A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The purpose of this survey was to expand the limited knowledge regarding non-radiologist physician preferences in radiology report styles and content.

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Clinician-patient relationships are central to health care, health systems and medical education. Current educational practice of doctor-patient relationships emerged from an episteme rooted in a biomedical understanding of disease, having epistemic and pedagogical roots in Global North contexts. The thesis offers an analysis of clinician-patient relationships that includes medical ethics, communication skills, and the development of the widely accepted (in Family Medicine) Biopsychosocial model of the clinical consultation. Using a South African clinical postgraduate Family Medicine training programme as a case study, this project answered two central research questions: (i) How do students learn to navigate relationships with patients in this training programme? And (ii) Can we develop an educational model of doctor patient relationships based on local experiences? Mezirow's transformative learning theory, Mbiti's conceptualisation of Ubuntu as an African philosophy, and Foucault's thoughts on structural power provided a conceptual framework. Aim The project aimed to understand the process of student learning about the doctor-patient encounter and to develop a model for teaching about the doctor-patient relationship. Methodology A qualitative longitudinal case study was conducted, drawing data from postgraduate students, educators, and patients. Data was collected from educational, clinical, and reflective activities, and analysed thematically using an inductive approach. Findings The key themes describe students' learning in relation to critical self-awareness, contextual awareness, the dialogic nature of learning, and the impact of transformed perspectives. Patients valued that their patient-hood and personhood were validated, and educators highlighted the theme that vulnerability has pedagogical implications. A new perspective of power dynamics in the clinical encounter is described and an Ubuntu-inspired episteme and pedagogy is synthesised from the findings. Conclusion This decolonial project provides evidence and proposes a model for incorporating an indigenous philosophy (Ubuntu) into mainstream health sciences education. Recommendations are made for educational and clinical practice, as well as future research.

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Career burnout, defined by feelings of high emotional exhaustion, depersonalization, and low personal accomplishment, is prevalent amongst clinicians. A literature search established mindfulness-based interventions are growing in popularity to reduce or prevent burnout in healthcare. One type of mindfulness-based intervention is Mindfulness Based Stress Reduction (MBSR) programming. MBSR, an eight-week course, has been shown to reduce stress and improve quality of life and self-compassion. Our research aims to investigate the current burnout landscape in the field of medicine, and evaluate the effects of a MBSR variant course on clinician burnout and professional fulfillment at Boston Medical Center (BMC). Through the creation and execution of an eight-week MBSR variant course, Mindfulness Training for BMC Clinicians: A Program for Stress Reduction, Vitality, and Professional Development, we surveyed clinicians before the course, after the completion of the course, and two months after the completion of the course. The surveys were used to collect quantitative and qualitative data; we employed mixed methods analysis to statistically evaluate these data. The survey results were used to calculate numerical professional fulfillment and burnout scores for each clinician. Changes in scores were evaluated over time. These data suggest participants' professional fulfillment increased and burnout decreased from baseline measures to post-intervention measures, and results were sustained two months after the course was completed. Likewise, our qualitative data revealed approximately two-thirds of participants remarked having greater value on self-care. The vast majority of participants plan on continuing their mindfulness practice after the course and would recommend the MBSR variant course to their colleagues. Mindfulness based interventions show promise in increasing professional fulfillment and alleviating aspects of career burnout in clinicians at Boston Medical Center (BMC). Continuation of our pilot course will allow our team to increase our sample size and continue to evaluate and modify methods to best serve clinicians and other hospital employees in the efforts to increase their overall wellbeing.

Becoming a new parent can cause both immense joy and immense stress that leads to increases and decreases in a new parent’s feeling of life satisfaction. In addition, working as a mental health clinician is a frequently challenging career. Given that many clinicians also become parents while working during the course of their careers, it is surprising that there is not more research on the experience of clinicians who become new parents. More research is needed to find out how people balance the stresses of new parenthood and their emotionally challenging jobs. There is some research on “stress-related growth” that suggests that people can experience stressful or traumatic events and emerge on the other side feeling like they have achieved positive personal growth. This study attempted to find out if this occurs when clinicians become parents. This was a narrative study aimed to add to the research literature on parent clinician’s (clinicians who were also parents) lives by presenting their stories of becoming new parents. Five parent clinicians were interviewed on two separate occasions and those interviews were transcribed; the transcriptions were edited into five individual stories that detail the parent clinician’s unique challenges, how they navigated their challenges, and how they reflected on their experiences and their personal growth. The five parent clinicians recounted many positive and negative experiences that new parenthood had on both their clinical work and personal lives. In addition, they described how their families and identities helped them to make meaning out of the challenges they faced. The parent clinicians all talked about how either the presence or absence of social support, or their personal and professional relationships, impacted their lives when they became new parents. Social support included institutional support such as their employers or graduate departments and personal support such as their co-parents, families, and friends. This support either helped or hindered the parent clinician’s ability to balance the demands of parenthood and work. Furthermore, the findings supported previous research on stress-related growth that suggest that cognitive processing (thinking about an event after it occurred) and social support predict the perception of positive personal growth. This was the first known narrative study on the impacts of new parenthood on mental health clinicians and the study adds to the research literature on clinician’s lived experiences. In addition, the findings from the study can help training directors, clinical supervisors, and agency directors to develop new policies that increase new parents’ social support which may help them weather the storms of becoming a new parent while working as a clinician.

Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work. Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting. Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work. References Proctor, E. K., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G. A., Bunger, A., . . . Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. doi:10.1007/s10488-010-0319-7. Polaha, J., & Sunderji, N. (2018). A vision for the future of Families, Systems, & Health: Focusing on science at the point of care delivery. Families, Systems, & Health, 36(4), 423-426. Polaha, J., Schetzina, K., Baker, M., & Morelen, D., (2018). Adoption and reach of parent management interventions in pediatric primary care. Families, Systems, & Health, 36(4), 507-512. Funderburk, J. & Polaha, J. (2017). To clinician innovators: A special invitation. Families, Systems, and Health, 35(2), 105-109 Polaha, J. & Nolan (2014). Dissemination and implementation science: research for the real world medical family therapist. In J. Hodgson, T. Mendenhall, & A. Lamson (Eds). Medical Family Therapy. Switzerland: Springer International.

The theory of planned behavior has been studied in a wide variety of health related research. One area that has not evaluated the relevance of the TPB is that of therapists' attitudes for involving parents in treatment. The current study examined the feasibility of Ajzen's (1985) Theory of Planned Behavior for explaining whether or not therapists include parents in treatment. Participants in this study were therapists with at least one-year experience in treating youth under the age of 11. It was hypothesized that all of the variables of the TPB would be significant predictors of therapists' intention to include parents in treatment. Overall, results of this study provided support for the role of the Theory of Planned Behavior in predicting therapists' inclusion of parents in youth treatment although subjective norm was not a significant predictor of intention and subsequent inclusion of parents in youth treatment. Results of posthoc analyses reveal that there are several therapist demographic characteristics that are related to TPB constructs. Specifically, coursework and training in Family Systems was found to be related to positive attitudes about involving parents in treatment. Also, therapists in practice settings were much more likely to intend to include parents in youth treatment than those in school settings. In addition, therapists' estimate of the percentage of the percentage of time others in the field include parents in youth related treatment was significant predictor of their ratings of subjective norm. These results highlight the importance of the relationship between therapist training and orientation and attitudes toward parental involvement. They also highlight the importance of examining precursors to the development of TPB constructs. Clinical implications of these results are discussed.

Studies have indicated that separate use of the technique of priming and recasting can increase the use of complex syntax by children with and without specific language impairment (SLI). The current study was devised to examine whether children with SLI differ from children who are typically developing (TD) in the use of relative clauses in response to an intervention composed of a combination of priming and recasting. Twenty-six children (13 with SLI and 13 TD) ranging in age from 6 years, 10 months to 10 years, 11 months participated in the study. Forty pairs of stimulus pictures and sentences for each relative clause type (SR and OR) were created. The examiner presented the picture and read a sentence to the participant. Next, a new picture was shown and the participant created a sentence. The examiner then recasted the participants’ responses into the desired syntactic form. A preliminary ANOVA for the trials to criteria (3 out of 4 consecutive correct responses) for the subject relative and object relative clauses revealed nonsignificant main effects for Order and Group by Order interactions. A two-way mixed ANOVA was conducted to assess differences between the two groups and the two sentence types when compared with the trials to criteria scores. There was a significant effect for group where the SLI group required more trials to reach the criteria for both sentence types than the TD group. Additionally, the subject relative sentences were easier for the participants in both groups (TD and SLI) than the object relative sentences. A regression analysis conducted to predict the trials to criteria scores for both sentence types using the participants’ age, CELF raw score, and UNIT raw score revealed that the CELF raw score was significantly related to the trails to criteria score for the two sentence types. When additional analysis of the group and sentence type interaction was completed with the CELF raw score as a covariate, the group main effect was no longer significant. Analyses of the error patterns observed in the sentences produced by the participants as well as implications of the results are discussed.

Economic, political and social forces are driving the implementation of reforms in health service systems worldwide. As the health industry concentrates on ways to improve operations and to achieve overall cost effectiveness, health service organisations are developing and implementing structural changes to address issues of cost containment, utilisation and resource allocation. One approach has been to devolve resource allocation and utilisation decisions to the program or unit level. Clinical practitioners have been required to assume general management responsibilities in addition to their clinical role. A new type of clinician, the clinician manager has emerged to take on this task. Despite the trend towards the clinician manager role in many sections of health care world wide, there is little research in the area and a poor understanding of the experience of the role.The aim of this research was to explore clinician managers' perceptions of their experiences in their adaptation to and their enactment of the new role. The study was based in the symbolic interactionist paradigm. Sensemaking, the process by which individuals ascribe meaning to the events in their environment, provided a theoretical context that directed the inquiry. Grounded theory was the methodological approach. The research sample was made up of Directors of Nursing/Health Service Managers, a clinician manager role that had emerged from the restructuring of rural health services in Western Australia. Data was gathered from in-depth interviews.Findings suggested that sensemaking was influenced by structural and personal elements. Structural elements were created by the stakeholders, individuals and groups who relied on the clinician manager for the achievement of their goals but upon whom, in turn, the clinician manager relied upon for their support and cooperation. The sensemaking process of the ++ / clinician manager was mediated by the interaction with the stakeholders - the most influential factors being the clinician manager's perceptions of the trustworthiness of the stakeholders, the political behaviour that characterised the interactions with the stakeholder and role stress. In particular, role conflict, role ambiguity and role overload emerged. Personal elements were the personal characteristics of the clinician manager - the most salient being the experience of role strain, self-efficacy (i.e. their belief in their ability to do the job) and their commitment to the sensemaking process.Circumstances in the environment constrained their reliance on others for validation of their explanations of events and the actions they took. Most made decisions based on intuition and "gut feeling" - validating these decisions with subjective evaluations of outcomes and retrospective explanations. These processes were further mediated by the characteristics of the individual, particularly perceptions of self-efficacy. The ways in which the clinician managers adapted to and interpreted their role was diverse, which made the role more an expression of individual preferences than a coherent part of a larger organisational structure. Findings indicated that the clinician managers relied on their sensemaking processes in order to explain the ambiguous nature of their practice environment and to plan actions within the context of a role that was poorly defined by the organisation.