Charo Rodríguez

Background: This empirical study aims to explore women’s perspectives on cardiovascular disease and the use of digital health interventions (DHIs) for their primary prevention and to gather insights on essential features for developing artificial intelligent–enabled technologies. Methods: Adopting a qualitative descriptive research design, we conducted 15 semi-structured, in-depth interviews via Zoom with women at higher risk for cardiovascular disease. Participants were women over 40 years old, residing in Quebec, with at least one cardiovascular disease risk factor, and proficient in English. Recruitment was from a McGill University-affiliated clinic. An inductive thematic analysis approach was used for data analysis. Results: Five major themes were identified: (i) understanding cardiovascular disease in a variety of ways, (ii) barriers and challenges to preventing cardiovascular disease in women, (iii) women taking charge of their cardiovascular well-being, (iv) mixed perspectives regarding artificial intelligent–enabled technologies for cardiovascular disease prevention such as Xi-Care, and (v) range of suggestions for the format and design of a prospective artificial intelligent–enabled technologies. Conclusions: Despite the prevalence of cardiovascular disease, there is a significant knowledge gap among women regarding the chronic nature and manifestations of these diseases. Artificial intelligent–enabled technologies like Xi-Care, with the potential for customization and interactive engagement, could enhance the primary prevention of cardiovascular disease in women, providing valuable insights for the subsequent phases of the project leading to Xi-Care’s development.

Current evidence suggests that family physicians, who have traditionally provided a wide range of services across various settings, are choosing to reduce their scope of practice. This can have negative effects on communities that rely on family physicians to meet their diverse primary care needs. The College of Family Physicians of Canada (CFPC) spearheaded a curriculum review and renewal of postgraduate residency training to support broad-scope family medicine and specifically address six areas of evolving societal need: (i) home and long-term care; (ii) addiction and mental health; (iii) Indigenous health; (iv) health equity and anti-racism; (v) virtual care and health informatics; and (vi) leadership, advocacy, and scholarship. This study answered the following research question: Which learning outcomes for the six areas of societal need identified by the CFPC should be prioritized in family medicine postgraduate education, according to local stakeholders? As part of a broad investigation, we conducted a descriptive study using the nominal group technique. Participants—researchers, clinical educators, and residents affiliated with a Canadian university—first generated ideas for learning outcomes and rated each idea’s importance on a five-point Likert scale. Then, they selected the five ideas per area of societal need that they believed to be of highest priority. Fifty-nine participants took part in six sessions in the fall of 2023. They generated and prioritized 227 learning outcomes, emphasizing topics related to patient-centred care and to personal and professional skills in care delivery. They also highlighted the need for both culturally safe care and a better understanding of the history of inequity in health care for marginalized populations. This study generated and prioritized many learning outcomes relevant to the six areas identified by the CFPC. Combined with national-level work and international consultations, this work provides actionable learning outcomes for family medicine residency training programs.

Remediation programs in postgraduate medical education aim to help struggling residents successfully complete their training and graduate. Research has mostly focused on educators' and program directors' perspectives on the development and quality of remediation programs. However, little is known about the experience of being remediated. This investigation aimed to understand how practicing family physicians who underwent remediation during their residency experienced their remediation program. In this Interpretative Phenomenological Analysis (IPA) study, we purposively sampled six family medicine practitioners who underwent successful remediation as residents in a Canadian medical school. We individually interviewed them in-depth, one to six years after graduation. For data analysis, we combined IPA thematic and narrative techniques. While each participant had a unique experience of remediation, we identified a common longitudinal process of four consecutive periods: pre-remediation, remediation, and early and late post-remediation. All participants experienced the remediation announcement as shocking, surprising, and disruptive, as most were unaware that they were not reaching the expected competency standards. This triggered the hot-cognition learning process that characterized the initial phases of their remediation experience. During remediation, they went through a progressive reorganization of a self-coherent professional identity formation process, mediated by the interactions with their educators. In the early post-remediation phase, most participants accepted their teachers' and institution's educational evaluations and expectations. Some, however, started developing a dissonant professional identity vis-à-vis their community of practice. In the late post-remediation phase, most participants viewed their remediation experiences as beneficial to their career development, but others felt lasting harm, evidenced by less career satisfaction and practice advancement. The experience of being remediated in postgraduate medical education is an emotionally charged one. It is modulated by a variety of personal factors and surrounding features. The quality of interactions between residents who need remediation and their remediators appears to be a critical element in the success of a remediation program. Remediation, even when successful, is a shocking and emotionally challenging educational experience for those who undergo it, with important and lasting implications.

Introduction: During catastrophes, physicians face significant stress and emotional challenges. This review explored existing evidence about the challenges family physicians face during infectious catastrophes, and their perceived well-being needs. Materials and Methods: We conducted a mixed studies literature review using 2 databases, Ovid MEDLINE ALL (1946 to February 2023) and PsycInfo on Ovid (1806 to February 2023). To assess methodological quality, we used Mixed Methods Appraisal Tool. The extracted data were analyzed employing a data-based convergent mixed methods design. Results: Thirty-four (34) studies met the criteria for data extraction. Line-by-line coding for thematic analysis was applied to Result and Discussion sections of included articles. Findings were categorized into 4 levels: Societal, Institutional, Organizational, and Individual. Seven themes were identified in total. Discussion: Public health authorities should focus on systemic changes, including organizational development to improve coordination within and across organizations. Clinician involvement in decision-making, clear communication, mental health support, and adequate resources are crucial. Policy implications underscore the necessity for healthcare policies prioritizing physician well-being, and organizational support during infectious catastrophes. Improving work conditions extends beyond personal protective equipment (PPE) access, requiring swift betterment of service innovations, with ongoing reassessment for sustainable care planning, financing, and delivery beyond emergencies.

Primary care is evolving around the world, and the need to address changing societal needs prompted a call to renew family medicine residency training. Experts were asked to generate learning topics around six areas of societal need. International family medicine experts were invited to participate in a Delphi study that concluded in 2024. The initial round generated 1275 submissions. Through content analysis, we distilled these submissions to 54 learning topics, which were rated for their importance using a 5-point scale. Importance was indicated if the median score was ≥3.5, and consensus was achieved if the interquartile range was ≤1. All learning topics were deemed important. Consensus was reached for 46 of 54 learning topics. Topics with low consensus included 'community support and engagement,' 'holistic understanding and proficiency in trauma-informed care,' 'historical and cultural aspects of Indigenous communities,' and 'acquiring research and scholarship competencies in virtual healthcare.' Consensus was reached in 46 learning topics, with low consensus in areas where physicians' roles overlap with other care providers. Learning topics generated in this study could be integrated to ensure residency programs meet current societal needs. These findings are relevant to family medicine and many residency programs.

Purpose: The primary aim of this study is to validate the Blended Learning Usability Evaluation–Questionnaire (BLUE-Q) for use in the field of health professions education through a Bayesian approach. As Bayesian questionnaire validation remains elusive, a secondary aim of this article is to serve as a simplified tutorial for engaging in such validation practices in health professions education.Methods: A total of 10 health education-based experts in blended learning were recruited to participate in a 30-minute interviewer-administered survey. On a 5-point Likert scale, experts rated how well they perceived each item of the BLUE-Q to reflect its underlying usability domain (i.e., effectiveness, efficiency, satisfaction, accessibility, organization, and learner experience). Ratings were descriptively analyzed and converted into beta prior distributions. Participants were also given the option to provide qualitative comments for each item.Results: After reviewing the computed expert prior distributions, 31 quantitative items were identified as having a probability of “low endorsement” and were thus removed from the questionnaire. Additionally, qualitative comments were used to revise the phrasing and order of items to ensure clarity and logical flow. The BLUE-Q’s final version comprises 23 Likert-scale items and 6 open-ended items.Conclusion: Questionnaire validation can generally be a complex, time-consuming, and costly process, inhibiting many from engaging in proper validation practices. In this study, we demonstrate that a Bayesian questionnaire validation approach can be a simple, resource-efficient, yet rigorous solution to validating a tool for content and item-domain correlation through the elicitation of domain expert endorsement ratings.

Background and objectives: Despite the importance of the Objective Structured Clinical Examination (OSCE) in Sport and Exercise Medicine, the literature on the topic is fragmented and has been poorly developed. The goal of this review was to map current knowledge about how the OSCE is used in Sport and Exercise Medicine, and to identify knowledge gaps for future research. Method: The authors conducted a scoping review. They searched PubMed and Scopus for articles using key terms related to 'OSCE' and 'sport medicine' with no limit on search start date and up to July 2022. Retrieved records were imported, abstracts were screened, and full-text articles were reviewed. A forward and backward citation tracking was conducted. Data was extracted and a qualitative meta-summary of the studies was conducted. Results: A total of 469 records were screened, and 22 studies were included. The objectives of the studies included using OSCEs to assess knowledge/skills after a training program (n = 11), to assess an intervention (n = 8), and to assess and improve the OSCE itself (n = 3). Thirteen studies reported validity and/or reliability of the OSCE. Conclusion: Despite the widespread use of OSCEs in the examination of Sport and Exercise Medicine trainees, only a handful of scholarly works have been published. More research is needed to support the use of OSCE in Sport and Exercise Medicine for its initial purpose. We highlight avenues for future research such as assessing the need for a deeper exploration of the relationship between candidate characteristics and OSCE scores.

Solo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams. A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed. For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals’ identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.

Practice pointsEmpirical research on empathy during postgraduate family medicine education has mostly measured its cognitive component.Much lesser attention has been devoted to the study of the emo...

Introduction: To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. Methods: We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. Results: We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. Discussion/Conclusions: This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality. Introduction : Pour fournir des soins compétents aux patients atteints d’un trouble du spectre de l’autisme (TSA) ou d’un trouble du développement intellectuel (TDI), les professionnels de la santé doivent reconnaître les besoins des populations neurodivergentes et adapter leur approche clinique. Nous avons évalué le degré perçu de préparation des étudiants en médecine à adapter la prestation de soins aux patients atteints de TSA/TDI, ainsi que leurs perceptions de la formation relative à la neurodiversité. Méthodes : Nous avons mené une étude séquentielle explicative à méthodes mixtes auprès d'étudiants en médecine de premier cycle de l'Université McGill au cours de l'année universitaire 2020-2021. Nous avons administré un sondage en ligne, suivi d'entretiens semi-structurés. Nous avons analysé les données en faisant appel à la statistique descriptive et à une analyse thématique. Nous avons intégré les résultats sur le plan interprétatif. Résultats : Nous avons inclus deux cent dix réponses à l'enquête (~29% de la classe), et 12 entretiens. Peu d'étudiants se sentaient préparés à adapter les soins aux patients atteints de TSA/TDI, bien que la plupart d'entre eux aient indiqué qu'il était important de le faire. Quatre-vingt-dix-sept pour cent d'entre eux souhaitaient davantage de formation sur l'adaptation des soins aux patients neurodivergents. L'analyse thématique a révélé que les participants considéraient la formation actuelle insuffisante et jugeaient utile l'apprentissage par l'expérience. Discussion/Conclusions : Cette étude met en évidence le faible niveau de préparation perçu par les étudiants en médecine en ce qui concerne l'adaptation des soins aux patients neurodivergents, ainsi que le désir d'une formation plus poussée. L'intégration dans les programmes des facultés de médecine d'une formation interactive portant sur la modification de la prestation des soins pour les personnes neurodivergentes pourrait améliorer la perception des étudiants en médecine de leur degré de préparation à travailler avec ce type de patients et de la qualité des soins.