Cheri Bethune

Rural interdisciplinary mental health team building via satellite: a demonstration project.

This paper reports on the results of a demonstration project that examined the role of telehealth/telemedicine (hereafter referred to as telehealth) in providing interdisciplinary mental health training and support to health professionals in a rural region of Atlantic Canada. Special emphasis was placed on addressing the question of how training might affect interdisciplinary collaboration among the rural health professionals. Five urban mental health professionals from three disciplines provided training and support via video-satellite and internet, print and video resources to 34 rural health and community professionals. In order to assess the rural communitys needs and the impact of the interventions, questionnaires were administered and on-site interviews were conducted before and after the project. Throughout the project, field notes were recorded and satisfaction ratings were obtained. Satisfaction with the video-satellite presentations was high and stable, with the exception of one session when signal quality was very poor. Rural participants were most satisfied with opportunities for interaction and least satisfied with the variable quality of the video transmission signal. High staff turnover among rural professionals resulted in insufficient power to permit statistical analysis. Positive reports of the project impact included expanded knowledge and heightened sensitivity to mental health issues, increased cross-disciplinary connections, and greater cohesion among professionals. The results suggest that, with some refinements, telehealth technology can be used to facilitate mental health training and promote interdisciplinary collaboration among professionals in a rural setting.

Rural professionals’ perceptions of interprofessional continuing education in mental health

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10-session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty-five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals confidence (n = 49) with mental health interventions, issues and populations was measured pre- and post-programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter-agency linkages and collaborations had increased. Conditions that appeared to underpin the programmes success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co-ordinators as liaisons. Participants dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.

Narrative Means to Humanistic Ends

Background: Efforts to rehumanize medical education through curriculum reform and program development have been numerous and ongoing in recent years. One particularly intriguing contribution has come from the area of narrative studies. It is now common to use literature in general, and physician-patient narratives in particular, both to expand students understanding of the clinical encounter and to sensitize them to the humanistic aspects of medicine. Description: In this article, we describe the process by which we have introduced key insights from and elements of narrative theory into our 1st-year clinical skills program. Rather than limiting our efforts to the use of literature and to the description of individual narrative encounters, however, we have framed our entire course as an exercise in narrative construction. We refer to this process as narrative structuring. Evaluation: A combination of short essays on topics related to the various literary materials utilized in the course, written reports on ethical aspects of the clinical cases presented in the clinical skills sessions, and student journaling are integral components of the evaluation of this course. Conclusion: Characterizing our course in terms of narrative structuring serves both to integrate the various elements of our complex curriculum around a common theme and to remind both students and faculty alike of the privileges and responsibilities we share as we participate in the writing of one anothers stories.

Medical student career choice: a qualitative study of fourth-year medical students at Memorial University, Newfoundland

BACKGROUNDnSpecialty career choice is a critical decision for medical students, and research has examined factors influencing particular specialties or assessed it from a demographic perspective. The purpose of this study was to explore and describe influential factors in students decision-making, irrespective of their particular specialty in a Canadian medical school.nnnMETHODSnStudy participants were recruited from fourth-year medical classes at the Memorial University of Newfoundland in 2003, 2006, 2007 and 2008. Sixteen focus groups (n = 70) were led by a nonfaculty facilitator to uncover factors affecting medical student career choice. The analysis was guided by principles of grounded theory methodology. The focus group transcripts were sequentially coded based on recurring topics and themes that arose in the students discussions. A set of key themes emerged and representative quotations for each theme were tracked.nnnRESULTSnTwenty themes were identified from the focus group discussions: 7 major, 3 intermediate and 10 minor themes. The major themes were undergraduate experience, exposure, public perception and recruitment, teacher influence, family/outside influences, residency issues and personal philosophy. Intermediate themes included lifestyle, bad-mouthing/negative perceptions and context. Minor themes included critical incidents/experiences, information gaps, uncertainty, nature of the work, extracurricular programs, timing of decision-making, financial issues, prestige, fit with colleagues and gender issues.nnnINTERPRETATIONnExposure to specialties and the timing of this exposure appears to be crucial to career choice, as does the context (who, what, when, where) of any particular rotation. Given the influence of personal philosophy, future research examining students level of self-assessment and self-reflection in their decision-making processes and level of certainty about their selected specialty would be useful.

Concurrent and Convergent Validity of the Simple Lifestyle Indicator Questionnaire

Lifestyle issues including physical activity, diet, smoking, alcohol consumption, and self-reported stress have all been shown to predispose people to higher risk of cardiovascular disease. This study provides further psychometrics on the Simple Lifestyle Indicator Questionnaire (SLIQ), a short, easy-to-use instrument which measures all these lifestyle characteristics as a single construct. One hundred and ninety-three individuals from St. Johns, Newfoundland, and Labrador, Canada completed the SLIQ and reference standards for diet, exercise, stress, and alcohol consumption. The reference standards were a detailed Diet History Questionnaire (DHQ), the Social Readjustment Rating Scale (SRRS), the SF36 Health Status Questionnaire, and a survey of eight questions from a cardiovascular risk questionnaire. Physical activity score was compared with number of steps on a pedometer. Correlations between scores on the SLIQ and the reference standards were the SLIQ versus DHQ (r = 0.679, P = 0.001), SLIQ versus pedometer (r = 0.455, P = 0.002), SLIQ versus alcohol consumption (r = 0.665, P = 0.001), SLIQ versus SRRS (r = −0.264, P = 0.001), SLIQ versus eight-question risk score (r = 0.475, P = 0.001), and SLIQ versus Question 1 on SF36 (r = 0.303, P = 0.001). The SLIQ is sufficiently valid when compared to reference standards to be useful as a brief assessment of an individuals cardiovascular lifestyle in research and clinical settings.

Interprofessional mental health training in rural primary care: findings from a mixed methods study

Abstract The benefits of interprofessional care in providing mental health services have been widely recognized, particularly in rural communities where access to health services is limited. There continues to be a need for more continuing interprofessional education in mental health intervention in rural areas. There have been few reports of rural programs in which mental health content has been combined with training in collaborative practice. The current study used a sequential mixed-method and quasi-experimental design to evaluate the impact of an interprofessional, intersectoral education program designed to enhance collaborative mental health capacity in six rural sites. Quantitative results reveal a significant increase in positive attitudes toward interprofessional mental health care teams and self-reported increases in knowledge and understanding about collaborative mental health care delivery. The analysis of qualitative data collected following completion of the program, reinforced the value of teaching mental health content within the context of collaborative practice and revealed practice changes, including more interprofessional and intersectoral collaboration. This study suggests that imbedding explicit training in collaborative care in content focused continuing professional education for more complex and chronic health issues may increase the likelihood that professionals will work together to effectively meet client needs.

Preparing teachers for competency-based medical education: Fundamental teaching activities

Abstract Introduction: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers. Methods: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development. Results: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools. Conclusions: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.

Examining Medical Student Specialty Choice Through a Gender Lens: An Orientational Qualitative Study

ABSTRACT Phenomenon: A growing number of women are entering the medical workforce, yet their distribution across medical specialties remains nonuniform. We sought to describe how culture, bias, and socialization shape gendered thinking regarding specialty choice at a Canadian undergraduate medical institution. Approach: We analyzed transcripts from the Career Choices Project: 16 semistructured focus group discussions with 70 students graduating from Memorial University of Newfoundland in 2003, 2006, 2007, and 2008. The questions and prompts were designed to explore factors influencing specialty choice and did not specifically probe gender-based experiences. Focus groups were audio-recorded, transcribed, and deidentified before analysis. Analysis was inductive and guided by principles of orientational qualitative inquiry using a gender-specific lens. Findings: The pursuits of personal and professional goals, as well as contextual factors, were the major themes that influenced decision-making for women and men. Composition of these major themes varied between genders. Influence of a partner, consideration of familial commitments (both present and future), feeling a sense of connectedness with the field in question, and social accountability were described by women as important. Both genders hoped to pursue careers that would afford “flexibility” in order to balance work with their personal lives, though the construct of work–life balance differed between genders. Women did not explicitly identify gender bias or sexism as influencing factors, but their narratives suggest that these elements were at play. Insights: Our findings suggest that unlike men, womens decision-making is informed by tension between personal and professional goals, likely related to the context of gendered personal and societal expectations.