Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics.

Introduction: For continuing professional development (CPD) to reach its potential to improve outcomes requires an understanding of the role of context and the influencing conditions that enable interventions to succeed. We argue that the heuristic use of frameworks to design and implement interventions tends to conceptualize context as defined lists of barriers, which may obscure consideration of how different contextual factors interact with and intersect with each other.

Methods: We suggest a framework approach that would benefit from postmodernist theory that explores how ideologies, meanings, and social structures in health care settings shape social practices.

Paradox of Patient-Centered Care and the Implications for Patient Involvement in Continuing Professional Development.

Introduction: Patient-centered care (PCC) is widely considered as essential in chronic disease management. As the underlying rationale for engaging patients in continuing professional development (CPD) is commonly described as fostering care that is more patient-centered, we hoped to understand the discursive conditions for how educators and health professionals can (or cannot) learn with, from, and about patients.

Methods: Using diabetes as a case, we conducted a Foucauldian discourse analysis of an archive of relevant policy documents, professional and educational texts, to explore different conceptualizations of practice and the implications for PCC.

A Dialogic Approach to Teaching Person-Centered Care in Graduate Medical Education.

Background: Training future physicians to provide compassionate, equitable, person-centered care remains a challenge for medical educators. Dialogues offer an opportunity to extend person-centered education into clinical care. In contrast to discussions, dialogues encourage the sharing of authority, expertise, and perspectives to promote new ways of understanding oneself and the world.

Determining Root Causes and Designing Change Ideas in a Quality Improvement Project.

In this second article of our diabetes quality improvement primer series, readers will become familiar with various diagnostic tools used to understand the root causes of a quality problem. We discuss change concepts, and specific change ideas are developed to match the root causes. We review the application of a plan-do-study-act cycle from the Model for Improvement quality improvement framework to test 1 change idea and measure for the intended improvements.

Beginning a Diabetes Quality Improvement Project.

There is a large evidence-to-clinical practice gap in diabetes care. Application of quality improvement (QI) strategies can be used to improve gaps in care delivery. In this first of 3 articles in the diabetes QI primer series, we introduce the steps required to plan a QI project by using a case example for improving foot screening of people with diabetes.

Implementing Change Ideas, Interpreting Data and Sustaining Change in a Quality Improvement Project.

This article is the third and final installment in our diabetes quality improvement primer series. It summarizes how to interpret real-time data with run charts and highlights 4 key rules that can be applied to understand whether improvement is statistically significant. We also review the importance of outlining a family of measures, including outcome, process and balancing measures.

Effects of a Longitudinal Interprofessional Educational Outreach Program on Collaboration.

Introduction: Interprofessional education (IPE) interventions lack clarity regarding development and implementation, impeding a clear understanding of their role and effectiveness. The aim of this study was to identify whether and how an outreach program targeting interprofessional health care teams can improve self-efficacy and interprofessional collaboration (IPC).

Methods: A cohort study was conducted to explore the effect of the program on individual self-efficacy and perceived IPC and investigate factors affecting interprofessional learning and collaboration.

Frontline over ivory tower: key competencies in community-based curricula.

Background: The Royal College of Physicians and Surgeons of Canada mandates that community experiences be incorporated into medicine-based specialties. Presently there is wide variability in community endocrine experiences across Canadian training programs. This is complicated by the paucity of literature providing guidance on what constitutes a 'community' rotation.

Shifting contours of boundaries: an exploration of inter-agency integration between hospital and community interprofessional diabetes programs.

This article reports on research into the relationships that emerged between hospital-based and community-based interprofessional diabetes programs involved in inter-agency care. Using constructivist grounded theory methodology we interviewed a purposive theoretical sample of 21 clinicians and administrators from both types of programs. Emergent themes were identified through a process of constant comparative analysis.

Defining Content for a Competency-based (CanMEDS) Postgraduate Curriculum in Ambulatory Care: a Delphi Study.

Background: Ambulatory training in internal medicine has been noted to be dysfunctional and inadequate. In this study, we developed a set of competency-based outcomes specific to ambulatory care to guide the design, implementation and evaluation of instructional events to ensure that societal needs are addressed.

Methods: In 2007 a Delphi technique was used to reach consensus and define the priorities for competency-based training in ambulatory care for internal medicine residents.

A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study.

Background: Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed.

Lymphocytic hypophysitis with a long latent period before development of a pituitary mass.

Background: Lymphocytic hypophysitis is an autoimmune condition that commonly presents in women of childbearing age as hypopituitarism and a sellar mass.

Case Report: A 66-year-old woman presented with anterior pituitary dysfunction. Computed tomography imaging revealed a small hypodensity that was not felt to be the cause of the pituitary dysfunction.