Distributed Medical Education (DME) in psychiatry: perspectives on facilitators, obstacles, and factors affecting psychiatrists' willingness to engage in teaching activities.

BACKGROUND: Distributed Medical Education (DME), a decentralized model focused on smaller cities and communities, has been implemented worldwide to bridge the gap in psychiatric education. Faculty engagement in teaching activities such as clinical teaching, supervision, and examinations is a crucial aspect of DME sites. Implementing or expanding DME sites requires careful consideration to identify enablers that contribute to success and barriers that need to be addressed. This study aims to examine enablers, barriers, and factors influencing psychiatrists' willingness to start or continue participating in teaching activities within Dalhousie University's Faculty of Medicine DME sites in two provinces in Atlantic Canada. METHODOLOGY: This cross-sectional study was conducted as part of an environmental scan of Dalhousie Faculty of Medicine's DME programs in Nova Scotia (NS) and New Brunswick (NB), Canada. In February 2023, psychiatrists from seven administrative health zones in these provinces anonymously participated in an online survey. The survey, created with OPINIO, collected data on sociodemographic factors, practice-related characteristics, medical education, and barriers to teaching activities. Five key outcomes were assessed, which included psychiatrists' willingness to engage in (i) clinical training and supervision, (ii) lectures or skills-based teaching, (iii) skills-based examinations, (iv) training and supervision of Canadian-trained psychiatrists, and (v) training and supervision of internationally trained psychiatrists. The study employed various statistical analyses, including descriptive analysis, chi-square tests, and logistic regression, to identify potential predictors associated with each outcome variable. RESULTS: The study involved 60 psychiatrists, primarily male (69%), practicing in NS (53.3%), with international medical education (69%), mainly working in outpatient services (41%). Notably, 60.3% lacked formal medical education training, yet they did not perceive the lack of training as a significant barrier, but lack of protected time as the main one. Despite this, there was a strong willingness to engage in teaching activities, with an average positive response rate of 81.98%. The lack of protected time for teaching/training was a major barrier reported by study participants. Availability to take the Royal College of Physicians and Surgeons of Canada Competency by Design training was the main factor associated with psychiatrists' willingness to participate in the five teaching activities investigated in this study: willingness to participate in clinical training and supervision of psychiatry residents (p = .01); provision of lectures or skills-based teaching for psychiatry residents (p < .01); skills-based examinations of psychiatry residents (p < .001); training/supervision of Canadian-trained psychiatrists (p < .01); and training and supervision of internationally trained psychiatrists (p < .01). CONCLUSION: The study reveals a nuanced picture regarding psychiatrists' engagement in teaching activities at DME sites. Despite a significant association between interest in formal medical education training and willingness to participate in teaching activities, clinicians do not consider the lack of formal training as a barrier. Addressing this complexity requires thoughtful strategies, potentially involving resource allocation, policy modifications, and adjustments to incentive structures by relevant institutions.

Exploring Current Practices, Needs, and Barriers for Expanding Distributed Medical Education and Scholarship in Psychiatry: Protocol for an Environmental Scan Using a Formal Information Search Approach and Explanatory Design.

BACKGROUND: Distributed medical education (DME) offers manifold benefits, such as increased training capacity, enhanced clinical learning, and enhanced rural physician recruitment. Engaged faculty are pivotal to DME's success, necessitating efforts from the academic department to promote integration into scholarly and research activities. Environmental scanning has been used to gather, analyze, and apply information for strategic planning purposes. It helps organizations identify current practices, assess needs and barriers, and respond to emerging risks and opportunities. There are process models and conceptual frameworks developed for environmental scanning in the business and educational sectors. However, the literature lacks methodological direction on how to go about designing and implementing this strategy to guide research and practice in DME, especially in the psychiatry field. OBJECTIVE: This paper presents a protocol for an environmental scanning that aims to understand current practices and identify needs and barriers that must be addressed to facilitate the integration of psychiatrists from the Dalhousie University Faculty of Medicine's distributed education sites in Nova Scotia and New Brunswick into the Department of Psychiatry, contributing for the expansion of DME in both provinces and informing strategic planning and decision-making within the organization. METHODS: This protocol adopts an innovative approach combining a formal information search and an explanatory design that includes quantitative and qualitative data. About 120 psychiatrists from 8 administrative health zones of both provinces will be invited to complete an anonymous web-based survey with questions about demographics, participants' experience and interest in undergraduate, postgraduate, and continuing medical education, research and scholarly activities, quality improvement, and knowledge translation. Focus group sessions will be conducted with a purposive sample of psychiatrists to collect qualitative data on their perspectives on the expansion of DME. RESULTS: Results are expected within 6 months of data collection and will inform policy options for expanding Dalhousie University's psychiatry residency and fellowship programs using the infrastructure and human resources at distributed learning sites, leveraging opportunities regionally, especially in rural areas. CONCLUSIONS: This paper proposes a comprehensive environmental scan procedure adapted from existing approaches. It does this by collecting important characteristics that affect psychiatrists' desire to be involved with research and scholarly activities, which is crucial for the DME expansion. Furthermore, its concordance with the literature facilitates interpretation and comparison. The protocol's new method also fills DME information gaps, allowing one to identify insights and patterns that may shape psychiatric education. This environmental scan's results will answer essential questions about how training programs could involve therapists outside the academic core and make the most of training experiences in semiurban and rural areas. This could help other psychiatry and medical units outside tertiary care establish residency and fellowship programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46835.

The development of National Safety and Quality Digital Mental Health Standards.

OBJECTIVE: Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. METHOD: The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. RESULTS: The NSQDMH Standards comprise three standards-Clinical and Technical Governance, Partnering with Consumers, and Model of Care-and were launched in November 2020. CONCLUSIONS: The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.

Barriers Related to Mask Wearing in African American Neighborhood Businesses.

African Americans and people of color have been disproportionately affected by the coronavirus (COVID-19) pandemic. As the second wave of the virus raged across the nation, there was a renewed effort to increase adherence to social distancing and mask-wearing guidelines. A community-based study led by members of the local National Black Nurses Association (NBNA) was conducted in a Midwest metropolitan city to identify barriers to mask-wearing experienced by business owners and employees in predominantly African American neighborhoods. Neighborhood business owners and their employees are essential to the life of a community as they provide needed goods and services from convenient neighborhood locations. Thus, attitudes and behaviors exhibited by business owners, supervisors, and other employees are important to combat COVID-19 in underserved communities. Semi-structured interviews were conducted with 39 business owners or supervising employees. Simple content analysis was used to identify codes and themes from the narrative data. Responses to the question 'What can make mask-wearing easier for your business and businesses in the neighborhood?' yielded three themes. Themes included 'a sense of community', the 'need for external support', and 'internal leadership'. These themes can be used to develop interventions to improve mask-wearing behaviors, support business owners and their customers, and lower the spread of COVID-19 in high-risk communities.

Using the Readiness for Clerkship and Residency Surveys to Evaluate the Effectiveness of Four MD Programs: A Cross-Institutional Generalizability Study.

PURPOSE: The importance of confidence for learning and performance makes learners' perceptions of readiness for the next level of training valuable indicators of curricular success. The "Readiness for Clerkship" (RfC) and "Readiness for Residency" (RfR) surveys have been shown to provide reliable ratings of the relative effectiveness of various aspects of training. This study examines the generalizability of those results. METHOD: Surveys were administered at four medical schools approximately four months after the start of clerkship and eight months after the start of residency during 2013-2015. Collected data were anonymized. A total of 647 medical students and 483 residents participated. RESULTS: Reliabilities of G = 0.8 could be obtained with only 6 to 12 medical students and 8 to 15 residents. Within MD programs, no meaningful differences in item ratings were observed across cohorts. Residents in each school consistently rated themselves higher than clerks on the majority of Medical Expert and Communicator competencies common to both surveys. Similar strengths and weaknesses were identified across programs, but differences were observed on five clerkship items and one residency item. CONCLUSIONS: Across four MD programs, the RfC and RfR surveys provided reliable ratings of the relative effectiveness of aspects of training with small numbers of respondents. The capacity of these surveys to efficiently identify perceived strengths and weaknesses held by cohorts of learners may, thereby, facilitate program improvement.

Perceptions of Graduating Health Professional Students of Their Interprofessional Education Experiences during Pre-Licensure Education.

The purpose of this qualitative descriptive study was to identify graduating students' perspectives on what makes prelicensure interprofessional education (IPE) and interprofessional collaboration (IPC) experiences valuable and effective and to identify other opportunities for effective IPE. We conducted telephone interviews with 12 students in medicine, nursing, pharmacy, and physiotherapy during their final year of training and thematically analyzed the verbatim transcripts. We found factors that make existing IPE experiences valuable and effective and could facilitate leverage of other curricular opportunities include: 1) experiential learning in clinical and classroom contexts, 2) relevancy of the IPE experiences, 3) opportunities for role clarification, 4) supervisors' influence (e.g., modeling collaborative skills), and 5) integration of IPE and IPC experiences into the existing curriculum.

Sociomateriality: a theoretical framework for studying distributed medical education.

Distributed medical education (DME) is a type of distance learning in which students participate in medical education from diverse geographic locations using Web conferencing, videoconferencing, e-learning, and similar tools. DME is becoming increasingly widespread in North America and around the world.Although relatively new to medical education, distance learning has a long history in the broader field of education and a related body of literature that speaks to the importance of engaging in rigorous and theoretically informed studies of distance learning. The existing DME literature is helpful, but it has been largely descriptive and lacks a critical "lens"-that is, a theoretical perspective from which to rigorously conceptualize and interrogate DME's social (relationships, people) and material (technologies, tools) aspects.The authors describe DME and theories about distance learning and show that such theories focus on social, pedagogical, and cognitive considerations without adequately taking into account material factors. They address this gap by proposing sociomateriality as a theoretical framework allowing researchers and educators to study DME and (1) understand and consider previously obscured actors, infrastructure, and other factors that, on the surface, seem unrelated and even unimportant; (2) see clearly how the social and material components of learning are intertwined in fluid, messy, and often uncertain ways; and (3) perhaps think differently, even in ways that disrupt traditional approaches, as they explore DME. The authors conclude that DME brings with it substantial investments of social and material resources, and therefore needs careful study, using approaches that embrace its complexity.

Integrating quality improvement and translational research models to increase exclusive breastfeeding.

Exclusive breastfeeding (EBF), a perinatal core measure, is associated with a longer duration of breastfeeding. The purpose of this quality improvement project was to increase the percent of healthy term singleton newborns who were exclusively breastfed at an academic medical center in the Midwest. Implementation of skin-to-skin contact between mother and newborn immediately following birth resulted in an increase in the percent of healthy term singleton newborns who were EBF from 55% to 64%.

Understanding, teaching and assessing the elements of the CanMEDS Professional Role: canadian program directors' views.

BACKGROUND: Physicians are required to maintain and sustain professional roles during their careers, making the Professional Role an important component of postgraduate education. Despite this, this role remains difficult to define, teach and assess. OBJECTIVE: To (a) understand what program directors felt were key elements of the CanMEDS Professional Role and (b) identify the teaching and assessment methods they used. METHODS: A two-step sequential mixed method design using a survey and semi-structured interviews with Canadian program directors. RESULTS: Forty-six program directors (48% response rate) completed the questionnaire and 10 participated in interviews. Participants rated integrity and honesty as the most important elements of the Role (96%) but most difficult to teach. There was a lack of congruence between elements perceived to be most important and most frequently taught. Role modeling was the most common way of informally teaching professionalism (98%). Assessments were most often through direct feedback from faculty (98%) and feedback from other health professionals and residents (61%). Portfolios (24%) were the least used form of assessment, but they allowed residents to reflect and stimulated self-assessment. CONCLUSION: Program directors believe elements of the Role are difficult to teach and assess. Providing faculty with skills for teaching/assessing the Role and evaluating effectiveness in changing attitudes/behaviors should be a priority in postgraduate programs.

Policy considerations for improving influenza vaccination rates among pregnant women.

BACKGROUND: Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. METHOD: A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. CONCLUSIONS: The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates.

Encouraging residents to seek feedback.

AIM: To explore resident and faculty perceptions of the feedback process, especially residents' feedback-seeking activities. METHODS: We conducted focus groups of faculty and residents exploring experiences in giving and receiving feedback, feedback-seeking, and suggestions to support feedback-seeking. Using qualitative methods and an iterative process, all authors analyzed the transcribed audiotapes to identify and confirm themes. RESULTS: Emerging themes fit a framework situating resident feedback-seeking as dependent on four central factors: (1) learning/workplace culture, (2) relationships, (3) purpose/quality of feedback, (4) emotional responses to feedback. Residents and faculty agreed on many supports and barriers to feedback-seeking. Strengthening the workplace/learning culture through longitudinal experiences, use of feedback forms and explicit expectations for residents to seek feedback, coupled with providing a sense of safety and adequate time for observation and providing feedback were suggested. Tensions between faculty and resident perceptions regarding feedback-seeking related to fear of being found deficient, the emotional costs related to corrective feedback and perceptions that completing clinical work is more valued than learning. CONCLUSION: Resident feedback-seeking is influenced by multiple factors requiring attention to both faculty and learner roles. Further study of specific influences and strategies to mitigate the tensions will inform how best to support residents in seeking feedback.

Mental health quality and outcome measurement and improvement in Australia.

PURPOSE OF REVIEW: This study outlines the broad approach taken in Australia to improve the quality of mental health services, including the use of performance and outcome measures along with a range of other linked quality initiatives. RECENT FINDINGS: The investment of Australia in a strategic national approach to mental health reform with a range of nationally coordinated quality initiatives has provided a firm foundation for continuing to engage governments, healthcare organizations and clinicians in the ongoing quest for quality and outcome measurement and improvement. SUMMARY: Australia has adopted a strategic national approach to quality and outcome measurement and improvement of mental health services despite having a federated health system involving nine governments and tiered care across public and private sectors. A range of interconnected initiatives including national plans, standards and guidelines, performance indicators and outcomes measures and benchmarking and reporting processes are the key components of this nationally coordinated system.

Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound.

OBJECTIVES: The purpose of this study was to evaluate the reliability of the pressure half-time (PHT) method for estimating mitral valve areas (MVAs) by velocity-encoded cardiovascular magnetic resonance (VE-CMR) and to compare the method with paired Doppler ultrasound. BACKGROUND: The pressure half-time Doppler echocardiography method is a practical technique for clinical evaluation of mitral stenosis. As CMR continues evolving as a routine clinical tool, its use for estimating MVA requires thorough evaluation. METHODS: Seventeen patients with mitral stenosis underwent echocardiography and CMR. Using VE-CMR, MVA was estimated by PHT method. Additionally, peak E and peak A velocities were defined. Interobserver repeatability of VE-CMR was evaluated. RESULTS: By Doppler, MVAs ranged from 0.87 to 4.49 cm2; by CMR, 0.91 to 2.70 cm2, correlating well between modalities (r = 0.86). The correlation coefficient for peak E and peak A between modalities was 0.81 and 0.89, respectively. Velocity-encoded CMR data analysis provided robust, repeatable estimates of peak E, peak A, and MVA (r = 0.99, 0.99, and 0.96, respectively). CONCLUSIONS: Velocity-encoded cardiovascular magnetic resonance can be used routinely as a robust tool to quantify MVA via mitral flow velocity analysis with PHT method.

Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography.

BACKGROUND: Valvular pathology can be analyzed quickly and accurately through the use of Doppler ultrasound. For aortic stenosis, the continuity equation approach with Doppler velocity-time integral (VTI) data is by far the most commonly used clinical method of quantification. In view of the emerging popularity of cardiac magnetic resonance (CMR) as a routine clinical imaging tool, the purposes of this study were to define the reliability of velocity-encoded CMR as a routine method for quantifying stenotic aortic valve area, to compare this method with the accepted standard, and to evaluate its reproducibility. METHODS AND RESULTS: Patients (n=24) with aortic stenosis (ranging from 0.5 to 1.8 cm2) were imaged with CMR and echocardiography. Velocity-encoded CMR was used to obtain velocity information in the aorta and left ventricular outflow tract. From this flow data, pressure gradients were estimated by means of the modified Bernoulli equation, and VTIs were calculated to estimate aortic valve orifice dimensions by means of the continuity equation. The correlation coefficients between modalities for pressure gradients were r=0.83 for peak and r=0.87 for mean. The measurements of VTI correlated well, leading to an overall strong correlation between modalities for the estimation of valve dimension (r=0.83, by means of the identified best approach). For 5 patients, the CMR examination was repeated using the best approach. The repeat calculations of valve size correlated well (r=0.94). CONCLUSIONS: Velocity-encoded CMR can be used as a reliable, user-friendly tool to evaluate stenotic aortic valves. The measurements of pressure gradients, VTIs, and the valve dimension correlate well with the accepted standard of Doppler ultrasound.