Medicine and Health Sciences Commons^™

Rules Of Engagement: Residents' Perceptions Of The In-Training Evaluation Process, Christopher Watling, Cynthia Kenyon, Elaine Zibrowski, Valerie Schulz, Mark Goldszmidt, Indu Singh, Heather Maddocks, Lorelei Lingard

Lorelei Lingard

BACKGROUND: In-training evaluation reports (ITERs) often fall short of their goals of promoting resident learning and development. Efforts to address this problem through faculty development and assessment-instrument modification have been disappointing. The authors explored residents' experiences and perceptions of the ITER process to gain insight into why the process succeeds or fails.

METHOD: Using a grounded theory approach, semistructured interviews were conducted with 20 residents. Constant comparative analysis for emergent themes was conducted.

RESULTS: All residents identified aspects of "engagement" in the ITER process as the dominant influence on the success of ITERs. Both external (evaluator-driven, such as evaluator credibility) …

Interprofessional Communication And Medical Error: A Reframing Of Research Questions And Approaches, Lara Varpio, Pippa Hall, Lorelei Lingard, Catherine Schryer

Lorelei Lingard

Progress toward understanding the links between interprofessional communication and issues of medical error has been slow. Recent research proposes that this delay may result from overlooking the complexities involved in interprofessional care. Medical education initiatives in this domain tend to simplify the complexities of team membership fluidity, rotation, and use of communication tools. A new theoretically informed research approach is required to take into account these complexities. To generate such an approach, we review two theories from the social sciences: Activity Theory and Knotworking. Using these perspectives, we propose that research into interprofessional communication and medical error can develop better …

Point-Of-Care Assessment Of Medical Trainee Competence For Independent Clinical Work, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Clinical supervisors make frequent assessments of medical trainees' competence so they can provide appropriate opportunities for trainees to experience clinical independence. This study explored context-specific assessments of trainees' competence for independent clinical work.

METHOD: In Phase One, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase Two, 36 in-depth interviews were conducted using video vignettes. Data collection and analysis employed grounded theory methodology.

RESULTS: Supervisors' assessments of trainee trustworthiness for independent clinical work involved consideration of four dimensions: knowledge/skill, discernment of limitations, truthfulness, and …

Grounded Theory, Mixed Methods, And Action Research, Lorelei Lingard, Mathieu Albert, Wendy Levinson

Lorelei Lingard

No abstract provided.

Critically Appraising Qualitative Research, Ayelet Kuper, Lorelei Lingard, Wendy Levinson

Lorelei Lingard

No abstract provided.

Know When To Rock The Boat: How Faculty Rationalize Students' Behaviors, Shiphra Ginsburg, Lorelei Lingard, Glenn Regehr, Kathryn Underwood

Lorelei Lingard

BACKGROUND: When faculty evaluate medical students' professionalism, they make judgments based on the observation of behaviors. However, we lack an understanding of why they feel certain behaviors are appropriate (or not).

OBJECTIVE: To explore faculty's reasoning around potential student behaviors in professionally challenging situations.

DESIGN: Guided interviews with faculty who were asked to respond to 5 videotaped scenarios depicting students in professionally challenging situations.

SUBJECTS: Purposive sample of 30 attending Internists and surgeons.

APPROACH: Transcripts were analyzed using modified grounded theory to search for emerging themes and to attempt to validate a previous framework based on student responses.

RESULTS: Faculty's …

Biomedical Scientists' Perception Of The Social Sciences In Health Research, Mathieu Albert, Suzanne Laberge, Brian Hodges, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

The growing interest in interdisciplinary research within the Canadian health sciences sector has been manifested by initiatives aimed at increasing the involvement of the social sciences in this sector. Drawing on Bourdieu's concept of field and Knorr-Cetina's concept of epistemic culture, this study explores the extent to which it is possible for the social sciences to integrate into, and thrive in, a field in which the experimental paradigm occupies a hegemonic position. Thirty-one semi-structured interviews were conducted to explore biomedical scientists' receptiveness toward the social sciences in general and to qualitative research in particular. We found that these respondents exhibited …

Catalyzing And Sustaining Communities Of Collaboration Around Interprofessional Care: An Evaluation Of Four Educational Programs, Eileen Egan-Lee, Elisa Hollenberg, Dale Dematteo, Stasey Tobin, Ivy Oandasan, Mary-Agnes Beduz, Debbie Kwan, Karen Leslie, Jacques Lee, Maria Tassone, Jane Merkley, Lorelei Lingard, Lynne Sinclair, Mandy Lowe, Danny Nashman, Cate Creede, Doreen Day, Ivan Silver, Scott Reeves

Lorelei Lingard

No abstract provided.

Paradoxical Effects Of Interprofessional Briefings On Or Team Performance, Sarah Whyte, Lorelei Lingard, Sherry Espin, G. Baker, John Bohnen, Beverley Orser, Diane Doran, Richard Reznick, Glenn Regehr

Lorelei Lingard

Our recent research has found that structured preoperative team briefings can reduce communication failures, improve the knowledge and practice of operating room (OR) team members, and garner broad support from surgeons, nurses, and anesthesiologists. However, we have also encountered challenges and unexpected, negative effects. Using qualitative analysis of fieldnotes from 302 preoperative team briefings, we identified five paradoxical findings: team briefings could mask knowledge gaps, disrupt positive communication, reinforce professional divisions, create tension, and perpetuate a problematic culture. Fifteen percent of the briefings exhibited only these paradoxical effects without any apparent utility. We describe these paradoxical findings and analyze them …

Measuring Educational Workload: A Pilot Study Of Paper-Based And Pda Tools, Susan Tallett, Lorelei Lingard, Karen Leslie, Jonathan Pirie, Ann Jefferies, Lawrence Spero, Rayfel Schneider, Robert Hilliard, Jay Rosenfield, Jonathan Hellmann, Marcellina Mian, Jennifer Hurley

Lorelei Lingard

BACKGROUND: Teaching is an important professional role for most faculty members in academic health sciences centres. Careful delineation of educational workload is needed to foster and reward teaching efforts, and to facilitate equitable allocation of resources.

AIMS: To promote recognition in teaching and facilitate equitable resource allocation, we developed, piloted, and qualitatively assessed a tool for delineating the educational workload of pediatric faculty in an academic health sciences centre.

METHODS: A prototype educational workload measurement tool was developed. Between 2002 and 2004, three successive phases of pilot implementation were conducted to (1) assess the face validity of the tool, (2) …

The Rhetoric Of Patient Voice: Reported Talk With Patients In Referral And Consultation Letters, Marlee Spafford, Catherine Schryer, Lorelei Lingard

Lorelei Lingard

Referral and consultation letters are written to enable the exchange of patient information and facilitate the trajectory of patients through the healthcare system. Yet, these letters, written about yet apart from patients, also sustain and constrain professional relationships and influence attitudes towards patients. We analysed 35 optometry referral letters and 35 corresponding ophthalmology consultation letters for reported 'patient voice' coded as 'experience' or 'agenda' and we interviewed 15 letter writers (eight optometry students, six optometrists, and one community ophthalmologist). There were 80 instances of reported 'patient voice' in 35 letters. The majority (68%) of the instances occurred in referral letters, …

Evaluation Of A Preoperative Checklist And Team Briefing Among Surgeons, Nurses, And Anesthesiologists To Reduce Failures In Communication, Lorelei Lingard, Glenn Regehr, Beverley Orser, Richard Reznick, G. Baker, Diane Doran, Sherry Espin, John Bohnen, Sarah Whyte

Lorelei Lingard

OBJECTIVE: To assess whether structured team briefings improve operating room communication.

DESIGN, SETTING, AND PARTICIPANTS: This 13-month prospective study used a preintervention/postintervention design. All staff and trainees in the division of general surgery at a Canadian academic tertiary care hospital were invited to participate. Participants included 11 general surgeons, 24 surgical trainees, 41 operating room nurses, 28 anesthesiologists, and 24 anesthesia trainees.

INTERVENTION: Surgeons, nurses, and anesthesiologists gathered before 302 patient procedures for a short team briefing structured by a checklist. Main Outcome Measure The primary outcome measure was the number of communication failures (late, inaccurate, unresolved, or exclusive communication) …