Recommendations For Medical Education Research Articles

Relationship between honesty-credit, specialty identity, career identity, and willingness to fulfill the contract among rural-oriented tuition-waived medical students of China: a cross-sectional study.

The fulfillment of contractual obligations by rural-oriented tuition-waived medical students (RTMSs) to work in rural medical institutions after graduation directly impacts the improvement of rural health quality. This study aimed to not only quantitatively measure the direct impact of honesty-credit, specialty identity, and career identity on willingness to fulfill the contract of RTMSs but also to quantify the intermediary role of specialty identity and career identity between honesty-credit and willingness to fulfill the contract. The research results provided recommendations for the rural-oriented tuition-waived medical education (RTME) program to achieve its goal of training rural primary healthcare personnel. From March to May 2022, 1162 RTMSs were selected as the research objects. The honesty-credit, specialty identity, career identity, and willingness to fulfill the contract were quantitated using a self-completed questionnaire. Pearson's correlation analysis and structural equation modeling were used for statistical analysis and mediating effect evaluation. A total of 455 (42.3%) RTMSs had high willingness to fulfill the contract, and honesty-credit had a significant direct positive effect on willingness (β = 0.198, P < 0.001), specialty identity (β = 0.653, P < 0.001), and career identity (β = 0.180, P < 0.001). In the intermediary path between honesty-credit and willingness, career identity [95% confidence interval (CI): 0.007-0.051] had significant mediating effects. Career identity (95% CI: 0.030-0.149) also had significant mediating effects between specialty identity and willingness, and specialty identity (95% CI: 0.465-0.760) had significant mediating effects between honesty-credit and career identity. These results strongly confirmed that honesty-credit, specialty identity, and career identity are early and powerful predictors of the willingness to fulfill the contract of RTMSs. The honesty-credit of RTMSs can predict their willingness to fulfill the contract early, significantly and positively. For the students who fail to pass the credit assessment for many times and have a strong tendency to default, their training qualifications should be canceled in time, so that students who are truly willing to serve rural areas can enter the project, and finally achieve the policy goal of "strengthening the rural primary medical and health system".

Patient-centred learning in practice. A mixed methods study of supervision and learning in student clinics

ObjectivePatient-centred learning (PCL) allows medical students to practice a patient-centred approach; however, didactic characteristics of PCL have yet to be fully elucidated. Clinical placements structured as a student clinic (SC) enable authentic student-patient learning relations through enhanced student responsibility and can serve as examples of PCL. We explored the didactic characteristics of supervision and learning in SCs to provide recommendations for PCL-oriented medical education. MethodsTriangulation mixed methods study based on qualitative data collected from in-depth interviews with clinical teachers and quantitative data collected from student evaluations of supervision and learning in the SCs. ResultsSupervision and learning in SCs were characterized by 1) a focus on student-patient compatibility and patient needs and resources, which indicated PCL, 2) person-centred explorative supervision to adjust challenges to students’ needs and resources, and 3) support of student autonomy to take responsibility for patient treatment. ConclusionPCL was facilitated by clinical teachers through a dual person-centred didactic approach combined with autonomy-supportive didactic practice. This enabled the integration of patients’ and students’ needs and resources in clinical teaching. Practice implicationsClinical teachers can stimulate student-patient learning relations by selecting patients, exploring students’ needs and resources, and supporting student autonomy through reflective practice and backup.

Tackling climate change and health inequalities in primary care.

The Climate Emergency is now widely accepted as the biggest public health crisis facing humanity. Previous research has highlighted how social and health inequalities shape the health impacts of climate change in the UK, but there has been little attention to the role of general practice in deprived areas. This Brief Report summarises a roundtable discussion of Scottish 'Deep End' GPs - family doctors working in the most socio-economically deprived areas - which took place weeks before the 26th UN Climate Change Conference (COP26), held in Glasgow in November 2021. The report highlights the need for urgent action to make general practice more sustainable, including recommendations for community engagement, (de)prescribing, medical education, digital inclusion, and investment in premises and capacity building.

Academic program recommendations for graduate degrees in medical physics: AAPM Report No. 365 (Revision of Report No. 197).

Academic program recommendations for graduate degrees in medical physics: AAPM Report No. 365 (Revision of Report No. 197).

Medical Students' Perspectives on LGBTQI+ Healthcare and Education in Germany: Results of a Nationwide Online Survey.

The healthcare needs of lesbian, gay, bisexual, trans*, queer, and intersex (LGBTQI+) persons are often overlooked, prompting national and international calls to include diversity-related competencies into medical students’ training. However, LGBTQI+-focused healthcare education targets remain elusive, as surveys reveal considerable variability across national student populations. To generate empirical data and vocalize recommendations for medical education, we conducted the first nationwide online survey among 670 German medical students from 33 universities. Overall, most respondents reported low confidence regarding their medical training preparing them for LGBTQI+ patients, stated that LGBTQI+ themes were not covered during training, and agreed that the inclusion of such themes is urgently needed. In addition, we found gender and LGBTQI+ community member status to be key variables. Men scored lower in knowledge than women, while community members scored higher than non-community members. Similarly, community members reported higher comfort levels. Non-community men showed the highest levels of prejudice and efficacy beliefs, while at the same time had the lowest scores in contacts and the perceived importance of LGBTQI+-related teaching. Keeping subgroup differences in mind, we recommend that educational training should include LGBTQI+ healthcare aspects and address self-efficacy beliefs in future medical professionals to overcome LGBTQI+ healthcare disparities.

ID:16419 Neuromodulation Education During Fellowship: Potential Barriers to Independent Practice and Cases Needed for Proficiency

Despite the growing body of evidence that neuromodulation is a promising cost-effective option in the management of chronic pain, few pain medicine providers practice neuromodulation after fellowship. The Accreditation Council for Graduate Medical Education (ACGME) recommends that pain fellows complete five neuromodulation cases, although this is not a requirement.1 Exposure to neuromodulation varies greatly among pain medicine fellowship programs. It is unclear how many cases need to be completed during fellowship for a trainee to feel comfortable practicing independently.

Language is brain: Improving neurologic health equity for linguistically diverse populations

Neurologic clinical care requires that clinicians gather and synthesize complex information, including a thorough, precise history and a detailed physical examination that maximizes the patient’s cooperation. Yet, for patients who do not speak the dominant language in the country or region where they live, effective communication with their clinician may not always occur. In this article, we discuss the impact of language on neurologic care, focusing on access to care and on the diagnosis and treatment of two common and potentially life-threatening conditions: stroke and epilepsy. We then review implications for clinical neurologic care as well as medical education and present evidence-based recommendations for improving neurologic health equity for linguistically diverse populations. Strategies should integrate professional medical interpreters (for oral communication) and translators (for written materials) into the neurologic team, account for families and caregivers in a culturally humble manner, and teach learners to apply clinical neurologic skills in both language-concordant and discordant situations.

Exploring the Great Divide: Comparing Professional Development Satisfaction and Opportunities of Program Coordinators at Academic Medical Centers and Community-Based Programs.

Program coordinators (PCs) need to maintain flexibility and evolve professionally with rapid changes in accreditation, specialty requirements, and policies. The Accreditation Council for Graduate Medical Education recommends professional development for PCs. This mixed-methods study explored professional development opportunities and current practices of PCs at community and academic programs. A survey was administered to the Chicago Area Medical Education Group members to elicit attitudes and opinions regarding professional development availability. A total of 109 participants (eligible = 178) completed surveys. 97.2% (n = 105, N = 108) of respondents indicated that development is necessary for being a great coordinator. PCs at community-based programs report lower attendance at national conferences and less satisfaction with professional development opportunities than their academic-based institution counterparts. 28.5% of the community-based coordinators are dissatisfied with opportunities compared with 7% of the academic-based coordinators. 37.7% of the community coordinators (compared with 2.9% academic) report a lack of development activities by their program or graduate medical education. Only half of the PCs report discussing professional development with their program director. However, institutional supports were regarded as facilitators to satisfaction. Despite recommendations for regular professional development, this study finds only half of the PCs regularly discuss professional development and finds disparities in opportunities between those in community versus academic settings.

Residency Program Director Perceptions of Resident Performance Between Graduates of Medical Schools With Pass/Fail Versus Tiered Grading System for Clinical Clerkships: A Meta-Analysis.

Purpose: The variability and imprecision of clerkship grading raise concerns for program directors (PDs) during applicant selection. 1 Although the majority of medical schools have adopted pass/fail (P/F) preclinical grading, only 12 schools formally use P/F grading for clerkships. 2 Additionally, per Liaison Committee on Medical Education recommendations, events such as Hurricane Katrina and the COVID-19 pandemic have led additional schools to adopt P/F clerkship grading temporarily. 3 Moreover, the rise in studies describing student- and institutional-level disparities in clerkship grading has tasked medical education personnel with weighing the fairness and risk of disparities as well as the potential benefits of tiered grading. 1,4 With the continued paucity of literature examining P/F grading in core clerkships, 5 we conducted a meta-analysis of studies comparing PDs’ perceptions of residency performance among residents from schools using P/F versus tiered clerkship grading systems. Approach/Methods: Embase, PubMed, and Scopus were searched since inception through October 2020, and hand searches were performed of the retrieved reference lists. No study or language restrictions were applied. Studies exploring P/F clerkship in the context of a cohort of PD assessments were included, and the CLARITY risk of bias was used. Reviewers assessed study characteristics, overall resident performance, learning ability, work habits, work products, educational assessments, and PD’s personal evaluation (worse: 0 to best: 100), and were assessed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. To account for different survey and grading metrics, adjusted standard difference in means were used. Main outcomes and measures were program director ratings of residents from U.S. medical schools using tiered versus P/F clerkship grading. Results/Outcomes: From 4,931 studies screened, we identified 6 eligible studies (3 cohort, 3 surveys; 6 low risk of bias) with 2,118 participants. From 31 accredited medical specialties, 7 specialties were represented with a median response rate of 81.0% (95% CI, 49.0–100.0). Reported as means, there was no difference in PD preference for residents from P/F or tiered grading system throughout residency training (37.0% Tiered; 95% CI, 0–100, P > .05). Adjusted scaled scores utilizing mean difference from an equal variance model from PDs showed overall performance (5.5; 95% CI, –1.9 to 12.9), learning ability (2.7; 95% CI, 0–5.4), work habits (2.9; 95% CI, 0–5.8), personal evaluations (–1.6; 95% CI, –3.8 to 0.6) and educational evaluation (1.7; 95% CI, –0.8 to 4.3) of residents from tiered clerkship grading systems were not statistically significant (P > .05) from P/F residents. However, there was a difference in work products produced (6.8; 95% CI, 1.4–12.2, P < .0001). Meta-regression standard difference in means revealed that there is no difference in tiered applicant’s overall performance in residency compared with P/F applicants (0.0001 fixed, P = .98; –0.0047 random, P = .81) Discussion: Clerkship performance has often been used as a metric to assess medical student preparedness for residency. 1,2 While PDs reported that residents from medical schools using P/F clerkship gradings tended to perform slightly lower on average, these results were not statistically significant. In addition, PDs did not generally prefer applicants from tiered medical schools. Given the continued expansion of P/F grading in medical school curricula, our findings allow for early discussion regarding the implications of P/F clerkship grading and its anticipated reception by stakeholders. Significance: In our cohort, there appears to be no perceived difference in resident performance based on clerkship grading system. This study provides further impetus for discussion of wider adoption of P/F grading in clinical clerkships.

I\u2019m No Superman: fostering physician resilience through guided group discussion of Scrubs

BackgroundAlmost half of trainees experience burnout during their career. Despite the Accreditation Council on Graduate Medical Education (ACGME) recommendation that training programs enact well-being curricula, there is no proven method of addressing this difficult topic.MethodsWe created a curriculum addressing physician resiliency and well-being, designed for an Internal Medicine Residency Program. This curriculum utilized episodes from a medical television series, Scrubs, to facilitate a monthly, 1-h faculty guided discussion group. We collected informal feedback and abbreviated Maslach Burnout Inventories (aMBI) monthly and conducted a formal focus group after 6 months to gauge its effectiveness.ResultsThe curriculum was successfully conducted for 12 months with each session averaging 18–20 residents. Residents reported high satisfaction, stating it was more enjoyable and helpful than traditional resiliency training. 19 of 24 residents (79 %) completed a baseline aMBI, and 17 of 20 residents (85 %) who attended the most recent session completed the 6-month follow-up, showing a non-significant 1-point improvement in all subsets of the aMBI.ConclusionsThis novel, low-cost, easily implemented curriculum addressed resiliency and burn-out in an Internal Medicine Residency. It was extremely well received and can easily be expanded to other training programs or to providers outside of training.

Медицинское образование в условиях пандемии коронавирусной инфекции: социально-этические рекомендации

Presented are social-ethical recommendations for medical education under conditions of pandemic of coronavirus infection. In the modern world there are many social and ethical problems, that depend on the worldview, philosophical and spiritual and moral positions of the state, society in general and individual in particular. Social and ethical issues of digital learning technologies caused by the new coronavirus infection have not yet been fully studied. The author analyzes a number of these aspects, related to medical education during the 2020 COVID-19 pandemic. The following research methods were used in the work, i.e. study and analysis of special literature, synthesis, modeling, comparison, generalization, observation, system analysis and theoretical knowledge. The article contains a number of social and ethical recommendations to help teachers and students better adapt to the distance learning format.

Impact of Patient Load on the Quality of Electronic Medical Record Documentation.

Objective:American College of Graduate Medical Education (ACGME) recommends ongoing care of 10 patients per resident however its implication is unclear. We hypothesized EMR quality to vary based on patient load and call status.Methods:We conducted a double-blind, single-center, retrospective observational study between 2017 and 2019 to investigate the quality and accuracy of resident documentation using the Responsible Electronic Documentation (RED) Checklist, a validated scoring system.Results:A total of 234 independent charts were analyzed and 80 met scoring criteria. Average patients per residents was 4, 9.1, 7.2, and 5.5 on “call” day (D0), “post-call” day (D1), “mid-call” day (D2), and “pre-call” day (D3), respectively. Mean RED checklist scores were 68.1%, 57%, 68.6%, and 72.1% on the above call status. The difference in score between D3 and D1 was statistically significant (P = .00042). There was a negative correlation between score and number of patients per resident (r = −0.286, P = .010).Conclusion:EMR documentation quality is directly impacted by patient load and resident call status with the lowest documentation quality on post-call day, correlating with patient load.

A Medical Education Recommendation for Improving Sexual Health and Humanism and Professionalism.

Sexual health in the United States is poor, yet most physicians do not address the topic. Sexual health education (SHE) guidelines are available but not used. The lack of SHE in undergraduate medical education (UME) impacts sexual and general health outcomes, as SHE in UME increases physicians' awareness of and ability to address sexual health, which is bidirectionally correlated with other health. To design and assess the need, feasibility, and outcomes of an educational recommendation for increased incorporation of SHE in UME. Comprehensive literature review was used to assess current and future needs of SHE in UME and humanism and professionalism education (HPE). Qualitative analysis was used to assess a potential solution. The main outcome measure was an educational recommendation based on qualitative analysis of (1) the benefits of SHE and HPE in UME, (2) the SHE and HPE overlap, and (3) the potential effect of a formally combined delivery on UME and patient and practitioner outcomes. Available literature on medical SHE supports increased SHE is necessary and should be incorporated into existing HPE whenever possible, secondary to numerous intersections. Qualitative analysis supports HPE could be enhanced when consistently exemplified through SHE, and this approach could be beneficial for (1) increased understanding, retention, application, and advocacy of both topics; (2) long-term improvement of sexual and general health at the patient and population levels; and (3) increased practice of humanism and professionalism, potentially resulting in better patient outcomes and professional satisfaction for physicians. Cross-disciplinary qualitative analysis supports using SHE as the primary topic to teach HPE is a viable method to increase SHE and potentially creates physicians who address sexual health and practice with increased humanism and professionalism, leading to population-level sexual and general health improvements. Gordon EG. A Medical Education Recommendation for Improving Sexual Health and Humanism and Professionalism. Sex Med Rev 2021;9:23-35.

Medical knowledge exchange by crosscultural education projects: a practical approach based on a structured qualitative analysis of radiology teaching in Azerbaijan

In 2015, the World Health Organization announced its Sustainable Development Goals. This agenda contributes to reducing inequity in healthcare and improving health. In a world with major differences between countries, the following question should be asked: How can healthcare professionals in general (and radiologists in particular) from highincome countries (HIC) and lowand middleincome countries (LMIC) work together to improve global health? The purpose of this paper is to evaluate several recent crosscultural educational efforts in radiology in Azerbaijan and to formulate practical recommendations for radiology education and medical education in general carried out in LMICs by volunteers from HICs. Methods. From a series of four consecutive education projects, we analyzed the evaluation forms of two of the sessions. Furthermore, we evaluated all four education projects by systematic comparison and reflection on 21 items in the categories Background Information, People, and Practice. Results. To all items in the list, a reflection was added that included viewpoints from both visiting and host professionals. The evaluation forms demonstrated that the third education project with practical radiology content was valued higher than the fourth education project on quality management. The participants of both education projects would recommend projects like these to their own colleagues. We formulated recommendations for shortterm crosscultural education projects based on the systematic evaluation, the reflection, and the evaluation forms. Conclusion. This systematic evaluation of serial crosscultural radiology education efforts in Azerbaijan fills a gap in global health research. It is an example of evidencebased crosscultural teaching, and it identified recommendations for future projects. A key finding is the importance of serving the host country’s professionals by carefully assessing their needs. Educational efforts should be seen in the broader context of healthcare development.

48. CONTINUITY CLINIC PRACTICE FEEDBACK: WHAT DO RESIDENTS WANT?

Background The Accreditation Council of Graduate Medical Education (ACGME) recommends that residents receive data on quality metrics and benchmarks related to patient care. Continuity clinic (CC) is an ideal setting to obtain practice habit data. Objective To determine which CC practice habit data residents would find beneficial to receive during feedback. Methods A multicenter qualitative study was conducted with pediatric continuity clinic residents at 3 academic medical centers in two different phases. During phase 1, small resident focus groups were conducted at each site. The focus groups explored preferred content feedback on CC practice habit data. The qualitative data were reviewed by all investigators to identify major themes. For the second phase of the study, the results obtained from the focus group were used to develop a survey in order to determine how strongly residents felt about the particular areas of feedback that were identified in phase one of the study. This survey, which utilized a 5-point Likert scale to determine the importance of each feedback item, was sent out electronically to all categorical residents at each academic center. Results were analyzed with the mean and standard deviation for each question calculated. Results Focus groups were held at 3 sites with 3-10 residents per focus group. Consistent major themes which arose from the focus groups at all sites as desired areas to receive feedback on CC practice included the following categories: patient panel characteristics, quality measures, measures of efficiency in patient care, population management and information on specific patients. For the second phase of the study, 277 residents received the survey with 92 responding (33% response rate). The mean value that residents placed on the importance of each content area is displayed (table 1) with 1 being not important at all and 5 being very important. Conclusion Residents are interested in receiving practice habit data from continuity clinic. Presentation of the feedback described may enhance the resident continuity clinic experience and improve overall performance and enhance patient care.

MEDICAL KNOWLEDGE EXCHANGE BY CROSSCULTURAL EDUCATION PROJECTS: A PRACTICAL APPROACH BASED ON A STRUCTURED QUALITATIVE ANALYSIS OF RADIOLOGY TEACHING IN AZERBAIJAN

In 2015, the World Health Organization announced its Sustainable Development Goals. This agenda contributes to reducing inequity in healthcare and improving health. In a world with major differences between countries, the following question should be asked: How can healthcare professionals in general (and radiologists in particular) from high-income countries (HIC) and low- and middle-income countries (LMIC) work together to improve global health? The purpose of this paper is to evaluate several recent cross-cultural educational efforts in radiology in Azerbaijan and to formulate practical recommendations for radiology education and medical education in general carried out in LMICs by volunteers from HICs. Methods. From a series of four consecutive education projects, we analyzed the evaluation forms of two of the sessions. Furthermore, we evaluated all four education projects by systematic comparison and reflection on 21 items in the categories Background Information, People, and Practice. Results. To all items in the list, a reflection was added that included viewpoints from both visiting and host professionals. The evaluation forms demonstrated that the third education project with practical radiology content was valued higher than the fourth education project on quality management. The participants of both education projects would recommend projects like these to their own colleagues. We formulated recommendations for short-term cross-cultural education projects based on the systematic evaluation, the reflection, and the evaluation forms. Conclusion. This systematic evaluation of serial cross-cultural radiology education efforts in Azerbaijan fills a gap in global health research. It is an example of evidence-based cross-cultural teaching, and it identified recommendations for future projects. A key finding is the importance of serving the host country’s professionals by carefully assessing their needs. Educational efforts should be seen in the broader context of healthcare development.

Evolutionary Biology: A Basic Science for Medicine

When the Flexner Report was written, evolutionary biology was not yet a well‐developed science and few people were interested in its applications to medicine. As a result, Flexner's recommendations for pre‐medical and medical education did not include evolution. Increasingly, however, physicians and medical scientists are appreciating the clinical relevance of evolutionary biology. The need for antibiotic stewardship to minimize selection for antibiotic resistance and the recognition that cancer is an evolutionary process involving variation and selection among clones of cancer cells have highlighted the urgency of bringing evolutionary principles into medicine. An evolutionary perspective can enhance students' understanding of health and disease in many ways. Evolutionary biology provides an enriched view of variation. Medicine has traditionally considered variations as deviations from a “normal” state. Evolutionary biology recognizes variation, both within populations and between populations, as an important characteristic of biological species. Variation is a prerequisite for selection and, in addition, it provides a defense against the spread of pathogens within populations. This view of variation leads to an understanding of the differences between individual health and population health. The causes of disease in individuals are different from the causes of the incidence of disease in populations. Much of the within‐population variation is genetic while environmental differences are major components of between‐population variation. The focus of medicine on disease in individuals has led to an overemphasis on genetic risk factors and a dependence on pharmacologic therapies. An evolutionary view of population health emphasizes the importance of environmental risk factors or determinants of disease and the possible role of behavioral or cultural interventions in disease prevention. Evolutionary life history theory is an account of the ways in which natural selection has shaped our entire life course. The theory is especially concerned with the acquisition and allocation of metabolic energy and other needed resources. Among other things, we use metabolic energy to build up excess physiological capacities, or reserves, early in development and to prevent or repair the inevitable bodily damage that occurs throughout our lives. Diseases of aging result from unrepaired somatic damage and the depletion of our physiological reserves. This understanding suggests that interventions designed to promote the accumulation of physiological reserves and to slow the accumulation of bodily damage may postpone the onset of diseases of aging. Recognition that signs and symptoms of disease may be adaptations that decrease the fitness loss caused by disease heightens the need for caution in treating the manifestations of disease. These are just a few of the benefits of incorporating evolutionary insights into medicine. Evolutionary biology is a basic science for medicine. Our challenge is to figure out the best ways of integrating evolution into an already overcrowded medical curriculum and of bringing evolution to the attention of busy physicians whose first responsibility is to address the pressing problems of their patients.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effect of General Medical Degree Curricular Change on Mental Health of Medical Students: A Concurrent Controlled Educational Trial

Objective: General medical degree (GMD) curriculum usually causes significant psychological distress for medical students, especially in transition periods between preclinical, clerkship, and internship periods. This study was conducted to assess the effect of curricular change in GMD program on mental health of medical students in internship period. Method : This study evaluated mental health of 2 concurrent groups of medical students under reformed and non-reformed GMD curriculum. In this study, 120 out of 180 interns in the non-reform GMD program and 60 interns in the reformed GMD program were selected and their mental health status evaluated using Symptom Checklist-90-Revised (SCL-90-R) questionnaire. The cut-off point of 0.7 was used for Global Severity Index (GSI) score. SPSS software, version 14 (SPSS Inc, Chicago, Il, USA) was used for analysis. Chi-square, Fisher's exact test, t student, Mann-Whitney U, one-way ANOVA, and Kruskal-Wallis tests were used when appropriate. Logistic regression was used to estimate odds ratios for various determinants of students' mental health. Results: About half of the participants in the 2 groups were male (P = 0.63), and the mean age of the students in the reformed and non-reformed programs was 24.8 (1.97) and 24.7(1.80), respectively (P = 0.9). About 20% of participants in the non-reformed and less than 2% of those in the reformed program had GSI score of more than 0.7. Medical students in the reformed program had lower scores in total GSI and 9 its dimensions (P<0.001). The results obtained from the logistic regression analysis indicated that reformed curriculum and good economic status were significant independent variables contributing to decreased psychological distress (OR = 0.016 and 0.11, respectively). Conclusion: The results revealed that curricular changes which were based on World Federation of Medical Education recommendation, could be associated with improvement in mental health status of medical students.

Primary Care for the Elderly Bereaved: Recommendations for Medical Education.

The aim of this study was to explore the current practices of primary care physicians (PCPs) in providing bereavement care to elderly patients, with implications for medical education. A total of 63 PCPs answered a brief online survey about their typical practices, barriers, comfort level with bereavement, and confidence in their ability to diagnose prolonged grief disorder (PGD). They were recruited through an online newsletter and contacts of one of the authors. The results found that two-thirds of the PCPs do not routinely screen their elderly patients for recent losses, nor do they refer to mental health clinicians when loss is identified. Barriers included not learning of the deaths in patients' lives and lack of time during clinic visits. Those PCPs who had experienced their own losses were significantly more comfortable in speaking to patients about recent losses and more confident in their ability to diagnose PGD. We recommend bereavement education be incorporated into the medical school curriculum from the outset, utilizing the psychological principle of graded exposure to bereaved individuals.

Exploring Canadian Physicians' Experiences With Type 2 Diabetes Care for Adult Indigenous Patients.

The perspectives of physicians caring for Indigenous patients with diabetes offer important insights into the provision of health-care services. The purpose of this study was to describe Canadian physicians' perspectives on diabetes care of Indigenous patients, a preliminary step in developing a continuing medical education intervention described elsewhere. Through in-depth semistructured interviews, Canadian family physicians and specialists with sizeable proportions of Indigenous clientele shared their experiences of working with Indigenous patients who have type 2 diabetes. Recruitment involved a purposive and convenience sampling strategy, identifying participants through existing research and the professional relationships of team members in the provinces of British Columbia, Alberta and Ontario. Participants addressed their understanding of factors contributing to the disease, approaches to care and recommendations for medical education. The research team framed a thematic analysis through a collaborative, decolonizing lens. The participants (n=28) included 3 Indigenous physicians, 21 non-Indigenous physicians and 4 non-Indigenous diabetes specialists. They practised in urban, reserve and rural adjacent-to-reserve contexts in 5 Canadian provinces. The physicians constructed a socially framed understanding of the complex contexts influencing Indigenous patients with diabetes in tension with structural barriers to providing diabetes care. As a result, physicians adapted care focusing on social factors and conditions that take into account the multigenerational impacts of colonization and the current social contexts of Indigenous peoples in Canada. Adaptations in diabetes care by physicians grounded in the historical, social and cultural contexts of their Indigenous patients offer opportunities for improving care quality, but policy and health system supports and structural competency are needed.