Time As A Catalyst For Tension In Nurse-Surgeon Communication, 2011 University of Toronto
Time As A Catalyst For Tension In Nurse-Surgeon Communication, Sherry Espin, Lorelei Lingard
Carefully studying communication patterns between nurses and surgeons questions popular stereotypes about OR discourse and expands educators' understanding of the factors that motivate team communication, patterns that are habitual among team members, and issues that act as catalysts for tension. This study examines the nature of communication between perioperative nurses and surgeons and identifies patterns and sites of tension. Researchers observed 128 hours of interaction between nurses and surgeons in four surgical divisions at one teaching hospital in Ontario, Canada. Field notes were read, coded, and analyzed independently. Results showed that higher tension in nurse-surgeon communication clusters around particular themes ...
Surgeons Managing Conflict: A Framework For Understanding The Challenge, 2011 Southern Illinois University
Surgeons Managing Conflict: A Framework For Understanding The Challenge, David Rogers, Lorelei Lingard
No abstract provided.
Perceptions Of Operating Room Tension Across Professions: Building Generalizable Evidence And Educational Resources, Lorelei Lingard, Glenn Regehr, Sherry Espin, Isabella Devito, Sarah Whyte, Douglas Buller, Bohdan Sadovy, David Rogers, Richard Reznick
BACKGROUND: Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD: Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS: The three professions rated tension levels of the various scenarios similarly (F=1.19, ns ...
Childhood Immunization. How Knowledgeable Are We?, 2011 University of Toronto
Childhood Immunization. How Knowledgeable Are We?, Helen Heurter, Karen Breen-Reid, Leya Aronson, Lorelei Lingard, David Manning, E. Ford-Jones
No abstract provided.
Teaching And Learning Communication In Medicine: A Rhetorical Approach, 2011 University of Toronto
Teaching And Learning Communication In Medicine: A Rhetorical Approach, Lorelei Lingard, R. Haber
The language people use both makes possible and constrains the thoughts they can have. More than just a vehicle for ideas, language shapes ideas--and the practices that follow from them. Thus, in medical education, teaching students how to talk about medical cases also teaches them how to think about patients and medical work, and how to define their relationships to both. Without a theoretical model, however, teaching efforts in this domain tend to be implicit and ad hoc, which can lead to serious problems. Rhetoric is one science that can deepen understanding of communication and improve teaching of this clinical ...
Getting Teams To Talk: Development And Pilot Implementation Of A Checklist To Promote Interprofessional Communication In The Or, Lorelei Lingard, S. Espin, B. Rubin, S. Whyte, M. Colmenares, G. Baker, D. Doran, E. Grober, B. Orser, J. Bohnen, R. Reznick
BACKGROUND: Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members' willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions.
METHODS: A checklist prototype was developed and OR team members were asked to implement ...
A Certain Art Of Uncertainty: Case Presentation And The Development Of Professional Identity, 2011 University of Toronto
A Certain Art Of Uncertainty: Case Presentation And The Development Of Professional Identity, Lorelei Lingard, K. Garwood, C. Schryer, M. Spafford
Healthcare professionals use the genre of case presentation to communicate among themselves the salient patient information during treatment and management. In case presentation, many uncertainties surface, regarding, e.g., the reliability of patient reports, the sensitivity of laboratory tests, and the boundaries of scientific knowledge. The management and portrayal of uncertainty is a critical aspect of professional discourse. This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students' professional socialization. This study was conducted during the third-year inpatient clerkship at a tertiary care, pediatric hospital in hospital in ...
The Rhetoric Of Rationalization: How Students Grapple With Professional Dilemmas, 2011 University of Toronto
The Rhetoric Of Rationalization: How Students Grapple With Professional Dilemmas, Lorelei Lingard, K. Garwood, K. Szauter, D. Stern
No abstract provided.
'You Learn Better Under The Gun': Intimidation And Harassment In Surgical Education, 2011 University of Toronto
'You Learn Better Under The Gun': Intimidation And Harassment In Surgical Education, Laura Musselman, Helen Macrae, Richard Reznick, Lorelei Lingard
BACKGROUND: Medical literature has documented a high prevalence of intimidation and harassment in the educational context. However, the research has failed to adequately delineate the nature of these phenomena as well as the different ways in which diverse actors perceive the behaviours in question.
METHODS: Based on qualitative methodology anchored in a social constructionism framework, how teachers (staff surgeons) and learners (surgical residents) define intimidation and harassment were documented and compared. In addition, teachers' and learners' perceptions of the impact of these behaviours on the learning environment, including their effects on the socialisation of surgeons in training, were examined.
Towards Embracing Clinical Uncertainty: Lessons From Social Work, Optometry And Medicine, 2011 University of Waterloo
Towards Embracing Clinical Uncertainty: Lessons From Social Work, Optometry And Medicine, Marlee Spafford, Catherine Schryer, Sandra Campbell, Lorelei Lingard
Summary: The oral transmission and transformation of client information in an apprenticeship setting provides a rich environment in which to observe students and their expert supervisors managing uncertainty. In this Canadian-based study, we examined the communicative features of 12 social work supervisions involving social work students and their supervisors and enriched our observations with subsequent interviews of the participants.
Findings: Social work students viewed the acknowledgement and examination of uncertainty as a touchstone of competent social work. This observation contrasted with our past study of medical and optometry students who focused on personal deficit and a distrust of acknowledging uncertainty ...
Basing The Evaluation Of Professionalism On Observable Behaviors: A Cautionary Tale, 2011 University of Toronto
Basing The Evaluation Of Professionalism On Observable Behaviors: A Cautionary Tale, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard
PROBLEM STATEMENT AND BACKGROUND: The evaluation of professionalism often relies on the observation and interpretation of students' behaviors; however, little research is available regarding faculty's interpretations of these behaviors.
METHOD: Interviews were conducted with 30 faculty, who were asked to respond to five videotaped scenarios in which students are placed in professionally challenging situations. Behaviors were catalogued by person and by scenario.
RESULTS: There was little agreement between faculty about what students should and should not do in each scenario. Abstracted principles (e.g., honesty, altruism) were defined and applied inconsistently, both between and within individual faculty. There was ...
A Theory-Based Instrument To Evaluate Team Communication In The Operating Room: Balancing Measurement Authenticity And Reliability, Lorelei Lingard, Glenn Regehr, Sherry Espin, Sarah Whyte
BACKGROUND: Breakdown in communication among members of the healthcare team threatens the effective delivery of health services, and raises the risk of errors and adverse events. AIM: To describe the process of developing an authentic, theory-based evaluation instrument that measures communication among members of the operating room team by documenting communication failures. METHODS: 25 procedures were viewed by 3 observers observing in pairs, and records of events on each communication failure observed were independently completed by each observer. Each record included the type and outcome of the failure (both selected from a checklist of options), as well as the time ...
The Rhetorical 'Turn' In Medical Education: What Have We Learned And Where Are We Going?, 2011 University of Toronto
The Rhetorical 'Turn' In Medical Education: What Have We Learned And Where Are We Going?, Lorelei Lingard
This paper presents a critical reflection on the contributions and challenges associated with one rhetorical approach to studying teaching and learning communication in health professions education. A rhetorical approach treats language as a social act, and attends to the role of language in establishing professional identities and relationships. The research has produced insights into the use of standard communication formats to teach novices, the nature of socialization on clinical teams, and the relationship between communication patterns and patient safety. Challenges and emerging questions include the problem of accounting for the material dimensions of communication in a rhetorical model, grappling with ...
Technical Skills In Paediatrics: A Qualitative Study Of Acquisition, Attitudes And Assumptions In The Neonatal Intensive Care Unit, 2011 The University of Western Ontario
Technical Skills In Paediatrics: A Qualitative Study Of Acquisition, Attitudes And Assumptions In The Neonatal Intensive Care Unit, Susan Bannister, Robert Hilliard, Glenn Regehr, Lorelei Lingard
PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate ...
Before The White Coat: Perceptions Of Professional Lapses In The Pre-Clerkship, 2011 University of Toronto
Before The White Coat: Perceptions Of Professional Lapses In The Pre-Clerkship, Shiphra Ginsburg, Natasha Kachan, Lorelei Lingard
BACKGROUND: It has been shown that the professional development of clinical clerks is influenced by their experiences of unprofessional behaviour, but the perceptions of pre-clerkship students have received relatively little attention. Our purpose was to develop a greater contextual understanding of the situations in which pre-clerkship students encounter professional challenges, and to investigate what pre-clerkship students consider to be professional lapses in these situations.
METHODS: We conducted 4 focus groups (n = 22 students); transcripts were analysed by 3 researchers using grounded theory.
RESULTS: Pre-clerkship students reported lapses in the areas of communicative violation, role resistance, objectification, accountability and harm, validating ...
To Be And Not To Be: The Paradox Of The Emerging Professional Stance, 2011 University of Toronto
To Be And Not To Be: The Paradox Of The Emerging Professional Stance, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard
PURPOSE: Understanding how students resolve professional conflict is essential to teaching and evaluating professionalism. The purpose of this study was to refine an existing coding structure of rationalizations of student behaviour, and to further our understanding of students' reasoning strategies in the face of perceived professional lapses.
METHODS: Anonymous essays were collected from final year medical students at two universities. Each essay included a description of a specific professional lapse, and a consideration of how the lapse was dealt with. Essays were analysed using grounded theory. The resulting coding structure was applied using NVivo software.
RESULTS: Twenty essays, containing 147 ...
Persistence Of Unsafe Practice In Everyday Work: An Exploration Of Organizational And Psychological Factors Constraining Safety In The Operating Room, S. Espin, Lorelei Lingard, G. Baker, G. Regehr
This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of "vulnerable system syndrome", Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a ...
Choosing Pathology: A Qualitative Analysis Of The Changing Factors Affecting Medical Career Choice, 2011 University of Toronto
Choosing Pathology: A Qualitative Analysis Of The Changing Factors Affecting Medical Career Choice, Simon Raphael, Lorelei Lingard
Concern over the number of medical students choosing pathology and the “graying” of pathology as a profession have been expressed over many years. In Canada, changes in the structure of training, as well as a reduction in the number of foreign medical graduates able to train in pathology, have meant that the profession has had to rely much more heavily than in the past on competitive recruitment directly from undergraduate medical students. The second-year undergraduate course in pathology is often the sole exposure of medical students to this profession. The purpose of this study is to explore the impression of ...
Spinal Manipulation - Evidence For Physiotherapist Delivery Of Effective Procedures, 2011 Auckland University of Technology
Spinal Manipulation - Evidence For Physiotherapist Delivery Of Effective Procedures, D. Reid, T. Flynn, W. Hing, C. Mccarthy, P. Westerhuis
Learning objectives: 1. Demonstrate an increased understanding of the evidence for the use of spinal manipulation in the management of musculoskeletal conditions. 2. Demonstrate an increased understanding of the required screening procedures to provide safe practice of spinal manipulation. 3. Demonstrate an increase understanding of different approaches to deliver HVT and undergraduate and post graduate level.
Pharmacokinetics Of Intravenous And Oral Tramadol In The Bald Eagle (Haliaeetus Leucocephalus), 2011 University of Tennessee - Knoxville
Pharmacokinetics Of Intravenous And Oral Tramadol In The Bald Eagle (Haliaeetus Leucocephalus), Marcy Souza, Tomas Martin-Jimenez, Michael Jones, Sherry Cox
Analgesia is becoming increasingly important in veterinary medicine, and little research has been performed that examined pain control in avian species. Tramadol is a relatively new drug that provides analgesia by opioid (mu), serotonin, and norepinephrine pathways, with minimal adverse effects. To determine the pharmacokinetics of tramadol and its major metabolite O-desmethyltramadol (M1) in eagles, 6 bald eagles (Haliaeetus leucocephalus) were each dosed with tramadol administered intravenously (4 mg/kg) and orally (11 mg/kg) in a crossover study. Blood was collected at various time points between 0 and 600 minutes and then analyzed with high-performance liquid chromatography to determine ...