Medicine and Health Sciences Commons^™

Jumping Ship And Going To The Other Side: Experiences Of Nurses Who Retrain As Doctors, Anne Robinson

Electronic Thesis and Dissertation Repository

Aim: To gain an understanding of the experience of medical training for nurses who retrain as doctors.

Methods: Using a Constructivist Grounded Theory design, semi-structured interviews were conducted with thirteen medical students and residents who had completed nursing training prior to entering medical school. Interviews were audiotaped and professionally transcribed. Transcripts were coded and analysis in an inductive manner to construct central themes.

Findings: Many left nursing due to negative effects of a hierarchal system. As preclinical medical students they felt both advantaged and burdened by their advanced clinical knowledge. During clinical placements, they experienced social distress and role confusion …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

The Changing Landscape Of Orthopaedic Surgery In Ontario: Where We Are, Where We Have Been, And Where We Are Going., Silvio Ndoja

Electronic Thesis and Dissertation Repository

Orthopedic surgery is a field which has often been talked about with regards to surgeon underemployment. This is particularly important given the paradoxical increasing demand for orthopedic care. There has not been well studied literature understanding the state of orthopedic surgery training in Ontario, Canada. Using a combination of various databases and surveying surgeons trained in Ontario we sought to provide some insight.

We demonstrated multiple important findings. More recent graduates are feeling less ready to enter practice and almost all graduates do at least 1 fellowship, with equal amount of 1 versus 2 fellowships. We showed an effect of …

Hidden In Plain Sight: Finding A Balance Between Assessment And Learning In Competency-Based Education In Canadian Health Care, Scott Murray

The Dissertation-in-Practice at Western University

Due to its emphasis on skill development and alignment with workforce demands, competency-based education (CBE) has garnered considerable attention in recent years. My organizational improvement plan (OIP) focuses on the potential benefits of incorporating learners’ voices into CBE in Canadian medical education and proposes a corresponding implementation framework. The traditional CBE model often lacks a critical component: the learner’s voice. My OIP reviews the literature and outlines its theoretical underpinnings (e.g., systems theory, adult education theory) within the scope of authentic leadership. The findings suggest incorporating learners’ voices into CBE to boost engagement, motivation, and agency. In response to such …

Relational Variables Impacting The Healthcare Team, Linda J. Macdougall Ms

Electronic Thesis and Dissertation Repository

The movement in the healthcare system towards interprofessional collaborative teamwork values the perspectives of various healthcare professionals. Although this system shift has been essential to quality improvement, there have been indications of issues occurring between professionals that include conflict and impaired team performance. Although the current literature on interprofessional collaboration acknowledges the competencies and demonstrated behaviours that indicate successful and difficult collaborative efforts there is a lack of research investigating the relational variables that occur between healthcare professionals.

The purpose of this research was to test a theoretically derived model of healthcare professionals’ relational variables. These variables related to warmth, …

Systemic, Institutional, And Teaching Factors In The Delivery Of Interprofessional Education Curriculum In Canada, Mohammad B. Azzam

Electronic Thesis and Dissertation Repository

The Canadian federal and several provincial governments are currently collaborating to establish ‘team-based’ primary healthcare—or interprofessional collaborative practice (IPCP), which can be effectively accomplished when interprofessional education (IPE) is sustainably delivered by health and social care (HASC) professional education programs. Indeed, achieving the intended patient/client-oriented outcomes of IPE and subsequent IPCP requires deliberate and purposeful considerations of several systemic, institutional, and teaching factors. Regrettably, the analyses of the extent to which these factors have influenced effective IPCP is currently under-researched. In this integrated-article dissertation, we took a purposeful and systematic approach to explore the extent to which these multi-tiered factors …

The Attainment Of Obstetrical Competency In Postgraduate Family Medicine Training: A Qualitative Study, Nisha Arora

Electronic Thesis and Dissertation Repository

Aims: This study explored the Family Medicine resident experience in working towards their obstetrical competencies from the perspectives of residents and educators.

Methods: Using a qualitative descriptive design, semi-structured interviews were conducted with second-year Family Medicine residents and obstetrical supervisors from one Family Medicine program in Ontario, as well as key informants of Canadian Family Medicine maternity education. Interviews were audio-taped and professionally transcribed. Transcripts were coded and interpreted for common themes.

Findings: There was a disconnect between the intent of the College of Family Physicians of Canada Key Features document, and how it is applied at …

How We Debrief: An Interpretive Description Of Social Service Community Workers' Experiences, Andrea C. Krywucky

Electronic Thesis and Dissertation Repository

The aim of this research was to understand current practices of debriefing being used or not used in community social service organizations and the presumed frameworks or evidence justifying these practices in London, Ontario. The geographical area under concern has seen an increasing poverty gap, lack of affordable housing, toxic drug crisis, with mental health issues being exasperated by the pandemic. Social service agencies are overwhelmed with caseloads, creating an increase in need of care for frontline workers, as they are the first point of contact for many. This research utilized an interpretive description methodology to explore workers’ experiences and …

Development Of An On-Call Assessment Tool For Competency-Based Surgical Training, Eric C. Mitchell

Electronic Thesis and Dissertation Repository

Introduction: A central tenet of competency-based medical education is formative assessment of trainees. There are no assessments examining resident competence on-call, despite this being a significant component of resident training and characterized by less supervision compared to daytime.

Methods: A national survey was conducted to evaluate the state of assessment in Canadian Plastic and Reconstructive Surgery programs. An on-call assessment tool was developed based on a consensus group and was piloted over six months. Validity of the tool was examined through qualitative and quantitative methods.

Results: There were 63 tools completed across ten residents and seven staff physicians. Tool reliability …

Navigating, Negotiating, And Narrating: Re-Envisioning Patient-Centered Chronic Illness Care, Wilma J. Koopman

Electronic Thesis and Dissertation Repository

Patient-centered care (PCC) is ubiquitous in how we think about patient-practitioner encounters. But such a taken-for granted stance may unknowingly obscure how conversations actually unfold in real life. The purpose of this work is to unravel the disconnect between how patient-centered care is talked about and how it is implemented in the real world. The overarching research question that framed this study was: What are the influences that shape the unfolding of the conversations that occur at chronic illness health encounters and how does this unfolding influence the learning and execution of PCC? The aim of this research was …

Troubling Service User Involvement In Health Professional Education: Toward Epistemic Justice, Stephanie Leblanc-Omstead

Electronic Thesis and Dissertation Repository

It has become increasingly popular in health professional education to solicit the contributions and involvement of people who have firsthand or ‘lived’ experiences of using mental health services – a practice hereafter referred to as service user involvement (SUI). SUI is founded on the premise that service users ought to be involved in the development and evaluation of services and systems they experience, which includes the education of future health professionals. Despite the momentum this practice has gained in a range of international contexts, SUI is often conceptualized, organized, and implemented uncritically, and with tremendous inconsistency across health professional education …

A Transformative Journey: The Lived Experience Of Healthcare Learners Participating In Pain Management Education, Zoe A. Leyland

Electronic Thesis and Dissertation Repository

There is little emphasis on pain management education for healthcare providers. In September 2019, the Master of Clinical Science (MClSc) program in Advanced Healthcare Practice at Western University in London, Ontario introduced a new, “Interprofessional Pain Management” (IPM) field. The program follows a competency-based framework, and the learners are all practicing healthcare providers with a special interest in pain. Part of the purpose of this thesis is to describe the process of development and implementation. The objective is to provide educators and healthcare providers an in-depth look at how the pain education is experienced. This includes exploring the lived experience …

Surgical Residency Workload, Perceptions And Educational Value: Implications For Competency- Based Medical Education, Eric Walser

Electronic Thesis and Dissertation Repository

Introduction: Surgical training has transitioned to competency-based medical education. There is incomplete understanding of current resident workload and how workload is perceived by trainees and faculty.

Methods: A prospective time-motion study was conducted in a Canadian general surgery training program. A web-based survey was used to compare observational data with faculty and learner perceptions of actual and ideal resident workloads and the educational value of workload components.

Results: 54 clinical periods were assessed (662.8 hours, 6375 individual events). 39.7% of time was spent on direct patient care, 33.2% on indirect patient care and 7.5% on education, including

Conclusion: Curriculum changes …

Developing Competencies For Public Policy Advocacy: A Comparative Case Analysis, Amy L. Lewis

Electronic Thesis and Dissertation Repository

While health care and social service students in Ontario are expected to graduate with competencies in policy advocacy, the lack of knowledge and skills negatively impacts their participation as licensed providers. This study used an exploratory, comparative case study methodology with a critical theory lens to identify the process of how community-based organizations engaged in public policy advocacy to create educational competencies for undergraduate curricula. Eight organizational leaders participated in semi-structured interviews that were transcribed and analyzed both inductively and deductively using major concepts from Kingdon’s multiple streams theory to distinguish the policy advocacy process and Bloom’s taxonomy to identify …

A Curriculum Framework At Glsm, A Canadian Medical School, Jeff Bachiu

The Dissertation-in-Practice at Western University

Medical education has seen minor changes over the decades, but a dynamic movement towards competency-based medical education (CBME) has swept across the field in recent years. Organizing medical education curriculum to respond to these changes can be challenging due to many factors, in both content and context. The public rightly expects that graduating medical students be competent physicians, ready to deliver effective health care. This Organizational Improvement Plan (OIP) looks at a relatively new medical school’s lack of an outcomes-based curriculum framework. The Problem of Practice (PoP) is focused on the difficulty of moving the school toward the development of …

Building A Co-Curricular Wellness Program For Medical Students At A Canadian Medical School, Renea D. Leskie

The Dissertation-in-Practice at Western University

The increasing number of medical students who present with mental illness and burnout is becoming a very real challenge among medical schools nationally and globally, prompting a need for medical schools to address this very real problem. This Organizational Improvement Plan (OIP) seeks to help solve this problem by means of a co-curricular wellness program aimed at preventing mental illness and burnout from happening. Rather than being reactive as students self-identify as having a mental illness, this OIP argues for preventative measures that help to prevent mental illness and burnout from occurring at all.

Using a three-pronged leadership approach of …

Evaluation Of The Basic Science Pre-Clerkship Curriculum In Medicine At Western University, Madeleine E. Norris

Electronic Thesis and Dissertation Repository

Basic sciences are a cornerstone of undergraduate medical education (UME), upon which the clinical sciences are built, however, research indicates that students’ basic science knowledge is not well retained. Additionally, UME curricula vary with respect to which basic science content is delivered, the depth in which it is taught, and the employed instructional methods, which could influence trainees’ knowledge retention. Thus, there is a need for an educational model that ensures students are competent in the fundamentals prior to entering a clinical setting. This investigation provides insights into current strengths and potential areas for improvement with respect to basic science …

Quality Assurance In Competency Training Of Pre-Anesthesia Consultation Skills, Michelle Wong

The Dissertation-in-Practice at Western University

The absence of quality assurance in training clinicians to perform pre-anesthesia consultations at a Canadian university is the Problem of Practice addressed in this Organizational Improvement Plan. This competency requires learners to apply their anesthesia knowledge to take medical histories; perform physical examinations; diagnose anesthetic risks; and generate anesthesia plans. Random chart audits of many learners identify deficiencies and suggest inconsistent training of this competency. This Organizational Improvement Plan analyzes the anesthesia program’s organizational context to be a complex adaptive system; organizational structure to be a hierarchy; and organizational state to be static. Through the paradigms of complexity theory, interpretivism, …

Patient Roles Within Interprofessional Collaborative Patient-Centred Care Teams: The Patient And Health Care Provider Perspectives, Kateryna Metersky

Electronic Thesis and Dissertation Repository

With current rapid expansions to medical knowledge and technology and rising chronicity of diseases, health care providers are increasingly called upon to work together within interprofessional teams to provide the most comprehensive care to their patients. Interprofessional teams have been depicted as enhancing patient health outcomes and increasing patient satisfaction with care, while decreasing health care spending and wait times for receiving care. However, there is little evidence on how to collaboratively include patients in these teams. The study’s purpose was to construct a framework on the conditions and processes required for patients to assume active participant roles in their …

Focused Practice And Enhanced Skills Pgy3 Training In Family Medicine: A Mixed Methods Study., Melad I. Marbeen

Electronic Thesis and Dissertation Repository

There is a growing trend among family physicians (FPs) to focus their practice in specialized areas. The reasons underlying this trend are incompletely understood. A mixed methods study was conducted to understand this issue. A secondary analysis of data from a survey of Western University family medicine program graduates highlighted the associations of postgraduate third-year (PGY3) training and physician’s remuneration strategy with focused practice. The overall service provision of focused practice FPs was centered on specialized areas, especially among those who practiced in non-office settings. A descriptive qualitative study explored the perspectives of residents accepted into the PGY3 programs at …

Death Of The Clinic: Trans-Informing The Clinical Gaze To Counter Epistemic Violence, Diana E. Kuhl

Electronic Thesis and Dissertation Repository

This case study research (Patton, 2002, 2014; Flyvberg, 2006) has grown out of an awareness of deep resistance from the psy disciplines to trans-informed epistemologies as a source of legitimate knowledge (Tosh, 2015, 2016; Winters, 2008). It focuses on examining how the closure of The Gender Identity Clinic (GIC) for Children and Youth at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, Canada, signaled a paradigm shift from the ‘treatment model’ to the ‘affirmative model’ with respect to clinical approaches for supporting trans and gender diverse children and youth. As such the case study involved tracing the …

Haptics-Enabled, Gpu Augmented Surgical Simulation Platform For Glenoid Reaming, Vlad Popa

Electronic Thesis and Dissertation Repository

Surgical simulators are technological platforms that provide virtual substitutes to the current cadaver-based medical training models. The advantages of exposure to these devices have been thoroughly studied, with enhanced surgical proficiency being one of the assets gained after extensive use. While simulators have already penetrated numerous medical domains, the field of orthopedics remains stagnant despite a demand for the ability to practice uncommon surgeries, such as total shoulder arthroplasty (TSA). Here we extrapolate the algorithms of an inhouse software engine revolving around glenoid reaming, a critical step of TSA. The project’s purpose is to provide efficient techniques for future simulators, …

The Development And Evaluation Of Resources To Improve The Quality Of Care For Patients With Knee Osteoarthritis, Laura K. Churchill

Electronic Thesis and Dissertation Repository

Purpose: The non-operative management of patients with knee osteoarthritis (OA) is often considered suboptimal. Sub-optimal management includes inadequate use of non-surgical treatments, misuse of diagnostic imaging, and non-operative referrals to surgeons in consideration of total knee replacement (TKR). These inefficiencies result from an interplay of factors involving primary care physicians, patients, and the systems in which they function. The overall purpose of this thesis is to develop a means to optimize the management of patients with knee OA, and the timing and quality of referrals to TKR.

Methods: This thesis includes three studies. In study 1, we identified and cross-validated …

Virtual Reality Simulation Of Glenoid Reaming Procedure, Mohammadreza Faieghi

Electronic Thesis and Dissertation Repository

Glenoid reaming is a bone machining operation in Total Shoulder Arthroplasty (TSA) in which the glenoid bone is resurfaced to make intimate contact with implant undersurface. While this step is crucial for the longevity of TSA, many surgeons find it technically challenging. With the recent advances in Virtual Reality (VR) simulations, it has become possible to realistically replicate complicated operations without any need for patients or cadavers, and at the same time, provide quantitative feedback to improve surgeons' psycho-motor skills. In light of these advantages, the current thesis intends to develop tools and methods required for construction of a VR …

Investigating The Use Of M-Health For Learning And Clinical Training By Medical Students In Ghana, Abdul M. Sulley

Electronic Thesis and Dissertation Repository

There is a challenge with healthcare access in most developing countries. With the high rate of mobile technology penetration in these countries, there is a strong belief that mobile technology can help address this and other health system and education challenges. This study investigated how clinical year medical students in Ghana used m-health and with what outcomes. This was a mixed-methods study to assess what technologies students used, what the impact of use was, what enablers and barriers they encountered, what factors explained m-health adoption and what the attitudes of students, staff and faculty members were towards m-health use. The …

Transitions In Medical Education, Britta Laslo

Electronic Thesis and Dissertation Repository

Transitions in medical education have been shown to increase unprofessional behaviours in learners but little is known about the experiences of first year Canadian Family Medicine residents or their preceptors. This qualitative descriptive study explored the experiences and feelings of Family Medicine preceptors and first year Family Medicine residents (FMRs) surrounding the transition to residency. Semi-structured interviews were conducted with 10 preceptors and 9 FMRs. The findings highlighted the complex but predominantly positive experiences during this transition in addition to competing and often evolving feelings experienced by both groups. Both studies noted the lack of support for preceptors and FMRs …

Oncoplastic Surgery: Is It Time To Change? From Innovation To Adoption Using Mentorship Program, Eman Khayat

Electronic Thesis and Dissertation Repository

Oncoplastic surgery is considered the standard of care for breast cancer therapy in numerous Western World countries, particularly in Europe. Despite the advancement of knowledge, Canada still lags in adoption of oncoplasty into the standard surgical practice. In our study, a mentorship program was used to introduce oncoplastic surgery to practicing breast surgeons at LHSC. The change in perception and adoption of oncoplastic surgery were evaluated using semi-structured interviews, before and after the intervention, by qualitative thematic analysis method. Mentorship program was validated as a superior method of learning new surgical techniques by practicing surgeons, demonstrating acceptance of different levels …

Design And Evaluation Of Neurosurgical Training Simulator, Trinette L. Wright

Electronic Thesis and Dissertation Repository

Surgical simulators are becoming more important in surgical training. Consumer smartphone technology has improved to allow deployment of VR applications and are now being targeted for medical training simulators. A surgical simulator has been designed using a smartphone, Google cardboard 3D glasses, and the Leap Motion (LM) hand controller. Two expert and 16 novice users were tasked with completing the same pointing tasks using both the LM and the medical simulator NeuroTouch. The novice users had an accuracy of 0.2717 bits (SD 0.3899) and the experts had an accuracy of 0.0925 bits (SD 0.1210) while using the NeuroTouch. Novices and …

Expanding The Concept Of ‘Care’: A Narrative Study Exploring Lessons From End-Of-Life Patients To Inform ‘Medical Assistance In Dying’ Curriculum In Canada, Jill Dombroski

Electronic Thesis and Dissertation Repository

This research primarily investigates what we can learn from patient experiences that can help inform the expected curricula that will be developed in response to the new Canadian legislation regarding Medical Assistance in Dying (MAID). This is a compelling area of research because of the rapidly evolving attitudes in the general population — largely driven by terminally ill patients asserting their legal rights over their bodies and the decision to put an end to their lives as a consequence of the illness they face. The issue of medical assistance in dying has been patient initiated and patient driven. Through the …

Using A Deliberative Dialogue To Facilitate The Uptake Of Research Evidence In Rehabilitation For Children With Cerebral Palsy, Alisiyah Daya

Electronic Thesis and Dissertation Repository

This study explores how to facilitate the use of research evidence to optimize outcomes for children with cerebral palsy (CP) in practice. Findings from two studies were used as the basis for exploring how to comprehensively assess developmental trajectories of children with CP and plan individualized interventions. Seventeen affiliated stakeholders (e.g. physicians, senior leadership, frontline clinicians, families and youth with CP) participated in this study.

Data from a deliberative dialogue and interviews were analyzed using grounded theory methods with a pragmatic perspective. The results highlighted that all areas of practice must engage in knowledge translation to be effective. Stakeholders outlined …