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 United States (U.S.) is currently facing a shortage of primary care physicians, an issue particularly salient in Arizona. The purpose of this project is to investigate predictors of students entering primary care specialties that may be apparent from their American Medical College Application Service (AMCAS) applications, in order to best serve the needs of the physician workforce. We hypothesized that factors such as female gender, older age at application (“non‐traditional” students), and being raised in a rural/underserved community background may be predictors of students who choose primary care fields. AMCAS applications are completed by aspiring medical students and contain demographic information including gender, age, race, languages spoken, and family/community characteristics. Data provided also include academic factors such as college major, grade point average (GPA), and Medical College Admissions Test (MCAT) scores. Other subjective data reported by applicants include descriptions of extracurricular activities and a personal statement. The National Resident Matching Program (NRMP) is the system used by graduating students during the last semester of medical school to match students with their choice of specialty and the residency program wherein they will spend an additional three years, minimum, in training. Based on the Association of American Medical Colleges (AAMC) designations, we are considering primary care to be Family Medicine, Pediatrics, Internal Medicine, and Medicine‐Pediatrics. We examined data from AMCAS applications of all 149 students who graduated from the University of Arizona College of Medicine‐Phoenix between 2011‐2014, and compared to their NRMP match outcomes. Comparisons were made between non‐primary care versus primary care‐overall, as well as Family Medicine alone versus all other matches given the increasing rate of specialization within Internal Medicine and Pediatrics. Multiple logistic regression revealed two predictors of primary care career choice compared to non‐primary care: having more siblings (P=.003) and non‐physician parents (P=.017). Specific to Family Medicine, several predictors were identified compared to the non‐Family Medicine cohort: a slightly greater percentage of earned community college credits (P=.03), lower MCAT physical science (P=.009), higher MCAT verbal scores (P=.02), and lower paternal education (P=.003). Our analyses suggest having a greater number of siblings and non‐physician parents may predict primary care career choice. Specific to Family Medicine, academic factors including community college enrollment and MCAT scores may be of predictive value. Though the exact implications behind these findings are unclear, it is important to continually examine such data as medical schools can shape admissions selection criteria targeted at increasing the number of graduates seeking careers in primary care.

Abstract Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared. / October 2006

The purpose of this study is to investigate the possible relationship between social mix and the quality of life in housing. Quality of life is measured by levels of satisfaction, social integration, mobility and freedom of choice, etc. This study has identified some factors which may have an effect on the quality of life in socially mixed housing projects. This study has formulated general observations from these factors which could influence the way the built environment is shaped, especially ways in which residents, can or cannot, appreciate and tolerate social mix. The evidence indicates that design, quality of construction, good management, and the overall environment are much more important for the acceptance and satisfaction of the residents than the question of social mix. Even so, the findings indicate that some of the positive and negative quality of life aspects derive from social mix.

Abstract Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared.

Abstract Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared.

Thesis (M.A.)--Rowan University, 2006. / Typescript. Includes bibliographical references.

Resident killer whales (Orcinus orca) in the Salish Sea use echolocation clicks to hunt for Chinook salmon, their preferred prey. An increase in underwater anthro- pogenic noise in recent decades has been identified as a threat to their survival due to auditory masking effects on these signals. Studies quantifying the effects of anthro- pogenic noise on echolocation signals have yet to be carried out due to a data gap for echolocation acoustic characteristics. In particular, to date, only one study has reported click characteristics for northern resident killer whales, and no results have been reported for southern residents. This thesis reports on acoustic recordings of resident killer whale echolocation clicks gathered over two summers in several loca- tions around Vancouver Island, and spectral and temporal characteristics extracted from them. Acoustic characteristics are reported separately for southern and north- ern resident killer whales based on 708 clicks from 19 click trains and 1277 clicks from 16 click trains, respectively. Results are further categorized into click type (slow, fast, and buzz clicks) based on inter-click interval, an indicator of foraging phase. Results show no differences in acoustic characteristics between the northern and southern killer whales, suggesting echolocation clicks do not vary between these subspecies. No significant differences are noted between slow- and fast-click characteristics, while buzz clicks appear to have some significant differences in characteristics from the oth- ers. Apparent source level values for northern and southern killer whales vary between 179-221 dB re 1 μPa at 1 m and 192-220 dB re 1 μPa at 1 m, respectively, based on the largest amplitude click from each click train (assumed to be directed towards the recording array). The values reported in this thesis will be used in subsequent noise modelling studies to quantify the effects of anthropogenic noise on resident killer whale ability to hunt for prey via echolocation signals. / Graduate

Physician health is a growing issue, garnering recognition by virtue and for potential negative impact on patient care. The state of physician mental health is troubling with above average prevalence of burnout, depression, and suicidal ideation across career stages. Well-being in resident physicians requires special consideration, given their dual role as trainees and physicians. The objectives of this study were to: (1) elucidate the mental health experiences of Ontario resident physicians, characterizing help-seeking behaviours in relation to awareness and utilization of available local and provincial services; and (2) generate knowledge that guides the development of resident-focused mental health services, informing wellness directives at the educational and organizational levels. A provincially focused study included an environmental scan of physician health programs and services at six postgraduate faculties of medicine, as well as in-depth, experiential interviews with residents on key trends across different residency contexts, the specific circumstances facing Ontario residents, their help-seeking behaviours, and experiences with physician health services. A total of 40 interviews were conducted with resident physicians across the province of Ontario, from which a subset of 12 was selected for in-depth analysis. This study found that resident physicians in Ontario were aware of resources for supporting their mental health but there were a number of challenges to seeking support. Barriers such as time, confidentiality, helpfulness, and impact on professional development and career trajectory were cited by participants. Factors that facilitated the use of resources included the accessibility and mode of delivery of services. This research offers insight towards the development and dissemination of resident-specific services and wellness resources. Furthermore, the findings of this study inform strategies and interventions to improve physician well-being through medical education in the postgraduate setting in addition to health and wellness directives at the organizational level.

No description available.

Resident remediation is often guided at the residency program level, however some institutions also have designated bodies within their departments of postgraduate medicine for this purpose, such as the Educational Advisory Board (EAB) at McMaster University. Research from the postgraduate department level has been limited, and this study aims to better understand remediation in postgraduate training with two primary objectives: 1) to review remediation processes and practices at McMaster University, from the standpoint of the postgraduate medical Education Advisory Board (EAB), and 2) to describe the characteristics and relevant outcomes for residents who underwent remediation at McMaster. A total of 85 residents were suitable for analysis and the majority of these residents were international medical graduates (62%). Most had knowledge or medical expert weaknesses (92%) while 51% of residents had behavioural (e.g. professionalism, communication) weaknesses, and a total of 42% of residents had both. A number of residents (25%) had a serious coexistent medical or psychosocial factor that contributed to the need for remediation. Remediation strategies were better described for knowledge weaknesses than for behavioural weaknesses, and there was more consistency in the remediation strategies used for knowledge weaknesses. The most commonly implemented strategies for remediation of behavioural weaknesses involved using resources that were external to the department of postgraduate medicine. The majority of residents completed their training programs at 71%. None of the analyzed predictors were found to be statistically significant for program completion, however this study was underpowered to find such predictors given the convenience sample size. This study represents the most comprehensive review of resident remediation at a single institution and it underscores the need for improved documentation and review of remediation practices at institutions. It also raises important questions regarding the effectiveness of remediation and it highlights the critical nature of accurately diagnosing a learner’s deficiencies and providing targeted remediation strategies. / Thesis / Master of Science (MSc) / Residency training is an apprenticeship period that follows the completion of medical school. It prepares doctors for independent practice within the chosen discipline or specialty of medicine. Some residents struggle during this period and need additional training time and help in order to improve their skills to become safe and effective doctors. It is not always immediately obvious how to help these residents, or which residents may be more likely to encounter difficulty, and who may have trouble completing residency training. This study attempts to answer these questions and has shown some common characteristics to residents who require remediation or additional training. It reflects the strategies that were used at McMaster University in order to help such residents. This study also indicates how many residents were able to complete their residency training programs and it provides linkages to previous research and proposes new directions for future research in resident remediation.