Sharon E. Card

Putting the ‘patient’ back into patient-centred care: An education perspective

Patient-centred care is a value espoused by most healthcare systems and a concept taught in nursing education programs as a fundamental concept of patient care. In this study, we focused on the patients experience of patient-centredness, interviewing eighteen patients and eight family members about their experiences as patients on an in-patient acute care medical unit in a large hospital in Canada. Approximately half of the patients expressed satisfaction with their experiences and their involvement in decisions about their healthcare. The remainder expressed concerns about their care that jeopardized their experiences of patient-centredness. These areas concerned issues of communication with and among healthcare professionals, relationships with these care providers, trust and respect in the professional relationships, and general satisfaction with care. Participants provided advice to professional students about ways to interact more effectively with their patients to establish caring, empathetic, patient-centred relationships as the basis for care. We address patient recommendations to support learner understanding of the patient experience both in classrooms and clinical experiences throughout educational programs as a means to enhance their patient-centredness.

Informed consent skills in internal medicine residency: how are residents taught, and what do they learn?

Purpose Obtaining informed consent is an essential skill in internal medicine (IM). The authors’ informal observations and formal testing revealed deficiencies in residents’ informed consent skills. This study evaluated how residents acquire informed consent skills and how informed consent skills are addressed in Canadian IM residency programs. Method A questionnaire was delivered to all 16 IM program directors in Canada, asking how informed consent is taught and assessed. At the University of Saskatchewan IM residency program, residents were assessed through an objective structured clinical examination station, written examination, and a self-assessment questionnaire. Results No consistent approach to teaching or evaluating informed consent skills exists within Canadian IM programs. Program directors and residents identified informal mentoring by residents as an important learning modality. Although residents performed well in discussing procedural indications and techniques, discussing risks was inadequate. Residents focused on general and minor risks but avoided discussing serious risks and had difficulty discussing the frequency of complications. Residents lacked a structured approach to assessing capacity and often assessed only comprehension. Residents were unfamiliar with concepts such as material risk, implied consent, and therapeutic privilege. Conclusion Explicit training in informed consent skills is urgently needed. Informal mentoring must be recognized as an important training method for informed consent and supported by appropriate teaching and evaluation strategies to ensure that resident–instructors do so effectively.

Constrictive Bronchiolitis and Ulcerative Colitis

Pulmonary complications occur in an estimated 0.21% of patients with inflammatory bowel disease. The most common presentation of pulmonary manifestations is large airway disease, such as tracheobronchitis, chronic bronchitis or bronchiectasis. Small airway disease, such as constrictive bronchiolitis or bronchiolitis obliterans with organizing pneumonia, is less frequently reported, and is described as occurring in isolation from large airway disease. A case of a postcolectomy ulcerative colitis in a patient who has both large airway involvement, tracheobronchitis and bronchiectasis, and constrictive bronchiolitis is presented.

Low Serum Albumin and Abnormal Body Shape in a Young Canadian First Nations Woman

Prior Medical History The patient had been admitted to a local hospital with pneumonia 1 year earlier and had a history of arthritic pain in the right knee. There was no other significant medical history, although the patient had an unusual body shape or habitus, including pronounced cellulite deposits on her buttocks and thighs that were disproportionately thick compared to the lipid deposition on her abdomen and trunk [I1].

Postgraduate internal medicine residents' roles at patient discharge - do their perceived roles and perceptions by other health care providers correlate?

Abstract Knowing one’s own role is a key collaboration competency for postgraduate trainees in the Canadian competency framework (CanMEDS®). To explore methods to teach collaborative competency to internal medicine postgraduate trainees, baseline role knowledge of the trainees was explored. The perceptions of roles (self and others) at patient discharge from an acute care internal medicine teaching unit amongst 69 participants, 34 physicians (25 internal medicine postgraduate trainees and 9 faculty physicians) and 35 health care professionals from different professions were assessed using an adapted previously validated survey (Jenkins et al., 2001). Internal medicine postgraduate trainees agreed on 8/13 (62%) discharge roles, but for 5/13 (38%), there was a substantial disagreement. Other professions had similar lack of clarity about the postgraduate internal medicine residents’ roles at discharge. The lack of interprofessional and intraprofessional clarity about roles needs to be explored to develop methods to enhance collaborative competence in internal medicine postgraduate trainees.

Expert Consensus on a Canadian Internal Medicine Ultrasound Curriculum

Ultrasonography is increasingly used at the bedside. In the absence of an already developed curriculum appropriate for Canadian internal medicine training programs, 13 representatives from internal medicine programs in five Western Canadian provinces met for 2 days to develop and propose a consensus-based internal medicine curriculum for training in the bedside use of ultrasonography in a Canadian health care context. All 13 had had interest or leadership role in those programs. The curriculum’s content was based on three overarching principles agreed upon by the group: (1) content should be selected on the basis of clinical or educational need; (2) content should be feasible (i.e., both cognitive and technical components of the curriculum could be reasonably taught and learned in a competency-based manner while minimizing potential risks to patients); and (3) content should be evidence based. A consensusbased curriculum of 16 proposed topics is to be considered for the core internal medicine residency training program (postgraduate year [PGY] 1 to PGY 3), and 22 topics are to be considered for general internal medicine subspecialty training programs (PGY 4 to PGY 5).

The Evolution of General Internal Medicine (GIM)in Canada: International Implications

General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.

Interprofessional Skills Learning Guide: A Multimedia E-Book for Small-Group or Individual Learning

Introduction Redefining learning space beyond physical classrooms with fixed resources is necessary to address challenges of interprofessional learning in a clinical setting. This multimedia e-book introduces recognized team skills of shared mental models, situational awareness, and the SBAR (situation, background, assessment, and recommendation) communication tool for individual or small-group learning. The e-book was derived from work done to develop an interprofessional small-group interactive learning tool for use in a clinical environment where resources, including meeting space, time, and facilitators, were limited. It is designed for individuals early in their clinical training but who have had previous clinical experience. Methods Utilizing readings, a series of videos, and reflective questions, a virtual narrator guides learners through an interactive case regarding a virtual chronic obstructive pulmonary disease patient preparing for discharge. Results Thirty-two responders evaluated the learning content as being clinically relevant. Comments encouraged all health care providers to become familiar with these interprofessional tools. Discussion Electronic, human, and space resources are often limited, especially in the clinical/education interface of the hospital or clinic environment for embedded interprofessional learning opportunities. The multimedia e-book provides a stand-alone learning resource for individuals or small groups of the same or different professions, with the opportunity for interactive learning with minimal space and human resource requirements.

General Internal Medicine Subspecialty Training Update

The vast majority of general internal medicine (GIM) programs in Canada have become distinct entities that provide training in additional competencies and leadership above and beyond those required for the specialty of internal medicine. In December 2010, after many years of effort, GIM finally achieved recognition as a distinct subspecialty by the Royal College of Physicians and Surgeons of Canada. A GIM Working Group has finalized the objectives and requirements for a 2-year subspecialty training program in GIM that will follow after the existing 3-year core internal medicine training program. These documents have now been approved by the Royal College.

Accessing Information on a General Internal Medicine Consultation Service: The Value of a GIM Online Guide

The advent of copyright law changes made it difficult for the authors’ Division of General Internal Medicine to continue providing their internal medicine learners with a compilation of key articles on general internal medicine for the consultative rotation. This was seen as an opportunity for collaboration with the library to develop an online guide to key articles for general internal medicine. This guide has been very useful and well received by both faculty and learners.