In regions of the world that experience a deficit of surgical care, educational initiatives can foster the development of a skilled surgical workforce. Implicit in training these health workers is the mandate to retain them in the country in order build capacity. Eyal’s framework presents ways in which locally relevant training can improve retention and outlines the ethical and pragmatic concerns of such initiatives. In 2006, Guyana established it’s first surgical training program, an example of locally relevant training. The University of Guyana Diploma of Surgery (UGDS) program was selected for this case study research. Consistent data collection, supported by a systemic procedure to analyze that data, is paramount to increase the effectiveness of the UGDS program. The purposes of this dissertation research were two-fold. Firstly, it sought to understand how the UGDS program influences retention and the ways in which the UGDS members contribute to capacity building and the program’s sustainability. Secondly, this program evaluation provides a useful context to inform Eyal’s framework. 8 graduates, 2 trainees, 4 faculty members and 2 persons identified as policy makers were interviewed. Interviews were conducted face to face, and then transcribed. Surveys were administered to graduates and trainees and reflective journals were coded and analyzed. Overall, the data mapped fairly well onto Eyal’s framework. The results of the study suggest that the benefits and concerns Eyal outlines would be better represented along a continuum rather than being classified as either advantageous or disadvantageous with respect to retention. While Eyal’s claims generalize across settings, he should acknowledge this limitation and consider the important role that context plays. Overall, the results suggest that the UGDS program has positively influenced retention and capacity building. Key recommendations were made to the UGDS program that aim to improve retention and capacity building. As regions continue to face challenges associated with providing adequate surgical care, fostering retention and capacity building is recommended so that a sustainable surgical workforce can meet surgical needs. / Thesis / Master of Health Sciences (MSc)

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Background: Distributed Medical Education sites are satellites of large academic medical schools with faculty who are community-based physicians. These medical teachers need faculty development and there is little data about how this can best be delivered. This study asked the question: How can medical teaching expertise be developed and sustained at a Distributed Medical Education Campus? Using constructivist grounded theory methodology, a total of 16 semi-structured interviews were conducted with faculty members at two DME site campuses in Southern Ontario, and two faculty development events, one at each site, were observed. Findings_ The communitWhat are the perceptions of faculty at a Distributed Medical Education site regarding effective and acceptable faculty development activities for improving their skills as medical educators? y in which a DME campus medical school is implanted is transformed through a process of interaction between learners, medical teachers, and the community itself, which results in the production of expert community teachers. Community based physicians can develop teaching expertise and require faculty development to maintain interest and skill. They can access high quality, relevant faculty development within their own practice groups, a model referred to as a Community of Practice. These communities can be virtual or in-person and need several elements to be successful, including facilitation and mentorship. Conclusion: Teaching experts can develop in a DME site when there is accessible, relevant faculty development, such as in a Community of Practice. More research is needed to determine the best way to reward community teachers, most of whom are part time faculty in private practice. / Thesis / Master of Health Sciences (MSc) / Recently, satellite campuses of medical schools have been established in smaller cities, called Distributed Medical Education (DME) sites. There, the teaching faculty is composed of non-academic, community-based physicians. These faculty members need training to learn how to teach, or Faculty Development. This study asked the question: How can medical teaching expertise be developed and sustained at a Distributed Medical Education Campus? Sixteen interviews were conducted with teaching physicians, and two faculty development events were observed at two DME site campuses in Southern Ontario. The findings of this study revealed that the community is transformed through a process of interaction between learners, medical teachers, and the community itself, resulting in the production of expert community teachers. These teachers can access high quality faculty development within their own practice groups, a model referred to as a Community of Practice.

Professional identity is defined as the internalized values of a profession as a representation of the self, and is formed through a process of socialization, or how a student learns to become a member of their profession. As medical students transition to residency, new social environments, clinical experiences, and curricular emphases can impact how they identify as professionals. The purpose of this thesis is to investigate how professional identity formation (PIF) occurs in surgical residents over their first year of postgraduate training. Twenty-four surgical residents were interviewed at the start of their postgraduate training. Questions explored participants’ understanding of what it means to be a medical professional. Six months later, residents completed a follow-up interview to investigate how their experiences in their training programs have influenced their professional identity. Thematic analysis was utilized to identify themes in responses. Central to participants’ understanding of their professional identity was their relationships with patients and the public, other healthcare professionals, their training program, and their own expectations for themselves. After six months, less emphasis was placed on the influence of the public and one’s own personal expectations. Factors such as patient encounters, a team-based work environment, time constraints and high volumes of work, and being prepared for all situations were all identified as crucial to professional development. It is important for medical education programs to consider their impact on the development of students, especially regarding the transition to competency-based medical education (CBME) that is currently occurring in medical education. This change could impact the social environment and formal curricula of these programs. The explicit study of PIF is important not only for students as they develop into independent health professionals, but also to ensure the proper care of the patients these surgeons will be working with. / Thesis / Master of Science (MSc)

Background: Over 50% of Canadian medical students report experiencing mistreatment, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide about formally reporting these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. Methods: This Constructivist Grounded Theory study interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Anonymized transcripts were reviewed, coded and theory was developed. Results: Students undergo a journey surrounding experiences of mistreatment in five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Discussion: This study revealed institutional mistrust from students especially as it related to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organizational trust and organizational compassion between students and the medical school. Students volunteered mechanisms of support and to improve the reporting process. Medical school administration should consider how they can increase trust with their learners while identifying areas of concern and procedures for intervening and providing more transparent resolutions. / Thesis / Master of Science (MSc) / More than half of all Canadian medical student experience mistreatment during their medical school but very few choose to formally report it. In this study we explored how students experienced mistreatment and their decisions about reporting it as well as what supports would be most helpful for them. To better understand this issue, 19 medical students were interviewed about their experiences. The interviews were analyzed through constructivist grounded theory and the identified themes were used to develop a theory of how students experience mistreatment and make decisions around reporting. Students go through five phases: Situating themselves in their learning environment, Experiencing and Appraising mistreatment, Reacting to that mistreatment, Deciding about reporting and the risks and benefits and Moving Forward within the same medical school as they continue. Students showed mistrust towards the medical school and suggested changes the medical school could make to better support them.

No / Patient safety is a major priority for health services. It is a multi-disciplinary problem and requires a multi-disciplinary solution; any education should therefore be a multi-disciplinary endeavour, from conception to implementation. The starting point should be at undergraduate level and medical education should not be an exception. It is apparent that current educational provision in patient safety lacks a systematic approach, is not linked to formal assessment and is detached from the reality of practice. If patient safety education is to be fit for purpose, it should link theory and the reality of practice; a human factors approach offers a framework to create this linkage. Learning outcomes should be competency based and generic content explicitly linked to specific patient safety content. Students should ultimately be able to demonstrate the impact of what they learn in improving their clinical performance. It is essential that the patient safety curriculum spans the entire undergraduate programme; we argue here for a spiral model incorporating innovative, multi-method assessment which examines knowledge, skills, attitudes and values. Students are increasingly learning from patient experiences, we advocate learning directly from patients wherever possible. Undergraduate provision should provide a platform for continuing education in patient safety, all of which should be subject to periodic evaluation with a particular emphasis on practice impact.

<p>The rise in popularity of smartphones and tablets has sparked substantial interest among healthcare providers. Increasing number of medical schools have launched curricula targeted for mobile tablets. A mobile tablet that facilitates clinical documentation can enhance the mobility of residents and physicians by eliminating the need to be tethered to a workstation. Considering the popularity of Apple’s iPad, a clinical evaluation tool for syncope was implemented on an iPad to test its usability in this environment.</p> <p>The primary objective of this thesis is to develop a mobile tablet app for clinical evaluation and to assess its usability. The contents of the app are based on clinical practice guidelines. The app facilitates clinical evaluation using structured, pre-populated items and unstructured free-text narratives. The participants of this study used the app and paper in pre-determined sequences to document clinical evaluation of a given scenario. A System Usability Scale (SUS) questionnaire was used to gather feedback on usability. A comparison questionnaire gathered participant preferences between app and paper.</p> <p>This study showed that evidence-based app could be developed, with an emphasis on usability during design and development. During the study, participants recorded more ‘structured’ than ‘unstructured’ free-text information on the tablet. The SUS scores indicated an above average usability score for the app. However, participants rated paper above the app in overall comparison. Future studies are needed to determine whether the level of detail of clinical information presented in mobile tablet apps have a negative effect on participant acceptance.</p> / Master of Science (MSc)

Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents.