 French-speaking family physicians who practise primarily in local community health centres (CLSCs), including physicians working in CLSC youth clinics, and 749 French-speaking practitioners randomly selected from private practice.Frequency with which physicians saw adolescents with mental health problems, such as depression, suicidal thoughts, behavioural disorders, substance abuse, attempted suicide, or suicide, during the last year or since they started practice.Response rate was 70%. Most physicians reported having seen adolescents with mental health problems during the last year. About 10% of practitioners not working in youth clinics reported seeing adolescents with these disorders at least weekly. Anxiety was the most frequently seen problem. A greater proportion of physicians working in youth clinics reported often seeing adolescents for all the mental health problems examined in this study. Between 8% and 33% of general practitioners not working in youth clinics said they had not seen any adolescents with depression, behavioural disorders, or substance abuse. More than 80% of physicians had seen adolescents who had attempted suicide, and close to 30% had had adolescent patients who committed suicide.Family physicians play a role in adolescent mental health care. The prevalence of mental health problems seems higher among adolescents who attend youth clinics. Given the high prevalence of these problems during adolescence, we suggest on the basis of our results that screening for these disorders in primary care could be improved.

To document with whom family physicians communicate when evaluating adolescents with mental health problems, to whom they refer these adolescents, and their knowledge and perceptions of the accessibility of mental health services in their communities.Mailed survey completed anonymously.Province of Quebec.All general practitioners who reported seeing at least 10 adolescents weekly (n = 255) among 707 physicians who participated in a larger survey on adolescent mental health care in general practice.Whether family physicians communicated with people (such as parents, teachers, or school nurses) when evaluating adolescents with mental health problems. Number of adolescents referred to mental health services during the last year. Knowledge of mental health services in the community and perception of their accessibility.When asked about the last 5 adolescents seen with symptoms of depression or suicidal thoughts, depending on type of practice, 9% to 19% of physicians reported routinely communicating with parents, and 22% to 32% reported not contacting parents. Between 16% and 43% of physicians referred 5 adolescents or fewer to mental health services during a 12-month period. Most practitioners reported being adequately informed about the mental health services available in their local community clinics. Few physicians knew about services offered by private-practice psychologists, child psychiatrists, or community groups. Respondents perceived mental health services in community clinics (CLSCs) as the most accessible and child psychiatrists as the least accessible services.Few physicians routinely contact parents when evaluating adolescents with serious mental health problems. Collaboration between family physicians and mental health professionals could be improved. The few referrals made to mental health professionals might indicate barriers to mental health services that could mean many adolescents do not receive the care they need. The lack of access to mental health services, notably to child psychiatrists, reported by most respondents could explain why some physicians choose not to refer adolescents.

Background and objectives The training of caring physicians represents an important goal of medical education. Little is known however, on whether medical faculty constitute good role models for teaching humanistic skills to medical students. In this study, we examined to what extent medical students at innovative and traditional schools perceived their teachers as humanistic physicians and teachers. We also explored whether pre-clinical and clinical students shared the same perceptions. Methods A mail survey was conducted in Canada of all second-year students and senior clerks at one innovative medical school (problem-based learning (PBL), patient-centred, community-oriented) and three traditional medical schools. Students were asked to what extent they agreed or disagreed that the majority of their teachers behaved as humanistic physicians and teachers; 10 statements were used. Overall, 65% of the 1039 students returned the questionnaire. Results Over 25% of second-year students and 40% of senior clerks did not agree that their teachers behaved as humanistic caregivers with patients or were good role models in teaching the doctor–patient relationship. More than half of second-year students and senior clerks did not agree that their teachers valued human contact with them or were supportive of students who had difficulties. There were few differences in the way medical students at innovative and traditional schools perceived their teachers’ humanistic qualities. At the pre-clinical level however, there were more students from the innovative school than from the traditional schools (around 60% vs. 40%, P

This study documents behaviours of people with HIV/AIDS regarding the disclosure of their HIV-positivity when seeking dental care. An anonymous survey was conducted in Québec, Canada, from 1993 to 1995, using a sample of 463 people with HIV/AIDS recruited from different sources. Over 80% of respondents reported having sought dental care since becoming aware of their positivity. Of these, 54% reported having always disclosed their HIV-positivity to dentists, while 25% reported never having disclosed this information to dentists. However, 83% of all respondents preferred that the dentist be aware of their HIV status. Respondents gave reasons related to the sociopathological impact of HIV infection to explain their behaviours. The predictors of disclosure of HIV-positivity to the dentist were: gender, main source of payment for dental care, prior disclosure of HIV status to family members, prior disclosure of HIV status to co-workers, and trust in the maintenance of confidentiality by the dentist. These results emphasize the need to use universal precautions in the dental office and to promote dentist-patient relations free of discrimination, so that people with HIV/AIDS are not reluctant to disclose their health status and are confident that such disclosure will lead to care best adapted to their condition.

OBJECTIVES: This study examined physicians' evaluation of sexual health risks during a general medical examination and sexually transmitted disease (STD) counseling during consultations for adolescent contraception and treatment of an STD. METHODS: An anonymous mail survey was conducted in 1995 with a stratified random sample of 1086 general practitioners and all 241 obstetrician-gynecologists practicing in Quebec, Canada. RESULTS: Fewer than half of the respondents reported routinely inquiring about condom use and number of sexual partners during a general medical examination. Female general practitioners engaged in more sexual health risk assessment and counseling than male general practitioners. CONCLUSIONS: This study suggests a low level of involvement in STD prevention by generalists and obstetrician-gynecologists.

Purpose To survey recently trained family physicians about their practices and perceptions regarding sexual history taking, drug-use history taking, and safe-sex counseling. Method The study was conducted with all 1991 graduates from the four family practice residency programs in Quebec, Canada. Data were collected in 1992 by using a mailed questionnaire. Results A total of 148 (80%) of the 186 contacted physicians responded. The physicians reported taking a sexual history less frequently than a drug-use history when seeing patients for a general medical examination (42% versus 71%) or a first pregnancy visit (75% versus 91%). When taken, the sexual history was often too superficial to detect risk behaviors. Consequently, safe-sex counseling was infrequent. Over 20% of the physicians worried about patients' discomfort, were uneasy discussing sexual matters, and did not feel properly trained in sexual history taking. Graduates from the family practice residency at the school that offered training in human sexuality performed better sexual history taking than did graduates from the residencies at the other schools. Conclusions Although infections from sexually transmitted diseases and the human immunodeficiency virus are important causes of morbidity and mortality, family physicians are still not actively involved in their prevention. The study suggests that medical education might be deficient in this area and that more training in human sexuality should be provided for family physicians.

We divided 900 general practitioners into two groups: one group received a questionnaire measuring both attitudes and behaviors toward preventive aspects of medical care, while the other received two separate questionnaires--one measuring behaviors, and one measuring attitudes. Response rates of the two groups were similar. Respondents in the first group retrieved their answer to the attitudinal items when responding to behavioral items, increasing the correlations between attitudes and behaviors by an average of .147 as compared to the second group; hence the second procedure was preferable.

Hospital emergency services located in urban areas have been severely congested for several years in the province of Quebec. This problem is not caused by ambulatory patients who are using emergency services as a regular source of care, but by patients in need of emergency services. To study the factors affecting the utilization rates of emergency services in two urban areas, the city of Laval and the Quebec metropolitan area, two samples of more than 30,000 patients each were drawn from the 1981 file of the Regie de l'assurance-maladie du Quebec. The utilization rates of emergency services for emergent and urgent causes in these two samples were computed on the basis of the census tract location of these patients. The socio-economic characteristics of these census tracts were taken from the 1981 Canadian census, the distance travelled from each census tract to the location of hospital emergency services was computed and included as a predictor of the utilization rates. Also, the prevalence of chronic and psychiatric diagnoses were obtained for each census tract. The result of the analysis showed that distance affected the utilization rates only in the Quebec metropolitan area where the hospitals are mostly located in the downtown area near deprived and working class neighbourhoods, while the socio-economic characteristics affected the utilization rates in both Quebec and Laval.

The authors examined how medical trainees and recent graduates of three Quebec medical schools value 16 dimensions of medical competence classified in four broad categories: clinical, technological, humanistic, and social and preventive. To assess perceived educational needs, the trainees' perceptions of the importance that medical faculties attribute to these same dimensions in the education of physicians were also examined. The survey was conducted in 1986-87 via a questionnaire mailed to 2,030 individuals, including freshmen, juniors, interns, residents, and newly practicing generalists; 80.3% responded. Compared with the views attributed to the faculty, the medical trainees gave more importance to basic diagnostic and therapeutic skills such as the medical history, the physical examination, and the treatment of common diseases. They also valued to a greater extent non-biological dimensions of clinical competence, such as communication with patients, patient education, the social context of disease, and the multidisciplinary nature of patient care, while they ascribed less importance to medical technology and rare diseases. The study raises the question of the relevance of medical education to medical practice by suggesting that those who are preparing themselves to become doctors may not be receiving the training they wish to receive.

OBJECTIVE: To describe the form of midwifery practice preferred by physicians practising obstetrics, nurses providing maternity care and midwives. DESIGN: Mail survey conducted in 1991. SETTING: Province of Quebec. PARTICIPANTS: A systematic random sample of 844 physicians, 808 nurses and 92 midwives; 597, 723 and 92 respectively completed the questionnaire, for an overall response rate of 80%. MAIN OUTCOME MEASURES: Midwife training options, range of responsibilities, location of midwifery care, relationship to other maternity care providers and degree of autonomy. RESULTS: Most of the physicians, nurses and midwives surveyed agreed that if midwifery was legalized, midwives should have a university degree, provide basic care to women with normal pregnancy and delivery, provide prenatal and postnatal care in hospitals and community health centres, perform delivery in hospitals and work in close collaboration with the other maternity care professionals. Disagreement existed concerning the level of university training required, the need for training in nursing first, the scope of medical intervention performed by midwives, out-of-hospital delivery, the autonomy of midwives and control over their practice. CONCLUSION: Some consensus on midwifery practice exists between physicians, nurses and midwives. In jurisdictions where opposition to midwives is strong, such consensus could serve as the starting point for the introduction of midwifery.

Summary. A mail questionnaire was used to survey the social and demographic characteristics, educational background, attitudinal profiles and expected career choice of 243 first-year students enrolled in three US medical schools. The aim was to determine whether different types of schools selected different types of students. Two schools were considered as conventional whereas one school was considered as innovative both in its admission policies and in its curriculum which emphasizes a biopsychosocial approach to health care. The survey achieved an 84% response rate. The results showed no difference in students' career expectations. Students recruited in the innovative school, however, differed from students recruited in the conventional schools with regard to their social and demographic characteristics, educational background and attitudinal profiles. This study suggests that as some medical schools are innovating in their curriculum and admission policies, new types of medical students are entering medicine. Implications of these results are discussed.

We examined the influence of various background characteristics as well as other variables such as personal health practices, specialty choice, and political orientation, on the attitudes of medical graduates toward the physician's role in prevention. The study was part of a 1979 survey conducted in three U.S. medical schools. The results revealed that graduates who believed more strongly in the physician's role in prevention tended to be in primary care training, had a more liberal political orientation, and came more often from physician families. These graduates also believed more strongly that physicians ought to be role models for their patients in health habits. However, they did not manifest better personal health practices than physicians less oriented toward prevention. There was also a medical school effect, although it could not be determined whether this represented the influence of the curriculum or of the selection process into medical school.

Three second-order factorial models are defined, using the LISREL notation, to assess the univocity of a construct. The first model assumes that the constructs are heterogeneous, the second that they are homogeneous. The third model introduces the notion of partial homogeneity between constructs. Partial homogeneity is defined in terms of a LISREL second-order factor model. In some cases, this model offers a viable alternative to the collapsing of items into a unique scale. An example is given of scales which fit the partial homogeneity model.

This study examined medical students' attitudes toward the issue of universal access to medical care in order to determine whether students become more conservative with increased training and, if this is the case, whether changes in students' sociopolitical attitudes can be mostly attributed to the influence of professional education (socialization effect) or to the fact that students change their way of thinking as a result of getting older (maturation effect). Data were obtained from a survey of 586 freshmen, juniors and recent graduates trained in three differently-oriented schools, one being more socially-oriented in its approach to medical education than the other two. The findings documented a conservative trend in more advanced students, not only in the two traditional schools but in the socially-oriented school as well. However, based on the authors' conceptual model, this conservative trend could not be attributed to a pure socialization effect nor to a pure maturation effect. Rather, both types of effect seemed simultaneously at play. In general, students' sociopolitical attitudes were more related to their personal background characteristics than to the characteristics of their professional medical training. These results suggest that selection more than medical training per se is the crucial determinant in influencing medical graduates' sociopolitical outlook.

The purpose of the study presented here was to assess medical students' perceptions of the weight given to scientific and humanistic values in their learning environment and to determine whether students' perceptions in a given school vary according to their level of medical training and personal characteristics. The study was conducted in 1979 via a mail questionnaire sent to a sample of 713 freshmen, juniors, and graduates from three U.S. medical schools; 82.2 percent responded. The results indicated that the students' perceptions of school values varied little according to the students' personal characteristics, such as sociodemographic and educational background, interests before medical training, and expected specialty choice. However, important differences were observed in students' perceptions of values emphasized to them at different schools. Preclinical and clinical students' perceptions of the importance given to scientific values were similar. As for humanistic values, significantly lower ratings were given by clinical students than preclinical students in two of the schools.

We conducted a survey of 518 patients who had been admitted to three hospitals for selected medical, surgical, and obstetrical conditions. All patients came from the same city. One of the hospitals had put forward health promotion and disease prevention as a formal goal. Almost 40% of the respondents reported that they received health counseling during their hospital stay. Logistic regression analyses revealed that medical care processes and organizational factors were more important than patient characteristics in determining health counseling. The only patient characteristic that was positively related to health counseling was "perceived poor health status." Favorable conditions for the development of health counseling included having an attending physician different from the one who treated the patient before entering the hospital, an adequate number of physician visits, and a longer length of stay. Being admitted to a medical ward rather than a surgical or an obstetrical ward also was associated with more frequent health counseling. No significant differences were found among hospitals. Finally, having a general practitioner rather than a specialist as attending physician did not make a difference. These findings support the view that although hospitals have an important and legitimate role to play in health promotion, organizational and institutional obstacles to implementing such practices must not be ignored.