By Philip Fine
With the goal of highlighting some of the research in medical education taking place at McGill, in this story, we look at Tim Dubé’s analysis of gender diversity in medical specialties and physician location outcomes of McGill graduates, Yvonne Steinert on what the academic literature says or leaves out about the role culture plays in faculty development, and we’ll hear Sylvia and Richard Cruess explain how the community of practice concept can be used to inspire health curriculum. All four are faculty members at the Centre for Medical Education.
Medical specialties now see increasing gender diversity, a big change in the last two decades, according to results from the tracking of McGill graduates between 1995 and 2015. The data set of 3,159 graduates also adds to the conversation on where new physicians are setting up their practice.
Dr. Tim Dubé, Assistant Professor, Postgraduate Medical Education, and colleagues analyzed data from the Canadian Post-M.D. Education Registry including age at graduation, sex, specialty, and practice locations at two, five, 10, 15 and 20 years after graduation.
While the number of female and male residents in Surgical and Pediatric specialties show significant variation over the years, Dubé observed that those specialties, as well as Family Medicine and Internal Medicine specialties, all reached near parity by 2015.
“It’s good news for the future,” says Dubé, who sees a growing number of role models for other women coming up the ranks. “Female physicians will act as mentors for the next generation.”
Related to practice location outcomes, Dubé notes that more than two-thirds of graduates currently practicing in Canada are working in Quebec, the majority of whom completed their undergraduate medical degree and residency training in the province.
“The literature shows that where you do your MD and residency has a strong influence on where you establish your practice.”
Dubé is looking forward to further research with data on residents’ hometowns and practice intentions. “We also know that one factor for people practicing in rural locations for example is that their intention from the outset is to go back and practice in their hometown.”
He says it will be interesting to see if residents who hail from the Outaouais and study at McGill’s distributed sites throughout the region will end up setting up practice there.
The word culture comes up a lot in faculty development. But when Yvonne Steinert, Director of the Centre for Medical Education and the Richard and Sylvia Cruess Chair in Medical Education, completed a literature review on the subject, she found little more than lip service paid to the word. As someone who leads faculty development workshops around the world, Steinert says culture, from language to social norms, plays a large role in building bridges between academics across continents, and yet little has been written about this topic. Moreover, she believes faculty development can transcend local contexts, celebrate diversity and take on global issues.
She and postdoctoral fellow Lerona Lewis reviewed a decade of faculty development articles, 58 of which talked of culture. But they found only one paper that actually defined culture.
“It’s like a grab bag. Everyone puts all kinds of descriptions into it, assuming that we all have a similar understanding,” says Steinert, who, in her search, found culture used in conjunction with other words such as academic culture, research culture and cultural awareness. She says the word has been used in so many contexts that it has come to mean everything and nothing.
Steinert has seen many instances in her own work where culture plays a role in the learners’ understanding of the material. During a lecture in Japan, she talked about the importance of feedback, only to later realize that her Japanese colleagues understood the concept differently, providing feedback infrequently. In another context, talking about role modelling in Sri Lanka, she asked for a show of hands of who might consider themselves role models. “Nobody put up their hands. They believed Lord Buddha was the role model.”
Steinert would like to see more “cultural humility” from those putting together professional development programs locally and overseas so the gaps that exist between different contexts and countries can be narrowed.
As she continues to lecture overseas, she may just help create a more fulsome definition for culture in the faculty development literature and in medical education in general.
Drs. Sylvia and Richard Cruess have spent their entire adult lives as part of the medical community. So it’s not surprising that at 88, the still-active researchers have looked to that feeling of community to play a pedagogical role in medical education. They have proposed that the social learning theory “communities of practice” can act as an overriding principle for teaching healthcare professionals.
Communities of practice is a learning theory that states that learners who wish to become healthcare professionals voluntarily move to join the medical community, and in so doing, they acquire the necessary knowledge and skills as well as the professional identity expected of community members. In medicine, this identity can best be described by the words the “good physician.” Sylvia, the former Medical Director of the Royal Victoria Hospital, explains that all those assets are not just gained when you become a clinical professional. “It starts in the pre-clinical years.”
The two see communities of practice as a voluntary act that takes on a life of its own, where the medical practitioner moves from peripheral participation to being fully involved in the community. “In the process of moving to full membership in the community, you absolutely must acquire a substantial amount of knowledge and espouse the values expected of community members,” says Richard, the former Dean of the Faculty of Medicine.
The two say communities of practice can act as an umbrella theory for medical education and provide a theoretical base in the training of professionals. And those professionals, like the Cruesses, will continue to garner more knowledge from their membership in the medical community throughout their careers.
August 14, 2018