Carrie Cartmill

Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice

Background Suboptimal communication within healthcare teams can lead to adverse patient outcomes. Team briefings were previously associated with improved communication patterns, and we assessed the impact of briefings on clinical practice. To quantify the impact of the preoperative team briefing on direct patient care, we studied the timing of preoperative antibiotic administration as compared to accepted treatment guidelines. Study design A retrospective pre-intervention/post-intervention study design assessed the impact of a checklist-guided preoperative team briefing on prophylactic antibiotic administration timing in surgical cases (N=340 pre-intervention and N=340 post-intervention) across three institutions. χ2 Analyses were performed to determine whether there was a significant difference in timely antibiotic administration between the study phases. Results The process of collecting and analysing these data proved to be more complicated than expected due to great variability in documentation practices, both between study sites and between individual practitioners. In cases where the timing of antibiotics administration was documented unambiguously in the chart (n=259 pre-intervention and n=283 post-intervention), antibiotic prophylaxis was on time for 77.6% of cases in the pre-intervention phase of the study, and for 87.6% of cases in the post-intervention phase (p<0.01). Conclusions Use of a preoperative team checklist briefing was associated with improved physician compliance with antibiotic administration guidelines. Based on the results, recommendations to enhance timely antibiotic therapy are provided.

Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis.

Background Medical educators have used the hidden curriculum concept for over three decades to make visible the effects of tacit learning, including how culture, structures, and institutions influence professional identity formation. In response to calls to see more humanistic-oriented training in medicine, the authors examined how the hidden curriculum construct has been applied in the English language medical education literature with a particular (and centering) look at its use within literature pertaining to humanism. They also explored the ends to which the hidden curriculum construct has been used in educational reform efforts (at the individual, organizational, and/or systems levels) related to nurturing and/or increasing humanism in health care. Method The authors conducted a scoping review and thematic analysis that draws from the tradition of critical discourse analysis. They identified 1,887 texts in the literature search, of which 200 met inclusion criteria. Results The analysis documents a strong preoccupation with negative effects of the hidden curriculum, particularly the moral erosion of physicians and the perceived undermining of humanistic values in health care. A conflation between professionalism and humanism was noted. Proposals for reform largely target medical students and medical school faculty, with very little consideration for how organizations, institutions, and sociopolitical relations more broadly contribute to problematic behaviors. Conclusions The authors argue that there is a need to transcend conceptualizations of the hidden curriculum as antithetical to humanism and offer suggestions for future research that explores the necessity and value of humanism and the hidden curriculum in medical education and training.

Transdisciplinary Teamwork: The Experience of Clinicians at a Functional Restoration Program

Introduction This research explored the experience of clinicians during the transition from working as an interdisciplinary team to providing a transdisciplinary model of care in a functional restoration program (FRP) for clients with chronic disabling musculoskeletal pain. Methods This qualitative study used a grounded theory approach to data collection and analysis. In depth interviews were conducted to gather data and analysis was performed by the coding of emergent themes. Results Three major themes were identified that contributed towards building a successful transdisciplinary team: the client population; opportunities for communication with colleagues; and an organizational structure that supports transdisciplinary teamwork. Conclusions Transdisciplinary teams with multiple health care providers are suitable for treating patients with complex needs and with injuries that are chronic in nature. However, transdisciplinary teamwork requires input from an organizational level and from a communication level to effectively contribute to both clinician satisfaction and to improved coordination in patient care.

Setting the standard: Medical Education's first 50 years.

By understanding its history, the medical education community gains insight into why it thinks and acts as it does. This piece provides a Foucauldian archaeological critical discourse analysis (CDA) of the journal Medical Education on the publication of its 50th Volume. This analysis draws upon critical social science perspectives to allow the examination of unstated assumptions that underpin and shape educational tools and practices.

Timing of surgical antibiotic prophylaxis administration: Complexities of analysis

BackgroundThe timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges.ChallengesTwo clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different timing classifications in a single case. A formalized protocol was developed for dealing with incomplete, ambiguous and unclear documentation. A hierarchical coding system was implemented for managing cases with multiple antibiotic regimens.InterpretationResearchers who are tracking prophylactic antibiotic timing as an outcome measure should be aware that documentation of antibiotic timing in the patient chart is frequently incomplete and unclear, and these inconsistencies should be accounted for in analyses. We have developed a systematic method for dealing with specific problematic patterns encountered in the data. We propose that the general adoption of a systematic approach to analysis of this type of data will allow for cross-study comparisons and ensure that interpretation of results is on the basis of timing practices rather than documentation practices.

In search of educational efficiency: 30 years of Medical Education's top-cited articles

Academic journals represent shared spaces wherein the significance of thematic areas, methodologies and paradigms are debated and shaped through collective engagement. By studying journals in their historical and cultural contexts, the academic community can gain insight into the ways in which authors and audiences propose, develop, harness, revise and discard research subjects, methodologies and practices.

Articulating the ideal: 50 years of interprofessional collaboration in Medical Education

Health care delivery and the education of clinicians have changed immensely since the creation of the journal Medical Education. In this project, we seek to answer the following three questions: How has the concept of collaboration changed over the past 50 years in Medical Education? Have the participants involved in collaboration shifted over time? Has the idea of collaboration itself been transformed over the past 50 years?

Misalignments of Purpose and Power in an Early Canadian Interprofessional Education Initiative.

Interprofessional education (IPE) has been widely incorporated into health professional curricula and accreditation standards despite an arguably thin base of evidence regarding its clinical effects, theoretical underpinnings, and social implications. To better understand how and why IPE first took root, but failed to grow, this study examines one of the earliest documented IPE initiatives, which took place at the University of British Columbia between 1960 and 1975. We examined a subset of 110 texts (academic literature, grey literature, and unpublished records) from a larger study that uses Critical Discourse Analysis to trace the emergence of IPE in Canada. We asked how IPE was promoted and received, by whom, for what purposes, and to what effects. Our analysis demonstrates that IPE was promoted as a response to local challenges for the Faculty of Medicine as well as national challenges for Canada’s emerging public healthcare system. These dual exigencies enabled the IPE initiative, but they shaped it in somewhat divergent ways: the former gave rise to its core component (a health sciences centre) and the latter its ultimate purpose (increasing the role of non-medical professions in primary care). Reception of the initiative was complicated by a further tension: nurses and allied health professionals were sometimes represented as independent experts with unique knowledge and skills, and sometimes as assistants or substitutes for medical doctors. We relate the successes and frustrations of this early initiative to particular (mis)alignments of purpose and relationships of power, some of which continue to enable and constrain IPE today.

Integrating programme evaluation and strategy: a promising practice

innovation is perceived as superior to alternatives. The relative advantage of online learning for geographically dispersed, busy trainees is easy to see. However, not all our faculty members are equally convinced that online educational experiences could promote meaningful learning. To address these doubts, we shared research on online learning outcomes and grounded our course design recommendations in the science of learning. 2 Compatibility: adoption is higher when the innovation is consistent with adopters’ values. Our faculty members were deeply committed to diversifying the biomedical workforce and working with a new trainee population, so project goals were intrinsically motivating. Department leaders also attended meetings regularly and developed modules themselves, sending a powerful message of institutional commitment and shared values. 3 Complexity: adoption is higher when complexity is reduced. Developing online courses can be difficult and time consuming. We reduced the complexity by providing course design templates (we’re happy to share them!), just-in-time technology training and ample instructional design support. Particularly helpful: we used a consistent structure for all modules; this gave faculty members a replicable model and eliminated potentially overwhelming choices. 4 Trialability: adoption is higher when adopters have opportunities to test out the innovation. To give faculty members the opportunity to try online teaching without a major time commitment, we kept each module short (2–4 weeks). We also encouraged faculty members to use freely available media (e.g. videos from NIH and TedMed, podcasts and blogs) for course content, thus minimising time-consuming recording of video lectures. 5 Observability: adoption is higher when the results are visible to others. Faculty members met regularly as a group, which gave them the opportunity to discuss discipline-specific content, brainstorm ideas, and follow the progress of one another’s modules. We also held periodic meetings after the modules launched, which allowed faculty members to relay their ‘boots on the ground’ experiences and advice to their colleagues.