Considerable effort and resources are invested in developing, implementing, and sustaining educational programs in palliative care, making evaluation an important component of these programs. Several frameworks, models and approaches are available to palliative care educators to inform their evaluation, and accompanying research activities. This paper describes the process used to develop a practical evaluation framework for Pallium Canada’s educational programs. The objective was not to produce another comprehensive review of evaluation frameworks, as several reviews already existed, but rather to identify a practical and fit-for-purpose evaluation approach that could be implemented rapidly across Pallium Canada’s expanding educational initiatives. A multiphase, multipronged approach was used, which included an environmental scan and input from a panel of national and international education and evaluation experts. Several trends in education evaluation were identified, including: a need to a) evaluate impact beyond learner feedback and acquisition of competencies, b) evaluate implementation alongside impact and outcomes, and c) approach education evaluation from a complexity lens. Twenty-one frameworks (including models and approaches) were shortlisted (and are summarized in the paper). They are organized in four categories based on their focus: a) Impact; b) Implementation; c) Economic evaluation; and d) Combinations. Several additional concepts, including pragmatism, quality improvement, and theories of change serve as useful lenses with which to approach evaluation. The final framework incorporates two main frameworks, namely the New World Kirkpatrick Model and the Consolidated Framework for Implementation Research. It also draws elements from other frameworks and approaches.

The concepts of metacognitive reflection, reflection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive reflection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive reflection in the concept of metacognition and moving beyond it to engage in cycles of reflection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive reflection works is elusive. Debates address whether metacognition drives reflection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related reflection, to self-reflection, and finally to metacognitive reflection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive reflection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive reflection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.

Background: Since 2015, the College of Family Physicians of Canada has certified enhanced skills in palliative care (PC) with a certificate of added competence. Aim: This study aimed to describe the ways family physicians with enhanced skills in PC contribute within their communities, the factors that influence ways of practicing, and the perceived impacts. Design: Secondary analysis of data from a multiple case study on the role and impacts of family physicians with enhanced skills (i.e., PC physicians) was undertaken. Setting/Participants: Interviews were conducted in 2018 to 2019 with PC and generalist family physicians and residents associated with six family medicine practice cases across Canada. An unconstrained qualitative content analysis was performed. Results: Twenty-one participants (nine PC physicians, five generalist family physicians, two residents, and five physicians with enhanced skills in other domains) contributed data. PC physicians worked by enhancing their own family practice or as focused PC physicians. Roles included collaborating with other physicians through consultations, comanaging patients (shared care), or assuming care of the patient as the main provider (takeover). PC physicians increased capacity among their colleagues, with some patient care and education activities not being remunerated. Funding models and other structures were perceived as incentivizing the takeover model. Conclusion: Family physicians with enhanced skills in PC contribute to comprehensive care through the end of life. Remuneration should support system capacity and relationships that enable family physicians to provide primary PC especially outside the takeover model.

Context: Since 2015, the College of Family Physicians of Canada’s Certificates of Added Competence (CAC) program has included enhanced skill certification in Palliative Care (PC) to support the scope of Family Medicine services available to patients and communities. Objective: To describe the ways in which family physicians with a CAC in palliative care contribute within their communities, the factors that influence the models in which these physicians work, and the perceived impacts of this work. Study Design: Secondary unconstrained content analysis of qualitative data from a multiple case study on the role and impacts of family physicians with a CAC. Population: Six family medicine practices across Canada, between September 2018 and June 2019. Data Source: Interviews with PC and generalist physicians, trainees, and administrators, which included discussion of the PC role, associated with these cases. Outcome Measure: Qualitative descriptions of the models of care, factors influencing the way PC physicians work, and their impacts in the community. Results: Twenty-one participants (nine PC physicians, five generalist family physicians, two residents, five physicians with enhanced skills in other domains) contributed data. PC physicians enhanced the workforce to meet palliative care needs in communities. PC physicians worked in various models, ranging from maintaining and enhancing their own family practice through to working exclusively as a PC physician. In the latter case, PC physicians worked in a collaborative model with other physicians by providing consultations to other physicians, co-managing patients (shared care), or assuming care of the patient as the main provider (transfer of care). PC physicians intentionally built capacity among their colleagues, with some activities not being remunerated. Funding models and other structures favoured the PC physician taking over care. Conclusion: PC physicians with added competency facilitate comprehensive care of people until the end of life, through direct patient care models and by building capacity among others. Remuneration models should support system capacity and relationships that enable family physicians to provide primary palliative care, especially outside the transfer of care model.

Introduction:Evaluation of education interventions is essential for continuous improvement as it provides insights into how and why outcomes occur. Specifically, for physicians' continuing professional development (CPD) programs, which aim to upskill physicians in a range of practice-essential domains, evaluations are crucial to assure physicians' continuous development, enhanced patient care and safety. However, evaluations of health professions education (HPE) interventions tend to be outcomes focused, failing to capture how and why outcomes occur. This scoping review aimed to identify evaluation techniques used to evaluate CPD programs for physicians, and to determine how these techniques are being implemented as well as the their quality. Methods:We searched PubMed, Embase, Web of Science, among others for English publications on evaluation of CPD programs for physicians, in the past decade. We used a data charting template to extract study details regarding the evaluation techniques and produced a checklist to assess the quality of the evaluations. Results:101 studies were included; of which 91 studies did not use an evaluation framework. Our findings revealed shortcomings in the evaluations of CPD programs including lack of attention to: intervention processes; unintended outcomes and contextual factors; use of theory; evaluation framework use; and rationale for chosen evaluation method. Discussion:Our findings highlighted major gaps in the evaluation techniques employed in physicians' CPD. Attention needs to be paid to evaluating both program processes and outcomes to illuminate how and why impacts are or are not occurring.

Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.

To obtain the perspectives of Christian pastors and parishioners on whether and how religious involvement may be related to cognitive functioning. Fifteen middle- and old-aged Christian pastors and parishioners from a metropolitan Canadian city participated in this qualitative descriptive study which involved purposive sampling and open-ended semi-structured interviews. The qualitative interviews were audio-recorded, transcribed verbatim, and thematically analysed. Participants expressed their thoughts on how religious involvements had allowed them to cope with stress, secure lasting and supportive relationships, and keep their minds active. All participants agreed that religious involvement extended beyond simple attendance. Religious involvement appears to be a significant contributor to the mental health of pastors and parishioners, potentially guarding their cognitive function against the negative impacts of stress. The findings have implications for the incorporation of individuals' religious/ spiritual needs in their circle of care particularly for the elderly dealing with cognitive deterioration.

Abstract Informal caregivers make up a critical part of long-term support in the communities due to their important role in caring for older adults living at home. Modern-day caregivers are facing greater responsibility and burden for managing their care recipients. The present study aimed to explore the effect of a caregiving training program in alleviating caregiver burden. This program included four standalone online modules each with specific foci. Completion of activities across the modules allowed for the creation of a Caregiver Action Plan which offered a personal and practical resource to the informal caregivers. This evaluation study was qualitative and a used thematic analysis method of data analysis. Data stemmed from semi-structured interviews with the caregivers and their reflections on the program’s discussion board. Most caregivers provided care for persons with dementia. Interviews with the family caregivers were conducted, transcribed, and thematically analyzed. Themes were identified through constant comparison and in an iterative process. The family caregivers demonstrated consensus on the efficacy of the program in raising competence and confidence and contributing to ameliorating burden levels. Important themes were identified in association with areas for which the caregivers needed support: Early dementia education, planning for future care, learning about navigating healthcare systems, peer support, enhancing self-care, and coping with emotional burden and self-blame. The findings will be informative in shaping the program based on the caregiver’s identified needs through addressing those areas that they would need support. These findings may offer recommendations to other programs designed to support the family caregivers.

Abstract The geriatric population is rapidly growing, and this growth is beyond the pace of increase in the number of healthcare professionals who are qualified to care for and tend to the various needs of this significant subgroup of the population. The current university curricula have not been sufficient in terms of quantity as well as their ability to address the ageism inherent in the perspectives of students from across the educational spectrum. In recognition of the absence of standardized geriatric guidelines, medical associations across Canada and the United States have established geriatric learning competencies for medical programs. Nevertheless, there are exiting gaps regarding the development and evaluation of geriatric-focused didactic programs that adequately train and build competency among the students interested in pursuing careers with geriatric-specific elements. A university-wide program was developed to enhance aging education and build competency through sparking interest, providing better education related to aging, and building better relationships between future healthcare professionals and older adults. To evaluate the impact of this program, a logical framework was developed a-priori and revised through constant iterations and following discussion with the program’s multidisciplinary stakeholder group. Quantitative measures are being augmented with in-depth qualitative interviews to explore elements influencing students’ experiences with the program and the effect on their interests in and attitudes towards geriatrics. The results will inform our conclusions regarding program effectiveness in enhancing interest in geriatric-focused education among the students and trainees and assist with recommending future directions regarding impact and large-scale dissemination and implementation.

ABSTRACT To investigate the association between religious participation and memory in persons aged 45–85 years. Using the Canadian Longitudinal Study on Aging, frequency of religious participation was measured from “daily” to “never”; immediate and delayed recall memory were assessed with the Rey Auditory Verbal Learning Test. We regressed memory onto religious participation for persons aged < 65 years and persons aged ≥ 65 years. We found some evidence of effect modification: among persons < 65 years, monthly to yearly participation versus never attending was positively associated with immediate and delayed recall memory; among persons aged ≥ 65 years, weekly or more participation versus never attending was negatively associated with immediate and delayed recall memory. However, regression coefficients were small (−0.09 ≤ B ≤ 0.06) and most were not statistically significant (p < 0.05). Insufficient evidence existed to conclude that religious participation was associated with memory in our sample.

Objectives: This study was conducted to review the current state of evidence on the association between age of initiation of cannabis use and symptoms of psychosis, depression, or anxiety among youth under 25 years of age. Methods: We conducted a systematic review of articles published prior to March 2018 by searching OVID MEDLINE, PsycINFO, EMBASE, and the references of included studies. We included comparative studies (cohort, case-control, cross-sectional) that reported on cannabis use in persons <25 years of age (exposure) and symptoms of psychosis, depression, or anxiety (outcome). We narratively synthesized the studies according to design (cohort, etc.) and psychiatric outcome. We used the Newcastle-Ottawa Scale to assess risk of bias. Results: Of the 534 citations identified through the literature search, 23 met the eligibility criteria and were included in this review. With psychosis as the outcome, all except one study found that earlier cannabis use was generally associated with higher risks. With depression/anxiety as the outcome, 6 of the 11 included studies reported findings indicating that earlier use of cannabis was linked to higher symptom levels. Conclusion: In persons <25 years old, greater cannabis use is associated with more psychological symptoms, especially among those with a predisposition or existing vulnerability to such outcomes (Oxford Centre for Evidence-Based Medicine level 3 or 4). Policy makers need to consider the adverse effects of cannabis use in youth when planning a public health approach to cannabis legalization.

Purpose of the Study The maintenance of cognitive health is an important component of healthy aging. Abnormal cognitive decline can signal the onset of dementing disorders such as Alzheimer's disease (AD). Normal cognitive decline can also adversely affect the health of aging populations. We investigated the association between religious/spiritual involvement (R/SI) and cognitive function in adults of any age and any setting. We also examined whether social engagement acts as a mediator or moderator of the effect of R/SI on cognitive function, and whether the association between R/SI and cognitive function differs according to how each of these constructs is measured.Design and Methods We conducted a systematic review of articles published between 1990 and September 2016 by searching OVID MEDLINE, PSYCHINFO, EMBASE, and Google Advanced Search. We included studies with a comparison group (cohort, case-control, cross-sectional) that reported on R/SI (exposure) and cognitive function (outcome).Results Of the 6,300 citations obtained in the literature search, 17 met our eligibility criteria and were included in the review. Most of the included studies (82%) reported positive associations between R/SI and cognitive function. R/SI appears to be protective against cognitive decline in middle- and old-age adults.Implications Public health practitioners should not overlook the benefits of enabling religious/spiritual practices among religious adults (i.e., offering ride programs could help isolated elders attend religious gatherings).

PURPOSE OF THE STUDY The maintenance of cognitive health is an important component of healthy aging. Abnormal cognitive decline can signal the onset of dementing disorders such as Alzheimer's disease (AD). Normal cognitive decline can also adversely affect the health of aging populations. We investigated the association between religious/spiritual involvement (R/SI) and cognitive function in adults of any age and any setting. We also examined whether social engagement acts as a mediator or moderator of the effect of R/SI on cognitive function, and whether the association between R/SI and cognitive function differs according to how each of these constructs is measured. DESIGN AND METHODS We conducted a systematic review of articles published between 1990 and September 2016 by searching OVID MEDLINE, PSYCHINFO, EMBASE, and Google Advanced Search. We included studies with a comparison group (cohort, case-control, cross-sectional) that reported on R/SI (exposure) and cognitive function (outcome). RESULTS Of the 6,300 citations obtained in the literature search, 17 met our eligibility criteria and were included in the review. Most of the included studies (82%) reported positive associations between R/SI and cognitive function. R/SI appears to be protective against cognitive decline in middle- and old-age adults. IMPLICATIONS Public health practitioners should not overlook the benefits of enabling religious/spiritual practices among religious adults (i.e., offering ride programs could help isolated elders attend religious gatherings).

Introduction Preserving cognitive health is a crucial aspect of healthy ageing. Both abnormal and normal cognitive decline can adversely affect the health of ageing populations. Evidence suggests religious involvement (RI) can preserve cognition in ageing populations. The primary purpose of this review is to examine the evidence regarding the association between RI and cognition from a life-course perspective. Methods and analysis This systematic review and meta-analysis has been registered with PROSPERO (registration number CRD42016032331). We will search MEDLINE, PSYCHINFO and EMBASE, and include primary studies with a comparison group, for example, cohort, cross-sectional and case–control studies. To supplement the database search, we will also search the grey literature and the reference lists of included studies. Two reviewers will independently assess and extract data from the articles. Risk of bias and the strength of evidence will be assessed. For sufficiently homogeneous data in domains such as study methods and measures of RI and cognition, we will pool the results using DerSimonian and Laird meta-analysis. Ethics and dissemination Since this is a protocol for a systematic review, ethics approval is not required. The findings of this review will be extensively disseminated through peer-reviewed publications and conference presentations.

Preserving cognitive health is a crucial aspect of successful aging. We propose to conduct a systematic review and explore the association between religious involvement (RI) and cognition across the aging lifespan from young adulthood to old age. We will conduct a systematic review of the literature in order to establish the current scope of knowledge on RI and cognitive function. We will assess the risk of bias of included articles using the Newcastle-Ottawa Scale and evaluate the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We will qualitatively synthesize the extracted data from all included articles and for subsets of studies that are sufficiently homogeneous in terms of sample characteristics, measures of RI and cognition, and methods, we will pool results using meta-analysis. The systematic review will provide the most comprehensive assessment of the state of knowledge on the subject to date and will provide information that will permit us to confirm our suspicions about knowledge gaps which could be used to guide future research in the field. We estimate that the results of the review would be available in time for the conference.