Academic literature on the topic 'Résidents (Médecine) – Attitudes'

Plusieurs études suggèrent que les professionnels de la santé entretiennent des attitudes négatives à l’égard des personnes présentant un trouble de personnalité limite (TPL). Cette recherche vise à évaluer les attitudes des omnipraticiens et des résidents en médecine familiale à l’endroit des personnes présentant ce trouble. Quarante résidents en médecine familiale et trente-cinq omnipraticiens ont été comparés à trente-neuf professionnels de la santé mentale à l’aide de l’Échelle d’attitudes à l’égard des personnes présentant un TPL (ÉA-TPL ; Bouchard, 2001). Les résultats démontrent que les omnipraticiens et les résidents en médecine familiale endosseraient des attitudes similaires à celles des professionnels de la santé mentale envers les personnes présentant ce trouble et que moins les cliniciens sont expérimentés, moins ils auraient tendance à présenter des attitudes positives à l’égard des personnes ayant un TPL.

Introduction: Evidence-based medicine (EBM) is the conscientious,explicit, and judicious use of the current best evidence in decision-making for the care of patients. Teaching best evidence practicein residency should include both formal or freestanding content,as well as integration into clinical scenarios and patient care.We sought to assess the attitudes, experience and knowledge ofEBM in urology residency training across Canada.Methods: An anonymous, cross-sectional, self-report questionnairewas completed by a convenience sample of 29 residents,including all chief urology residents in English-speaking programsacross Canada. The survey included both open-ended and closedendedquestions designed to assess familiarity and attitudes towardsEBM and potential barriers to developing EBM skills in a surgicaltraining program. Questions were formatted to determine the understandingof statistical and analytical concepts, as well as familiarityof available EBM resources. Descriptive and correlative statisticswere used to analyze the responses.Results: The response rate was 100%. An overwhelming majorityof residents felt that EBM is an important component of the urologyresidency and journal club was the most common vehiclefor discussing best evidence concepts. However, there was significantvariation in the presence of freestanding, formal curriculaacross programs, with only 28% of residents signifying thatthey received any formal training in their program. The apparentlevel of understanding of important EBM terminology and resourcesappears to be limited. The most frequently stated barriers to incorporatingEBM curricula into urology training were time constraintsand a perceived lack of expert educators.Conclusion: This self-report survey of urology chief residents identifiedthe overwhelming acceptance of the importance of EBM intheir training. Although best evidence practices appears to beaddressed in journal clubs and in real-life clinical experiences,the obvious lack of familiarity and understanding of EBM contentand resources would suggest a need for redoubling efforts to ensureappropriate exposure and instruction in our training programs.Introduction : La médecine factuelle vise l’utilisation consciencieuse,explicite et judicieuse des meilleures données actuellesdans le processus décisionnel concernant les soins aux patients.L’enseignement de cette approche factuelle aux étudiants en résidencedoit inclure du contenu officiel et indépendant, ainsi quedes exercices d’intégration dans des scénarios cliniques et despratiques de soins. Nous avons tenté d’évaluer les attitudes, l’expérienceet les connaissances vis-à-vis la médecine factuelle dansles programmes de résidence en urologie au Canada.Méthodologie : Un questionnaire anonyme d’auto-évaluation glo -bale a été rempli par un échantillon de commodité comprenant29 résidents, y compris tous les chefs-résidents des programmesd’urologie des universités anglophones du Canada. Le sondagecomprenait des questions ouvertes et fermées visant à évaluer leniveau de familiarité et les attitudes vis-à-vis la médecine factuelleet les obstacles pouvant nuire au développement de compétencesen médecine factuelle dans un programme de formation en chirurgie.Les questions étaient formulées de manière à permettre de déterminerle niveau de compréhension des concepts statistiques etanalytiques, ainsi que le niveau de familiarité avec les ressourcesexistantes de la médecine factuelle. Les réponses ont été analyséesà l’aide de méthodes statistiques descriptives et corrélatives.Résultats : Le taux de réponse obtenu était de 100 %. Une majoritéécrasante de résidents croyait que la médecine factuelle était unecomposante cruciale de leur formation en urologie et que l’examenen groupe d’articles publiés (Journal Club) représentait le moyenle plus fréquent de discuter des concepts de la médecine factuelle.Néanmoins, on a noté une variation significative dans la présencede contenu indépendant et officiel dans les différents programmes;en effet, seulement 28 % des résidents ont indiqué recevoir uneformation officielle dans le cadre de leurs études. Le niveau appa -rent de compréhension des principaux termes et ressources liés àla médecine factuelle semble limité. Les obstacles les plus souventmentionnés à l’intégration d’un contenu sur la médecine factuelledans la formation en urologie étaient les contraintes de temps etun manque perçu d’éducateurs bien versés sur le sujet.Conclusion : Ce sondage mené auprès de chefs-résidents en urologiea permis de montrer que ces derniers valorisent grandementle rôle de la médecine factuelle dans leur formation. Même si lespratiques factuelles semblent être abordées dans les groupes d’exa -men d’articles et les expériences cliniques réelles, le manque évidentde familiarité et de compréhension des concepts et desressources liés à la médecine factuelle porte à croire qu’il fautredoubler les efforts afin de s’assurer que les résidents soientThe status of evidence-based medicine education in urology residencyKirk Roth MD; D. Robert Siemens MD, FRCSC suffisamment exposés à cette approche et reçoivent la formation requise pendant leur résidence.

Background: New scheduling models were needed to adjust to residents’ duty hour reforms while maintaining safe patient care. In interdisciplinary night-float rotations, four to six residents from most residency programs collaborated for after-hours cross-coverage of most adult hospitalised patients as part of a Faculty-led rotation. Residents worked sixteen 12-hour night shifts over a month. Methods: We measured residents’ perception of the patient safety climate during implementation of night-float rotations in five tertiary hospitals. We surveyed 267 residents who had completed the rotation in 2015-2016 with an online version of the Safety Attitudes Questionnaire. First year residents came from most residency programs, second- and third-year residents came from internal medicine.Results: One-hundred-and-thirty residents completed the questionnaire. Scores did not differ across hospitals and residents’ years of training for all six safety-related climate factors: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition.Conclusion: Simultaneous implementation in five hospitals of a Faculty-led interdisciplinary night-float rotation for most junior residents proved to be logistically feasible and showed similar and reassuring patient safety climate scores._____Contexte: De nouveaux horaires de garde en établissements hospitaliers étaient nécessaires pour s’adapter aux réformes des heures de travail des résidents tout en maintenant des soins sécuritaires pour les patients. Dans les stages cliniques de nuit interdisciplinaires, quatre à six résidents de la plupart des programmes de résidence ont collaboré pour assurer une couverture croisée, après les heures normales de travail, de la plupart des patients adultes hospitalisés. Les résidents ont travaillé seize nuits de 12 heures durant un mois.Méthodes: Nous avons mesuré la perception des résidents du climat de travail lié à la sécurité des patients lors de la mise en place de stages de nuit dans cinq hôpitaux universitaires. Nous avons interrogé 267 résidents ayant terminé le stage en 2015-2016 avec une version numérique du Safety Attitudes Questionnaire. Les résidents de première année provenaient de la plupart des programmes de résidence, les résidents de deuxième et troisième années provenaient du programme de médecine interne.Résultats: 130 résidents ont complété le questionnaire. Les scores ne différaient pas entre les hôpitaux et les années de formation des résidents pour les six facteurs liés à la sécurité des patients: climat de travail en équipe, satisfaction au travail, perceptions des supérieurs, climat de sécurité, conditions de travail et reconnaissance du stress.Conclusions: La mise en place simultanée, dans cinq hôpitaux, de stages cliniques de nuit réunissant des résidents juniors de la majorité des programmes de résidence fut logistiquement possible et a montré des résultats similaires et rassurants sur le climat de travail lié à la sécurité des patients.

OBJECTIVE To describe the type and frequency of drug-related problems discussed in regular team meetings conducted in 15 Swedish nursing homes and report physician and staff assessments of these interventions and residents' outcomes. DATA SOURCES AND METHODS The data were collected within the context of a controlled trial with the primary aim of exploring the effects of regular team interventions on drug prescribing practices in Swedish nursing homes. In 15 experimental nursing homes, the residents' drug therapy was discussed regularly by a team consisting of a pharmacist, a physician, nurses, undernurses (similar to licensed practical nurses), and nurse's aides. The pharmacist documented problems, made changes, and observed outcomes. Following the intervention period, a questionnaire was sent to the medical staff that contained items regarding perceived outcomes, the intervention's impact on knowledge of drug therapy in the elderly, and attitudes toward the pharmacist's role. RESULTS Unclear indication and problematic choice of drugs were the most common drug-related problems discussed. In 19% of the situations, therapy changes were reported to have had a beneficial effect on the residents' clinical status; in 47% of the situations, staff reported no observable outcome from changes, suggesting that the changes had been appropriate. Finally, medical staff claimed in the follow-up survey that their knowledge about drug therapy had increased; they expressed an overall positive attitude toward this interactive collaboration. CONCLUSIONS Regular interventions conducted by a multidisciplinary team incorporating a pharmacist can effectively improve prescribing practices, increase staff knowledge about appropriate drug therapy in the elderly, and result in improved quality of care for nursing home residents. OBJETIVO: Describir el tipo y frecuencia de problemas relacionados a medicamentos discutidos durante las reuniones de equipo conducidas en 15 casas de convalecencias en Suecia. Reportar las evaluaciones de los médicos y otro personal de estas intervenciones y el resultado en los residentes. FUENTES DE INFORMACIÓN Y MÉTODOS: La información se recopiló dentro del contexto de un estudio controlado con el propósito primario de explorar el efecto de las intervenciones durante reuniones de equipo en las prácticas de prescripción en las casas de convalecencia en Suecia. En 15 casas de convalecencia, regularmente se llevan a cabo discusiones de la terapia de los residentes con la participación de un equipo compuesto por un farmacéutico, un médico, enfermeras, y asistentes de enfermeras. El farmacéutico documenta los problemas, cambios realizados, y resultados observados. Luego del período de intervención, se envió un cuestionario al personal médico que contenía aseveraciones sobre los resultados percibidos, el impacto de la intervención en su conocimiento sobre la farmacoterapia en el paciente de edad avanzada, y sus actitudes hacia el papel del farmacéutico. RESULTADOS: Los problemas relacionados a medicamentos más comunmente identificados y discutidos fueron falta de indicación y selección de fármaco inadecuada. En el 19% de los casos, los cambios en terapia resultaron de beneficio en el estatus clínico del residente; en el 47% de los casos, el personal reportó que no observaron resultados de los cambios, sugiriendo que los cambios fueron apropiados. Finalmente, el personal médico alegó en el cuestionario que sus conocimientos sobre la farmacoterapia en el paciente de edad avanzada aumentó y expresaron tener una actitud positiva hacia esta colaboración interactiva. CONCLUSIONES: Las intervenciones rutinarias conducidas por un equipo multidisciplinario que incorpora un farmacéutico puede efectivamente mejorar las prácticas de prescripción, aumentar el conocimiento del personal médico sobre la farmacoterapia en el paciente de edad avanzada y puede así resultar en una mejoria en la calidad del cuidado que se ofrece en las casas de convalecencia. OBJECTIF: Décrire le genre de problèmes reliés aux médicaments discutés lors des réunions d'équipe régulièrement tenues dans 15 centres d'accueuil Suédois. Rapporter l'évaluation que les médecins et le personnel soignant ont fait des résultats obtenus et du processus d'intervention. REVUE DE LITTÉRATURE ET MÉTHODES: Les données ont été collectées dans le cadre d'une étude contrôlée ayant pour objectif principal d'explorer l'effet d'interventions régulières sur les pratiques de prescription dans des centres d'accueuil Suédois. Dans les 15 centres à l'étude, des discussions concernant la thérapie médicamenteuse des résidents ont été tenues régulièrement par une équipe formée d'un pharmacien, d'un médecin, d'infirmières, de sous-infirmières, et d'aide-infirmières. Le pharmacien documentait les problèmes, les changements effectués, et observait les résultats de l'intervention. Après l'intervention, un questionnaire était envoyé au personnel médical. Ce questionnaire portait sur les résultats perçus, l'impact de l'intervention sur leurs connaissances de la thérapie médicamenteuse chez la personne âgée, et leurs attitudes envers le rôle du pharmacien. RÉSULTATS: Les problèmes les plus fréquemment discutés étaient le choix du médicament et les médicaments ayant une indication incertaine. Dans 19% des cas, les changements thérapeutiques ont eu un effet bénéfique sur l'état clinique du résident. Dans 47% des cas, le personnel n'a rapporté aucun changement à l'état du résident, suggérant ainsi que le changement était approprié. Finalement, le personnel médical reconnaît, par l'entremise du questionnaire, que leurs connaissances sur la thérapie médicamenteuse des personnes âgées se sont accrues et ils ont exprimés une attitude positive envers cette collaboration interactive. CONCLUSIONS Des interventions régulières conduites par une équipe multidiciplinaire incorporant un pharmacien peuvent effectivement améliorer les pratiques de prescription et la connaissance du personnel quant aux médicaments appropriés pour les personnes âgées. Ces interventions permettent ainsi d'améliorer la qualité des soins en centre d'accueuil.

Morning report (MR) is a valued educational experience in internal medicine training programs. Many senior residents and faculty have not received formal training in how to effectively facilitate MR. Faculty at the University of Toronto were surveyed to provide insights into what they felt were key elements for the successful facilitation of MR. These insights fell within 5 major categories: planning and preparation, the case, running the show, wrapping up and closing the loop.Résumé Le rapport du matin (RM) est un outil pédagogique précieux dans les programmes de formation en médecine interne. Nombre de résidents séniors et de membres du corps enseignant n’ont toutefois jamais reçu de formation officielle sur la façon de faciliter l’élaboration du RM. Nous avons sondé les membres du corps enseignant de l’université de Toronto pour avoir un aperçu de ce qu’ils percevaient comme étant des éléments-clés susceptibles d’améliorer grandement l’élaboration du RM. Les réponses reçues se répartissent en cinq principales catégories: la planification et la préparation du RM, les caractéristiques du cas évalué, l’importance et la façon de prendre en main le processus, le résumé des informations et l’art de « boucler la boucle». Morning report (MR) has long been an integral and valued part of Internal Medicine training programs in North America.1,2 Some residents recognize MR as the most important educational activity during their training.3 Medical students, residents and faculty typically attend MR. Although the structure and function of MR can vary across institutions, it usually involves a case-based discussion facilitated by a faculty member, chief medical resident (CMR), or other senior resident. The facilitator discusses pertinent aspects of one or more clinical cases to teach medical knowledge, clinical reasoning and other important aspects of physician competencies, such as communication and collaboration skills. 4 Residents have expressed a preference for an interactive teaching session led by an individual with extensive medical knowledge and excellent clinical acumen.5Despite trainees’ perceptions about the core educational function of MR and their preference for skilled facilitators, most residents and many faculty have never received any formal training on how to conduct an effective MR. This, coupled with a lack of resources in the literature, may contribute to feelings of trepidation about assuming the role of facilitator.6 Based on this need, we were invited by the organizing group of residents at the 2015 Canadian CMR Conference, held in Toronto, Canada, to lead a seminar to introduce CMRs to the principles of effective MR facilitation. The conference was attended by over 70 current and future CMRs. In preparation for this seminar, we reviewed available literature and found that practical guidelines on how to facilitate a successful MR were generally lacking. To help us to provide guidance and to capture broad opinions and experiences, we recruited a sample of 24 faculty at the University of Toronto, including many award-winning teachers whose experience in leading MR ranges from 3 to over 30 years. We asked them to provide insights into what they felt were key elements of facilitating a successful MR. While not a systematic collection of data, their insights taken together represent a broad experience base. Given the relative lack of evidence-based literature describing how to facilitate MR, we decided to disseminate a refined summary of the shared wisdom we uncovered in hopes that it would benefit other CMRs and junior faculty as they take on this challenging role.The insights provided fall within 5 main themes (Table 1) which are discussed below, followed by a brief discussion about future directions for MR:1) Planning and preparation2) The case3) Running the show4) Wrapping up5) Closing the LoopTable 1. Experience-Based Tips to Running an Effective Morning ReportPLANNING AND PREPARATION:1) Ensure audiovisual aids are present and working before starting. 2) Start and end on time. 3) Encourage all faculty to attend and participate. 4) Know the audience (including names).THE CASE:5) The case can be undifferentiated or one for which the diagnosis and even response to treatment is known. 6) There are pros and cons to the facilitator knowing details of the case in advance. 7) If details of the case are not known to the facilitator, determine with the person presenting if the discussion should be focused on diagnosis, management or other pertinent issues. 8) Cases need not be limited to inpatients and can include ambulatory cases and case simulations.RUNNING THE SHOW:9) Establish a respectful learning climate. 10) Personal anecdotes and reflections on past cases can engage the audience. 11) Ensure time is spent discuss learning issues valuable to all present. 12) Facilitate and engage in discussion rather than deliver a lecture. 13) Use a mix of pattern recognition (heuristics) and analytical reasoning strategies. 14) Start with a question that has an obvious answer if dealing with a quiet audience. 15) Promote volunteerism for answers as much as possible, but direct a question to a specific person if no one volunteers. 16) Begin by engaging the most junior learners and advance to involve senior learners. 17) Encourage resource stewardship and evidence-based medicine. 18) Acknowledge areas of uncertainty and don’t be afraid to say “I don’t know”. 19) Teaching “scripts” or the use of a systematic approach to developing a differential diagnosis can be used when discussing less familiar topics. 20) Highlight the variability in clinical approach amongst "the experts" in the room.WRAPPING-UP:21) Ensure there is time to summarize “take home points”. 22) Provide learners with the opportunity to summarize what they have learned.CLOSING THE LOOP23) Reinforcement of learning can include a distribution of a relevant paper or providing a summary of learning points via email or blog. 24) Maintain a case log to ensure a balanced curriculum. 25) Provide feedback to the case presenter and facilitator.Planning and Preparation It is important for the organizer and facilitator (these may or may not be the same person) to be diligent when preparing for MR. The person in charge of organizing MR should ensure that all necessary audiovisual equipment is in working order, which may be as simple as ensuring there is a whiteboard and working marker. To optimize housestaff attendance, the sessions and facilitators should be scheduled in a regular and predictable way. The lure of a light breakfast should not be underestimated and may add to the social aspect of this event. Sessions should begin and finish on time (or even slightly early). Ideally, deferring pages for all but critical clinical issues should occur. Having faculty regularly attend MR as audience participants, and not just as facilitators, improves the attendance of learners who see through role-modelling the importance of continuing medical education and lifelong learning. Faculty presence also raises the level of discussion around grey areas of diagnosis and management, providing trainees with a spectrum of opinions and approaches to clinical medicine, specifically role-modelling how faculty approach clinical uncertainty. The organizer must also ensure that someone, usually a trainee, is responsible for bringing the details of one or more clinical cases to be discussed.The facilitator should ensure they know the names and year of training of the housestaff in attendance. It is helpful if the organizer can provide a list (ideally with pictures) of those who will be in attendance for the facilitator to reference. Over time, this helps to develop a sense of community within the group. It also allows the facilitator to engage all participants and with the goals of first posing level-specific questions to the more junior learners and ending with the most senior learners.The Case The selected clinical case can be either a new patient seen in consultation in the past 24 hours or a patient that has been in hospital for some time and for whom results of investigations and response to treatment are known. Ideally, the majority of the cases selected should not involve particularly rare medical issues and should mirror the clinical case mix of patients being cared for by the trainees. Trainees will benefit more from discussions about common clinical problems rather. However, to highlight issues of diagnostic reasoning, it can be beneficial to occasionally discussing uncommon case including typical presentations of rare diseases or unusual presentations of common problems.The faculty surveyed expressed differing opinions when asked if they thought the details of the case should be known to the facilitator in advance. Knowing the details of the case in advance can ensure the facilitator is comfortable with the content area and allows them to focus on aspects of the case that they think will have the highest learning impact for trainees. However, when the case is not known to the facilitator, the audience will be more likely to garner insight into the clinical reasoning process of the facilitator. The opportunity to learn about the cognitive process that an “expert” uses when generating a differential diagnosis and formulating plans for investigation and management is potentially much more valuable than the discussion of content that could be read in a textbook or electronically. When the details of a case are not known, the discussion is more spontaneous and the lines of discussion are more reflective of the thoughts of the trainees, rather than the facilitator. The discussion can be guided by the case itself and the trainees’ questions and answers. A mixed approach to case discussion will provide the variety that the participants value.Although traditionally MR has focused on the diagnosis or management of one or more clinical cases from the inpatient service, its format is flexible enough to provide opportunity for discussion or for other important aspects of patient care. MR can also address ambulatory cases,7 include the presence of a real patient for the purposes of highlighting history-taking and clinical findings and also incorporate discussion of simulated cases, such as code blue scenarios. The discussion can also be enriched by the health professionals from other disciplines including, pharmacists, physical therapists, occupational therapists, nurses, and social workers. The case can also be selected to allow the discussion to be focused on other specific elements of management, such as resource utilization and “choosing wisely,”8 quality and safety, bioethics, and evidence-based medicine.9Running the Show In developing their skills in facilitation, many of the faculty surveyed discussed that they continuously build on the facilitation skills that they have learned over time, the basic principles of which are described elsewhere.10,11 Through feedback and reflection, they adapt to a style that reflects how they believe the MR should be conducted.The facilitator must establish a respectful climate at MR that is conducive to learning. He or she must ensure that the session is collegial and enforce that the goal of the session is learning, rather than showmanship. The environment should encourage interaction and permit people to ask questions. Trainees should feel comfortable enough to answer questions and test hypotheses, even if answers are incorrect. However, the facilitator must ensure that the correct information is conveyed to the group and that incorrect answers are explored as key teaching points. Humour can put people at ease. Self-deprecating humour can be non-threatening and freely employed if it is within the facilitator’s comfort zone. However, humour should never come at the expense of a trainee. Personal anecdotes and reflections on past cases can engage the audience, relax the atmosphere and vividly impart key facts and clinical wisdom.It is important for the facilitator to be respectful of time. Trainees often report that too much time is spent on reviewing the history and physical examination and on the development of an exhaustive differential diagnosis while less time is spent on investigation and management issues, which senior trainees find most valuable. There need not be a fixed formula related to how much time to spend on specific components of the case. A skilled facilitator will expand and abbreviate aspects of the case discussion based on the specific case presented. Some cases represent excellent opportunities to review evidence-based physical examination, some may highlight issues of resource stewardship related to investigation and some are particularly well-suited to discussion of evidence-based management.The facilitator should facilitate a clinical discussion, rather than deliver a didactic talk. He or she should coach the audience to identify key historical facts or findings on physical examination to allow everyone to fully participate in the case formulation and clinical reasoning that will follow. Demonstrating a mix of pattern recognition and heuristics (e.g., “Quick – what do you think the diagnosis is?”) and analytical reasoning strategies will help trainees learn to employ and recognize the strengths and limitations of each.In the face of a quiet audience, questions that have obvious answers should be posed first. The facilitator should promote volunteerism as much as possible; however, addressing specific members of the audience prevents silence and can help ensure everyone is engaged in the discussion. Sensitivity to the level of trainee is important. A facilitator should avoid potential embarrassment of a trainee by allowing a more junior learner to come up with the answer to a question that the more senior trainee could not answer. In other words, there should be an inviolate sequence wherein, for any given topic, the facilitator starts with trainees at an appropriate level for the questions and moves upward sequentially by level of training. This allows participants to relax and set their focus on learning, rather than avoiding eye contact and fearing embarrassment.A skilled facilitator should not allow any one person to dominate the discussion and should also refrain from asking multiple questions to the same participant. However, it can be valuable to challenge a respondent or the group to elaborate on their answers, as this can uncover gaps in knowledge and understanding and provide additional opportunities for learning.It is important to ensure that the discussion is of interest to trainees at all levels. If faculty are present, their opinions should be sought throughout the case. It is helpful to highlight the variability in approach amongst “the experts” in the room. Judicious use and justification of investigations should be encouraged to promote learning about resource stewardship and evidence-based medicine principles should be incorporated, when relevant.Many facilitators are anxious about how to handle situations where they don’t know the answer to a particular clinical problem. In these cases, a demonstration of the clinical reasoning process and a focus on an approach to clinical problems can be helpful. Some of the most useful discussions centre on how to deal with uncertainty and on how to find answers to clinical questions in real-time using available resources. The facilitator should not hesitate to say “I don’t know,” as this demonstrates that nobody has infinite knowledge and role-models the necessity of recognizing one’s limitations. Teaching scripts relating to specific topics or the use of an etiologic or body systems-based approach to developing a differential diagnosis are helpful teaching approaches6.Wrapping Up Sufficient time should be dedicated to recapitulation and repetition of one to 3 key take home messages. This serves to reinforce the important points that were discussed and to ensure that participants walk away with key messages to facilitate learning. Having a few members of the audience identify what they have learned is often beneficial as the facilitator may not identify the same issues as the trainees.Closing the Loop Further reinforcement can occur if a summary of the take home points, or a relevant paper, is circulated by email or posted to a blog.12 This must be done in a manner that protects patient confidentiality. Updates on previously presented diagnostic dilemmas will enhance learning. Finally, the organizer of MR can keep a log of cases that have been presented to avoid excessive repetition of topics and ensure a balanced curriculum.A process for the person presenting the case to be provided with feedback about their presentation skills by the facilitator or peers should be implemented. It is also important for the facilitator to receive feedback about their teaching and the session overall. Feedback will help faculty refine their facilitation skills, especially if coupled with faculty development initiatives to improve teaching skills.13 It may also be important for novice clinician teachers who need to build a teaching portfolio as part of their academic review and promotion process. 14 If it is clear the faculty utilize the feedback, it serves to role-model self-reflection and promote a culture of frequent formative feedback.The Future of MR MR has a long tradition and can be an evolving teaching format capable of meeting current educational needs. For example, with the implementation of competency-based medical education (CBME) into residency training programs, the competencies being developed for Internal Medicine trainees can provide a framework to organize aspects of learning experiences, including MR. 15 Issues of advocacy and stewardship may be highlighted as explicit learning points of cases, as MR allows for discussion of authentic core clinical tasks and problems, avoiding the reduction of competencies to endless lists taught without the necessary context needed for deeper learning.16 There are also challenges to implementing and sustaining a successful MR in today's current training climate. Issues such as duty-hour restrictions, increased volume and acuity of patients, and pressure to discharge patients early in the day17–19 have prompted some to modify the traditional MR. An “afternoon report” allows for attention to clinical duties early in the day and preserves teaching for later in the day. MR should continue to evolve to meet current education and healthcare delivery needs, and these innovations should be described in the literature and studied.Although these tips have been generated from shared experiences at a single centre, we believe they will be useful to facilitators in many other settings, as they represent the experiences of many facilitators with many cumulative years of experience. This article is intended to stimulate others to reflect upon and discuss what they have found to be the key elements to facilitating a successful MR.Acknowledgements We would like to thank our colleagues who contributed tips and whose teaching has influenced the careers of countless trainees: Dr. Ahmed Bayoumi, Dr. Isaac Bogoch, Dr. Mark Cheung, Dr. Allan Detsky, Dr. Irfan Dhalla, Dr. Vera Dounaevskaia, Dr. Trevor Jamieson, Dr. Lauren Lapointe Shaw, Dr. Jerome A. 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Résumé Problématique. La spirométrie permet d’objectiver l'obstruction des voies aériennes, mais reste sous-utilisée en soins primaires. Objectifs. Nous avons évalué, chez des médecins de famille enseignants et des résidents en médecine familiale, leur intention de prescrire la spirométrie chez des patients chez qui ils suspectent une maladie pulmonaire obstructive chronique (MPOC) et celle d’en interpréter le résultat. Cette évaluation est fondée sur le cadre théorique proposé par Godin et al. pour l'étude des facteurs influençant le comportement des professionnels de la santé. Méthodes. Les participants à cette étude descriptive transversale ont été recrutés dans huit Unités de médecine familiale (UMFs) du réseau de l’Université Laval. Ils ont rempli un questionnaire autoadministré de 23 items mesurant leur intention de prescrire et d’interpréter les tests de spirométrie ainsi que certains déterminants de cette intention (croyances en ses capacités, croyances concernant les conséquences, influence sociale et norme morale). Les réponses à chacun des items du questionnaire ont été notées sur une échelle de Likert (score de 1 à 7) où un score plus élevé indiquait un plus grand accord avec l’énoncé. Résultats. Parmi les 284 médecins éligibles, 104 ont été inclus. Le score moyen ± écart type de l'intention des médecins de prescrire la spirométrie (6,6 ± 0,7) était plus élevé que celui d’en interpréter les résultats (5,8 ± 1,5). Les scores moyens de tous les déterminants de l’intention mesurés étaient également plus élevés pour la prescription que pour l’interprétation de la spirométrie. Conclusion. Les résultats suggèrent que les participants ont une très forte intention de prescrire la spirométrie. Même si l’intention d’en interpréter les résultats est positive, elle est plus faible que celle de prescrire le test. Des études supplémentaires seront nécessaires pour évaluer les barrières à l’interprétation des résultats de la spirométrie.
Background: Spirometry is the best test to demonstrate airway obstruction, but remains underused in primary care. Objectives: We assessed, among family medicine physician teachers and residents, their intention to prescribe spirometry in patients suspected of chronic obstructive pulmonary disease (COPD) and their intention to interpret spirometry results. This evaluation is based on the theoretical framework proposed by Godin et al. for the study of factors influencing healthcare professionals’ behaviors. Methods. Participants of this descriptive cross-sectional study were recruited in eight Family medicine units (FMUs) of Laval University’s net. They completed a 23-item self-administered questionnaire measuring their intention to prescribe and to interpret spirometry as well as some determinants of this intention (beliefs about capabilities, beliefs about consequences, social influence and moral norm). Answers to each of the items in the questionnaire were scored on a Likert scale (score 1 to 7) where a higher score indicated a greater agreement with the statement. Results. Of the 284 eligible physicians, 104 were included. The mean score ± standard deviation of physicians' intention to prescribe spirometry (6.6 ± 0.7) was higher than to interpret the results (5.8 ± 1.5). Mean scores for all determinants of intention measured were also higher for prescription than for interpretation of spirometry. Conclusion. The results suggest that participants have a very strong intention to prescribe spirometry. Although the intention to interpret the results is positive, it is weaker than for the prescription of the test. Further studies will be needed to assess the barriers of spirometry interpretation.

Cette thèse présente, dans le premier article, les résultats de la validation préliminaire d’un outil permettant de décrire et mesurer les attitudes des professionnels de la santé qui interviennent auprès de personnes présentant un trouble de personnalité limite (TPL). Cet outil a été développé au Québec. Il s’agit de l’Échelle d’attitudes à l’égard des personnes présentant un TPL (ÉA-TPL; Bouchard, 2001). Le deuxième article s’est intéressé aux attitudes des médecins de famille et des résidents en médecine familiale. Les attitudes des médecins ont été mesurées à l’aide de l’ÉA-TPL (Bouchard, 2001) et comparées à celles présentées par d’autres professionnels de la santé mentale. En guise d’introduction à ces articles, la problématique des personnes présentant un TPL est d’abord décrite. Ensuite, les résultats de recherche portant sur les attitudes généralement entretenues par les intervenants qui travaillent auprès de cette clientèle et l’impact de ces attitudes sur la qualité des soins prodigués aux personnes ayant un TPL sont présentés. Également, les difficultés rencontrées par les médecins de famille dans la prise en charge de cette clientèle sont soulignées. Les deux articles sont ensuite présentés. Les résultats de la première étude démontrent que l’ÉA-TPL constitue un outil valide et intéressant pour mesurer les attitudes des professionnels de la santé envers les personnes présentant un TPL. Les résultats de la seconde étude indiquent que les médecins de famille présentent en moyenne le même niveau d’endossement d’attitudes à l’endroit des personnes présentant un TPL que les autres professionnels de la santé mentale. La discussion permettra d’élaborer sur l’impact des attitudes négatives envers les personnes présentant un TPL sur le développement de l’alliance thérapeutique, la contribution positive d’une bonne alliance thérapeutique sur les résultats des soins, et l’accent mis sur l’enseignement des habiletés communicationnelles chez les médecins afin de créer une meilleure relation avec leurs patients. L’importance d’offrir une formation plus étoffée et spécifique portant sur les troubles de la personnalité est ensuite soulignée, ceci afin de permettre d’améliorer la compréhension de ce trouble, influencer positivement les attitudes des intervenants, permettre le développement d’une meilleure alliance de travail avec cette clientèle et, ultimement, d’améliorer la qualité des soins qui leur sont prodigués. En conclusion, l’auteure insiste sur l’importance de mieux outiller les médecins de famille qui constituent le plus souvent la principale porte d’entrée vers les services de santé pour cette clientèle qui consulte fréquemment pour de multiples problèmes de santé physique.