Browsing by Author "Cooke, Lara"

Now showing 1 - 6 of 6
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    Exploring How Best to Teach Trauma-Informed Care in Undergraduate Medical Education
    (2023-05-09) Young, Jessica Lynn; Brown, Allison; Cooke, Lara; Jalil, Rabiya; Waegemakers Schiff, Jeannette
    Trauma-informed care (TIC) is an approach that recognizes the potential for patients to have experienced trauma and requires care to be sensitive and adaptive to this; ongoing calls to action continue to highlight the need for TIC to be incorporated into the training of medical doctors. This exploratory qualitative study employed constructivist grounded theory methods to empirically investigate how leading physicians in Canada conceptualize and operationalize TIC and further examine how it could be effectively taught to medical learners during undergraduate medical education (UME). The study found that physicians view TIC as a practice philosophy, rather than a specific framework or set of skills, oriented around seven principles. Rather than viewing trauma as a biomedical or psychiatric condition, physicians saw structures and systems of oppression as mediators for – and causes of – trauma. Findings illuminate foundational knowledge and skills necessary to augment the translation of TIC in clinical practice that can be used to inform what and how medical schools teach TIC. This study identified the importance of longitudinal integration, spirality, and meaningful applications of TIC in a UME-level TIC curriculum, which ensures that all learners are introduced to the construct of TIC and are able to apply it in early clinical interactions. However, challenges such as the contradictory and powerful influence of the hidden curriculum as well as the critical need for faculty development must be addressed. Overall, this emphasizes the need for physician training to cultivate context- dependent and adaptable approaches to TIC in an effort to break the cycle of systemic violence and trauma in medicine.
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    Exploring the longitudinal experiences of physicians transitioning to unsupervised practice: A realist study
    (2022-01-17) Zaver, Fareen; Ellaway, Rachel; Lord, Jason; Cooke, Lara; Sherbino, Jonathan
    Problem: The transition from residency to unsupervised practice is a longitudinal process that is fraught with challenges. Most new attendings do not feel adequately prepared or supported for their new roles and responsibilities. We need to better understand the challenges physicians face transitioning to unsupervised practice.Method of Study: The study aim was to explore the different mechanisms that shape a physician’s ability to successfully transition to unsupervised practice. As the transition to unsupervised practice is complex and highly context-dependent, a qualitative realist evaluation study design was used to explore how different factors (mechanisms) can lead to different outcomes for different individuals transitioning to practice. Participants in a variety of specialties were recruited for semi-structured interviews at three points in time - one in the final months of residency, and two at different points in their first year in unsupervised practice. Conclusion: Eight middle-range theories were developed from the data covering: the varying opportunities and challenges participants faced whether or not they stayed at the institutions they trained at, the challenges of learner supervision, the effects of fellowship training, how variable their practice was compared to what they were exposed to in residency training, the timing of orientation or training sessions, being hired into a locum contract, and how sheltered trainees were from the realities of unsupervised practice. Each of these theories have implications for key stakeholders. Residency programs should expose their trainees to the breadth of practice available in each specialty and provide resident autonomy that reflects realistic experiences of unsupervised practice. Departments should have formalized mentorship programs, shadow shifts, and site and department specific orientations. In addition, they should strive to protect new staff from unnecessary stressors through a graduated increase in responsibilities. Both residency programs and departments should provide sessions regarding the new supervisory role, specifically teaching how to manage senior learners and learners in difficulty.
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    How do competence committees make decisions about resident progression? A qualitative study
    (2021-10-15) Curtis, Colleen Mary; Cooke, Lara; Kassam, Aliya; Lord, Jason
    Competence committees (CC) determine trainees’ progression through postgraduate competency-based medical education (CBME) programs. Models of how CC function identify that most programs take a problem-identification approach while others provide developmental feedback to every trainee. While CC are tasked with high stakes decisions, the process by which they discuss and make decisions about resident progression remains uncertain, with few publications addressing this question. The purpose of this qualitative study was to describe the factors affecting CC decision-making. This instrumental case study examined two CC at a Canadian institution, three years post-CBME launch. Over a six-month period, one researcher observed four CC meetings and conducted interviews with 10 CC members which were audio recorded and transcribed verbatim. Royal College documents, CC terms of reference, investigator reflections, and memos created throughout the study were also examined. Following a constructivist grounded theory approach with constant comparison, two investigators coded transcripts independently and jointly to refine a codebook and identify themes in the data. Our theory-informed analysis led to a theoretical framework of CC decision-making: a process beginning within a social decision schema model and evolving to a discussion invoking social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. The committee mindset determined the likelihood of entering a discussion about trainees; triggers for discussion related to CC members’ uncertainty of the process or concerns with the adequacy of the data. Ensuing conversations considered the context of the individual resident and CC members’ experiences. We found that ongoing challenges with CC functioning persist three years post-CBME implementation. Despite Royal College recommendations and local terms of reference, CC provide limited developmental feedback to trainees who are doing well, and acknowledge that biases could affect the intended process. While this study only examined two CC, it identified important themes to address when considering a robust CC process.
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    Identifying Core Curricular Content for the Health Advocate Role in Neurology
    (2013-07-12) Abuzinadah, Ahmad; Cooke, Lara; Violato, Claudio; Cooke, Lara; Yeung, Michael; Fletcher, William
    Background: Health advocacy is one of the competencies required by the Royal College of Physicians and Surgeons of Canada. Lack of curriculum and clarity around this competency are obstacles for effectively teaching health advocacy to neurology residents. The purpose of this study was to identify the top five neurological diseases suitable to form the core content of a Health Advocacy curriculum and to develop the detailed curricular content items on health advocacy based on these findings. Methods: This is a cross-sectional study that includes a survey and Delphi procedure in two separate steps. In step one, neurologists and neurology residents were asked to rank 56 neurological diseases on a Likert scale based on how well the neurological disease lends itself to teaching the health advocacy aspects of neurology. In step two, curricular items were developed for the top five neurological diseases based on the mean Likert scale score, using a modified Delphi procedure. Cronbach’s alpha was used to determine the reliability of the survey instrument, and factor analysis was used for construct validity. Results: 46 neurologists and 14 neurology residents were surveyed with total response rate of 88.33%. The top five neurological presentations that neurologists identified, which lend themselves easly to teaching health advocacy are: stroke/transient ischemic attacks, alcoholism, epilepsy, Alzheimer's disease and multiple sclerosis. The reliability of the survey instrument was 0.97. Exploratory factor analysis revealed four factors that can explain the variability in the survey instrument: chronic conditions affecting mobility and cognition, Paroxysmal or transient neurological conditions, conditions requiring cross-disciplinary specialist care, and Chronic conditions affecting cognition with potential improvement. Consensus on the curriculum content items was achieved using modified Delphi procedure. Conclusion: Neurological presentations that suitable for a foundational curriculum for neurology health advocacy were identified. Consensus was achieved on curricular items for the top five neurological presentations that easily fit into a program of teaching health advocacy.
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    A prospective randomized trial of content expertise versus process expertise in small group teaching
    (BioMed Central, 2010-10-14) Peets, Adam D.; Cooke, Lara; Wright, Bruce; Coderre, Sylvain; McLaughlin, Kevin
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    The evolution of a pattern language of feedback in medical education
    (2024-07-03) Patocka, Catherine; Ellaway, Rachel; Cooke, Lara; Ma, Irene
    Feedback is embedded within the fabric of medical education. Although the literature refers to feedback as if it were well-defined, in practice what feedback means can vary greatly. Consequently, it remains a source of consternation for learners and teachers as a process fraught with paradoxes. When done well, feedback can improve performance, however it can also have highly variable outcomes. Through an in-depth examination of feedback, my research has acknowledged the challenges presented by it and other equally polysemic concepts. My research has considered the philosophical, theoretical, and methodological assumptions underpinning our existing approaches to feedback and in response I present a path to a more inclusive approach through the application of pattern theory. To approach the task of applying pattern theory, I adapted scoping review methodology to develop a pattern system of feedback in medical education which includes 36 pattern representations. Through a comparative case study, I applied the pattern system to models of feedback, and I provided validity evidence for the pattern system. By outlining the connections between pattern representations within it, I also began to elaborate the pattern system into a pattern language. Finally, I used a case study research methodology to develop a thick description of the challenges of bringing this novel theory-informed conceptual framing of feedback into a more practical space. In all this work, I have advocated for generative (rather than successionist) models of explanations of feedback and lay the foundations for exploring the intersection of realist inquiry and pattern epistemology. Feedback is used as an illustrative case throughout this thesis. The pattern system of feedback I developed, my documentation of the disjointed discourses of feedback in medical education, and my description of this evolving pattern language of feedback can all serve to advance thinking and theory building in this conceptual space. Furthermore, my use of various methodologies to tackle this polysemic concept is, I will argue, a viable approach for studying other fuzzy concepts in our field. As such, not only can my work provide insights into feedback, but it also provides opportunities to explore other equally vexing problems.