Quentin Durand-Moreau

Faculty development is a field in tension between the need to achieve institutional goals and claims that it would support the personal growth of individual faculty members. Sheets and Schwenk have...

Background: The impact of presumptive coverage policies for work‐related mental health disorders has not been extensively studied to date. Using data from the Association of Workers’ Compensation Boards of Canada (AWCBC), our objectives were to describe the evolution of compensated mental health conditions, and to explore the association between the implementation of presumptive coverage and the number of compensated mental health conditions. Methods: Datasets on mental health lost‐time claims (LTCs) were obtained from the AWCBC for 2001–2019. The total number of all‐cause LTCs was used as a denominator. Independent variables included presumptive coverage, union coverage, unemployment rate, proportion of service industry workers, proportion of working women, physicians and psychologists per 100,000 inhabitants, and workers’ compensation board coverage. Regression and interrupted time series analyses were conducted. Results: Over the study period, mental health LTC accounted for 0.97% of all‐cause LTCs: half of the former were PTSD cases. In the multivariate analysis, presumptive coverage policies restricted to PTSD were only positively associated with the proportion of PTSD LTCs (Incidence Rate Ratio, [IRR] = 1.237, 95% CI 1.005–1.521) but not with other mental health LTCs. More lenient policies were positively associated with the proportion of PTSD LTCs (IRR = 1.211, 95% CI [1.025–1.430]), and non‐PTSD mental health LTC (IRR = 1.435; 95% CI [1.001–2.058]). Conclusions: Workers’ compensation presumptive coverage policies for mental health conditions have the effect of increasing claim volumes for these conditions. When restricted to coverage of PTSD, the portion of PTSD of all LTC is larger, but there is no documented ripple effect on other mental health conditions.

Background: Current Canadian Occupational Medicine residency program training routes and curriculum are being redesigned, using a competence by design model and reverting to a primary entry specialty likely in 2027. This is an opportunity to improve training standards and better prepare residents to address psychosocial risk prevention and worker’s compensation. Aims: To conduct an environmental scan on the educational experience pertaining to mental health and psychosocial risks. Methods: We conducted an environmental scan in 2025 collecting data on requirements, educational experiences, and examination on mental health and psychosocial risks for occupational medicine residents via contacts with program directors and the chair of the subspecialty exam committee, review of the national academic half-day curriculum, Royal College of Physicians and Surgeons of Canada standards and objectives, accreditation standards, and a recommended reference textbook. Results: Few requirements are mandated in specialty accreditation standards, mostly about mental health and addiction medicine experiences, delivered by all programs. The national academic half-day curriculum includes 8% of programmed sessions on these issues (mental health and addiction medicine diagnosis, stress models, burnout, bullying, psychosocial risks and work organization). Several additional learning experiences were noted locally such as learning modules or optional webinars. Conclusions: Programs go beyond requirements and deliver educational experiences addressing psychosocial factors. Canadian academic occupational medicine specialists have been able to influence educational standards at the undergraduate level and have an opportunity to do the same with the updated residency standards. An international framework for psychosocial risks education in occupational medicine residency training may be helpful.

Introduction: Long COVID is characterized by the presence of new onset or persistent symptoms 3 months after a suspected or confirmed history of SARS-CoV-2 infection. It is a complex and multi-faceted condition that affects people in different ways. Long COVID affects individuals’ labour market participation. While some cannot work, others may return to work (RTW) in a limited capacity. Determining what rehabilitation or related strategies are safe and effective for facilitating RTW is necessary. Objectives: To synthesize evidence on RTW interventions for people living with Long COVID and to identify ‘promising’ interventions for enhancing work ability and RTW. Methods: We followed Arksey & O’Malley’s methodology and the PRISMA extension for scoping reviews. Five electronic bibliographic databases and grey literature were searched. The literature search included various study designs, such as randomized controlled trials (RCT), quasi-experimental designs, and observational studies as well as clinical practice guidelines (CPGs). Two reviewers conducted screening and data extraction, with disagreements resolved through consensus. Intervention studies were categorized as promising (statistically significant RTW outcomes or ≥ 50% RTW), somewhat promising (20% to < 50% RTW), not promising (non-statistically significant RTW outcomes or < 20% RTW), or uncertain (did not specify proportion of RTW). Results: Twelve CPGs and nineteen intervention studies were identified. Of the intervention studies, 5 were cohort studies, 3 quasi-experimental studies, 4 observational, 2 interventional, 3 RCTs, and 2 case reports. Promising interventions included multimodal and interdisciplinary work-focused rehabilitation, multidisciplinary inpatient and outpatient rehabilitation, psychoeducation, pacing, and breathing strategies, shifting focus from symptom monitoring to optimizing functional outcomes, enhanced external counterpulsation inflatable pressure to improve blood flow, and constraint-induced cognitive therapy. Conclusion: Many uncertainties remain regarding which RTW interventions are effective or the optimal characteristics of these interventions.

Instruction to the Double is a method used in work psychology. Its key interest is that it bridges the gap between real and prescribed work. From a theoretical standpoint, Instruction to the Double is embedded in Vygotskian socio-constructivism. It aims at developing the learners’ power to act. In practice, learners select a practical situation from their work experience and participate in an interview where the learner presents step-by-step instructions to a facilitator as to how intervene in that situation. The facilitator must focus on the how, rather than the why. Learners subsequently access the recorded interview and transcript. The method’s potential for development resides in surprising learners with the discrepancy between what they think they do, and what they say they do. Such discrepancy facilitates learner’s development of their power to act. Instruction to the Double can be a promising learning method in medical education, especially for post-graduate and continuing professional development learners.

Background: Many studies have documented exposure to psychosocial factors in healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic. Few have done it prospectively with open-ended questions. Aims: To describe the evolution of stress factors reported by HCWs during the pandemic. Methods: A prospective cohort of 4964 HCWs (physicians, nurses, healthcare aides and personal support workers), from four Canadian provinces, received four online questionnaires between the spring 2020 and 2022. Responses to an open-ended question on stressful events were coded into 25 stressors. Multilevel logistic regressions assessed trends in stressors, and the effect of gender, occupation and age. Results: In 2020, 91% of participants reported at least one stressor compared to 51% in spring 2022. Overall, eight stressors were reported 1000 times or more among 16 786 questionnaires. Five stressors decreased over time: fear of COVID-19, problems with personal protective equipment, changing guidelines, management of difficult cases and changes to work routine. Conversely, an increasing trend was noted for volume of work, and poor behaviour from the public or colleagues. Difficulties managing patients’ deaths remained steady. Changes in stressors over time were similar by gender, professional role and age group, although the reporting of some stressors varied within subgroups. Conclusions: Reporting of most stressors decreased over the pandemic, except for stressors arising from the changing demands on staff and patients as the pandemic progressed. Such changes in workplace psychosocial factors need to be addressed by prevention programmes to ensure an appropriate support response to the needs of HCWs.

Objective: We aimed to estimate prevalence of post-COVID conditions (PCCs) among healthcare workers (HCWs) and to identify predisposing factors. Methods: A cohort of Canadian HCWs completed four questionnaires during the pandemic. At the final questionnaire, HCWs reported conditions attributed to earlier COVID-19. The proportion developing a PCC was estimated. Risk factors were evaluated by logistic regression. Results: Among 4964 HCWs, 995 had one positive COVID test >90 days before completing the final questionnaire. A total of 266 (27%) developed a PCC. Factors predisposing HCWs to a PCC included depression and increased alcohol consumption reported preinfection, chronic ill-health prepandemic, and a perception that the infection was work-related. PCCs were less likely following vaccination. Most HCWs (98%) returned to work within 30 days, with 8% reporting severe PCC (n = 80). Conclusions: Predisposing factors reflected poor health preinfection. Most conditions were mild.

Objective: The aim of the study was to identify determinants of mental health in healthcare workers (HCW) during the COVID-19 pandemic. Methods: A cohort of Canadian HCW completed four questionnaires giving details of work with patients, ratings of workplace supports, a mental health questionnaire, and substance use. Principal components were extracted from 23 rating scales. Risk factors were examined by Poisson regression. Results: A total of 4854 (97.8%) of 4964 participants completed ratings and mental health questionnaires. Healthcare workers working with patients with COVID-19 had high anxiety and depression scores. One of three extracted components, ‘poor support,’ was related to work with infected patients and to anxiety, depression, and substance use. Availability of online support was associated with feelings of better support and less mental ill-health. Conclusions: Work with infected patients and perceived poor workplace support were related to anxiety and depression during the pandemic.

We investigated the availability and use of workplace mental health (MH) supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers (HCW) and measured anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) completed at four contacts 2020-2022. Reports were available for 4400 HCW working with patients. Half the HCWs had a clinically significant HADS score at one or more contacts Access to MH supports increased during the pandemic, with 94% reporting access to some workplace support by 2022: 47% had made use of at least one support. 25% of those with high HADS scores used no support. Older women and men with depressive conditions were less likely to report use. Reported use of an Employee Assistance Program was associated with a reduction in HADS scores in the following months.

Persistent symptoms are common after acute COVID-19, often referred to as long COVID. Long COVID may affect the ability to perform activities of daily living, including work. Long COVID occurs more frequently in those with severe acute COVID-19. This guidance statement reviews the pathophysiology of severe acute COVID-19 and long COVID and provides pragmatic approaches to long COVID symptoms, syndromes, and conditions in the occupational setting. Disability laws and workers’ compensation are also addressed. Export