W. Wayne Weston

Improving Communication Between Doctors and Breast Cancer Patients

PURPOSE We wanted to assess the effectiveness of intensive education for physicians compared with a traditional session on communicating with breast cancer patients. METHODS A randomized controlled trial was conducted in practices in London, Hamilton, and Toronto, Canada, with 17 family physicians, 16 surgeons, and 18 oncologists, and with 102 patients of the surgeons and oncologists. Doctors were randomized to 1 of 2 continuing education approaches: a traditional 2-hour version (control group), or a new 6-hour intensive version including exploring the patients’ perspectives and reviewing videotapes and receiving feedback (intervention group). Communication behavior of the physicians was measured objectively both before and after the intervention. As well, 4 postintervention patient outcomes were measured, by design only for surgeons and oncologists: patient-centerdness of the visit, satisfaction, psychological distress, and feeling better. RESULTS No significant differences were found on the communication score of the intervention vs the control physicians when controlling for preintervention communication scores. Intervention family physicians, however, had significantly higher communication subscores than control family physicians. Also, patients of the intervention surgeons and oncologists were significantly more satisfied (scores of 82.06 vs 77.78, P = .03) and felt better (88.2% vs 70.6%, P=.02) than patients of the control surgeons and oncologists when controlling for covariates and adjusting for clustering within doctor. CONCLUSIONS The continuing medical education intervention was effective in terms of some but not all physician and patient outcomes.

Evaluation of a particle repositioning maneuver Web-based teaching module.

Objectives/Hypothesis: To compare the pass rate of residents performing the Particle Repositioning Maneuver (PRM) after one of three interventions: 1) small group PRM instruction (SG); 2) standard classroom instruction (CI); and 3) Web‐based learning module (WM). We hypothesize that our Web‐based learning module is more effective than CI and as effective as SG.

Education scholarship: it's not just a question of ‘degree’

Background: Although medical faculty are frequently encouraged to participate in education scholarship, there is a paucity of literature addressing how to support those who wish to do so. Aims: The purpose of this study was to explore faculty involvement in and support needs for pursuing education scholarship. Methods: A purposive sample of 108 medical faculty with an interest in medical education were invited to participate in a two-phase, mixed-methods study (survey and focus groups). Results: Seventy-three faculty (67.6%) completed the questionnaire with 16 subsequently participating in focus group sessions. Nearly 40% had enrolled in or completed formal education training. Although the majority had been involved in at least one education project during the past five years, few had received funding or published their work. Three support-related themes emerged: education research support; enhancing colleague interactions; and ongoing development activities. Three related barriers were identified: time, access to support staff, and knowledge of research methodology. No significant differences were identified between those with and without additional education training. Conclusions: Assisting faculty to participate in education scholarship is a complicated endeavor. Institutional supports should not be limited to those with advanced degrees nor rely on Master-level degree programs to provide all the necessary training.

Nursing Students' Perceptions of Clinical Teachers' Use of Empowering Teaching Behaviours: Instrument Psychometrics and Application

The authors present findings of 2nd year nursing students’ (N = 352) perceptions of their clinical teachers’ use of empowering teaching behaviours (ETB) and to highlight steps undertaken to establish psychometric properties of the Empowering Teaching Behaviours Questionnaire – Student (ETBQ-S). The authors identify a) the process involved in the adoption of the ETBQ-S, b) ETBQ-S validity procedures completed prior to instrument implementation, c) results of nursing students’ responses to the ETBQ-S, d) criterion validity, and e) ETBQ-S confirmatory factor analysis findings conducted after study completion. The ETBQ-S reliably measures five facets of empowering actions that clinical teachers can employ with nursing students in practice to enhance their confidence, involve them in decision-making and goal setting, make learning meaningful, and help them to become more autonomous nurses.

Ensuring the Success of Interprofessional Teams: Key Lessons Learned in Memory Clinics

Cliniques de mémoire en soins de santé primaires suscitent un intérêt croissant, car elles offrent la possibilité d’améliorer le diagnostic et le traitement de la démence. En Ontario, plus de 30 établissements de soins primaires ont participé à un programme de formation visant à aider les participants à établir une clinique de mémoire indépendante dans leur milieu de pratique. Cet article présente les principales leçons acquises dans la mise en oeuvre de ces cliniques sur la base d’une étude qui a utilisé une méthodologie d’entrevue avec les membres des équipes de cliniques de mémoire et a identifié les facteurs favorables, les défis et les recommandations pour la soutenabilité. L’accès à la formation qui facilite le transfert des connaissances et soutient les changements dans la pratique, la collaboration interprofessionnelle, et le soutien de l’infrastructure en cours était d’une importance capitale. Des suggestions pour la mise en place de cliniques et de renforcement des capacités continues ont été identifiés. Les leçons apprises sont applicables à la mise en oeuvre d’autres modèles de prise en charge des maladies chroniques dont le but est la gestion des soins de santé primaires de maladies chroniques complexes. Primary care–based memory clinics are attracting increasing interest because they present an opportunity to improve dementia diagnosis and management. In Ontario, more than 30 primary care setting participated in a training program aimed at assisting participants to establish an independent memory clinic in their practice setting. This article outlines the key lessons learned in implementing these clinics, on the basis of a study that – used an interview methodology with memory clinic team members and – identified facilitating factors, challenges, and suggestions for sustainability. Of key importance was access to training that facilitates knowledge transfer and supports practice change, interprofessional collaboration, and ongoing infrastructure support. Suggestions for clinic implementation and ongoing capacity building were identified. Lessons learned are applicable to the implementation of other chronic-disease care models aimed at improving the primary care management of complex chronic conditions.

The Patient in the Family and the Family in the Patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.

Improving family medicine resident training in dementia care: an experiential learning opportunity in Primary Care Collaborative Memory Clinics

ABSTRACT Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents’ ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.

“Booster Days”: An educational initiative to develop a community of practice of primary care collaborative memory clinics

ABSTRACT This study explores the value of a Booster Day education initiative for clinicians working in interprofessional Primary Care Collaborative Memory Clinics (PCCMC) to share updates in dementia care, challenging cases, key lessons learned, and best practices, as a mechanism to foster learning and support the PCCMC Community of Practice (CoP). Between 2010 and 2016, 17 annual Booster Days were delivered to health professionals who completed the PCCMC training program. All participants were invited to complete an evaluation survey in which they identified the ways in which the sessions have been helpful; 89% (1361/1530) completed surveys. The Booster Days were valued as opportunities for networking to learn from other clinicians, fostering a sense of community, learning new information, learning to support practice improvements, and team building. An annual Booster Day that incorporates active participant engagement, information sharing, and networking may effectively support CoPs, learning, team building, and practice change within interprofessional teams.