Robert Woollard

Caring for a common future: medical schools' social accountability

Origins and context  The concept of ‘the social accountability of medical schools’ is moving from the peripheral preoccupation of a few to a more central concern of medical schools themselves. Born of concerns about the professionalism and relevance of both the institutions and their graduates, it is seen increasingly as an urgent call to focus the considerable social resources vested in academic health science institutions on addressing the priority health concerns of the societies they serve. For a profession embedded in an ethos of service, this would seem an obvious transition. However, as with any movement towards transformative change, it runs the risk of being more mantra and rhetoric than mandate and responsibility.

A study of a rural community's readiness for telehealth

A qualitative approach was used to explore the readiness of a rural community for the implementation of telehealth services. There were four domains of interest: patient, practitioner, public and organization. Sixteen semistructured telephone interviews (three to five in each domain) were carried out with key informants and recorded on audio-tape. Two community awareness sessions were held, which were followed by five audio-taped focus groups (with five to eight people in each) in the practitioner, patient and public domains. In addition, two in-depth interviews were conducted with community physicians. Analysis of the data suggested that there were four types of community readiness: core, engagement, structural and non-readiness. The level of readiness varied across domains. There were six main themes: core readiness; structural readiness; projection of benefits; assessment of risk; awareness and education; and intra-group and inter-group dynamics. The results of the study can be used to investigate the readiness of rural and remote communities for telehealth, which should improve the chance of successful implementation.

The potential role of prophylactic/functional knee bracing in preventing knee ligament injury.

It is estimated that knee injuries account for up to 60% of all sport injuries, with the anterior cruciate ligament (ACL) accounting for almost half of these knee injuries. These knee injuries can result in high healthcare costs, as an ACL injury is often associated with surgery, long and costly rehabilitation, differing degrees of impairment and potential long-term consequences such as osteoarthritis. The interest in ACL injury prevention has been extensive for the past decade. Over this period, many ACL (intrinsic and extrinsic) injury risk factors have been identified and investigated by numerous researchers. Although prevention programmes have shown potential in decreasing knee ligament injuries, several researchers have suggested that no conclusive evidence has been presented in reducing the rate and/or severity of ACL injuries during sporting competition. Knee braces have been available for the last 30 years and have been used to assist individuals with ACL-deficient and ACL-reconstructed knees. However, research is limited on the use of knee braces (prophylactic and functional) to potentially prevent knee ligament injury in the non-injured population. One possible explanation for the limited research could be that the use of these devices has raised concerns of decreased or impaired athletic performance. In summary, the review of subjective and some objective publications suggests that a functional knee brace may offer stability to an ACL-deficient knee joint; however, research is limited on the use of a knee brace for prophylactic use in non-injured athletes. The limited research could be a result of fear of performance hindrance that has led to poor knee brace compliance.

The Meaning of Patient Experiences of Medically Unexplained Physical Symptoms

Current diagnostic models in medical practice do not adequately account for patient symptoms that cannot be classified. At the moment, when all known diagnostic possibilities have been excluded, physicians—and patients—confront uncertainty in diagnosis, which gives rise to the label of Medically Unexplained Physical Symptoms (MUPS). This phenomenological study, conducted by two research teams in two geographic locations, sought to explore patients’ experiences of prolonged uncertainty in diagnosis. Participants in this study described their experiences with and consequences of MUPS primarily in relation to levels of acuity and acceptance of uncertainty, the latter loosely correlated to length of time since onset of symptoms (the longer the time, the more forbearance participants expressed). We identified three experiential periods including the active search for a diagnosis, living with MUPS, and, finally, acceptance/resignation of their condition. Findings point to the heightened importance of the therapeutic relationship when dealing with uncertainty.

Social accountability in action: University-community collaboration in the development of an interprofessional Aboriginal health elective

A survey of the health professional curriculum at the University of British Columbia revealed a need for improvements in education relating to Aboriginal health. At the same time, interprofessional education has been increasingly viewed as an essential aspect of sustainable health care reform. Interprofessional approaches to education and community practice have the potential to contribute to improvements in access to care, as well as health professional recruitment in underserved communities. While the benefits of interprofessional approaches have been identified, there are few published examples of the application of interprofessional learning and care in Aboriginal communities. This article describes the co-development by university and community partners of an accredited interprofessional, practice-based Aboriginal health course. Seed funding for this course was originally granted in November 2004 for a demonstration project led by the UBC Faculty of Medicine from a national Primary Health Care Renewal initiative focused on Social Accountability, namely “Issues of Quality and Continuing Professional Development: Maintenance of Competence” (referred to as CPDiQ project). This article presents findings from the development and implementation of this innovative course, run as a pilot during the summer of 2006 in two Aboriginal communities in British Columbia, Canada. Recommendations for integrating Aboriginal perspectives and foregrounding principles of social accountability in interprofessional health curricula are highlighted. In addition, successes and challenges are described related to garnering administrative and curricular support among the various health disciplines, interprofessional scheduling, and fostering cross-discipline understanding and communication.

Achieving social accountability through interprofessional collaboration: the Canadian medical schools experience.

Social accountability in the health professions is increasingly recognized as a necessary foundation for delivering effective healthcare. Inter- and intra-professional collaboration is critical to the process in order to transform intent into action. This article outlines the three-year program undertaken by a national collaboration among all 17 Canadian medical schools and their partners as they engaged in a journey leading to the incorporation of social accountability in an interprofessional context as the cornerstone of healthcare education and practice. An overview of the various dimensions of this project is discussed in order to shed light on how a national initiative in collaboration with local initiatives can synergistically work toward a common goal. Successes and challenges in working on a national level are reviewed with implications for future directions for interprofessional collaboration in healthcare based upon principles and values of social accountability.

Continuing medical education in the 21st century

Needs to recapture professionalism in lifelong learning

The good, the bad, and the ugly of partnered research: revisiting the sequestration thesis and the role of universities in promoting social justice.

As universities increasingly rely on external sources of research funding, researchers worldwide are realizing that if their work is financially supported by organizations with distinct political or financial interests, they risk their careers if their results deviate from the interests of their funding partners. This article presents a case that illustrates how ugly this situation can become. Reviewing the literature on the advantages and dangers of partnered research, the historical role of universities, funding trends, and university mission statements, the authors contend that universities must engage in service learning and participatory action research, but must ensure that faculty members engaging in academic activity with partners—whether industry, hospitals, governments, nongovernmental organizations, or communities—have their professional integrity protected. If doubt exists about whether the partner can or will honor these principles or the mission of universities for social good, universities should avoid granting joint or affiliate appointments or accepting funds or favors of any kind. Universities also need formal structures to ensure ethical application of innovation and principled partnership engagement. In becoming servants of government or corporatism, universities have become less vital to society and are failing in their mission to promote social justice and sustainability. Strong measures are needed to restore public trust.

Silos of Silence, Stress, and Suffering: Patient and Physician Experiences of MUPS and Diagnostic Uncertainty

Ours is a qualitative investigation that interviews practitioners and patients about the phenomenon of MUPS (medically unexplained physical symptoms)–i.e., the context of lacking clear diagnostic and treatment options and the experience of being “not yet diagnosed.” With regard to practitioners, since current diagnostic models in medical practice do not adequately account for patient symptoms that cannot be classified (Lolas 1985; Salmon 2007), our study explores how physicians respond to uncertainty, how they communicate ambiguity to colleagues and to patients, and which resources they opt to employ in relating to patients and addressing treatment options. With regard to patients, as societal views of allopathic medicine are of a practice that is highly technological and all-knowing, few understand that physicians sometimes cannot fathom patients’ complaints. By conversing with MUPS patients, our project aims to reveal the agencies of persons who live with baffling symptomology—their searching, reasoning, communication and coping methods. Moreover, an ethics-based framework informs our conversations. Considerations of nonmaleficence and beneficence, deontological autonomy, consent and truth-telling, as well as feminist relational ethics all orbit our discussions. it seems as though physicians and patients share more than they realize when confronting diagnostic uncertainty and MUPS. While both cohorts are silent, stressed, and isolated by the experience of either treating or living with unexplained physical symptoms, they do so in separate silos of understanding and experience. A phenomenological approach reveals how very important it is to pay attention to peoples experiences of health care from both sides of the gurney.

Effect of functional knee brace use on acceleration, agility, leg power and speed performance in healthy athletes

Objectives To investigate performance levels and accommodation period to functional knee brace (FKB) use in non-injured braced subjects while completing acceleration, agility, lower extremity power and speed tasks. Design A 2 (non-braced and braced conditions) × 5 (testing sessions) repeated-measures design. Methods 27 healthy male athletes were provided a custom fitted FKB. Each subject performed acceleration, agility, leg power and speed tests over 6 days; five non-braced testing sessions over 3 days followed by five braced testing sessions also over 3 days. Each subject performed two testing sessions (3.5 h per session) each day. Performance levels for each test were recorded during each non-braced and braced trial. Repeated measures analysis of variance, with a post hoc Tukeys test for any test found to be significant, were used to determine if accommodation to FKB was possible in healthy braced subjects. Results Initial performance levels were lower for braced than non-braced for all tests (acceleration p=0.106; agility p=0.520; leg power p=0.001 and speed p=0.001). However, after using the FKB for approximately 14.0 h, no significant performance differences were noted between the two testing conditions (acceleration non-braced, 0.53±0.04 s; braced, 0.53±0.04 s, p=0.163, agility non-braced, 9.80±0.74 s; braced, 9.80±0.85 s, p=0.151, lower extremity power non-braced, 58±7.4 cm; braced, 57±8.1 cm, p=0.163 and speed non-braced, 1.86±0.11 s; braced, 1.89±0.11 s, p=0.460). Conclusions An initial decrement in performance levels was recorded when a FKB is used during an alactic performance task. After 12.0–14.0 h of FKB use, performance measures were similar between the two testing conditions.