Background: In Ethiopia, 17.6% of the population has disabilities. Research has largely overlooked students with disabilities (SWDs), focusing instead on caregivers, teachers and officials. Objectives: The current study sought to include SWD voices by examining their experiences and identifying barriers and enablers to education in Ethiopia. Method: A participatory action research approach with a critical theory lens, engaging SWDs in two phases was carried out. In phase one, student researchers received training through collaboratively developed modules on research concepts, questions, tools and data analysis. Student researchers identified, co-created, refined and finalised the study methods. In phase two, student researchers conducted 18 interviews and two focus group discussions. Results: Results indicated that physical, sensory and financial inaccessibility negatively influenced the social lives of SWDs, reinforced stigmatising societal perspectives and disadvantaged them compared to their peers without disabilities. Stigma led to feelings of hopelessness and social exclusion. However, having a supportive (‘threshold’) person or organisation, individual grit, love and trust in education and a desire to defy critics (i.e. positive revenge) contributed to student success. Conclusion: Early interventions are vital for supporting SWDs in engaging with education. A dedicated advocate can significantly impact their success. Contribution: This study contributes to disability studies and inclusive policy by centring the voices of SWDs in Ethiopia, highlighting their lived experiences. It offers practical insights into how systemic stigma, inadequate infrastructure and limited psychosocial support hinder inclusion, while support systems, personal resilience and early interventions enhance educational success.

Background: There is an ongoing need for Equity, Diversity, and Inclusion (EDI)-focused admission reform in Canadian health sciences programs. Extensive literature on critical race Theory (CRT) and Postcolonial Theory (PCT) have provided frameworks to understand and challenge existing inequities. However, there is a lack of research regarding specific challenges and dynamics involved in the application of CRT and PCT to admissions in health professions education. Methods: This study investigates systemic factors influencing EDI-focused admission reform through the perceptions of Canadian health sciences faculty leaders. Using a critical constructivist lens informed by CRT and PCT, we conducted semi-structured interviews with six leaders and applied critical thematic analysis, which uses theories of racism, coloniality, and power, to interpretate participants’ views and institutional discourses. Results: Participants acknowledged bias in traditional admission metrics (e.g., GPA, MCAT) but continued to prefer them over equity-based alternatives, perceiving the former as better indicators of curricular and professional success. Admission reform was perceived to be a resource-intensive add-on that was difficult to prioritize. Broader societal and institutional forces, such as accreditation, peer institutions, and leadership discourses shaped support for equity initiatives. Conclusion: We conclude that the concurrent reliance on traditional measures of merit in admissions, curriculum, and practice reinforces the cultural currency of those colonial measures. Admission reform efforts should be accompanied by parallel initiatives across other academic domains and appropriate funding and regulatory support to break the self-fulfilling cycle of bias and inequity.

Objectives: The objective of this review is to identify, appraise, and synthesize available evidence on the experiences of informal caregivers providing HIV and/or AIDS care and the experiences of care received by people living with HIV and/or AIDS (PLHIV) in sub-Saharan Africa. Introduction: PLHIV share the burden of the disease with their informal caregivers throughout their lives. Experiences of HIV- and/or AIDS-related caregiving and care receiving have a significant impact on the treatment and physiological health outcomes of both care receivers and caregivers. However, there is limited evidence regarding how caregiving approaches and caregiving experiences influence HIV and/or AIDS care. Inclusion criteria: This review will consider qualitative studies on informal caregivers providing HIV- and/or AIDS-related care and PLHIV receiving care in sub-Saharan Africa. Eligible studies will focus on positive and negative experiences of informal caregivers and PLHIV throughout the HIV/AIDS caregiving continuum. Methods: A comprehensive search strategy will be developed to retrieve relevant articles from Ovid MEDLINE (R), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCOhost). The review will be conducted by 2 independent reviewers using the JBI approach to perform study selection, critical appraisal, data extraction, assessment of confidence, and data synthesis. Review registration: PROSPERO CRD42023470996

Background:Lyme disease (LD) is a multisystemic disease without a current approved human vaccine. Increasing infection rates have created pressure to improve the diagnosis and treatment of LD in Canada. This study aims to inform LD care through the exploration of health care practitioner (HCP) perspectives, experiences, beliefs, and knowledge of LD diagnosis and treatment. Methods:Canadian HCPs took part in bilingual (English and French) semi-structured interviews to explore their experiences and perspectives related to LD diagnosis and treatment. Major themes within and between participants were identified using inductive thematic analysis and axial coding. Results:A total of 43 HCPs working in LD-related fields participated in this study. Four major themes were identified; HCPs have: 1) Similar perspectives regarding antibiotic use, regional influences, and physician referral; 2) diverse perspectives on the use of serology testing and barriers for LD diagnosis and treatment between endemic and nonendemic regions; 3) challenges and disagreement toward diagnosing and treating chronic LD; and 4) trust in one (among several) LD guidelines, yet consult a variety of secondary sources for additional LD knowledge. Discussion:The findings reveal a pressing need for greater consistency among HCPs regarding the diagnosis and treatment of LD in Canada. Variation can be attributed to diverse beliefs, perspectives, and approaches within LD practitioners generally, but is particularly evident when addressing, acknowledging, and defining chronic LD.

Objectives:The objective of this review is to identify, appraise, and synthesize available evidence on the experiences of informal caregivers providing HIV/AIDS care, as well as the experiences of care received by people living with HIV/AIDS (PLHIV) in sub-Saharan Africa.Introduction:PLHIV share the burden of the disease with their informal caregivers throughout their lives. Experiences of HIV/AIDS-related caregiving and care-receiving have a significant impact on the treatment and physiological health outcomes of both caregivers and care recipients. However, there is limited evidence regarding how caregiving approaches and caregiving experiences influence HIV/AIDS care.Eligibility criteria:This review will consider qualitative studies on informal caregivers providing HIV/AIDS-related care as well as the experiences of PLHIV receiving care in sub-Saharan Africa. Eligible studies will focus on both the positive and negative experiences of informal caregivers and PLHIV throughout the HIV/AIDS caregiving continuum.Methods:This review will follow the JBI methodology for systematic reviews of qualitative evidence. A comprehensive search strategy will be developed to retrieve relevant articles from MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCOhost). The review will be conducted by 2 reviewers who will independently perform study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence in the findings.Review registration:PROSPERO CRD42023470996

This is a protocol for a Campbell Review following JBI scoping review methodology. The objectives are to answer the following questions: What has been reported in the literature about collaborative learner-educator design, implementation, or evaluation of learner assessment in health professional education? (1) Where is learner-educator co-creation of assessment occurring? (i.e., which disciplines, course types, level of learner, year of study). (2) What course assessment decisions are influenced or being made together? (i.e., assessment instructions and/or grades). (3) How much influence do learners have on decision-making? (i.e., where does it fall on Bovill and Bulley's ladder of participation). (4) How do learners and educators go about making decisions together? (i.e., discussion or voting, with a whole class or portion of the class). (5) What are the perceived benefits, disadvantages, barriers, and/or facilitators reported by the authors?

Objective: The objective of this review is to describe the experience of loneliness and/or depression due to spousal separation when one or both spouses are admitted into a long-term care facility. Introduction: Loneliness and depression are important concerns for the health and well-being of older adults separated from their spouses due to long-term care placement. Social relationships, specifically spousal relationships, have a significant impact on the mental health of older adults. However, there is limited research on the experience or effect of spousal separation on long-term care residents' and their spouses' experience of loneliness and/or depression. Inclusion criteria: This review will include long-term care residents and their spouses who are over the age of 50 and have a spouse they are separated from due to long-term care placement. Studies will be included in this review if they explore the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in a long-term care facility. Methods: This review will be conducted in line with the JBI methodology for systematic reviews of qualitative evidence. MEDLINE was used for the initial search. A full search strategy was then developed for MEDLINE, CINAHL, Embase, and PsycINFO. The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be used. Two reviewers will pilot test the screening criteria and data extraction protocol. Review registration:PROSPERO CRD42022333014

Private well owners in Ontario are responsible for maintaining their wells and monitoring the quality of their well water supplies. Protective actions including well maintenance, treatment and regular water quality testing are crucial in preventing well water contamination and reducing exposure to waterborne pathogens, however participation rates are low. The current study sought to explore knowledge, perceptions, and behaviours among private well owners in two communities in southeastern Ontario (i.e., Town of Greater Napanee and Stone Mills Township) and contextualize relationships between motivators and barriers to undertaking protective actions. Semi-structured interviews were used to collate data from 40 private well owners (20 per community) in March 2021. The authors used a reflexive thematic analysis approach to arrive at central themes. Overall, four major themes were identified: (1) barriers to protective actions, (2) motivators to protective actions, (3) knowledge of potential sources and factors affecting local groundwater quality, (4) satisfaction and perceived drawbacks of well water as a drinking water source. Complacency regarding well water quality, low perceptions of risk, and inconvenience were key barriers, whereas “peace of mind” was a primary motivator to protective actions. Participants were more responsive to health events than environmental events, with differences in perceptions of risk and awareness between the two study communities found. This study provides insights into key socio-cognitive factors influencing protective actions and the unique and context-specific needs of private well owners. Findings may be used to inform development of tailored knowledge-translation strategies and evidence-based tools to enhance sustainable well water safety and management among private well owners in the province, Canada and globally.

OBJECTIVES:The objective of this scoping review is to map methods used to study medication safety following electronic health record (EHR) implementation. Patterns and methodological gaps can provide insight for future research design. MATERIALS AND METHODS:We used the Joanna Briggs Institute scoping review methodology and a custom data extraction table to summarize the following data: (1) study demographics (year, country, setting); (2) study design, study period, data sources, and measures; (3) analysis strategy; (4) identified limitations or recommendations; (5) quality appraisal; and (6) if a Safety-I or Safety-II perspective was employed. RESULTS:We screened 5879 articles. One hundred and fifteen articles met our inclusion criteria and were assessed for eligibility by full-text review. Twenty-seven articles were eligible for extraction. DISCUSSION AND CONCLUSION:We found little consistency in how medication safety following EHR implementation was studied. Three study designs, 7 study settings, and 10 data sources were used across 27 articles. None of the articles shared the same combination of design, data sources, study periods, and research settings. Outcome measures were neither defined nor measured consistently. It may be difficult for researchers to aggregate and synthesize medication safety findings following EHR implementation research. All studies but one used a Safety-I perspective to study medication safety. We offer a conceptual model to support a more consistent approach to studying medication safety following EHR implementation.

Lyme disease (LD) is the most commonly diagnosed tick-borne disease in North America and parts of Europe. Current mitigation strategies rely on personal protective behaviours, early diagnosis, and antibiotic treatment. This review updates on previous reviews on educational interventions for the prevention of LD and examines the impact of different interventions on the knowledge, attitudes and behaviours of healthcare professionals and the general public. We searched six databases for studies reporting participant assessment on knowledge, attitudes, and behaviours related to LD. We included studies targeting the public as well as healthcare professionals. We used keywords related to Lyme disease, health knowledge, attitudes, practices, community, health education, prevention, diagnosis, and treatment. Fourteen studies were included in this review; 13 reported educational interventions focused on the prevention of LD in the public, and one on physicians’ diagnosis of LD. Regardless of the type of intervention, the public’s knowledge (11/13 studies) were generally observed to improve post-intervention, though changes to preventive behaviours and attitudes were inconsistent. A key finding in this study was that no studies reported outcomes from interventions targeted at educating healthcare professionals on their knowledge of LD, or how to treat LD. Our review demonstrated that public health interventions enhance assessed and/or perceived LD knowledge. However, more research is needed to investigate interventions directed at healthcare professionals across the spectrum of LD: prevention, diagnosis, and treatment of early, late and post-treatment illness. PROSPERO 2019.

Simulation-based activities (SBAs) research has explored the perceived and actual impact of SBAs on nursing education. The current study compares the perceived efficacy and transferability of nursing simulation to clinical practice from the point of view of simulation facilitators (SFs), course professors (CPs) and students. A one-time online survey was administered to SFs, CPs and students regarding SBA effectiveness. Quantitative data were analysed using descriptive analysis. Student participants (especially those in years 2 and 3) perceived simulation to be a poorer (relative to course professors and SFs) reflection of their capabilities and means of developing clinical skills. Participants (including students, CPs and SFs) who reported that simulation group sizes as ideal were better prepared for SBAs, able to engage in clinical roles and to more effectively incorporate feedback. Qualitatively, CPs identified low-quality SBA facilitation as a barrier to learning effectiveness, and SFs described multiple approaches to simulation that influence transferability to clinical practice. We conclude that a misalignment between the strengths and weaknesses of SBAs by CPs, SFs and students may challenge improvement efforts. Group size, less positive student attitudes and a lack of confidence in SFs should be specifically addressed.

Purpose: To develop a method for objective analysis of the reproducible steps in routine cataract surgery.Design: Prospective study; machine learning.Participants: Deidentified faculty and trainee surgical videos.Methods: Consecutive cataract surgeries performed by a faculty or trainee surgeon in an ophthalmology residency program over 6 months were collected and labeled according to degrees of difficulty. An existing image classification network, ResNet 152, was fine-tuned for tool detection in cataract surgery to allow for automatic identification of each unique surgical instrument. Individual microscope video frame windows were subsequently encoded as a vector. The relation between vector encodings and perceived skill using k-fold user-out cross-validation was examined. Algorithms were evaluated using area under the receiver operating characteristic curve (AUC) and the classification accuracy.Main Outcome Measures: Accuracy of tool detection and skill assessment.Results: In total, 391 consecutive cataract procedures with 209 routine cases were used. Our model ach-ieved an AUC ranging from 0.933 to 0.998 for tool detection. For skill classification, AUC was 0.550 (95% confidence interval [CI], 0.547-0.553) with an accuracy of 54.3% (95% CI, 53.9%-54.7%) for a single snippet, AUC was 0.570 (0.565-0.575) with an accuracy of 57.8% (56.8%-58.7%) for a single surgery, and AUC was 0.692 (0.659-0.758) with an accuracy of 63.3% (56.8%-69.8%) for a single user given all their trials.Conclusions: Our research shows that machine learning can accurately and independently identify distinct cataract surgery tools in videos, which is crucial for comparing the use of the tool in a step. However, it is more challenging for machine learning to accurately differentiate overall and specific step skill to assess the level of training or expertise.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology Science 2023;3:100235 & COPY; 2022 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum.Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method.Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes.Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.

BACKGROUND: A perioperative acute pain care program integrating standardized assessment and treatment forms into pain care was developed and implemented at an urban hospital in Rwanda through a collaboration between Rwandan and Canadian experts. This study evaluated the perioperative acute pain care program using a quality improvement lens. METHODS: Using the Model for Improvement: Plan, Do, Study, Act (PDSA) cycle, a mixed methods evaluation was performed. Over one year, 519 randomized patient chart audits were conducted and analyzed through control charts. Through purposeful sampling, focus groups comprised of surgeons and nurses (N=34) involved in pain care in surgery, obstetrics, and anesthesiology were performed and analyzed via thematic coding. RESULTS: The average attempted form completion rate across all forms varied monthly between 56-93% (mean=79%; median=81%). Across all forms, both the mean and median total number of errors per form were 12.5. Enablers of form use included improved pain care for patients and feelings of professional satisfaction. Program implementation was challenged by resource constraints, form integration, and health care provider training. CONCLUSION: Future quality improvement collaborations should identify and address improved pain care while working with local experts to ensure PDSA cycles are continuous, and evidence based.

OBJECTIVE:This review sought to collect and synthesize studies that investigated the lived experience of barriers and facilitators to educational access and excellence for students with disabilities in low- and middle-income African countries. INTRODUCTION:Access to education in low- and middle-income African countries for students with disabilities is often inequitable. Although governments have developed policies and programs for student with disabilities, much of the literature guiding policy and program development has focused on the views of academics, parents, teachers, and political figures. INCLUSION CRITERIA:This systematic review considered studies that included participants who were students or trainees at the time of the study, have a disability, and were located in a low- and middle-income African country. The phenomena of interest were barriers and facilitators to educational success for students with disabilities. This review included qualitative, interpretive, and critical studies that drew on the experiences of students with disabilities. METHODS:An initial search was conducted in CINAHL and MEDLINE, followed by development of a full search strategy that was used for AMED, Embase, CINAHL, Global Health, MEDLINE, and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions, spanning from 1910-2021. Articles were limited to those published in English. The JBI approach was followed for study selection, critical appraisal, data extraction, data synthesis, and assessing confidence in the findings with ConQual. RESULTS:Thirteen qualitative studies were included from seven African countries, and included primary, secondary and postsecondary students. The data were qualitatively synthesized into 64 findings, within six categories, which then formed two synthesized findings. The synthesized findings were: barriers and challenges to engaging in education, and supports for educational success. CONCLUSIONS:This review is a synthesis of the lived experiences of students with disabilities in low- and middle-income African countries to understand, in their own words, the challenges and supports they encounter during their educational journeys. Although many barriers and supports reported by students with disabilities and other stakeholders (eg, parents, teachers, administrators) are similar to those identified in this review, our findings identify that integrated research that includes students with disabilities will provide contextual and individual factors that are crucial for students to achieve equitable access to education. SYSTEMATIC REVIEW REGISTRATION NUMBER:PROSPERO CRD42019137951.

Handover is the transfer of important clinical information between health providers. The current report describes a needs assessment of interprofessional labor and delivery handover at an urban hospital in Canada. The goal of this study was to explore the perceptions of the current handover meeting and opportunities for improvement. Using a constructivist paradigm, we conducted 28 semi-structured inter- views with handover participants. We used a recruitment grid to ensure we included the voices of participants representing each profession involved in interprofessional handover meetings. An inductive process was used to code the interview transcripts and theme the data. Major themes identified were: (1) Interprofessional handover contributes positively to team situational awareness, interprofessional relationships, and team communication; (2) Handover could be better if it had a more defined process; (3) Interprofessional handover can lead to feelings of intimidation; and (4) Interprofessional handovers on the labor and delivery unit in our setting need increased inclusivity of midwives. From these themes, continued development of interprofessional handover meetings on labor and delivery should be aimed at a formal definition of the scope and process for these meetings reducing feelings of intimidation, increased integration of Midwifery providers, and continued improvement of relationships between different professions and practitioners on labor and delivery.

INTRODUCTION:Lyme Disease (LD) is the most common tick-borne disease in North America. With the number of cases increasing yearly, Canadian healthcare professionals (HCP) rely on up-to-date and evidence-informed guidelines, instruction, and resources to effectively prevent, diagnose, and treat Lyme disease (LD). This review is the first of its kind to examine gray literature and analyze the diversity of recommendations provided to Canadian HCP about the prevention, diagnosis, and treatment of Lyme disease.METHODS:A gray literature review consisting of 4 search strategies was conducted to retrieve materials targeted to Canadian HCP. Searches within targeted websites, targeted Google searches, and gray literature databases, and consultation with content experts were done to look for continuing medical education (CME) events, clinical flow charts, webinars, videos, and reference documents that discussed the prevention, diagnosis, and treatment of Lyme disease.RESULTS:A total of 115 resources were included in this study. Recommendations surrounding prevention strategies were less varied between materials, whereas diagnosis and treatment recommendations were more varied. Our findings suggest that Canadian HCP are met with varying and sometimes contradictory recommendations for diagnosing and treating LD.CONCLUSIONS:Due to the increasing incidence of LD in Canada, there is a greater need for resource consistency. Providing this consistency may help mitigate LD burden, standardize approaches to prevention, diagnosis and treatment, and improve patient outcomes.

Background: Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. Methods: We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016–February 2017) and post-MDC implementation (February 2017–December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. Results: We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, p < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, p = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, p = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, p < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. Conclusions: An MDC led to a reduction in patient visits and direct patient and caregiver costs.

This study sought to identify opportunities for improvement of an Internal Medicine (IM) resident quality improvement (QI)/patient safety (PS) program at an academic teaching hospital. The authors conducted semi-structured interviews with 15 residents and 6 attending physicians, which were analyzed from an inductive and thematic lens using NVivo software. Ethics was approved by the institution’s Research Ethics Board (File #: 6026140). Four themes emerged from this analysis. Residents and attending physicians agreed on (i) integrating QI/PS knowledge and skills into practice using active learning approaches. However, there was concern that requiring QI project completion through (ii) standardization of QI/PS education could create a barrier to clinical research required for sub-specialization. There was agreement that the (iii) QI/PS culture within the IM program was supportive and that a lack of safe reporting efficiency within the hospital, along with interprofessional discord, could cause (iv) external barriers to QI/PS training. By integrating these findings, evidence-informed and low-resource solutions could be incorporated into the QI/PS curriculum that uses minimal preparation requirements, and fulsome conversation-based exploration of QI/PS techniques within real-world clinical cases. RésuméCette étude visait à trouver des possibilités d’améliorer un programme d’amélioration de la qualité (AQ)/sécurité des patients (SP) pour les résidents en médecine interne (MI) à un hôpital universitaire. Les auteurs ont mené des entrevues semi-structurées auprès de 15 résidents et de 6 médecins traitants, lesquelles ont été analysées d’un point de vue inductif et thématique à l’aide du logiciel NVivo. Le comité d’éthique de la recherche de l’établissement a approuvé cette recherche (dossier no : 6026140). Quatre thèmes sont ressortis de cette analyse. Les résidents et les médecins traitants sont d’accord sur les éléments suivants : i) l’intégration dans la pratique des connaissances et des compétences en AQ/SP au moyen d’approches d’apprentissage actif. Toutefois, on craint que l’obligation de mener à bien le projet d’AQ par l’intermédiaire de ii) l’uniformisation de l’enseignement de l’AQ/SP ne crée un obstacle à la recherche clinique requise pour la sous-spécialisation. Les participants s’entendent pour dire iii) que la culture de l’AQ/SP au sein du programme de MI est fondée sur le soutien et que le manque d’efficacité lié aux déclarations relatives à la sécurité au sein de l’hôpital ainsi que les désaccords interprofessionnels pourraient causer iv) des obstacles externes à la formation sur l’AQ/SP. En intégrant ces constatations, des solutions fondées sur des données probantes et nécessitant peu de ressources pourraient être incorporées dans le programme d’AQ/SP qui utilise des exigences minimales en matière de préparation et une exploration approfondie des techniques d’AQ/SP sur le mode de la conversation dans le cadre de cas cliniques réels.