Supporting early academic family medicine careers with the clinician scholar enhanced-skills program.

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 œuvre 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.

Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56.

Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options. Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use. Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990-2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations. Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.

Airway inflammatory responses following exposure to occupational agents.

BACKGROUND: Airway inflammatory responses to specific inhalation challenges (SICs) with low-molecular-weight (LMW) and high-molecular-weight (HMW) agents have not been studied thoroughly. We assessed the changes in airway inflammatory cells following SIC in sensitized workers, and looked at the influence of various factors on the pattern of inflammatory responses to SIC. METHODS: Induced sputum analysis was performed in workers sensitized to LMW (n = 41) or HMW agents (n = 41) after a control day and after a positive SIC. Cell counts were compared with lung function and various clinical parameters. RESULTS: In the LMW group, eosinophils were increased following late asthmatic responses (median [interquartile range], 0.02 [0.04] × 10(6) cells/g vs 0.30 [0.80] × 10(6) cells/g and 1.0% [3.5] vs 8.9% [8.0], P < .05), as were neutrophil numbers (0.8 [1.3] × 10(6) cells/g vs 2.3 [5.4] × 10(6) cells/g, P = .04). In the HMW group, eosinophil percentages increased both after early (1.0% [2.2] vs 5.5% [14.5], P = .003) and dual asthmatic responses (4.5% [3.7] vs 15.0% [13.7], P = .02). In the LMW group, the increases in neutrophils were higher in current smokers than in ex-smokers or nonsmokers. The length of exposure to the agent, tobacco use, and baseline percentage of eosinophils were independent predictors of the change in eosinophils, whereas age and baseline neutrophil percentage were predictors of the change in neutrophils. CONCLUSIONS: This study confirms that eosinophils and neutrophils are increased after SIC, whatever the causal agent. The type of agent is not predictive of the inflammatory response to SIC. Smoking is associated with a more neutrophilic response after SIC with an LMW agent.

Characteristics and medical resource use of asthmatic subjects with and without work-related asthma.

BACKGROUND: Asthma is work related when there is an association between symptoms and work. Occupational asthma (OA) is induced by the workplace, whereas work-exacerbated asthma (WEA) is triggered by the workplace but not induced by it. OBJECTIVE: We sought to compare the clinical characteristics and the use of medical resources between subjects with work-related asthma (WRA) and asthmatic control subjects without WRA, as well as between subjects with OA and subjects with WEA. METHODS: We performed a retrospective cohort study of the charts of subjects with WRA who were investigated between 2001 and 2004 in our centers. These subjects were matched according to sex, age, and FEV(1) to subjects with non-WRA investigated during the same period. All charts were linked to the information provided by the Régie de l'assurance maladie du Québec, including outpatient clinic visits and visits to the emergency department and hospitalizations during the year before and after the initial assessment in our centers. RESULTS: Three hundred fifty-one subjects had WRA (WEA, 145; OA, 206), whereas 384 subjects were asthmatic control subjects without WRA. Subjects with WRA had more asthma exacerbations than subjects with non-WRA. The risk factor of experiencing a severe asthma exacerbation was no greater for OA than for WEA (odds ratio, 1.15; 95% CI, 0.75-1.75). CONCLUSION: WRA is associated with a larger use of medical resources than non-WRA. CLINICAL IMPLICATIONS: Improving the diagnosis and management of WRA is crucial for limiting the use of medical resources associated with this condition.