In Canada, residents’ views on which roles and tasks are effective to becoming a competent physician is not yet part of the research discourse. Ensuring that competency-based curriculum (CBC) objectives are aligned with competencies and evaluation methods is critical to build a curriculum that will produce competent physicians. This research reports on the residents' views of the current Orthopaedic Surgery curriculum (UofT) which is solely competency-based. The residents' views were explored about which CanMEDS Roles and Entrustable Professional Activities (EPA’s) would be important to develop for them to become competent physicians. This study employed a mixed methodology. The individual interviews were from CBC orthopaedic surgery residents and the survey respondents were orthopaedic surgery regular time-based stream and competency-based stream residents. This research provides a better understanding of the resident experience so that educational practice and residency education can influence decisions around the curriculum design in postgraduate competency-based medical education programs.

In Canada, residents’ views on which roles and tasks are effective to becoming a competent physician is not yet part of the research discourse. Ensuring that competency-based curriculum (CBC) objectives are aligned with competencies and evaluation methods is critical to build a curriculum that will produce competent physicians. This research reports on the residents' views of the current Orthopaedic Surgery curriculum (UofT) which is solely competency-based. The residents' views were explored about which CanMEDS Roles and Entrustable Professional Activities (EPA’s) would be important to develop for them to become competent physicians. This study employed a mixed methodology. The individual interviews were from CBC orthopaedic surgery residents and the survey respondents were orthopaedic surgery regular time-based stream and competency-based stream residents. This research provides a better understanding of the resident experience so that educational practice and residency education can influence decisions around the curriculum design in postgraduate competency-based medical education programs.

Over the past decade, there has been a turn in applied health research towards the use of performance as a tool for knowledge translation. The turn to performance in applied health sciences has emerged as researchers have struggled to find new and engaging ways to communicate complex research findings regarding the human condition. However, the turn to performance has occurred within the political landscape of the knowledge economy, and thus conforms to contemporary practices of knowledge production and evaluation. Recent studies about health-based performances exhibit two hallmarks of economized modes of knowledge production. First, these studies focus their attention on the transmission of knowledge to health care professionals through an exposure to performance. Knowledgeable, and thus more useful or efficient, health care providers are the end-product of this transaction. Second, many of these productions are created in the context of application, and thus are driven by an accountability and goals-oriented approach to knowledge acquisition. This thesis argues that economized and rationalized modes of knowledge production do great harm to performance’s pedagogical and ethical potential. By utilizing scientific evaluative methodologies to monitor performance’s ‘success’ as an evaluable, predictable and ends-oriented practice obscures performance’s libratory value, and thus misses performance’s potentially most potent and critical contributions. To mount this argument, I present a case study of Margaret Edson’s play Wit, which has been used widely in medical education. Drawing from the philosophy of Emmanuel Levinas, I critically explore the impact of the knowledge economy on arts-based pedagogical models within health research and education. Further, I seek to redress potential harms inflicted by the knowledge economy by developing the notion of ethical “response-ability.” Through this concept I argue that performance challenges normative conceptions of reason, rationality and scientific evaluation, making the use of theatre in contemporary educational settings at once troublesome and vital.

Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 249-259). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 249-259). Also available on the Internet.

Healthcare in the United States experienced a remarkable transformation during the late 19th and early 20th centuries. While this transformation is well documented in descriptive historical accounts there are few empirical studies investigating the mechanisms through which reform was disseminated or the affects of the reform on healthcare. To this end, this dissertation examines four issues related to changes in the American healthcare industry during the early 1900's.Chapter 2 examines changes in medical education. This chapter provides a qualitative analysis of motivations behind the medical education reforms in America and an empirical analysis of the shakeout of medical schools that occurred from 1905 to 1920. Licensing laws and medical school reviews were found to have influenced exiting decisions of many medical schools. Reform of medical education in America was followed by a disproportionate decline of physician supply in rural areas. Along these lines, Chapter 3 provides a case study of the geographic distribution of physicians during the early 20th Century. Data on individual physicians was compiled to analyze variation in physician counts across counties and to investigate out-migration of rural county physicians. This analysis indicates physicians were drawn more and more to areas offering better financial opportunities, greater access to medical facilities, and more opportunity for professional contact.It is unclear to what extent patients initially benefited from the changes in medicine. Chapters 4 and 5 focus on one aspect of this issue by examining the impact of physicians on mortality rates. Chapter 4 utilizes the individual physician data from Chapter 3 to assess whether variation in physician counts explain variation in infant and non-infant mortality rates across counties. Estimates indicate that physicians were still unable to reduce mortality in the early 1920's. Chapter 5 focuses on the impact on maternal mortality resulting from the transition of childbirth during the first half of the 20th Century from the home to the hospital setting. Using hospital beds as a proxy for medical inputs, regression analysis revealed that the transition may have contributed to more maternal deaths until the introduction of sulfa drugs in the late 1930's.

The surgical culture values certainty and confidence, and this was proposed to be a source of internal conflict for surgeons, particularly during times of stress and uncertainty. Surgeons previously described the need to manage their image during these times, putting on an external appearance that is inconsistent internally. As part of a larger program of research on surgical judgment and decision making, this study used a constructivist grounded theory approach to explore 15 general surgery trainees’ perceptions and experiences of impression management during moments of decision making. Residents described their perceived expectations in training, and the impression management strategies they used to appear as though they were meeting them in circumstances when they were not. Participants described those who did not meet these expectations as branded the ‘struggling resident’. Concerns about one’s impression had implications for residents’ evaluations, learning opportunities, decision making, and wellness.

The surgical culture values certainty and confidence, and this was proposed to be a source of internal conflict for surgeons, particularly during times of stress and uncertainty. Surgeons previously described the need to manage their image during these times, putting on an external appearance that is inconsistent internally. As part of a larger program of research on surgical judgment and decision making, this study used a constructivist grounded theory approach to explore 15 general surgery trainees’ perceptions and experiences of impression management during moments of decision making. Residents described their perceived expectations in training, and the impression management strategies they used to appear as though they were meeting them in circumstances when they were not. Participants described those who did not meet these expectations as branded the ‘struggling resident’. Concerns about one’s impression had implications for residents’ evaluations, learning opportunities, decision making, and wellness.

Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.