Complementary and Alternative Medicine (CAM) has been demonstrated to be an effective addition to traditional medical practice. However, patient awareness of CAM techniques may be low, particularly in rural areas. The aim of this study is to measure adult patient interest in CAM, particularly Osteopathic Manipulative Medicine (OMT), acupuncture, meditation, nutrition, and breathing techniques in a community Family Medicine practice. An anonymous survey was given to 200 adult patients in an outpatient clinic over the course of 3 months. Survey items were designed to assess if patients were aware of CAM, if they had experience with any of the mentioned modalities, if they were interested in the mentioned modalities, and which CAM services patients would like to see offered in clinic. In regards to having heard of CAM, 57.3% of patients had reported that they were aware of CAM, while 42.7% were not. Of those that had heard of CAM, 42.4% had experience with OMT, 55.1% had experienced acupuncture, 7.6% had experienced breathing techniques group, 14.4% had experienced nutrition groups, and 5.1% had experienced meditation groups. 22.3% of patients were not interested in any form of CAM being offered in clinic, while 77.7 were interested in at least one type of CAM. OMT held the highest rating among interested patients, with 29.1% wanting to see it offered in clinic. These results indicate that, while many patients were not aware of CAM, there was nonetheless a high degree of interest in seeing CAM techniques offered. The implication of this study is that CAM should be implemented in the clinic as soon as possible. Future research should assess the degree to which patients actually utilize these services, once offered.

Indiana University-Purdue University Indianapolis (IUPUI) / Recent literature on well-being of physicians in general, and residency program directors (PD) specifically, has demonstrated those meeting the criteria of burnout reaching almost 50% in physicians, and 20-30% in PDs. However, few studies have explored engagement, or the positive or meaningful aspects, in physicians and no studies have explored engagement in the PD and Assistant PD community. Therefore, this study employed a qualitative approach to explore the experiences of PDs and APDs as they encountered burnout, engagement, and every combination in between through their multifaceted, roles, responsibilities, and tasks embedded in their institutional context and personal lives. Phase 1 participants (n=3) included two PDs and one APD from Indiana University School of Medicine (IUSM). Participants in Phase 1 took part in three semi-structured interviews at 6-month intervals, and direct observations in their clinical, administrative, and education roles. Phase 2 participants (n=5) were PDs from IUSM who completed a single semi-structured interview based on preliminary results and exploration of Phase 1 participants’ experiences. Interviews and field notes from observations were analyzed using inductive thematic analysis, followed by a deductive application of Job Demands-Resources (JD-R) theory. Document analysis was incorporated to add context, understanding, and a rich description of the participants’ experiences. This study found multiple sub-themes situated within four major themes: It Takes a Village, Integration of the “Hats” They Wear, Motivation and the Meaning of Their Career, and Coping. Exploring the sub-themes to JD-R theory allowed contextualization of how job demands, job resources, personal resources, absence of resources, job crafting, recovery, self-undermining, and strain, interact to add context, nuance, and broader conceptualization of how PD and APD experienced their multifaceted roles. This study provides a rich description of the experiences of PDs and APDs embedded in their social context of roles, tasks, and responsibilities. These results indicated that understanding how the individual experiences their job demands as they interact with their experiences of job and personal resources, and how the individual proactively engages with their environment through job crafting and recovery enables for a nuanced appreciation of engagement and burnout.

OBJECTIVE: Because training in pediatric disaster medicine (PDM) is neither required nor standardized for pediatric residents, we designed and integrated a PDM course into the curriculum of a pediatric residency program and assessed if participation increased participants' knowledge of managing disaster victims. METHODS: We adapted and incorporated a previously studied PDM course into a small-sized pediatric residency program. The curriculum consisted of didactic lectures and experiential learning via simulation with structured debriefing. With IRB approval, the authors conducted a longitudinal series of pretests and posttests to assess knowledge and perceptions. RESULTS: Sixteen eligible residents completed the intervention. Before the course, none of the residents reported experience treating disaster victims. Pairwise comparison of scores revealed a 35% improvement in scores immediately after completing the course (95% confidence interval, 22.73%-47.26%; P < 0.001) and a 23.73% improvement 2 months later (95% confidence interval, 7.12%-40.34%; P < 0.01). CONCLUSIONS: Residents who completed this course increased their knowledge of PDM with moderate retention of knowledge gained. There was a significant increase in perceived ability to manage patients in a disaster situation after this educational intervention and the residents' confidence was preserved 2 months later. This PDM course may be used in future formulation of a standardized curriculum.

The United States health care expenditures are higher than any other developed country. Due to this, physician payment reform is moving from fee-for-service (FFS) to a value-based model, with a focus on prevention and quality. The purpose of this quantitative study was to measure the effect of a series of data delivery interventions associated with the quality scorecards and which method increased the quality scores at a medical teaching practice in Tennessee. Data were gathered via the Physician Quality Scorecard, an internally developed instrument. Each quarter, a different data delivery intervention was performed, and scorecard data were analyzed for comparison. The study population included all living faculty and resident physicians who practiced medicine between quality years 2018-2020. Statistical procedures included one-way ANOVA, independent t-test, and Pearson correlation coefficient. Data analyses revealed that the data delivery intervention of email only was more likely than other interventions to yield the most positive change in quality scores in the years 2018-2020. However, the classroom training data delivery method generated the most positive change and email only generated the least positive change in the quality year 2019 only. The quality year 2018, yielded the best quality year overall. It is important to note that data collected in 2020 may have limitations due to the COVID-19 pandemic.

This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. In the first study, we report a number of barriers that might prevent supervisors from providing constructive feedback to medical trainees, including a fear of being labeled as intimidating or harassing. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees including insufficient documentation, a perceived lack of support from program leadership, insufficient opportunities to observe performance, competing demands on time, fear of appeals or legal action, and fear of reciprocated poor staff evaluations. The second study examines the effectiveness of two new tools for assessing trainees’ performance and determines that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Participants reported that the new tools were helpful for improving learning in six ways: by sparking a dialogue regarding performance; by promoting a structured, procedure-specific framework which could be used as a mechanism for providing high quality feedback; by providing a framework for directing future learning; by facilitating a systematic tracking of progress over time; by promoting an increased motivation to learn; and by introducing a learning focus to the intraoperative environment. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessments and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care. / Thesis / Master of Science (MSc) / This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. We present two studies. In the first, we explore barriers that might prevent supervisors from providing constructive feedback to medical trainees. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees. The second study examines the effectiveness of two new tools for assessing trainees’ performance and demonstrates that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessment and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care.

No description available.

The launch of Competence by Design (CBD) in 2017 by the Royal College of Physicians and Surgeons of Canada (RCPSC) ushered in a new era of residency education in Canada. For CBD to succeed, faculty responsible for training residents must undergo faculty development to attain the relevant knowledge and skills required to fulfil their new duties. This thesis examines the faculty development resources available to faculty, and the approaches taken by program directors to facilitate faculty development. This research was guided by two research questions: (1) What faculty development resources (e.g., online modules, websites, slide decks) are currently available for faculty members in CBD programs across Canada? (2) How do program directors facilitate faculty development within their specific program? Phase 1 of this study involved a document review of all English-speaking medical schools in Canada with a post graduate CBD program. In phase 2, semi-structured interviews were conducted with program directors from the emergency medicine and psychiatry specialties. The document review found that Canadian universities hosted a range of informative websites, documents, newsletters, live sessions, and online modules to support faculty development efforts on a range of topics. During the interview phase, program directors identified live faculty development sessions, both in-person and online, were the most effective. They also expanded on their experience in the transition to CBD, some noting that their previous assessment models shared similarities with CBD, lessening the burden on faculty to change their teaching practice. Many expressed concerns over resource and time constraints on faculty development and the implementation of CBD as a whole.

<p>The Royal College of Physicians and Surgeons recognizes the role of health advocate as a central aspect of doctoring that can greatly impact the quality of care one receives. Current literature discussing physicians as health advocates is sparse, particularly in the area of medical training. This study aims to identify how medical residents negotiate between their identity as a physician, which is bound by the narrow confines of biomedicine, and a more comprehensive vision of health care that incorporates advocacy. A thematic narrative analysis of four weblogs authored by medical residents was employed to complete this study. The culture of medicine and the hidden curriculum surfaced as impediments to advocacy in residency training, resulting in residents experiencing a crisis in caring, compassion and communication. When residents were not able to care for their patients in ways that met their moral expectations of what it means to be a healer, they felt depersonalized and became disenchanted with medicine. Arthur Frank’s theory regarding the demoralization of medicine is used to illuminate the importance of dialogue within the doctor-patient relationship, as well as its impacts on health advocacy. This study explores the concept of advocacy and brings forth the question: Given what we know about medicalization and the culture of medicine, should physicians be health advocates for their patients when their training is restricted to biomedical interventions and notions of care?</p> / Master of Arts (MA)

Competency-based medical education (CBME) is a paradigm of assessing resident performance through well-defined tasks, objectives and milestones. A large number of data points are generated during a five-year period as a resident accomplishes the assigned tasks. However, no tool support exists to process this data for early identification of a resident-at-risk failing to achieve future milestones. In this thesis, the implementation of CBME at McMaster's Royal College Emergency Medicine residency program was studied and the development of a machine learning algorithm (MLA) to identify patterns in resident performance was reported. The adaptivity of multiple MLAs to build a tool support for monitoring residents' progress and flagging those who are in most need of assistance in the context of emergency medicine education was evaluated. / Thesis / Master of Science (MSc)

Behavioral science faculty (BSF) who work in family medicine residency education find themselves in inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that BSF fill while working in inpatient medicine teaching services within family medicine residencies. The purpose of the present modified sequential explanatory study was to clarify the roles of BSF and how the BSF responsibilities inform training of mental health clinicians. The convenience sample for quantitative analysis included 60 BSF who currently work on an inpatient medicine teaching service and completed a web-based survey on contextual demographics and roles on inpatient medicine teaching service. The convenience sample for qualitative analysis included 24 BSF who participated in a semi-structured interview about the roles and responsibilities on an inpatient medicine teaching service. Results suggest that behavioral science faculty members assume the roles of Educator, Administrator, Patient Care Supporter, Evaluator, Scholar/Researcher, Community Service Liaison, Mentor/Advisor, and Gatekeeper, and perform multiple responsibilities within each role. I will identify the responsibilities within each role that BSF fill in inpatient medicine teaching services using qualitative analysis and explore discrepancies between previous frameworks and this study's outcomes. Implications for this research will help to inform the hiring process for behavioral science faculty, resident education, and comprehensive behavioral science faculty and marriage and family therapy training. / Ph. D.