Teaching pharmacotherapeutics to family medicine residents: a curriculum

PROBLEM BEING ADDRESSED     

Identifying Bioethics Learning Needs: A Survey of Canadian Emergency Medicine Residents

Objectives: Emergency medicine (EM) postgraduate training programs must prepare residents for the ethical challenges of clinical practice. Bioethics curricula have been developed for EM residents, but they are based on expert opinion rather than resident learning needs. Educational interventions based on identified learning needs are more effective at changing practice than interventions that are not. The goal of this study was to identify the bioethics learning needs of Canadian EM residents. Methods: A survey‐based needs assessment of Canadian EM residents was performed between July 2000 and June 2001. Residents were asked to identify their learning needs by rating bioethics topics and by relating their clinical experiences. Physicians and nurses who work with residents were surveyed in a similar manner and also asked to identify the residents' bioethics learning needs. Results: A total of 129 EM residents (77% of eligible residents), 94 physicians, and 87 nurses responded. Residents, physicians, and nurses all identified issues in end‐of‐life care as the greatest bioethics learning needs of the residents. Other areas identified as learning needs included negotiating consent, capacity assessment, truth telling, and breaking bad news. A learning need identified by nurses, but not residents, was the manner in which residents interact with patients and colleagues. Conclusions: This needs assessment provides valuable information about the ethical challenges EM residents encounter and the ethical issues they believe they have not been prepared to face. This information should be used to direct and shape ethics education interventions for EM residents.     

Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: a survey of internal medicine residents

OBJECTIVE: We aimed to determine internal medicine residents' perceptions of the adequacy of their training to serve as in-hospital cardiac arrest team leaders, given the responsibility of managing acutely critically ill patients and with recent evidence suggesting that the quality of cardiopulmonary resuscitation provided in teaching hospitals is suboptimal. DESIGN: Cross-sectional postal survey. SETTING: Canadian internal medicine training programs. PARTICIPANTS: Internal medicine residents attending Canadian English-speaking medical schools. INTERVENTIONS: A survey was mailed to internal medicine residents asking questions relating to four domains: adequacy of training, perception of preparedness, adequacy of supervision and feedback, and effectiveness of additional training tools. MEASUREMENTS AND MAIN RESULTS: Of the 654 residents who were sent the survey, 289 residents (44.2%) responded. Almost half of the respondents (49.3%) felt inadequately trained to lead cardiac arrest teams. Many (50.9%) felt that the advanced cardiac life support course did not provide the necessary training for team leadership. A substantial number of respondents (40%) reported receiving no additional cardiac arrest training beyond the advanced cardiac life support course. Only 52.1% of respondents felt prepared to lead a cardiac arrest team, with 55.3% worrying that they made errors. Few respondents reported receiving supervision during weekdays (14.2%) or evenings and weekends (1.4%). Very few respondents reported receiving postevent debriefing (5.9%) or any performance feedback (1.3%). Level of training and receiving performance feedback were associated with perception of adequacy of training (r(2) = .085, p < .001). Respondents felt that additional training involving full-scale simulation, leadership skills training, and postevent debriefing would be most effective in increasing their skills and confidence. CONCLUSIONS: The results suggest that residents perceive deficits in their training and supervision to care for critically ill patients as cardiac arrest team leaders. This raises sufficient concern to prompt teaching hospitals and medical schools to consider including more appropriate supervision, feedback, and further education for residents in their role as cardiac arrest team leaders.     

Development of a Canadian family medicine pharmacy practice experience programme

Faculties of Pharmacy in Canada must currently provide students with at least 16 weeks of structured pharmacy practice experience. In recent years, the College of Pharmacy at Dalhousie University in Halifax, Nova Scotia, Canada has been developing more practice experience sites in non-institutional settings. One of these is at the Department of Family Medicine at Dalhousie University. This paper describes the development and expansion of clinical pharmacy services in the Family Medicine Clinics, provided by one of the College's clinical faculty members. With those services in place, the clinical pharmacist was ready to begin precepting pharmacy students at the Family Medicine Clinics. A proposal for a family medicine pharmacy practice experience programme was written, accepted and piloted in 1994-95. Following the success of that initial trial, the programme has continued and expanded over the years. Evaluation from the programme participants indicates that experience allows the pharmacy student to successfully complete programme objectives and gain an appreciation for working with other health care professionals to optimize patient care. The Family Medicine Clinics also appreciate the contributions made by the pharmacy students and value the interaction between students training in pharmacy and residents in family medicine.     

Survey of moonlighting practices and work requirements of emergency medicine residents

We conducted an anonymous moonlighting and academic practice survey of all emergency medicine residents enrolled in accredited programs during 1997. Expanding on previous work, this survey included specific details and practice trends of moonlighting emergency medicine residents and for comparison also included academic work requirements. The typical emergency residency program requires residents to work 204 hours monthly. However, the range of required work-hours is strikingly large (120-300). Half of emergency medicine residents moonlight. The typical moonlighting resident works as a solo emergency department practitioner in multiple facilities outside of residency-affiliated institutions. Moonlighting salaries generally double a resident's annual income and are used to pay off student loans and other debt. Residents with higher student debt are more likely to moonlight. Despite the fact that most residency programs restrict moonlighting, a majority of moonlighting residents have violated an Accreditation Council for Graduate Medical Education prohibition restricting work within one period of a regular residency-scheduled shift. Half of all residents surveyed, whether involved in moonlighting practice or not, would violate a ban on the practice. Residents universally felt that moonlighting enhanced residency performance and was a positive educational experience. Use of these data may aid in the development of formal guidelines regarding emergency medicine moonlighting practice.     

An approach to educating family practice residents and family physicians about complementary and alternative medicine

Complementary and alternative medicine (CAM) in the context of medical education is a controversial topic among the medical community. With the increased popularity of complementary and alternative medicine, medical educators are faced with the need of educating physicians so they would become competent to communicate with patients about CAM. As academic medicine shows more interest in CAM, it is critical to develop initiatives to overcome physicians' attitudinal barriers toward CAM and develop an instruction strategy that can address these needs. An approach to educate family practice residents and family physicians about CAM is described in this article. This patient-centered teaching approach hinges on the belief that CAM and family medicine are closely related. It espouses utilizing critical thinking and basing decisions on evidence-based material. The course covered four main topics in CAM: herbal medicine, traditional Chinese medicine (TCM), homeopathy and complementary nutrition. The course had limited objectives of exposing physicians to the common methods in CAM and providing sufficient information, so physicians could provide their patients with an informed, safe and balanced advice. The instructions emphasized the importance of improving physician-patient relationship and enriching the participant both professionally and personally. Results of our study revealed that after the course physicians' referral to CAM became more selective, at the same time, their personal use of CAM also increased. This reflects the increased value of CAM in the physicians' own healthcare, as well as their improved knowledge of appropriate referral patterns. Most importantly, the course increased the physicians' awareness of the psychosocial aspect of clinical problems encountered in family practice and, through the close observation of CAM in practice, gave them an additional viewpoint to better understand the patient-doctor relationship.