ABSTRACT
CONTEXT: The Clinician Scholar Program (CSP) is an enhanced-skills (R3) residency program to train clinician researchers/educators/leaders for academic family practice. This article intends to share Laval University's CSP development and evaluation strategy, and provide recommendations for similar innovations in other disciplines/settings. METHODS: This article uses Kern's model to present the program development, and a program-oriented approach for program evaluation, carried from 2011 to 2017 using descriptive data. Questionnaires, reflexive texts and an Objective Structured Teaching Exam supported data collection. RESULTS: Seven CSP graduates and 14 controls participated in the program evaluation. Residents were highly satisfied with the program, nevertheless they suggested to allow physicians to come back for training later in career. The CSP enriched knowledge, skills and attitudes about academic practice. CSP increased residents' entrustment level about academic competencies. All graduates joined an academic practice within five years of program completion. CONCLUSION: Key recommendations to implement similar programs include academic medicine core training, project- based learning with learner-centered objectives, relevant and authentic learning and assessment, and multi-level program evaluation approach. Programs should consider concomitant graduate studies and opportunity to offer such training after a few years of clinical practice to meet other needs at a timely stage of career.
CONTEXTE: Le programme clinicien érudit (PCÉ) est un programme de résidence de compétences avancées (R3) destiné à former des cliniciens chercheurs / éducateurs / leaders en vue d'une pratique de médecine familiale universitaire. Cet article a pour but de faire connaître la stratégie de développement et d'évaluation du PCÉ de l'Université Laval et de formuler des recommandations pour des innovations similaires dans d'autres disciplines/contextes. MÉTHODES: Cet article utilise le modèle de Kern pour présenter le développement du programme et une approche d'évaluation orientée sur le programme, réalisée de 2011 à 2017 à l'aide de données descriptives. Des questionnaires, des textes réflexifs et un examen d'enseignement objectif structuré ont permis de recueillir des données. RÉSULTATS: Sept diplômés du PCÉ et 14 témoins ont participé à l'évaluation du programme. Les résidents étaient très satisfaits du programme, suggérant néanmoins de permettre une formation plus tard dans la carrière. Le PCÉ a enrichi les connaissances, les habiletés et les attitudes relatives à la pratique universitaire. Le PCÉ a augmenté le niveau de confiance des résidents en ce qui concerne les compétences académiques. Tous les diplômés se sont engagés dans une pratique universitaire dans les cinq années suivant leur graduation du programme. CONCLUSIONS: Les principales recommandations pour la mise en Åuvre de programmes similaires incluent la réalisation d'un tronc commun en médecine universitaire, l'apprentissage par projet avec des objectifs centrés sur l'apprenant, des stratégies d'apprentissage et d'évaluation pertinentes et authentiques, et une approche d'évaluation de programme à plusieurs niveaux. Les programmes doivent envisager offrir des études supérieures en parallèle et la possibilité d'offrir cette formation après quelques années de pratique clinique afin de répondre à d'autres besoins à un stade opportun de leur carrière.
ABSTRACT
Depression can be the first sign of dementia or can occur in the follow-up of a clearly demented patient. One must be able to distinguish symptoms of depression and dementia, and recognize depression superimposed on dementia in order to provide optimal treatment. Suicidal risk must be assessed, and major depressive episodes must be appropriately treated. Useful drugs to treat depression in demented patients are reviewed. At this stage of the dementing illness, the patient still needs medical attention for other medical problems, periodic health exams, other chronic conditions, etc. It is also important to address the issues of CPR and level of care, if it has not been done previously. Legal aspects must also be clarified at this stage. The patient's ability to consent or to make financial decisions must be assessed. Some objective criteria are suggested. At this stage of the disease, the family physician can really make the difference between a premature nursing home placement and a patient staying at home with his family.
Subject(s)
Dementia , Anxiety/etiology , Dementia/complications , Dementia/drug therapy , Dementia/psychology , Depression/drug therapy , Depression/etiology , Humans , Mental Competency/legislation & jurisprudence , Mood Disorders/etiology , SwitzerlandABSTRACT
The decision to refer a demented patient to a nursing home is not always an easy one. The family physician has an active role to play: asking timely questions, helping families to prevent what can be prevented; giving proper advice on how and when to make arrangements for private or public accommodation; giving adequate support to the patient and his/her family before and after entering a nursing home. Some difficult situations can occur: family members may disagree on the necessity for the patient to be sent to a nursing home, or the patient may refuse to leave home. Here as well, the physician can play an essential role: his knowledge of the patient's family and personal history, his communication skills and his capacity to assess the patient's ability to consent are key factors in making a smooth transition. Occasionally, the patient's family decides to keep the patient at home until the end. The success of such a venture is highly dependent on the following elements: thorough understanding of the patient's condition and of its possible complications, a readily available and reliable support network, good teamwork, medical follow-up and full-time on-call system.
