Canadian medical faculty senior leaders: what skills do they need?

PURPOSE: Many academic leaders have little formal leadership training, which can result in challenges to effective leadership, succession planning and burnout. This paper aims to explore the leadership skills needed to be an effective senior academic leader in a Canadian medical faculty. DESIGN/METHODOLOGY/APPROACH: An anonymous voluntary survey of needed leadership skills and supports was sent to 60 senior academic leaders at the University of Alberta. This was followed by interviewing a purposive sample, using open-ended questions based on a multimodal needs assessment of senior academic leaders. The authors used an iterative process to analyze the data; anonymized transcripts were coded and categorized separately by two researchers, and themes were created. FINDINGS: The "ability to influence" was the highest rated needed leadership skill in the survey. The interviewed leaders (n = 12) were unanimous that they felt unprepared at the start of the leadership role. The survey and interviews identified five major themes for leadership skills: Mentoring, Finances, Human Resources, Building Relationships and Protected Time. Networking and leadership courses were identified as major sources of support. RESEARCH LIMITATIONS/IMPLICATIONS: Although a single site study, the results were similar to another large Canadian medical faculty (University of Toronto, Lieff et al., 2013). While the survey had a 42% response rate (25/60), the survey responses were echoed in the interviews. Although the purposive sample was small, the interviewed leaders were a representative sample of the larger leadership group. ORIGINALITY/VALUE: Academic leaders may benefit from a mentorship team/community of leaders and specific university governance knowledge which may help their ability to influence and advance their strategic initiatives.

Informed consent challenges and strategies: A qualitative study of the orthodontists' perspective.

OBJECTIVE: To identify the barriers and strategies perceived by orthodontists when obtaining consent from their adult patients concerning patients' comprehension or recollection of treatment information. SETTINGS AND SAMPLE POPULATION: The sample comprised 12 orthodontists working in 8 different cities in Alberta, Canada. METHODS: An exploratory investigation using qualitative inquiry was conducted. Participants were recruited through a combination of purposive, maximum variation and snowball sampling. Data were collected through audio-recorded, semi-structured interviews until saturation was reached. Then, data were analysed using thematic analysis. Quality and credibility were achieved by employing member checks, memo writing and analyst triangulation strategies. RESULTS: Two major themes were identified, with subthemes: (1) Challenges that may interfere with patients' comprehension and recollection of treatment information (i. patients' internal barriers, ii. patients' external barriers and iii. financial barriers); and (2) strategies to optimize information delivery and communication (i. tailoring the content to be delivered, ii. communication fashion, iii. communication timing and iv. being accommodative). CONCLUSION: The participants reported barriers that may be overlooked in the daily routine of orthodontic practices. Information is provided that may guide orthodontists to overcome or minimize these challenges, increase patient comprehension and improve the quality of informed consent processes.

Transforming Health Experience and Action through Shifting the Narrative on Obesity in Primary Care Encounters.

We sought to understand the impact of primary care conversations about obesity on people's everyday life health experience and practices. Using a dialogic narrative perspective, we examined key moments in three very different clinical encounters, the patients' journals, and follow-up interviews over several weeks. We trace how people living with obesity negotiate narrative alternatives that are offered during clinical dialogue to transform their own narrative and experience of obesity and self. Findings provide pragmatic insights into how providers can play a significant role in shifting narratives about obesity and self and how such co-constructed narratives translate into change and tangible health outcomes in people's lives.

Addressing Women's Unmet Health Care Needs in a Canadian Remand Center: Catalyst for Improved Health?

Incarcerated women have a disproportionate burden of infectious and chronic disease, substance disorders, and mental illness. This study explored incarcerated women's health and whether a Women's Health Clinic improved care within this vulnerable population. Retrospective chart reviews and focus groups were conducted. Poor access to care in the community due to competing social needs was described. Barriers to care during incarceration included lack of comprehensive gender-specific services, mistrust of providers, and fragmentation. Of 109 women, high rates of mental illness, partner violence, substance use, sexually transmitted infection (STI), and irregular Pap testing were observed. Pap (15% to 54%, p < .001) and STI (17% to 89%, p < .001) testing rates increased. Fragmentation of care remained at transition points, and further work is needed to improve continuity within corrections and the community.

Access to healthcare services during incarceration among female inmates.

Purpose Incarcerated women have a disproportionate burden of infectious and chronic disease, in addition to substance use disorder and mental health illness, when compared to the general population ( Binswanger et al., 2009 ; Fazel et al., 2006 ; Fuentes, 2013; Kouyoumdjian et al., 2012 ). Women often enter the correctional system in poor health, making incarceration an opportunity to address health issues. The purpose of this paper is to explore the barriers to accessing health services that female inmates face during incarceration, the consequences to their health, and implications for correctional health services delivery. Design/methodology/approach Focus groups were conducted in Canadian correctional center with female inmates. Focus groups explored women's experiences with accessing health services while incarcerated; the impact of access to health services on health during incarceration and in the community; and recommendations for improving access to health services. Thematic analysis was completed using N-vivo 10. Findings The women described multiple barriers to accessing health services that resulted in negative consequences to their health: treatment interruption; health disempowerment; poor mental and physical health; and recidivism into addiction and crime upon release. Women made three important recommendations for correctional health service delivery: provision of comprehensive health entry and exit assessments; improvement of health literacy; and establishment of health support networks. The recommendations were organized into an "Accessing Health Services Resource Manual" for incarcerated women. Originality/value There is a paucity of existing literature examining provision of health services for female inmates. These findings have relevancy for correctional and community health care providers and organizations that provide health services for this vulnerable population.

Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review.

BACKGROUND: The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. METHODS: A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. RESULTS: From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. DISCUSSION: This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. CONCLUSION: The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

WORK PATTERN DIFFERENCES BETWEEN MALE AND FEMALE ORTHODONTISTS IN CANADA.

OBJECTIVE: To examine sex-specific differences in the demographics and work patterns of Canadian orthodontists. METHODS: Questionnaires were mailed and emailed to a random sample of 384 orthodontists: 289 men and 95 women. Questions regarding work patterns and personal demographics were created and results were compared by sex. RESULTS: The response rate was 53.9%. The demographics and work patterns for male and female orthodontists were similar for most variables. Women were found to be 6 years younger; have 6 fewer years of work experience; expect to retire earlier; be more often married to a professional in full-time employment; and be more likely to take a leave of absence during their career than their male colleagues. Age significantly affected the number of hours worked per week and number of phase II starts per year; both variables increased with increasing age until approximately 50 years, after which they decreased with age. Having children did not significantly affect any of the analyzed variables. CONCLUSIONS: As the practice of female orthodontists was not found to be substantially different from that of men, it is not possible to speculate whether the increasing number of women specializing in orthodontics will provoke a significant change in the profession. As this is the first survey of its kind in Canada, these results may be used as a reference for future comparisons to determine work patterns and trends in the orthodontic workforce.

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

OBJECTIVE: Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. METHOD: Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. RESULTS: Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. DISCUSSION: These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. CONCLUSIONS: This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings.

Informed consent comprehension and recollection in adult dental patients: A systematic review.

BACKGROUND: Patients' ability to recollect and comprehend treatment information plays a fundamental role in their decision making. TYPES OF STUDIES REVIEWED: The authors considered original studies assessing recollection or comprehension of dental informed consent in adults. The authors searched 6 electronic databases and partial gray literature and hand searched and cross-checked reference lists published through April 2015. The authors assessed the risk of bias in the included studies via different validated tools according to the study design. RESULTS: Nineteen studies were included: 5 randomized clinical trials, 8 cross-sectional studies, 3 qualitative studies, 2 mixed-methods studies, and 1 case series. Conventional informed consent processes yielded comprehension results of 27% to 85% and recollection of 20% to 86%, whereas informed consent processes enhanced by additional media ranged from 44% to 93% for comprehension and from 30% to 94% for recollection. Patient self-reported understanding ranged positively, with most patients feeling that they understood all or almost all the information presented. Results of qualitative data analyses indicated that patients did not always understand explanations, although dentists thought they did. Some patients firmly stated that they did not receive any related information. Only a few patients were able to remember complications related to their treatment options. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Results of this systematic review should alert dentists that although patients in general report that they understand information given to them, they may have limited comprehension. Additional media may improve conventional informed consent processes in dentistry in a meaningful way.

The Impact of Homelessness and Incarceration on Women's Health.

Female inmates have multiple challenges during incarceration and as they transition into the community including: barriers to accessing health care within correctional facilities, poor transitional preparation preceding release, and inadequate continuity of health care after release. This qualitative study explored the health-seeking experiences and the health and housing needs of female inmates. Four focus groups were conducted in a remand facility in Canada. Women described poor health at entry to the correctional system and viewed incarceration as a means to access health care services. Transition back into the community represented a crossroad that was dependent on the stability of housing status. These findings support gender-sensitive health and housing programs to reduce addictions, recidivism, and poor health among this vulnerable population.

Conceptual understanding of social capital in a First Nations community: a social determinant of oral health in children.

Objectives. The purpose of the study was: (a) to better understand the concept of social capital and its potential role in oral health of children in a First Nations community and (b) to identify the strengths and resources in terms of social capital and a health promotion model that the community has at its disposal to address its oral health issues. Methods. In this qualitative case study, participants were purposively selected in a First Nations community: Seven individual interviews and two focus groups involving 18 parents/care givers were selected. Putnam's concept of social capital guided all the interviews. The interviews were recorded and transcribed verbatim. Thematic analysis was employed using the NVivo software. Results. The community was close-knit and seemed to have strong moral fibre, which encouraged members to help each other. A strong bonding social capital was also found among the members, especially inside the clans (families). A need for improvement in bridging social capital that would help the community to reach external resources was observed. While members of the community were actively involved in religious rituals and cultural ceremonies, more efforts seemed to be required to recruit volunteers for other events or programs. Active engagement of community members in any program requires that members be given a voice as well as some ownership of the process. Mobilizing or building community's social capital can play a role when planning future interventions. Conclusions. A better understanding of social capital may enhance the community's investment and efforts by reinforcing healthy oral behaviours and improving access to external resources. With more dynamic collaboration, it may be possible to create more sustainable community-based oral health promotion programs.

Women in orthodontics and work-family balance: challenges and strategies.

The number of women entering the orthodontic profession over the past few decades has increased dramatically. A review of the literature revealed the lack of research on achieving a work-family balance among female dentists and dental specialists. Work-family balance has been researched more extensively in the field of medicine; however, despite some critical differences, parallels between these 2 professions exist. This study identified issues that Canadian female orthodontists face and strategies they use to achieve a work-family balance. A phenomenological qualitative study was used to analyze the results of semi-structured telephone interviews of a purposive sample of 13 Canadian female orthodontists. The results strongly support the role-conflict theory about the competing pressures of maternal and professional roles. Female orthodontists described their challenges and strategies to minimize role conflict in their attempt to achieve a work-family balance. The women defined balance as having success and satisfaction in both their family life and professional life. They identified specific challenges of achieving a work-family balance that are unique to orthodontic practice and strategies for adapting to their maternal and professional roles. Achieving a work-family balance is of paramount importance to female orthodontists, and the results of this study may be applied to other specialties in dentistry.

Social interaction and participation: formative evaluation of online CME modules.

INTRODUCTION: This exploratory study examines Canadian physicians' participation in online social activities and learning discussions, perceptions of online social closeness, barriers and motivators to participation, and perceptions of the impact of course duration and face-to-face meetings on learning. METHODS: Formative evaluations were administrated to physicians participating in two online continuing medical education (CME) courses. Responses were recorded and calculated by the Blackboard Learning System. Content analysis was used to categorize comments and identify influencing factors. Online postings were counted to measure participation in the learning activities. RESULTS: The participation rate of 158 physicians and 10 facilitators in online social activities was very low. Forty-five percent of responding participants reported that more time for discussion would help them learn more; 62% stated that the initial face-to-face meeting helped improve online social relations and increase peer interactions online. Thirty-five percent of respondents reported participating in online social activities, while 29% had no time to do so, and 18% were not interested in doing so. Thirty-five percent felt closer or more connected to their peers after two discussion sessions; 11% did not feel closer because of their low participation; and 16% did not feel closer because of inadequate peer interaction. On the two evaluations, 49% and 22% of respondents, respectively, perceived lack of time and social bonding as major barriers to participating in learning discussion. DISCUSSION: Lack of time and peer response were given as the main reasons for low participation in social activity and learning discussions. Time and social bonding were major barriers to learning discussion. Course usefulness and participants' desire, commitment, and time management skills helped overcome barriers. Facilitators needed training in online systems and facilitation skills. Longer course duration and realistic pacing would probably foster more social interaction and greater course participation.

Qualitative analysis of the process for selecting graduate orthodontic students in Canada.

The literature on selection criteria for admission to graduate orthodontic programs in Canada and the United States is limited. The objectives of this study were to describe the processes for selecting students for master"s programs and to identify the qualities of "ideal candidates." Grounded theory was used to analyze recorded telephone interviews with 14 Canadian participants (directors or faculty members of orthodontic programs or students). The following chronology of events was identified: pre-application steps, application, evaluation of references, social evening, testing, clinic visit, interviews, post-interview discussion and ranking, final selection and candidate feedback. The "ideal candidate" was one with excellent intellectual abilities, a particular set of skills and personality traits, and additional positive attributes. The findings of this study may serve as a resource for future applicants and may allow individual programs to analyze their selection procedures.