Browsing by Author "Lord, Jason"

Now showing 1 - 5 of 5
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    An Examination of the Impact of Simulation and Multimedia Instruction on Central Venous Catheterization
    (2017) Lord, Jason; Lockyer, Jocelyn; Palacios Mackay, Maria; Zuege, Danny
    Dependable assessment tools are essential for Competency Based Medical Education (CBME).  Competence in central venous catheterization (CVC) is a key objective to be learned by trainees. Tools to assess technical competency include checklists, critical error tools, Objective Structured Assessment for Technical Skills (OSATS) tools and the Ottawa Surgical Competency Operating evaluation (O-SCORE) tool. This study examined the impact of a simulation-based educational intervention on resident knowledge and performance of CVC. It also compared the dependability of the scores derived from the four assessment tools.  Junior residents completing their first ICU rotation in Calgary participated in the study. The control group received didactic instruction. The intervention group received simulation-based teaching and an online multimedia educational module. No observed differences between groups were identified in any of the assessment measures. Global rating scales such as the OSATS or O-SCORE tools outperformed checklists or critical error tools when assessing competence for this procedure.
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    Competence committees decision-making; an interplay of data, group orientation, and intangible impressions
    (2023-10-10) Curtis, Colleen; Kassam, Aliya; Lord, Jason; Cooke, Lara J.
    Abstract Background The implementation of competency-based medical education and utilization of competence committees (CC) represents a paradigm shift in residency education. This qualitative study aimed to explore the methods used by two operational CC and their members to make decisions about progression and competence of their residents. Methods An instrumental case study methodology was used to study the CC of two postgraduate training programs. Transcripts from observed CC meetings, member interviews, and guiding documents were analyzed using a constructivist grounded theory approach to reveal themes explaining the decision-making process. Results Our study found that the CC followed a process that began within a social decision schema model and evolved to a discussion that invoked social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. We identified that the CC decision-making was at risk of bias, primarily influenced by the group composition, the group orientation and individual members’ mindset, as well as their personal experiences with the trainees. Conclusions Increased awareness of the sources of bias in CC functioning and familiarity with the CC role in competency-based medical education would enable committees to provide valuable feedback to all trainees regardless of their trajectory.
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    Exploring the longitudinal experiences of physicians transitioning to unsupervised practice: A realist study
    (2022-01-17) Zaver, Fareen; Ellaway, Rachel; Lord, Jason; Cooke, Lara; Sherbino, Jonathan
    Problem: The transition from residency to unsupervised practice is a longitudinal process that is fraught with challenges. Most new attendings do not feel adequately prepared or supported for their new roles and responsibilities. We need to better understand the challenges physicians face transitioning to unsupervised practice.Method of Study: The study aim was to explore the different mechanisms that shape a physician’s ability to successfully transition to unsupervised practice. As the transition to unsupervised practice is complex and highly context-dependent, a qualitative realist evaluation study design was used to explore how different factors (mechanisms) can lead to different outcomes for different individuals transitioning to practice. Participants in a variety of specialties were recruited for semi-structured interviews at three points in time - one in the final months of residency, and two at different points in their first year in unsupervised practice. Conclusion: Eight middle-range theories were developed from the data covering: the varying opportunities and challenges participants faced whether or not they stayed at the institutions they trained at, the challenges of learner supervision, the effects of fellowship training, how variable their practice was compared to what they were exposed to in residency training, the timing of orientation or training sessions, being hired into a locum contract, and how sheltered trainees were from the realities of unsupervised practice. Each of these theories have implications for key stakeholders. Residency programs should expose their trainees to the breadth of practice available in each specialty and provide resident autonomy that reflects realistic experiences of unsupervised practice. Departments should have formalized mentorship programs, shadow shifts, and site and department specific orientations. In addition, they should strive to protect new staff from unnecessary stressors through a graduated increase in responsibilities. Both residency programs and departments should provide sessions regarding the new supervisory role, specifically teaching how to manage senior learners and learners in difficulty.
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    How do competence committees make decisions about resident progression? A qualitative study
    (2021-10-15) Curtis, Colleen Mary; Cooke, Lara; Kassam, Aliya; Lord, Jason
    Competence committees (CC) determine trainees’ progression through postgraduate competency-based medical education (CBME) programs. Models of how CC function identify that most programs take a problem-identification approach while others provide developmental feedback to every trainee. While CC are tasked with high stakes decisions, the process by which they discuss and make decisions about resident progression remains uncertain, with few publications addressing this question. The purpose of this qualitative study was to describe the factors affecting CC decision-making. This instrumental case study examined two CC at a Canadian institution, three years post-CBME launch. Over a six-month period, one researcher observed four CC meetings and conducted interviews with 10 CC members which were audio recorded and transcribed verbatim. Royal College documents, CC terms of reference, investigator reflections, and memos created throughout the study were also examined. Following a constructivist grounded theory approach with constant comparison, two investigators coded transcripts independently and jointly to refine a codebook and identify themes in the data. Our theory-informed analysis led to a theoretical framework of CC decision-making: a process beginning within a social decision schema model and evolving to a discussion invoking social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. The committee mindset determined the likelihood of entering a discussion about trainees; triggers for discussion related to CC members’ uncertainty of the process or concerns with the adequacy of the data. Ensuing conversations considered the context of the individual resident and CC members’ experiences. We found that ongoing challenges with CC functioning persist three years post-CBME implementation. Despite Royal College recommendations and local terms of reference, CC provide limited developmental feedback to trainees who are doing well, and acknowledge that biases could affect the intended process. While this study only examined two CC, it identified important themes to address when considering a robust CC process.
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    Mapping the Transition to Competence By Design in Public Health and Preventive Medicine in Canada
    (2022-10-03) Mejia, Fernando; Ellaway, Rachel; Cabaj, Jason; Lord, Jason; Millar, Kelly
    Public Health and Preventive Medicine (PHPM) is a 5-year Royal College of Physicians and Surgeons of Canada (RCPSC) postgraduate medical training program which aims to prepare specialists who work to safeguard and improve the health of populations. In Canada, PHPM offers a broad scope of practice that includes different fields such as clinical, academic, administrative, and/or a mix of any of those. Most commonly, PHPM training prepares graduates to practice as a Medical Officer of Health (MOH) or equivalent. This role serves to protect and promote the wellbeing of populations based on principles of biostatistics and epidemiology, environmental health, social and behavioral sciences, health program planning and policy, management, health economics, and relevant biological and social sciences. PHPM training varies across provinces depending on public health systems and structures. Consequently, implementation of Competence By Design (CBD) in this specialty is inherently challenging. CBD is the outcome-based medical education model mandated by the RCPSC to be adopted in all postgraduate medical training programs in Canada. This constructivist grounded theory (CGT) based study involved 35 iteratively conducted, semi-structured interviews which were analyzed through paired and parallel coding to explore and describe PHPM stakeholders’ perspectives about the landscape in PHPM training and practice in Canada as well as the anticipated changes required for a successful transition to CBD. Challenges of CBD implementation identified in this study included the non-standardized training path across Canada, the scarcity of financial and human resources to support this transition, and the lack of integration of the three different training components in this specialty (clinical, academic, and public health).