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Royal College/Associated Medical Services CanMEDS Research Development Grant — Recipients

2018

Anita Cheng, MD, FRCPC, MHPE

“Difficult conversations training through reflective practice initiative”

Anita Cheng
Anita Cheng, MD, FRCPC, MHPE
Assistant Professor and Neonatologist
Children’s Hospital, London, ON

Abstract

Breaking bad news can be challenging and anxiety provoking for both trainees and families. Because unexpected challenges often arise during high stakes conversations, reflection and developing a reflective practice are required for compassionately and effectively responding to these challenges. We propose a Difficult Conversations Training through Reflective Practice Initiative that is a research program founded on the three pillars of educational research, innovative curriculum and creating community.

Research—Rich picture stories: We will build on our previous research studying trainee perspectives about difficult conversations by exploring the parent and health care professional (HCP) experiences, either engaging in or observing difficult conversations with trainees in the NICU. Using rich picture reflections and grounded theory, we will explore both what compassionate communication means to parents and HCPs, and their perceptions about trainees’ performance during difficult conversations.

Curriculum—Teaching communication skills and reflective practice: Findings will contribute to the development of a pilot curriculum that teaches trainees medical content, communication skills and an approach to difficult conversations. We will also teach trainees how to develop a reflective practice through the stories and rich picture reflections of past trainees, and by practising critical reflection techniques. Trainees will build a portfolio of reflections and multi-source feedback about their performance of navigating difficult conversations with families.

Community—Learning through the collective experience: As a long-term outcome of the research program, we will develop an online community for families and training programs to access and contribute to a multi-perspective database of rich picture reflections. The goal of this community is to create a safe place to share and learn from each other’s experiences, to offer encouragement and support, and to provide an avenue for stories to be voiced.

Ongoing evaluation of the initiative by trainees, HCPs, and parents will inform iterations of redesign.

How this work will inform research in medical education
This work is important to medical education because it encourages trainees to thoughtfully reflect on their practice and growth as physicians, and to take initiative in striving for competence and excellence in compassionate care for families. Involving all stakeholders in the process of identifying gaps in training, developing curriculum, delivering teaching, and assessment and evaluation, increases accountability, potentially builds collaborative interdisciplinary relationships, and ultimately aims to improve the patient and family experience.

Taryn Taylor, MD, PhD, FRCSC

“Fatigue management strategies among practicing clinicians and residents: a descriptive catalogue with implications for patient care and provider wellbeing”

Taryn Taylor
Taryn Taylor, MD, PhD, FRCSC
Assistant Professor, Department of Obstetrics & Gynaecology, London Health Sciences Centre
Scientist, Centre for Education Research & Innovation,
Schulich School of Medicine & Dentistry, Western University

Abstract

Fatigue threatens physician wellbeing and interferes with the provision of high-quality, compassionate patient care. Other industries that provide 24/7 services have embraced fatigue management frameworks in an attempt to address this issue from two perspectives: workplaces integrate checks and balances to prevent fatigue-related errors from resulting in actual incidents; in turn, individuals are responsible for optimizing their alertness, recognizing their fatigue-related impairment, and seeking out assistance as needed. This individual aspect of fatigue management aligns with an enabling competency for the “Professional” CanMEDS role, which states that trainees must “exhibit self-awareness and manage influences on personal well-being and professional performance.” Unfortunately, we lack an empirical description of how physicians employ fatigue management in the clinical workplace. Strategies emerging from other industries focus on managing the performance hazards of fatigue while overlooking the personal impact of fatigue. Similarly, these strategies ignore the negative interpersonal implications of working while fatigued, which we cannot afford to disregard in the clinical context. Thus, the purpose of this research is to determine the current fatigue management practices of physicians and senior trainees as they pertain to patient safety, interpersonal conduct and physician wellness.

First, we will conduct semi-structured interviews with participants after sampling for a range of relevant professional variables (i.e. procedural and non-procedural fields, rural and tertiary centres) and personal variables (i.e. stage of career, personal circumstances). The resulting descriptive qualitative analysis will inform further semi-structured interviews with nurses, as they may be altering their behaviour to manage physician fatigue in ways that are not obvious to physicians. In anticipation of competency-based medical training, this research is key to ensuring clear expectations around what it means to demonstrate competence in fatigue management as professionals, for the sake of patients and physicians alike.

How this work will inform research in medical education
Fatigue threatens physician well-being and interferes with the provision of high-quality, compassionate patient care. The “Professional” CanMEDS role states that trainees must “exhibit self-awareness and manage influences on personal well-being and professional performance.” Unfortunately, we lack an empirical description of how physicians employ fatigue management in the clinical workplace. Strategies for managing fatigue in other industries focus on managing the performance hazards of fatigue while overlooking the personal impact of fatigue. Similarly, these strategies ignore the negative interpersonal implications of working while fatigued, which we cannot afford to disregard in the clinical context. Thus, the purpose of this research is to determine the current fatigue management practices of physicians and senior trainees as they pertain to patient safety, interpersonal conduct and physician wellness. This research will help to ensure clear expectations around what it means to demonstrate competence in fatigue management for the sake of patients and physicians alike.

Katherine Wisener, M.A. Ph.D (Candidate)

“Incentivizing medical teachers: exploring the role of incentives in influencing clinicians’ motivations to teach”

Katherine Wisener
Katherine Wisener, M.A. Ph.D (Candidate)
Associate Director, Office of Faculty Development,
Faculty of Medicine, University of British Columbia

Abstract

Objectives: The advancement of CanMEDS in medical education programs is not only dependent on well-crafted competencies and assessments, but also depends on the availability and quality of teaching provided by clinicians (who often volunteer time and expertise to teaching). Unfortunately, the literature reports increasingly high levels of dissatisfaction, burnout and attrition with teaching roles. Incentivization strategies provide an obvious intervention, but they must be implemented judiciously or risk unintended consequences. This research seeks to understand how to effectively position incentives to foster productive forms of motivation and high quality medical education to support learners’ effective development of the CanMEDS competencies in workplace-based settings.

Design: Following a constructivist framework, an interpretive description methodology will be applied to understand how clinicians view their roles as teachers, and to explore what incentives influence their decisions and commitment to teach medical students. Clinicians with varying amounts and types of teaching experiences will be interviewed.

Setting: The University of British Columbia’s medical training programs are distributed across British Columbia with four regional campuses. Clinicians from both the Vancouver-Fraser Medical Program (VFMP) and the Northern Medical Program (NMP) will be included.

Analysis: Constant comparative and iterative analysis will help ground findings within existing knowledge structures and to locate explanatory factors that can inform a broadened perspective. Themes will be shared with participants to ensure accurate representation of their experiences and perceptions.

Conclusion: Building an understanding of medical teachers’ experiences and perceptions towards teaching will offer both a broad and a nuanced understanding of how they can be incentivized to teach effectively within a CanMEDS framework. This work will advance our knowledge of the unique and understudied role medical educators, specifically, play in realizing the CanMEDS mission of developing compassionate and caring clinicians and specialists.

How this work will inform research in medical education
This work is important to medical education because the success of any competency-based medical education program is dependent on the quality of teaching provided by medical educators; however, recruiting motivated and effective educators — particularly through times of change — can be challenging, and many clinical teaching faculty members feel dissatisfied and are considering leaving their teaching roles. Further, researchers have suggested that the more intrinsic CanMEDS roles are not being taught in many settings, among those who do teach. This research aims to identify what motivates clinicians to teach, what drives them to prioritize a focus on competencies about which they might have less comfort or natural inclination to teach, and what role incentives play in influencing these motivations. These views will inform strategies in how to incentivize effective teaching across all CanMEDS domains, and help to address the growing issues around the recruitment of medical educators.

Yvonne Ying, MD, MSE, Med, MSc (GlobSurg), FRCSC

“The hidden curriculum and the "un-teaching" of health advocacy in specialty medicine”

Yvonne Ying
Yvonne Ying, MD, MSE, Med, MSc (GlobSurg), FRCSC
Associate Professor, Division of Plastic Surgery
Department of Surgery, University of Ottawa

Abstract

Introduction: The role of Health Advocate has been a part of postgraduate medical education since the introduction of CanMEDS in 2005; however, physicians and surgeons continue to find the role of health advocate challenging to teach and assess. Correspondingly, residents are often unable to identify teaching of health advocacy in their formal and informal curriculum, and do not appear to be involved in health advocacy during their training. The health advocacy competency is also perceived as less relevant than other intrinsic roles. Health advocacy teaching is susceptible to hidden curriculum effects and dependent on the socializing effects of positive role-modeling of staff. There are signs that advocacy activities amongst residents decrease as they progress through training. Our objective is to understand why this decrease takes place by exploring potential hidden curriculum effects within specialty medicine. By understanding how trainees come to perceive the role of advocacy in their practice, curriculum and evaluation tools can be designed to encourage a positive change in the teaching of advocacy through residency.

Methods: We will conduct semi-structured interviews (10-15 interviews per speciality) with residents from a range of specialty training programs to determine how health advocacy is perceived, pursued and taught. Interviews will be collected, transcribed and analyzed concurrently for emerging patterns and themes. The iterative process will be continued until saturation is achieved.

Conclusion: Obtaining a deeper understanding of how residents perceive the culture of health advocacy will help guide our understanding of why advocacy activity decreases during training. Variations between specialties will allow an examination of how different specialties may approach health advocacy and perhaps guide changes in other specialties. The themes identified in these interviews will be used to inform staff and residents of commonalities and differences, and be used by educators for faculty development and formal education initiatives.

How this work will inform research in medical education
Physicians and surgeons have a responsibility to become health advocates within their communities. Specialists can use their clinical knowledge to augment community outreach and bring their medical expertise to enhance social engagement. As such, health advocacy is considered a key CanMEDs role and is taught in all postgraduate specialty training programs. Yet residents self-report decreasing health advocacy and community engagement during post-graduate medicine specialty training. This dichotomy between curriculum content and behavioural change could be due to socialization and the hidden curriculum counteracting attempts to teach health advocacy in a theoretical context. The goal of this project is to better understand why trainees withdraw from community activities and how they perceive advocacy within their profession. By doing so, we can consider curriculum changes to ensure that health advocacy becomes something not only understood in theory, but part of a resident’s professional identity development and practice.

2017

Melissa Duffy, PhD

2016

Kori A. LaDonna, PhD

Maria Hubinette, MD, CCFP, MMEd

Ryan Snelgrove, MD, FRCSC

Sarah Wright, MBA, PhD