Search

Introduction: Physicians undertake many transitions during the course of a medical career. The purpose of this study was to explore the experiences of physicians who moved to a new community. Methods: A semistructured interview format was used to explore transitional experiences, including reasons for moving; the role of colleagues, learning, and organizational structures; how various mediating factors affected perceptions; and how the experience affected the physicians personally. We used qualitative methods in which data were collected, coded, and analyzed concurrently. Results: 20 physicians from family medicine, internal medicine, and pediatrics described their experiences. Both the professional context and the geographic location affected physicians' perceptions of the move. Both internal and external mediating factors appeared to influence how physicians experienced and adjusted to the move. Physicians who joined functioning units appeared to have fewer problems. The physicians who had more difficulty were physicians who did not come to a specific job, often coming as the result of a spousal move; did not have a professional network in the city; had not sorted out licensure requirements; and were entering community (not institutional) practice. Discussion: This study demonstrates the critical nature of institutional support structures to integrate the newcomer, collegial relationships within the workplace, and the importance of family and friends in mediating the adjustment period. Consideration should be given to structured mentorship or peer-buddy programs and longitudinal educational programs (eg, rounds) that may enable physicians to establish networks and gain practical local knowledge quickly. (Contains 1 figure.)

Introduction: There is movement of physicians internationally. In some cases, physicians are recruited from low-income countries to wealthier countries like Canada to provide medical services in underresourced communities. This needs assessment examined the clinical medicine learning challenges faced by international medical graduates (IMGs) from the perspective of both the IMGs and medical leaders (eg, Vice President--Medical for a Health Region). Methods: Focus groups with 25 IMGs were held in 6 regional centers. Face-to-face interviews were held with 10 medical leaders. Participants were asked about the learning associated with patient management, patient referral, and investigation, for billing and insurance, and learning about new systems of care. Qualitative data were analyzed to determine how well the perspectives on learning were aligned. Results: IMGs and medical leaders recognized that learning and support were needed by physicians without previous experience in Canada. They had similar lists of learning issues. Although medical leaders believed the new information was explicit, readily available, and could be learned from short explanations and lists; IMGs found that guidelines and expectations were implicit, confusing, and contradictory. There were mediating influences in the form of orientation programs, other IMGs, and "how to" lists in some cases, which helped the newcomer. Discussion: There was concordance about aspects of the learning that was required between IMGs and medical leaders. There was little agreement about the approach to learning or a recognition that the learning tasks were complicated.

Introduction: There is little known about the learning that is undertaken by physicians who graduate from a World Health Organization-listed medical school outside Canada and who migrate to Canada to practice. What do physicians learn and what resources do they access in adapting to practice in Alberta, a province of Canada? Methods: Telephone interviews with a theoretical sample of 19 IMG physicians were analyzed using a grounded theory constant comparative approach to develop categories, central themes, and a descriptive model. Results: The physicians described two types of learning: learning associated with studying for Canadian examinations required to remain and practice in the province and learning that was required to succeed at clinical work in a new setting. This second type of learning included regulations and systems, patient expectations, new disease profiles, new medications, new diagnostic procedures, and managing the referral process. The physicians "settled" into their new setting with the help of colleagues; the Internet, personal digital assistants (PDAs), and computers; reading; and continuing medical education programs. Patients both stimulated learning and were a resource for learning. Discussion: Settling into Alberta, Canada, physicians accommodated and adjusted to their settings with learning activities related to the clinical problems and situations that presented themselves. Collegial support in host communities appeared to be a critical dimension in how well physicians adjusted. The results suggest that mentoring programs may be a way of facilitating settlement. (Contains 1 table.)

Introduction: Course outcomes have been assessed by examining the congruence between statements of commitment to change (CTCs) and course objectives. Other forms of postcourse reflective exercises (for example, impact and unmet-needs statements) have not been examined for congruence with course objectives or their utility in assessing course outcomes. This study assessed the congruence of course objectives and statements of commitment to change, effects on practice, unmet-needs, and the utility of supplementing CTCs with other forms of reflective work in course evaluations. Methods: A 3-module course on Alzheimer's disease and other dementias provided end-of-course CTC statements, follow-up data, and statements of effects on practice and unmet needs. Statements were aligned to module objectives and analyzed descriptively. Results: Of the 932 physicians who registered for 1 of the 3 modules, 404 provided CTCs, 302 provided impact statements, and 265 provided unmet-needs statements. Sixty percent of the CTCs could be assigned to an objective for their module, and between 14% and 25% of CTCs were assigned to objectives for another module. Three-quarters of CTCs were fully or partially implemented. Physicians did not have an opportunity to implement the new content in 70% of nonimplemented CTCs. Fewer impact and unmet-needs statements were congruent with course objectives than CTCs. Conclusions: Commitment-to-change statements had more congruence with objectives than did impact or unmet-needs statements. These latter statements, particularly those that could not be assigned to an objective, may reinforce and supplement the information provided by CTC analyses.

Interviews with 10 facilitators and 22 members of physician learning groups indicated that the groups functioned as communities of practice; they supported learning, agreed to disagree, and discussed scientific information with the goal of refining practice. Facilitators provided administrative support and sustaining energy. (Contains 18 references.) (SK)

Of 344 physicians who attended continuing education, 197 provided 6-month follow-up data indicating that 66% of practice changes they committed to were completed. A significant correlation between number of changes made and amount of time allocated to that content in the course was found. Commitment to change statements as a means of course evaluation were recommended. (SK)

A literature review, focus groups (n=200), and questionnaire responses from 324 family physicians identified their learning needs related to osteoporosis. The three methods identified different learning issues, suggesting the importance of triangulation to ensure currency and relevance in continuing-education needs-assessment. (SK)

OBJECTIVE. To determine whether it is possible to develop feasible, valid, and reliable multisource feedback data for pediatricians. METHODS. Surveys with 40, 22, 38, and 37 items were developed for assessment of pediatricians by patients, co-workers, medical colleagues, and themselves, respectively, using 5-point scales with an "unable to assess" category. Items addressed key competencies related to communication skills, professionalism, collegiality, continuing professional development, and collaboration. Each pediatrician was assessed by 25 patients, 8 medical colleagues, and 8 co-workers. Feasibility was assessed with response rates for each instrument. Validity was assessed with rating profiles, the percentage of participants unable to assess the physician for each item, and exploratory factor analyses to determine which items grouped together into scales. Cronbach's [alpha] and generalizability coefficient analyses assessed reliability. RESULTS. One hundred pediatricians participated. The mean number of respondents per physician was 23.4 (93.6%) for patients, 7.6 (94.8%) for co-workers, and 7.6 (95.5%) for medical colleagues. The mean ratings ranged from 4 to 5 for each item on each scale. Few items had high percentages of "unable to assess" responses. The factor analyses revealed a 4-factor solution for the patient survey, a 3-factor solution for the co-worker survey, and a 4-factor solution for the medical colleague survey, accounting for at least 64% of the variance. All instruments had high internal consistency. The generalizability coefficients were .85 for patients, .87 for co-workers, and .78 for medical colleagues. CONCLUSION. Surveys can be developed to provide feedback data on key competencies. Key Words pediatricians, assessment Abbreviations PAR--Physician Achievement Review CIS--Customer Information Services MSF--multisource feedback CPSA--College of Physicians and Surgeons of Alberta [Ep.sup.2]--generalizability coefficient, APPROACHES TO MAINTAINING competence and certification for physicians have received worldwide attention. In the United States, the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties [...]

Abstract Background The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada for trained health care providers for the identification and management of newborns who are at-risk and/or become unwell in the first few hours or days after birth. The ACoRN process follows an 8-step framework that enables the evaluation and management of babies irrespective of the experience or expertise of the caregiving individual or team. This study assesses the applicability of the program to Chinese pediatric practitioners. Methods Course content and educational materials were translated from English into Chinese by bilingual neonatal practitioners. Confidence and knowledge questionnaires were developed and reviewed for face and content validity by a team of ACoRN instructors. Bilingual Chinese instructors were trained at the tertiary perinatal centre in Hangzhou Zhejiang to deliver the course at 15 level II county hospitals. Participants completed pre- and post-course confidence and knowledge questionnaires and provided feedback through post-course focus groups. Results 216 physicians and nurses were trained. Confidence and knowledge relating to neonatal stabilization improved significantly following the courses. Participants rated course utility and function between 4.2 and 4.6/5 on all items. Pre/post measures of confidence were significantly correlated with post course knowledge. Focus group data supported the perceived value of the program and recommended course adjustments to include pre-course reading, and increased content related to simulation, communication skills, and management of respiratory illness and jaundice. Conclusions ACoRN, a Canadian educational program, appears to be well received by Chinese health care providers and results in improved knowledge and confidence. International program adaptation for use by health care professionals requires structured and systematic evaluation to ensure that the program meets the needs of learners, reflects their learning styles, and can be applied in their setting.

* Context.--There is increasing interest in ensuring that physicians demonstrate the full range of Accreditation Council for Graduate Medical Education competencies. Objective.--To determine whether it is possible to develop a feasible and reliable multisource feedback instrument for pathologists and laboratory medicine physicians. Design.--Surveys with 39, 30, and 22 items were developed to assess individual physicians by 8 peers, 8 referring physicians, and 8 coworkers (eg, technologists, secretaries), respectively, using 5-point scales and an unable-to-assess category. Physicians completed a self-assessment survey. Items addressed key competencies related to clinical competence, collaboration, professionalism, and communication. Results.--Data from 101 pathologists and laboratory medicine physicians were analyzed. The mean number of respondents per physician was 7.6, 7.4, and 7.6 for peers, referring physicians, and coworkers, respectively. The reliability of the internal consistency, measured by Cronbach [alpha], was [greater than or equal to] .95 for the full scale of all instruments. Analysis indicated that the medical peer, referring physician, and coworker instruments achieved a generalizability coefficient of .78, .81, and .81, respectively. Factor analysis showed 4 factors on the peer questionnaire accounted for 68.8% of the total variance: reports and clinical competency, collaboration, educational leadership, and professional behavior. For the referring physician survey, 3 factors accounted for 66.9% of the variance: professionalism, reports, and clinical competency. Two factors on the coworker questionnaire accounted for 59.9% of the total variance: communication and professionalism. Conclusions.--It is feasible to assess this group of physicians using multisource feedback with instruments that are reliable. (Arch Pathol Lab Med. 2009;133:1301-1308), In the United States and Canada, the Accreditation Council for Graduate Medical Education (ACGME) competencies (1) and the Royal College of Physicians and Surgeons of Canada CanMEDS roles (2) are [...]

PURPOSE. The purpose of this work was to develop and assess the feasibility, reliability, and validity of a brief performance checklist to evaluate skills during a simulated neonatal resuscitation ("megacode") for the Neonatal Resuscitation Program of the American Academy of Pediatrics. METHODS. A performance checklist of items was created, validated, and modified in sequential phases involving: an expert committee, review, and feedback by Neonatal Resuscitation Program instructors for feasibility and criticality and use of the performance checklist by Neonatal Resuscitation Program instructors reviewing videotaped megacodes. The final 20-item performance checklist used a 3-point scale and was assessed by student and instructor volunteers. Megacode scores, the NRP multiple-choice examination scores, student assessments of their ability and performance, and sociodemographic descriptors for both students and instructors were collected. Data were analyzed descriptively. In addition, we assessed the megacode score internal consistency reliability, the correlations between megacode and multiple-choice examination scores, and the variance in scores based on instructor and student characteristics. RESULTS. A total of 468 students and 148 instructors volunteered for the study. The instrument was reliable and internally consistent. Student's scores were high on most items. There was a significant but low correlation between the megacode score and the written knowledge examination. Instructor and student characteristics had little effect on the variance in scores. CONCLUSIONS. This performance checklist provides a feasible assessment tool. There is evidence for its reliability and validity. KEYWORDS. neonatal resuscitation, neonatology, megacode, clinical assessment, simulation, competence assessment, educational outcome. PEDIATRICS 2006;118:e1739-e1744. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2006-0537, Jocelyn Lockyer, PhD, Nalini Singhal, MBBS, FRCPC, Herta Fidler, MSc, Gary Weiner, MD, Khalid Aziz, MA, FRCPC, Vernon Curran, [...]

Objective: To examine the beliefs and attitudes of FPs and health care professionals (HCPs) regarding FPs' roles and responsibilities on interdisciplinary geriatric health care teams.Design: Qualitative study using focus groups.Setting: Calgary Health Region.Participants: Seventeen FPs and 22 HCPs working on geriatric health care teams.Method: Four 90-minute focus groups were conducted with FPs, followed by 2 additional 90-minute focus groups with HCPs. The FP focus groups discussed 4 vignettes of typical teamwork scenarios. Discussions were transcribed and the 4 researchers analyzed and coded themes and subthemes and developed the HCP focus group questions. These questions asked about HCPs' expectations of FPs on teams, experiences with FPs on teams, and perspectives on optimal roles on teams. Several meetings were held to determine themes and subthemes.Main Findings: Family physicians identified patient centredness, role delineation for team members, team dynamics, and team structure as critical to team success. Both FPs and HCPs had a continuum of beliefs about the role FPs should play on teams, including whether FPs should be autonomous or collaborative decision makers, the extent to which FPs should work within or outside teams, whether FPs should be leaders or simply members of teams, and the level of responsibility implied or explicit in their roles.Conclusion: Comments from FPs and HCPs identified intraprofessional and interprofessional tensions that could affect team practice and impede the development of high-functioning teams. It will be important, as primary care reform continues, to help FPs and HCPs learn how to work together effectively on teams so that patients receive the best possible care. [ABSTRACT FROM AUTHOR]

Background: New approaches are needed to ensure that surgical trainees attain competence in a timely way. Traditional solutions have focused on the years spent in surgic al training. We sought to examine the outcomes of graduates from 3-year versus 4-year medical schools for differences in surgeon performance based on multisource feedback data., Methods: We used data from the College of Physicians and Surgeons of Alberta's Physician Achievement Review program to determine curricular outcomes. Data for each surgeon included assessments from 25 patients, 8 medical colleagues and 8 nonphysician coworkers (e.g., nurses), and a self-assessment. We used these data to compare 72 physicians from a 3-year school matched with graduates from 4-year schools. The instruments were assessed for evidence of validity and reliability. We compared the groups using 1-way analysis of covariance and multivariate analysis of covariance, with years since graduation as a covariate, and a Cohen d effect size calculation to assess the magnitude of the change., Results: Data for 216 surgeons indicated that there was evidence for instrument validity and reliability. No significant differences were found based on the length of the undergraduate program for any of the questionnaires or factors within the questionnaires., Conclusion: Reconsideration might be given to the time spent in medical school before surgical training if training in the specialty and career years are to be maximized. This assumes that students are able to make informed career decisions based on clerkship and other experiences in a 3-year setting.

Background and Objectives: The global migration of physicians has led many international physicians to enter practice in Alberta, Canada. The study was designed to explore the personal side of migration and transition experiences of these international medical graduates (IMGs)., Methods: A qualitative study using telephone interviews and a semi-structured interview guide was used to interview 19 IMGs who are currently practicing and have held Part V, restricted or temporary practice licenses for less than 7 years., Results: Three major themes were identified. The first was the "push" from their own country of origin and their perception that moving to Alberta would be better for them. Professional opportunities in their home country had been affected by changing policies, lack of infrastructure, and personal/family safety issues culminating in highly stressful work environments. The second was "pull." An improvement in the quality of personal life was associated with geographical, educational, recreational, and spiritual aspects of daily living for participants and their families in their new environment. The third theme was "plant"ie, factors that encouraged them to stay in Alberta., Conclusions: This study demonstrates the continued relevance of push and pull theory in understanding IMG physician migration. Our findings in this study indicate that remaining in place, or "being planted" is conditional on political, social, and economic aspects.