Detection of Residents With Progress Issues Using a Keyword-Specific Algorithm.

BACKGROUND: The literature suggests that specific keywords included in summative rotation assessments might be an early indicator of abnormal progress or failure. OBJECTIVE: This study aims to determine the possible relationship between specific keywords on in-training evaluation reports (ITERs) and subsequent abnormal progress or failure. The goal is to create a functional algorithm to identify residents at risk of failure. METHODS: A database of all ITERs from all residents training in accredited programs at Université Laval between 2001 and 2013 was created. An instructional designer reviewed all ITERs and proposed terms associated with reinforcing and underperformance feedback. An algorithm based on these keywords was constructed by recursive partitioning using classification and regression tree methods. The developed algorithm was tuned to achieve 100% sensitivity while maximizing specificity. RESULTS: There were 41 618 ITERs for 3292 registered residents. Residents with failure to progress were detected for family medicine (6%, 67 of 1129) and 36 other specialties (4%, 78 of 2163), while the positive predictive values were 23.3% and 23.4%, respectively. The low positive predictive value may be a reflection of residents improving their performance after receiving feedback or a reluctance by supervisors to ascribe a "fail" or "in difficulty" score on the ITERs. CONCLUSIONS: Classification and regression trees may be helpful to identify pertinent keywords and create an algorithm, which may be implemented in an electronic assessment system to detect future residents at risk of poor performance.

Training in interprofessional collaboration: pedagogic innovation in family medicine units.

PROBLEM ADDRESSED: A number of agencies that accredit university health sciences programs recently added standards for the acquisition of knowledge and skills with respect to interprofessional collaboration. Within primary care settings there are no practical training programs that allow students from different disciplines to develop competencies in this area. OBJECTIVE OF THE PROGRAM: The training program was developed within family medicine units affiliated with Université Laval in Quebec for family medicine residents and trainees from various disciplines to develop competencies in patient-centred, interprofessional collaborative practice in primary care. PROGRAM DESCRIPTION: Based on adult learning theories, the program was divided into 3 phases--preparing family medicine unit professionals, training preceptors, and training the residents and trainees. The program's pedagogic strategies allowed participants to learn with, from, and about one another while preparing them to engage in contemporary primary care practices. A combination of quantitative and qualitative methods was used to evaluate the implementation process and the immediate results of the training program. CONCLUSION: The training program had a positive effect on both the clinical settings and the students. Preparation of clinical settings is an important issue that must be considered when planning practical interprofessional training.

Prediction of health professionals' intention to screen for decisional conflict in clinical practice.

OBJECTIVE: To identify the determinants of the intention of physicians to screen for decisional conflict in clinical practice. BACKGROUND: Screening for decisional conflict is one of the key competencies when educating health professionals about shared decision making. Theory-based knowledge about variables predicting their intention to screen for decisional conflict in clinical practice would help design effective implementation interventions in this area. DESIGN: Data of two cross-sectional surveys embedded within a large implementation study of the Ottawa Decision Support Framework (ODSF) in primary care. SETTING AND PARTICIPANTS: In total, 122 health professionals from five family practice teaching units. METHODS: Intention to screen for decisional conflict in clinical practice was defined as the intention to use the clinical version of the Decisional Conflict Scale (DCS) with patients at the end of the clinical encounter. It was assessed at the entry and the exit from this study. Both intentions were entered as a dependent variable in multivariate analyses. MAIN RESULTS: At entry, the intention was influenced by: attitude (P < 0.001), subjective norm (P < 0.001), perceived behavioural control (P < 0.001) and clinical site (P < 0.05). On exit, it was influenced by: subjective norm (P < 0.001), perceived behavioural control (P < 0.001), clinical site (P < 0.05), international Continuing Medical Education (CME) (P < 0.05), other diplomas (P < 0.05) and intervention (P < 0.05). In post hoc analyses, there was a statistically significant difference between entry and exit in the impact of the level of exposure to the multifaceted implementation intervention on the intention (P = 0.003). CONCLUSIONS: Variables predicting the intention of health professionals to screen for decisional conflict in clinical practice using the DCS change over time suggesting that effective implementation interventions in this area will need to be modified longitudinally.

[Hospital family medicine. Education in an urban university hospital center]. / La médecine hospitalière en médecine familiale. La formation dans un centre hospitalier universitaire urbain.

OBJECTIVE: To describe the patients residents see in one hospital's family medicine unit and to determine whether these patients resemble family medicine patients in other Quebec hospitals. DESIGN: Descriptive study. SETTING: Urban teaching hospital. PARTICIPANTS: Patients 20 years and older who were admitted to the family medicine unit at Hôpital du St-Sacrement between April 1, 1999, and March 31, 2000, were compared with all patients admitted in general medicine to Quebec hospitals during this period. MAIN OUTCOME MEASURES: Sex, age, main diagnosis, secondary diagnoses, types of diseases, length of stay, number of consultations and specialties involved, referral after hospitalization. RESULTS: Patients hospitalized in this unit were older, had more secondary diagnoses, and stayed in hospital slightly longer than patients hospitalized in general medicine in Quebec as a whole. Residents were, therefore, exposed to patients who were more medically complex. CONCLUSION: Patients to whom residents were exposed resemble patients they will see in future hospital practice.

The Association of Low and High Ferritin Levels and Anemia with Pregnancy Outcome.

There are few data about the influence of iron stores and anemia on pregnancy outcome. Results that are available are controversial. This study used the medical records of 202 pregnant women aged 29.5 + 4.8 years to examine the association of low and high ferritin levels and anemia with pregnancy outcome. Iron depletion (serum ferritin <20 µg/L) evaluated at 16 +/-4 weeks of gestation was present in 35% of subjects. Anemia affected 6.2%, 3.2%, and 24.2% of subjects during the first, second, and third trimesters. Average hemoglobin (Hb) measurements among anemic women were less than 110 g/L, less than 105 g/L, and less than 110 g/L in the first, second, and third trimesters, respectively. When hematocrit (Ht) values were used to diagnose anemia, the percentages of anemic women were 14.6% (Ht <0.33) in the first trimester, 22.6% (Ht <0.32) in the second trimester, and 39.8% (Ht <0.33) in the third tri-mester. Shorter gestation was found in women with a serum ferritin level below 20 µg/L (279 +/-1 d) or >50 µg/L (278 +/-2 d) than in women with intermediate levels (20 ug/L to 50 ug/L) (283 +/-1 d). When multiple regression analysis was used, an inverse relationship was also observed between first trimester anemia (low Ht levels) and birth weight and fetal growth ratio. No such association was observed during the second and third trimesters. The strength of this inverse relationship between first trimester Ht levels and birth weight and fetal growth ratio was similar to that between first trimester Ht levels and newborn sex and smoking, but much less than parity. This finding indicates the importance of evaluating iron status early in pregnancy.