Physicians' Perceptions and Experiences Regarding Leadership: A Link Between Beliefs and Identity Formation.

Introduction: Despite the development of national recommendations and training programs for effective leadership, junior and senior medical leaders often find themselves ill-prepared to take on these new responsibilities. This study aimed to explore physicians' perceptions, feelings, and beliefs regarding leadership and to provide recommendations regarding appropriate training and institutional post-training support. Methods: We conducted a qualitative study at the Geneva University Hospitals. A purposeful sample of residents (R), fellows (F), attending physicians (A), and chairpersons (CP) were invited to participate in focus groups (or semi-structured interviews) between April and June 2021. We investigated their understanding of leadership, self-perception as leaders, difficulties, and paths to improvement in their leadership skills. Focus groups were transcribed verbatim and analyzed both inductively and deductively using Fishbein's model of behavior prediction and Irby's professional identity formation framework. Results: We conducted ten focus groups (R=3; F=4, A=2, and CP=1) and one interview (CP). Physicians expressed poor self-efficacy at all hierarchical levels: feelings of insecurity and confusion (R and F), frustration (A), and feeling stuck between divisional and institutional governance (CP). Such negative feelings were nurtured by personal beliefs with an intuitive and idealized representation of leadership. Beliefs focused more on personal characteristics rather than on skills, processes, or perceived institutional norms. Unclear expectations regarding physicians' role as leaders, overemphasis on academic achievement, and silo professional organizations fueled their feelings. Participants reported developing their leadership through trial and error, observing role models, and turning to personal resources rather than formal training. Conclusion: Our results show that physicians' leadership skills are still mainly acquired intuitively and that institutional norms do not encourage clarification of leadership roles and processes. Physician training in leadership skills, together with more explicit and clear institutional processes, may help to improve physicians' self-efficacy and develop their identity as leaders.

[Prevention recommendations for transgender persons]. / Recommandations de prévention chez les personnes transgenres.

Transgender people are at risk of being in worse health than the cisgender population. On the one hand, they encounter specific health problems, mostly related to the impact of minority stress on their mental and somatic health. On the other hand, the preventive recommendations usually do not account for gender-affirming hormonal or surgical treatments that can alter their biologic or anatomic risk profile. The health of transgender people is an area in which research is yet sparse, professionals seldom trained, and where uncertainty remains. The aim of this review article is to summarize the current state of knowledge and propose recommendations for clinical practice.

Les personnes transgenres sont à risque d'avoir une moins bonne santé que la population cisgenre. D'une part, elles rencontrent des problématiques de santé spécifiques, majoritairement en lien avec l'impact du stress minoritaire sur leur santé mentale et somatique. D'autre part, les conseils de prévention habituels ne prennent que rarement en compte l'éventuel recours à des traitements hormonaux ou chirurgicaux d'affirmation de genre pouvant modifier les profils de risque sur les plans biologiques ou anatomiques. La prévention chez les personnes transgenres est une thématique pour laquelle la recherche est peu fournie, les professionnel-le-s peu formé-e-s et l'incertitude présente. Cet article a pour objectif de faire le point sur l'état actuel des connaissances et de proposer des recommandations pour la pratique clinique.

[Applying consent, in healthcare and beyond]. / Appliquer le consentement, dans les soins et au-delà.

Sexual violence constitutes a form of gender-based violence, to the extent that the victims are mainly women. Other groups of vulnerable people are also more affected, in particular gender and sexual diversity persons. Sexual and gender-based violence can also occur in healthcare. To respect the legal framework and people's rights, but also to promote safety and quality in healthcare, it is essential to obtain and respect consent. Consent must be informed, explicit, freely given, and reiterated throughout the consultation. This article reviews the concept of consent and offers practical tools for its application in healthcare.

Les violences sexuelles constituent une violence de genre, dans la mesure où les victimes sont principalement des femmes et les auteurs des hommes. D'autres groupes de personnes vulnérables sont également davantage concernés, en particulier les personnes de la diversité sexuelle et de genre. Ces violences sexuelles et de genre existent également dans les soins. Afin de respecter le cadre légal et les droits des personnes, mais aussi de favoriser des soins de qualité et en sécurité, il est primordial de recueillir et respecter le consentement. Celui-ci doit être éclairé, explicite, libre et réitéré tout au long de la consultation. Cet article fait le point sur le concept du consentement et offre des outils pratiques pour son application dans les soins.

Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians.

BACKGROUND: While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE: This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS: We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS: A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS: Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.

[LGBTQIA+ people: care issues in the emergency department]. / Personnes LGBTQIA+ : enjeux de prise en charge aux urgences.

Visits to the emergency department are often a difficult time for LGBTQIA+ people, mainly because of the frequent discrimination in healthcare environments and the lack of knowledge of medical and nursing staff. This article begins by presenting some epidemiological features, before discussing specific issues such as contraception and fertility, hormone therapy, sexually transmitted infections, surgical complications, psychiatric pathologies, and traumatology, from the perspective of the emergency physician. Finally, suggestions for further reflection and improvement are proposed.

Les visites aux urgences représentent souvent des moments difficiles pour les personnes LGBTQIA+, principalement en raison des discriminations particulièrement fréquentes dans les milieux de soins et du manque de connaissances du personnel médico-soignant. Cet article présente dans un premier temps quelques chiffres épidémiologiques, avant de discuter des enjeux spécifiques, comme la contraception et la fertilité, l'hormonothérapie, les infections sexuellement transmissibles, les complications opératoires, les pathologies psychiatriques ou la traumatologie, le tout sous le prisme de l'urgentiste. Enfin, des pistes de réflexion et d'amélioration sont proposées.

[Teaching health equity in the French-speaking part of Switzerland : inventory in 2023]. / Enseignements sur l'équité en santé en Suisse romande : état des lieux en 2023.

The theme of health equity was for a long time absent or little addressed in the pre- and postgraduate teaching programs of universities and training university hospitals in Switzerland. This gap has gradually been filled by the development and provision of structured teaching on health equity, adapted to the needs of their target audiences. This article aims to highlight a selection of teachings that have emerged in recent years in the French-speaking part of Switzerland.

La thématique de l'équité en santé a été pendant longtemps absente ou peu abordée dans les programmes d'enseignement pré et post-gradué des universités et établissements hospitaliers de formation en Suisse. Cette lacune a été progressivement comblée par le développement et la mise à disposition de formations structurées portant sur l'équité en santé, adaptées aux besoins de leurs publics cibles. Cet article vise à mettre en avant une sélection d'enseignements qui ont vu le jour ces dernières années en Suisse romande.

[Gender and sexual diversity medicine:ensuring equity in health care delivery]. / Médecine et diversité sexuelle et de genre : assurer l'équité dans les soins de santé.

The literature on the subject systematically shows that LGBTIQ+ people suffer from a worse health status than heterosexual and cisgender people. They are subject to more medical errors, discriminations, and delays in receiving care. They face many specific barriers in their access to care. Health institutions and health care professionals have the responsibility to adapt to the specific health needs of LGBTIQ+ people and to offer quality healthcare free from discrimination. This article highlights these barriers and proposes strategies to overcome them, both at individual and organisational levels.

Les études sur le sujet démontrent de manière systématique que les personnes LGBTIQ+ présentent un moins bon état de santé que la population hétérosexuelle et cisgenre. Elles sont plus souvent victimes d'erreurs médicales, de délais dans la prise en soins et de discrimination, et elles rencontrent des barrières spécifiques d'accès aux soins. Les institutions de santé et les professionnel-le-x-s y travaillant ont la responsabilité de s'adapter aux besoins de santé spécifiques aux personnes LGBTIQ+ afin de leur offrir des soins de qualité, inclusifs et libres de discrimination. Cet article a pour objectif de décrire ces barrières et de proposer des stratégies pour y remédier, tant au niveau individuel qu'organisationnel.

Allophone immigrant women's knowledge and perceptions of epidural analgesia for labour pain: a qualitative study.

OBJECTIVES: To explore allophone immigrant women's knowledge and perceptions of epidural analgesia for labour pain, in order to identify their information needs prior to the procedure. DESIGN: We conducted focus groups interviews with allophone women from five different linguistic immigrant communities, with the aid of professional interpreters. Thematic analysis of focus group transcripts was carried out by all authors. SETTING: Women were recruited at two non-profit associations offering French language and cultural integration training to non-French speaking immigrant women in Geneva. PARTICIPANTS: Forty women from 10 countries who spoke either Albanian, Arabic, Farsi/Dari, Tamil or Tigrigna took part in the five focus groups. Four participants were nulliparous, but all others had previous experience of labour and delivery, often in European countries. A single focus group was conducted for each of the five language groups. RESULTS: We identified five main themes: (1) Women's partial knowledge of epidural analgesia procedures; (2) Strong fears of short-term and long-term negative consequences of epidural analgesia during childbirth; (3) Reliance on multiple sources of information regarding epidural analgesia for childbirth; (4) Presentation of salient narratives of labour pain to justify their attitudes toward epidural analgesia; and (5) Complex community positioning of pro-epidural women. CONCLUSIONS: Women in our study had partial knowledge of epidural analgesia for labour pain and held perceptions of a high risk-to-benefits ratio for this procedure. Diverse and sometimes conflicting information about epidural analgesia can interfere with women's decisions regarding this treatment option for labour pain. Our study suggests that women need comprehensive but also tailored information in their own language to support their decision-making regarding epidural labour analgesia.

[New approaches to risk and the use of electronic tools in primary care medicine in 2021]. / Approches du risque et usage d'outils électroniques en médecine de premier recours en 2021.

Our selection of articles published in 2021 sheds light on topics related to risk, and to the use of electronic tools in primary care medicine. They cover blood pressure targets, telemonitoring, and the omega-3 fatty acid diet in the elderly and/or in patients with high cardiovascular risk. They present the role of primary care physicians in the management of patients with NAFLD, and in screening for domestic violence in all couples. They assess the risk of recurrence of a depressive episode after stopping antidepressant treatment. Finally, they discuss the place of apps to communicate with foreign-speaking patients and of vaping in smoking cessation.

Notre sélection d'articles parus en 2021 propose un éclairage sur des sujets en lien avec le risque chez nos patient·e·s et l'usage d'outils électroniques. Ils abordent le thème des cibles tensionnelles, du télémonitoring, et du régime riche en acides gras oméga 3 chez la personne âgée et/ou à haut risque cardiovasculaire. Ils présentent le rôle des médecins de premier recours dans la prise en charge de patient·e·s avec une stéatopathie métabolique, et dans le dépistage des violences conjugales dans tous les couples. Ils évaluent les risques de récidive d'épisode dépressif à l'arrêt d'un traitement antidépresseur. Enfin, ils discutent la place des applications pour la communication avec les patient·e·s allophones et du vapotage dans l'arrêt du tabac.

[Bias in the consultation : What tools for the clinician ?] / Biais dans la consultation : quels outils pour le·la clinicien·ne ?

Implicit biases are a daily occurrence during medical consultations. Biases disrupt the clinical judgment and modify the attitude of the practitioner. They are a source of medical errors and they impact negatively all indicators of quality of care. Biases are rooted in collective stereotypes and individual prejudice and can contribute to sexual harassment and discrimination. Developing strategies to reduce stereotypes and their impact must be a part of any program targeting sexual harassment, sexism or discrimination of any kind. This article offers an understanding of the essence of biases, based on complex cognitive processes, and proposes strategies to increase awareness at the individual and collective level.

Les biais implicites sont quotidiens lors de la consultation médicale. Perturbant le jugement clinique et l'attitude des professionnel·le·s, ils peuvent être à l'origine d'erreurs médicales et avoir un impact négatif sur l'ensemble des indicateurs de qualité des soins. Les biais peuvent avoir pour source les stéréotypes ancrés dans la société ou les préjugés de chacun·e et aboutir à une forme de discrimination. L'élaboration de stratégies permettant de réduire les stéréotypes fait donc partie intégrante de la lutte contre le harcèlement sexuel et toutes sortes de discriminations. Cet article propose des outils de compréhension de l'essence des biais, basée sur des processus cognitifs complexes, et une gamme de stratégies offrant un renforcement de la prise de conscience à l'échelle individuelle et collective pour en diminuer l'impact.

Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!

AIMS OF THE STUDY: Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges. METHODS: We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework. RESULTS: We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…). CONCLUSION: Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.

[Covid-19: how the pandemic revealed gender inequalities]. / Covid-19 : dans le genre on peut faire mieux !

The SARS-CoV-2 pandemic has revealed inequalities between men and women and has deepened some existing disparities. While in Switzerland, more women than men have been infected, men have been at greater risk of developing complications and dying. A weaker immune response and more co-morbidities help to explain this poorer prognosis. Socially and economically, women have become more precarious as a result of less stable employment and greater involvement in domestic work. Domestic violence has increased and women's access to sexual and reproductive health services has become more difficult. Finally, women have been under-represented as research authors but also among experts in task forces and media.

La pandémie liée au SARS-CoV-2 a révélé des inégalités entre les hommes et les femmes et a creusé certaines disparités existantes. Si en Suisse les femmes sont plus nombreuses à avoir été infectées que les hommes, ces derniers ont eu un plus grand risque de décéder. Une réponse immunitaire moins performante et davantage de comorbidités contribuent à expliquer ce pronostic défavorable. Sur le plan social et économique, les femmes ont été davantage précarisées du fait d'emplois moins stables et d'une plus grande implication dans les tâches domestiques. La violence domestique a augmenté et l'accès des femmes aux services de santé sexuelle et reproductive a été plus difficile. Finalement, les femmes ont été sous-représentées comme autrices dans la recherche mais également parmi les expert·e·s dans les task forces et les médias.

How Do Patients Want Us to Use the Computer During Medical Encounters?-A Discrete Choice Experiment Study.

BACKGROUND: Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves. OBJECTIVE: To explore patients' preferences regarding physicians' EHR-related behaviors. DESIGN: Discrete choice experiment study. PATIENTS: French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland. MAIN MEASURES: We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians' hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen. KEY RESULTS: Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0-40.2% vs 31.6%; 95% CI: 24.9-39.0% or 14.9%; 95% CI: 10.2-21.1%) and psychosocial issues (38.7%; 95% CI: 31.6-46.3% vs 24.4% 95% CI: 18.4-31.5% or 17.9%; 95% CI; 12.7-24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9-46.3%) over verbal (30.3%; 95% CI: 23.9-37.5%) or visual contact only (11.4%; 95% CI: 7.5-17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5-64.0% vs 34.8%; 95% CI: 29.9-40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0-57.4%) favored the position with the physician's bust towards the patient and hands away from the keyboard. CONCLUSIONS: Our study shows that patients' preferences regarding EHR-related behaviors are in line with most experts' recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.

Online Synchronous Clinical Communication Training During the Covid-19 Pandemic.

PURPOSE: As the COVID-19 pandemic outbreak occurred, most structured clinical communication training were transformed from in-person to remote seminars. The aim of our study was to evaluate the usefulness and feasibility of online synchronous clinical communication training from both students' and tutors' perspectives. PATIENTS AND METHODS: We conducted a cross-sectional study. Geneva Faculty of Medicine' 3rd year medical students and tutors involved in clinical communication were asked to respond to an online survey. RESULTS: Eighty-five of 149 students and 15/16 tutors responded. Students highly valued both online seminars and reported little technical difficulty. They felt that tutors were well prepared and actively involved them in experiential learning. Tutors globally reported little technical difficulty and felt rather well prepared to do so online. Although both students and tutors preferred the in-person format, half of them could still consider using an online format in the future outside the pandemic but mentioned it required specific rules. CONCLUSION: Our results suggest that clinical communication can be taught and practiced online and that tutors can quickly adapt to such changes.

[Ethical questions regarding the medical care of adults with disabilities]. / Questions éthiques soulevées par la prise en charge médicale des adultes en situation de handicap.

Medical care of adults with disabilities, especially those with intellectual disabilities, can be ethically difficult. Several questions arise frequently. Can we administer a life-saving treatment that could impact negatively the patient's quality of life when the patient isn't able to give consent? During this Covid-19 period, can the use of chemical or physical restraints be considered as mistreatment, whereas the aim is to protect others? These are situations where the ethical question holds a central role. Although each clinical situation is unique, this article highlights, through four clinical cases, the ethical principles that should guide physicians in their decision-making process.

La prise en charge médicale des adultes en situation de handicap, notamment ceux souffrant de déficience mentale, peut se révéler difficile d'un point de vue éthique. Plusieurs questions se posent fréquemment. Peut-on proposer un traitement vital mais qui risque d'impacter la qualité de vie du patient sans pouvoir obtenir son consentement ? En période de Covid-19, l'utilisation de moyens de contention chimique ou physique peut-elle être considérée comme de la maltraitance alors qu'on cherche à protéger autrui ? Autant de situations où la question éthique prend une place centrale. Si chaque cas est évidemment différent, nous vous proposons, à travers quatre vignettes cliniques, de mettre en lumière les principes éthiques accompagnant le médecin dans son processus décisionnel.

[Cross glances on the videoconsultation]. / Regards croisés sur la vidéoconsultation.

The covid-19 outbreak prompted many health care providers to use video consultation for the first time. While it is particularly useful in times of pandemic, a number of patients wish to continue using video consultation as it allows easy access to their physician. However, many physicians may be uncomfortable communicating with new technologies and without performing a traditional physical examination. Training in communication and virtual physical examination in telemedicine appears to be necessary, making it possible to make videoconsultation sustainable into daily practice while guaranteeing quality of care.

La crise liée au Covid-19 a poussé de nombreux soignants à utiliser pour la première fois la vidéoconsultation. Si celle-ci est particulièrement utile en temps de pandémie, elle est également sollicitée au quotidien par certains patients, leur permettant un contact facilité avec leur médecin. Pourtant, ce dernier est parfois peu à l'aise pour communiquer avec les nouvelles technologies et du fait de l'absence d'examen physique traditionnel. Une formation à la communication et à l'examen physique virtuel en vidéoconsultation apparaît nécessaire, permettant d'inscrire la télémédecine dans la pratique quotidienne tout en garantissant une prise en charge de qualité.

Training junior faculty to become clinical teachers: The value of personalized coaching.

Background: Junior clinical faculty require institutional support in the acquisition of feedback and clinical supervision skills of trainees. We tested the effectiveness of a personalized coaching versus guided self-reflection format of a faculty development program at improving faculty skills and self-efficacy.Methods: Participants were evaluated both before and after the program using a four-station Objective Structured Teaching Exercise (OSTE). A gain-score analysis, one-way ANOVA, and paired t-tests were used to evaluate both groups. The impact on the learning environment was measured by resident ratings of the Maastricht Clinical Teaching Questionnaire.Results: One hundred and twenty-seven participants completed the study over a three-year period. Both groups had significant improvements in self-efficacy. Participants in the coaching group demonstrated superior performance in encouraging learner self-reflection, teaching effectiveness, verifying learner understanding, exploring feelings/needs, and defining learning objectives. Over a 5-year period, the overall institutional learning climate significantly improved concerning faculty role-modeling, coaching, articulation, and explorations skills.Conclusion: Offering a contextualized faculty-development program using OSTEs that provides multiple opportunities for feedback and is focused on creating a community of practice is an effective method to facilitate the transfer of skills to the clinical environment, supports teacher identity development, and favorably impacts the learning climate.