Leadership development in postgraduate medical education: a systematic review of the literature

Mar 1, 2019

Authors: Nabil Sultan, Jacqueline Torti, Wael Haddara, Ali Inayat, Hamza Inayat, Lorelei Lingard

 

Source: Academic Medicine

 

Volume: 94
 

Issue: 3

 

Publisher: LWW
 

Description:

Purpose To evaluate and interpret evidence relevant to leadership curricula in postgraduate medical education (PGME) to better understand leadership development in residency training.
Method The authors conducted a systematic review of peer-reviewed, English-language articles from four databases published between 1980 and May 2, 2017 that describe specific interventions aimed at leadership development. They characterized the educational setting, curricular format, learner level, instructor type, pedagogical methods, conceptual leadership framework (including intervention domain), and evaluation outcomes. They used Kirkpatrick effectiveness scores and Best Evidence in Medical Education (BEME) Quality of Evidence scores to assess the quality of the interventions.
Results Twenty-one articles met inclusion criteria. The classroom setting was the most common educational setting (described in 17 articles …

Navigating complexity in team‐based clinical settings

Nov 11, 2018

Authors: Kori A LaDonna, Emily Field, Christopher Watling, Lorelei Lingard, Wael Haddara, Sayra M Cristancho

 

Journal: Medical education
 

Volume: 52
 
Issue: 11
 

Description:

Context

Educators must prepare learners to navigate the complexities of clinical care. Training programmes have, however, traditionally prioritised teaching around the biomedical and the technical, not the socio‐relational or systems issues that create complexity. If we are to transform medical education to meet the demands of 21st century practice, we need to understand how clinicians perceive and respond to complex situations.

Methods

Constructivist grounded theory informed data collection and analysis; during semi‐structured interviews, we used rich pictures to elicit team members’ perspectives about clinical complexity in neurology and in the intensive care unit. We identified themes through constant comparative analysis.

Results

Routine care became complex when the prognosis was unknown, when treatment was either non‐existent or had been exhausted or when being patient and family centred …

The impact of delayed critical care outreach team activation on in-hospital mortality and other patient outcomes: a historical cohort study

Nov 1, 2018

Authors: Bourke W Tillmann, Michelle L Klingel, Shelley L McLeod, Scott Anderson, Wael Haddara, Neil G Parry

 
Journal: Canadian Journal of Anesthesia/Journal canadien d’anesthésie
 

Volume: 65

 

Issue: 11
 

Publisher: Springer US
 

Description:

Purpose

Early warning scores (EWS) and critical care outreach teams (CCOT) have been developed to respond to decompensating patients. Nevertheless, controversy exists around their effectiveness. The primary objective of this study was to determine if a delay of ≥ 60 min between when a patient was identified as meeting EWS criteria and the CCOT was activated impacted in-hospital mortality.

Methods

This was a historical cohort study evaluating all new CCOT activations over a four-year study period (1 June 2007 to 31 August 2011) for inpatients ≥ 18 yr of age at two academic tertiary care hospitals in London, Ontario, Canada. Multivariable logistic regression accounting for repeated measures was used to determine the effect of delayed CCOT activation on in-hospital mortality (primary outcome). Differences in outcomes between medical and …

 

Triiodothyronine replacement in critically ill adults with non-thyroidal illness syndrome

Oct 1, 2018

Authors: Salmaan Kanji, Jonathan Neilipovitz, Benjamin Neilipovitz, John Kim, Wael MR Haddara, Michelle Pittman, Hilary Meggison, Rakesh Patel

 

Journal: Canadian Journal of Anesthesia/Journal canadien d’anesthésie
 

Volume: 65

Issue: 10
 
Publisher: Springer US
 

Description:

Purpose

Non-thyroidal illness syndrome is commonly encountered in critically ill patients, many of whom are treated with thyroid hormones despite uncertainty regarding their safety and effectiveness. This retrospective observational study sought to evaluate the utilization, safety, and effectiveness of triiodothyronine (T3) supplementation in critically ill adults admitted to either of two non-cardiac surgery mixed-medical/surgical intensive care units (ICU).

Methods

Consecutive adults admitted to an ICU and treated with enterally administered T3 were identified over a two-year period. Data pertaining to demographics, T3 utilization, safety, and clinical outcomes were collected.

Results

Data were extracted from the medical records of 70 consecutive patients. All had baseline serum free T3 concentrations below the lower limit of …

 

Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave

Apr 3, 2018

Authors: Amanda Grant-Orser, Brennan Ballantyne, Wael Haddara

Journal: Case reports in critical care

Volume: 2018

Publisher: Hindawi

Description:

A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.

 

Exploring the premise of lost altruism: content analysis of two codes of ethics

Sep 26, 2017

Authors: Wael Haddara, Lorelei Lingard
 

Journal: Advances in Health Sciences Education

Volume: 22

Issue: 4
 
Publisher: Springer Netherlands
 
Original link:
 

Abstract

As an ideal, altruism has long enjoyed privileged status in medicine and medical education. As a practice, altruism is perceived to be in decline in the current generation. A number of educational efforts are underway to reclaim this “lost value” of medicine. In this paper we explore constructions of altruism over a defined period of time through a content analysis of the Canadian and Australian Medical Associations (CMA and AMA respectively) Codes of Ethics. We analyzed all editions of both Codes (1868–2004), using a content analysis approach, including thematic analysis. We coded as altruistic or non-altruistic, respectively, statements in which the interest of the patient is placed ahead of the physician’s and statements in which the interest of the physician is given primacy. We examined the pattern of appearance and disappearance of these statements over time. We identified 13 altruistic and 2 non-altruistic statements across all editions. There is a gradual and uneven loss of altruistic content over time. The CMA Codes of 1938, 1970 and 2004 and the AMA code of 1992 represent significant change points. The most recent versions of both Codes contain only 1 altruistic statement and both non-altruistic statements. We conclude that altruism appears to be a fluid and changing concept over time. Loss of altruism is not merely a current generational issue but extends through the past century and is likely due to political and social forces. These results call into question current educational attempts to reclaim altruism, and point to the social evolution of the ideal.

 
 
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Acknowledgments

Lorelei Lingard is supported as a scientist in the Program of Experimental Medicine in the Department of Medicine at the Schulich School of Medicine and Dentistry, Western University.

Author information

Affiliations

  1. Divisions of Critical Care Medicine and Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine, Western University, 339 Windermere Road, Office B2-194, London, ON, N6G 2K1, Canada

    Wael Haddara

  2. Department of Medicine, The Faculty of Education, The Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Lorelei Lingard

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  1. Wael Haddara
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Correspondence to Wael Haddara.

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Cite this article

Haddara, W., Lingard, L. Exploring the premise of lost altruism: content analysis of two codes of ethics. Adv in Health Sci Educ 22, 839–852 (2017). https://doi.org/10.1007/s10459-016-9713-6

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Keywords

  • Altruism
  • Medical education
  • Codes of ethics