Zubin Austin

Flower Power: The Armoured Expert in the CanMEDS Competency Framework?.

Competency frameworks based on roles definitions are currently being used extensively in health professions education internationally. One of the most successful and widely used models is the CanMEDS Roles Framework. The medical literature has raised questions about both the theoretical underpinnings and the practical application of outcomes-based frameworks, however little empirical research has yet been done examining specific roles frameworks. This study examines the historical development of an important early roles framework, the Educating Future Physicians of Ontario (EFPO) roles, which were instrumental in the development of the CanMEDS roles. Prominent discourses related to roles development are examined using critical discourse analysis methodology. Exploration of discourses that emerged in the development of this particular set of roles definitions highlights the contextual and negotiated nature of roles construction. The discourses of threat and protection prevalent in the EFPO roles development offer insight into the visual construction of a centre of medical expertise surrounded by supporting roles (such as collaborator and manager). Non-medical expert roles may perhaps play the part of ‘armour’ for the authority of medical expertise under threat. This research suggests that it may not be accurate to consider roles as objective ideals. Effective training models may require explicit acknowledgement of the socially negotiated and contextual nature of roles definitions.

‘The fault lies not in our students, but in ourselves’: academic honesty and moral development in health professions education—results of a pilot study in Canadian pharmacy

Numerous explanations have been offered to explain the ubiquity and enduring nature of academic dishonesty in post-secondary education and professional programs, including dissatisfaction with curricula, disengagement from academic institutions, and poor admissions criteria for students. A pilot study in Canadian pharmacy education was undertaken to determine students’ and educators’ behaviours and attitudes towards academic dishonesty. Consistent with findings in other fields, this study illustrated a self-reported high incidence of academic dishonesty by both educators and students, although educators’ attitudes towards acts of dishonesty were somewhat more severe. In explaining these results, the author suggests an alternative, developmental explanation for academic dishonesty. By viewing academic dishonesty as a normative, developmental event, one in which students learn to behave professionally and morally by making choices, abiding by consequences, and (paradoxically) behaving immorally, academic dishonesty (while serious) may not be the result of any serious act of omission on the part of educators. If developmental, attempts to eliminate academic dishonesty through revised admissions policies, updated curricula, or other measures, may be of only limited success in addressing this ubiquitous and enduring issue.

Assessment of Pharmacists’ Patient Care Competencies: Validity Evidence from Ontario (Canada)’s Quality Assurance and Peer Review Process

Maintenance of competence is integral to health care practitioners’ continuing professional development. The adequacy and value of indirect assessment of competence (through, for example, learning portfolios or attendance at educational events) has been questioned. Direct assessment (such as written tests of clinical knowledge or objective structured clinical examinations, OSCEs) has been advocated as a more meaningful indicator of a practitioner’s competence. This paper describes the Ontario (Canada) College of Pharmacists’ experience with direct assessment through the Peer Review/Quality Assurance process. This process consists of a self- assessment questionnaire, ongoing maintenance of a learning portfolio, a written test of clinical knowledge, and an OSCE. Each year, a randomly selected group of pharmacists in Ontario undertake the Peer Review process. After five years of operation, 992 pharmacists had participated in this program; 86% of participants met or exceeded standards and were encouraged to continue with their own professional development while 14% of participants did not meet standards in identified assessment areas, and were directed to a peer-assisted process to facilitate professional development. Findings suggest individuals who were educated outside Canada or the United States, those in community pharmacy practice, and those who had been in practice 25 years or more demonstrated greatest difficulty in meeting standards. The implications of these results for pharmacy practice and professional development are discussed as are issues related to direct and indirect assessment of clinical skills.

Captive on a carousel: discourses of ‘new’ in medical education 1910–2010

Medical educators aim to train physicians with sound scientific knowledge, expert clinical skills and an ability to work effectively with patients, colleagues and health systems. Over the past century, educators have devoted considerable thought and effort to how medical education might be improved. Analysing the language used to describe these initiatives provides insight into assumptions and practices. The authors conducted a Foucauldian critical discourse analysis of prominent recurrent themes in the North American medical education literature. The assembled archive of texts included works of Abraham Flexner, articles from the journal Academic Medicine (including its predecessor journals) and major medical education reports. A series of recurring themes were identified, including the need to avoid over-specialization, the importance of generalism, and the need to broaden criteria for medical student selection. Analysis of these recurring themes allowed identification of a prominent and recurrent discourse of ‘new.’ This discourse places focus on the future, ignores the ongoing historical nature of issues, suggests a sense of urgency and enables the proposal of modest solutions. It emphasizes changes for individual future doctors, thereby limiting consideration of institutional and systemic factors. Using the image of a carousel, the regular return of themes can be seen as carousel ponies circling around repeatedly in medical education. Identification of this medical education carousel provides an opportunity for medical educators to understand the historical nature of calls for change, and to consider what kinds of reform might be required if they wish to avoid this repetition in the future.

Negotiation of interprofessional culture shock:The experiences of pharmacists who become physicians

Summary Professions generally operate within a shared set of values, symbols, and norms; in short, professions may be characterized as having somewhat unique sub-cultures. As inter-professional teamwork and collaboration gain prominence, understanding the inter-cultural dimensions of professional interactions may be useful in explaining how and why such teams function. One way of examining the unique (and common) elements of professional sub-cultures is to study the experiences of professionals who have “migrated” from one field to another. In this paper, the “culture shock” experience of pharmacists who have become physicians is described and discussed. Results from interviews with 32 pharmacist-physicians were used to frame four major themes that depict salient and unique characteristics of the cultures of pharmacy and medicine.

Structuring communication relationships for interprofessional teamwork (SCRIPT): A Canadian initiative aimed at improving patient-centred care

There is a growing movement in health care that advocates the use of interprofessional education to help deliver collaborative patient-centred care (Oandasan et al., 2004). For example, the Romanow Commission (2002) and the First Ministers’ Accord (Health Canada 2003) both stress the need for collaborative practice to help ensure that the quality of health care delivered to Canadians can be enhanced. Both reports identified that introducing interprofessional education within the health professional education system was the key to achieving this aim. Evidence of the effectiveness of interprofessional education suggests that it can generate a number of positive outcomes for professionals and for patients (Barr et al., 2005). However, at present, this evidence base is generally weak and fragmentary in nature (Zwarenstein & Reeves, 2006). To help generate a more informed understanding of interprofessional education and its potential impact on collaborative relationships and the delivery of patient care, the Canadian federal government has recently funded eleven projects across the country. This paper describes one of these projects based at the University of Toronto. The project involves the development of an intervention designed to improve interprofessional collaboration across three separate clinical settings: general internal medicine (GIM); primary care; and rehabilitation and complex continuing care. Each of these settings was selected as they represent key trajectories along which patients travel while receiving care in the Toronto Academic Health Science Network (TAHSN), the network of partnerships between the University of Toronto and its fully affiliated health services’ institutes. Journal of Interprofessional Care, January 2007; 21(1): 111 – 114

Responsibility and confidence: Identifying barriers to advanced pharmacy practice

Background: Despite the changing role of the pharmacist in patient-centred practice, pharmacists anecdotally reported little confidence in their clinical decision-making skills and do not feel responsible for their patients. Observational findings have suggested these trends within the profession, but there is a paucity of evidence to explain why. We conducted an exploratory study with an objective to identify reasons for the lack of responsibility and/or confidence in various pharmacy practice settings. Methods: Pharmacist interviews were conducted via written response, face-to-face or telephone. Seven questions were asked on the topic of responsibility and confidence as it applies to pharmacy practice and how pharmacists think these themes differ in medicine. Interview transcripts were analyzed and divided by common theme. Quotations to support these themes are presented. Results: Twenty-nine pharmacists were asked to participate, and 18 responded (62% response rate). From these interviews, 6 themes were identified as barriers to confidence and responsibility: hierarchy of the medical system, role definitions, evolution of responsibility, ownership of decisions for confidence building, quality and consequences of mentorship and personality traits upon admission. Discussion: We identified 6 potential barriers to the development of pharmacists’ self-confidence and responsibility. These findings have practical applicability for educational research, future curriculum changes, experiential learning structure and pharmacy practice. Due to bias and the limitations of this form of exploratory research and small sample size, evidence should be interpreted cautiously. Conclusion: Pharmacists feel neither responsible nor confident for their clinical decisions due to social, educational, experiential and personal reasons. Can Pharm J 2013;146:155-161.

Learning Styles of Pharmacists: Impact on Career Decisions, Practice Patterns and Teaching Method Preferences

This study examined possible associations between learning styles of pharmacists (as identified through Kolb’s Learning Styles Inventory (LSI) and the Pharmacists’ Inventory of Learning Styles (PILS)) and career decisions, practice patterns and teaching method preferences. A total of 166 pharmacists were involved in this study and completed either the LSI or the PILS, and a supplemental questionnaire. Of them, 33.7% of the respondents were identified as Assimilators, 32.5% as Convergers, 21.1% as Divergers and 12.1% as Accommodators. Results suggest that there is a statistically significant correlation between identified learning style and teaching method preferences as well as years since graduation. While there was no statistically significant correlation between learning styles and gender, career decisions or practice patterns, there does appear to be a trend that warrants further investigation. Implications for delivery of continuing education are discussed, since learning preferences for each group varied considerably.

Consumers of natural health products: natural-born pharmacovigilantes?

BackgroundNatural health products (NHPs), such as herbal medicines and vitamins, are widely available over-the-counter and are often purchased by consumers without advice from a healthcare provider. This study examined how consumers respond when they believe they have experienced NHP-related adverse drug reactions (ADRs) in order to determine how to improve current safety monitoring strategies.MethodsQualitative semi-structured interviews were conducted with twelve consumers who had experienced a self-identified NHP-related ADR. Key emergent themes were identified and coded using content analysis techniques.ResultsConsumers were generally not comfortable enough with their conventional health care providers to discuss their NHP-related ADRs. Consumers reported being more comfortable discussing NHP-related ADRs with personnel from health food stores, friends or family with whom they had developed trusted relationships. No one reported their suspected ADR to Health Canada and most did not know this was possible.ConclusionConsumers generally did not report their suspected NHP-related ADRs to healthcare providers or to Health Canada. Passive reporting systems for collecting information on NHP-related ADRs cannot be effective if consumers who experience NHP-related ADRs do not report their experiences. Healthcare providers, health food store personnel, manufacturers and other stakeholders also need to take responsibility for reporting ADRs in order to improve current pharmacovigilance of NHPs.

Development of a Prior Learning Assessment for Pharmacists Seeking Licensure in Canada

Prior learning assessment (PLA) has been used to provide an indication of learning acquired through formal educational and unstructured professional experiences. PLA has been used in a variety of professions and trades to complement traditional credential-based evaluations of knowledge and skills. Within the context of pharmacy, PLA is currently being used as a tool to assess the competencies of foreign- trained pharmacists seeking licensure in Ontario, Canada. A competency-based approach moves beyond the traditional prior learning tools (e.g. interviews, portfolios, and transcript reviews) and incorporates performance-based assessment such as the objective structured clinical examination (OSCE). This paper describes the systematic method for developing a structured, competency-based prior learning assessment for foreign-trained pharmacists seeking licensure in Ontario, Canada. Beginning with the identification of critical competency standards, a model for sequen- tial assessment of knowledge, skills and values is presented. Results from a pilot program are presented, suggesting the importance of cultural competency (over and above linguistic competency and in conjunction with a strong declarative pharmacotherapeutic knowledge base) in pharmacy practice.