Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum.

BACKGROUND: Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. METHODS: We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. RESULTS: The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. CONCLUSIONS: We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.

Culturally safe interventions in primary care for the management of chronic diseases of urban Indigenous People: a scoping review.

OBJECTIVES: Chronic conditions represent an important source of major health issues among Indigenous People. The same applies to those, who live off-reserve and in urban areas. However, very few healthcare services are considered culturally safe, resulting in some avoidance of the public healthcare system. Our goal was to review the literature on culturally safe practices available to urban Indigenous People who suffer from chronic diseases. DESIGN: We conducted a scoping review to determine what culturally safe healthcare services are currently offered for the management of chronic conditions in urban Indigenous populations, to contribute to a tailored, holistic and safe space in mainstream healthcare systems. ELIGIBILITY CRITERIA: Peer-reviewed original research articles had to be published by 27 October 2020, in English or French. INFORMATION SOURCE: In October 2020, we searched five academic databases (EBSCO, PsycArticles, SocINDEX, MEDLINE and PsycINFO) and also reviewed grey literature and the websites of organisations or governments. The data were extracted and collected in an EXCEL spreadsheet. Two reviewers independently screened 326 titles and abstracts, followed by an independent evaluation of 48 full text articles. A total of 19 studies were included in this scoping review, as well as 5 websites/documents from the grey literature. RESULTS: In total, 19 studies were included in our analysis. We found that Elders, family and the assistance of an interpreter are crucial elements to include to make urban Indigenous feel safe when they seek healthcare services. With this scoping review, we report interventions that are successful in terms of healthcare delivery for this population. Our findings provide insight on what services should be in place in mainstream healthcare settings to create a culturally safe experience for urban Indigenous People. CONCLUSIONS: In recent years, there appears to be a growing awareness of the need to provide culturally safe health services. This scoping review identified multiple strategies to promote cultural safety in this context, as well as barriers and facilitators to their implementation. These elements, which have been extensively documented in the literature, should be included in the chronic diseases management interventions to be developed by urban and primary care settings.

Evaluation of an evidence-based medicine educational intervention in a regional medical campus.

BACKGROUND: Enhanced educational activities were developed by a regional medical campus (RMC) in order to incorporate evidence-based medicine (EBM) practice in the learning process of medical students. This study aimed to measure the effectiveness of these activities. METHODS: The experimental group was made up of third-year students from the RMC. The comparison group included students from the main campus of the medical school and another of its RMCs. The experimental group received additional training on EBM: one additional hour in class, plus skills development exercises throughout the semester. During the regular academic sessions, clinical questions requiring EBM literature searching skills were incorporated in the curriculum. Tests on knowledge and self-assessment of competencies were administered to all participants at the beginning and at the end of the semester. Data were analyzed using repeated measures analysis of variance and post hoc tests for within and between groups comparison. RESULTS: The Friedman test demonstrated a statistically significant effect of the intervention on knowledge (p <0.0001). The score of the knowledge test was significantly higher for the experimental group, when compared with baseline testing and with the comparison group (p <0.0001). Repeated measures analysis of variance demonstrated a statistically significant effect of the intervention on the score of the self-assessment of competencies (p=0.032). The score for the self-assessment of competencies was significantly higher for the experimental group when compared to baseline score (p <0.0001), but not with respect to the comparison group. CONCLUSION: Our study demonstrated the effectiveness of additional training and longitudinal integrated skills development leading to an increase in medical student knowledge and self-perception of competencies in EBM practice.

Physician perceptions of recruitment and retention factors in an area with a regional medical campus.

BACKGROUND: The factors that influence physicians to establish and maintain their practice in a region are variable. The presence of a regional medical campus (RMC) could influence physicians' choice. The objective of this study was to explore the factors influencing physician recruitment and retention, and in particular the role of a RMC, in a region of Quebec. METHODS: A literature review of factors influencing physicians to stay in a rural area was conducted in order to create an interview guide. Questions were divided into sections: general information, family situation, medical training, career choice, current practice, intent to stay in the region, and impact of the RMC. Thirteen semi-structured individual interviews were conducted with practicing physicians. Data were analyzed using QDAMiner. RESULTS: Recruitment factors were divided into six major themes: type of practice, spousal interest, opportunity for teaching, training in a region, workforce planning, and quality of life. Participants identified positive and negative factors associated with retention. In both cases, family and quality of work environment were mentioned. The RMC was perceived as having important impacts on the quality of professional life, research, medical practice, and regional development. CONCLUSION: This study highlights the role of RMCs in physician recruitment and retention via multiple impacts on the quality of practice of physicians working in the same area.

CONTEXTE: Les facteurs influençant les médecins à s'établir et à rester dans une région sont variables. La présence d'un campus médical régional (CMR) pourrait influencer ce choix. L'objectif de cette étude était d'explorer les facteurs de recrutement et de rétention influençant les médecins ayant choisi de pratiquer dans la région du Saguenay-Lac-Saint-Jean au Québec, en particulier le rôle du CMR. MÉTHODES: Une synthèse de la littérature a permis d'identifier différents facteurs influençant les médecins dans leur choix de lieu de pratique. Un guide d'entrevue a été élaboré à partir de ces facteurs. Les questions étaient séparées selon les sections suivantes: informations générales, situation familiale, études médicales, choix de carrière, pratique actuelle, intention de rester dans la région, impact du CMR. Treize entrevues semi-dirigées individuelles ont été réalisées avec des médecins en pratique. Les données ont été analysées avec QDA Miner. RÉSULTATS: Les facteurs influençant le recrutement étaient séparés en six thèmes majeurs : type de pratique, intérêt du conjoint, opportunité d'enseigner, formation en région, planification gouvernementale des effectifs médicaux et qualité de vie. Les participants ont identifié des facteurs de rétention négatifs et positifs. Ceux-ci concernaient la famille et la qualité de l'environnement de travail. D'après les participants, le CMR avait un impact direct sur la qualité de la vie professionnelle, la recherche, la pratique médicale et le développement régional. CONCLUSION: Cette étude a permis de mettre en évidence le rôle des CMRs dans le recrutement et la rétention via de multiples impacts sur la qualité de pratique des médecins exerçant dans la même région.