The Besrour Forum / Le Forum Besrour

08:00 AM 05:00 PM

Location | Endroit : TBD
Ticket price | Prix du billet : $250 | 250 $

Join the global family medicine community at The Besrour Forum, where Canadian and international family medicine champions will share, debate and learn together to advance family medicine and health equity globally through a range of activities and discussions, including: research and quality improvement workshops, feedback on a framework to support ethical international educational partnerships, plenary and small group discussions regarding priorities and directions for the Besrour Centre community. Participants will acquire the knowledge and skills to support effective teaching and clinical practice in order to better respond to the needs of their own patients and communities. For those participants registered for FMF, Besrour Centre sessions will also be running throughout Wednesday, November 8 to Friday, November 10.

Joignez-vous à la communauté mondiale en médecine familiale au Forum Besrour, ou les champions de la médecine familiale du Canada et de l'étranger partageront, discuteront et apprendront ensemble pour faire avancer la médecine familiale et l'équité en santé grâce à une panoplie d'activités et de discussions, dont : ateliers sur la recherche et l'amélioration de la qualité, rétroaction sur un cadre de soutien des partenariats éducatifs internationaux éthiques, des plénières et des discussions en petits groupes concernant les priorités et les directions à prendre pour la communauté du Centre Besrour. Les participants vont acquérir les connaissances et les habiletés pour appuyer des pratiques efficaces en enseignement et en clinique afin de mieux répondre aux besoins de leurs propres patients et communautés.Pour les participants inscrits à FMF, des sessions du Centre Besrour seront également diffusées du mercredi le 8 au vendredi le 10 novembre.


The Besrour Forum Dinner / Souper Besrour

07:00 PM 09:00 PM

Location | Endroit : TBD
Ticket price | Prix du billet : $60 | 60 $

The Besrour network will be celebrating family medicine and primary care’s contribution to advancing primary health care and health equity. Come and join our global family medicine community!

Le réseau Besrour célébrera la contribution de la médecine familiale et des soins primaires dans l'avancement des soins de santé primaires et de l'équit� en santé. Venez-vous joindre à la communauté mondiale en médecine familiale!

Breakfast / Petit déjeuner

07:00 AM 08:00 AM

Registration open / Ouverture des inscriptions

07:00 AM 07:00 PM

Dr. Ian McWhinney Keynote Address / Discours d’ouverture Dr Ian McWhinney

08:00 AM 09:30 AM Room | Salle : Palais des congrès de Montréal - 710ab

Are we ready for true generalism? Tackling the “social” in biopsychosocial approaches to care

Sommes-nous prêts pour le vrai généralisme ? Agir sur les éléments « sociaux » dans les approches biopsychosociales des soins

Learning Objectives
1. To outline our understanding of generalism to include a focus on addressing the social determinants of patients’ health
2. To discuss practical approaches to, and challenges in, attempting to mitigate the negative impact of the social determinants of health
3. To describe, through examples, the opportunities and challenges for family physician researchers and teachers when focusing on interventions and scholarship into the social determinants of health

Objectifs d’apprentissage
1. Résumer notre définition de généralisme, en portant une attention particulière aux déterminants sociaux de la santé des patients
2. Discuter d’approches pratiques pour tenter de mitiger les effets négatifs des déterminants sociaux de la santé, et des défis connexes
3. Décrire au moyen d’exemples les occasions et les défis que rencontrent les chercheurs et les enseignants en médecine familiale lorsqu’ils se penchent sur les interventions et l’érudition sur les déterminants sociaux de la santé

Description: The specialty of family medicine has positioned itself as the only specialty capable of understanding and addressing the health needs of whole patients, their families, and their communities. While we have been very successful in developing a holistic approach to individuals’ and families’ physical and mental health, we have had a harder time defining our role in addressing the social contexts that have such a large impact on our patients’ health.

Building on the work of Ian McWhinney among others, Gary Bloch will propose a broader approach to generalism that attempts to fill this gap in our efforts to improve patients’ health through individual and community interventions. He will describe an approach that focuses on multi-level, practical interventions, for individual health providers and their teams into the social determinants of health. This approach will further enable our patients, their communities, and our society, to achieve optimal health. Drawing on experiences from more than a decade of working on health and its social construction, Gary will share how educators, advocates, and researchers can learn from and draw upon the successes and challenges he and his collaborators have faced in attempting to develop this under- realized realm of family medicine practice.

Description : La spécialité de médecine familiale s’est positionnée comme la seule spécialité en mesure de comprendre et d’aborder l’ensemble de besoins de santé des patients, de leurs familles, et de leurs communautés. Bien que nos efforts pour développer une approche holistique de la santé physique et mentale des personnes et des familles aient connu du succès, nous avons eu plus de mal à définir notre rôle dans des contextes sociaux qui ont une forte incidence sur la santé de nos patients.

En s’appuyant sur le travail de ses prédécesseurs, notamment d’Ian McWhinney, Gary Bloch proposera d’aborder le généralisme dans une optique plus large qui, au moyen d’interventions individuelles et communautaires, vise à pallier cette lacune dans nos efforts pour améliorer la santé des patients. Il décrira une approche destinée aux professionnels de la santé et à leurs équipes, axée sur des interventions pratiques à plusieurs niveaux pour aider à agir sur les déterminants sociaux de la santé. Cette approche permettra de promouvoir la santé optimale pour nos patients, leurs communautés ainsi que notre sociét.
En s’appuyant sur plus d’une décennie d’expériences dans le domaine de la santé et sa construction sociale, Dr Bloch indiquera comment les éducateurs, les promoteurs des intérêts de la discipline et les chercheurs, peuvent tirer parti des succès connus et des défis rencontrés — les leurs ou ceux de leurs collaborateurs — dans l’avancement de ce domaine sous-développé de la pratique de médecine familiale.

Speakers

Break and Poster Viewing / Pause et visite d’affiches

09:30 AM 10:00 AM

Sessions / Séances

10:00 AM 12:15 PM

Lunch

12:15 PM 01:30 PM

Section of Researchers Lunch and Business Meeting / Déjeuner et réunion de la Section des chercheurs

12:15 PM 01:30 PM

Teachers and Preceptors Knowledge Café Lunch / Déjeuner des enseignants et des superviseurs au Café du savoir

12:30 PM 01:30 PM

Sessions / Séances

01:30 PM 02:30 PM

Break and Poster Viewing / Pause et visite d’affiches

02:30 PM 03:00 PM

Sessions / Séances

03:00 PM 05:15 PM

Free-standing Paper Presentations / Présentations libres

03:00 PM 05:00 PM

Fireside Chat / Discussion informelle

04:15 PM 05:15 PM

Section of Researchers Dinner / Souper de la Section des chercheurs

06:30 PM 10:00 PM InterContinental Montreal / I’Intercontinental Montréal

Location | Endroit : InterContinental Montreal / I’Intercontinental Montréal
Reception | Réception : 18:30, Sherwood/Stratton Room | Salon Sherwood/Stratton
Dinner | Souper : 19:00, Sarah Bernhardt Ballroom | Salle de bal Sarah Bernhardt
Ticket price | Prix du billet : $125 | 125 $

Join your research colleagues for the annual Section of Researchers Dinner. Your registration includes a welcome reception, dinner, wine, and non-alcoholic beverages.

We will proudly present the Family Medicine Researcher of the Year Award along with several other prestigious awards of recognition.

Joignez-vous à vos collègues pour le souper annuel de la Section des chercheurs. Votre billet comprend la réception d’accueil, le repas, le vin et les boissons non alcoolisées.

Pendant le souper, nous serons fiers de présenter le Prix du chercheur de l’année en médecine familiale ainsi que de nombreux autres prix de reconnaissance prestigieux
Research | Recherche
Teaching | Precepting | Enseignement | Supervision

W100: Are we ready for true generalism? Tackling the “social” in biopsychosocial approaches to care / Sommes-nous prêts pour le vrai généralisme ? Agir sur les éléments « sociaux » dans les approches biopsychosociales des soins

08:00 AM 09:30 AM Room | Salle : 710AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. to outline our understanding of generalism to include a focus on addressing the social determinants of patients’ health
2. to discuss practical approaches to, and challenges in, attempting to mitigate the negative impact of the social determinants of health
3. to describe, through examples, the opportunities and challenges for family physician researchers and teachers when focusing on interventions and scholarship into the social determinants of health

Objectifs d’apprentissage :
1. résumer notre définition de généralisme, en portant une attention particulière aux déterminants sociaux de la santé des patients
2. discuter d’approches pratiques pour tenter de mitiger les effets négatifs des déterminants sociaux de la santé, et des défis connexes
3. décrire au moyen d’exemples les occasions et les défis que rencontrent les chercheurs et les enseignants en médecine familiale lorsqu’ils se penchent sur les interventions et l’érudition sur les déterminants sociaux de la santé

Description: The specialty of family medicine has positioned itself as the only specialty capable of understanding and addressing the health needs of whole patients, their families, and their communities. While we have been very successful in developing a holistic approach to individuals’ and families’ physical and mental health, we have had a harder time defining our role in addressing the social contexts that have such a large impact on our patients’ health.
Building on the work of Ian McWhinney among others, Gary Bloch will propose a broader approach to generalism that attempts to fill this gap in our efforts to improve patients’ health through individual and community interventions. He will describe an approach that focuses on multi-level, practical interventions, for individual health providers and their teams into the social determinants of health. This approach will further enable our patients, their communities, and our society, to achieve optimal health. Drawing on experiences from more than a decade of working on health and its social construction, Gary will share how educators, advocates, and researchers can learn from and draw upon the successes and challenges he and his collaborators have faced in attempting to develop this under-realized realm of family medicine practice.

Description :
La spécialité de médecine familiale s’est positionnée comme la seule spécialité en mesure de comprendre et d’aborder l’ensemble de besoins de santé des patients, de leurs familles, et de leurs communautés. Bien que nos efforts pour développer une approche holistique de la santé physique et mentale des personnes et des familles aient connu du succès, nous avons eu plus de mal à définir notre rôle dans des contextes sociaux qui ont une forte incidence sur la santé de nos patients. En s’appuyant sur le travail de ses prédécesseurs, notamment d’Ian McWhinney, Gary Bloch proposera d’aborder le généralisme dans une optique plus large qui, au moyen d’interventions individuelles et communautaires, vise à pallier cette lacune dans nos efforts pour améliorer la santé des patients. Il décrira une approche destinée aux professionnels de la santé et à leurs équipes, axée sur des interventions pratiques à plusieurs niveaux pour aider à agir sur les déterminants sociaux de la santé. Cette approche permettra de promouvoir la santé optimale pour nos patients, leurs communautés ainsi que notre société. En s’appuyant sur plus d’une décennie d’expériences dans le domaine de la santé et sa construction sociale, Dr Bloch indiquera comment les éducateurs, les promoteurs des intérêts de la discipline et les chercheurs, peuvent tirer parti des succès connus et des défis rencontrés — les leurs ou ceux de leurs collaborateurs — dans l’avancement de ce domaine sous-développé de la pratique de médecine familiale.

Speakers

Teaching | Precepting | Enseignement | Supervision

W528: CanMEDS-FM 2017 – Applying and using the Competency Framework across the continuum of learning

10:00 AM 12:15 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. validate the intended and potential uses of the CanMEDS-FM 2017 Competency Framework in various learning and practice contexts
2. identify and assess the potential impact of the CanMEDS-FM 2017 Competency Framework on various roles of a family physician and on education across the continuum
3. develop strategies for the dissemination and implementation of the CanMEDS-FM 2017 Framework within competency-based medical education and practice

Description:
At FMF 2016, participants had the opportunity to understand and provide feedback on the proposed changes to the CanMEDS-FM Competency Framework. In this year’s interactive session, participants will learn how to use, and share strategies for using, CanMEDS-FM 2017 for its intended purpose and potential. The CanMEDS-FM 2017 Competency Framework has specifically been designed for family physicians, articulating a comprehensive definition of the abilities needed throughout the training and practice lifetime. It can be applied across the entire continuum of learning, from undergraduate through to continuing professional development. This workshop will explore the application of the framework to the various roles of a family physician—learner, teacher, practitioner, administrator, and leader. Based on multi-source feedback received over the past year, the framework has undergone significant revisions. A didactic presentation will describe the final framework, highlighting the Family Medicine Expert Role and the most significant changes from the original CanMEDS-FM Framework, and the intended and potential uses of the CanMEDS-FM Framework. The workshop will focus on small group discussion, providing further consultation and exploration of the use of the framework and its impact on the various roles of the family physician. In addition, suggestions for dissemination across the educational continuum, and overcoming any identified barriers to implementation with be discussed. Feedback from the workshop will assist the CanMEDS-FM Working Group in its communication and knowledge translation.

Speakers

Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Mental Health | Santé mentale

W480: Adolescents and Adults with ASD: Ensuring access, managing common conditions, supporting transitions

10:00 AM 12:15 PM Room | Salle : 510C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:
1. describe anticipatory primary care, as well as accessible, patient-centred medical homes for transitional-age youth and adults with autism spectrum disorder (ASD)
2. anticipate and manage common genetic, gastrointestinal, neurological, mental health, and women’s health issues in ASD
3. describe the family physician, caregiver, and patient roles in supporting transition from pediatric to adult health care

Description:
Autism spectrum disorders (ASD) are an important condition to recognize and manage in family practice, with prevalence reports as high as 1:160 individuals having this diagnosis. This session will review management of common physical comorbidities such as genetic conditions, developmental feeding disorder, gastroenterology issues, mental health issues, and epilepsy. Particular attention will be placed on women’s health issues for individuals with ASD. Participants will be introduced to a new tool for anticipatory care for adult patients with ASD designed specifically for primary care providers as well as a helpful tools and processes for supporting transition from pediatric to adult health care. Preliminary research evidence on the use of coordinated care plans to support transition from children’s treatment centres to the primary care medical home will be reviewed.


Speakers

Research | Recherche

W188: Presentation by the recipients of the Research Awards for Family Medicine Residents - 1 / Présentation par le récipiendaire du Prix de recherche pour les residents en médecine familiale

10:00 AM 10:15 AM Room | Salle : 710AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.5
Teaching | Precepting | Enseignement | Supervision

W532: Foundations of Assessment in Residency Training

10:00 AM 12:15 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe and explain the principles of assessment
2. choose assessment tools and strategies that align with the purpose of assessment
3. describe and explain educational leadership strategies to help address assessment challenges in your own program

Description:
Assessing learners is one of the greatest challenges for clinical preceptors. The difficulties arise due to the lack of understanding of the assessment role in both accelerating learning (coaching and feedback) and in ensuring that learners focus on those skills they have not yet mastered. The crux of assessment is the learner-teacher relationship whereby expert family physicians help learners achieve competence. The preceptor is the most important and effective assessment tool in authentic work-based learning. This course will use interactive plenaries and small group discussions to provide the fundamental theoretical concepts in assessment, enhance participants’ understanding of the various tools for effective assessment, and facilitate the appropriate choice of tools depending on the assessment tasks. This course is designed specifically for those new to assessment and have educational leadership responsibilities to engage preceptors in effective assessment. This includes addressing and overcoming those barriers (both personal and institutional) to reliable assessment.

Speakers

Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Health Care of the Elderly | Soins aux personnes âgées

W172: TLC for LTC: Providing best care for your long-term care patients

10:00 AM 11:00 AM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. highlight the importance of continuous primary care and deprescribing for elderly residents
2. review the investigation and treatment of urinary tract infections in the elderly
3. evaluate behavioural and medication options in problem behaviour/dementia

Description:
Family physicians provide the majority of care to the 250,000 residents in Canadian long-term care (LTC) facilities. This interactive, bilingual workshop will help participants review best practices for assessing and treating possible urinary tract infections, behavioural problems of dementia, constipation, and polypharmacy. Come join the conversation with your LTC/residential care colleagues!

Speakers

Teaching | Precepting | Enseignement | Supervision

W414: Teaching Residents to Teach: Developing distributed curricula for family medicine residents

10:00 AM 12:15 PM Room | Salle : 511F

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe distributed learning strategies used to teach family medicine residents how to become effective teachers
2. discuss the drawbacks and possibilities with technology-enhanced learning
3. apply practical strategies to develop curricula for teaching family medicine residents how to teach

Description:
Family medicine residents have important roles to play as both role models for and teachers of medical students, resident peers, and other health care professionals. Developing the knowledge and skills necessary to become an effective teacher also helps fulfill some of the requirements of the CanMEDS-FM competency framework, particularly the Scholar role. Although residents are expected to teach, only a few might have had any formal training on how to teach effectively. Residents often voice the need for some instructional approaches, particularly regarding their readiness for clinical teaching. Educational leaders must ensure there is a curriculum available to teach residents how to teach and provide them with opportunities to develop their teaching skills. Residents should also receive formal assessment of their clinical teaching to facilitate their achievement of the relevant competencies. There is no one-size-fits-all educational approach to teaching family medicine residents how to teach. The use of interactive instructional strategies such as distributed online modules should emphasize for residents the key concepts they need in their roles as teachers. This workshop will highlight how distributed educational strategies can bring new ideas to an old topic. Moreover, the educational principles used in developing curricula for teaching residents to teach can be used to address educational needs in designing curricula for other CanMEDS-FM roles. Participants are encouraged to bring questions and perspectives from their own work. Organization and method of presentation: Introduction (15 minutes); interactive practical application (75 minutes); and large group discussion and wrap-up (30 minutes). Target audience: Beginner and intermediate clinical teachers, program directors, residents, and others who are planning to develop, or are implementing, a curriculum to support family medicine residents in their role as teachers.

Speakers

Teaching | Precepting | Enseignement | Supervision

W321: Diagnostiquer l’étudiant/le résident en difficulté et faire des prescriptions pédagogiques adaptées

10:00 AM 12:15 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. identifier les difficultés d’un étudiant/résident pour poser un diagnostic pédagogique précis
2. à partir du répertoire proposé, sélectionner les interventions pertinentes pour aider le résident dans son cheminement
3. proposer un plan d’appui à la réussite adapté aux difficultés de l’apprenant

Description:
Le plan d’appui à la réussite (plan de remédiation) est un outil qui vise à soutenir les résidents présentant des difficultés en proposant des interventions pour les surmonter. À partir d’une revue systématique de la littérature, nous avons développé un Répertoire de prescriptions pédagogiques visant à alimenter les plans d’appui à la réussite conçus par les cliniciens enseignants et les apprenants. Dans cet atelier, les participants apprendront comment tirer avantage de cet outil. Par la suite, à partir de scénarios d’enseignement, ils seront appelés à identifier les symptômes et signes de difficultés, à poser un diagnostic pédagogique et à sélectionner les interventions pertinentes pour compléter le plan d’appui à la réussite, en vue d’aider l’étudiant ou le résident dans son cheminement.

Speakers

Sport Medicine | MSK | Orthopedics | Médecine du sport | MSK | Orthopédie
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées

W221: A Full Wrist Exam for Your Busy Clinic

10:00 AM 11:00 AM Room | Salle : 510B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. develop a sequenced order to examine the wrist
2. perform the special tests required to support common diagnoses in wrist pathology
3. describe the relevant anatomy needed to understand wrist pathologies

Description:
In this interactive session participants will be able to review and practise the steps and the techniques needed to perform a comprehensive wrist examination. The examination will be carried out step by step while reviewing th functional tests to determine specific diagnoses. Participants will work in pairs to practise the learned concepts and skills.

Speakers

Teaching | Precepting | Enseignement | Supervision

W298: Quality Improvement Basics to Help You Teach Students and Residents

10:00 AM 12:15 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:
1. differentiate between quality improvement, scientific research, and quality assurance
2. evaluate the completeness of an aim statement in a quality improvement project
3. identify common challenges students and residents encounter in completing quality improvement projects

Description:
The importance of quality improvement (QI) concepts in health care are affecting both undergraduate and postgraduate curricula. Medical students and family medicine residents are increasingly being required to design, lead, and conduct QI projects. This session is designed for teachers who supervise the completion of these projects. QI basics including defining quality improvement, writing aim statements, developing project measures, using common QI tools, and developing Plan-Do-Study-Act cycles will be discussed. Ideas for generating project topics and guidelines for publication will be reviewed. The session will include case studies of actual student and resident projects to provide the opportunity to apply the concepts discussed.

Speakers

Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Emergency Medicine | Médecine d’urgence
Addiction Medicine | Médecine des toxicomanies

W173: The Opioid Epidemic: How emergency physicians can help

10:00 AM 12:15 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. manage opioid withdrawal and overdose risk with appropriate patient education and pharmacotherapy
2. assess opioid-related harms
3. balance patients’ acute pain management needs with safer opioid prescribing practices

Description:
Canada is in the midst of an epidemic of opioid use, dependence, and resulting harms, including an increasing rate of deaths due to overdose. Emergency physicians regularly treat patients with opioid-related toxicity, withdrawal, or related medical/psychiatric complications. They also treat patients with acute pain who may benefit from receiving prescribed opioids on discharge. Emergency physicians, therefore, are in a good position to mitigate some of the harms of the opioid epidemic and help prevent its continuation. This talk will review key interventions that can be provided in the emergency department to meet these goals. The initiation of buprenorphine/naloxone can control symptoms of opioid withdrawal, decrease other opioid use, and facilitate entrance to longer-term addiction treatment. Dispensing of injectable naloxone kits for home use can prevent overdose-related deaths. Conscientious management of acute pain and judicious prescription of opioids on discharge can help limit the misuse and diversion of these drugs. Participants will receive practical education on implementing these interventions. Evidence to support their use will be included and barriers to uptake will be explored.

Speakers

Teaching | Precepting | Enseignement | Supervision

W521: Tools for Teachers: The fundamental teaching activities resource repository

10:00 AM 12:15 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. understand the need for, and purpose of, a national repository of resources for family medicine teachers
2. apply tools from the current faculty development resource repository
3. discover additional tools that are useful in developing teaching competencies

Description:
The CFPC Section of Teachers’ Faculty Development Education Committee has developed an online password-free repository of teaching tools resources to accompany the Fundamental Teaching Activities Framework. This interactive session is meant for teachers at all levels of experience working in diverse family medicine contexts. The session will begin with a plenary discussion on the utility of a national repository of resources for family physician teachers with participants using their own teaching experiences. The current online repository as it exists on the CFPC website will be presented, and participants will try using it to develop approaches to common teaching scenarios. Potential barriers to its use, and strategies to overcome them, will be discussed. Finally, participants will be invited to identify additional tools and resources that could be added to the repository by the committee.

Complete the Session Evaluation for this course here: W21 Session Evaluation

Speakers

W174: Introduction to Office Based Surgical Instruments and Materials

10:00 AM 12:15 PM Room | Salle : 510D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. become familar with the names and uses of basic instruments used in office based procedures
2. understand the principles of suture and needle selection
3. understand the basic principles of wound closure

Description:
The program will present a basic introduction into surgical instruments including, the naming, basic parts, and functions of basic office based surgical equipment. The differences between the basic uses of instruments, including selection of instrument and of scalpel blades will be addressed in the lecture. The lecture will discuss the different types of cutting, grasping, clamping, retracting and needle holding instruments. The second part of the lecture will focus on the principles of suture and needle selection, and basic principles of wound closure. The differences between absorbable, and non-absorbable sutures, the differences within suture types and the sizes of suture material, will be explored. Similarly the differences between the needle types, cutting, reverse cutting, tapered, traumatic and non traumatic needles will be discussed. The attendee will be given guidance as what factors should be considered when making the selection of material and needle. Finally the lecture will discuss the various suture patterns used in wound closure and the principles of suture placement and knot tying.

Speakers

Teaching | Precepting | Enseignement | Supervision

W396: Managing Uncertainty in Medical Education and Practice: Teaching how to be a “good enough doctor”

10:00 AM 12:15 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. define uncertainty in the context of science, family medicine, and medical education
2. apply the “principle of good enough” to medical practice and medical education
3. learn techniques to leverage the management of uncertainty to increase the resilience of learners and teachers in practice

Description:
In our current competency-based educational environment learners are required to gain a certain set of clinical skills. Often overlooked are the consultation skills required to synthesize history taking and information gathered during the physical exam, and to incorporate this with the broad variety of external factors in a therapeutic plan. Finding effective ways to help our learners manage uncertainty can assist with problems such as time management, selectivity, and early diagnostic closure. By broadening our teaching approaches to address thinking strategies we can broaden their cognitive apprenticeship, support their passage from novice to expert, and increase their confidence levels. In this session we will explore the concepts of diagnostic and therapeutic uncertainty, what it means to be a “good enough doctor,” and how to apply this in both didactic and clinical teaching contexts. We will also explore possible effects on resilience during and after residency.

Speakers

Teaching | Precepting | Enseignement | Supervision

W139: The Delicate Art of Feedback: An evidence-based practical toolbox on providing learner-centred feedback

10:00 AM 12:15 PM Room | Salle : 511E

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. acquire skills related to forming strong coaching relationships
2. assess a learner’s specific needs
3. develop and implement effective coaching strategies

Description:
Despite more than three decades of work on feedback in medical education and published literature on the importance of feedback during early training, there remains a gap in providing and receiving effective feedback. With the competing pressures of being attentive to learners, addressing work responsibilities, managing interruptions, and completing evaluation tools, it is difficult to have dedicated, thoughtful and intentional conversations with learners. The objective of this workshop is to explore some well-established perceived barriers to feedback (lack of a relationship with the learner, lack of vocabulary, fear of damaging the relationship with learner, lack of time, and lack of a safe environment) and develop strategies to overcome these barriers. Using this interactive workshop, we aim to enhance participants’ skills in providing effective feedback in clinical practice using a strength-based feedback framework that focuses on the relationship with the learner. Using real case scenarios, video, role play, and small group discussions, participants will practise the application of context, goal setting, and collaborative approaches to engage the learner. Participants will acquire skills on how to create a safe environment in a busy workplace and provide time-efficient feedback. Participants will learn and implement specific feedback language to foster a trusting relationship, with the goal of improving learners’ skills and maintaining their overall wellness.

Speakers

Research | Recherche

W189: Presentation by the recipients of the Research Awards for Family Medicine Residents - 2 / Présentation par le récipiendaire du Prix de recherche pour les residents en médecine familiale

10:15 AM 10:30 AM Room | Salle : 710AB

Mainpro+ certified credits / Crédits certifiés Mainpro+ = 0.5
Research | Recherche

W187: Presentation by the recipient of the CFP Best Original Research Article / Présentation par le récipiendaire du Prix du MFC pour le meilleur article de recherche originale

10:45 AM 11:15 AM Room | Salle : 710AB

Mainpro+ certified credits / Crédits certifiés Mainpro+ = 0.5
Occupational Medicine | Médecine du travail
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées

W287: Canadian Armed Forces as a Patient’s Medical Home Model for Occupational Medicine

11:15 AM 12:15 PM Room | Salle : 510B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. demonstrate how the Canadian Armed Forces’ primary health care delivery model aligns with the Patient’s Medical Home pillars
2. explain how useful the Patient’s Medical Home model is in managing common occupational medicine issues
3. identify areas for future development of the Patient’s Medical Home concept in support of occupational medicine

Description:
The CFPC presented the Patient’s Medical Home (PMH) vision in 2011 to provide a framework for the future of family practice in Canada. The goal of this initiative is for every family practice in each community across Canada to be able to offer comprehensive, coordinated, and continuing care to their populations through family physicians working with health care teams. Teams may involve, physically or virtually, several allied health care providers and specialists, depending on the needs of the patient community. The PMH is where patients can present and discuss their personal and family health concerns and receive a full spectrum of care. Relationships between patients and family physicians and other health care professionals are developed and strengthened over time, enabling the best possible health outcomes for each person, the practice population, and the community being served. In 2004 the Canadian Armed Forces (CAF) Health Services implemented a care delivery model in its Canada-wide network of primary care clinics. The presenters will demonstrate that this model aligns very well with the pillars of the PMH. Barriers to implementing such a model in the CAF will also be shared. This interactive session will explore the usefulness of the PMH model in the context of managing occupational medicine issues, particularly in challenging scenarios, and will be aimed at sharing best practices in addressing these challenges. Areas for future development will also be proposed for discussion by and feedback from participants. Participants will be invited to share their experiences and contribute to the discussion and possibly inform the future developments of the Patient’s Medical Home concept in support of occupational medicine in an environment such as the CAF.

Speakers

Choosing Wisely | Screening | Preventative Medicine | Choisir avec soins | Dépistage | Prévention
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Health Care of the Elderly | Soins aux personnes âgées

W464: Choosing Wisely in Long Term Care

11:15 AM 04:00 PM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 3

Learning Objectives:

1. explore approaches to initiation of early palliative care in long-term care practice
2. describe appropriate screening practices in long-term care practice
3. apply practising wisely principles to practice in long-term care

Description:
This workshop will focus on the principles of practising wisely in long-term care (LTC). Care for individuals in LTC is becoming increasingly complex as patients are being admitted later in life and with more comorbidities. Prevalence of dementia in this clinical population is upwards of 70 per cent and, increasingly, people are admitted with a shortened life expectancy. It is estimated that average length of stay for new admissions to LTC is close to 18 months with a wide variation across this spectrum. That being said, residents and families are often unaware of this and far too often discussions about prognosis and clinical expectations have not been had. The workshop will start with an exploration of attitudes and awareness of the benefits of initiating of conversations about end-of-life care. Materials from Pallium Learning Essentials for Applied Palliative Care (LEAP) LTC focus on early adoption of a palliative approach to care. Case scenarios that focus on communicating with residents and families will be used to facilitate interactive discussions highlighting key issues challenging our approach to LTC. The second part of this workshop will focus on discussions around appropriate prescribing and use of investigations in the LTC setting. This will build upon the newly released Choosing Wisely Canada LTC recommendations developed by the Long Term Care Medical Directors Association of Canada, as well as recommendations and adaptation of materials developed for the popular workshops of Practising Wisely. We will present this in a case-based format to stimulate interactive discussion and practical challenges faced by clinicians in this setting. We hope to have education on a national stage by introducing this workshop at FMF, as LTC practices are not standard amongst the provinces.

Speakers

Research | Recherche

W186: Presentation by the recipient of the CFPC Outstanding Family Medicine Research Article / Présentation par le récipiendaire du Prix du CMFC pour un article exceptionnel de recherché en médecine familiale

11:15 AM 11:45 AM Room | Salle : 710AB

Mainpro+ certified credits / Crédits certifiés Mainpro+ = 0.5
Research | Recherche

W190: Presentation by the Family Medicine Researcher of the Year

11:45 AM 12:15 PM Room | Salle : 710AB

Mainpro+ certified credits / Crédits certifiés Mainpro+ = 0.5
Clinical
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Mental Health | Santé mentale
Health Care of the Elderly | Soins aux personnes âgées

W326: Assessing and Understanding Challenging Behaviours in Patients with Cognitive Impairments: Tools and tips

01:30 PM 04:00 PM Room | Salle : 510C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. identify the function of a patient’s behaviour by using behavioural assessment tools
2. apply key narratives to motivate the patient, caregivers, and family to engage in a behaviour management plan
3. develop and implement a management plan to address these behaviours in collaboration with the patient, caregivers, and family

Description:
Patients with impaired cognition often communicate through behaviour. Understanding the functions of these behaviours allows us to hear our patients’ voices and respond to their needs. Such behaviours can pose a risk to the patient, their families, and/or the community. Historically, the behaviour of people with impaired cognition has been misunderstood to be simply a symptom of the disability or an inappropriate effort to manipulate caregivers. However, these hypotheses can neglect the important information communicated by behaviour. Assessing and responding to the specific function of behaviour can lead to a greater understanding of the patient’s health needs, improve emotional well-being, promote self-determination, and decrease the incidence of high-risk behaviours. Physicians providing primary care to individuals with impaired cognition frequently identify a need for education regarding challenging behaviours. This workshop will use a combination of didactic teaching and case-based discussion to introduce concepts and practical assessment tools behavioural specialists use when working with this population. Participants will be provided with a framework for establishing a behaviour management plan that can be implemented in collaboration with the patient, caregivers, family, and allied health professionals. Discussion will include resources for patients and caregivers and how to re-evaluate patients in follow-up.

Speakers

Teaching | Precepting | Enseignement | Supervision

W523: A How-to Guide for Teaching and Assessing Collaborator Competencies in Family Medicine

01:30 PM 02:30 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the collaborator role’s key and enabling competencies and list strategies for teaching and assessing these competencies in family medicine
2. review clinical teaching scenarios to identify opportunities to integrate the collaborator role and reflect on these examples in their contexts
3. access and apply the CPFC How-to guide to support teaching and assessing the collaborator competencies

Description:
Globally, health systems are transitioning to integrated team-based care models. As such, collaborative practice education and assessment are now accreditation requirements for family medicine and most health professional programs. However, without common teaching and assessment tools, ensuring the acquisition of integrated person-centred practice competencies in training remains challenging. Family medicine preceptors need easily accessible tools to support them in their day-to-day roles of teaching and assessing the collaborative practice competencies of their learners. To address this need, the CFPC engaged an interprofessional group of educators to develop a how-to guide for teaching and assessing collaborator competencies. The guide has been purposefully designed to align with the CFPC Fundamental Teaching Activities Framework, and provides strategies applicable across a variety of educational settings—clinical preceptor, outside of the clinical setting, and educational leaders (e.g., curriculum designers, assessment leads, etc.) This interactive workshop is geared to family medicine educators (e.g., teachers, preceptors, program directors, health professional learners, etc.). The workshop will present the current state of teaching and assessment of the collaborator role in Canada, review some of the best practices identified, and give participants an opportunity to familiarize themselves with the how-to guide for teaching and assessing collaborative practice competencies. Through interactive scenarios, participants will be able to practice identifying teaching and assessment opportunities and applying some of the teaching and assessment strategies contained within the guide. Participants will be encouraged to reflect on the strategies and how they would apply in their own teaching contexts.

Speakers

Teaching | Precepting | Enseignement | Supervision

W389: Supporting Family Medicine Resident Research: How to facilitate high-quality, feasible, successful projects

01:30 PM 02:30 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. understand feasibility in resident research and identify common pitfalls impeding the success of research projects
2. appraise a resident research proposal for scientific rigour and originality
3. develop a comprehensive plan to support a family medicine resident in completing a research project

Description:
Many Canadian family medicine residency programs require the completion of a scholarly project. In some programs this takes the form of a research project. Designing and completing a high-quality research project can be challenging in the course of a residency program. Time constraints and the process of learning research methods and study design are barriers in the context of busy clinical training programs. One of the most significant barriers residents encounter is the Research Ethics Board (REB) application process, which can be difficult particularly for those without prior research experience. Our team of family physicians at North York General Hospital, an academic community hospital in Toronto, Ontario, has instituted various initiatives and processes to support residents in doing research. We use the Feasible, Interesting, Novel, Ethical, and Relevant (FINER) framework when working with residents to develop and carry out projects. Our process for assisting residents in completing projects includes staff physician review, resident peer review, and deliberate engagement with the local REB to facilitate successful, expeditious reviews. We support residents in planning for a presentation or publication, rather than merely the completion of a rote requirement of the residency program. Our strategies have been successful and well received by residents and we think they are of value to the greater academic family medicine community. This session will provide family physicians in both academic and community settings involved with supporting resident research projects with practical strategies for success. Building on what we have learned we will discuss suggestions and tips for incorporating them into your setting for this purpose.

Speakers

Research | Recherche

W191: Distinguished Papers

01:30 PM 02:30 PM Room | Salle : 710AB

Mainpro+ certified credits / Crédits certifiés Mainpro+ = 1

13:30-13:45

W618 - Documentation of Chaperone Use: What are family physicians doing and why?

Maeve O’Beirne, MD, CCFP, FCFP, PhD; Juli Finlay, PhD; Sonya Lee, MD, CCFP, FCFP, MHSc

Learning objectives:
1. Describe differences between physicians in the documentation of chaperone use
2. Describe how regulatory college guidance documents influence the use of chaperones by family physicians

Background: In Alberta, recommendations set out by the provincial regulatory college state that when a chaperone is used this should be documented in the patient’s medical record. How family physicians are applying this guidance in their daily practice is unknown. Objective: To examine whether and how family physicians are documenting the use of chaperones, how aware family physicians are of provincial recommendations regarding chaperone use, and how provincial guidance influences family physicians’ decisions on chaperone use. Design: Mixed methods design. Data on documentation practices and awareness of provincial recommendations were collected by cross-sectional survey, with analysis using SPSS statistical software. Data on influencing factors were collected through individual interviews that underwent thematic analysis by constant comparison method. Participants: Survey participants included 438 family physicians in Calgary. Interview participants included 17 family physicians in three academic, community-based Calgary teaching clinics. Results: There were 353 surveys used for analysis (30 per cent response rate) and 17 individual interviews were completed. Survey results showed that 67 per cent of respondents never/rarely documented the offer of a chaperone, and the majority of physicians never/rarely documented whether a chaperone was used. Gender differences were noted, with male physicians being more likely to document chaperone use (P < 0.001). Interview findings suggested physician reasoning around documentation was variable and included individual physician standard of practice, anticipation of concern, patient choice, and other patient factors. Survey results demonstrated that only 25 per cent of respondents were aware of provincial recommendations. This was supported by interview findings, which also showed that while many did not use the recommendations in determining chaperone use, others used them as a way to counsel patients that a chaperone was required. Conclusion: Documentation of chaperone use and application of provincial guidance are variable. Most physicians do not document chaperone use and physician gender may affect documentation practices.

13:45-14:00

W742 - The Normative Definition of Comprehensive Practice Across Three Generations of Alumni of
One Family Practice Program

Tom Freeman, MD, MClinSci, CCFP, FCFP; Leslie Boisvert, MA; Eric Wong, MD, MClinSci, FCFP; Stephen Wetmore, MD, MClinSci, CCFP, FCFP

Learning objective:
1. Compare the self-reported practice activities of three generations of graduates of one family medicine program

Objective: To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare their responses across three generations of alumni of one family practice program. Design: Cross-sectional survey. Setting: One family medicine program in the province of Ontario. Participants: All graduates of one family medicine program between 1985 and 2012. Main outcome measures: Self-reported provision of care in office, care in-hospital, intrapartum obstetrics, house calls, palliative care, after hours care, nursing home care, minor surgery, emergency room, sport medicine, walk-in care. In addition, gender, training stream (urban or rural), size of community of practice, practice model, and satisfaction with practice were considered. Results: Participants practised in eight provinces across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services across three generations of graduates, with newer graduates providing fewer services than the older graduates. Significant declines across the three groups were observed in the provision of house calls, palliative care, and nursing home care. Non-significant changes were seen in the provision of intrapartum obstetrics across the three alumni groups with an initial decline then an increase in reported activity. The average number of types of procedures offered declined from the oldest to the newest graduates. Most respondents were in a patient-enrolment practice model and those in such models reported offering significantly more services than those in either fee for service, Family Health Group, or salary models Conclusion: The normative definition of comprehensive care varies across three generations of graduates of this family medicine program, with newer physicians reporting fewer overall services and procedures than older graduates. A greater understanding of the forces that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicine is to be preserved.

14:00-14:15

W819 - Adherence to Choosing Wisely Recommendations Within Primary Care

Alexander Singer*, MB BAO BCh, CCFP; Leanne Kosowan, MSc; Lisa Lix, MSc, PhD, P.Stat; Kheria Jolin, MSc, MD, CCFP; Alan Katz, MBChB, MSc, CCFP, FCFP

Learning objectives:
1. Identify and define Choosing Wisely Recommendations applicable to primary care
2. Recognize factors associated with adherence to the Choosing Wisely recommendations
3. Review an approach to evaluate adherence to the Choosing Wisely recommendations in primary care settings

Objective: To assess factors associated with adherence to four Choosing Wisely (CW) recommendations during patient encounters with a primary care clinician. Design: We conducted a retrospective review of electronic medical record data from the Manitoba Primary Care Research Network (MaPCReN). Setting: Data from 239 clinicians in 46 clinics representing 162,728 patients. Population: All patients with at least one encounter (2014 to 2016) from a participating MaPCReN primary care clinician. Data relating to the following CW recommendations: a) prescription of antibiotics for viral infections; b) prescription of antipsychotics in patients with dementia; c) vitamin D–level testing, or d) prostate-specific antigen (PSA) test. Main outcome measures: Adherence to each of the four CW recommendations. Methods: Descriptive statistics and multivariable logic models with generalized estimating equations assessed adherence to the CW recommendations and association with patient, provider, and practice characteristics. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported. Results: There were 164,195 primary care encounters related to one of the four CW recommendations evaluated. Overall, 15.6 per cent (n = 25,629) of the encounters did not adhere to one of the investigated CW recommendations. The most common non-adherent CW encounter related to an antibiotic prescription for viral infection (65.4 per cent). The remainder related to PSA screening (28.7 per cent), vitamin D tests (9 per cent), and antipsychotic prescriptions for patients diagnosed with dementia (0.7 per cent). Female patients had an increased odds of an encounter with an antibiotic prescription for viral infections (OR 1.18, 95% CI 1.1 to 1.3) or vitamin D test (OR 1.5, 95%CI 1.3 to 1.9). Salaried physicians, older patients, patients with more frequent office visits, and patients residing in rural areas had increased odds of non-adherence. Conclusions: There are patient-, provider-, and practice-related factors that affect adherence to CW recommendations. Understanding factors associated with adherence is essential to designing strategies to reduce unnecessary investigations and treatments.

14:15-14:30

W662 - Experiences With Medical Assistance in Dying (MAID): Patient and loved ones’ perspectives

Ellen Wiebe*, MD, CCFP, FCFP; Jessica Shaw, MSW, PhD; Amelia Nuhn, MD; Sheila Holmes, MD

Learning objectives:
1. Describe to patients what their experience with medical assistance in dying might be like
2. Describe to patients’ loved ones what their experiences with medical assistance in dying might be like

Context: Canada passed its medical assistance in dying (MAID) law on June 17, 2016. Objective: To explore the experiences and perspectives of Canadians who requested and were eligible for MAID as well as the experiences of people supporting them. Methods: This was a qualitative study using semi-structured interviews and thematic analysis. Patients who had a consultation about MAID in a clinic in British Columbia and were found eligible were recruited for the study. Semi-structured interviews were conducted by two family practice residents with patients and the patients’ support people to explore the wishes, fears, beliefs, and experiences as they pursued, prepared for, and in some cases reflected on MAID. Basic demographics were recorded for context. Results: Twenty-three patient experiences were explored in interviews with 11 patients and 18 support people. Most patients had a malignancy, neurological disorder, or organ failure. The major reason for requesting assisted death was a self-perceived unacceptable quality of life, most commonly due to the loss of autonomy, independence, physical function, and ability to communicate. Some patients expressed fear of future suffering and future disability. The support people included spouses, sons, daughters, and friends. All supported their loved one’s decisions, although some were initially opposed and some found it very hard. All 11 support people who were interviewed after the MAID death said the death was peaceful. They valued that they could be present, prepared, and able to say some final words. Discussion: The reasons patients in our study requested assisted death were similar to the findings in other countries, namely loss of autonomy and the ability to do the things they enjoyed. Their loved ones supported their decisions and valued the chance to be prepared and present.

Teaching | Precepting | Enseignement | Supervision

W531: Selling Family Medicine: Further building the brand

01:30 PM 02:30 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. examine the myths about family medicine within the medical student population
2. contemplate the information medical students are seeking about family medicine
3. develop a message for medical students reflective of our changing discipline

Description:
Following 2008, when the number of students matching to family medicine was at its lowest, the CFPC undertook a number of strategies to overcome the barriers to students selecting a career in family medicine. Subsequently, attitudes towards family medicine began to shift. Our discipline has grown. The Undergraduate Medical Education Committee began a process to reconsider our messaging to medical students about our changing discipline. At FMF 2016, we heard new myths and barriers, as well as new ideas in considering this message. In the workshop we will explore the outcome of last year’s workshop, along with the outcomes of additional surveys and focus groups, to craft a new message, overcoming these myths and barriers about our discipline, that will resonate with medical students of today.

Speakers

Practice Management | Gestion de la pratique
Global Health | Santé mondiale
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées

W341: Preparedness for Your Practice: A discussion and simulation for family doctors in disasters

01:30 PM 05:15 PM Room | Salle : 510A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 3

Learning Objectives:

1. identify the various types of disasters and forms of humanitarian response and discuss ethical considerations for disaster response
2. access resources that will help develop next steps for active contribution in their community for disaster preparedness
3. define specific next steps and actions in the approach to disaster preparedness and response in their own Canadian community

Description:
This workshop is a novel and highly pertinent exercise for Canadian family physicians (FPs). As the complexity and diversity of disasters and emergencies continue to increase, FPs need to be prepared and understand our role in these contexts. This workshop is based on identified needs of family physicians in multiple contexts: hospital rounds, different departments of family medicine in Canada, a United Nations–funded meeting, and family medicine resident requests. Our three-stage workshop will be informed by existing literature and expert input on experiences in disaster contests. The first stage will be a discussion of foundational concepts that FPs should be able to engage in and understand. Participants will be asked to share their working definitions of terms such as disaster, humanitarian emergency, and the phases of disasters. They will be encouraged to draw on experiences within the Canadian context, including the Fort McMurray wildfire and Maritime ice storms. The second and main stage will be an interactive tabletop simulation. Participants will each be given a community “role” to play as groups navigate various disaster scenarios, unpacking the complexities of disaster response and working collaboratively to understand the processes. A team of circulating facilitators will introduce various ethical challenges and scenario-based content as the disaster event evolves. Participants will learn concepts of risk assessment and about the roles of different agencies and organizations involved in the response. The third stage will be a debrief and discussion about what each individual can do to move forward with this concept in their own communities/provinces in Canada. Participants will work in province-specific groups to develop their plans and will present this in five “regional” groups (North, West, Prairie, East, Maritime). Follow-up resources will be provided and may include webinars, evidenced-based ethical tools for disaster response, and appropriate publications.

Speakers

Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Emergency Medicine | Médecine d’urgence
Addiction Medicine | Médecine des toxicomanies

W307: Alcohol Withdrawal in the Emergency Department: Evidence-based assessment and treatment

01:30 PM 02:30 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. learn to assess the severity of alcohol withdrawal
2. learn best practices for the medical management of alcohol withdrawal in the emergency department
3. learn how and when to discharge patients in alcohol withdrawal safely

Description:
Alcohol withdrawal is a common and potentially life-threatening condition encountered in emergency departments across the country. There is a high degree of variability in the assessment and treatment of such patients. During this seminar participants will learn the current best practices involved in the safe assessment, treatment, and discharge of this vulnerable population. The treatment protocols discussed will stress a simple, non-invasive approach that can be used for the majority of patients in most emergency department settings.

Speakers

Teaching | Precepting | Enseignement | Supervision

W392: The Coaching Model: A novel approach for clinical teachers

01:30 PM 02:30 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. become familiar with the coaching model as it applies to the family medicine clinical preceptor
2. learn how coaching techniques can be incorporated in the evaluation portfolio of our learners
3. experiment with coaching tools to identify learner goals, including the Priority Wheel and the GROW model

Description:
Have you ever had the experience of working with a really good sports coach or music teacher? If so, you will probably remember how amazing it felt to have someone working with you to help you achieve at a level that was just not possible for you to do on your own. Research suggests that learning medicine is no different. We all know that a good coach needs to observe your performance in order to help, but that does not occur often enough in medicine. As medical education moves toward a more competency-based structure, direct observation, feedback, and the facilitation of deliberate practice are becoming essential teaching competencies for faculty and learners. The Doctor as Coach framework intentionally supports the implementation of contemporary concepts in medical education. Through this workshop attendees will learn practical techniques from the coaching model to apply to the learner in the family medicine setting. You will get a better understanding of how coaching can be applied to teaching and be able to apply the coaching tools in a hands-on manner to identify learners’ goals and provide meaningful evaluations.

Speakers

Teaching | Precepting | Enseignement | Supervision

W500: Competency-Based Assessment for Family Medicine Enhanced Skills Programs

01:30 PM 02:30 PM Room | Salle : 511F

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe essential components of a competency-based assessment framework for an enhanced skills program
2. explain the need for cumulative evidence of progress towards competence in the context of Certificates of Added Competence
3. plan how to incorporate competency-based assessment into your own enhanced skills programs

Description:
Enhanced skills programs in Canada are currently facing two challenges: firstly, meeting the need to shift to competency-based education and assessment; and secondly, ensuring that programs are able to collect and provide adequate evidence for their graduates to receive Certificates of Added Competency (CAC). Two programs in Sport and Exercise Medicine (SEM) addressed these challenges by adapting the Competency-Based Achievement System (CBAS). CBAS is a competency-based assessment framework, developed by researchers in family medicine at the University of Alberta, that uses formative feedback to inform summative evaluation. CBAS offers a straightforward, learner-driven method to capture and document workplace observations of competency (FieldNotes), which provides immediate feedback, tracks learner progress, and allows for early identification of learners who are encountering difficulty. With CBAS, residents guide their learning using formative feedback. For preceptors and program directors, CBAS offers a way to document workplace observations and feedback, so that summative decisions are evidence-based and defensible. In this interactive workshop, an enhanced skills program director will present evidence of proof-of-concept for using CBAS via exploration of findings from a pilot study in the two SEM programs. Case studies will also be reviewed. Participants will gain some experience using CBAS tools through demonstration and group discussion. Applying the tools to unique cases within participants’ programs will be emphasized. We will also discuss the value of the CBAS as a tool for collecting appropriate evidence to support applications for CACs. Participants will be encouraged to share their own experiences.

Speakers

Maternity and Newborn Care | Soins de maternité et de périnatalité
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées

W347: Maternity and Newborn Enhanced Clinical Session: Important decisions and skills in intrapartum care

01:30 PM 05:15 PM Room | Salle : 510B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 3

Learning Objectives:

1. interpret and respond to challenging intrapartum fetal surveillance; review intrauterine resuscitation and indications for emergency delivery
2. manage intrapartum challenges and delivery complications and use under-utilized techniques for managing pain
3. explore evidence-based third stage management and optimize skin-to-skin maternal child care in all environments

Description:
This clinically based session will focus on the difficult decisions encountered and the skills required in providing intrapartum care. Participants are encouraged to bring their own challenges for discussion. Faculty will facilitate small group discussions and practical, low-fidelity simulations with adequate time for interactive learning. This workshop will create an environment that allows participants to achieve increased competence and confidence in emergency procedures. All management strategies will involve teamwork and effective communication. Examples of scenarios are: interpreting and responding to abnormal intermittent auscultation and electronic fetal monitoring; managing occiput posterior fetal position; performing emergency vacuum-assisted delivery; using new ideas on delivery of the shoulders; managing shoulder dystocia; managing unplanned breech delivery; performing intradermal sterile water injections and pudendal block analgesia; and providing evidence-based third stage management and skin-to-skin maternal child care.

Speakers

Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Mental Health | Santé mentale
Compassionate Care | Soins prodigués avec compassion

W250: Screening for Adverse Childhood Experiences to Build Resiliency and Improve Mental Health Outcomes

01:30 PM 05:15 PM Room | Salle : 510D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 3

Learning Objectives:

1. screen for adverse childhood experiences
2. provide trauma-informed care to patients
3. build healthy therapeutic boundaries with your patients

Description:
A large landmark study done by the Centers for Disease Control and Prevention and the HMO Kaiser Permanente confirmed that adverse childhood experiences (ACEs), such as exposure to violence, neglect, and abuse, are strongly associated with long-term poor mental health. In addition, the study revealed that these adverse events are associated with many other deleterious effects on health, such as increased rates of addiction, increased cardiovascular events, increased cancer rates, and earlier death. Screening for ACEs is an opportunity for family physicians to be better aware of a patient’s risk factors for compromised health and an opportunity to intervene. At the end of this workshop participants will be able to use ACE screening and integrate it into everyday practice. Participants will learn how to use the insight of trauma-informed care to improve the health and well-being of patients. Participants will learn to use the power of empathy, compassion, and self-care to build resiliency in both patients and themselves. Experiences of current ACE screening pilot projects will be shared with the goal of developing a variety of ways to incorporate this tool into everyday family practice and measure outcomes of ACE screening.

Speakers

Teaching | Precepting | Enseignement | Supervision
Compassionate Care | Soins prodigués avec compassion

W522: A Resident-led Initiative to Review and Improve Training in Advance Care Planning

01:30 PM 02:30 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. review feedback from a national survey of residents on current teaching of advance care planning within family medicine residency
2. review results from a literature review on best practices on teaching advance care planning to medical learners
3. practise using a new clinical guide to performing advance care planning, developed by the CFPC Section of Residents

Description:
Each year, the CFPC’s Section of Residents (SoR) reviews a specific aspect of Canadian family medicine residency training programs. The theme of the 2017 review is advance care planning (ACP). This workshop will: review current ACP training within family medicine residency programs in Canada; review best practices and existing resources for teaching ACP to medical learners; and introduce a new guide to ACP developed by the SoR for use in a clinical environment. The SoR performed an online national survey of current family medicine residents in December 2016. The survey had a response rate of 267, representing approximately 20 per cent of all current Canadian family medicine residents. Eighteen per cent of responses were submitted in French. Responses were received from each of the 17 family medicine residency programs, and there was a proportional representation of residents at different stages of residency training. Two-thirds of respondents had not received didactic or clinical instruction about ACP in their residency training. Most respondents who were taught ACP rated the quality of the teaching they received as satisfactory or excellent. More than 77 per cent of respondents would like to see more ACP instruction in their residency training. Detailed results from this national survey, as well as the findings from literature searches on the topics of best practices in teaching ACP to medical learners and resources in teaching and performing ACP, will be reviewed in the workshop.

Speakers

Teaching | Precepting | Enseignement | Supervision

W495: An Online Tool for Programmatic Assessment in Competency-Based Education: Presenting eCBAS 2.1

01:30 PM 02:30 PM Room | Salle : 511E

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the elements needed for managing the data associated with competency-based assessment
2. list advantages and disadvantages of paper versus online systems for competency-based assessment
3. evaluate using a system like eCBAS 2.1 in your own program

Description:
Competency-based medical education became an undeniable fact of curriculum and assessment in family medicine residency programs across Canada in 2013, when the College of Family Physicians of Canada implemented the Triple C Competency-Based Curriculum. While individual programs across Canada have approached competency-based medical education in different ways, there have been some common challenges for many programs. One of those challenges has been how best to assess and track competence. The Working Group on Certification has provided guidance in the form of the Continuous Reflective Assessment for Training document. Individual programs have had to decide which actual tools and processes to use for assessment. Some programs have workable systems, but many are still struggling with how and what to do for competency-based assessment. Our program addressed the challenge of managing assessment information by developing an electronic portfolio, called the Electronic Competency-Based Achievement System (eCBAS). Regularly evaluating and monitoring eCBAS has proven to be an integral part of our change management strategy, allowing us to learn within the system, evolve, and continuously improve. In this session, we present the newest version, eCBAS 2.1, an online system for collecting and managing data generated during programmatic assessment. We will share evaluation data about the system. A system demonstration will be followed by the opportunity for participants to practise, using some of the tools in eCBAS. Table and group discussions will address issues of assessment centred around two case studies about residents—one progressing well and one encountering difficulty. This primarily interactive workshop is excellent for anyone with questions about how to implement workable competency-based assessment, and those who are already carrying out competency-based assessment and would like to share their experiences—positive and negative—with others.

Speakers

Teaching | Precepting | Enseignement | Supervision

W499: Tales From the Program Director's Office: The learner in difficulty

01:30 PM 02:30 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe how to identify a learner in difficulty and the range of problems this term encompasses
2. describe how to deal with these resident learning issues including the institution of learning, remediation, and probation plans
3. understand the processes involved from remediation to appeal, and recognize the inherent challenges in finding solutions that work

Description:
As program directors, we are sometimes faced with supporting residents in difficulty. Having a robust tracking system to identify residents in trouble early is key. Following identification, proper procedures should take place to assist the resident and protect the program’s interests as well. Designing an adequate learning program as well as remediation and probation plans are often challenging but should be done using an evidence-based rubric with input from multiple sources including the learner. Understanding the resident’s and program’s rights and responsibilities is of prime importance when navigating these murky waters. We will discuss the definition of a problem learner, the confounding issues in making this definition, and potential strategies that can be used to assist these learners in need. We will also present a tracking system and administrative structure that help identify residents in distress, as well as discuss how to design adequate learning, remediation, and probation plans. Strong ties with the postgraduate medical education office helps in these situations, and having a working knowledge of the appeal process can help you design the plans. We will then present case scenarios that will be discussed in a workshop-based format.

Speakers

Research | Recherche

W618: Documentation of Chaperone Use: What are family physicians doing and why?

01:30 PM 01:45 PM Room | Salle : 710AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Maeve O’Beirne, MD, CCFP, FCFP, PhD; Juli Finlay, PhD; Sonya Lee, MD, CCFP, FCFP, MHSc

Learning objectives:
1.Describe differences between physicians in the documentation of chaperone use
2.Describe how regulatory college guidance documents influence the use of chaperones by family physicians

Background: In Alberta, recommendations set out by the provincial regulatory college state that when a chaperone is used this should be documented in the patient’s medical record. How family physicians are applying this guidance in their daily practice is unknown. Objective: To examine whether and how family physicians are documenting the use of chaperones, how aware family physicians are of provincial recommendations regarding chaperone use, and how provincial guidance influences family physicians’ decisions on chaperone use. Design: Mixed methods design. Data on documentation practices and awareness of provincial recommendations were collected by cross-sectional survey, with analysis using SPSS statistical software. Data on influencing factors were collected through individual interviews that underwent thematic analysis by constant comparison method. Participants: Survey participants included 438 family physicians in Calgary. Interview participants included 17 family physicians in three academic, community-based Calgary teaching clinics. Results: There were 353 surveys used for analysis (30 per cent response rate) and 17 individual interviews were completed. Survey results showed that 67 per cent of respondents never/rarely documented the offer of a chaperone, and the majority of physicians never/rarely documented whether a chaperone was used. Gender differences were noted, with male physicians being more likely to document chaperone use (P < 0.001). Interview findings suggested physician reasoning around documentation was variable and included individual physician standard of practice, anticipation of concern, patient choice, and other patient factors. Survey results demonstrated that only 25 per cent of respondents were aware of provincial recommendations. This was supported by interview findings, which also showed that while many did not use the recommendations in determining chaperone use, others used them as a way to counsel patients that a chaperone was required. Conclusion: Documentation of chaperone use and application of provincial guidance are variable. Most physicians do not document chaperone use and physician gender may affect documentation practices.
Research | Recherche

W742: The Normative Definition of Comprehensive Practice Across Three Generations of Alumni of One Family Practice Program

01:45 PM 02:00 PM Room | Salle : 710AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Tom Freeman, MD, MClinSci, CCFP, FCFP; Leslie Boisvert, MA; Eric Wong, MD, MClinSci, FCFP; Stephen Wetmore, MD MClinSci, CCFP, FCFP

Learning objective:
1.Compare the self-reported practice activities of three generations of graduates of one family medicine program

Objective:
To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare their responses across three generations of alumni of one family practice program. Design: Cross-sectional survey. Setting: One family medicine program in the province of Ontario. Participants: All graduates of one family medicine program between 1985 and 2012. Main outcome measures: Self-reported provision of care in office, care in-hospital, intrapartum obstetrics, house calls, palliative care, after hours care, nursing home care, minor surgery, emergency room, sport medicine, walk-in care. In addition, gender, training stream (urban or rural), size of community of practice, practice model, and satisfaction with practice were considered. Results: Participants practised in eight provinces across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services across three generations of graduates, with newer graduates providing fewer services than the older graduates. Significant declines across the three groups were observed in the provision of house calls, palliative care, and nursing home care. Non-significant changes were seen in the provision of intrapartum obstetrics across the three alumni groups with an initial decline then an increase in reported activity. The average number of types of procedures offered declined from the oldest to the newest graduates. Most respondents were in a patient-enrolment practice model and those in such models reported offering significantly more services than those in either fee for service, Family Health Group, or salary models Conclusion: The normative definition of comprehensive care varies across three generations of graduates of this family medicine program, with newer physicians reporting fewer overall services and procedures than older graduates. A greater understanding of the forces that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicine is to be preserved.
Research | Recherche

W819: Adherence to Choosing Wisely Recommendations Within Primary Care

02:00 PM 02:15 PM Room | Salle : 710AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Alexander Singer*, MB BAO BCh, CCFP; Leanne Kosowan, MSc; Lisa Lix, MSc, PhD, P.Stat; Kheria Jolin, MSc, MD, CCFP; Alan Katz, MBChB, MSc, CCFP

Learning objectives:
1.Identify and define Choosing Wisely Recommendations applicable to primary care
2.Recognize factors associated with adherence to the Choosing Wisely recommendations
3.Review an approach to evaluate adherence to the Choosing Wisely recommendations in primary care settings

Objective:
To assess factors associated with adherence to four Choosing Wisely (CW) recommendations during patient encounters with a primary care clinician. Design: We conducted a retrospective review of electronic medical record data from the Manitoba Primary Care Research Network (MaPCReN). Setting: Data from 239 clinicians in 46 clinics representing 162,728 patients. Population: All patients with at least one encounter (2014 to 2016) from a participating MaPCReN primary care clinician. Data relating to the following CW recommendations: a) prescription of antibiotics for viral infections; b) prescription of antipsychotics in patients with dementia; c) vitamin D–level testing, or d) prostate-specific antigen (PSA) test. Main outcome measures: Adherence to each of the four CW recommendations. Methods: Descriptive statistics and multivariable logic models with generalized estimating equations assessed adherence to the CW recommendations and association with patient, provider, and practice characteristics. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported. Results: There were 164,195 primary care encounters related to one of the four CW recommendations evaluated. Overall, 15.6 per cent (n = 25,629) of the encounters did not adhere to one of the investigated CW recommendations. The most common non-adherent CW encounter related to an antibiotic prescription for viral infection (65.4 per cent). The remainder related to PSA screening (28.7 per cent), vitamin D tests (9 per cent), and antipsychotic prescriptions for patients diagnosed with dementia (0.7 per cent). Female patients had an increased odds of an encounter with an antibiotic prescription for viral infections (OR 1.18, 95% CI 1.1 to 1.3) or vitamin D test (OR 1.5, 95%CI 1.3 to 1.9). Salaried physicians, older patients, patients with more frequent office visits, and patients residing in rural areas had increased odds of non-adherence. Conclusions: There are patient-, provider-, and practice-related factors that affect adherence to CW recommendations. Understanding factors associated with adherence is essential to designing strategies to reduce unnecessary investigations and treatments.
Research | Recherche

W662: Experiences With Medical Assistance in Dying (MAID): Patient and loved ones’ perspectives

02:15 PM 02:30 PM Room | Salle : 710AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Ellen Wiebe*, MD, CCFP, FCFP; Jessica Shaw, MSW, PhD; Amelia Nuhn, MD; Sheila Holmes, MD

Learning objectives:
1.Describe to patients what their experience with medical assistance in dying might be like
2.Describe to patients’ loved ones what their experiences with medical assistance in dying might be like

Context: Canada passed its medical assistance in dying (MAID) law on June 17, 2016. Objective: To explore the experiences and perspectives of Canadians who requested and were eligible for MAID as well as the experiences of people supporting them. Methods: This was a qualitative study using semi-structured interviews and thematic analysis. Patients who had a consultation about MAID in a clinic in British Columbia and were found eligible were recruited for the study. Semi-structured interviews were conducted by two family practice residents with patients and the patients’ support people to explore the wishes, fears, beliefs, and experiences as they pursued, prepared for, and in some cases reflected on MAID. Basic demographics were recorded for context. Results: Twenty-three patient experiences were explored in interviews with 11 patients and 18 support people. Most patients had a malignancy, neurological disorder, or organ failure. The major reason for requesting assisted death was a self-perceived unacceptable quality of life, most commonly due to the loss of autonomy, independence, physical function, and ability to communicate. Some patients expressed fear of future suffering and future disability. The support people included spouses, sons, daughters, and friends. All supported their loved one’s decisions, although some were initially opposed and some found it very hard. All 11 support people who were interviewed after the MAID death said the death was peaceful. They valued that they could be present, prepared, and able to say some final words. Discussion: The reasons patients in our study requested assisted death were similar to the findings in other countries, namely loss of autonomy and the ability to do the things they enjoyed. Their loved ones supported their decisions and valued the chance to be prepared and present.
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Cancer Care | Soins aux patients atteints du cancer
Emergency Medicine | Médecine d’urgence

W401: Oncology Emergencies

03:00 PM 04:00 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. become aware of common oncology emergencies
2. learn to treat common oncology emergencies
3. learn to recognize rare oncology emergencies

Description:
Emergencies related to cancer and cancer treatment are common in the emergency department. This session will help participants recognize and treat these emergencies.

Speakers

Research | Recherche

W603: Overcoming Language Barriers Through the Training of Health Professional Students as Volunteer Interpreters

03:00 PM 03:15 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Shiva Adel, MD, MSc; Belle Song, MD, CCFP; Eva Purkey, MD, CCFP, FCFP, MPH

Background and Purpose: In recent years Kingston, Ontario, has seen an influx of new Canadians with limited English proficiency, most recently with the arrival of Syrian refugees. Currently, there are limited resources for medical interpretation at the Queen’s Family Health Team (QFHT). Patients with limited English proficiency have significant health disparities, which can be improved through access to trained interpreters. Objective: To develop and evaluate a sustainable model to provide free interpreter services within primary care to patients with limited English proficiency at the QFHT. Design: Surveys, program evaluation, qualitative descriptive. Setting: Academic family health team in a medium-size city. Participants: Forty-four student volunteers from health sciences backgrounds, more than 50 patients with limited English proficiency, and health care providers at the QFHT. Intervention: Student volunteers underwent a training session regarding medical interpretation, confidentiality, and cultural competency. They were paired with patients with low English proficiency and attended medical intake and follow-up appointments at the QFHT to provide interpretation between patients and health care practitioners throughout the year. Main outcome measures: Surveys were distributed to volunteer interpreters prior to the training session to assess interest, level of experience, and exposure to medical interpretation. A second survey was then administered several months later to collect feedback from volunteers, patients, and health care practitioners regarding the effectiveness of the program and potential improvements that could be implemented. Results: Volunteer interpreters attended two evenings of patient intake sessions and more than 40 follow-up appointments and urgent care visits. Preliminary feedback from volunteers and health care providers is positive and suggests that this provides a valuable service to underserved patients and health care providers at the QFHT. Conclusions and Discussion: Our program provides access to free interpreter services at the QFHT through health sciences students who have received informal training in interpretation, cultural competency, and confidentiality.
Research | Recherche

W613: Home-Based Dialysis for Patients With End-Stage Kidney Disease: What does the evidence say?

03:00 PM 03:15 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Eftyhia Helis, MSc; Alison Sinclair, MD, MSc, PhD; Bernice Tsoi, MSc, PhD; Tamara Rader, MLIS; Ken Bond, MA; Janet Crain; Kristen Moulton, MSc; Gino De Angelis, MSc

Learning objective:
1.Compare current dialysis practices for managing end-stage kidney disease with the current evidence on the effectiveness of various dialysis modalities

Context:
Some patients with chronic kidney disease (CKD) often progress to having end-stage kidney disease (ESKD), also known as kidney failure. When kidney transplantation is not an option, most patients living with ESKD are treated with dialysis, which is often a lifelong treatment. Even though several options for having dialysis treatment at home (e.g., home hemodialysis and peritoneal dialysis) are available to ESKD patients, traditional hemodialysis offered in a clinical setting remains the most frequently used modality in Canada. Objective: The presentation will provide an overview of the clinical effectiveness of home hemodialysis and peritoneal dialysis as well as other considerations that may be important when planning for dialysis treatment. Design: A health technology assessment reviewed the evidence on clinical effectiveness, cost effectiveness, patient perspectives, ethical issues, and implementation considerations for home-based dialysis modalities. The review assessed the evidence based on the published literature and surveys relevant to Canadian dialysis stakeholders. An expert panel, which included family physicians, made recommendations on the use of home-based dialysis based on the reviewed evidence. Target population: Medical practitioners who need to provide care or consultation to patients with CKD or ESKD or their caregivers. Findings: Overall, compared with in-centre hemodialysis, home-based modalities appear to offer similar clinical benefits and are less costly for eligible patients. Discussion/Conclusion: The findings of the evidence review will be discussed in the context of how they may inform treatment decisions, particularly for patients living in areas with no easy access to treatment (i.e., patients in rural or remote areas) and patients with unique health and cultural profiles (e.g., Indigenous patients).
Research | Recherche

W622: False Positive Newborn Screening Results for Cystic Fibrosis: Impact on health service use

03:00 PM 03:15 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

June C. Carroll, MD, CCFP, FCFP; Robin Z. Hayeems, ScM, PhD; Fiona A. Miller, PhD; Marian Vermeulen, MHSc; Beth K. Potter, PhD; Pranesh Chakraborty, MD; Christine Davies, MSc; Felix Ratjen, MD, PhD; Astrid Guttmann, MD CM, MSc

Learning objective:
1.Assess the possible harms that may result from false positive newborn screening results

Objective:
Evidence is mixed regarding the impact of false positive newborn screening results on health care use. Using cystic fibrosis (CF) as an example, we determined the association of false positive newborn screening results with health care use in infants and their mothers in Ontario, Canada. Design: Population-based cohort study Setting and Participants: All infants with false positive CF results (n = 1,564) and screen negative matched controls (n = 6,256) born between April 1, 2008, and November 30, 2012, using linked health administrative data sets. Outcomes: Maternal and infant physician and emergency department visits and inpatient hospitalizations from the infant’s third to 15th month of age. Negative binomial regression tested associations of newborn screening status with outcomes, adjusting for infant (comorbidities, income quintile, rurality) and maternal (age, mental health history) characteristics. Results: A greater proportion of infants with false positive results had more than two outpatient specialist visits (16.2 per cent versus 13.2 per cent) and more than two hospital admissions (1.5 per cent versus 0.7 per cent) compared with controls; emergency department visits were not significantly different. Differences persisted after adjustment, with higher rates of specialist visits (RR 1.39, 95% CI 1.20 to 1.60) and hospital admissions (RR 1.70, 95%CI 1.24 to 2.34) for false positive infants. Stratified models indicated the effect of false positive status was greater among those whose primary care provider was a pediatrician compared with those whose primary care provider was a family physician. No differences in health care use among mothers were detected. Conclusion: Higher use of outpatient specialist services among false positive infants may relate to follow-up carrier testing or heightened perceptions of vulnerable infant health by parents or providers. However, increased rates of hospitalization might signal increased medicalization of these healthy infants. By understanding the downstream experience for patients and providers, newborn screening programs can better support them in navigating screening results. Specifically, counselling and education resources can be improved to ensure that parents and providers understand the benign nature of false positive CF screening results.
Research | Recherche

W644: R2C2 in Residency: Facilitating feedback implementation

03:00 PM 03:15 PM Room | Salle : 511E

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Heather Armson, MD, MCE, CCFP, FCFP; Joan Sargeant, PhD; Jocelyn Lockyer, PhD; Marygrace Zetkulic, MD; Andrew Warren, MD, MSc, FRCPC

Learning objectives:
1.Explore the effectiveness of the R2C2 feedback model in promoting feedback acceptance and use for improvement across varied disciplines and sites
2.Determine and explain factors that appeared to moderate the use and effectiveness of the model across sites
3.Examine implications for participants’ teaching practices

Background:
An evidence-based model (R2C2) was tested in residency education. The model focuses on: 1) building Relationships; 2) exploring Reactions to the feedback; 3) exploring understanding of feedback Content; and 4) Coaching for performance change. Methods: This was an international study of five residency programs using case study methodology and realist evaluation. Dyads of residents and their supervisors were recruited. Supervisors were trained and then asked to use the R2C2 model in two feedback sessions, three to six months apart. Feedback sessions and subsequent debrief interviews were recorded and transcribed. Content and template analysis were used within and across cases. Synthesis consisted of case and comparative analysis to identify the usefulness of each component and suggest revisions required to strengthen the R2C2 model. Results: Forty resident-preceptor dyads were recruited. The R2C2 model was effective in engaging residents in a reflective feedback conversation, although variability was noted across sites. The process appeared to enhance resident engagement and reflection, guided self-assessment, and encouraged active collaboration in the development of goals and outcomes. The model appeared to be useful with both excelling and struggling residents. Coaching for change was the most useful feature of the model, with the learning change plan an integral component to the coaching discussion. Factors influencing the use of the R2C2 model included supervisor and resident factors, such as the resident-supervisor relationship, and programmatic assessment approaches and contextual factors. Conclusions and Significance: The model can be effective in engaging residents in reviewing their performance assessment data, in reflecting and identifying opportunities for improvement, and in working with their supervisors to plan and implement improvements. 
Research | Recherche

W685: Implantation de l’accès adapté en unités de médecine de famille : une recherche participative

03:00 PM 03:15 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Mireille Luc, RD MSc; Marie-Claude Beaulieu, MD; Isabelle Boulianne, RN MOrgM; Mylaine Breton, PhD; Louise Champagne, MD; Sandra Conway; Nick Côté, MD; Jean-François Deshaies, MD; Marylène Fillion, MEd; Philippe Villemure, MD; Catherine Hudon, MD PhD

Objectifs d’apprentissage : 
1.Identifier des stratégies pour favoriser l’implantation et l’enseignement de l’accès adapté en UMF
2.Mieux comprendre l’utilité de la recherche participative en première ligne dans un contexte d’UMF

Objectifs :
(1) Soutenir l’implantation de l’accès adapté (AA) dans les unités de médecine de famille (UMF) de l’Université de Sherbrooke et (2) identifier les défis et solutions à l’enseignement de l’AA aux résidents. Méthodologie : Une recherche participative a été menée de 2015 à 2017 avec la communauté de pratique des directeurs d’UMF, en utilisant une méthode qualitative descriptive. Un comité Accessibilité a été formé pour accompagner le processus d’implantation de l’AA. Le comité réunissant la directrice de la recherche, une coordonnatrice, deux directeurs d’UMF, un résident, une patiente partenaire, trois expertes (changement organisationnel, amélioration de la qualité et AA) et deux représentants du département. Les données ont été recueillies au moyen de six groupes de discussion traitant de différents aspects de l’implantation. Les résultats des analyses thématiques ont été validés avec la communauté de pratique. Contexte : Le projet a été réalisé dans 10 UMF de l’Université de Sherbrooke (province de Québec, CANADA). Participants : La communauté de pratique des directeurs d’UMF (n=18) représente les 110 superviseurs et 190 résidents des UMF. Résultats : Toutes les UMF ont adopté le modèle d’AA. La majorité (80 %) a implanté l’AA, tant pour les superviseurs que pour les résidents. Quatre défis à l’enseignement de l’AA aux résidents ont émergé : 1) définir la patientèle ; 2) assurer une continuité des soins ; 3) adopter une approche de collaboration interprofessionnelle ; et 4) formaliser l’enseignement de l’AA. La planification préalable de la patientèle, l’appariement des résidents, la clarification des rôles des professionnels et la formation initiale et continue de l’AA ont été identifiés comme des solutions pour faciliter l’enseignement de l’AA aux résidents. Conclusion : À la fin de cette présentation, le participant sera en mesure d’identifier des stratégies pour favoriser l’implantation et l’enseignement de l’AA en UMF et de mieux comprendre l’utilité de la recherche participative.
Research | Recherche

W719: Does a Structured Curriculum Help Residents Diagnose and Treat Skin Cancer?

03:00 PM 03:15 PM Room | Salle : 511F

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Christine Rivet*, MD CM, CCFP (EM), FCFP, MClSc; Farhad Motamedi, MD, CCFP, FCFP; Douglas Archibald, PhD; Joseph Burns, MSc

Learning objective:
1.Be able to determine whether a longitudinal procedural curriculum could be implemented at their teaching site

Objective:
To determine whether a biweekly procedure clinic and structured procedural curriculum throughout family medicine (FM) residency prepares residents to identify and manage skin cancers better than routine opportunistic teaching of skin procedures. Design: A survey and photo quiz. Setting: Family medicine training sites at the University of Ottawa. Participants: All incoming FM residents starting residency (N = 60). Intervention: All incoming FM residents were asked to fill out a survey and photo quiz at the beginning of their training to establish their level of experience with and knowledge of skin conditions. The photo quiz was validated by a dermatologist. FM residents at one site received training in the procedure clinic every two weeks along with a structured procedural curriculum focused on the diagnosis and management of skin cancer during eight months of FM training throughout the two years of residency. The other sites had routine opportunistic teaching on on the diagnosis and management of skin cancer. The procedure clinic is based on hands-on experience with direct supervision by the study authors. At the end of their first year and at the end of their training, all FM residents were asked to fill out a survey and photo quiz to verify their knowledge. Results: Twenty-five residents participated in the initial survey and photo quiz. The study participants and non-participants obtained a score of 61 per cent and 58 per cent, respectively, at the beginning of residency and 76 per cent and 57 per cent, respectively, at the end of residency. Conclusion: Our results indicate that a longitudinal curriculum helps FM residents identify and treat skin cancers, whereas opportunistic teaching showed no objective benefit.
Research | Recherche

W766: Impact of a Criterion-Based Competency Assessment Tool on Identification and Management of Residents in Difficulty

03:00 PM 03:15 PM Room | Salle : 511D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Miriam Lacasse, MD, MSc, CCMF; Jean-Sébastien Renaud, PhD; Caroline Simard, MA

Learning objective:

1.Discuss the impact of a criterion-based competency assessment tool on the identification and management of residents in difficulty

Background: The family medicine residency program at Université Laval has developed and validated an innovative criterion-based competency assessment tool (CCAT) adapted to each rotation and training period. This computerized tool includes a decision support system suggesting educational diagnoses and prescriptions to support resident feedback and guide teachers in their judgment of competency achievement for each milestone. Objective: To determine the impact of a CCAT on the identification and management of residents in difficulty. Methods: Clinical teachers who had filled out at least one family medicine resident summative assessment in the previous three months participated in this study. They filled out a questionnaire before and after implementation of the CCAT to appraise Factors that Influence Reporting of Residents in Difficulty (Q-FIR-RID: 12 items, α = 0.81) to assess four constructs on a Likert scale (1-5): documentation, knowledge of what to document, consequences for the evaluator, and remediation options. Anonymized data about remediation rotations was obtained from the program promotion committee. Results: A total of 254 clinical teachers completed the questionnaire. The Q-FIR-RID score increased after implementation of the CCAT (mean change = 0.25). Three constructs improved after CCAT implementation: documentation (P < 0.001), knowledge of what to document (P < 0.001) and remediation options (P < 0.01). Residents in difficulty were identified earlier after implementation of the CCAT, and remediation rotations were offered earlier to residents (pre: 85 per cent of remediation rotations offered during PGY-1 and 15 as PGY-2; post: 100 per cent as PGY-1). Conclusion: This project suggests a criterion-based competency assessment tool that includes a decision support system improves the identification and management of residents in difficulty.
Research | Recherche

W769: Access to Primary Care for Persons Recently Released From Prison: An audit study

03:00 PM 03:15 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Nahla Fahmy, MBBCH; Ruth Martin, MD, CCFP, FCFP; Fiona Kouyoumdjian, MD, CCFP, PhD; Stephen Hwang, MD, MPH; Sharif Fahmy, MBA; Carlos Magnas Neves; Jonathan Berkowitoz, PhD

Learning objectives:
1.Identify barriers to accessing primary care for previously incarcerated individuals
2.Highlight the need for improved accessibility
3.Understand the need to address barriers to care

Objective:
To determine whether a history of recent imprisonment affects the response a person receives when seeking a primary care appointment. Design: We conducted a controlled audit study in which we made unannounced telephone calls to the offices of family physicians (N = 339). Male and female researchers played the role of a patient seeking a physician and requested an initial appointment for primary care, according to one of four patient scenarios that were sequentially assigned to each physician office: 1) a male recently released from prison; 2) a female recently released from prison; 3) a male not recently released from prison; and 4) a female not recently released from prison. Participants: Family physicians who were listed as accepting new patients on the College of Physicians and Surgeons of British Columbia website. Setting: This study was conducted in British Columbia. Main outcome: Whether the caller was offered an initial appointment. Results: For physician offices that we contacted that were eligible for inclusion (n = 250), the proportion of calls resulting in an appointment being offered was significantly lower when the callers said they had recently been released from prison compared with controls (46.2 per cent of 122 versus 84.4 per cent of 128, P = 0.001). The odds of being offered an appointment was 7.3 times higher (95%CI 4.0 to 13.2) for controls compared with those who reported a recent release from prison. There was no significant difference based on the gender of the caller, with 48.3 per cent of 62 calls from a male and 37.1 per cent of 60 calls from a female (P = 0.42) resulting in an appointment. Interpretation: In a setting with a universal health insurance system, people who presented themselves as having recently been released from prison had poorer access to primary care. Efforts to improve access to primary care for this vulnerable population need to address barriers to care beyond health insurance.
Research | Recherche

W792: Mental Health Impacts of Partnering Indigenous Elders Within Primary Care Teams: A mixed methods prospective cohort study

03:00 PM 03:15 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

David Tu, MD, CCFP*; Elder Roberta Price; George Hadjipavlou, MD, FRCPC; Colleen Varcoe, RN, PhD; Jennifer Dehoney; Annette Brown, RN, PhD

Learning objectives:
1.Understand the benefits Indigenous Elders have on patient care

Objective:
To determine the mental health and broader impacts of patients connecting with Indigenous Elders as part of routine primary health care. Design: Mixed methods prospective cohort study with quantitative measures at baseline and after one, three, and six months; and in-depth qualitative interview at more than three months post intervention. Setting: AWestern Canadian urban Indigenous primary care clinic. Inclusion criteria: Age > 18 years, self-identifying as Indigenous, and no prior contact with an Elders program. Participants: Forty-two patients were enrolled—four had incomplete follow-up and one died—allowing for complete quantitative data for 37 participants. Seventy per cent were female; the mean age was 51 years. Thirty-three per cent had attended residential school and 67 per cent had experience in the foster care system. Intervention: Participants connected with an Indigenous Elder as part of a one-on-one and/or group sessions. Follow-up visits were left to the discretion of the participant and the Elder. Main outcome measures: Quantitative depressive symptoms (PHQ9) and suicide risk (SQB-R) and qualitative descriptions of health impacts and harms. Results: Twenty-four participants at baseline had moderate/severe depression (PHQ9 > 10); of these there was a decrease in depressive symptoms (5 points) that was sustained over a six-month period (P = 0.002). Ten participants had an above-average suicide risk at baseline (SQB-R > 7); of these there was a decrease in suicide risk (2 points) that was sustained over a six-month period (P = 0.008). Twenty-nine participants completed qualitative interviews; 28/29 indicated a clear positive impact, 0/29 indicated harms. Common impacts were improved emotional regulation, adaptive behavioural changes, increased social connection, improved housing status, improved employment status, and less use of mood-altering substances. Conclusions: Connection with Indigenous Elders as part of routine primary care had a significant positive impact on depressive symptoms and suicide risk; it was also associated with beneficial mood, behavioural, and social outcomes and was not associated with identifiable harms.
Research | Recherche

W546: Barriers and Facilitators in Primary Care Follow-Up Upon Hospital Discharge: Patients’ and caregivers’ perspectives

03:15 PM 03:30 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Soumia Meiyappan*, MSc; Benjamin Kaasa, MD, MScCH, CCFP; Hannah Sidrak, MBBS

Learning objective:
1.Identify a number of barriers and facilitators patients face in post-discharge follow-up care

Objective: To explore patient and caregiver experiences with how easy or difficult it was for patients to follow up with their primary care provider upon discharge from hospital. The transition period from an in-patient setting to an outpatient setting is a vulnerable time for patients. Design: Qualitative descriptive research design through the use of semi-structured individual interviews. Setting: The study took place at the Toronto Western Family Health Team (TWFHT) in Ontario. Interviews were held on-site or over the phone. Participants: Interviews were carried out with a total of 13 participants (11 patients and two caregivers). The purposive sampling technique was used to select patient participants who were: discharged home from the Family Inpatient Service unit of the TWFHT in the past 30 days; had an identified primary care provider in Ontario at the time of discharge; suffered from one or more of chronic obstructive pulmonary disease exacerbations, congestive heart failure, gastrointestinal disorders, pneumonia, or acute myocardial infarction; and able to speak English, Portuguese, or Mandarin (interpretation was made available). Findings: Thematic analysis identified a number of barriers to follow-up by patient participants, including language barriers, lack of communication between the patient and their primary care provider and/or in-patient physician, and lack of communication between the primary care provider and in-patient physician. Among the main facilitators of follow-up identified were the availability and accessibility of a patient’s primary care provider, a patient’s proximity to the primary care provider, and accessible transportation to and from the primary care provider’s office. Conclusion: Understanding patients’ post-discharge experiences has the potential to aid in developing interventions to improve patient quality of life and care in the post-discharge transitional period. By including the experiences and perspectives of both the patient and their caregiver, our research team was able to gain broader critical insight into patients’ post-discharge experiences and create recommendations on strategies to improve them.
Research | Recherche

W559: Integrating a Medical Assistance in Dying Curriculum in a Family Medicine Residency Training Program

03:15 PM 03:30 PM Room | Salle : 511F

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Susan MacDonald*, MD, MHSc, CCFP, FCFP; Sarah LeBlanc, MD, MSc, CCFP; Nancy Dalgarno, PhD, MEd, OCT; Karen Schultz, MD, CCFP, FCFP; Daniel Zimmerman, MD; Emily Johnston, MSc

Learning objective:
1.Be able to identify perceptions of MAID among family medicine faculty and residents

Objective:
To determine family medicine (FM) resident and faculty perceptions of medical assistance in dying (MAID) in terms of interest in and knowledge of MAID, experiences with MAID, willingness and readiness to learn and/or teach about MAID, anticipation of participating in MAID, and recommendations for curricular content for residents, faculty development, and continuing professional development (CPD). Design: An exploratory mixed method design was used to help inform the development of an integrated MAID curriculum. Setting: A Canadian FM residency program that included four distributed sites: one academic FM site and three community-based FM sites. Participants: Using purposive sampling, anonymous online surveys were distributed to FM physician preceptors (n = 158) and postgraduate year (PGY)-1 and PGY-2 FM residents (n = 193) associated with the FM program under study. Results: Survey response rates were 45 per cent for faculty and 33 per cent for residents. Faculty were significantly more confident, competent, and comfortable than residents in explaining and discussing MAID with colleagues and patients (P < 0.05). Residents, however, were more willing to participate in administering MAID than faculty (P < 0.05). Seventy-two per cent of respondents believe it is important to integrate MAID into the core curriculum, with faculty who were non-conscientious objectors being more likely to believe it should be included in the curriculum (P < 0.05). The curricular elements deemed most important included advance care/end-of-life planning (76 per cent), technical aspects (73 per cent), and regulations/ethical issues (56 per cent). Conclusions: Developing a MAID curriculum will bridge the competency gap self-identified by participants. Patients’ access to compassionate end-of-life care can be improved through training that increases the comfort, confidence, and competence of both faculty and residents in the topic of MAID. Of importance is developing faculty development/CPD sessions to educate and support both conscientious objectors and non- conscientious objectors, allowing all residents to learn about the care of patients requesting MAID.
Research | Recherche

W614: Predictors of Non-Adherence to Colorectal Cancer Screening Among Immigrants to Ontario

03:15 PM 03:30 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Shixin (Cindy) Shen*, MD, MPH; Aisha Lofters, MD, PhD, CCFP; Richard H. Glazier, MD, MPH, CCFP, FCFP; Jill Tinmouth, MD, PhD, FRCPC; Lawrence Paszat, MD, MSc, FRCPC; Linda Rabeneck, MD, MPH, FRCPC

Learning objective:
1.Describe the prevalence of non-adherence to colorectal cancer screening among immigrants to Ontario

Objective:
Though colorectal cancer (CRC) screening rates have increased over time, immigrants continue to have lower rates of screening. This study aims to examine the association between characteristics related to immigration, socio-demographics, health care use, and primary care physicians’ non-adherence to CRC screening when caring for immigrants to Ontario. Design: This is a population-based retrospective study with a cross-sectional design. Setting: This study used multiple health care administrative databases housed at the Institute for Clinical Evaluative Sciences and the Immigration, Refugees and Citizenship Canada database. Participants: Our cohort comprised immigrants between the ages of 60 to 74 years who had been eligible for the Ontario Health Insurance Plan for at least 10 years and who lived in Ontario on March 31, 2015. Those who had a history of CRC, inflammatory bowel disease, or total colectomy were excluded. The final cohort contained 182,949 individuals. Main outcome measure: The outcome was defined as not being up-to-date with any modality of CRC screening on March 31, 2015, which included fecal occult blood test in the previous two years, sigmoidoscopy in the previous five years, and colonoscopy in the previous 10 years. Results: Risk of non-adherence to CRC screening was higher among immigrants who were from low- or middle-income countries, refugees, unmarried, without post-secondary education, and non-English speaking, and among those who had immigrated more recently and lived in only one world region before landing in Canada. Compared with those from the United States, Australia, and New Zealand, immigrants from most other world regions had higher risks of non-adherence. Significant associations were also found between screening non-adherence and several socio-demographic, health care use, and provider factors, especially resource use, rostering status, and neighbourhood income quintile. Conclusion: Many immigration and non-immigration factors predicted the risk of non-adherence to CRC screening. These findings can be used in future efforts to improve the uptake of CRC screening among immigrants.
Research | Recherche

W681: What Can We Learn From Action on Social Determinants of Health in Low-Resource Countries?

03:15 PM 03:30 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Labib Girgis*, MD; Anne Andermann, MD, DPhil, CCFP, FRCPC

Learning objective:
1.Understand the social challenges faced by patients in their countries of origin

Objectives: To explore how health care providers from low- and middle-income countries (LMICs) address the social challenges faced by their patients in their clinical practices. Design: A qualitative descriptive research methodology was used involving semi-structured in-depth interviews. All interviews were conducted in English (either in person or by phone), audio recorded, and transcribed verbatim. A conventional content analysis was used to analyze the data. Setting: The study was conducted at a large, university-affiliated family medicine centre in Montreal that serves one of the most ethnically diverse patient populations in Canada. Participants: Purposive sampling was used to recruit health workers with clinical experience in LMICs, specifically the Eastern Mediterranean region, as well a good understanding of the Canadian context. Recruitment of health workers trained in the Eastern Mediterranean region and who have since moved to Canada continued until data saturation was reached (N = 19). Main outcomes: Common social challenges, barriers, and facilitators for action in LMICs and South-North learning to help Canadian health workers identify and act on social challenges of the diverse patient populations they serve. Findings: The main social challenges of patients in LMICs include poverty, illiteracy, domestic violence, unstable families, and food insecurity. Health workers reported assisting vulnerable patients by increasing their access to health care services, helping them afford medications, and referring them to social supports, where available. Barriers included cultural and time constraints, unfamiliarity with social support resources, large patient loads, and inadequate numbers of family doctors. Participants suggested that both health workers and patients need to be educated on the importance of discussing and addressing social challenges during the clinical encounter. Conclusions: Many Canadian health care providers have socially and ethnically diverse practices. Understanding the social challenges faced by patients in their countries of origin can promote cultural competence to help health workers better address marginalization and inequity in the Canadian context.
Research | Recherche

W755: Breastfeeding Discontinuation in the Cypress Health Region and Intrapartum Factors

03:15 PM 03:30 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Kristin Bonkowski, MD; Nicole Heintz, MD; Dalynne Peters, MD; Breanne Irving*, MBBS; Kevin Wasko*, MD, CCFP, MA; Kelechi Eguzo, MD, MPH

Learning objective:
1.Determine the relationship between intrapartum factors and breastfeeding discontinuation

Background: Previous research reveals that breastfeeding rates in the Cypress Health Region (CHR) of Saskatchewan dropped from 97 per cent at discharge to 36.1 per cent and 22.3 per cent at two and four months postpartum, respectively. Little is known about the relationship between intrapartum factors and breastfeeding discontinuation. Objective: To determine the relationship between intrapartum factors and breastfeeding discontinuation in the CHR. Design and participants: A cross-sectional retrospective chart audit of all women who delivered live infants in the CHR between January 1, 2014, and December 31, 2015, was performed. Methods: Predictors considered were: duration of labour, gestational age at delivery, route of delivery, skilled attendant at labour, group B strep (GBS) status, type of analgesia, presence of perineal tear, and presence of postpartum hemorrhage. Outcomes considered were breastfeeding status at discharge and at two and four months postpartum. Data were analyzed using descriptive statistics, t test, chi-square test, and logistic regression. Results: A total of 762 charts met the inclusion criteria, representing normal vaginal deliveries (65.5 per cent, 499/762), Cesarean sections (27 per cent, 206/762), and operative vaginal deliveries (7.5 per cent, 57/762). The average patient age was 28 years and 40 per cent (303/758) were primiparous. Ninety-two per cent of mothers breastfed at discharge, while 44.6 per cent (340/762) and 37.5 per cent (286/762) were breastfeeding at two and four months, respectively. Women who had a normal vaginal delivery were more likely to breastfeed at discharge (OR 3.03, 95%CI 1.76 to 5.21). Significant multivariate predictors of breastfeeding at two months were type of analgesia (P < 0.001) and presence of perineal tear (P = 0.027), while the provider involved predicted breastfeeding at four months (P = 0.001). Women delivered by family physicians were three times more likely to continue breastfeeding at four months compared with those who were delivered by specialists (95%CI 1.81 to 6.25, P < 0.001). Conclusions: The CHR has a high rate of breastfeeding discontinuation. Intrapartum factors that may predict breastfeeding discontinuation are type of analgesia, presence of perineal tear, and the provider involved in the delivery.
Research | Recherche

W786: Les courbes cognitives pour différencier un déclin normal relié à l’âge du développement d’une démence

03:15 PM 03:30 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Patrick J. Bernier*, MD CCMF PhD; Christian Gourdeau, MSc; Pierre-Hugues Carmichael, MSc ; Jean‑Pierre Beauchemin, MD ; René Verreault, MD ; Rémi W. Bouchard, MD MSc ; Edeltraut Kröger, PhD; Robert Laforce Jr, MD PhD FRCPC

Objectif : Concevoir des courbes cognitives d’usage facile pour appuyer les cliniciens dans le suivi de leurs patients en utilisant uniquement des résultats du MMSE(mini-mental state examination) combinés à l’âge et à la scolarité. Type d’étude : Modélisation mathématique rétrospective. Contexte : Le MMSE demeure l’outil cognitif le plus utilisé dans le monde. Les performances au MMSE sont principalement influencées par l’âge et par la scolarité. La tâche demeure difficile en première ligne de faire la différence entre un déclin cognitif normal et l’apparition des premiers signes d’un processus dégénératif. Participants : La base de données de l’Étude sur la santé et le vieillissement au Canada (ESVC) qui regroupe 7 569 personnes âgées de ≥65 ans ayant complété le MMSE au départ, puis à 5 et à 10 ans. Intervention : La modélisation mathématique de la relation entre l’âge, la scolarité et le résultat du MMSE a permis de générer des courbes cognitives (CC) de percentiles selon la trajectoire normale attendue et basées sur les nouveaux concepts de quotient cognitif (QuoCo) et d’âge standardisé (AS). Une zone de seuil inférieur (cut-off) était intégrée. Les CC ont ensuite été validées à l’aide d’une base de données externe (NACC). Paramètres à l’étude : Les sensibilités, les spécificités, les VPP, les VPN des CC et la stabilité de ces mesures. Résultats : Le déclin d’un intervalle de percentile ou plus à partir de la mesure initiale suggère la présence d’une trajectoire cognitive anormale avec une sensibilité de 80 %, une spécificité de 89 % et une valeur prédictive négative de 99 %. Conclusion : À l’image des courbes de croissance pédiatriques, nous proposons ici un modèle innovateur de courbes cognitives qui tient compte du MMSE, de l’âge et de la scolarité pour déterminer si des patients âgés ont un déclin cognitif normal ou non. Les CC rendent possible un suivi longitudinal tout en intégrant un seuil ponctuel qui permet d’orienter précocement vers des investigations plus poussées.


Research | Recherche

W802: Barriers to Acquiring Minor Procedural Skills in Family Medicine Training at the University of Toronto

03:15 PM 03:30 PM Room | Salle : 511E

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Jeremy Rezmovitz, MD, CCFP*; Ian MacPhee, MD, CCFP, PhD; Risa Freeman, MD, CCFP, FCFP, MEd; John Maxted, MD, CCFP, FCFP, MBA; Anne Wideman, MD, CCFP; Sharon Domb, MD, CCFP, FCFP; Dimitrios Tsirigotis, MD, PhD; Tuhina Biswas MD, CCFP; Kulamakan (Mahan) Kulasegaram

Learning objectives:
1.Identify barriers to acquiring procedural skills perceived by residents at the University of Toronto
2.Identify barriers to teaching procedural skills perceived by staff at the University of Toronto

Objective:
To evaluate current barriers to minor procedural skills training in postgraduate family medicine at the University of Toronto in Toronto, Ontario. Design: This is a qualitative study that employed a grounded theory methodology. The data set is multi-sourced, including accreditation documents, one-on-one interviews, and surveys. Interviews were audio-recorded and transcribed verbatim. Documents, transcripts and survey responses were coded and categorized for common themes. Setting: This study took place during postgraduate residency training within the Department of Family and Community Medicine (DFCM). Participants: DFCM faculty physicians (11 from 10 sites), program directors (five), and PGY-1/PGY-2 family medicine residents who volunteered to participate (nine). Main outcome measures: The identification of barriers in teaching and acquiring minor procedural skills facilitates further inquiry to improve current standards of training in postgraduate family medicine. Findings: Family medicine sites employ a variety of approaches to deliver procedural skills training. Three are identified in family medicine: 1) routine clinical practice; 2) designated clinics; and 3) academic workshops. Each has its own barriers. Despite various strategies employed by sites, nearly all residents surveyed feel their current curricula are insufficient to develop procedural competence and confidence. Significant barriers identified include: insufficient volume of patients/case mix, infrequent procedural clinics spread among too many residents, and insufficient protected time to pursue complementary training. Residents have difficulty obtaining procedure-rich electives within family medicine and experience tends to come disproportionately and inconsistently from external rotations. Teachers also identify underlying influences on training. In addition to an insufficient case mix, these include a perception of insufficient initiative among residents, an insufficient pool of experienced supervisors, and easy access to other specialists for procedural referrals in urban settings. Conclusion: Challenges to minor procedural training are multi-faceted; strategies to address this must also be multi-faceted. This study identifies minor procedural skills training needs at the University of Toronto with a view to improvement.
Research | Recherche

W803: What’s in an ITER?

03:15 PM 03:30 PM Room | Salle : 511D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Gary Viner*, MD, CCFP, FCFP, MEd; Douglas Archibald, PhD; Eric Wooltorton, MD, CCFP, FCFP, MSc; Alison Eyre, MD CM, CCFP, FCFP

Learning objectives:
1.Describe rating behaviour by preceptors when assessing residents
2.Demonstrate the value of data analysis for program evaluation
3.Validate the approach of an action-oriented rating scale for competency attainment

Context:
Since 2013 the University of Ottawa’s family medicine (FM) in-training evaluation reports (ITERs) have used an “action-based” ITER evaluation scale having four parameters: “Not observed/applicable” (0); “Off trajectory for this benchmark (action required)” (1); “On trajectory for this benchmark (minimal/no action required)” (2); and “Attained this benchmark (no action required)” (3). The 29 PGY-1 and 32 PGY-2 stems of core FM ITERs are communicated as benchmarks that state expectations to be attained at completion of each training year. Objective: To explore how preceptors have completed ITERs since this rating system was implemented. Design: We retrospectively analyzed aggregated ITER data contained in our assessment system (one45 WebEval) from July 2013 to present. Participants: One hundred thirty-six preceptors completed 1,351 ITERs (666 PGY-1; 685 PGY-2). Intervention: ITER data in one45 were sorted by preceptor with sequenced FM rotations for five communication competencies. Outcome measures: Using descriptive statistics and frequencies and non-parametric tests we analyzed preceptors’ use of FM ITERs. Results: Mean scores and standard deviations for PGY-1 ITERs were 2.26 (0.51) and 2.65 (0.48). Preceptors completed between one to 20 PGY-1 ITERs and one to 24 PGY-2 ITERs over more than three years. There was a statistically significant difference between PGY-1 ITERs completed at sequential FM rotations as determined by one-way ANOVA (F[4,632] = 48.79, P < 0.001) and for PYG-2 ITERs (F[4,654] = 22.90, P < 0.001). Post hoc tests revealed when the sequential changes in ITER scoring occurred. Discussion: Communication skills differ in PGY-1 and PGY-2 due to higher expectations. Supervisors should flag concerns and discern progression so residents can attain competencies required for graduatoin. We confirm that these ITERs reflect the preceptors’ assessment of gradual development along the competency journey. Conclusions: Residents in a department of FM acquire communication competencies progressively. Analysis of preceptor ITER ratings allows normative feedback to preceptors on their patterns of scoring residents.
Research | Recherche

W828: Achieving Health Goals With Formerly Incarcerated Men

03:15 PM 03:30 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Ruth Elwood Martin, MD, CCFP, FCFP, MPH; Catherine Latimer; Debra Hanberg; Larry Howett; Daniel Baufeld; Blake Stitilis, MPH; Kate Roth, MA; John Oliffe, PhD, RN; Jane Buxton, MBBS, MHSc, FRCPC; Nicole Myers, PhD; Carl Leggo, PhD; Wayne Taylor; Naomi Dove, MD, MPH, FRCPC

Learning objectives:
1.Determine health priorities with formerly incarcerated men
2.Reflect on factors that support incarcerated men in their integration into society
3.Understand barriers to navigating the health care system for formerly incarcerated men

Objective:
To determine the immediate-, short-, and long-term health priorities of formerly incarcerated men leaving federal correctional facilities in the Lower Mainland of British Columbia. Design: A community-based participatory research approach using interpretive descriptive methods: survey data and focus group data. Setting: Two John Howard Society of the Lower Mainland of British Columbia halfway houses. Participants: Eighteen formerly incarcerated men participated in two focus groups. The first focus group (n = 10) included men released within three months from a federal correctional facility. The second focus group (n = 8), included men released from a federal correctional facility more than six months prior to the focus group. Main outcome measures: Focus group interviews yielded qualitative data regarding the formerly incarcerated men’s health priorities and the factors that supported or prevented their self-health. Interview transcripts were coded and thematically analyzed by co-authors, including formerly incarcerated project assistants. The findings were member checked with some focus group participants (n = 6) to ensure validation of interpretation. Findings: The immediate- and short-term health priorities of recently released men related to acquiring personal identification and/or a medical card, refilling prescriptions, obtaining their medical records from prison, finding a family physician, learning how to navigate the health care system, and addressing mental health and substance use issues. As the men integrated into the community, their long-term health priorities focused on living healthy, building long-term relationships, maintaining ongoing medical care, addressing hepatitis C, and connecting to culture, spirituality, and volunteering. The focus group findings were primarily used to inform the design of the main research study. Conclusion: Men encountered significant individual and systemic barriers to achieving their health priorities as they transitioned from a federal correctional facility back into the community. All focus group participants reported post-release stressors as they adapted to community life.
Research | Recherche

W111: Implementation of the OCFP Poverty Screening Tool in Primary Care and Pediatrics

03:30 PM 03:45 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Michael P. Flavin, MBBCh; Eva Purkey, MD, MPH, CCFP, FCFP; Imaan Bayoumi, MD, MSc, CCFP, FCFP; Helen Coo, MSc; Andrew D. Pinto, MD, CCFP, FRCPC, MSc; Christina Klassen, MD; Shannon French, MD; Matti D. Allen, PhD; Ethan Toumishey, MD

Learning objective:
1.Identify some of the barriers to universal poverty screening in primary care and pediatric settings

Objective: To evaluate the feasibility of universal screening for poverty in primary care and pediatric settings. Design: This study was an implementation evaluation of universal poverty screening. Health care providers were first trained using the Ontario College of Family Physicians’ (OCFP’s) “Treating Poverty” workshop and related Poverty Tool. They were instructed to perform universal poverty screening on their patients using the question “Do you have difficulty making ends meet at the end of the month?” for the duration of the study (three months). Health care providers tracked the numbers of patients screened. Surveys were distributed to patients to assess the acceptability of being screened for poverty in a health care setting. Following the study period, health care providers were invited to focus groups to explore barriers to and facilitators of implementing universal screening with this tool. Setting: This study took place in six family medicine practices (community health centres, family health teams, an academic family health team, and private practice), as well as in in-patient and outpatient pediatric settings in Kingston and Napanee, Ontario. Participants: Twenty-two health care providers (family doctors, nurse practitioners, pediatricians). One hundred forty-eight patients completed the questionnaire about poverty screening. Findings: Despite the substantial motivation of the providers, only approximately 10 per cent of patients were screened during the study period. Most patients (72 per cent) either agreed or strongly agreed that screening was important. Lack of time and simply forgetting were some of the barriers encountered. Despite these barriers, most health care providers strongly supported normalizing the discussion of a patient’s financial situation. Conclusion: For health providers to identify and intervene in cases of poverty, barriers need to be addressed to ensure that screening is universal.
Research | Recherche

W580: Impact of RADT on Antibiotic Prescription for Pharyngitis: A systematic review and meta-analysis

03:30 PM 03:45 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Omar Anjum; Pil Joo, MD CM, CCFP

Learning objective:
1.Review the evidence exploring the impact of RADT in patients presenting with pharyngitis on the antibiotic prescribing behaviour of clinicians

Objective: To assess the impact of rapid antigen detection test (RADT) in patients presenting with acute group A Streptococcus (GAS) pharyngitis on the antibiotic prescription rate and appropriateness of antibiotic management. Design: Systematic review and meta-analysis of prospective and retrospective cohort studies. Setting: Primary care clinics and emergency departments. Participants: Adult and pediatric population presenting with acute pharyngitis, excluding those with comorbidities such as altered mental status and immunosuppression. Ten out of 4,003 identified studies met the inclusion criteria (N = 10,859 participants, median age 31 years, 56.7 per cent female). Intervention: Studies were systematically searched using MEDLINE and Embase and selected according to a predefined PRISMA protocol. Data were extracted by two reviewers using DistillerSR. Study quality was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Studies were combined if there was low clinical and statistical heterogeneity (I2 < 30%). The bivariate Mantel-Haenszel random effects model was used to perform meta-analyses using SPSS 22 and RevMan 5. Main outcome measures: Dichotomous measure of antibiotic prescription, with or without RADT availability. Results: Mean antibiotic prescription rates in the RADT and control arms were 38.2 per cent (SD 15.6) and 55.9 per cent (SD 16.3), respectively. The use of RADT was associated with a lower antibiotic prescription rate in both adults (OR = 0.60, 95% CI 0.45 to 0.80, I2 = 8%, n = 1,407) and pediatrics (OR = 0.49, 95%CI 0.44 to 0.55, I2 = 5%, n = 976). There was no overall difference (P = 0.3) in antibiotic prescription rate among disease severity (Centor scores 1-4). The use of RADT did not significantly affect the appropriateness of antibiotic management (OR 1.15, 95%CI 0.94 to 1.5). Conclusion: The use of RADT is associated with reduced antibiotic prescription for patients with GAS pharyngitis without an increase in appropriate antibiotic use. Despite low prevalence of the disease, antibiotic prescription rates are still high. These findings suggest a great potential for antibiotic stewardship and re-evaluation of current guidelines for managing GAS pharyngitis.
Research | Recherche

W672: La télétraumatologie en milieux ruraux : une revue de littérature — travail en cours

03:30 PM 03:45 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Marie-Hélène Lavallée-Bourget, MSc*; Luc Lapointe, MA; Alexia Pichard-Jolicoeur; Jade Labrie; Richard Fleet, MD PhD

Contexte : Les traumatismes sont une cause importante de morbidité et de mortalité dans les milieux ruraux. Ces milieux ont cependant moins facilement accès à des médecins spécialistes en traumatologie que les milieux urbains, ce qui entraîne des délais de prise en charge et nécessite parfois des transferts sur de longues distances vers les centres hospitaliers spécialisés. Avec l’avènement des technologies de l’information, la télémédecine semble offrir des avenues prometteuses pour pallier ce problème. Objectif : Déterminer l’impact de la télémédecine sur la prise en charge des patients victimes de traumatismes en milieux ruraux. Design : Une revue systématique rapide de la littérature scientifique a été effectuée à partir des concepts suivants : « traumatology » et « rural » et « telemedicine » ou « teletrauma ». La stratégie de recherche a été lancée dans 13 bases de données bibliographiques. Cette recherche a permis d’identifier 157 documents. Le tri des articles a été effectué par deux codeurs indépendants selon des critères d’inclusion prédéfinis. Uniquement les articles parus après 2010 ont été conservés pour l’analyse, réduisant le nombre d’articles à 19. Les bibliographies des documents retenus ont été ratissées, à la recherche de nouveaux articles pertinents. La question de recherche étant de nature causale, seules les études expérimentales, quasi expérimentales et de cohorte ont été conservées. Résultats : Jusqu’à maintenant, neuf articles ont été sélectionnés pour extraction. Les résultats préliminaires suggèrent que l’utilisation de la télémédecine (téléphones intelligents, logiciels, réseaux privés virtuels, etc.) peut améliorer la prise en charge des patients. Conclusions : L’apport de la télémédecine semble donc avoir un impact positif sur la qualité des soins prodigués aux patients traumatisés en milieu rural. Les résultats préliminaires confirment l’intérêt de poursuivre la recherche de nouveaux articles, notamment en élargissant la période temporelle et en effectuant des recherches dans la littérature grise.
Research | Recherche

W679: I’m So Glad You Found Me! Caring for Patients With Multimorbidity Who Are Vulnerable

03:30 PM 03:45 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Judith B. Brown*, PhD; Pauline Boeckxstaens, MD, PhD; Sonja M. Reichert, MD, MSc, CCFP; Luan Januzi, MSc; Moira Stewart, PhD; Martin Fortin, MD, CCFP, FCFP, MSc

Learning objectives:
1.Identify factors that increase the vulnerability of patients with multimorbidity
2.Define and apply components of an innovative interdisciplinary primary health care team approach to their own practices to care for patients with multimorbidity who are vulnerable

Context:
Patients with multimorbidity often require an interdisciplinary primary health care team approach. Within this population a subset of patients may be more vulnerable and require a tailored approach to address their complex needs. Objectives: To explore how a one-hour consultation outside of usual care, conducted by innovative interdisciplinary primary health care teams, addresses the needs of vulnerable patients with multimorbidity. Design: A descriptive qualitative study. A purposive sample was used to recruit participants for a 30- to 45-minute semi-structured interview. An iterative and interpretative process was conducted with both individual and team analysis to identify overarching themes and sub-themes. Setting: Ontario, Canada. Participants: Forty-eight interviews were conducted with 20 allied health care professionals (e.g., nurses, social workers, pharmacists), 10 non-family-physician specialists (e.g., psychiatrists, internal medicine specialists), nine decision makers, and nine family physicians who had made referrals to the primary health care consultation teams. Results: The collaborative nature of the team supported the sharing of ideas about how to overcome some of the barriers patients experienced and facilitated the development of creative recommendations specifically designed to meet the needs of each patient. Participants paid specific attention to how and why certain patients with multimorbidity were vulnerable. Patients who were described as vulnerable were those who face major challenges in accessing and navigating the health care system and consequently “fall through the cracks.” Mental health issues were a major contributor to patients being vulnerable and were often linked to common social determinants of health (e.g., poverty, homelessness, and social isolation). Cultural factors (e.g., language, values, and beliefs) were also identified as potentially causing patients to be vulnerable. Conclusions: These unique, one-time consultations go beyond the assessment of a patient’s multimorbidity by including a psycho-social contextual understanding of their vulnerability within the primary health care setting. Findings may have important clinical and policy implications for supporting the spread of this innovative approach.
Research | Recherche

W728: Training Doctors for Rural Generalist Practice: Memorial’s pipelines to pathways approach

03:30 PM 03:45 PM Room | Salle : 511E

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

James Rourke*, MD, CCFP (EM), MCISci, FCFP; Shabnam Asghari, MD, MPH, PhD; Oliver Hurley, MEnvSc; Mohamed Ravalia, CM, CCFP, FCFP; Michael Jong, MBBS, MRCP, CCFP, FCFP; Wanda Parsons, MD, CCFP, FCFP; Norah Duggan, MD, CCFP, FCFP

Learning objective:
1.Have a good understanding of the “pipeline” and “pathways” approach and what steps must be taken for its proper implementation

Objective:
The objective of Memorial University of Newfoundland’s “pathways to rural practice” approach is to produce rural family physicians to meet the rural health care needs of Newfoundland and Labrador and Canada. Design: The pathways to rural practice approach has led to a program made of four components: 1) a targeted pre-admission process (Indigenous initiative, MedQuest, geographic/minority selection); 2) medical school clinical placements (rural experiences); 3) vocational family medicine (FM) residency training (extended rural training experiences, deeper community integration); and (4) postgraduate (PG) training (opportunities for professional and faculty development). Setting: This study considers data from Atlantic Canada and Memorial University’s school of medicine. Participants: This study included Memorial’s medical school students and graduates from the classes of 2011 to 2019. Intervention: A survey and administrative data were used to collect student background data (address history, MD/PG placements, and practice location data). Main outcome measures: To evaluate Memorial’s medical school curriculum we considered the percentage of placement weeks spent in rural locations for clinical placements and FM residencies. Findings: For the graduating classes of 2011 to 2019 (N = 617), 90 per cent of year 1 community health placement weeks took place in rural locations. Of the 537 students (classes of 2011 to 2018) who completed year 3 FM placements, 97 per cent of their placements were spent in a rural location (community or town). Of the students who graduated between 2011 and 2013 and went on to complete FM-PG training at Memorial (n = 49), 100 per cent completed rural training in some capacity. The same graduates (2011 to 2013, n = 49) spent 52 weeks (55 per cent) out of 95 weeks in rural areas while completing their FM training. Conclusion: The “pathways” approach has allowed Memorial to become one of the main producers of rural generalists for both Newfoundland and Labrador and Canada.
Research | Recherche

W759: From Reactive to Proactive: Disease prevention and health promotion in undergraduate medical education

03:30 PM 03:45 PM Room | Salle : 511F

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Richelle Schindler*, MD, MSc; Lauren Capozzi; Marianna Hofmeister, PhD; Kevin Busche, MD, PhD, FRCPC; Martina Kelly, MBBCh, MA, CCFP

Learning objectives:
1.Identify a mixed methods approach to curriculum mapping
2.Describe data sources and methods that can be used to map disease prevention and health promotion in an undergraduate curriculum
3.Apply suggestions for the improvement in curriculum delivery of disease prevention and health promotion content

Objective:
To evaluate the delivery of health promotion and disease prevention (HPDP) content in the curriculum at the University of Calgary medical school. Design: Mixed methods study. Setting: Cumming School of Medicine, Calgary, Alberta. Participants: Purposive sampling of 18 faculty from seven specialties. Eighteen student volunteers. Intervention: Using the Clinical Prevention and Population Health Curriculum Framework, data extraction was piloted, refined, and used to document HPDP content in the published curriculum. Students extracted quantitative and qualitative data on teaching activities. Two focus groups were conducted with year 1 and 2 learners. Faculty participated in semi-structured interviews. Main outcome measures: Quantitative data were analyzed using descriptive statistics to give the proportion of learning events with HPDP content and the proportion of content in each of the four key areas identified by the Framework. Qualitative data were analyzed thematically using the aforementioned theoretical framework. Findings: Of the 935 learning events identified, 88.8 per cent were available for analysis: 30.2 per cent of the learning events contained disease prevention content, while only 16.8 per cent contained health promotion content. The most frequently identified subject was Foundations of Population Health (75.6 per cent) and least frequent was Health Systems and Health Policy (9.45 per cent). Students in focus groups called for more integration of HPDP into existing content and suggested HPDP be included in communications cases. Faculty emphasized a need to address HPDP proactively by focusing on disease before it manifests, rather than concentrating on secondary and tertiary prevention. Conclusion: Health promotion and disease prevention content is well represented in the curriculum at the University of Calgary, but the experiences of students and faculty suggest the need for a HPDP approach that helps students better integrate and apply HPDP knowledge in clinical practice. This includes raising students’ awareness of their own attitudes toward HPDP and providing opportunities for HPDP communication skills development in the undergraduate curriculum.
Research | Recherche

W775: Age-Related Decline in Social Connections: Does it affect loneliness and depression in the elderly?

03:30 PM 03:45 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Alanna Cluff, MD, CCFP (EM); Adam Rosanally, MD, CCFP; Matthew Orava, MD, MHSc, CCFP; Anwar Parbtani*, MD, CCFP, FCFP, PhD

Learning objective:
1.Assess age-related decline in social connections and its impact on loneliness and/or depression in the elderly

Objective:
To explore whether an age-related decline in social connections/capital exists, and whether it has an impact on loneliness and/or depression in the elderly. Design, setting, and participants: A survey of patients, 55 to 85 years of age, was conducted at 10 primary care practices using a written questionnaire inquiring about employment and social and family connections via personal contact, telephone, the Internet, or social media. The questionnaire also inquired about living arrangement, loneliness, and depression. In addition, patients filled out a 15-question Geriatric Depression Scale (GDS). Results: One hundred one survey questionnaires were completed. These were divided into three age-groups (Group 1: 55 to 60 years, n = 32; Group 2: 61 to 70 years, n = 32; and Group 3: 71 to 85 years, n = 37) and analyzed using chi-square and z statistics. There was a significant age-related decline in employment-related connections (66 per cent versus 28 per cent versus 16 per cent, Groups 1 to 3, respectively; P < 0.005). There was no difference for connections with friends (53 per cent; 66 per cent; 65 per cent) or family (66 per cent; 66 per cent; 62 per cent, for Groups 1 to 3, respectively). Only a small number were living alone (13 per cent versus 25 per cent versus 19 per cent, Groups 1 to 3 respectively; NS). Depression was reported by 13 per cent, 25 per cent, and 16 per cent in Groups 1 to 3, respectively (NS). GDS score was similar in all three groups (8±3 versus 7±2 versus 7±2 in Groups 1 to 3, respectively). History of depression was lowest in Group 3 (19 per cent versus 41 per cent for Group 2 and 50 per cent for Group 1; P < 0.02). Loneliness was similar in all three groups (25 per cent, 19 per cent, and 22 per cent, respectively; NS). Conclusions: Other than an expected employment-related decline in social connection, there was no age-related decline in social capital. The oldest cohort (Group 3) did not show any greater loneliness and had a lower prevalence of depression than the other two cohorts. We conclude that the loss of social connections is not a major determinant for loneliness or depression in the elderly, warranting greater attention to parameters such as economic status and service accessibility.
Research | Recherche

W841: Capturing Resident Progression Toward Competence Using the Competency-Based Achievement System (CBAS)

03:30 PM 03:45 PM Room | Salle : 511D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Chris Donoff, BSc; Shelley Ross, PhD; Shirley Schipper, MD, CCFP; Oksana Babenko, PhD; Paul Humphries, MD, CCFP, FCFP; Mike Donoff, MD, CCFP, FCFP

Learning objective:
1.Describe the feasibility of using the Competency-Based Achievement System to track resident progress to competence

Context:
Competency-based assessment in medical education incorporates multiple constructs, including: “assessment for learning” or coaching, to promote guided self-assessment; and assessment of learning to determine resident progress toward competence. In both cases the provision of continuous formative feedback is paramount for improving both the validity of summative assessments and the quality of coaching that residents receive. In our family medicine residency program we use the Competency-Based Achievement System (CBAS) as our assessment framework. The current study examined the effectiveness of CBAS in capturing evidence of resident progress from PGY-1 to PG-Y2. Objective: The objective of this study was to examine: 1) whether progress levels assigned by expert judges change to reflect the increased competence of residents from PGY-1 to PGY-2; and 2) if there were differences in progress level assignment between academic years, teaching sites, and mentor-learner relationship strength (advisors versus preceptors). Design: Secondary data analysis. Participants: FieldNotes (N = 6,664) spanning four academic years (2012, 2013, 2014, and 2015). Data came from residents (n = 156), preceptors (n = 451), academic advisors (n = 48) across four urban teaching sites. Main outcome measures: Between- and within-resident as well as between- and within-preceptor comparisons were made. Results: Overall, there was 14% increase in “Carry on, got it” from PGY-1 to PGY-2, irrespective of whether comparing between different residents or preceptors. One site maintained a high proportion of “Carry on, got it” between PGY-1 and PGY-2, indicative of ongoing implementation and buy in of the CBAS framework. No apparent differences in progress level assignment existed between preceptors and academic advisors when controlling for differences between residents. Conclusions: FieldNotes captured residents’ increase in competence over time. Similarities between advisor- and preceptor-made notes support triangulation in formative assessment. Observed teaching site differences suggest further research is needed to examine reasons behind site discrepancies.
Research | Recherche

W866: Reluctance to Discuss Advance Care Planning With Primary Care Providers Despite Prompting During Emergency Department Visits

03:30 PM 03:45 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Mandeep Pinky Gaidhu*, MD, PhD; Natasha Stribbell, MD; Kathryn Armstrong, MD, FRCP; Jaewoo Park

Learning objectives:
1.Assess whether prompting at the emergency department would increase advance care planning discussions by patients with their primary care providers
2.Determine patient-perceived barriers to discussing advance care planning with their primary care providers

Context:
Advance Care Planning (ACP) is important for patient-preferred care goals. Due to the complexity of ACP, discussions should occur with patients’ primary care providers. However, ACP discussions often occur in the emergency department (ED) during acute clinical encounters; this is not a conducive setting for such discussions. Objective: To determine whether introducing the importance of ACP in the ED would promote discussions with primary care providers. Participants and Setting: Patients, 75 years or older, attending a community hospital ED for non-urgent medical conditions. Interventions: Patients who consented to participate were given a handout describing ACP and encouraged to pursue discussions with their primary care providers upon ED discharge. A follow-up telephone survey ensued at four to six weeks post-ED discharge to assess whether patients had initiated ACP discussions with their primary care providers. We also sought information regarding barriers to ACP discussions with their primary care providers. Results: Fifty-four handouts were offered during the ED visits, of which 50 were accepted. However, only 26 (52 per cent) patients agreed to participate in the post-discharge telephone survey. The post-discharge survey indicated only three of the 26 patients, all females, had initiated ACP discussion with their primary care providers. Of those who did not initiate ACP discussions with their primary care providers (23 of 26), 36 per cent stated it was not a priority, 27 per cent stated their physician-patient relationship was not open to such conversations, and 36 per cent felt it was a family matter not requiring discussions with the primary care provider. Conclusions: The intervention implemented at the ED to promote ACP discussion by patients with their primary care providers was not successful due to the patient-perceived barriers described above. Knowing these patient-perceived barriers would be important for primary care providers to initiate appropriate, targeted strategies to encourage ACP discussions, and to help alleviate the burden of such discussions at the ED during acute clinical encounters.
Research | Recherche

W578: Understanding Curricular Messaging Surrounding Enhanced Skills Programs From the Family Medicine Resident Perspective

03:45 PM 04:00 PM Room | Salle : 511F

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Lauren Payne*, MD, MPH; Azadeh Moaveni, MD, CCFP; Curtis Handford, MD, MHSc, CCFP

Learning objective:
1.Identify the main curricular messages surrounding enhanced skills fellowships from the resident perspective in one postgraduate family medicine program

Objective: To understand better the messages family medicine residents are receiving about enhanced skills fellowship programs throughout their training. Design: Phenomenologic approach using structured qualitative interviews. Setting: Postgraduate family medicine program in Ontario. Participants: Residents were recruited using both purposive and, subsequently, snowball sampling until data saturation was reached. Eleven family medicine residents (five PGY-1, six PGY-2) were interviewed from four separate training sites. Methods: Interviews were audiotaped and transcribed, and codes were developed by the study investigators. Themes arose from the data via immersion and crystallization techniques. Findings: Themes emerged in three categories: 1) perception of purpose; 2) sources of messaging; and 3) formal/informal versus hidden curricular messages. Residents viewed fellowship programs in terms of their personal and professional benefits. Residents learned about fellowship programs through word of mouth and role modelling. The formal curriculum remained neutral about fellowship training. The hidden curriculum highlighted a number of messages: 1) to maximize the chances of acceptance into some fellowship programs, one should focus most of their elective time in that clinical area; 2) many fellowships graduate subspecialists to the exclusion of family medicine; 3) a fellowship is required to practise in a large urban centre but not in rural communities; and 4) graduates without fellowship training are less well regarded. Conclusion: Residents both hear and perceive mixed messages regarding fellowship training. This may be an isolated phenomenon at a larger urban centre in Ontario. Decision making at the individual level in terms of career path seems to be affected and this may have implications at the larger system level.
Research | Recherche

W659: Lifelong Learning in Health Professions: Meta-analysis along the education and career continuum

03:45 PM 04:00 PM Room | Salle : 511E

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Oksana Babenko*, PhD; Lindsey Nadon; Sudha Koppula, MD, MClSc, CCFP, FCFP

Learning objective:
1.Describe the long-term trend in the orientation toward lifelong learning in health professions

Objective:
Lifelong learning is an important aspect of health professionals’ maintenance of competence. Several studies have examined the orientation toward lifelong learning at various stages of the education and career continuum; however, none has looked at changes throughout training and practice. The main objective of the present study was to determine whether there are differences in this orientation between groups defined by their places on the education and career continuum. Additionally, involvement in scholarly and research activities was considered for the influence on the orientation toward lifelong learning. Design: This was a group-level meta-analysis of studies that used the 14-item Jefferson Scale of Physician Lifelong Learning or its variants. In total, 11 studies conducted with post-secondary health professions students, residents, and practising professionals met the inclusion criteria. Means and standard deviations of the total scores on the Jefferson Scale, together with sample sizes, were extracted from each study and used in the analysis. Results: Results of the meta-analysis indicated that the orientation toward lifelong learning in health professions tended to increase gradually further along the career continuum; however, substantial variability was observed within each group of studies with students, residents, and practising professionals. Significant differences in group means were found between trainees (students and residents) and practising professionals. Involvement in scholarly and research activities appeared to be associated with a greater orientation toward lifelong learning along the career continuum. Conclusion: The findings offer insights into the long-term trend in the orientation toward lifelong learning in health professions. Although the links between lifelong learning and its behavioural manifestations in health professions have been reported in the literature, much work in this area still needs to be done, including the examination of the impact of lifelong learning on patient care.
Research | Recherche

W680: An Interdisciplinary Approach to Caring for Patients with Multimorbidity

03:45 PM 04:45 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Judith B. Brown*, PhD; Pauline Boeckxstaens, MD, PhD; Sonja M. Reichert, MD, MSc, CCFP; Martin Fortin, MD, CCFP, FCFP, MSc; Moira Stewart, PhD

Learning objectives:
1.Understand how primary health care providers describe their teams’ delivery of patient-centred care
2.Explain how an interdisciplinary primary health care team consultation approach provides patient-centred

Primary health care providers describe patient-centredness in a variety of ways; they are often relevant to the one-on-one relationship but rarely within the context of interdisciplinary team care. Objective: Reveal how providers describe their patient-centredness during a one-time telemedicine interdisciplinary consultation for patients with multimorbidity. Design: A descriptive qualitative study. A purposive sample was used to recruit participants for a 30- to 45-minute semi-structured interview. An iterative and imperative process was conducted with both individual and team analysis to identify overarching themes and sub-themes. Setting: Ontario, Canada. Participants: Thirty nine interviews were conducted with 20 allied health care professionals (e.g., social workers, nurses, pharmacists), 10 physician specialists (e.g., internal medicine specialists, psychiatrists), and nine decision makers. Results: Participants described a strong commitment to providing patient-centred care, starting at the outset of the consultation: “Make sure that it’s patient-centred from the very beginning.” They explored patients’ perceptions of “how they would like to improve their quality of life and health” as well as the daily “struggles” they encountered in managing their multimorbidity. Participants explained their interest in “looking at the patient as a whole,” hence going beyond the disease to understanding the person in context. Close attention was paid to identifying the patient’s goals throughout the consultation: “What are the patient’s goals?” As the team provided their concluding recommendations, they actively engaged the patient in the process: “Does this make sense to you? Would this be helpful?” Finally, patient-centredness was described as “coming up with a care plan that the patient would be able and willing to implement.” Conclusion: These findings demonstrate how an interdisciplinary primary health care team consultation provides patient-centred care to a complex patient population with multimorbidity. This team approach to care is for a brief one-time consultation, yet the findings reflect how patient-centred care is achievable in this unique context.
Research | Recherche

W692: Améliorer les soins des patients ayant des besoins complexes en première ligne

03:45 PM 04:00 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Catherine Hudon*, MD, PhD, CCMF ; Maud-Christine Chouinard, inf. PhD ; Marie-Dominique Beaulieu, MD, FCMF, MSc ; Paul Morin, MSc, PhD ; Danielle Bouliane, MA ; Fatoumata Diadiou; Mireille Lambert, MA ; Véronique Sabourin

Objectifs d’apprentissage : 
1.Comprendre les enjeux dans l'amélioration des services aux patients ayant de grands besoins de soins de santé et services sociaux.
2.Identifier des piste de solution pour améliorer les soins et services des patients vulnérables ayant de grands besoins de soints de santé et services sociaux.

Objectif :
Identifier les enjeux et des pistes de solution pour améliorer les soins et les services aux patients ayant des besoins de santé complexes en groupes de médecine de famille (GMF). Devis et méthode : Approche de recherche participative dans le cadre d’un forum provincial utilisant des groupes de discussion mixtes d’acteurs-clés des milieux de la santé, des services sociaux, universitaires et communautaires ainsi que des patients partenaires, pour identifier les enjeux ; puis des groupes de discussion disciplinaires pour identifier des pistes de solution. Une analyse thématique des données a été réalisée. Organisations : Les participants provenaient de centres intégrés et de centres intégrés universitaires de santé et de services sociaux (CISSS et CIUSSS), de GMF et d’organisations communautaires de 16 régions du Québec. Participants (n=160) : Gestionnaires (n=52), décideurs (n=15), chercheurs (n=23), pharmaciens (n=13), médecins (n= 9), infirmiers et infirmières praticiens spécialisés (n=18), patients partenaires (n=11), travailleurs sociaux (n=10), représentants d’organismes communautaires (n=6), psychologues (n=2) et kinésithérapeute (n=1). Résultats : Les enjeux identifiés portaient sur : 1) la conciliation des mandats des GMF, axés sur une population de patients inscrits, et des CIUSSS/CISSS, axés sur la population d’un territoire ; 2) la méconnaissance mutuelle du réseau des GMF et du réseau des organismes communautaires ; 3) une clientèle à risque hétérogène, qui passe souvent sous le radar ; 4) le défi de structurer l’action collective de plusieurs professionnels et partenaires. Les pistes de solution suggéraient : 1) la conception de l’usager en tant qu’expert de sa complexité ; 2) la conception des organismes communautaires comme partenaires de l’équipe GMF ; 3) la création de nouveaux modèles professionnels ; 4) la gestion du changement ; 5) la contribution de la recherche axée sur le patient ; 6) un financement qui favorise le travail interprofessionnel. Conclusion : Cette présentation permettra aux participants d’envisager de nouvelles pistes de solution pour l’amélioration des soins et des services aux patients ayant des besoins de santé complexes en GMF, et de comprendre les enjeux qui s’y rattachent.
Research | Recherche

W723: Palliative Care Quality Standard: Guiding evidence-based, high-quality palliative care

03:45 PM 04:00 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Ahmed Jakda*, MD, CCFP (PC); Melody Boyd, RN, MSc, MN; Tara Walton, MPH; Lisa Ye, RN, MN; Erin Redwood, MBA; Lacey Phillips, MAHSR

Learning objective:
1.Be able to describe what high-quality palliative care should look like

Objective:
The Ontario Palliative Care Network is creating a quality standard focused on palliative care for adults with progressive life-limiting illness. This quality standard is a go-to resource containing a set of evidence-based, measurable statements outlining what high-quality palliative care should look like for patients, caregivers, and health care providers. Design: A systematic search was conducted for palliative care clinical practice guidelines published between 2011 and 2016. The AGREE II instrument was used to appraise the methodological quality of the guidelines. An open call was conducted to recruit experts for a working group using a skills matrix to ensure broad representation across health sectors and geographic regions. A modified Delphi process was used to prioritize topic areas for the standard. A quality statement was developed for each topic area based on guideline evidence and working group expertise. Setting: The standard considers palliative care services provided in Ontario inclusive of all settings and geographic regions, including family medicine practices and primary health care. Participants: A 26-member working group of clinical experts and lived experience advisers was recruited. The clinical experts include: physicians, nurses, volunteers, spiritual care providers, allied health care providers, researchers, administrators, and other service providers. The lived experience advisers were caregivers to people with progressive life-limiting illnesses. Results: The working group prioritized topic areas, which include: identification; advance care planning and goals of care; assessment of needs; person-centred care plans; management of pain and symptoms; psychosocial aspects of care; education for health care professionals and volunteers; education for patients, families, and caregivers; setting of care and place of death; models of care; and transitions in care. These topic areas were developed into quality statements. Conclusions: At the conclusion of this presentation participants will be able to describe what high-quality palliative care should look like in Ontario.
Research | Recherche

W750: The Competency of Family Physicians in Adolescent Medicine: A mixed-methods systematic literature review

03:45 PM 04:00 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Diana Ramos, MD, MA; Pierre-Paul Tellier, MD, CCFP, FCFP; Julius Erdstein, MD, FRCP; Suzanne MacDonald, MD, FRCP; Charo Rodriguez, MD, PhD

Learning objectives:
1.Identify the areas of concern in adolescent medicine and the challenges of providing optimal care to young adults
2.Be able to contrast current evidence with daily practice
3.Be able to propose recommendations to reinforce skill acquisition in adolescent medicine

Objective:
To synthesize knowledge on family physicians’ preparedness in adolescent medicine. Design: A systematic literature review of works on this topic in which authors used either qualitative, quantitative, or mixed methods research approaches, published in scholarly journals between 1996 and 2016. Analysis was based on narrative synthesis. Setting: Ovid MEDLINE, PsycINFO, Embase, Web of Science, CINALH, and ERIC were searched, combining these main concepts: family physicians, competence, and adolescent. Article eligibility: Eligible papers should: 1) be published in English, French, or Spanish; 2) report results of empirical investigations; 3) include medical care provided to 12- to 25-year-old individuals; 4) examine family doctors’ competences; and 5) mention barriers to and/or facilitators of acquiring competency in adolescent medicine. Intervention: Relevant studies were selected following the PRISMA guidelines. Upon deduplication and application of a language filter, 1,905 articles were identified. Screening of the titles and abstracts yielded 692 articles. Full text reading resulted in 49 articles for analysis. A scoring system was used to assess the quality of studies. Main outcome measures: A narrative synthesis analytical approach was adopted, which included a thematic analysis and elaboration of a conceptual map with the main findings. Findings: Family doctors do not achieve the same level of competency in the areas of adolescent mental health, gynecology, and pharmacology as they do in adult medicine. Specifically, knowledge, communication, advocacy, and the application of guidelines are the main themes in need of improvement. More results will be presented. Conclusion: Although the literature regarding objective measures of competency remains scarce, this study reveals that family doctors need to respond to several issues in adolescent medicine, specifically the areas where training is insufficient. Also, it gives some recommendations on how to align competencies, population needs, and health care systems structure. 
Research | Recherche

W796: Follow-Up of COPD Patients at 14 or 30 Days Post-Discharge Affects Rebound to Emergency Department

03:45 PM 04:00 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Eric Traficante*, MD, CCFP; Mina Salama, MD, CCFP; Andre Bedard, MD, CCFP; Matthew Orava, MD, CCFP MHSc; Anwar Parbtani, MD, CCFP, FCFP, PhD

Learning objectives:
1.Assess the impact of timely follow-up of COPD patients by primary care providers post hospital dicharge on emergency department rebound
2.Determine whether there is a difference on emergency department rebound if COPD patients are followed by a primary care provider either at 14 or 30 days post-discharge

Context:
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with more hospitalization compared with other chronic diseases, with an estimated health care cost of approximately $1.5 billion annually. Timely follow-up in the community post-discharge from the hospital/emergency department (ED) has been shown to reduce ED rebound. However, optimal timing for the follow-up or distinction between specialist versus primary care provider follow-up is not clear. Objective: To assesses the impact of primary care provider follow-up of COPD patients upon ED/hospital discharge on ED rebound. Design and outcome measures: A retroactive chart review of COPD patients presenting at the ED at a community hospital over a three-year period (2013 to 2015) was conducted. We gathered data for no primary care provider follow-up, follow-up within 14 days, and follow-up 30 days post-discharge versus 90-day ED rebound. Statistics: Data were analyzed using chi-square analysis with Bonferroni corrections. Results: One hundred four ED visits (73 patients) were assessed. Forty-three visits (41 per cent) had no primary care provider follow-up within 30 days, 61 (59 per cent) had primary care provider follow-up within 30 days, and 37 (36 per cent) had primary care provider follow-up within 14 days of ED discharge. Ninety-day ED rebound was significantly lower for 30-day (20 per cent) and 14-day (19 per cent) post ED discharge with primary care provider follow-up versus no primary care provider follow-up (58 per cent; P < 0.001). Conclusions: Follow-up of COPD patients by a primary care provider within 14 days or 30 days post ED discharge significantly reduced 90-day ED rebound compared with those with no primary care provider follow-up. In the present study, 14-day primary care provider follow-up was not superior to 30-day primary care provider follow-up in reducing 90-day ED rebound. This study suggests there is ample time (at least up to 30 days) for post-discharge follow-up of COPD patients by primary care providers to optimize care and prevent hospital/ED rebound.
Research | Recherche

W824: A Realist Canada-Wide Audit of Triple C Implementation

03:45 PM 04:00 PM Room | Salle : 511D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Sonya Lee*, MD, CCFP, MHSc, FCFP; Rachel Ellaway, PhD; Maria Palacios-Mackay, DDS, PhD; Mariana Hofmeister, PhD; Juli Finlay, PhD

Learning objective:
1.Explain the different approaches to implementation of the Triple C curriculum and its impacts across Canadian family medicine residency programs

Context:
The College of Family Physicians of Canada’s Triple C (TC) initiative was one of the first national approaches to competency-based medical education. All family medicine residency programs at Canada’s 17 medical schools have adopted TC, and program evaluation is ongoing. Objective: To examine the different approaches to implementation of TC and its impacts across Canadian family medicine residency programs. Design: A realist audit of the different approaches to the implementation of TC and its impacts was conducted. Realist analysis of the results was to identify the different contexts, mechanisms, and outcomes associated with implementing TC. Data were collected through individual interviews and focus groups that underwent thematic analysis by constant comparison method. Participants: Participants included program directors, department chairs, deans, administrators, preceptors, and residents at all 17 schools. Outcome measures: Outcomes included the identification of narrative themes related to TC implementation and its impact. Results: Every family medicine residency program had implemented some part of TC, in some way or form. Implementation was pragmatic, making use of opportunities where they arose. Some challenges in implementing TC were common to all schools, others were more localized. TC has been broadly successful, with earlier and more specific identification of struggling students being of particular value. Some programs struggled with renegotiating the role and presence of specialist physicians outside of family medicine in the training of family doctors. Implementing TC involved substantial administrative and resource costs. Schools that delayed the adoption of the TC curriculum learned from earlier adopters and many partially attribute their success to concurrent and new assessment programs. Conclusion: Despite many challenges, TC has been a driver for much quality improvement in programs and it has catalyzed the Canadian family medicine community to be much more engaged in and attentive to educational matters.
Research | Recherche

W840: Health Outcomes and Family Physician Patient Volumes: Phase I results

03:45 PM 04:00 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Terrence McDonald, MD, MSc, CCFP (SEM), DipSport Med; Lee Green, MD, MPH

Learning objectives:
1.Understand the demographics and billing patterns of high-volume family physicians in Alberta
2.Understand the current labour supply of family physicians in Alberta

Primary care physician remuneration policies in Alberta are currently under review; at the moment it is a predominantly fee-for-service (FFS) system. Using blended capitation and capping FFS billings per day are being considered. Both would discourage high-volume (> 50 patients/day) practice, but little is known about high-volume practice in Alberta and its impact on patient outcomes. Using Alberta family physician (FP) billing and demographic data on all FFS FPs in the province (N = 3,465), we set out to improve our understanding of current physician patient volumes and billing practices in relation to associated provider demographics. Our first step was to characterize high-volume practice, including international medical graduate (IMG) status, geography, and billing patterns. Approximately 30 per cent of FPs currently working in Canada are IMGs. High-volume status was modelled on general practice billing data from 2011 to 2015, provider demographic characteristics, and geographic parameters in simple comparisons and in a logistic regression. Logistic regression analysis revealed that high-volume practitioners tended to avoid service codes representing time-intensive services, were typically older, were typically male, and tended to be located in the north of the province. IMGs were substantially more likely to be high-volume practitioners. Rurality was not associated with high-volume practice independently of location in the north. A large number of FPs do work not full-time. The results of this study serve to fill an important knowledge gap about high-volume practitioners and facilitate the next step in exploring the interaction between service volume and health outcomes. These results are important for policy-makers when considering the design of a payment system to optimize patient outcomes. Health outcomes data and analysis (Phase II) are also expected to be ready to present at the time of this presentation.
Research | Recherche

W558: A Simple Clinical Prognosis Tool to Predict Mortality After a “First” Hospitalization for COPD

04:00 PM 04:15 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Alain Vanasse*, MD, PhD; Josiane Courteau, PhD; Simon Couillard, MD; Marie-France Beauchesne, PharmD; Pierre Larivée, MD

Objective: To provide family physicians with a simple score sheet to estimate a one-year all-cause mortality risk for patients with chronic obstructive pulmonary disease (COPD) who are hospitalized for the “first” time. Design: Retrospective cohort study using linked administrative and clinical data. Setting: Hospitalized care. Participants: Patients with COPD between 40 and 84 years old hospitalized in a regional hospital (Sherbrooke, Quebec, Canada) between April 2006 and March 2013 and discharged alive. Patients with a previous COPD hospitalization within five years were excluded to retain only “first” COPD hospitalizations. Main outcome measures: One-year all-cause mortality after discharge was assessed and analyzed using multiple logistic regression on a derivation sample (backward elimination with P <0.01) and validated on a testing sample. Results: A total of 141 (12.5 per cent) of the 1,129 patients died within one year of discharge from their first hospitalization for COPD. Predictors of one-year mortality were: older age (OR 1.055, 95%CI 1.026 to 1.085), male gender (OR 1.474, 95%CI 0.921 to 2.358), having a severe COPD exacerbation during index hospitalization (OR 2.548, 95%CI 1.571 to 4.132), a higher index hospital length of stay (OR 1.024, 95%CI 0.996 to1.053), a higher Charlson Comorbidity Index score (OR 1.262, 95%CI 1.099 to 1.449), a diagnosis of cancer (OR 2.928, 95%CI 1.456 to 5.885), the number of prior all-cause hospitalizations (OR 1.323, 95%CI 1.097 to 1.595), and COPD duration exceeding three years (OR 1.710, 95%CI 1.058 to 2.763). Using estimates of the logistic model for these eight predictors, a simple clinical prognosis tool is proposed. The model shows good discrimination in both the derivation and validation cohorts (C statistic exceeding 0.78). Conclusion: One out of eight patients discharged alive from a first COPD hospitalization will die in the following year. It is thus important to identify high-risk patients to plan and manage appropriate treatments.
Research | Recherche

W689: Identifying Potentially Inappropriate Prescriptions in Ontario’s Older Adult Population

04:00 PM 04:15 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Lise M. Bjerre, MD, PhD, CCFP*; Timothy Ramsay, PhD; Catriona Cahir, HDip, PhD; Cristin Ryan, MPharm, PhD; Roland Halil, PharmD; Barbara Farrell, PharmD; Kednapa Thavorn, MPharml PhD; Christina Catley, PhD; Steven Hawken, PhD; Ulrika Gillespie, Msc, PhD; Douglas G. Manuel, MD, MSc, FRCPC

Learning objective:
1.Be able to demonstrate how large health administrative databases can identify potentially inappropriate prescribing in large populations

Objectives:
To describe the prevalence of potentially inappropriate prescriptions (PIPs) in Ontario’s older adult population by applying criteria used in clinical settings to population-level health data. Design: Population-based retrospective cohort study. Setting: Ontario health administrative data set. Participants: Patients ≥ 66 years of age who were issued at least one prescription between April 2003 and March 2014 (N = 2,477,403). Intervention: Subsets of the 2014 STOPP/START criteria and of 2015 Beers criteria were selected as applicable to health administrative databases, codified using diagnostic and medication codes, and used to identify PIPs in the health administrative database among the patients selected. Main outcome measures: The incidence of a first PIP ever and the PIP prevalence for each criterion over the study period. Results: In this study, 95.5 per cent (84/88) of Beers criteria, 64.2 per cent (52/81) of STOPP criteria, and 26.5 per cent (9/34) of START criteria were identified as applicable to the health administrative database. The Beers criteria identified 51.1 per cent (1,265,295/2,477,403) of patients as having a first PIP ever, while 26.8 per cent of patients had more than one PIP and 2.56 per cent of patients had more than five PIPs ever. The STOPP/START criteria identified 69.2 per cent (1,714,311/2,477,403) of patients as having at least one PIP over the course of the cohort membership, 30.8 per cent of patients had more than 1 PIP, and 18.0 per cent of patients had more than five PIPs ever. The most common PIP criteria were diseaseB4, drugG3, drug-drug6 for Beers, and STOPP D12, STOPP D10, STOPP D6 for STOPP/START (excluding START 1—immunizations). Conclusion: Applying clinical criteria for identifying PIPs in Ontario’s population age ≥ 66 years found that as many as 1.7 million older Ontarians who were issued a prescription between April 2003 and March 2014 had at least one PIP, and more than one in four had two or more. This likely underestimates the true prevalence of PIPs in this population, given the number of patients excluded due to limitations in the health administrative database.
Research | Recherche

W724: Medical Assistance in Dying: Concern and optimism from palliative care physicians

04:00 PM 04:15 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Joshua Shadd, MD, MClSc, CCFP (PC); Marilyn Swinton, MSc; Cait O’Donnell, MBHL; Joseph Pellizzari, PhD; Kathleen Willison, MSc; Andrea Frolic, PhD; Anne Woods, MD, CCFP (PC), FCFP

Learning objective:
1.Understand palliative care physicians’ perceptions of the anticipated impact of the legalization of medical assistance in dying

Objective:
To understand palliative care physicians’ perceptions of the anticipated impact of the legalization of medical assistance in dying (MAID) Design: Qualitative descriptive from in-depth interviews. Setting: Interviews were conducted in the time period between the 2015 Supreme Court ruling that decriminalized MAID in Canada and the implementation of federal legislation to govern the practice. Participants: Forty-four physicians (42 family physicians) practising primarily palliative care in southern Ontario. Findings: Participants articulated a wide spectrum of ideas regarding the nature and degree of anticipated impacts of the legalization of MAID. Participants anticipated impacts in multiple overlapping spheres affecting their patients, themselves, and their colleagues. Responses demonstrated complex and evolving ways of thinking about MAID that expressed a mixture of concern and optimism. Conclusions: Participants described the anticipated impact of the legalization of MAID primarily in relational terms. The principles of relational ethics were not a sensitizing concept for this study, but they provide a helpful lens through which to understand participants’ perspectives.
Research | Recherche

W748: Le Programme de sensibilisation à la santé cardiovasculaire pour les patients en liste d’attente pour obtenir un médecin de famille

04:00 PM 04:15 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Marie-Thérèse Lussier, MD, MSc; Janusz Kaczorowski, PhD; Magali Girard*, PhD

Objectifs d’apprentissage : 
1.À la fin de cette présentation, le participant sera en mesure de déterminer les éléments essentiels du Programme de sensibilisation à la santé cardiovasculaire, de reconnaître l'importance d'adapter et d'offrir un programme de prévention et de promotion de la santé aux adultes qui n'ont pas de médecin de famille et de différencier le profil de santé de ces adultes de celui de la population générale.

Contexte :
Le Québec affiche le pourcentage de patients orphelins le plus élevé au Canada. Par conséquent, des listes d’attente centralisées ont été mises sur pied dans le but de contrer les difficultés à obtenir un médecin de famille. Au moment de s’inscrire, les patients sont répartis selon des codes de priorité. En raison des délais d’attente et du caractère réduit des évaluations, il peut arriver que les codes de priorité ne soient plus à jour ou qu’ils soient erronés. Le Programme de sensibilisation à la santé cardiovasculaire (PSSC) pourrait permettre à des patients sur la liste d’attente de se voir accorder une nouvelle priorité et obtenir plus rapidement l’accès à un médecin de famille. Le BUT de ce projet pilote est de déterminer dans quelle mesure il serait réalisable et acceptable de mettre en place un programme comme le PSSC pour les patients adultes en attente d’un médecin de famille. Méthode : L’intervention était offerte à des patients adultes de 40 ans et plus inscrits sur la liste d’attente du guichet d’accès à un médecin de famille de Laval (Québec). Des séances PSSC ont été menées par des bénévoles formés, sous la supervision d’une infirmière. Leur déroulement comprenait notamment la prise de la pression artérielle, la mesure du tour de taille et de l’IMC, l’évaluation du risque cardiométabolique, la distribution de documentation éducative et d’information sur les ressources communautaires liées aux saines habitudes de vie, et la recommandation à un MF local pour les patients chez qui un risque de santé a été décelé. Résultats : Le projet a permis d’identifier les patients qui nécessitaient de l’aide médicale immédiate. En effet, plus de 40 % des participants ont été orientés vers des programmes de promotion de la santé offerts par des autorités sanitaires locales. La plupart des participants étaient sédentaires, ne consommaient pas suffisamment de fruits et légumes et souffraient d’embonpoint ou d’obésité. Conclusion : Les programmes communautaires de sensibilisation à la santé cardiométabolique, tels que le PSSC, peuvent présenter des avantages pour les évaluations des guichets d’accès : ils permettent d’identifier les participants qui nécessitent des soins immédiats et de leur attribuer un médecin, d’offrir de la documentation éducative sur les saines habitudes de vie et d’orienter les participants vers des ressources communautaires locales gratuites ou à prix abordable, qui souvent, sont inconnues des participants ou généralement sous-utilisées. 
Research | Recherche

W817: Are Direct Oral Anticoagulants Being Prescribed Appropriately in Canadian Primary Care Practices?

04:00 PM 04:15 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Alexander Singer*, MB BAO BCh, CCFP; Finlay McAlister, MD, MSc, FRCPC, FACP; Leanne Kosowan, MSc; Scott Garrison, MD, CCFP, PhD

Learning objectives:
1.Recognize factors associated with inappropriate prescribing of direct oral anticoagulants
2.Identify and define direct oral anticoagulants prescribing patterns in Canada

Objective:
To evaluate the appropriateness of direct oral anticoagulant (DOAC) prescribing patterns in Canada among patients with atrial fibrillation being managed in the outpatient setting by primary care providers and explore the impact of patient or provider factors. Design: Retrospective review of electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network repository. Population: Data from 744 primary care clinicians in 137 clinics, with 6,854 patients prescribed a DOAC between 2010 and 2015. Outcome measures: Inappropriate DOAC prescribing, defined as under-dosing, overdosing, or not indicated based on comorbidity or CHADS2 score. Methods: We performed multivariate analysis using logistic regression considering inappropriate DOAC use as the outcome and patient, provider, and practice as independent variables. Results/findings: Of the 6,854 patients prescribed a DOAC (mean age 74.8 years, 55 per cent male), 12.3 per cent (n = 844) of patients had an inappropriate prescription. Of these, 59.1 per cent were prescribed too low a dose; 3.7 per cent were prescribed a dose too high given their age, weight, and eGFR; and 42.5 per cent had conditions for which DOACs are not indicated (i.e., valvular atrial fibrillation, low CHADS2 score). Nearly half of the patients prescribed a DOAC were also prescribed antiplatelet agents or NSAIDs. Inappropriate prescribing of a DOAC was associated with polypharmacy (AOR 1.3, 95%CI 1.1 to 1.6), female patients (AOR 1.3, 95%CI 1.1 to 1.6), and patients younger than 65 years (AOR 1.6, 95%CI 1.3 to 2.2). Patients with comorbid heart failure or dementia were significantly more likely to be prescribed inappropriate DOAC doses. Regarding provider characteristics, inappropriate DOAC prescribing was more common among younger physicians (AOR 1.3, 95%CI 1.1 to 1.5), rural physicians (AOR 1.9, 95%CI 1.6 to 2.3), and medium-size practices (600 to 1,000 patients) compared with smaller practices (fewer than 600 patients: AOR 2.7, 95%CI 1.9 to 3.8). Conclusions: These findings are similar to rates of inappropriate DOAC prescribing found in other registries (ORBIT-AF II) with predominantly cardiologist prescribers. Patient and provider factors should be considered when designing quality improvement efforts to improve care.
Research | Recherche

W837: Examining Family Medicine Residents’ Self-Reported Perceptions of Their Specialty

04:00 PM 04:15 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Deena M. Hamza*, PhD; Shelley Ross, PhD; Ivy Oandasan, MD, CCFP, FCFP, MHSc

Learning objectives:
1.Explain how the Family Medicine Longitudinal Survey can be used to explore resident perceptions of their training and discipline
2.Describe family medicine residents’ perceptions of how they and others value family medicine as a discipline
3.Identify ways in which perceptions of value of family medicine as a discipline may change over time in residency training

Context:
Triple C is a competency-based medical education initiative that aims to ensure graduates from any family medicine residency program in Canada are prepared to provide comprehensive care to patients across their lifespan and meet the needs of the community. The Family Medicine Longitudinal Survey (FMLS), which began in 2012, is intended to evaluate Triple C. In this study, we used data from the FMLS to explore potential changes in perceptions about the discipline of family medicine pre- and post-residency. Objective: To explore resident responses on the FMLS responses from residents to: understand how residents perceive their medical specialty; identify aspects of the discipline that may need improvement; and show evidence of changes in perceptions pre- and post-residency. Design: Secondary data analysis. Intervention (data sources): De-identified FMLS responses from one cohort at entrance (T1) and exit (T2) of residency (N = 424). Outcome measures: Level of agreement with statements about family medicine as a discipline. Results: The majority of residents agreed with feeling proud to become a family physician; that patients recognize the value of the discipline; and that family physicians provide a valuable contribution that is different from other specialists and valuable beyond referrals. This high level of agreement was consistent at T1 and T2. Interestingly, a significant proportion of T2 respondents felt the government does not perceive family medicine as essential to the health care system, a notable reduction from T1 responses. This finding was not found to be correlated with practice intentions. Discussion: The FMLS has provided insight into resident perceptions of family medicine. While most perceptions about the discipline were positive at T1 and T2, more than 50 per cent of respondents indicated they perceived the government does not value the discipline. Conclusions: Surveying residents about their perceptions about family medicine has provided valuable insights into areas needing further examination. 
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées
Emergency Medicine | Médecine d’urgence

W428: Integrating Family Medicine and Emergency Medicine Practice

04:15 PM 05:15 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. understand the challenges of combining family medicine and emergency medicine practice
2. understand the benefits of combining family medicine and emergency medicine practice
3. learn strategies to combine family medicine and emergency medicine practice

Description:
It can be difficult to practise emergency medicine and family medicine. This session will explore the challenges and benefits of a combined family medicine/emergency medicine practice.

Speakers

Teaching | Precepting | Enseignement | Supervision

W874: Fireside Chat

04:15 PM 05:15 PM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifi�s Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. recommend family medicine teacher and preceptor initiatives and activities during the FMF
2. identify strategies to support family medicine teachers and preceptors with their various roles
3. appraise current FMF family medicine teacher and preceptor educational sessions and activities

Description:
Fireside Chat with the CFPC’s Section of Teachers Council Chair, Dr. Ian Scott, incoming Chair, James Goertzen and Director of Education, Dr. Ivy Oandasan
Join us for a free flowing audience directed discussion about how the College can best serve teachers and preceptors in their important roles. Based on your input last year we made a number of changes to both the FMF program and some of the activities.
Research | Recherche

W555: Breaking the Cycle of Survival Drinking: A peer-run managed alcohol program

04:15 PM 04:30 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Bernie Pauly, RN, PhD; Vashti King, MD; Ashley Smith, MD; Sarah Tranquilli-Doherty*, MD; Christy Sutherland, MD, CCFP; Kate Vallance, MA

Learning objective:
1.Recognize managed alcohol programs in the therapeutic spectrum for individuals with severe alcohol use disorder and homelessness

Objective:
Managed alcohol programs (MAPs) have been implemented in Canada to assist individuals with severe alcohol use disorder and homelessness by providing regularly dispensed standard-size drinks to prevent alcohol withdrawal symptoms and minimize non-beverage alcohol consumption. This study describes the individual experience of the members in a non-residential, peer-run MAP. Design: This project is part of a larger mixed methods study of five Canadian MAPs. Fourteen qualitative, semi-structured interviews were conducted using a previously developed and ethically approved set of questions from the National Study of Managed Alcohol Programs in Canada. Setting: A non-residential, peer-run MAP in a large urban setting, run by a non-governmental organization. Participants: MAP members were recruited by announcements at meetings, posters, and word of mouth. To be included participants had to have a minimum of 30 days in the program and speak English. Fourteen participants were eligible, and all were included. The mean age of participants was 42 years (range 29 to 61) and two were female. Eight participants identified as Indigenous or First Nations. Findings: This study describes the importance of community among individuals with chronic alcohol use disorder and homelessness. Prior to the program participants described injuries related to drinking, frequent hospitalizations, and overdoses as a result of concurrent illicit alcohol and drug use. While in the program participants noted decreased or discontinued illicit alcohol consumption and had fewer blackouts and withdrawal symptoms. Our findings suggest this non-residential, peer-run MAP was fundamental in participants’ transition from daily survival drinking to meaningful engagement in their community. Conclusion: This non-residential, peer-run MAP played an integral role in the lives of its participants, improving health, substance use patterns, relationships, and community connections. These benefits are consistent with the current literature on residential Canadian MAPs.
Research | Recherche

W690: Evaluating the Consistency of Medication Warnings Issued to Canadian, American, and British Prescribers

04:15 PM 05:15 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Lise Bjerre, MD, PhD, CCFP; Simon Parlow, MD; David De Launay; Matthew Hogel, PhD; Cody D. Black; Donald Mattison, MD; Carlos Rojas-Fernandez, PharmD; Jeremy Grimshaw, MD, PhD; Margaret Watson PhD, MSc, MRPharmS

Learning objective:
1.Be able to evaluate differences in regulatory warnings issued to prescribers in three similar jurisdictions

Objective:
To determine whether, and to what extent, there was consistency in the format, content, and timing of medication warnings issued by regulatory health authorities to prescribers in three similar jurisdictions. Design: Cross-sectional analysis. Setting: Online databases of health advisory letters (HALs) in Canada, the United States, and the United Kingdom. Participants: HALs issued by Health Canada, the US Food and Drug Administration (FDA), and the United Kingdom’s Medicines and Healthcare products Regulatory Agency (MHRA) between January 1, 2010, and December 31, 2014, inclusive. Intervention: An abstraction tool, consisting of 21 clinically desirable HAL characteristics and developed by consensus of the research team, was created to facilitate identification and documentation of the presence or absence of these characteristics in each HAL selected. Main outcome measures: Jurisdictional overlap of the content, format, and timing of HALs. Results: A comparison of the HALs issued by Health Canada, the FDA, and the MHRA determined that of 245 unique letters issued between January 1, 2010, and December 31, 2014, inclusive, 227 (93 per cent) pertained to medications available in all three jurisdictions. Of these 227 letters, only 21 (9 per cent) were issued by all three jurisdictions; 40 (18 per cent) were issued by two; and 166 (73 per cent) were issued by only one. Only 13 of the letters published in all three jurisdictions were issued within six months of each other. While there was consistency in the basic format and content of the HALs across jurisdiction, there were differences in the way additional information was presented or emphasized. Conclusions: There is a lack of consistency in the format, content, and timing of medication warnings issued by authorities to prescribers in Canada, the United States, and the United Kingdom, raising important questions about how and when medication safety–related issues are identified and communicated to prescribers by the authorities in each jurisdiction.
Research | Recherche

W706: Implications of Identifying Older Patients in Primary Health Care at Risk of Dying

04:15 PM 04:30 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Robin Urquhart*, PhD; Jyoti Kotecha, MPA; Cynthia Kendell, MSc; Mary Martin, MSc; Han Han, PhD; Beverley Lawson, MSc; Cheryl Tschupruk, MSW; Emily Marshall, PhD; Carol Bennett, MSc; Fred Burge, MD, CCFP, FCFP, MSc

Learning objective:
1.Be able to identify the value and implications of practice-based end-of-life identification

Objective:
To explore the acceptability and implications of using a primary health care (PHC)-based electronic medical record (EMR) algorithm to help providers identify patients in their practices at risk of declining health and dying. Design: Qualitative descriptive study using focus group methods (six in total). Participants were purposively sampled to gain maximum variation. Thematic analysis, using a constant comparative approach, was used to analyze data. Setting: PHC, palliative care, and geriatric care in Nova Scotia and Ontario. Participants: Twenty-nine health care providers and policy-makers in PHC, palliative care, and geriatrics. Main outcome measures: Knowledge of whether EMR identification algorithms are acceptable to health care providers and policy-makers, and informed views on the clinical, policy, and social implications of practice-level identification in PHC. Findings: PHC-based identification was viewed as acceptable and aligned with the values, aims, and positioning of PHC. Participants were less concerned about the identification algorithm itself and more concerned about what to do after identification. Participants felt PHC providers require additional training and supports to undertake conversations around a patient’s values, wishes, and goals for future health care (i.e., advance care planning, ACP). Participants emphasized early identification and ACP conversations require an integrated team approach. They also noted early identification would not only trigger ACP discussions, but also prompt patients to reflect on and undertake life planning. Participants highlighted the need for a public health approach to early identification and that ACP is needed to optimize early identification and its impact. Conclusion: The research team has developed a validated algorithm using PHC EMR data to identify persons at risk of dying within 12 months. Understanding the implications of practice-level identification is critical to implementing EMR algorithms in ways that facilitate sensitive and responsive identification and care planning.
Research | Recherche

W740: Who Still Uses Manual Blood Pressure Measurement in Routine Clinical Practice? Results From a National Survey

04:15 PM 04:30 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Claudio Del Grande, MSc; Janusz Kaczorowski, PhD, MCFP

Learning objective:
1.Identify factors that are associated (or not) with using manual BP measurement in clinical practice

Objective:
To explore whether sex of family physicians (FPs), age, type of patient population served, and province of practice are associated with routine use of manual blood pressure (BP) measurement for screening, diagnosing, and managing hypertension. Design: Web-based cross-sectional survey distributed by e-mail, conducted in 2016. Setting: Stratified random sample of FPs in Canada. Participants: FP members of the College of Family Physicians of Canada with valid e-mail addresses. Main outcome measures: FPs’ self-reported routine use of manual BP measurement (mercury or aneroid device) for recording BP in their practices to screen for, diagnose, and manage hypertension. Results: A total of 774 valid responses was received (response rate: 16.2 per cent). Respondents were similar to nonrespondents except for underrepresentation of male physicians. Slightly more than half of Canadian FPs (54 per cent) reported using manual BP as their routine measurement method for hypertension screening; one out of five (21 per cent) did so for diagnosis; and two out of three (64 per cent) reported using manual BP measurement for management, generally along with other measurement methods. Following multivariate logistical regression analyses, province of practice was the most statistically significant factor related to using manual BP for hypertension screening, diagnosis, and management (adjusted ORs in the range of 0.2 to 2.8). FPs primarily serving rural or isolated/remote patient populations were less likely (adjusted OR 0.6) than those serving urban/suburban populations to report using manual BP measurement for hypertension diagnosis, although ambulatory BP monitoring was reported to be significantly less available to them, as well as to FPs in British Columbia, the Atlantic provinces, and Northern Canada. Conclusion: A sizable proportion of Canadian FPs routinely use manual BP measurement, counter to current national guidelines. Efforts to encourage FPs to adopt evidence-based BP measurement practices should reflect the uneven distribution of manual BP users among provincial jurisdictions, independent of FPs’ individual characteristics.
Research | Recherche

W752: Évaluation de l’état de préparation à la mise en place du Programme de sensibilisation à la santé cardiovasculaire dans les logements sociaux subventionnés du Québec

04:15 PM 04:30 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Janusz Kaczorowski, PhD; Marie-Thérèse Lussier, MD, MSc; Gina Agarwal, MD, PhD; Magali Girard, PhD

Objectifs d’apprentissage : 
1.À la fin de cette présentation, le participant sera en mesure de déterminer les éléments essentiels du Programme de sensibilisation à la santé cardiovasculaire, de comprendre les profils de santé et conditions de vie particuliers des adultes vivant dans un logement social subventionné et de comprendre à quel point les consultations avec les intervenants clés sont importantes pour adapter un programme communautaire afin de répondre aux besoins d'une population vulnérable.

Contexte : Les résidents des logements sociaux subventionnés constituent une tranche de la population vulnérable, à faible revenu, et reconnue comme étant en moins bonne santé que les locataires de logement privé ou les propriétaires. Le Programme de sensibilisation à la santé cardiovasculaire (PSSC) est un programme communautaire de prévention et de prise en charge des maladies chroniques. Son objectif consiste à réduire le fardeau associé aux maladies chroniques qui pèse sur le système de santé en s’attaquant aux facteurs de risques, en aidant les patients à obtenir des soins primaires et en améliorant les liens avec les ressources communautaires. Présenté sous forme d’évaluation des besoins et de l’état de préparation, ce projet a pour BUT, avant tout, d’évaluer les attitudes des principaux intervenants (disposés au changement), les conditions (le contexte, la structure), et les ressources (humaines, matérielles et financières) : en somme, tout ce qui est nécessaire à l’intégration d’un programme comme le PSSC dans les logements sociaux du Québec. Méthode : Ce projet propose d’adapter le PSSC aux besoins locaux en appliquant une approche intégrée de transfert du savoir qui repose sur la consultation de cliniciens, de participants, de gestionnaires du système de santé et d’édifice de logements sociaux, et d’ambulanciers. L’intervention comprend une série de groupes de discussion avec les principaux intervenants, et un sondage ciblant les résidents des logements sociaux. Milieu et participants : Ce projet sera réalisé dans des cliniques et des logements sociaux situés dans les réseaux de recherche fondée sur la pratique de l’Université McGill et de l’Université de Montréal. Résultats : Les paramètres à l’étude compteront notamment un profil de l’état de santé des locataires de logements sociaux, ainsi qu’une analyse de leurs besoins en matière de soins de santé et de leur niveau de littératie en santé. Les groupes de discussion éclaireront les positions des intervenants, et mettront en valeur les conditions et les ressources qui entrent en jeu dans la mise en œuvre de programmes comme le PSSC pour les résidents des logements sociaux. Conclusion : Les résultats du sondage et des groupes de discussion seront indispensables pour formuler des recommandations et pour rédiger un guide d’implantation. On s’attend à ce qu’une part importante des résidents n’aient pas d’interactions régulières avec des fournisseurs de soins primaires et, probablement, que peu d’entre eux aient un médecin de famille. Un protocole de suivi sera ajouté au guide d’implantation une fois que les facteurs de risques seront identifiés.
Research | Recherche

W760: The Personal Health of Family Physicians: Barriers, gaps in care, and solutions

04:15 PM 04:30 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Mumta Gautam, MD, FRCPC, MBA; Caroline Gerin-Lajoie, MD, FRCPC; David Harel, MD; Bismil Ramprasad, MD, FRCPC, MBBS; Christopher Simon, PhD; Iuliia Oleksand Povieriena, MSc; Bridget McDonald

Learning objectives:
1.Recognize the barriers and gaps in the system preventing physicians from maintaining their personal health
2.Explore solutions within their work environment to build support and improve ease of access to resources

Objective: To determine the barriers and systemic gaps physicians encounter when seeking help, and suggest solutions to prevent physician burnout. Design: This qualitative study used grounded theory to uncover the recurrent themes identified in semi-structured discussion groups. Setting: This study was conducted in the setting of a conference on physician wellness. Participants: Convenience sampling, 57 participants, 51 per cent family physicians, 35 females, 22 males. Intervention: Following the testimonials of local physicians on themes of physician wellness and resilience, the participants were divided into 10 focus groups for discussion. Main outcome measures: Based on the recordings and scribe notes of the discussions, a spreadsheet of identified themes was created. These themes were then grouped into categories such as barriers, gaps, and solutions. The frequency of each theme being mentioned was tabulated and the most common themes were identified. Findings: Twenty-two themes related to barriers, nine themes on gaps, and 24 related to solutions were identified and their occurrence summarized. The most frequently mentioned barriers to seeking help were stigma, unsupportive work environment, and denial. The most commonly identified gap was lack of accessibility of existing services. This was especially true for family physicians in the community. The most frequently suggested solutions to barriers were creating a culture of support, providing continued mentorship, and improving awareness and accessibility of existing resources. Conclusion: The CanMEDS Framework for the role of Professional stipulates that the provision of optimal patient care requires physicians to take responsibility for their own health and well-being and that of their colleagues. The findings of this study indicate that for physicians to accomplish this, a culture of support, mentorship, and awareness must be created. Proposed solutions include improved communication and collaboration among colleagues to reduce stigma and remove the shame in seeking help.
Research | Recherche

W549: Engaging Family Practice Physicians in System Change: Partnering with a health authority and communities

04:30 PM 04:45 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

David Snadden, MBChB, MClSc, MD, CCFP; Martha MacLeod, PhD, RN; Neil Hanlon, PhD; Trish Reay, PhD; Cathy Ulrich, MSc, RN

Learning objective:
1.Explain how a British Columbia Health Authority engaged and partnered with Divisions of Family Practice to support whole-system primary care change

Northern Health (NH), a British Columbia Health Authority, is leading a process of whole-system change in partnership with physicians and communities. Objective: To examine engagement with family physicians and how they have become partners in creating and scaling up NH–wide integrated, patient-centred primary health care. Design: Longitudinal, multiple case study. Setting: NH region and seven communities within it. Participants: A total of 236 participants, including 20 community physicians. Approach: Two hundred fifty semi-structured interviews were undertaken within the communities over three years. Data were analyzed by thematic analysis. Intervention: How NH had engaged physicians in the change process. Findings: Fundamental, transformative change that addresses the needs of people in communities, while meeting regional and provincial directions, takes longer than anticipated and physician engagement as true partners is critical to overall success. The Divisions of Family Practice in British Columbia have been instrumental in that engagement. In northern British Columbia this engagement has been facilitated by regular meetings between NH and five separate divisions, the development of shared strategic directions, and local flexibility in the development of the priorities of divisions. We also observed that over time, as personnel changed, there was a need to renegotiate the partnerships and orient new personnel on vision and priorities. Strong, flexible leadership from the divisions and NH was also important in building trust. Interim indicators of change are reflected in joint initiatives between the divisions and NH, positive quality improvement measures, and fewer unattached patients. Conclusion: An in-depth examination of processes of change illuminated the relationships, challenges, and approaches that are needed for services and structures to be reformed to serve the needs of patients and families better. This also demonstrated how the Divisions of Family Practice in British Columbia have facilitated physician engagement with NH. Partnerships allow for working through the inevitable tensions and barriers to fundamental, far-reaching system change.

Research | Recherche

W574: Addressing Driving Retirement with Our Clients: A scoping review

04:30 PM 04:45 PM Room | Salle : 513AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Julie Lapointe, erg., OT(C), OT Reg. (Ont.), PhD; Katelyn Bridge, OT Reg. (Ont.), Christopher C. Frank, MD, CCFP (COE), FCFP; Janet M. Craik*, MSc, OT(C), OT Reg. (Ont.)

Objective: To review the existing literature on interventions supporting clients in their transition to driving retirement. Design: A scoping review was completed in September 2016. Articles were identified through PubMed, Embase, and the reference lists of relevant articles with key words that included “driving retirement intervention” and “driving cessation intervention.” The selected articles had to be published in English and provide specific directions to support the transition to driving retirement. Articles strictly focused on the assessment of driving capacities were excluded. A thematic analysis was conducted to synthesize findings. Findings: Twenty articles were deemed relevant to informing professionals’ interventions related to driving retirement. These articles fell into four themes: outcomes of driving retirement (n = 5), perceived barriers to driving retirement (n = 2), suggestions for driving retirement interventions (n = 3), and description and evaluation of existing programs (n = 10). Programs and interventions were often delivered in a group format by multidisciplinary teams including occupational therapists, physicians, nurses, and peer leaders and addressed both practical and emotional concerns associated with driving retirement. Conclusions: The results of this review will enable family physicians to identify and explore with clients the practical and emotional concerns linked to driving retirement. Family physicians will also be able to provide concrete and evidence-based strategies to their clients who need to transition to driving retirement. Finally, family physicians will be able to determine situations that would benefit from the input of an occupational therapist.
Research | Recherche

W661: Reasons for Requesting Medical Assistance in Dying

04:30 PM 04:45 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Ellen Wiebe* MD, CCFP, FCFP; Jessica Shaw, MSW, PhD; Stefanie Green MD; Michaela Kelly

Learning objectives:
1.Describe the most important reasons Canadian patients give for requesting MAID
2.Describe some of the differences between the reasons given by patients with different diagnoses
3.Describe some of the differences between the reasons given by patients who had or did not have MAiD

Background: Canadians have had the right to medical assistance in dying (MAID) nationally since June 2016. Objectives: The purpose of this study was to review charts of people who requested MAID to examine the reasons for their requests. Method: This was a retrospective chart survey of patients who requested an assisted death and were assessed by one of six physicians in British Columbia during 2016. Results: We have data on 270 assessments for MAID, with 132 assisted deaths, 14 natural deaths, and 124 others. The patients who had assisted deaths ranged in age from 26 to 102 years with a mean age of 74.2 years. The most common diagnoses were malignancies (61, 46.2 per cent), end-organ failure (29, 22.0 per cent), and neurological diseases (28, 21.2 per cent). For people who had assisted deaths, the reasons they gave as being the most important for their choice were disease-related symptoms (57, 43.2 per cent), loss of autonomy (32, 24.2 per cent), loss of the ability to enjoy activities (32, 24.2 per cent), and fear of future suffering (10, 7.6 per cent). There were significant differences in reasons given by people with different diagnoses; 66.7 per cent of patients with malignancies gave either disease-related symptoms or fear of future suffering as their most important reason while 66.7 per cent of people with neurological diseases gave either loss of autonomy or loss of the ability to do enjoyable or meaningful activities as their most important reason. (P < 0.001). Conclusion: This study shows that the reasons patients in British Columbia give for requesting an assisted death are somewhat different from those in other jurisdictions. Only 53.4 per cent of our patients listed loss of autonomy as the first or second most important reason for the request compared with 91.4 per cent of patients in Oregon. Loss of ability to enjoy activities was given as a reason by 53.4 per cent of our patients compared with 86.7 per cent of the Oregon patients.

Research | Recherche

W663: Describing the Pause: A phenomenological study of physical examination in family practice

04:30 PM 04:45 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Lisa Freeman*, MD, MPH, CCFP; Martina Kelly, MBBCh, MA, FRCGP, CCFP

Learning objectives:
1.Interpret family physicians’ experiences of physical examination
2.Investigate the association between diagnosis and communication during physical examination

Context:
Physical examination is a cornerstone of family practice and serves not only to diagnose but also to communicate reassurance and care. However, with a shift to evidence-based medicine in the past few decades, physicians may be moving away from traditional aspects of touch and the use of physical examination to communicate with and reassure patients. Objective: This study was conducted to understand family physicians’ experiences of physical examination. Design: Qualitative. In the tradition of phenomenology, a series of thick descriptions were sought through in-depth, semi-structured interviews with 16 family physicians recruited through purposive sampling to ensure participants included men and women, rural and urban family physicians, and individuals newer to practice and those more established in practice. Interviews were analyzed through template analysis starting with literature-informed a priori codes. Findings: Study participants described physical examination as core to their practice to diagnose, communicate, and validate patient and practitioner concerns. Participants described a pause, a slowing of time experienced while conducting physical examination, during which they were conscious of their bodies and their relation to time and space. This pause is a time when physicians experience affective, intellectual, and physical phenomena and integrate information to inform their behaviour, diagnosis, and management of the patient. The role of physical examination is therefore not only to diagnosis in the context of the physician’s role as an evidence-based medical expert, but also to act as a form of embodied, non-verbal communication to express care. Conclusions: This study describes and interprets family physicians’ experiences of physical examination and demonstrates physicians’ beliefs and attitudes toward physical examination. This includes the tension between the roles of physical examination in diagnosis and non-verbal communication. This understanding may inform the role of physical examination in practice and teaching as it reinforces the value of examination in patient-centred care.
Research | Recherche

W780: Assessment of Patient-Physician Communication in Primary Care Practices: What is retained immediately post clinical encounter?

04:30 PM 04:45 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Kyle Lee, MD, CCFP, MSc; Erzebet Kiss*, MD, CCFP; Matthew Orava, MD, CCFP, MHSc; Anwar Parbtani, MD, CCFP, FCFP, PhD

Learning objectives:
1.Assess physician-patient communication for three distinct types of clinical encounters in primary care practice
2.Assess what information is retained by patients immediately after clinical encounters in primary care practice
3.Assess concordance versus discordance between patients and physicians regarding the information relayed/understood at clinical encounters

Context:
Effective communication is central to fostering shared decision making and empowering patient participation in their care plans. Numerous studies have identified gaps in patient-physician communication, but most are limited to single types of encounters or relate to specialty practices other than family medicine. Primary care physicians interact with patients for diverse conditions in a single day, hence assessing physician-patient communication for different types of clinical encounters is more relevant. Objective: To assess patient-physician communication in primary care practices for three different kinds of clinical encounters. To assess concordance versus discordance between physicians and patients for the information relayed and retained. Design and setting: A cross-sectional survey of patient-physician communication in eight primary care practices, for three types of clinical encounters; cholesterolemia, colon cancer screening, and smoking cessation. Intervention: Survey forms with five to seven identical questions for patients and physicians but on separate sheets, coded to allow comparisons, were employed. Each sheet had a standard overall question: for the physician, “Did you feel your patient understood the information discussed today?” and for the patient, “Did you understand the information discussed today?” Result: Fifty-eight completed surveys were obtained: 24 for cholesterolemia, 20 for colon cancer screening, and 14 for smoking cessation. The overall question about whether the information discussed was understood had 81 per cent concordance and 7 per cent discordance; 12 per cent were incomplete. Concordance for specific, encounter-related answers was high (85 per cent to 100 per cent), except for the importance of medications for cholesterolemia (54 per cent concordance) and referral for smoking cessation (66 per cent concordance); P < 0.05 for both, z statistics. Conclusions: This is a unique study assessing patient-physician communication in primary care settings for three distinct types of clinical encounters. The immediate post-encounter recall of communication between physicians and patients showed high concordance for the overall information, but there were gaps for details such as discussion of management/therapeutic approaches.
Research | Recherche

W801: What Is the Link Between eConsult and CPD Programming?

04:30 PM 05:00 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Erin Keely, MD; Clare Liddy, MD, CCFP, FCFP; Douglas Green, MD; Julia Stratton, MD; Christine Prudhoe; Douglas Archibald*, PhD

Learning objectives:
1.Identify learning opportunities that arise from eConsults
2.Compare clinical questions asked by primary care providers through eConsult to continuing professional development offerings

Objective:
The objective of this study is to assess whether local annual refresher session offerings for primary care providers match their needs by coding and comparing session syllabi to clinical questions collected electronically through the Champlain Building Access to Specialists through eConsultation (BASE) service. Design: Retrospective review of eConsult clinical questions and continuing professional development (CPD) course offerings. Participants: Clinical questions posed by primary care providers through eConsult from July 2011 to January 2015. Intervention: Syllabi from 521 refresher CPD sessions offered to primary care providers in the eastern region of Ontario, Canada, over a three-year period (2012 to 2014). CPD session descriptions were coded using hybrid taxonomies derived from the International Classification of Primary Care Second edition (ICPC-2), Journal of the American Medical Association specialty classifications, and our eConsult specialty services experts. Of the 22,670 total CME minutes, 12,215 corresponded to the content offered through 12 eConsult specialty services. Main outcome measure: Percentage differences between CPD content and clinical questions posed through eConsult. Results: Congruence and dissonance between CPD content and clinical questions posed through eConsult varied significantly across the 12 specialty services. Within each specialty some topics were well covered while others were not. For example, psychiatry content such as depressive mood disorders, neurodevelopmental disorders, and substance-related and addictive disorders showed per cent differences ranging from 11.5 per cent to 26.3 per cent. Personality disorders, somatic system disorders, and trauma-related disorders showed strong congruence (1.5 per cent to 2.4 per cent difference). Conclusion: Differences between questions asked by primary care providers at the point of care through eConsults and the content of contemporaneous CPD refresher courses can be analyzed to identify gaps in offerings. This knowledge, if shared with CPD program offices and providers, could be used to develop CPD curricula and highlight areas of need for inclusion in primary care update activities.
Research | Recherche

W550: Recruitment and Retention in Rural Practice in the Context of Generational Change

04:45 PM 05:00 PM Room | Salle : 516A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

David Snadden, MBChB, MClSc, MD, CCFP; Mark Kunzli, RPh, MBA

Learning objective:
1. Explore the impact on rural practice recruitment and retention of the aspirations of a younger generation of physicians

Objective: To examine the implications for rural practice of the changing aspirations of young practitioners. Design: Qualitative in-depth interviews and thematic interpretive analysis. Setting: Rural northwestern Canada. Participants: A purposefully diverse sample of 46 practitioners, mostly family physicians, but including some other specialists and nurses. The sample included early-, mid-, and late-career physicians. Intervention: The adaptation of practices to changing generational aspirations. Methods: A mixture of small group and one-on-one interviews. Data were analyzed thematically by both researchers independently and then a common coding framework and interpretation was developed. Initial findings were returned to respondents for validation. Findings: There were three main themes: scope of practice and generalism; the importance of connectivity and relationships; and sensitivity to generational change. These interact together to influence the ecosystem of practices and have major implications for the future recruitment and retention of young physicians in rural areas. Enablers are local mentorship and community support, supportive specialist networks, connectivity, flexibility of contract arrangements, the ability of communities to adapt to changing working preferences, teamwork, and collaboration. Conclusions: Those communities that adapt to theaspirations of the next generation of physicians, who work hard but differently, may find it easier to recruit and retain young physicians. There may be potential implications in terms of educating patients and communities for care by teams, and in terms of how our professional associations negotiate on behalf of physicians.


Research | Recherche

W650: “Prisoner of measurement”—Kahlil Gibran

04:45 PM 05:00 PM Room | Salle : 513CD

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Robert Bernstein, PhD, MD CM, CCFP, FCFP

Learning objectives:
1.Understand longitudinality and comorbidity as key issues for family medicine research
2.Understand relevant measurements of quality of care
3.Understand how to use a structured electronic medical record for research

Recent trends in the measurement of quality seem almost irrelevant to the actual provision of care. Initiatives seem to focus on what is easily counted rather than what is important—the measurement of the irrelevant because it is available. Family medicine is the practice of general medicine for all ages in a context of low prevalence of disease, multiple accumulating comorbidities, and an ongoing doctor-patient relationship. The epidemiology of general practice is founded on treating the whole patient: treating all their diseases, providing prevention and screening, seeing patients over time, seeing symptoms evolve (either resolving or mutating into diseases), and managing multiple comorbidities for which evidence is scanty. Electronic medical records (EMRs) afford us the chance to analyze comorbidities and the longitudinal evolution of symptoms. To that end we need accurate, complete, and coded problem lists. We need new EMR recording paradigms to allow the analysis of episodic care. It is clear that the “episode of care” model will never be inculcated in Canadian EMRs and episodic care statistics have been obscured in billing diagnosis databases that suffer from being poorly coded and limited to one condition per visit. We need to teach our teachers and residents how to structure, manage, and use large EMR databases for the productive analysis of our practices. We should recognize comorbidity and longitudinality as urgent areas of research in family medicine. It is this scientific approach that must be used to measure quality. We are not just patient-satisfaction oriented. We practise scientific generalism over time with a known, defined group of patients as a denominator. I will present unexpected comorbidity data from our EMR; for instance, our patients with diabetes are seven times more likely to have chronic back pain and GERD than expected, and our patients with asthma are 3.5 times more likely to be depressed.
Research | Recherche

W784: Reducing Clinically Unnecessary Free Thyroid Indices in a Family Health Team

04:45 PM 05:00 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Ji Hyeon Choi*, MD, MSc; Megan Tan*, MD; Karuna Gupta, MD, CCFP; John Maxted, MD, MBA, CCFP, FCFP; Pamela Tsao, MD, FRCPC; Muhammad Shuvra, MBBS, MPH, MSc (ECD)

Learning objective:
1.Be able to identify inappropriate indications for ordering free thyroid indices

Objective: To reduce clinically unnecessary ordering of free thyroid indices (fT3 and fT4) for patients at a family medicine teaching unit. If there is low suspicion for pituitary disease, fT3/fT4 are not required to investigate thyroid function or to monitor levothyroxine replacement when thyroid-stimulating hormone (TSH) is normal (0.5 to 5.0 mIU/L). Design/setting: This quality improvement project was initiated at the Health for All (HFA) Family Health Team in Markham, Ontario. All fT3s/fT4s, with their associated TSH values, were collected during a one-year period. Participants: From November 23, 2015, to November 23, 2016, 894 fT3/fT4s were ordered for adult patients (> 18 years old) at HFA. Of these, 646 (72.2 per cent) fT3s/fT4s were associated with a normal TSH, representing 487 patients. Ninety-seven charts (20 per cent) were randomly selected for review. Intervention: From the chart review, the most common reasons for ordering fT3s/fT4s despite a normal TSH were: to monitor levothyroxine dose in patients with known primary hypothyroidism (34.6 per cent), to investigate thyroid nodules (8.0 per cent), and to screen for primary hypothyroidism (6.5 per cent). A poster was created to educate providers at HFA not to order fT3s/fT4s for the reasons above. An accompanying survey quantified provider engagement. It was expected that the number of clinically unnecessary free thyroid indices ordered would decrease as the poster raised awareness about the largest contributors to the problem. Main outcome measures: Eighteen out of 34 providers at HFA received the poster. Data analysis one month after distribution revealed a reduced proportion of fT3s/fT4s associated with a normal TSH: 62 per cent (31 out of 50) compared with 72 per cent prior to the poster. Conclusion: By educating providers on the most common reasons for ordering clinically unnecessary fT3s/fT4s, we were able raise awareness and address the largest contributors to this problem. It is expected that continued data analyses will reflect a further reduction in the number of clinically unnecessary fT3s/fT4s ordered.
Research | Recherche

W799: Engaging Patients as Observers in Monitoring Hand Hygiene Compliance in Family Practice

04:45 PM 05:00 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Chaitali Desai, Peng, MScHQ; Jeremy Rezmovitz*, MD, CCFP; Judith Manson, RN, NCMP; Sandra Callery, RN, MHSc, CIC; Mary Vearncombe, MD, FRCPC

Learning objective:
1.Identify a patient engagement strategy to monitor hand hygiene compliance in family practice

Objective:
The objective of this quality improvement (QI) study was to assess the feasibility of engaging patients as observers to investigate hand hygiene compliance rates in our family practice clinic at Sunnybrook Hospital in Toronto, Ontario, and whether all four moments of hand hygiene were being met. Design: This QI study was conducted from 2013 to 2016. Each cycle occurred for a 2.5-week period. A convenience sampling strategy was used to obtain representative data by engaging a sample of participants presenting for scheduled appointments. Setting: The Sunnybrook Academic Family Health Team (SAFHT), which provides primary care services to patients and families. Participants: Participants included patients presenting to the SAFHT clinic. Intervention: Patients presenting to the clinic were asked if they would be willing to participate in observing and recording their health care providers’ hand hygiene compliance. Patients agreeing to participate were given a one-page survey audit tool with instructions on which to record their observations. The surveys were collected from a drop box at the end of the observation period and responses were entered into a spreadsheet for analysis and reporting. Main outcome measures: Hand hygiene compliance rates. Results: This study demonstrated a hand hygiene compliance rate of 94 per cent in 2016 to 97 per cent in 2013, maintaining the target of 95 per cent for the clinic and exceeding the overall hospital target of 87 per cent. Conclusion: This study emphasized the importance of patient communication as a novel way to evaluate programs that have direct patient care implications. The success of this initiative has encouraged its expansion to other ambulatory areas of the hospital. The results must be considered in light of study limitations, such as reliance on volunteer resources and the Hawthorne effect.
Research | Recherche

W800: Family Physicians’ Awareness of Charles Bonnet Syndrome: A Canadian national survey

04:45 PM 05:00 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 0.25

Tina Felfeli*; Keith D Gordon, MSc, PhD

Learning objectives:
1.Distinguish Charles Bonnet syndrome from other causes of visual hallucinations
2.Recognize the challenges patients face with visual hallucinations following vision loss
3.Apply appropriate strategies for the management and referral of this patient population

Objective:
To assess the awareness of Canadian family physicians (FPs) of Charles Bonnet syndrome (CBS). Design: National perception and practices survey. Setting: All provinces and territories across Canada. Participants: A total of 500 English- and French-speaking FPs across Canada were randomly selected. Main outcome measures: 1) The level of awareness of CBS among FPs. 2) The frequency of FPs’ encounters with patients who have visual hallucinations. 3) Management strategies and referral patterns for CBS patients presenting to FPs. Results/findings: A total of 499 respondents answered at least one question on the survey. Approximately 54.7 per cent of FPs indicated they were not at all aware, 19.7 per cent were only slightly aware, and 25.6 per cent were well aware of CBS. Among the respondents who were slightly or well aware of CBS, the most commonly reported sources of information included medical training (27.5 per cent), colleague(s) (18.4 per cent), conference(s) or continuing medical education (16 per cent), and patient(s) (14.3 per cent). With respect to the frequency of patient encounters with visual hallucinations, 5.3 per cent of physicians reported having encountered patients once a month, 18.9 per cent every six months, 13.4 per cent once a year, and 37 per cent less than once a year, while 25.4 per cent reported no encounters in their practice. The number of patients presenting to practice with visual hallucinations significantly predicted awareness of FPs about CBS (β = 0.501, t(371) = 5.59, P < 0.001). Of FPs who had previously encountered patients with visual hallucinations, 21.3 per cent reported having supported patients through pharmacological interventions and 31.6 per cent through non-pharmacological interventions, while 29.3 per cent FPs completed both and 17.8 per cent did neither. When speaking with patients who have visual hallucinations, 84.9 per cent of FPs do not discuss the possibility of developing CBS, while 7.9 per cent and 7.2 per cent discuss it always or sometimes, respectively. Conclusion: There is a lack of knowledge about CBS among FPs. Increased awareness of CBS is critical for the appropriate diagnosis, assessment, and management of biological and psychosocial manifestations of this condition. 
Emergency Medicine | Médecine d’urgence
Respiratory Medicine | Médecine respiratoire

W101: Airway Intervention and Management in Emergencies (AIME)

07:30 AM 05:30 PM Room | Salle : 516b

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 18

Learning Objectives:

1. be more confident and comfortable in making acute care airway management decisions
2. acquire a practical, staged approach to airway management
3. be able to choose the most appropriate method of airway management based on a variety of patient presentations

Description: The Airway Intervention and Management in Emergencies (AIME) course has been providing valued and practical hands-on airway management learning experiences for clinicians around the world for more than 15 years. AIME educators are experienced (and entertaining) clinical instructors who understand the varied work environments of practising clinicians. Whether you work in a large, high-volume centre or a small, remote setting, AIME will provide a practical approach for airway management in emergencies. AIME program highlights include: case-based clinical decision making; new practical algorithms; when, why, and how to perform awake or rapid sequence intubation; a new textbook/manual based on the AIME program; unique, customized clinical videos; limited registration to ensure a clinician-to-instructor ratio of 5:1 or 6:1; clinician-to-simulator ratios of 2:1; reinforcement of core skills; an introduction to newer alternative devices (e.g., optical stylets, video laryngoscopes); and exposure to rescue devices (e.g., King laryngeal tubes, LMA Supreme).

Speakers

Palliative Care | Soins palliatifs
Pharmacology | Pharmacologie

W94: Management of Chronic Non-Cancer Pain: Assessment, treatment, and responsible prescribing

08:00 AM 05:00 PM Room | Salle : 511a

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 12  

Learning Objectives:
1. perform a complete assessment of a patient with chronic pain
2. assess patient with chronic pain for addition risk
3. prescribe appropriate therapy for a patient with chronic pain

Description: Chronic pain affects 20 per cent of Canadians. The assessment and the management of chronic pain is now taught well in medical school. As well, there are ongoing controversies regarding chronic pain management, especially with opioids. This workshop will empower participants with the knowledge needed to assess patients with chronic pain, address risks for addiction, and manage chronic pain patients safely. Topics will include pain assessment, review of addiction risks, non-pharmacological management of pain, and pharmacological management of pain. This session will include both didactic and interactive components. Care is taken to engage the audience in a lively discussion regarding the management of this often challenging patient population.

Speakers

Dermatology | Dermatologie
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées

W34: Office Dermatology Surgery Procedures for the Family Physician

10:00 AM 02:30 PM Room | Salle : 511d

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 9  

Learning Objectives:
1. perform punch and shave excisions
2. learn how to close a wound with deep and superficial sutures
3. learn how to excise a lesion using proper techniques

Description:
Hands-on demonstration of office-based surgical techniques. Family physician and dermatologist presentation followed by a physician-supervised hands-on simulated practical experience.

Speakers

Women's Health | Santé des femmes

W98: IUD Update, Insertion, Troubleshooting, and Endometrial Biopsies

10:00 AM 12:15 PM Room | Salle : 511b

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe=  

Learning Objectives:
1. help patients choose from the 13 IUDs available
2. perform IUD insertion and troubleshoot difficult IUD insertion
3. perform endometrial biopsies

Description:
Now that copper and levonorgestrel IUDs are recommended for a much wider variety of women and conditions—such as for teens, for emergency contraception, and for treating dysfunctional uterine bleeding in peri-menopause—we can expect more challenges in inserting IUDs, particularly into tight cervices or into patients with uterine fibroids. There are 13 IUDs on the Canadian market today with which you will become familiar. This hands-on workshop will take advantage of plastic models, slides, and discussion and is suitable for clinicians with all ranges of experience with inserting IUDs. Participants are encouraged to bring up clinical scenarios they have found challenging. The facilitators are family doctors who run IUD clinics and insert thousands of IUDs per year. They will share their experiences with a range of clinical equipment and techniques, such as cervical anesthesia, to simplify challenging IUD insertions. All 13 IUDs currently available in Canada will be at the workshop. Any doctor who can insert an IUD can also do an endometrial biopsy. This will allow you to investigate your patients with suspicious peri-menopausal or post-menopausal bleeding and quickly rule out endometrial cancer.

Speakers

Infectious Disease | Maladies infectieuses

W253: PAACT Anti-infective: 2017 update

01:30 PM 05:15 PM Room | Salle : 511c

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 9  

Learning Objectives:
1. review the principles of antibiotic resistance as well as what’s new and how this affects antibiotic prescribing
2. feel more comfortable investigating and managing common infectious diseases, including upper and lower respiratory tract infections and urinary tract infections
3. acquire patient tools to help implement antibiotic stewardship in your practice

Description:
This is an independent educational program developed by family physicians based on the latest edition of the Anti-infective Guidelines for Community-acquired Infections. Cases are designed to highlight common infectious diseases, including upper and lower respiratory tract infections, skin infections, and urinary tract infections (including in long-term care). Materials: The 2017 Anti-infective Guidelines for Community-acquired Infections, participant manual, and viral prescription pads. Teaching method: Interactive, case-based, small group.

Speakers

Palliative Care | Soins palliatifs
Compassionate Care | Soins prodigués avec compassion

W97: Providing Medical Assistance in Dying (MAiD)

01:30 PM 05:15 PM Room | Salle : 511b

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 6  

Learning Objectives:
1. assess patients for eligibility for MAID
2. prescribe and administer MAID drugs

Description: The presenters are family physicians who have been providing medical assistance in dying (MAID) since Canadian law changed in 2016 and are members of the Canadian Association of MAID Assessors and Providers. The purpose of this session is to give clinicians the tools to be both assessors and providers of MAID. It will be suitable for clinicians who have already provided MAID as well as ones who are considering becoming assessors or assessors/providers in the future. We will spend about half of the time reviewing best practices in performing robust assessments for MAID, including interpreting the medical parameters of Bill C-14, and will use case discussion to explore the more challenging assessments of patients who have dementia or mental illness or are non-verbal. We will describe best practices in the provision of both IV and oral medications. We will discuss how to mitigate the risks and stress on ourselves and to do good self-care. Each province and institution has its own guidelines and we will ensure that each participant has access to the local rules as well as an understanding of the federal law and best practices in providing MAID. There will be a pre-test and post-test as well as a reflection exercise and possible mentorship for new providers.

Speakers

Registration open / Ouverture des inscriptions

06:30 AM 05:30 PM

Breakfast and Networking Breakfasts / Petit-déjeuner et petits-déjeuners de réseautage

07:00 AM 08:00 AM

Exhibit Hall open / Ouverture du Hall d’exposition

07:00 AM 05:00 PM

Family Medicine Plenary / Plénière en médecine familiale

08:00 AM 09:30 AM Room | Salle : Palais des congrès de Montréal - 710ab

Quality: Our fifth pillar

Learning Objectives
1. Have a shared definition of ‘quality'
2. Understand the overall approach to Quality Improvement and Improvement Science
3. Think about system and practice level strategies to create a culture of 'quality first’ and quality improvement

La qualité : notre cinquième pilier

Objectifs d’apprentissage
1. Obtenir une définition commune du concept de « qualité »
2. Comprendre l’approche globale à l’amélioration de la qualité et des principes qui s’y rattachent
3. Faire un retour sur des stratégies au niveau du système et de la pratique pour développer une culture qui accorde la priorité à la qualité et qui favorise son amélioration

Speakers

Break and Poster Viewing / Pause et visite d’affiches

09:30 AM 10:00 AM

Sessions / Séances

10:00 AM 12:15 PM

Lunch

12:15 PM 01:30 PM

CFPC Annual Meeting of Members / Assemblée annuelle des membres du CMFC

12:15 PM 01:30 PM Palais des congrès de Montréal - 710b

Hear from your Board of Directors and Executive Director/CEO.

Ask questions and provide feedback.

Meet your newly elected 2017-18 Board.

Écoutez les propos du Conseil d’administration et de la directrice générale et chef de la direction.

Posez des questions et présentez vos commentaires.

Rencontrez les nouveaux membres du CA pour 2017-18.

Sessions / Séances

01:30 PM 02:30 PM

Break and Poster Viewing / Pause et visite d’affiches

02:30 PM 03:00 PM

Sessions / Séances

03:00 PM 05:15 PM

CQMF Cocktail-Réseautage / QCFP Networking Cocktail

05:00 PM 07:00 PM Le Westin Montréal, Bar Reporter (3rd Floor)

Le président du Collège québécois des médecins de famille (CQMF), le Dr Frédéric Turgeon, profite du passage du FMF à Montréal pour inviter les membres du Québec et d’ailleurs à venir échanger avec lui dans une ambiance décontractée lors d’un cocktail-réseautage, compliments du CQMF. Amenez-vous seul(e) ou entre amis(ies) et profitez de cette occasion pour faire une courte pause entre pairs, et ce, sans en ajouter aux engagements que vous procure le FMF.

The President of the Quebec College of Family Physicians (QCFP), Dr. Frédéric Turgeon, would like to take advantage of the FMF in Montréal to invite members from Quebec and elsewhere to come chat with him in a very laid-back ambiance during a networking cocktail, courtesy of the QCFP. Come alone or with your friends and enjoy some well-deserved down time with your peers that will not infringe on your FMF commitments.

FMF Welcome Reception / Réception d’accueil au FMF

05:30 PM 06:30 PM Palais des congrès de Montréal - 517a

All delegates are invited to attend the annual FMF Welcome Reception.

Meet with friends and colleagues and make new acquaintances while enjoying beverages and appetizers.

Tous les délégués sont invités à la Réception d’accueil annuelle du FMF.

Rencontrez vos amis et vos collègues, et faites de nouvelles connaissances. Boissons et hors-d’œuvre servis.

Section of Teachers Dinner / Souper de la Section des enseignants

06:00 PM 10:00 PM Le Westin Montreal | Le Westin Montréal

Location | Endroit : Le Westin Montréal, Montreal Ballroom | Le Westin Montréal — Salle de bal Montréal
Reception | Réception : 18:30 | 18 h 30
Dinner | Souper : 18:45 | 18 h 45
Ticket price | Prix du billet : $125 | 125 $

Join your teaching colleagues for the annual Section of Teachers Dinner. Your registration for this event includes a welcome reception, dinner, wine, and non-alcoholic beverages.

Presentations will include the Ian McWhinney Family Medicine Education Award, the Murray Stalker Award, Medical Student Leadership Awards, and Resident Leadership Awards.

Joignez-vous à vos collègues enseignants au souper annuel de la Section des enseignants. Votre billet comprend la réception d’accueil, le repas, le vin et les boissons non alcoolisées.

Durant la soirée, nous remettrons le Prix Ian McWhinney pour l’éducation en médecine familiale, le Prix Murray Stalker et les Prix de leadership pour les résidents en médecine familiale et les étudiants en médecine.

Ancillary Session - T887: At the Heart of It: A new look at Clinical Cardiovascular Disease (CVD) in diabetes

06:45 AM 07:45 AM Room | Salle : 710A


Learning Objectives:
1. review and interpret the CDA recommendations, including the November 20L6 updates, for vascular protection and diabetes management in patients with type 2 diabetes, with and without cardiovascular disease
2. summarize available cardiovascular outcome data and discuss their relevance in the primary care setting
3. Compare and contrast among individual agents within the DPP-4 inhibitor, GLP-L receptor agonist, and SGLT2 inhibitor classes

Description:
Since 20L3, the CDA has recommended that healthcare providers individualize the choice of pharmacologic treatments according to patient and agent characteristics. In light of the availability of new cardiovascular outcome trial data, and their corresponding inclusion into the two 20L6 CDA Guidelines Interim Updates (March and November), this program aims to help healthcare providers navigate the wealth of treatment choices available to manage type 2 diabetes. Through case-directed learning, participants will address multiple considerations-in particular cardiovascular disease-associated with treating patients with diabetes today.

Networking Breakfast

T884: OCFP Networking Breakfast

07:00 AM 08:00 AM Room | Salle : 510D


Networking Breakfast

T530: Researchers in Education Networking Breakfast

07:00 AM 08:00 AM Room | Salle : 510B


Learning Objectives:
1. learn about research being undertaken by colleagues
2. generate opportunities for collaborations
3. discuss ideas for future research in education

Description: This event is an informal networking opportunity to connect colleagues considering or conducting like-minded research and to provide a forum to discuss and share current and prospective research ideas.

Speakers

Networking Breakfast

T382: International Collaboration Promoting Scholarly Activity Among Family Physicians Working in Latin American Networking Breakfast

07:00 AM 08:00 AM Room | Salle : 510A


Learning Objectives:
1. strategize to encourage international collaboration on scholarly activities that overcome geographical barriers
2. demonstrate the importance of international partnerships to advancing family medicine as a specialty worldwide
3. strengthen leadership among family physicians and continuous medical education

Description:
Scholarly activity, a residency requirement for most family medicine residents worldwide, encourages the acquisition of new knowledge within our field. One of the most exciting ways to enrich research in primary care is through collaborations with international colleagues. This interaction and teamwork empowers physicians from regions of the world in which research is limited or even nonexistent. These partnerships allow physicians from other regions to learn effective research methodology that facilitates dissemination and publication of their work in peer-reviewed medical journals. Several family medicine organizations such as WONCA, the American Academy of Family Physicians Center for Global Health Initiatives, the Society of Teachers of Family Medicine, and the Besrour Centre—among various other entities—exist to facilitate research and collaboration. Also, research highlights the role of the family physician in academic medicine within their region as well as the leadership skills needed to develop and consolidate projects in primary care that benefit the community and the individuals they serve. This round table discussion with colleagues from several Latin American countries will elucidate ideas for and methods of improving collaborations between these regions and Canada.

Speakers

Networking Breakfast

T880: Residency PBSG Networking Breakfast

07:00 AM 08:00 AM Room | Salle : 510C


Description:
Looking for tips for running PBSG sessions in your residency program? Are you a resident or student interested in learning or enhancing your small group learning? Interested in how PBSG can be used to help residents with transition to practice? Learn from others who are using residency PBSG across the country. Come meet Dr. Risa Bordman, Residency Director for the Foundation for Medical Practice Education and other program staff. Please join us for an open discussion about using PBSG in residency programs and a chance to interact with other program participants from across the country.

T200: Quality: Our Fifth Pillar / La qualité : notre cinquième pilier

08:00 AM 09:30 AM Room | Salle : 517

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. have a shared definition of ‘quality'
2. understand the overall approach to Quality Improvement and Improvement Science
3. think about system and practice level strategies to create a culture of 'quality first’ and quality improvement

Objectifs d’apprentissage :
1. obtenir une définition commune du concept de « qualité »
2. Comprendre l’approche globale à l’amélioration de la qualité et des principes qui s’y rattachent
3. Faire un retour sur des stratégies au niveau du système et de la pratique pour développer une culture qui accorde la priorité à la qualité et qui favorise son amélioration

Speakers

Teaching | Precepting | Enseignement | Supervision

T419: Mapping the Triple C Curriculum: Capacity building for educational leaders

10:00 AM 12:15 PM Room | Salle : 510C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe the key considerations and best practices for mapping the Triple C curriculum
2. discuss the benefits of curriculum mapping, challenges to implementation, and possible strategies to help overcome these challenges
3. describe effective capacity-building strategies to engage faculty in the continuous quality improvement of mapping the Triple C curriculum

Description:
Curriculum mapping can facilitate the alignment of what is taught, how it is taught, when it is taught, and the assessment methods used to determine whether a resident has achieved the expected learning outcomes. Specifically, curriculum mapping as a process can assist with providing a longitudinal examination of the topics currently being taught, the learning outcomes and objectives being achieved by residents, and whether the curriculum is aligned to meet its intended purpose. The evidence shows that curriculum mapping can lead to: creating a roadmap for residents and faculty regarding the learning outcomes and the pathways toward achieving them; establishing important patterns and relationships for the purposes of curriculum management, analysis, and reporting ; and developing individualized learning/remediation plans. This workshop will define and describe curriculum mapping and provide a framework for undertaking this important work. There will be a review of the benefits and challenges in the process of curriculum mapping, including some possible solutions in building capacity among educational leaders within a distributed family medicine residency training program. Participants are encouraged to bring questions about and experiences with curriculum mapping. Organization and method of presentation: Introduction (15 minutes); interactive practical application (75 minutes); and large group discussion and wrap-up (30 minutes). Target audience: Beginner and intermediate clinical teachers, program directors, residents, and medical educators who are planning to develop, or are implementing, a curriculum to support family medicine residents.

Speakers

Clinical
Health Care of the Elderly | Soins aux personnes âgées

T71: Approach to Preventive Care in the Elderly

10:00 AM 11:00 AM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe three helpful areas when considering a preventive health intervention
2. have an approach for estimating remaining years of life in frail elderly patients
3. list key primary care preventive areas with a mnemonic, CCFP, short for cancer, cardiovascular disease, falls/osteoporosis, and preventive immunizations

Description:
Objective: To guide family physicians in creating preventive screening and treatment plans for their elderly patients. Sources of information: The MEDLINE database was searched for Canadian guidelines on primary health care and the elderly; guidelines, meta-analyses, practice guidelines, or systematic reviews related to mass screening in those age 80 and older and the frail elderly, limited to between 2006 and July 2016; and articles on preventive health services for the elderly related to family practice or family physicians, limited to English-language publications between 2012 and July 2016. Main message: Estimating life expectancy is not an easy or precise science, but frailty is an emerging concept that can help with this. The Canadian Task Force on Preventive Health Care offers cancer screening guidelines, but they are less clear for patients older than 74 years and management plans need to be individualized. Estimating remaining years of life helps guide your recommendations for preventive screening and treatment plans. Risks often increase with an increase in frailty and comorbidity. Conversely, treatment benefits often diminish as life expectancy decreases. Preventive management plans should take into account the patient’s perspective and be mutually agreed upon. A mnemonic device for key primary care preventive areas—CCFP, short for cancer, cardiovascular disease, falls and osteoporosis, and preventive immunizations—might be useful. Conclusion: Family physicians might find addressing the following areas helpful when considering a preventive health intervention: age, life expectancy (including the concept of frailty), comorbidities and functional status, risks and benefits of screening or treatment, and values and preferences of the patient.

Speakers

Clinical
Mental Health | Santé mentale

T284: Couples in Distress: How family physicians can help

10:00 AM 11:00 AM Room | Salle : 521ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. recognize the causes of distress and contraindications to couple therapy
2. apply evidence-based approaches and helpful strategies to working with couples in distress
3. access and implement resources such as effective attachment-based couple relationship education programs in your practice

Description:
Marital and couple distress can cause considerable stress for our patients and their families and have a considerable impact on their health, both physical and psychological. These effects can cause chronic stress and medical problems, including physical symptoms, psychological concerns, sexual issues, addiction, parenting issues, and domestic violence, to name a few. Because these patients usually seek medical assistance, it is advantageous for family physicians to have basic knowledge and skills for dealing with couple relationship issues. Being able to work effectively with a couple is a critical skill for the family-oriented clinician. Individuals in a positive relationship tend to lead healthier lifestyles with more exercise, less smoking and alcohol use, and reduced stress. Children raised in well-adjusted and supportive families have better outcomes. Because of a lack of training in this area, most family physicians feel ill-equipped to deal with relationship stress in the context of an office visit, creating barriers to further counselling and care. Simple strategies such as active listening, intentional dialogue, psychoeducation, and facilitation of collaborative problem solving can easily be achieved by most physicians in the context of an office practice. Evidence-based approaches such as emotionally focused therapy and formal marital therapy provide more in-depth counselling. Using case-based scenarios and interactive audience participation, this presentation will focus on practical approaches, counselling strategies, and resources that will help family physicians support their patients who are experiencing marital or couple distress.

Speakers

Clinical

T294: Mainpro+ Credit Reporting: A practical demonstration

10:00 AM 11:00 AM Room | Salle : 522ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. navigate the Mainpro+ dashboard effectively to assist in planning your continuing professional development learning goals
2. define Mainpro+ credit categories and how they relate to continuing professional development activities
3. track continuing professional development activities in your Mainpro+ dashboard with confidence

Description:
Join us for an informative and interactive session on Mainpro+. This session will cover changes to the Mainpro+ credit and activity categories. Participants can engage in a live demonstration on how to report various types of learning activities on the member dashboard. You will learn how to earn and report credits for practice activities you do on a daily basis. The CFPC is committed to providing high-quality continuing professional development to meet your evolving interests and learning needs.

Speakers

Emergency Medicine | Médecine d’urgence
Child and Adolescent Health | Santé de l’enfant et de l’adolescent

T399: Pediatric Emergency Medicine Update for the Family Doctor / Nouveautés en médecine d’urgence pédiatrique pour les médecins de famille

10:00 AM 11:00 AM Room | Salle : 710B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. learn the latest evidence for return to play following a concussion
2. find out what is the latest in bronchiolitis management
3. apply the take-home messages from the top articles in the field of pediatrics to your practice

Objectifs d’apprentissage :
1. s’informer des toutes dernières données probantes concernant le retour au jeu après une commotion cérébrale
2. découvrir ce qu’il y a de nouveau dans la prise en charge de la bronchiolite
3. appliquer dans votre pratique les points essentiels des meilleurs articles du domaine de la pédiatrie

Description: Top practice-changing articles will be discussed from the field of pediatric emergency medicine. The latest updates about return to play in pediatric concussion will be interpreted. A quick overview of recent evidence behind the management of bronchiolitis and other common pediatric infections will be reviewed.

Description :
La discussion portera sur des articles susceptibles de changer la pratique, qui comptent parmi les meilleurs écrits dans le domaine de la médecine d’urgence pédiatrique. Ce sera aussi l’occasion d’interpréter les dernières nouvelles sur le retour au jeu après une commotion cérébrale pédiatrique. De plus, il y aura un aperçu des données récentes sur la prise en charge de la bronchiolite et d’autres infections courantes chez les enfants.

Speakers

Global Health | Santé mondiale

T267: From the Arrival Gate Onward: Key issues in refugee health primary care

10:00 AM 11:00 AM Room | Salle : 524C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. identify key primary care priorities in refugee health including immunizations, infectious diseases, and chronic disease assessment/management
2. list early screening approaches and their relevance to the refugee population
3. describe patient-centred approaches to care used at the Crossroads Clinic in Toronto, Ontario, that facilitate delivery of service

Description:
The world is experiencing an unprecedented refugee crisis. The UNHCR, the United Nations Refugee Agency, estimates there are 65 million people displaced worldwide. As refugees arrive in Canada, primary care providers are uniquely positioned to offer comprehensive, continuous care to support their migration process. Using evidence-based practices grounded in the Canadian Collaboration for Immigrant and Refugee Health guidelines, the Crossroads Clinic at Women’s College Hospital in Toronto, Ontario, serves new refugees. This session will provide an overview of key primary care screening opportunities, immunization recommendations, tuberculosis screening, and prioritized infectious disease and chronic disease interventions. The session will actively engage participants in sharing their experiences regarding approaches to health care delivery and ways to overcome barriers to health care delivery in their settings.

Speakers

Research | Recherche

T491: MedEd Research 101: An introduction to the basics of conducting medical education scholarship

10:00 AM 11:00 AM Room | Salle : 510D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe medical education scholarship
2. identify the factors that need to be considered when setting up a medical education scholarship project
3. plan for a medical education scholarship project in your home program or clinic

Description:
Have you ever thought about conducting a medical education research project? Are you not sure how to start? This workshop is for you! Many clinical educators who teach students and residents, or who are involved in continuing professional development, develop a curiosity about some aspect of learning or assessment. It may be about the best way to deliver material, or whether their learners have really mastered the material, or perhaps whether a change in the way they teach has resulted in improved learning. Whatever makes a clinical educator start thinking about how to develop or evaluate an aspect of their clinical teaching, classroom teaching, or faculty development, there are common elements to consider and address when carrying out a research or scholarship project. Some of these elements—like developing a research question, choosing a research design and method, and looking at the need for ethics approval—are common to most projects. While they may seem intimidating if you are new to medical education research and scholarship, there are some tips and tricks to get you on your way. Through case examples and a review of resources, the presenters will walk participants through things to consider for medical education scholarship projects. In response to feedback from last year, this workshop will be more interactive, with didactics reduced and more resources provided for participants to look at in detail later. Working in small groups with shared interests, participants will work with the presenters as discussion facilitators. Participants will leave the workshop with a clear research question to begin planning a medical education scholarly project. This workshop is intended for those who are just beginning their journey in medical education scholarship.

Speakers

Pharmacology | Pharmacologie
Addiction Medicine | Médecine des toxicomanies

T361: Medication-Assisted Treatment for Alcohol and Opioid Use Disorders: Lessons from META:PHI

10:00 AM 11:00 AM Room | Salle : 710A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. recognize the indications for anti-craving medications (naltrexone, acamprosate, gabapentin, and disulfiram) and apply prescribing protocols
2. explain and apply protocols for managing opioid use disorder in primary care: opioid tapering, buprenorphine prescribing, and take-home naloxone
3. participate in ongoing education via materials developed by METAPHI, including a handbook, a pocket card, and online training modules

Description:
Medication-assisted management of alcohol and opioid use disorders has been shown to be safe and effective when used by family physicians in primary care settings, including anti-craving medications for alcohol use disorders (e.g., naltrexone, acamprosate) and buprenorphine for opioid use disorders. These Interventions provide better long-term care than current treatment modalities, i.e., stand-alone psychosocial programs and methadone clinics. The family medicine setting offers several advantages over current treatments: It combines medication-assisted treatment with counselling; integrates addiction treatment with management of comorbid psychiatric and medical conditions; and offers flexible, easily accessible, and non-stigmatizing long-term care. Despite this, family doctors have traditionally been left out of the addiction care pathway. This creates an addiction treatment system that is overburdened, unsustainable, and ineffective. This session is intended to introduce family physicians to medication-assisted treatment. The session will consist of a didactic presentation and two short videos of office encounters with addicted patients. Increasing patient access to medication-assisted treatments was a primary objective of Project META:PHI (Mentoring, Education, and Clinical Tools for Addiction: Primary Care–Hospital Integration), a two-year program designed to create an integrated care pathway between the emergency department, hospital, community agencies, and primary care. META:PHI established rapid-access addiction medicine (RAAM) clinics in or near seven hospitals across Ontario, Canada. RAAM clinics provide immediate treatment access for patients in primary care and acute care settings, shared care with family physicians, and mentorship and training to health care providers. To date, 186 primary care physicians have participated in the care pathway across seven regions. The first 152 patients who attended the RAAM clinics experienced marked reductions in emergency department visits and hospitalizations.

Speakers

Clinical
Palliative Care | Soins palliatifs
Compassionate Care | Soins prodigués avec compassion

T469: Artificial Nutrition and Hydration: Exploring requests for initiating, continuing, or withdrawing treatment

10:00 AM 11:00 AM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe indications for artificial nutrition and hydration
2. identify when discussions about continuation or discontinuation of therapy may be appropriate
3. apply the legal principles of withholding and withdrawal of potentially life-saving treatment to this intervention

Description:
This presentation will use case studies to illustrate issues that family physicians, residents, and students engaged in delivering palliative care may encounter around requests for artificial nutrition and hydration. The rationale for and against initiating these interventions, the importance of re-assessing the goals of continued interventions over time with patients and their families, and understanding the legalities of withholding or withdrawing from this treatment will be highlighted. At the conclusion of the presentation participants will be able to apply factual information, and develop trigger points and strategies to guide decision making and conversations with patients and their families when oral intake and functional status declines.

Speakers

Teaching | Precepting | Enseignement | Supervision

T454: What Residents Want: The periodic review of progress

10:00 AM 12:15 PM Room | Salle : 511C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe the essential steps of a periodic review
2. discuss key points that residents find support or detract from a periodic review
3. integrate these key points to take back to their home programs to facilitate appropriate change and reinforce best practices

Description:
The periodic review of progress is a key element in family medicine residency training for effective resident continuity of development and assessment. When reviews are done well, residents are engaged, motivated, and reflective adult learners who are guided to develop and accomplish their learning plans over the length of their programs. Setting the stage and grasping a deeper understanding of what facilitates and what inhibits this critical process is vital to fostering excellence in this aspect of resident education. This workshop brings together foundational information and evidence about the periodic review along with the resident point of view—from both the Section of Residents 2017 GIFT document and a diverse and articulate panel of residents from across Canada. Participants will engage in a facilitated discussion and small group work to integrate this information as part of advocacy to improve periodic reviews at their residency programs.

Speakers

Teaching | Precepting | Enseignement | Supervision

T368: Teaching Through a Generalist Lens

10:00 AM 12:15 PM Room | Salle : 510B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe the key elements of generalism
2. apply an evidence-informed generalism tool to teaching scenarios in curriculum development to assess them for evidence of generalist principles
3. identify opportunities to teach generalism principles in daily practice

Description:
Generalism is believed to be a widely held fundamental value in medical education. The Faculty of Medicine at the University of Toronto is currently engaged in preclerkship curriculum renewal. The new curriculum is purported to be based on “generalist” principles. However, in the course of the curriculum review it became apparent that perspectives on generalism held by faculty and other stakeholders were varied and unclear. In response to this an environmental scan and literature review related to generalism were undertaken. From this, Department of Family and Community Medicine faculty developed an evidence-informed tool incorporating the key elements of generalism. This workshop will explore definitions and key elements of generalism in medicine and reflect on its position within both the formal and the hidden curriculum. The evidence-informed Generalism Tool will be introduced and participants will have opportunities in small groups to apply the tool to curriculum scenarios to assess them for evidence of generalist principles and consider where this could be enhanced. This interactive workshop will include a discussion about opportunities to teach generalism principles in daily practice at both the undergraduate and postgraduate levels. This workshop will be of interest to clinical preceptors, teachers outside the clinic setting, and educational leaders wishing to reflect on their teaching and curricula through a generalist lens.

Speakers

Clinical
Choosing Wisely | Screening | Preventative Medicine | Choisir avec soins | Dépistage | Prévention
Cancer Care | Soins aux patients atteints du cancer

T328: Should I Perform a Digital Rectal Exam for Prostate Cancer Screening?

10:00 AM 11:00 AM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. appreciate the quality of evidence (or lack thereof) behind the use of the digital rectal exam in screening for prostate cancer
2. understand the lack of inter-rater reliability in the accuracy of the digital rectal exam in diagnosing prostate cancer
3. appreciate the challenges of screening for prostate cancer with the combination of prostate-specific antigen testing and digital rectal exam

Description:
Should we be performing the digital rectal exam (DRE) in primary care for the screening of prostate cancer? Traditionally, the DRE is commonly used as a clinical skill to screen for prostate cancer in primary care and other specialty (primarily urology) settings. Although the DRE is recommended as a screening tool in numerous guidelines for prostate cancer screening, it is neither a specific nor sensitive exam, with limited data to support its routine use in primary care. Our team performed a review to evaluate the effectiveness of the DRE in screening for prostate cancer, specifically in primary care. Pooled data on the accuracy of the DRE in primary care settings were analyzed using meta-analysis techniques. Pooled sensitivity of the DRE among primary care physicians was 0.51 (95%CI 0.36 to 0.67), with a large heterogeneity (I2 = 98.4%), and pooled specificity was 0.59 (95%CI 0.41 to 0.76; I2 = 99.4%). The pooled positive predictive value was 0.41 (95%CI 0.31 to 0.52; I2 = 97.2%), and the pooled negative predictive value was 0.64 (95%CI 0.58 to 0.70; I2 = 95.0%). This recent analysis supports previous studies that have shown overall low diagnostic accuracy of the DRE and demonstrates that this exam may have limited clinical utility in the primary care setting. The presenter aims to provide an overview of the literature review and meta-analysis while interacting with the participants. Interaction will provide a fruitful discussion and review of different practice patterns, as the use of the DRE in screening for prostate cancer is known to be quite variable across North America. The bulk of this session will focus on practice patterns, the application of evidence-based guidelines, and a further exploration of the psychology behind patient and physician decision making.

Speakers

Clinical
Dermatology | Dermatologie

T265: Acne Therapy Demystified

10:00 AM 11:00 AM Room | Salle : 517D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. determine the optimal evidence-based acne therapy for any given patient based on lesion morphology and patient demographics
2. confidently and safely prescribe a broad spectrum of targeted topical and systemic therapies, being mindful of pertinent risks and benefits
3. distinguish between common acne mimickers

Description:
Acne is firmly within the competencies of the modern family doctor. After all, more than 85 per cent of adolescents will be affected by acne. Its sequelae in the psychosocial realm—by means of body image, social anxiety, and physical scarring—can be lifelong if not treated quickly and competently. Yet the choices among therapeutic modalities are often incredibly puzzling. In this interactive presentation we will provide an evidence-based, simplified, systematic approach to acne therapy. How do I assess a patient with facial erythema, papules, and/or pustules? What are the common mimickers? What basic skin care advice should I recommend to each patient? Which topical, where, how, and when? What is my armament of systemic therapies, and how effective are they? How can I confidently and safely prescribe isotretinoin? When should I refer? And, finally, what is fact and what is fiction in acne and its relation to diet, inflammatory bowel disease, and depression?

Speakers

Clinical
Occupational Medicine | Médecine du travail

T122: Returning Your Patient to Work

10:00 AM 11:00 AM Room | Salle : 516C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. understand the role of the family doctor in return to work
2. identify barriers and solutions to return to work
3. appreciate return to work as a therapeutic modality

Description:
Returning a patient to work can sometimes be a very difficult task for the busy family physician. This presentation reviews the extent and parameters of this issue, then looks at the common medical and non-medical barriers patients might experience in going back to work after a period of illness or injury. Solutions to these common barriers are discussed. The role of the family physician in this process is clarified so that roles and responsibilities are clear for the various stakeholders in this process (e.g., doctor, patient, employer, insurance company, etc.)

Speakers

Women's Health | Santé des femmes
Cardiology | Cardiologie

T488: Women’s Cardiovascular Health: What does a sex-specific cardiovascular risk assessment look like?

10:00 AM 11:00 AM Room | Salle : 524A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. interpret and integrate relevant evidence and clinical guidelines to identify and manage sex-specific cardiovascular disease risk factors
2. devise strategies to identify at-risk women in your practice through electronic medical records or other mechanisms
3. participate in case-based scenarios facilitating implementation of guidelines to practice

Description:
Cardiovascular disease (CVD) is the second-leading cause of death in women and in men in Canada. Despite marked sex-specific differences, many female-specific risk factors commonly go unnoticed, leading to increased female mortality. Women have unique risk factors for heart disease, such as pregnancy and hormone therapy, which need to be considered during primary treatment and management. For example, preliminary results from a patient recall survey conducted at Sunnybrook’s Academic Family Health Team indicated that while two-thirds of the patients with CVD-related pregnancy complications were counselled on their future health risks by their family doctor during post-delivery visits, one-third were not. This represents a missed opportunity for primary CVD prevention. Recently, the Canadian Cardiovascular Society updated their screening criteria for dyslipidemia to include women with a history of hypertensive disorders of pregnancy as one of the at-risk populations for CVD—a positive step to improve current practice. This session will provide family physicians with updated evidence-based proficiencies to manage sex-specific CVD risk factors and deliver individualized care to their patients based on the updated Canadian Cardiovascular Society clinical guidelines. The session will be interactive, using clinical vignettes to address pregnancy-related complications, menopause, prior chest radiation, prior breast cancer (chemotherapy and radiation treatments), migraines (with aura), collagen vascular diseases, and traditional risk factors and CVD management. We will also address barriers to implementing sex-specific cardiovascular risk assessments in practice. All participants will be asked to complete a pre- and post-workshop survey to identify the impact of the workshop to their practice

Speakers

Respiratory Medicine | Médecine respiratoire

T119: Chronic Airway Disease: Management of asthma, COPD, interstitial lung disease, and bronchiectasis in your office

10:00 AM 11:00 AM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. apply current guidelines (CTS and GINA) to the management of asthma in the office setting
2. identify and implement the use of bronchodilators for the COPD patient,including step-up and step-down therapy
3. investigate unexplained dyspnea and organize the management of interstitial lung disease and bronchiectasis in the office

Description:
Many patients present to the office with shortness of breath, often of long duration. In this 60-minute session the learner will be taken through the investigation and management of this population. The talk will be divided into three 20-minute sessions in which the unique aspects of each disease will be explored (session 1: asthma; session2: COPD; and session 3: interstitial lung disease and bronchiectasis). Learn about new testing and medications, including where they fit into what we already do. The patient who does not clearly fit into a category will also be discussed. There will be time to ask questions and discuss management, even cases that have you stumped!

Speakers

Teaching | Precepting | Enseignement | Supervision

T519: #Milleducation: A guide to teaching millennial learners, by millennial medical educators

10:00 AM 11:00 AM Room | Salle : 510A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. characterize millennial learners and their unique learning styles based on current evidence in the education literature
2. describe the learning needs of millennial learners in the context of the complex dynamic world of technology
3. identify potential areas for greater effectiveness as an educator in teaching millennial learners

Description:
As millennials are now in the majority of students in medical schools and residency training programs across the world, medical educators must strive to adapt their teaching methods to meet the value system of this new generation of learners. As the literature on medical education of millennials has largely been written and reviewed from the perspective of non-millennials, this session offers a creative and novel perspective—it will be led by young medical educators and leaders who are millennials. Conference participants who are either interested or experienced in medical education at all levels and in various settings should attend in order to benefit from discourse and idea-sharing across generations, practice settings, and provinces. The presentation will focus on all of levels of medical education, with particular focus on undergraduate medical education, postgraduate residency training, and maintaining tenets of professionalism and CanMEDS-FM roles. Both millennial and non-millennial medical educators and learners are encouraged to participate in this workshop in order to stimulate a comprehensive discussion of this burgeoning topic. The session will be highly interactive, reflecting key characteristics of the technology-focused millennial generation, with a dynamic real-time approach to audience questions using a Prezi-based lecture, rather than traditional PowerPoint, and using tools like Twitter and Instagram for audience interaction. Small group collaboration will be used throughout the session to develop questions, share challenges, and create innovative solutions to share with the larger group. The intended outcome is to stimulate discourse amongst medical educators at all stages of practice, leadership experience, and teaching exposure, on the challenges in medical education based on the current generation of learners, with a focus on positive solutions and methods to engage this generation, facilitated by the unique perspectives offered by millennial staff family physicians and young innovative leaders in medical education.

Speakers

Clinical
Maternity and Newborn Care | Soins de maternité et de périnatalité

T116: Untangling The Helix 2017: Prenatal genetics for primary care providers

10:00 AM 11:00 AM Room | Salle : 523AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. discuss options for prenatal genetic screening, including non-invasive prenatal testing, and ethnicity-based prenatal screening tests
2. discuss the results of expanded carrier screening tests and management options related to results
3. find high-quality genomics educational resources appropriate for primary care

Description:
This seminar will use a primary care case-based approach to discuss new advances in prenatal genetic screening. Topics will include prenatal screening for aneuploidy, non-invasive prenatal testing, ethnicity-based screening, and expanded carrier screening. Participants will be introduced to the Genetics Education Canada - Knowledge Organization genomics resource website: www.geneticseducation.ca.

Speakers

Clinical

T390: What’s New, True, and Poo: Evidence updates for clinically relevant primary care topics / Quoi de neuf, de vrai et de faux : Mises à jour des données probantes sur des sujets cliniquement pertinents en soins de première ligne

10:00 AM 11:00 AM Room | Salle : 517BC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. review clinically relevant and practice-changing evidence from the preceding year
2. encourage delegates to examine the evidence before adopting new diagnostic tests or medications
3. review indirectly evidence-based medicine terms such as baseline risk, absolute and relative risk, and number needed to treat

Objectifs d’apprentissage : 
1. revoir les données probantes pertinentes sur le plan clinique et ayant transformé la pratique de l’année précédente
2. encourager les délégués à examiner les données probantes avant d’adopter de nouveaux tests diagnostiques et médicaments
3. examiner indirectement les termes du programme EBM tels que risque initial, risque absolu et relatif et nombre de patients à traiter

Description:
In “What's New, True, and Poo” in 2017, we provide brief evidence updates pertaining to clinically relevant primary care topics. Typically each topic/knowledge piece will be reviewed in about two minutes, allowing for a breadth of clinical topics/knowledge pieces to be presented and discussed. We discuss patient-orientated and clinically relevant evidence pertaining to: 1) new therapies, new diagnostic tests, or new uses for existing medications (New); 2) the confirmation of current medical practice or prescribing (True); and 3) the refutation of practice or medical myths (Poo).

Description :
En 2017, dans « Quoi de neuf, de vrai et de faux », nous fournissons une brève mise à jour des données probantes sur des sujets cliniquement pertinents en soins de première ligne. Habituellement, chaque sujet est revu pendant deux minutes pour permettre d’inclure une vaste gamme de sujets cliniques dans la présentation. Nous parlerons de donn�es probantes axées sur les patients et pertinentes sur le plan clinique portant sur : 1. Nouveaux traitements, tests diagnostiques ou nouveaux emplois de médicaments existants « neuf »; 2. Confirmer la pratique médicale actuelle ou la prescription « vrai »; 3. Réfuter les mythes médicaux ou de la pratique « faux ».

Speakers

Clinical
Sport Medicine | MSK | Orthopedics | Médecine du sport | MSK | Orthopédie
Health Care of the Elderly | Soins aux personnes âgées

T436: Clinical Application of the 2015 Long-Term Care Fracture Prevention Guidelines

11:15 AM 12:15 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. identify long-term care residents who are at high risk for fracture
2. apply new LTC Fracture Prevention guideline recommendations
3. stop pharmacotherapy when appropriate

Description:
Osteoporosis Canada’s guideline, Recommendations for Preventing Fracture in Long-Term Care, is the first guideline in Canada that focuses on preventing fractures among the frail and elderly in long-term care, in whom fractures are much more common than among community-dwelling seniors. Launched in 2015, the guideline is specifically designed to reduce immobility, pain, and hospital transfers and, most importantly, improve the quality of life of residents at these facilities. We will present valuable, practical information contained in the guideline, such as strategies to prevent fractures, that is useful to doctors, caregivers, and frail older adults at long-term care facilities and in the community.

Speakers

Pharmacology | Pharmacologie

T357: Using Pharmacogenetics for Common Problems Managed in Family Practice

11:15 AM 12:15 PM Room | Salle : 524A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. use Stanford University’s PharmGKB CPIC pharmacogenetic online free tool to look up clinically relevant genetic tests
2. explain to patients how pharmacogenetic tests are performed, how DNA is analyzed, and what the results mean
3. use a pharmacogenetic test result to identify drug options for a patient managed in primary care

Description:
Each year in Canada there are approximately 200,000 severe adverse drug events, claiming up to 22,000 lives. Physicians cannot predict whether a patient taking a drug for the first time will gain the desired benefit from that drug or experience harmful side effects. This is particularly relevant in primary care, where most prescriptions are written. Pharmacogenetic tests may reduce this uncertainty for many medications but the knowledge about these tests, their benefits, their quality, and their use in practice is not readily available for family physicians in Canada. This session will be interactive using a world-renowned pharmacogenetics platform called PharmGKB run by Stanford University. This tool works in two ways: It enables clinicians to look up drugs to see clinically relevant tests of variants and to look up genetic variant results patients may bring in to identify the drugs the variant may affect. Working in small groups, physicians will learn to navigate this system using information from prepared patient scenarios, and any real patient examples from the audience, to answer questions about whether patients might benefit from a test and what the pharmacogenetic test result means for them. The session will also include explanations of the technical aspects of pharmacogenetics with a demonstration of the whole process of genetic variant detection from swab to report. A primer on pharmacogenetics with a glossary of terms and a short description of tests will be provided. This includes the various laboratory techniques available, the terminology of the test results, and a description of the resources available for further reading relevant to primary care.

Speakers

Clinical
Cardiology | Cardiologie

T271: Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Management of AF for the family physician / Lignes directrices sur la fibrillation auriculaire de la Société canadienne de cardiologie : Prise en charge de la FA par le médecin de famille

11:15 AM 12:15 PM Room | Salle : 517BC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. examine the latest evidence on the management of concomitant anticoagulants and antiplatelet therapy in clinical practice
2. discuss recommendations regarding the role of catheter ablation for the treatment of patients with atrial fibrillation
3. update knowledge and decision making on screening patients for atrial fibrillation after cryptogenic stroke

Objectif d’apprentissage :
1. examiner les toutes dernières données probantes sur la gestion du traitement anticoagulant et antiplaquettaire concomitant en pratique clinique
2. discuter des recommandations sur le rôle de l’ablation par cathéter dans le traitement de la fibrillation auriculaire
3. actualiser les connaissances et la prise de décision sur le dépistage de la fibrillation auriculaire après un AVC cryptogénique

Description: Affecting approximately 350,000 Canadians, atrial fibrillation (AF) is the most common arrhythmia managed by physicians. As AF can lead to more serious medical problems such as stroke, heart failure, reduced quality of life, and additional heart rate and rhythm issues, the detection and management of AF in patients is important. Given the emergence of new evidence on AF, the Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Panel periodically provides updated recommendations that address clinically important advances in the management and treatment of AF. In this workshop session, members of the CCS Atrial Fibrillation Guidelines Panel will present practical clinical strategies in the management of patients with AF. Members will use case examples to discuss: 1) emerging evidence on the management of concomitant anticoagulants and antiplatelet therapy in clinical practice; 2) the “who, when, and how” of catheter ablation; and 3) how and when to screen for atrial fibrillation after cryptogenic stroke.

Description : Touchant quelque 350 000 Canadiens, la fibrillation auriculaire (FA) est l’arythmie la plus souvent prise en charge par les médecins. Comme la FA peut entrainer des problèmes médicaux plus graves, comme l’AVC, l’insuffisance cardiaque, la réduction de la qualité de vie et d’autres problèmes liés à la fréquence et au rythme cardiaque, la FA doit être dépistée et prise en charge. Vu la publication de nouvelles données probantes sur la FA, les membres du comité de rédaction des Lignes directrices sur la fibrillation auriculaire de la Société canadienne de cardiologie (SCC) actualisent périodiquement ses recommandations afin d’intégrer les progrès cliniques importants dans la prise en charge et le traitement de la FA. Dans cet atelier, les membres du comité de rédaction des Lignes directrices sur la fibrillation auriculaire de la SCC présenteront des stratégies cliniques pratiques de prise en charge de la FA. Les membres du comité traiteront des sujets suivants par l’intermédiaire d’exemples de cas : 1) données émergentes sur la gestion du traitement anticoagulant et antiplaquettaire concomitant en pratique clinique ; 2) le « qui, quand et comment » de l’ablation par cathéter ; 3) quand et comment effectuer le dépistage de la fibrillation auriculaire après un AVC cryptogénique.

Speakers

Dermatology | Dermatologie
Enhanced Clinical Sessions | Séances sur les compétences cliniques avancées

T141: It’s Overgrown Toeskin, Not Ingrown Toenail

11:15 AM 12:15 PM Room | Salle : 523AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. explore evidence-based research demonstrating that there is no nail abnormality but rather an excessive amount of soft tissue
2. gain confidence in this technical procedure that can be performed in the family physician’s office
3. gain confidence in an evidence-based rationale for the cessation of removing part or all of the toenail

Description:
This is an innovative approach to an old problem. The term ingrown toenail incriminates the nail as the causative factor; however, there is excellent, evidence-based research demonstrating that there is no nail abnormality and the problem is due to an excessive amount of soft tissue, which can be excised. Removal of this tissue results in less bulging over the nail with weight bearing and eliminates the problem. The nail is not touched! The result is cosmetically excellent and the problem will never recur.

Speakers

Occupational Medicine | Médecine du travail

T420: Veteran Health: Life After Service Studies (LASS) and family practice

11:15 AM 12:15 PM Room | Salle : 524C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. examine the health status of Canadian veterans Including determinants of health from various well-being domains
2. apply insights from the LASS program of research to veteran care in family ractice
3. identify barriers and solutions to change in veteran health

Description:
Occupational medicine involves the effects of work on health and the effects of health on work. This includes these effects on our veterans. There are approximately 600,000 former Canadian Armed Forces (CAF) members living in Canada today who served after the Korean War. The well-being of recent CAF veterans across major areas of life, including health and disability, employment, finances, and social integration, has been described in more than two dozen publications from the Life After Service Studies (LASS). The LASS are nationally representative surveys of the well-being of former CAF members released since 1998 that were conducted in 2010, 2013, and 2016 in a collaboration between Veterans Affairs Canada, the Department of National Defence, and Statistics Canada. These findings have important implications for health care and disability mitigation in this important Canadian sub-population. This interactive session will explore participants’ involvement in and understanding of veteran health. Original, cutting-edge Canadian research will be incorporated. Expected changes in veteran numbers and demographics will be explored. Reservist care and seven domains of veteran well-being will be examined in examples of barriers and solutions. The session will conclude with an interactive exchange on concrete action steps for Canadian family physicians caring for veteran patients.

Speakers

ANNULÉE T490: L’enseignement des soins à domicile aux résidents: établissement des compétences de base particulières et de repères mesurables

11:15 AM 12:15 PM

ANNULÉE

Speakers

Clinical
Mental Health | Santé mentale

T316: Practical Tips for Managing ADHD in Your Office / Conseils pratiques pour prendre en charge le TDAH dans votre clinique

11:15 AM 12:15 PM Room | Salle : 517D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. recognize clues of the presence of ADHD in patients in a practice
2. be able to prescribe and adjust dosages of medications for ADHD in primary care
3. be able to differentiate ADHD from other commonly occuring mental health problems

Objectifs d’apprentissage :
1. reconnaître dans sa pratique les indices de la présence de TDAH chez les patients
2. pouvoir prescrire et ajuster la posologie des médicaments contre le TDAH en soins de première ligne
3. pouvoir différencier le TDAH des autres problèmes de santé mentale courants

Description: More than 60 per cent of children with attention-deficit/hyperactivity disorder (ADHD) will continue to have symptoms as adults, making it one of the most commonly encountered mental health problems in primary care but also one that is frequently overlooked. This workshop reviews the prevalence of ADHD in primary care and the different ways it can affect an individual’s life. Using case examples the workshop describes ways ADHD can present in primary care and how to recognize when it may be a comorbid condition, often accompanying a mood or anxiety disorder. It outlines the specific criteria required to make a diagnosis of attention-deficit disorder with or without hyperactivity and screening tools available to detect its presence. It presents an overview of treatment approaches, including psychoeducation and support, the provision of structure and routine, family involvement, cognitive approaches, and the use of medication. It outlines the different medication options available and guidelines for their initiation, maintenance, and discontinuation and provides links to reading materials and resources that can be provided to patients.

Description :
Plus de 60 % des enfants atteints de TDAH manifesteront toujours des symptômes à l’âge adulte, ce qui en fait le problème de santé mentale le plus souvent vu en soins de première ligne, mais aussi souvent omis. Cet atelier se penche sur la prévalence du TDAH en soins de première ligne et les différentes façons dont il peut perturber la vie d’une personne. À l’aide d’exemples de cas, il décrit les façons dont le TDAH se manifeste en soins de première ligne et comment reconnaître lorsqu’il pourrait être une comorbidité, souvent accompagnée d’un trouble anxieux ou de l’humeur. L’atelier décrit les critères précis nécessaires au diagnostic de TDA avec ou sans hyperactivité, et les outils de dépistage qui peuvent en détecter la présence. Il présente un survol des approches thérapeutiques y compris la psychoéducation et le soutien, la structure et la routine, la participation familiale, les approches cognitives et le recours aux médicaments. Il décrit les différentes options pharmacologiques et les lignes directrices régissant l’instauration, le maintien et l’arrêt du traitement, et fournit des liens vers des lectures et des ressources pouvant être remises aux patients.

Speakers

Pharmacology | Pharmacologie
Addiction Medicine | Médecine des toxicomanies

T517: Office-Based Use of Buprenorphine-Naloxone for Opioid Use Disorders

11:15 AM 12:15 PM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. compare methadone and buprenorphine-naloxone and evaluate which medication to prescribe for treating opioid use disorder
2. explain the pharmacology and pharmacodynamics of buprenorphine-naloxone, and plan an office-based induction without precipitating opioid withdrawal
3. explore provincial guidelines and identify how to obtain certification to prescribe buprenorphine-naloxone

Description:
Methadone has been used successfully for treating opioid use disorder since the 1960s, and remains the standard of care. While effective, methadone has several risks that require careful prescribing and dispensing practices that can be prohibitive for some patients. More recently, the combined medication buprenorphine/naloxone was approved for use in Canada, and has several advantages over methadone. In particular, it carries a much lower risk of overdose and adverse drug reactions, and is prescribed more liberally in other countries such as the United States. During this session, we will review the unique pharmacological and pharmacodynamic properties of buprenorphine-naloxone. Participants will be introduced to an office-based protocol for safe induction of buprenorphine-naloxone to prevent precipitated withdrawal. Furthermore, we will review the present provincial guidelines for the availability and use of buprenorphine-naloxone, and discuss how potential changes to these policies could result in safer, more effective treatment of opioid use disorder in a primary care setting.

Speakers

Clinical
Mental Health | Santé mentale
Child and Adolescent Health | Santé de l’enfant et de l’adolescent

T355: The Many Faces of Adolescent Eating Disorders: Would you recognize them?

11:15 AM 12:15 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the updated DSM classification of eating disorders and their incidences in adolescence
2. discuss barriers to implementing screening for eating disorders in primary care
3. discuss the challenges inherent in the diagnosis and management of eating disorders in primary care

Description:
Disordered eating and eating disorders are common in adolescence. The chapter on Feeding and Eating Disorders was recently updated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Statistics from the 2013 Youth Risk Behavior Surveillance System survey found 18.7 per cent of females and 7.7 per cent of males went without eating for more than 24 hours and 6.4 per cent and 3.2 per cent, respectively, took diet pills, powders, or liquids without the advice of a health care provider in an attempt to lose weight or avoid gaining weight. Eating disorders occur in all major ethnicities and socio-economic classes, with an increasing incidence in children younger than 12, and are the mental health diagnosis with the highest mortality and significant morbidity. Early intervention in adolescence is associated with improved long-term outcomes. Primary care providers should be aware that many adolescents do not want help with their eating disorders, so parents, schools, or coaches may be the ones to raise concerns. Adolescents may, however, present with bothersome eating disorder symptoms and the relationship with the family/teen provides an opportunity for screening and intervention. Referral by primary care providers is the most likely reason families/patients seek expert care. Primary care providers need to be aware of comorbidities associated with eating disorders and the identification and management of medical complications associated with various eating disorders. Outpatient care is the first line of treatment and primary care providers can assist families in understanding available treatments and accessing timely, specialty-based care and providing care while awaiting specialty care.

Speakers

Mental Health | Santé mentale

T423: Medically Unexplained Symptoms in the Family Physician’s Office

11:15 AM 12:15 PM Room | Salle : 516C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. become aware how stress can manifest as physicial symptoms
2. learn approaches to help patients with somatic symptoms related to psychological causes
3. recognize when physical symptoms have orgins in stress and anxiety

Description:
Medically unexplained symptoms often are related to manifestations of stress. These symptom can be perplexing and frustrating. The participant will develop an approach to these patients in this session.

Speakers

Clinical
Pharmacology | Pharmacologie
Respiratory Medicine | Médecine respiratoire

T330: Acute Bronchitis, Pharyngitis, and Sinusitis: Mainly viral! But some physicians still using antibiotics?!

11:15 AM 12:15 PM Room | Salle : 522ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. understand the unique pressures family physicians experience from patients for unnecessary antibiotics
2. understand how patients, physicians, and the medical system all perpetuate the problem of inappropriate antibiotic prescribing
3. appreciate the unique logical fallacies that both patients and physicians find themselves using when it comes to antibiotic prescribing

Description:
Many family physicians acknowledge that acute bronchitis, pharyngitis, and sinusitis are generally viral in nature and self-limiting illnesses, but then why do prescribing patterns still consistently show that physicians often give out antibiotics for these infections? Respiratory infections (specifically acute bronchitis, pharyngitis, and sinusitis) are common chief complaints presenting to a family doctor’s office, yet there are growing data that show many cases of these infections are not being managed properly. It is estimated that up to 30 per cent of antibiotic prescriptions given in an outpatient setting in this context are unnecessary and often inappropriate. There is great risk to these prescribing patterns, including avoidable side effects and antibiotic resistance. One of the important predictors of antibiotic prescriptions can be patient expectations. Some studies suggest that 39 per cent to 75 per cent of patients presenting with any combination of runny nose, sinus pain, cough, ear pain, congestion, and sore throat had an expectation of receiving an antibiotic, despite a very strong likelihood that these infections are viral and self-limiting. Our team produced a paper after performing a literature search of the Cochrane library and PubMed for articles pertaining to antibiotic use in upper respiratory tract infections published between 1990 and 2016. Our search was limited to systematic reviews, meta-analyses, and randomized controlled trials. We found there is little evidence to support a clinically significant benefit of antibiotic therapy for symptom management and/or prevention of complications in acute bronchitis, pharyngitis, and acute sinusitis. The next critical step in this discussion will be to explore further the cognitive psychology and decision-making patterns of both patients and physicians to understand why these patterns of inappropriate prescribing continue to exist. This will be done largely through an interactive review of evidence and prescribing challenges that physicians continue to experience pertaining to acute bronchitis, pharyngitis, and sinusitis.

Speakers

Emergency Medicine | Médecine d’urgence

T447: How to Diagnose Motor Vehicle Accident Patients at Risk

11:15 AM 12:15 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe risk factors, prognosis, diagnosis, and treatment of symptoms related to the polytrauma clinical triad
2. perform a soft tissue examination to identify and treat muscle spasm and other triggers of brain dysfunction
3. provide follow-up and self-care advice including prescription drugs , natural health products, and other non-drug interventions

Description:
More than 80 per cent of motor vehicle accident (MVA) victims sustain soft tissue injuries that appear to be minor. These patients are usually diagnosed with whiplash and managed with reassurance and a wait-and-see approach. One year later, up to 50 per cent will be on long-term disability benefits. Family physicians have an important role to play in the identification and evaluation of patients at greatest risk of disability. The polytrauma clinical triad (PCT) is an emerging syndrome that remains poorly understood by the average physician and under-diagnosed in primary care. It includes symptoms of chronic pain, post-concussion syndrome, and post-traumatic stress disorder. PCT has been described in military populations but is also seen in other patients after MVA and other traumatic injuries. This workshop will provide participants with an evidence-based review of these syndromes in the setting of MVA and related trauma. This will be supported by our clinical experience with patients referred to our community-based chronic pain management program.

Speakers

Research | Recherche

T516: Patient-Partners in Primary Care Research: A physician’s experience

11:15 AM 12:15 PM Room | Salle : 510D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the roles of a patient partner
2. recognize the added value of including patient partners in primary care research
3. explore ways to integrate patient partners into their current or future research projects

Description:
The goal of primary health care research is to improve quality of care for patients. By including patient partners in the research process, clinicians and researchers can develop health interventions that are patient-centred and address the needs of the population. Patient partners can help at all levels of research from helping identify relevant research questions, evaluating health programs, and helping develop novel health care interventions, to helping develop strategies for dissemination. The presenters will discuss their experience of including patient partners in the Diabetes Empowerment Group Program research team. Two examples will be discussed: the development of a knowledge translation plan, and the validation of a diabetes empowerment questionnaire. The patient partners will also provide their perspective on the clinician-patient-researcher collaboration. Participants will gain a better understanding of processes for working with patient partners and gain greater appreciation of the value that patient participants can bring to primary care research. Participants will be provided practical tips for integrating patient partners into their research projects.

Speakers

Clinical
Practice Management | Gestion de la pratique
First Five | Resident | Student | Cinq premières années de pratique | Résident | Étudiant

T472: First Five Years in Family Practice: Top five essentials for early career physicians

11:15 AM 12:15 PM Room | Salle : 521ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. prepare for common challenges encountered by new physicians and gain confidence for approaching various clinical and patient-centric scenarios
2. implement specific strategies to address practice management concerns for those new in practice or in early career
3. apply the actionable methods and phrases discussed when similar situations arise in their own practice

Description:
This innovative session will focus on common areas of concern for early career physicians in five brief 10-minute presentations. The presenters will approach each topic by identifying a challenge commonly reported by many new family physicians and offering concrete tactics that can be employed by attendees in day-to-day practice. The topics will range from clinical questions, to practice management challenges, and to patient management situations. The strategies offered will be actionable and provide attendees with the confidence to tackle their most difficult situations as they begin practising family medicine. Over the course of an hour, established family physicians will share their top suggestions for managing the most common concerns that arise during the first five years of practice in a series of highly-informative, bite-sized sessions. Each bite-sized session will be followed by an opportunity to ask the speaker questions, with a longer question period at the conclusion of the session.

Speakers

Ancillary Session - T882: Understand, Empower, Treat: Revolutionizing obesity care

12:30 PM 01:30 PM Room | Salle : 710A


Learning Objectives:
1. explore the multifactorial pathophysiology of obesity as a chronic disease and describe the rationale for its management
2. compare currently available Canadian pharmacotherapy options for the management of obesity
3. discuss practical approaches to the initiation and maintenance of obesity management in clinical practice

Description:
As knowledge and research in the area of obesity have advanced, so have the approaches to the management of patients living with obesity. Revolutionizing obesity care not only means incorporating a fundamental understanding of the complex pathophysiology of obesity, but also assessing and building a patient’s motivation for change and tailoring a management plan to the patients' needs.

Join us for an engaging session, where you will explore the key concepts of obesity, and review practical approaches to its assessment and management in clinical practice.

Ancillary Session - T881: MDD - At work, but not really working

12:30 PM 01:30 PM Room | Salle : 517A


Learning Objectives:

1. describe the prevalence of MDD in working adult patients and the burden of the disorder in the workplace
2. explain current data about approaches to management of MDD to help improve workplace functioning and productivity
3. apply data to the clinical context to help patients with MDD return to better functioning

Description:
One in five Canadians will experience a mental health issue in his or her life. This is of particular concern for working individuals – the largest proportion of people living with depression – and employers, as mental and behavioural health issues are the leading cause of short- and long-term disability in Canada. The impact depression can have on all areas of an individual’s life is significant, and the related decline in work productivity is increasingly the subject of study. Like the other aspects of an individual’s life, the effects of MDD on work functioning can be mediated by any of the broad spectrum of MDD symptoms – emotional, physical, and cognitive. This is an important consideration in that the 2016 CANMAT guidelines for the treatment of MDD state that a return to full functioning is the treatment goal in both the acute and maintenance phases of the disease, implying that a holistic view of symptoms and functional impairment is necessary for optimal disease management. In the context of real-life patient cases and recent study data, participants in this session will consider how the current management of depression affects the function of a patient with MDD, particularly in the workplace, and evaluate the potential correlation between improving some or all symptoms dimensions of MDD and improved workplace productivity.
Emergency Medicine | Médecine d’urgence

T365: Top 10 Articles of the Year in Emergency Medicine / Les top 10 articles de l’année en médecine d’urgence

01:30 PM 02:30 PM Room | Salle : 517BC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. review 10 great practice-changing articles of the year in emergency medicine
2. apply the findings to emergency medicine practice in Canada
3. address barriers to implementing the changes suggested by this literature

Objectifs d’apprentissage :
1. revoir dix excellents articles qui ont changé la pratique en médecine d’urgence cette année
2. appliquer les résultats à la pratique de la médecine d’urgence au Canada
3. examiner les obstacles à la mise en œuvre des changements suggérés dans cette littérature

Description: This fast-paced, high-level review of 10 practice-changing articles from the previous year in emergency medicine will provide critical appraisal, use both absolute and relative terms, and discuss clear risks and benefits at the end of each article. This is not a comprehensive review session; however, the review behind each article is done in depth to ensure appropriate conclusions are provided. Come see what’s new and leave with a few evidence-based pearls for your emergency medicine practice. The format includes five presenters each reviewing two articles in 10 minutes for a fast-paced, just-the-facts approach with one minute per article for questions.

Description :
Cette revue rapide et de haut niveau de dix articles qui ont changé la pratique de la médecine d’urgence au cours de la dernière année donnera lieu à une lecture critique. Des termes absolus et relatifs. À la fin de chaque article seront utilisés ; une discussion sur les risques et les bienfaits manifestes suivra chaque article. Bien que cette séance ne soit pas une étude approfondie, chacune des revues a subi un examen de long en large, et en profondeur, afin de garantir la justesse des conclusions présentées. Venez découvrir les nouveautés et repartez avec quelques nouvelles perles fondées sur des données probantes pour enrichir votre pratique de la médecine d’urgence. Durant la séance, cinq présentateurs passeront en revue deux articles chacun en 10 minutes afin de privilégier une approche rapide, qui va droit aux faits. Pour chaque article, il y aura une période de questions d’une minute.

Speakers

Clinical
Mental Health | Santé mentale

T476: Implementing the 2017 Canadian Guidelines for Primary Care of Adults With IDD

01:30 PM 02:30 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. identify specific health issues of people with intellectual and developmental disabilities (IDD) that are different from those of the general population
2. apply this knowledge to conduct comprehensive preventive health assessments of people with IDD
3. use adapted approaches to assessment, and care of health and behavioural disorders for people with cognitive and communication difficulties

Description:
This session highlights what is new in the 2017 Canadian Consensus Guidelines for the Primary Care of Adults with Intellectual and Developmental Disabilities (IDD), emphasizing how to apply its recommendations. Participants will also learn approaches to recognizing, assessing, and providing interventions for physical and mental health issues, as well as behaviours that challenge. Such approaches to care can be used not only to improve care of people with IDD but also other patients with cognitive impairments and communication difficulties.

Speakers

Teaching | Precepting | Enseignement | Supervision

T504: Coaching Conversations

01:30 PM 02:30 PM Room | Salle : 510A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. explore the growing body of evidence behind coaching
2. describe five communication skills of effective coaching conversations
3. review practical application of coaching conversation skills

Description:
Preceptors require a myriad of skills to successfully assess and provide feedback to learners. One efficient and effective process for ongoing, positive, and effective adult learning that promotes reflectivity and supports competency-based assessment and feedback is coaching. As educational coaches, preceptors partner with learners in trusting, thought-provoking, and creative processes that offer reflective opportunities to maximize personal, educational, and professional potential. Coaching relationships involve having coaching conversations that are empowering and provide structure, accountability, expertise, and inspiration to enable residents (and faculty!) to learn and grow in professional and personal development. Effective coaching conversations require specific and defined communication skills. Come join an interactive session that will provide you with a solid introduction to the art and science of coaching conversations.

Speakers

Teaching | Precepting | Enseignement | Supervision

T236: The Top Five Problems in Competency Coaching

01:30 PM 02:30 PM Room | Salle : 510B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. be able to state the purpose of competency coaching
2. be able to describe the components of a good academic goal
3. be able to describe two methods to motivate learners

Description:
Academic advising, or competency coaching, is a new and complex task for many preceptors. There are many parallels between competency coaching and patient-centred care. This presentation attempts to build on skills that academic advisers use in clinical practice. The five most common problems encountered by the presenter are: It is unclear what the goal of the process is; the resident doesn’t buy into the process; data are scarce or incomplete; the resident is already performing well; or the resident is performing poorly and nothing seems to help. The presentation accomplishes this goal by reviewing some basic principles of qualitative data analysis, continuous quality improvement, feedback, and motivational interviewing. Some of these principles will then be applied to two cases: a resident who is doing well according to the sparse data available and a resident who is struggling despite multiple academic meetings. In both cases attendees will try to form specific, measurable, agreed-upon, realistic, and measurable goals that engage the resident.

Speakers

Palliative Care | Soins palliatifs
Compassionate Care | Soins prodigués avec compassion

T430: Living the Best Till Last: Conversations for end-of-life planning

01:30 PM 02:30 PM Room | Salle : 524A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the most important elements of any advance care plan for end-of-life care
2. engage confidently in end-of-life planning conversations
3. facilitate these conversations in varied formats including for patient/citizen groups, individuals, and families


Description:
Making a shift from acute/curative thinking to comfort/quality thinking is part of the palliative approach to care. Improving our ability to talk about the dying process, goals, and fears before serious illness occurs is the first step toward making this shift go well. At McMaster Family Health Team in Hamilton, Ontario, we have designed a workshop offered to anyone and everyone who wishes to delve into this conversation for themselves or for their loved ones. Most of those attending do not yet have a serious illness. They are interested in exploring their goals and priorities should serious illness occur, and understanding how to ensure that those are followed if they are unable to speak for themselves. We have found that this group approach to improving end-of-life conversations is highly effective, fun, and well received. Main aspects of the group process will be demonstrated. Skills for guiding this process will be highlighted and practised. Adapting this group approach to individual and family conversations at all stages of life will be explored. Preliminary evaluation data will be presented. This will be a lighthearted discussion on a very deep topic. This session is appropriate for individuals from any discipline, including general family practice, and especially for those working with people with all types of chronic disease. It is also relevant to those with a focus in palliative care. Prepare to befriend your own death.

Speakers

Clinical
Child and Adolescent Health | Santé de l’enfant et de l’adolescent

T502: Optimizing Family Medicine Team Function: Sharing well child care with primary care nurses

01:30 PM 02:30 PM Room | Salle : 513EF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. provide an overview of international evidence supporting nurse-provided well child care and the relevance to Canadian practice
2. discuss the implementation steps of nurse-provided well child care in two primary care teams
3. allow participants to imagine how to implement shared well child care in their own setting, anticipating possible challenges and resource needs

Description:
This session will focus on implementing shared well child care in family practices across the country. Many family medicine clinics now include nurses and other allied health care providers, and optimizing all providers’ roles and functions is key to allowing everyone to work to their full scope of practice and abilities. Providing routine well child care is well within the scope of practice of primary care registered nurses. The speakers will describe their own experiences with establishing both shared and nurse-led well child care in their family practice units, including preparatory steps, implementation, and evaluation of outcomes. Participants will be allowed to work through imagined steps of implementing such a program in their own setting, anticipating challenges and barriers, and thinking through facilitating factors and solutions, using the speakers’ personal experiences and examples from the literature. At the end of this session, participants should feel prepared to establish a program of shared or nurse-led well child care in their own family practice and be part of a community of practice innovating this new model of practice.

Speakers

Research | Recherche

T394: Authentic Engagement: Boot camp translation/workshop on participatory research and patient-oriented research

01:30 PM 02:30 PM Room | Salle : 510D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. be able to describe the elements of participatory research
2. be able to list the steps necessary for engaging in patient-oriented research
3. reflect on how this could be used in clinical practice, quality improvement, and/or research

Description:
Purpose: Integration of the principles/values of engagement into research, evaluation, and knowledge translation. Methodology: Taking the lead from experiences in working with Indigenous communities, participatory, action-oriented approaches facilitate the integration of authentic engagement. Findings/Discussion: In Canada the framework for engaging patients, communities, or organizations is clearly outlined in Chapter 9 of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, which indicates that people and communities are to have a role in shaping/co-creating the research that affects them. Thus, these principles/values are being more broadly applied and as such have application to patient-oriented research funded by the Canadian Institutes of Health Research and the Patient-Centered Outcomes Research Institute. Rather than having the various elements of a research project designed by professional researchers, there needs to be engagement with patients and communities to find common ground while ensuring that the individuals/communities have a role in shaping/co-creating the research that affects them. Examples of research projects and processes that have been established over time will be shared by researchers and community members. As recently identified in the 2016 Council for International Organizations of Medical Sciences guidelines, there is an increased emphasis on the scientific and social value of research: the prospect of generating the knowledge and the means necessary to protect and promote health in and with individuals and communities. Proactive and sustained engagement with the communities from which individuals will be invited to participate demonstrates respect for them and for the traditions and norms they share. Community engagement is also valuable for knowledge translation of the results from the research by individuals and the communities into outcomes that are both clinically relevant and meaningful. Conclusions: The integration of principles/values of authentic engagement has the potential to change practice and research and build capacity in and with the communities.

Speakers

Teaching | Precepting | Enseignement | Supervision

T529: The Triple C Evaluation Project: Current results with question and answer session

01:30 PM 02:30 PM Room | Salle : 511C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the Triple C Evaluation Project and the data that have been collected to date
2. consider ways that data emerging from the project may be used for improving curricula design or conducting further research
3. assess opportunities and challenges related to sharing data from the Triple C Evaluation project with stakeholders and end users

Description:
In 2010, after a five-year extensive consultation and review process, the CFPC introduced the Triple C Competency-based Curriculum (Triple C) for residency programs. While development of the Triple C was evidence-based, early concern was raised about lack of evidence about whether the Triple C will lead to better outcomes. With this in mind, the CFPC decided it was imperative to examine outcomes of Triple C. An evaluation plan was developed with a logic model highlighting the activities and expected short- and long-term outcomes. Both qualitative and quantitative methodologies were included to understand both the experience of implementing CBME as well as to measure outcomes experienced by learners and programs. Surveys of residents at residency program entry and exit began with a pilot group of six schools in 2012, and expanded to 16 of 17 schools in 2014. Cognizant that each residency program is different and implementation challenges are specific to context, a qualitative study was also conducted in 2016 to understand the experiences of residency programs implementing Triple C. Aggregate results from the Evaluation Plan Project will be available to family medicine training stakeholders and end users beginning in mid-2017. In this interactive workshop, we will first offer an overview of the methodologies used and data currently available from the Triple C Evaluation Plan project. The remaining time will be a question and answer discussion to allow stakeholders and end-users to better understand the project, and offer suggestions for future areas to explore.

Speakers

Clinical
Sport Medicine | MSK | Orthopedics | Médecine du sport | MSK | Orthopédie
Health Care of the Elderly | Soins aux personnes âgées

T112: Bone Density, Fractures, and the Evidence: Simplifying osteoporosis management

01:30 PM 02:30 PM Room | Salle : 517D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. apply a simplified approach to osteoporosis screening and follow-up bone mineral density testing
2. assess fracture risk and discuss with patient the risk and benefits of treatment options
3. understand the uncertainty around therapy duration and follow-up testing but have a reasonable approach for each patient

Description:
The approach to the management of osteoporosis has been challenged by guideline recommendations that are frequently incongruent with evidence and unduly complex. In this session we will review a simplified approach to osteoporosis management that is evidence based and promotes shared decision making with the patient. We will describe a streamlined method, more reliable than those presently promoted, that can accurately select patients for bone mineral density testing. We will then discuss how to assess the risk of fracture in patients and how soon to repeat bone mineral density testing in those at low risk. For those with risk of fracture ≥ 10 per cent, we’ll review how to present this information and explain to patients the potential benefits and harms of available therapies. Lastly, we’ll review challenges in the evidence around monitoring bone mineral density to assess therapeutic success, and when or if treatment holidays can be considered. Although the evidence is imperfect, we’ll discuss reasonable approaches for practical use in the office.

Speakers

Women's Health | Santé des femmes
Pharmacology | Pharmacologie

T308: Mifepristone Abortion and Family Physicians: CAPS online support is a click away

01:30 PM 02:30 PM Room | Salle : 516C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. identify clinical and professional supports for physicians wishing to implement mifepristone abortion practice
2. integrate knowledge and insights of experienced mifepristone abortion providers to prepare/improve your practice
3. navigate the Canadian Abortion Providers Support (CAPS) online community of practice

Description:
Many family doctors may consider learning the new practice of medical abortion but be unaware of CFPC-approved resources available to support them in doing so. Mifepristone availability offers family doctors the opportunity to provide this common reproductive health service to women in their practices and communities. For regions without existing abortion services this will enable women to have abortions without leaving their communities and families to seek care. This session will introduce participants to the online Medical Abortion Training Program required for prescribing mifepristone and the Canadian Abortion Provider Support (CAPS) platform. CAPS is a secure website on which Canadian physicians who have completed the mifepristone training program can access tools for practice, discuss clinical challenges with expert providers, and share strategies discovered in their own practices to facilitate mifepristone abortion care. During this interactive session we will present practical tips for successful mifepristone abortion implementation identified by CAPS members and invite participants to bring questions about mifepristone abortion practice for discussion. The Medical Abortion Training Program and CAPS are supported by the College of Family Physicians of Canada and the Society of Obstetricians and Gynaecologists of Canada.

Speakers

Clinical
Pharmacology | Pharmacologie
Chronic Pain | Douleur chronique

T56: Cannabis for Medical Purposes Update: The essentials for effective practice

01:30 PM 02:30 PM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. apply to clinical practice the CFPC’s Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary guidance
2. describe the role and function of the endocannabinoid system
3. understand how to avoid misuse, diversion, and inappropriate authorization of cannabinoids

Description:
Using a case-based, interactive approach the learner will gain the knowledge needed to effectively authorize the use of cannabis for medical purposes. This will be in accordance with the CFPC document Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary guidance as well as Health Canada regulations. Topics to be covered include the role and function of the endocannabinoid system, evidence regarding the use of cannabis in neuropathic pain, multiple sclerosis and other conditions where benefit has been demonstrated, potential risks and benefits, regulations regarding authorization and avoidance of misuse, diversion and inappropriate prescribing. Clinical pearls will include how to identify the appropriate and inappropriate patient, how to adequately document initial and follow-up patient visits, use of the patient agreement and harm-reduction strategies. This session will provide an update to the FMF 2016 presentation.

Speakers

Research | Recherche

T540: The Best of Primary Care Research from NAPCRG 2016

01:30 PM 02:30 PM Room | Salle : 521ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. synthesize clinically relevant research presented at the North American Primary Care Research Group (NAPCRG) conference
2. stimulate the interest of practising family physicians in primary care research
3. understand how primary care clinicians can impact the research agenda

Description:
In a repeat of hugely successful presentations from the past two years, three outstanding speakers will present the best of clinically relevant, primary care research from among over 500 presentations at the North American Primary Care Research Group (NAPCRG) conference. Three family physician researchers will discuss what presentations they found most meaningful for their own practice and what they think every practising family physician should know. Each speaker will outline three or four studies, emphasizing what is new, why it is important, and how it can change practice. The focus will be on problems that are common and important in the family medicine setting. Copies of the original abstracts and presentations will be available. NAPCRG is the premier international forum for communicating new knowledge in primary care; this presentation will showcase the best of NAPCRG for a clinical audience. This session might be of interest to family medicine researchers.

Speakers

Clinical
Maternity and Newborn Care | Soins de maternité et de périnatalité

T432: Recent Research to Inform Rural and Family Physician Models of Obstetrical Care

01:30 PM 02:30 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. cite evidence comparing obstetrical outcomes between family physicians and obstetricians
2. apply evidence to decisions about proceeding to Cesarean section
3. use recent evidence to make decisions about obstetrical service level at rural hospitals of a given size and remoteness

Description:
We will review recent evidence comparing maternal and neonatal obstetrical outcomes and Cesarean-section rates between family physicians and obstetricians. We will also review Canadian evidence showing how obstetrical outcomes are affected by poor geographic access to obstetrical services and the impact of delivering at hospitals of different annual delivery volumes and levels of service. Finally, we will hear about successful models of rural obstetrical care and attempt to apply the evidence above to real-world health system decisions provided by members of the audience or from our own experience. If they wish to discuss cases, audience members should come with information about the obstetrical service level and volume at the hospital of interest as well as the next closest hospitals and the distance between these hospitals.

Speakers

Clinical
Choosing Wisely | Screening | Preventative Medicine | Choisir avec soins | Dépistage | Prévention
Cancer Care | Soins aux patients atteints du cancer

T192: Lymphoma Diagnosis Workshop

01:30 PM 02:30 PM Room | Salle : 522ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. describe the various clinical presentations in which these malignancies should be included on the differential diagnosis
2. explain when and how to expedite the diagnostic workup of aggressive forms of these malignancies
3. examine the role of prostate-specific antigen in the workup of suspected prostate cancer and its limitations in screening for prostate cancer

Description:
To assist primary care providers, algorithms for the workup of suspected lymphoma and prostate cancer have been developed by a multidisciplinary group of Manitoba experts. That guidance is the basis for the content of these case-based, interactive, small-group workshops. Unexplained lymphadenopathy, with or without other symptoms, is the most common presentation for lymphomas. However, the differential diagnosis of unexplained adenopathy is large and includes other malignancies, infectious diseases, and some connective tissue diseases. The primary care clinician needs to keep this broad differential diagnosis in mind when working up adenopathy. In the case of neck adenopathy secondary to a primary squamous cell carcinoma of the head and neck, excisional biopsy of a pathologic node as part of the diagnostic workup, if performed prior to definitive treatment, can make subsequent surgery more technically challenging and can put the patient at higher risk of contralateral disease recurrence. These case-based modules will discuss the diagnostic approach to unexplained adenopathy and suspected prostate cancer, with a particular view to expediting the diagnostic workup and navigating provincial cancer care systems to the benefit of the patient.

Speakers

Clinical
Practice Management | Gestion de la pratique

T438: Quality Improvement Basics for Day-to-Day Practice

01:30 PM 02:30 PM Room | Salle : 523AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. differentiate between quality improvement, scientific research, and quality assurance
2. write a SMART aim statement for a quality improvement project
3. describe common quality improvement tools and project measures

Description:
Using the concepts of quality improvement (QI) in day-to-day practice can be challenging. This session will introduce participants to the basics of QI, including common vocabulary and concepts. Topics to be discussed include defining QI, developing QI ideas, writing aim statements, using common QI tools, determining QI project measures, developing change ideas, and understanding how to approach testing change ideas. Examples of actual QI projects will be used to deliver the content. This session is intended for clinicians who would like to start doing practice-level QI or improve their knowledge regarding QI that is already occurring in their practice.

Speakers

Teaching | Precepting | Enseignement | Supervision

T533: Rural Educator’s Forum

01:30 PM 05:15 PM Room | Salle : 510C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 3

Learning Objectives:

1. review the recommendations developed by the Advancing Rural Family Medicine: The Canadian Collaborative Taskforce, presented in the Rural Road Map for Action
2. apply the Rural Road Map for Action to various settings by identifying actions that can be undertaken in participants’ individual roles
3. identify and share examples and actions from across the country that support implementation of the Rural Road Map for Action

Description:
In this session, participants will have the opportunity to discuss the pan-Canadian Rural Road Map for Action, developed to support recruiting, retaining, and training the rural and remote family physician workforce. In addition, participants will be engaged in the application of the Rural Road Map for Action by discussing the implementation plan developed at the Rural Health Care Summit and identifying individual actions that can contribute to ensure comprehensive health services delivery for communities in rural Canada. Small and large group discussions will be used in the session to engage participants in these conversations.

Speakers

T505: Implementation of a Diabetic Program in a Family Health Team

01:30 PM 02:00 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe =0.5

Learning Objectives:

1. describe the steps for creating a diabetes program in a family health team
2. share the electronic tools used to track the rostered population
3. adopt a new way to treat the diabetic population in a multidisciplinary approach

Description:
Implementing a diabetic program in a family health team (FHT): The goal of the diabetic program in our FHT was taking charge of a roster of patients, affected by diabetes, by a multidisciplinary team to improve on outcomes. According to the Canadian Diabetes Association, the best approach for care of diabetes and improving outcomes is to invest in a multidisciplinary approach. After creating a new FHT, the board was faced with the challenge of implementing a program that would organize, in a coordinated way, the care of all diabetic patients rostered in the FHT. A custom form was created in the electronic medical record and a computerized list of patients was used to track the results and visits. All clinical staff were solicited in the project. The outcomes of this new way of treating chronic disease are presented. The participants will be interested to learn about experiences implementing such a program.

Speakers

Clinical
Global Health | Santé mondiale
Humanities | Sciences humaines

T195: Besrour Center Narrative Working Group: Appreciative inquiry and storytelling for mutual understanding

01:30 PM 02:30 PM Room | Salle : 524C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. implement the use of appreciative inquiry and narrative for scholarly purposes
2. develop research questions at multiple levels: micro, meso, macro
3. integrate the use of storytelling for inquiry purposes in clinical practice and personally

Description:
Family physicians are inherently drawn to the narrative of the patient to understand the context of their illness experience. We learn the story of a community to define its priorities and the roles of the determinants of health. Stories enrich our mutual understanding and shape our values when we explore how another has lived, including the lessons they have learned and the meaning they have drawn from their experiences. The use of narrative is an important research tool. The Besrour Center of the CFPC aims to support the development of family medicine worldwide, and the Narrative Working Group formed in 2012 to gather stories of family medicine. Using multiple lenses, we will share and explore how to use narrative and an appreciative inquiry approach for research and mutual understanding. The “micro” level will be covered by the Besrour-WONCA Storybooth Project from Rio de Janeiro, Brazil, last fall, at which we gathered 136 stories from 55 countries, each describing the experience of physicians practising family medicine. At the “meso” level we describe a project in which we explored institutional narratives describing how a country or university relates enabling factors in the growth of our discipline. And the “macro” level we have the “pentagram partners” (i.e., policy-makers, health professionals, academic institutions, communities, and health administrators), those voices that are instrumental in ensuring we achieve social accountability and a sustainable relationship within our communities. This session presents these three levels of scholarly projects and invites audience members to learn more about how to use storytelling to deepen their understanding of their own discipline, both locally and globally.

Speakers

Clinical

T512: Group Diabetes Care: An innovative way of providing chronic disease care

02:00 PM 02:30 PM Room | Salle : 512CDGH

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe =0.5

Learning Objectives:

1. describe how group diabetes care can be organized
2. understand the potential benefits and barriers to implementing group diabetes care in your practice
3. consider how to develop a similar program in your clinical practice

Description:
Diabetes management is complex and can be overwhelming for individual primary care physicians, as well as patients. The Canadian Diabetes Association recommends multidisciplinary care and increasing a person’s sense of control over their medical condition. Evidence also suggests that diabetes management is improved when patients are empowered and engaged in self-care. Group-based care models have been shown to improve patient care, leading to better health outcomes, more patient satisfaction, and more patient empowerment. With this in mind, the presenters implemented a group-based diabetes program in their clinic. They will discuss some of the successes and challenges to implementing a group-based program. The authors will use their experience to educate the participants on how to create a similar program for patients in other communities.

Speakers

Sexual Health

T124: Sex Med Update 2017: What’s coming?

03:00 PM 04:00 PM Room | Salle : 710A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. define an approach to sexual medicine in primary care/family medicine
2. manage key topics in female, male, and LGBTQ+ sexual health
3. describe controversial sexual health issues of 2017

Description:
What is the place of Sexual Medicine in a busy family practice? When it comes to sexual health, what is “normal” for most men and women? What is the appropriate language when dealing with LGBTQ patients? In our rapidly changing, highly sexualized society there is still so much confusion about sex and we as family doctors are supposed to have all (if not most) of the answers. This interactive and entertaining “trouble shooting” session will provide a practical approach to sexual medicine in a busy family practice setting. It will focus on key topics in male, female and LGBTQ sexual health and will explore some of the controversies arising in 2017. Dr. Ted Jablonski is an award winning family physician based in Calgary. In addition to family medicine, Jablonski has done consultant work in sexual and transgender medicine for southern Alberta and central British Columbia for over a decade. Dr. Jablonski has a special interest in CME for physicians and has been involved in the creation and delivery of a wide range of programs at provincial, national and international levels. Ted is a sought after musical entertainer, media spokesperson and public educator with many conference, radio, television and video credits.

Speakers

T878: Facilitated Poster Session

03:00 PM 04:00 PM Room | Salle : Level 5 Foyer / Foyer - niveau 5

Mainpro+ certified credits / Crédits certifiés Mainpro+ = 1

During this session, five posters will be presented in 10-minute segments, followed by audience Q & A and a discussion.

T715: Deprescribing Bisphosphonates in Primary Care

Ruben Hummelen* MD, PhD; Charnelle Carlos, MD; Olivier Saleh, MD

Objective: To identify and deprescribe bisphosphonates among patients who are at low or moderate risk for fragility fractures. Design: Chart review and individual risk assessments. Setting: This study took place in three academic family physician practices at McMaster Family Practice in Hamilton, totalling 942 patients of age ≥ 50 years. Participants: Chart reviews for 48 patients (five per cent) identified as receiving a prescription for a bisphosphonate between November 2014 and November 2015. After a thorough chart review of these 48 patients, 25 were excluded because they: were followed by a rheumatologist (n = 6); had stopped taking their bisphosphonate (n = 6); were high risk or had a prior fragility fracture (n = 5); or other reasons (n = 8). Intervention: Assessment of patients’ risk factors with a FRAX score calculation and counselling on their bisphosphonate use. Results: A total of 23 participants were assessed, of whom eight were low risk, 13 moderate risk, and two high risk according to FRAX. Duration of use was significantly longer among the low-risk group (median 10 years) than the intermediate- and high-risk group (median 7.5 years, P = 0.05). Among those in the low-risk group, six (75 per cent) chose to discontinue the use of their bisphosphonate after counselling. Among those in the moderate risk group, four (70 per cent) chose to discontinue the use of their bisphosphonate, while none in the high-risk group discontinued the use of their bisphosphonate. Conclusion: This study shows that a majority of patients in primary care may be eligible for a drug holiday or for discontinuing their bisphosphonate based on an absolute risk estimation. Periodic reassessment of bisphosphonate use using the FRAX can lead to better prescribing of these medications.


T790: Development of Family Practice Guidelines for Pain Management

M. Hamilton* MD, MPH; J. Pilla, MSc; L. Dunn, MSc

Background: Pain management is a common presentation in the primary care setting. There are currently no comprehensive, evidence-based, independent clinical practice guidelines available in Canada to assist in prescribing for this clinical entity. One outcome of a Canadian expert review panel on opioids convened by the Institute for Safe Medication Practices (ISMP) Canada was that the development of a pain management prescribing resource is a priority and that family physicians should play a pivotal role in the process. Objective: To develop a practical resource for pain management for family practice. Methods: A modified Delphi processwas used to develop the guideline. This process has been well documented in the literature and has beenused previously to develop other Canadian primary care guidelines in this series, such as the Anti-infectiveGuidelines for Community-acquired Infections (‘Orange Book’). The preliminary draft was reviewed by theexpert review panel. The subsequent iterations underwent peer review by a national interdisciplinary panelcomprised of family physicians, specialists, other primary care providers, and patients. Results: The resultingdocument includes recommendations on management of commonly-seen presentations of both acute andchronic pain, and includes specific dosing recommendations and available products. It also includes evidence- based, non-pharmacological recommendations for each diagnostic category, the role of opioids and appropriateprescribing of these agents, and a summary of the role of medical marijuana. Prescribing and patient informationtools are available in the appendices. Multidisciplinary guidelines developed by front line family physicians andother primary care providers resonate with the end users, ensuring widespread uptake. While the process is timeconsuming,the outcome is a robust, practical, and user-friendly guide to pain management. Conclusions: Basedon subsequent feedback from family physicians across Canada, the guideline is a useful resource in day-to-daypractice. Next steps include a more robust dissemination and implementation strategy.


T601: COPD Self-Management Education Group: A program evaluation

D. Van Dam*, MD, CCFP; J. Hodgins, RRT, CR; E. Lortie, MHA; N. Snyder, RRT, CRE; G. Cimino, RPh; T. Kontio, RPh; G. Fish, OT Reg; N. Bowen-Smith, OT Reg; J. Withers, RN

Objective: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in Canada. However, research suggests that many individuals diagnosed with COPD have poor knowledge regarding the management of their condition. This study assessed whether providing patients with knowledge about COPD could improve their self-management of this disease. Design: Program evaluation. Setting: A rural family medicine clinic in Southwestern Ontario. Participants: Seventeen individuals with a diagnosis of COPD. Intervention: A program was designed and offered to improve self-management of COPD, and provided education about topics such as how to develop an exercise plan, breathing strategies, and how and when to take medications. Surveys were administered to participants before and after the program to assess self-reported knowledge/understanding of COPD and level of confidence in managing COPD. A program satisfaction survey was administered following the program. Main outcome measures: Participant knowledge of COPD, confidence in self-managing COPD, and satisfaction with the program. Results: Mean level of self-reported knowledge/ understanding of COPD and mean level of confidence in self-managing COPD significantly increased after the program (6.15 to 7.38, P = 0.02; 6.73 to 7.55, P = 0.01, respectively). The mean number of questions answered correctly, of 12 COPD knowledge questions, significantly increased following the program (7.71 to 9.71, p = 0.01). The mean participant rating of overall experience of the program was high (4.15 on a scale of 1 (poor) to 5 (superior)). Conclusion: Preliminary results of this study demonstrate that this COPD program had a positive impact upon patient knowledge of COPD and confidence in self-management. Improving patient self-management of COPD has been shown to reduce the severity and frequency of exacerbation and improve health-related quality of life. Further sessions are required to better evaluate this novel program.


T671: Increased Cut-offs Improve the Sensitivity of the MMSE in Highly Educated Older Adults

Shannon Baker; Katie Kent; Matthew Greenacre*; Ayman Shahein; Laszlo A. Erdodi, PhD, C.Psych.

At the conclusion of this activity, participants will be able to: 1) interpret the MMSE in highly educated older adults using multiple cut-offs; and 2) more accurately identify early cognitive decline in highly educated
populations. Context: The Mini-Mental Status Exam (MMSE) is a widely-used screening test for early cognitive decline. Its comprehensiveness, short administration time, easy scoring, and straightforward clinical interpretation (intact/impaired) make it an attractive choice for a first-line assessment tool. However, the same diagnostic criterion may not be appropriate for all patients. Using a single cut-off may inflate false negatives in examinees with high premorbid functioning, as their cognitive reserve may mask the deleterious effects of neurodegenerative diseases. Objective: To determine whether increasing the cut-off would improve the MMSE’s classification accuracy in highly educated older adults. Design: Prospective quasi-experimental design. Participants: Data were collected from 113 highly educated (M = 16.4 years) older adults (M = 72.4 years) from northern New England; 64 were classified as cognitively normal (intact), while 49 were classified as showing clinical signs of cognitive decline (impaired) by a panel of experts. Instrument: The MMSE at commonly used clinical cut-offs. Results: An MMSE score ≤ 25 had perfect specificity, but low sensitivity (.36). Raising the cut-off to ≤26 improved sensitivity (.53), at minimal cost to specificity (.95). Further increasing the cut-off to ≤27 achieved a reasonable balance between sensitivity (.86) and specificity (.88). An impaired participant was seven times more likely to score ≤27 than an intact participant. Conversely, an impaired participant was six times less likely to score >27 than an intact participant. Conclusions: Raising the standard cut-offs improved the overall classification accuracy with minimal loss in specificity, and appears to be a clinically justifiable trade-off. Results suggest that higher cut-offs may be warranted in examinees with high educational achievement.


T651: Implications of Guideline Change: Have Pap test guidelines impacted sexually transmitted infection screening in primary care?

Margaret Casson*, MD; Rebecca Zur, MD; Jackie Bellaire, MD, CCFP; Mark Yudin, MD, MSc, FRCSC

Objective: In 2012, Cancer Care Ontario introduced new cervical cancer screening guidelines for women in Ontario. The goal of our research is to build on previous research and to examine how the cervical cancer screening guideline changes have impacted care of young female patients with respect to STI screening in the primary care setting. Design: A retrospective chart review analyzing the frequency of STI screening before and after the implementation of the cervical cancer screening guidelines in May 2012. Setting: Two family health teams in east Toronto. Participants: Female patients, aged 19 to 25 years, with at least one visit to their primary care physician. Main outcome measures: Number of Pap tests collected, the number of patients who had STI screening, and the number of visits during which they had STI screening. Results: There was a statistically significant difference in the number of visits with STI screening before the guideline implementation compared to after (mean number of visits with STI screening 1.21 before, 0.75 after, Mann-Whitney rank test P = 0.010). The difference in the number of Pap tests in the pre-guideline group (mean number of Pap tests 1.07) compared to the post guideline group (mean number of Pap tests 0.39; P < 0.001) was significant, and more cervical and vaginal screens used pre-guideline changes (P < 0.001 and P = 0.002 respectively) while more urine NATT was used in the post period (P < 0.001). Conclusions: Female patients aged 19 to 25 years had more visits to their primary care physicians that included STI screening in the three years before the guideline changes than the three years afterward. As expected, there was a difference in the number of Pap tests before the guideline implementation compared to after. In keeping with previous studies, there is a continued demonstration of a trend towards to non-invasive testing.
Global Health | Santé mondiale

T511: La médecine de famille peut-elle contribuer à l’aide internationale du Canada ?

03:00 PM 04:00 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Objectifs d’apprentissage :
1. décrire l’orientation des trois mémoires soumis au ministre responsable d’Affaires mondiales Canada (AMC)
2. décrire les priorités d’AMC en développement international pour la santé
3. expliquer la possible contribution de la médecine de famille canadienne aux soins de santé primaires dans les pays en développement

Description :
Les soins de santé primaires appuyés par une médecine de famille à l’écoute des besoins des populations améliorent la santé des individus et des communautés, et minimisent l’impact négatif des inégalités sociales. L’efficacité de ce principe a été démontrée dans les pays développés et dans les pays émergents qui l’ont appliqué. Il y a cependant moins de données concernant les pays en développement les plus pauvres. En effet, les grandes agences de développement international et de financement ont surtout centré leurs efforts sur des programmes verticaux, spécifiques � des maladies, à des médicaments ou à des technologies. Elles ont négligé le renforcement des systèmes de soins et la formation de professionnels de la santé prêts à répondre aux besoins des populations par une approche intégrée, centrée sur l’individu et la communauté. En juin 2016, le gouvernement canadien lançait une consultation publique sur l’examen de l’aide internationale du Canada et sur le cadre de financement de cette aide. Le Centre Besrour et les facultés de médecine de l’Université de Toronto et de l’Université de Sherbrooke ont répondu à cet appel. Les mémoires présentés insistaient sur l’importance de soutenir le développement de systèmes de soins de santé primaires robustes et professionnalisés, ancrés dans les communautés et répondant aux besoins des femmes, des filles et des enfants, notamment en termes de santé reproductive et sexuelle. Le but de cette séance est d’engager la communauté des médecins de famille du Canada dans une réflexion sur le rôle que pourrait jouer notre discipline pour améliorer la santé des individus et des populations dans les pays en développement. Elle s’adresse à ceux et celles dont les champs d’intérêt chevauchent l’amélioration de la médecine de famille et des soins primaires partout dans le monde, la responsabilité sociale et l’engagement du Canada, plus particulièrement en ce qui concerne le développement en santé.

Speakers

Pharmacology | Pharmacologie

T412: How the Future of e-Prescribing Will Affect Your Practice

03:00 PM 04:00 PM Room | Salle : 521ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. prepare for a future state in which family physicians will play an even more central role in medication management
2. differentiate between different levels of electronic prescribing
3. recognize the potential of true digital prescribing as a central tool for quality improvement in prescribing practices

Description:
Effectively using emerging e-health technologies has become important to family medicine. There is a growing body of evidence that suggests access to expanded data related to care delivery can be leveraged for quality improvement. Electronic medical records (EMRs) are used by more than 80 per cent of family physicians in many provinces and some also have access to provincial drug information (dispensing) systems via their EMRs. Family physicians already encounter a tremendous burden of chronic diseases that frequently necessitate several prescription medications; this burden will expand with an aging population. Access to digital health technology in the family physician’s office can be used effectively to enable safe prescribing practices and optimal medication management. Data captured in prescriptions from digitally interoperable systems connecting physicians to pharmacists can facilitate quality improvement (QI) efforts targeted at optimal prescribing. Further, access to well-curated data, specifically related to the prescribing of controlled classes of medications, can assist with safer prescribing of these medications. Indeed, the federal government has identified electronic prescribing as a tool that can be used to address Canada’s opioid crisis. Family physicians also play an important role in medication list management, as we are often custodians of a patient’s most comprehensive medication profile. This session will provide an overview of how this role will become increasingly central as prescription data from EMRs, electronic health records, hospital information systems, and electronic prescription systems become increasingly accessible. Additionally, strategies that optimize the use of digital prescription data will be discussed. The evolution of e-prescribing will enable QI in prescribing practices, including standardizing prescription data, enhancing interprofessional communication and collaboration with community pharmacists, and facilitating medication reconciliation in the community. As the journey toward true e-prescribing progresses in Canada, it will be essential for family physicians to recognize and embrace our critical role in establishing quality in prescribing and expand leadership in medication management.

Speakers

Clinical
Emergency Medicine | Médecine d’urgence
Addiction Medicine | Médecine des toxicomanies

T131: Managing Patients with Opioid Use Disorder in the Emergency Department: Case studies

03:00 PM 04:00 PM Room | Salle : 517D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. use an acute pain management protocol to treat pain in opiate-tolerant patients in the emergency department
2. manage opioid withdrawal in the emergency department in patients with opioid use disorder who are either on or off opiate replacement therapy
3. explore the addicted patient’s experience in the emergency department and generate some trauma-sensitive approaches to care and treatment

Description:
It’s no secret that opioid use disorder is on the rise in Canada, as are opioid-related overdoses. Often, opioid users first present to the health care system via the emergency department requiring management of withdrawal and/or pain. This interactive session will guide you through common emergency department presentations of acute pain and withdrawal management in complex patients with opioid use disorder. In small groups, you and your colleagues will discuss specific cases, management plans, protocols, and common practices to better support vulnerable patients with opioid use disorder.

Speakers

Clinical

T537: Health Advocacy Regarding Solitary Confinement Inside Canadian Prisons

03:00 PM 04:00 PM Room | Salle : 524C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. understand established evidence regarding health impacts of solitary confinement inside prisons
2. review current solitary confinement practices within Canadian correctional facilities
3. explore ways that health care providers might advocate to change solitary confinement practices within Canadian correctional facilities

Description:
Thousands of prisoners worldwide are housed in solitary confinement, which can lead to worsening of mental health. In addition, prisoners are sometimes punished with solitary confinement for behaviour that is a result of their mental illness. Solitary confinement can create barriers for individuals to access necessary medical and mental health care, with the risk that their health will worsen. Workshop participants will review the 2017 CFPC Position Statement on Solitary Confinement, which was developed by the CFPC Prison Health Program Committee. Participants will discuss ways that health care providers might advocate to address barriers to change regarding solitary confinement practices within Canadian correctional facilities.

Speakers

Teaching | Precepting | Enseignement | Supervision

T395: CRAFTing The FTA: Enhancing teaching in a program of assessment

03:00 PM 05:15 PM Room | Salle : 510B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe the crucial role of the family medicine teacher as “the assessment tool” in competency-based education in family medicine
2. explain Continuous Reflective Assessment For Training as an educational construct and strategy for acheiving training for competence
3. use the Fundamental Teaching Activities Framework to explore the skills teachers need to use the Continuous Reflective Assessment For Training approach

Description:
Continuous Reflective Assessment For Training (CRAFT) is the descriptive process of how competency-based assessment can be achieved in our family medicine training programs. The Fundamental Teaching Activities (FTA) Framework describes the skills all teachers need to enhance family medicine training. The integration of these two models in this workshop will address the barriers family medicine teachers experience in learner assessment. Through an interactive format using facilitated discussion and role play, participants will gain an understanding of the components and process of assessment and identify the teaching skills all preceptors need. An action plan for teacher development will conclude this workshop so participants leave with concrete steps that can be used to enhance their own teaching and contribute to this development in their own programs.

Speakers

Clinical

T89: Dangerous Ideas Soapbox / Tribune aux idées dangereuses

03:00 PM 04:00 PM Room | Salle : 710B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. acquire new perspectives on the scope of and approach to primary care practice, innovation, and research
2. understand new, leading-edge, and unusual issues in family practice
3. discuss ideas with national and international colleagues that touch on the breadth and scope of family practice and primary care

Objectifs d’apprentissage :
1. Acquérir de nouvelles façons de percevoir la portée et l’approche de la pratique en soins primaires, de l’innovation et de la recherche
2. comprendre les nouveaux enjeux de pointe et inhabituels en médecine familiale
3. entretenir des discussions pour générer des idées entre collègues au Canada et dans le monde sur la portée de la pratique de médecine familiale et des soins primaires

Description:
The Dangerous Ideas Soapbox has hosted enthusiastic audience debates about how best to improve patient care or the health care system since its debut at FMF 2013. This session offers a platform for four finalist family physician innovators to share an important idea that isn’t being heard but needs to be heard in the family medicine community. A dangerous idea could be controversial, completely novel thinking or something that challenges current thinking. But it must also demonstrate a commitment to moving the idea forward to make a difference. Each speaker will have three minutes to explain the idea, then audience members have eight minutes to challenge and critique the presenters. The audience will vote to decide the most potent dangerous idea. All finalist ideas will be published in Canadian Family Physician.

Description :
Depuis ses débuts au FMF 2013, la Tribune aux idées dangereuses a été la scène de débats passionnés avec l’auditoire quant à la meilleure façon d’améliorer les soins/le système de santé. Cette séance offre à quatre finalistes la possibilité de partager une idée importante qui passe inaperçue, mais qui devrait être répandue dans a communauté de médecine familiale. Une idée dangereuse peut prêter à controverse, être très créative et nouvelle, ou encore aller à l’encontre de la façon actuelle de penser. Il faut cependant qu’il y ait un engagement à aller de l’avant, à vouloir changer les choses. Chaque conférencier disposera de 3 minutes pour présenter son idée, puis l’auditoire aura 8 minutes pour débattre et pour critiquer les présentations. L’auditoire votera ensuite pour déterminer l’idée dangereuse la plus puissante. Toutes les idées finalistes seront publiées dans Le Médecin de famille canadien.
Clinical
Choosing Wisely | Screening | Preventative Medicine | Choisir avec soins | Dépistage | Prévention

T494: The Adult Periodic Health Examination: Screening and Prevention / Les examens médicaux périodiques des adultes : le dépistage et la prévention

03:00 PM 04:00 PM Room | Salle : 517BC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. provide an evidence-based periodic health exam to an adult patient
2. order appropriate screening tests based on relevant patient demographics
3. counsel patients on the use of appropriate resources and on health promotion

Objectifs d’apprentissage :
1. faire passer un examen médical périodique fondé sur les données probantes à un patient adulte
2. prescrire des tests de dépistage appropriés selon des données démographiques pertinentes sur les patients
3. conseiller le patient sur l’utilisation de ressources adéquates et sur la promotion de la santé

Description:
With the replacement of the annual physical with the new periodic health examination, physicians are struggling to adopt this new practice. Understanding the relevant recommendations and the evidence behind them, will aid in managing clinical practice and counselling patients. A comprehensive review of the most relevant and recent guidelines will be presented, with a focus on, but not limited to, the recommendations of the Canadian Task Force on Preventive Health Care and the Choosing Wisely Canada program.

Description :
Depuis que « l’examen physique annuel » a été remplacé par le nouvel examen médical périodique, les médecins ont du mal à adopter cette nouvelle pratique. Avec une bonne compréhension des recommandations pertinentes et des données probantes qui les appuient, il deviendra plus facile de gérer la pratique clinique et de conseiller les patients. Cette présentation consiste en une étude approfondie des lignes directrices les plus pertinentes publiées récemment. Sans toutefois s’y limiter, elle portera surtout sur les recommandations du Groupe d’étude canadien sur les soins de santé préventifs et du programme Choisir avec soin.

Speakers

Clinical

T103: Diabetes in the Hospitalized Patient

03:00 PM 04:00 PM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. identify the target glucose for hospitalized patients
2. recognize the impact of comorbidities on glucose control and choices of treatment
3. prescribe sliding scales confidently

Description:
Recent years have seen the introduction of multiple new classes of agents for the treatment of diabetes. This poses particular challenges for the physician caring for diabetic patients when they are admitted to the hospital, whether it be for a primary diabetic complication or for another acute problem. Some specific issues include the impact of an acute illness on glucose levels (especially acute kidney injury and sepsis), the potential side effects of newer agents, and the safe and appropriate use of insulin sliding scales. For this presentation I will briefly review the classes of agents currently being used to treat diabetes, with particular emphasis on newer agents. I will discuss their mechanism(s) of action, metabolism, and potential side effects (including the risk of hypoglycemia). I will then discuss the appropriate goals of care for diabetic patients as it relates to glucose targets and blood pressure. Next I will present a rational approach to the (re)prescribing of the patient’s current diabetic medications in the context of their acute medical and/or surgical problem(s),including kidney disease, infections, etc. I will then present an approach to the use of insulin sliding scales. Lastly I will present a couple of clinical vignettes illustrating some of the principles that have been discussed. At the conclusion of this talk you should confidently be able to care for your patients with diabetes admitted to the hospital.

Speakers

Maternity and Newborn Care | Soins de maternité et de périnatalité
Respiratory Medicine | Médecine respiratoire

T65: Dyspnea in Your Pregnant Patient: Does it make YOU short of breath?

03:00 PM 04:00 PM Room | Salle : 516C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. understand the relevance of changes in respiratory physiology in pregnancy
2. review the respiratory complications of and in pregnancy
3. review the safety of investigations and treatments in pregnancy

Description:
Your pregnant patient presenting to you is actually two patients. She can get respiratory illness like anyone else, and there are specific respiratory complications that occur due to the pregnancy. This session will review the changes in the respiratory system that occur because of pregnancy and how they present clinically. Respiratory illnesses can present differently in pregnancy, and of course their treatments and investigations may need to be modified due to concerns regarding fetal safety. Similarly, there are specific respiratory risks to the mom due to being pregnant that need to be evaluated and treated.

Speakers

T333: La prise de décisions interprofessionnelle partagée avec les patients aux besoins de soins complexes

03:00 PM 05:15 PM Room | Salle : 524A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Objectifs d’apprentissage :
1. définir les patients aux besoins de soins complexes et leurs besoins décisionnels (situations où des options doivent être soupesées)
2. identifier les besoins décisionnels prioritaires et les facteurs favorisant ou entravant la prise de décisions
3. participer à la création d’un outil d’aide à la décision interprofessionnelle partagée

Description :
Les patients aux besoins de soins complexes souffrent d’une combinaison de maladies chroniques multiples, de problèmes de santé mentale, d’interactions médicamenteuses et de vulnérabilité sociale, pouvant conduire à une surutilisation ou une sous-utilisation des services de santé. Ces patients, leurs familles, leurs aidants naturels et leurs praticiens (ci-après les parties prenantes) font face à des conflits décisionnels reliés à des incertitudes et des désaccords quant aux options possibles. Le manque de connaissances sur les situations prioritaires où les options doivent être soupesées (besoins décisionnels clés) entrave l’application d’interventions efficaces pour favoriser une prise de décisions interprofessionnelle partagée avec les patients aux besoins de soins complexes. Une revue systématique financée par les IRSC et combinée à une étude qualitative appuyée par l’Unité SOUTIEN SRAP du Québec a permis de produire une liste de besoins décisionnels concernant les patients aux besoins de soins complexes et les grands utilisateurs de services. Cette évaluation des besoins décisionnels a permis d’identifier, selon la perspective des parties prenantes : (1) les types de décisions les plus difficiles à prendre ; (2) les raisons des conflits décisionnels ; (3) les obstacles à la prise de décisions interprofessionnelle partagée ; (4) les formats possibles d’outils d’aide à la décision pour les patients aux besoins de soins complexes. La première partie de l’atelier présentera les résultats de l’évaluation des besoins décisionnels des patients aux besoins de soins complexes et des grands utilisateurs des services. Dans la deuxième partie, les participants se réuniront en petits groupes pour classer ces besoins décisionnels en ordre de priorité. L’activité se conclura par une séance plénière où chaque équipe partagera ses réflexions. Les participants détermineront comment ces résultats peuvent informer la conception d’un outil de prise de décisions interprofessionnelle partagée avec les patients aux besoins de soins complexes et quelle forme cet outil pourrait prendre.

Speakers

Global Health | Santé mondiale

T358: So You’re Interested in Global Health? Taking the Next Steps

03:00 PM 05:15 PM Room | Salle : 523AB

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. explore the various pathways in global health and identify which activities meet their individual learning goals
2. tackle effective global health projects and initiatives
3. take the first steps to participate as CFPC members with WONCA Polaris and other international family medicine networks

Description:
The World Health Organization defines global health as “the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.” This panel discussion will bring together leaders in global health to discuss their journeys in the field. Global health is diverse and involves everything from responding to crises as front-line health workers, to being leaders in health policy and research, to making health equity a priority in your own community. Learn from panelists about a variety of ways to get involved and hear their suggestions about making global health a part of family practice.

Speakers

Research | Recherche

T493: MedEd Research 102: I have a research question, now what? Research design basics

03:00 PM 05:15 PM Room | Salle : 510D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. describe common medical education scholarship methodologies
2. explain the importance of matching a specific research question to a research methodology
3. plan a medical education scholarship project with appropriate methodology and analysis to match the research question

Description:
Do you already have a research question, but need a primer on methods to help you get started designing your education scholarship project? This workshop is for you, whether you want to explore if your innovation is having an effect on the learning and/or understanding of learners, or examine what is really happening in the minds of learners as they progress through a learning experience. The easiest part of medical education research and scholarship is deciding what interests you the most. Once that initial “I wonder” has been formulated as a research question, the next step is to design a project thoughtfully in order to get the most meaningful results. One of the biggest pitfalls that novice medical education researchers encounter is that they plan and carry out a study, only to discover that the results cannot be analyzed or interpreted in a way that gives the researcher the information they wanted to know. A bit of planning saves a lot of frustration. In this highly interactive workshop, participants will be given a whirlwind tour through the most common qualitative and quantitative research methodologies, with lots of resources for later viewing. As well, basic approaches to data analysis will be presented briefly. Participants will work with the presenters and with each other to determine which methodology is most appropriate to their research question. They will receive guidance about how to decide what data to collect, and what to consider regarding data analysis. Particular attention will be given to the importance of matching the research question to an appropriate research method. Presenters will also provide some possible resources that participants can explore at their own institutions to help support their medical education research. Participants will leave the workshop with a preliminary plan for a medical education research project.

Speakers

Teaching | Precepting | Enseignement | Supervision

T148: Addressing Physician Boundary Violations: Education tools and strategies for students, residents, and physicians

03:00 PM 05:15 PM Room | Salle : 510A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 2

Learning Objectives:

1. discuss physician-patient boundary transgressions, including risk factors and prevention for both the learner and practising physician
2. examine physician professional identify formation, including predictable transitions and their relevance to the teaching of physician-patient boundary issues
3. apply tools and strategies for teaching about physician-patient boundary issues applicable to preceptor clinical settings or learner academic sessions

Description:
Maintaining clear professional boundaries is critical to the therapeutic relationship physicians have with patients. Although the physician-patient relationship is based on trust, the relationship is characterized by an imbalance of power in favour of the physician with the patient in a position of vulnerability. Therapeutic boundaries are important as they shape respective roles and expectations for both parties. Boundary transgressions vary from the subtle to the obvious and can be categorized into crossings or violations. Crossing are departures from usual practices that are not exploitive and can sometimes be helpful to the patient, while violations are exploitive and always harmful to the patient. Serious violations, including sexual contact between a physician and a patient, often develop as the final stage of a series of boundary crossings. Physician professional identity formation provides a useful framework for the teaching of both the therapeutic physician-patient relationship and boundary transgressions to both students and residents. Important principles to incorporate in the teaching of physician-patient boundary issues include: individual risk factors for learners and practising physicians; preventive strategies that incorporate self-care, , and support structures; and knowledge of provincial medical regulatory policies and reporting requirements. Discussions with learners should also include potential educational boundary transgressions that require familiarity with training program and institutional polices on harassment and intimidation. Teaching tools and strategies will be incorporated into the session that are relevant to the preceptor in their personal clinical setting, learner academic session, or curriculum development responsibilities.

Speakers

Clinical
Occupational Medicine | Médecine du travail

T332: Return to Work Following Concussion: Is prolonged rest best?

03:00 PM 04:00 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. determine which industries present the greatest risk of concussion
2. use knowledge of the neurometabolic changes that accompany a concussive incident in treatment decisions
3. implement evidence-based clinical guidelines to assist in assessment, treatment, and accommodation in the workplace

Description:
Although concussion receives substantial attention in sports, this discussion will centre on concussion in the workplace. Workers with mild to moderate concussion or mild traumatic brain injury form the largest brain-injured group requiring treatment and accommodation in Canada. Understanding the neurometabolic changes related to concussions provides the treating physician with valuable guidance when prescribing rest and accommodation in the workplace. This presentation will concentrate on simplifying concussion assessment and treatment using evidence-based guidelines that will ideally improve our approach to return to work.

Speakers

Clinical
First Five | Resident | Student | Cinq premières années de pratique | Résident | Étudiant

T133: Back to the Future: The family physicians of today meet the family physicians of tomorrow

03:00 PM 04:00 PM Room | Salle : 522ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. provide valuable insights into a career as a family physician
2. discuss opportunities in family medicine and ease the transition into practice for family medicine residents
3. provide mentorship from the 2017 Family Physicians of the Year as well as peer support

Description:
In Back to the Future, the family physicians of today meet the family doctors of tomorrow. This session allows students and residents to speak with the recipients of the Reg L. Perkin Awards who are named as Canada’s Family Physicians of the Year. This unique opportunity allows students and residents to ask questions regarding work/life balance and transitioning into family medicine practice, and to discuss the challenges and rewards they may face. This session also provides the opportunity for award winners to share their insights and experiences from when they were starting out in family medicine.

Speakers

Clinical
Emergency Medicine | Médecine d’urgence

T386: Office Emergencies / Urgences à la clinique

04:15 PM 05:15 PM Room | Salle : 710B

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. learn how to prepare your office for emergencies
2. learn an approach to common office emergencies, including anaphalaxis
3. learn an approach to common office emergencies, including chest pain

Objectifs d’apprentissage :
1. les participants apprendront comment préparer leur clinique pour faire face aux urgences
2. les participants apprendront une approche pour faire face aux urgences courantes dans les cliniques, y compris les réactions anaphylactiques
3. les participants apprendront une approche pour répondre aux urgences dans les cliniques, y compris pour la douleur thoracique

Description:
Emergencies and potentially acutely ill patients occasionally present to our offices. This session will help participants prepare their offices for emergencies. In addition, participants will learn approaches to common office emergencies. These include chest pain and anaphylaxis.

Description :
Des cas urgents et des patients dans un état potentiellement aigu se présentent occasionnellement dans nos cliniques. Cette séance aide les participants à préparer leur clinique pour mieux réagir aux urgences. De plus, les participants apprendront diverses approches pour répondre aux urgences courantes dans les cliniques, y compris la douleur thoracique et les réactions anaphylactiques.

Speakers

Clinical
Cancer Care | Soins aux patients atteints du cancer
Emergency Medicine | Médecine d’urgence

T225: Les Urgences Oncologiques

04:15 PM 05:15 PM Room | Salle : 515ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Objectifs d’apprentissage :
1. décrire les urgence oncologiques les plus fréquentes
2. révisez la prise en charge initiale des urgences oncologique
3. discuter de l'approche au sujet des niveaux interventions a la salle d'urgence

Description :
Au terme de la conférence, l'auditoire, autant ceux qui pratiquent en clinique, en milieu hospitalier ou à l'urgence vont être en mesure d'identifier et de prendre en charge efficacement les urgences oncologiques les plus fréquentes. Les sujets couverts, notamment les métastases cérébrales, les compressions médullaires métastatiques, les épanchements malins, le syndrome de la veine cave supérieure (et bien d'autres!) seront révisés. Les participants auront la chance d'intervenir pour approfondir leurs connaissances ou bien pour discuter d'interventions ciblées dans le contexte particulier de leur milieu de travail.

Speakers

Clinical
Practice Management | Gestion de la pratique

T474: An Online Guided Practice Assessment Tool to Support Individual Learning and Practice Improvement

04:15 PM 05:15 PM Room | Salle : 521ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. access the online (e-COACH) self-assessment tool for practice improvement
2. list the steps involved in developing an individualized learning plan for practice improvement
3. develop a personal context-relevant, practice improvement question to apply to the online e-coach self-assessment tool

Description:
It is broadly accepted that physicians are poor at self-assessment. As a result, it is difficult for practitioners to identify personal learning needs. In an era of practice improvement and physician enhancement programs, family physicians require support identifying and addressing knowledge and practice gaps. The University of British Columbia Continuing Professional Development Division and the BC College of Family Physicians collaborated to design and pilot an online guided self-assessment tool that walks family physicians through the process of identifying and addressing personal learning needs. This workshop will briefly review the evidence for supported self-assessment in practice improvement. It will engage participants in a discussion about current challenges with implementing and sustaining practice quality improvement initiatives. The main portion of the session will introduce participants to the newly developed online tool that guides the learner through identifying and defining a personal learning issue, often a clinical or practice-based question. Participants will work in small groups, using the tool, through the different steps of defining a practice query, formulating a researchable question, and collecting objective practice data to more accurately gauge the practice issue. Once the sources are identified (and reviewed) the learner is guided through outlining measurements of indicators for improvement and developing a practice improvement action plan. The table work will allow participants to use the tool and explore some of the embedded resources. The goal of the session is to not only introduce participants to the tool but to demonstrate how individual learning needs can be (more) objectively identified and how quality improvement can be done in active practice. The tool has been certified for three credits per hour, up to eight hours, and is expected to be open source.

Speakers

Clinical
Cardiology | Cardiologie

T302: Canadian Cardiovascular Society Heart Failure Guidelines: Top five take-aways for the family physician

04:15 PM 05:15 PM Room | Salle : 710A

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. discuss advances in the diagnosis and prevention of heart failure by reviewing results of new trials
2. update knowledge and decision making around risk assessment of patients and optimal pharmacological and nonpharmacological treatment options
3. align heart failure prevention and treatment strategies to integrate the new 2017 Canadian Cardiovascular Society Heart Failure Guidelines into daily clinical practice

Description:
Heart failure remains a common diagnosis and continues to be associated with significant morbidity and mortality. It presents in many different guises and circumstances that require individualized therapy. In 2017 the Canadian Cardiovascular Society (CCS) Heart Failure Guideline Panel published a comprehensive update to consolidate 10 years of annual guideline updates. This comprehensive guideline forms the basis of high-quality care for patients with heart failure and underpins the development of best practices. In this presentation members of the CCS Heart Failure Guideline Panel will present key messages from the 2017 heart failure update and highlight new evidence from a family physician perspective. Using cases to illustrate relevant clinical applications and guideline recommendations, presenters will discuss: 1) how heart failure is preventable, supported by evidence that treating cardiovascular risk factors and ventricular dysfunction leads to fewer patients developing heart failure; 2) the emerging role of biomarkers and risk scores; that natriuretic peptides have become the gold standard biomarkers in heart failure for diagnosis, prognosis, and monitoring disease activity; and that risk scores should be incorporated into practice and used to convey heart failure risk to patients; 3) how to titrate medications, including newly available heart failure treatment options with an emphasis on novel pharmacological approaches; 4) the role of implantable devices, the evidence supporting their recommendation, and how to choose the right option and time for referring your patient; and 5) advanced therapies and what you need to know about therapeutic options for patients with very advanced heart failure.

Speakers

Clinical
Health Care of the Elderly | Soins aux personnes âgées
Pharmacology | Pharmacologie

T254: Identifying Potentially Harmful Medications When Prescribed Inappropriately in Patients With Chronic Kidney Disease

04:15 PM 05:15 PM Room | Salle : 524C

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. recognize the common causes of adverse drug reactions and implement steps within your practice to help prevent them
2. identify a list of commonly prescribed, potentially harmful medications when used inappropriately for patients with chronic kidney disease
3. determine which medications should be dose-adjusted or avoided in patients with decreased kidney function

Description:
Adverse drug reactions (ADRs) are a public health problem in Canada. Approximately 3 per cent to 6 per cent of hospital admissions are due to ADRs, resulting in significant costs to the health care system. Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) are at increased risk for ADRs, including acute kidney injuries, due to the nephrotoxic effects of certain drugs. Inappropriate drug dosing, particularly for those drugs that rely on kidney function for elimination, also remains a challenge for this patient population as it often represents an older demographic with patients taking numerous medications for multiple comorbidities. It is difficult for primary care providers to access a list of commonly prescribed, potentially harmful medications in those patients with CKD or ESRD. The development of such a list would contribute to an effective strategy to reduce and prevent patient harm. The Ontario Renal Network, a provincial government agency, is responsible for overseeing and funding the delivery of kidney disease services across Ontario. It has committed to developing tools and resources for hospitals and primary care providers by 2019 to reduce the incidence of avoidable harm in people with, or at risk of, kidney disease. In the past year a literature review was conducted to identify commonly prescribed medications associated with harm to patients with CKD, followed by a modified Delphi method to generate a nationally accepted list of inappropriate medications and those requiring dose adjustment for patients with compromised renal function. The Delphi panel included representation from across Canada with participation from nephrologists, pharmacists, clinical pharmacologists, and family physicians. This lecture will use interactive case-based scenarios to provide an evidence-informed list of common medications prescribed by primary care providers that need to be used cautiously in patients with CKD. Office workflow strategies to prevent ADRs will also be presented.

Speakers

Clinical
Child and Adolescent Health | Santé de l’enfant et de l’adolescent

T311: Implications of Early Peanut Introduction in Family Medicine

04:15 PM 05:15 PM Room | Salle : 512ABEF

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. assess the current international guideline on early peanut introduction
2. consider the implications for primary care of early introduction of allergenic foods in Canada
3. explore emerging Canadian guidelines on food introduction and allergy prevention

Description:
In early 2017 an international guideline on peanut allergy prevention was released recommending early peanut introduction in high-risk infants. However, there remain practical issues that may affect the feasibility and tolerability of early peanut introduction in infants. For example, a study by the session’s authors noted knowledge gaps nationally among pediatricians, family physicians, and allergists in the definition of a high-risk infant, the knowledge of which infants require evaluation prior to peanut introduction, and how to counsel parents about the introduction of other allergenic foods. In addition, there remain national issues (such as long wait-list times for allergist evaluation) identified in this survey that may affect successful implementation of this guideline. The goal of this session is to review the newly released guideline, explore the practical implications for family physicians in various practice settings, and attempt to provide practical recommendations for counselling on food introduction in infants. In addition, one of the session’s authors is working on a Canadian Paediatric Society practice point about food introduction, which ideally will be released prior to FMF. The session will also review this practice point’s recommendations. Particular attention will be placed on the potential care gaps revealed in our research and other literature. The session will provide a balanced approach to responding to this paradigm shift of early introduction with practical and realistic strategies.

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe =
1

Speakers

Dermatology | Dermatologie

CANCELLED T520: Dermoscopy: Chaos and clues—Benign versus malignant lesions

04:15 PM 05:15 PM

CANCELLED 

Speakers

Pharmacology | Pharmacologie
Addiction Medicine | Médecine des toxicomanies

T248: Weeding Through the Evidence for Medical Marijuana 2.0 / Derrière la fumée 2.0 : Distinguer les données probantes concernant la marijuana médicale

04:15 PM 05:15 PM Room | Salle : 517BC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. identify the evidence for the use of dried cannabis, including edibles, in the treatment of medical conditions
2. determine key factors related to cannabis in specific populations, including children, adolescents, pregnant women, and people with mental health disorders
3. use the guidance document for decision making, including requests for prescriptions, recommendations for driving, and identification of cannabis use disorders

Objectifs d’apprentissage :
1. identifier les données probantes sur l’utilisation du cannabis séché, y compris les produits comestibles, dans le traitement de troubles médicaux
2. déterminer les facteurs clés reliés à la consommation de cannabis chez certaines populations, y compris les enfants, les adolescents, les femmes enceintes et les personnes souffrant de troubles de santé mentale
3. Utiliser le document d’orientation pour la prise de décision, y compris en ce qui concerne les demandes de prescription, les recommandations au sujet de la conduite automobile et le dépistage des troubles liés à la consommation de cannabis

Description: This workshop continues from last year’s well-attended “Weeding Through the Evidence for Medical Marijuana.” During this case-based presentation, participants will continue to use the CFPC’s Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance document to guide clinical decision making for authorizing cannabis use in chronic pain, particularly neuropathic pain. With the emergence of edible marijuana products, this workshop will also address the evidence and risks associated with these products. Specific attention will be paid to children, youth, pregnant and breastfeeding women, and individuals with comorbid mental health issues. Specific issues such as the identification and management of cannabis use disorder and driving will be addressed. Addressing challenges presented from requests for prescription cannabis will be discussed. Evidence from the preliminary guidance document as well as recent updates in the literature will be presented.

Description :
Cette présentation fait suite à l’atelier très populaire de l’année dernière qui s’intitulait « Derrière la fumée : Distinguer les données probantes concernant la marijuana médicale ». Au cours de cette présentation basée sur des cas, les participants continueront d’utiliser le document de’orientation préliminaire pour guider leur prise de décision clinique en ce qui concerne l’autorisation de l’usage du cannabis pour le soulagement de la douleur chronique, particulièrement la douleur neuropathique. Avec l’émergence des produits comestibles, cet atelier portera également sur les données probantes et les risques qui leur sont associés. Une attention particulière sera portée sur les enfants, les jeunes, les femmes enceintes ou qui allaitent, ainsi que les personnes souffrant de troubles de santé mentale en comorbidité. En outre, nous aborderons des enjeux précis tels que le dépistage et la prise en charge de troubles liés à la consommation de cannabis, et la conduite automobile. La discussion portera également sur les défis que présentent les demandes de cannabis d’ordonnance. De plus, des données probantes tirées du document d’orientation préliminaire ainsi que les récentes nouveautés dans la littérature seront présentées.

Speakers

Clinical
Women's Health | Santé des femmes
Mental Health | Santé mentale

T82: Mood Disorders in Women During the Reproductive Years

04:15 PM 05:15 PM Room | Salle : 514ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. review the impact of, manifestations of, diagnostic criteria for, and treatment options for mood disorders in reproductive-age women
2. highlight specific mood disorders affected by hormonal fluctuation during the menstrual cycle, pregnancy, postpartum, and peri-menopause
3. apply learning pearls through case material

Description:
This session will seek to improve the participants’ awareness of the impact of, manifestations of, diagnostic criteria for, and treatment options for mood disorders in reproductive-age women. Factors increasing suicidal risk will be reviewed. Specific mood disorders associated with or affected by hormonal fluctuation during the menstrual cycle, pregnancy, postpartum, and peri-menopause will be highlighted. A focus will be placed on premenstrual syndrome to define it, recognize its impact on health and society, review the etiology and pathophysiology, highlight clinical assessment tools, and explore treatment options. Learning pearls will be applied through case material.

Speakers

Clinical

T565: Mainpro+ Continuing Professional Development Program Certification (Repeat)

04:15 PM 05:15 PM Room | Salle : 522ABC

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. explain the basic requirements for Mainpro+ certification
2. define the minimum requirements for one-credit-, two-credit-, and three-credit-per-hour certification
3. provide examples of activities that meet the definition of Group Learning, Self-Learning, and Assessment credit categories

Description:
 This session will provide a high-level overview of the standards and processes for program certification in Mainpro+. The session will cover eligible topics, conflict of interest requirements, and submission requirements. We will review frequently asked questions related to Mainpro+ certification and program development. The intent of this session is to prepare continuing professional development program developers to complete and submit an application for Mainpro+ certification.

Speakers

Respiratory Medicine | Médecine respiratoire

T115: Respiratory Medicine: Five top articles for 2017

04:15 PM 05:15 PM Room | Salle : 517D

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe = 1

Learning Objectives:

1. review five top articles in respiratory medicine relevant to your clinical practice
2. learn how to apply new information to your practice
3. learn new ideas in respiratory medicine

Description:
Executive of the Respiratory Medicine Program Committee of the Section of Communities of Practice in Family Medicine will review five top articles in respiratory medicine from this year. Learn what is new in the literature; we will make all the articles clinically relevant to you. We had a packed house the past two years; you do not want to miss this!

Speakers

Emergency Medicine | Médecine d’urgence
Respiratory Medicine | Médecine respiratoire

T102: Airway Intervention and Management in Emergencies (AIME) Repeat session

07:30 AM 05:30 PM Room | Salle : 516b

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 18  

Learning Objectives:
1. be more confident and comfortable in making acute care airway management decisions
2. acquire a practical staged approach to airway management
3. be able to choose the most appropriate method of airway management based on a variety of patient presentations

Description:
The Airway Intervention and Management in Emergencies (AIME) course has been providing valued and practical hands-on airway management learning experiences for clinicians around the world for more than 15 years. AIME educators are experienced (and entertaining) clinical instructors who understand the varied work environments of practising clinicians. Whether you work in a large, high-volume centre or a small, remote setting, AIME will provide a practical approach for airway management in emergencies. AIME program highlights include: case-based clinical decision making; new practical algorithms; when, why, and how to perform awake or rapid sequence intubation; a new textbook/manual based on the AIME program; unique, customized clinical videos; limited registration to ensure a clinician-to-instructor ratio of 5:1 or 6:1; clinician-to-simulator ratios of 2:1; reinforcement of core skills; an introduction to newer alternative devices (e.g., optical stylets, video laryngoscopes); and exposure to rescue devices (e.g., King laryngeal tubes, LMA Supreme).

Speakers

Palliative Care | Soins palliatifs

T450: Learning Essential Approaches to Palliative Care (LEAP) Mini Course for Family Physicians in Community-Based Settings

07:30 AM 06:00 PM Room | Salle : 511e

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 16.5  

Learning Objectives:
1. identify patients who require a palliative care approach early and implement a generalist-level palliative care approach
2. manage symptoms and psychosocial/spiritual needs at a generalist level
3. undertake essential conversations

Description:
LEAP Mini is an intensive one-day course (total of 8.5 hours) geared toward health care professionals on the front lines of community-based care, including family physicians, nurses, social workers, and pharmacists working in community-based settings. It is highly interactive and uses different learning methods, including case-based learning and small group discussions. This particular LEAP course at this FMF is limited to 30 learners and will have two facilitators. LEAP Mini has been accredited by the College of Family Physicians of Canada for 16.5 certified Group Learning Mainpro+ credits. LEAP Mini consists of 9 modules: Taking Ownership (includes identifying patients who would benefit from a palliative care approach); Advance Care Planning and Decision-Making; Nausea, Hydration and Nutrition; Pain; Delirium; Dyspnea; Psychosocial-spiritual Distress; Essential Conversations; and Last Days and Hours. Participants will do a short self-assessment of knowledge, comfort, and attitudes prior to the course and identify areas for quality improvement in their practices after the course. Participants will receive copies of The Pallium Pocketbook as a resource.

Speakers

T338: Treating Poverty

07:30 AM 05:30 PM Room | Salle : 511f

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 18  

Learning Objectives:
1. intervene in poverty using the Poverty Tool and guide patients to relevant income benefit programs
2. critically assess income benefit programs that require physician input
3. build and empower a team to address poverty and social determinants of health and advocate for patients living in poverty

Description:
Poverty represents a significant and reversible risk factor for poor health. This practical, active learning workshop supports the development of relevant clinical skills, a deeper understanding of the federal and provincial income security systems, and other related resources including the Poverty Tool, which is now available for all provinces. Participants will explore key online resources during the workshop and are required to bring a laptop or tablet to fully participate. This workshop is a Signature Program of the Ontario College

Speakers

Sport Medicine | MSK | Orthopedics | Médecine du sport | MSK | Orthopédie
Emergency Medicine | Médecine d’urgence

T256: CASTED: Emergency - 1 Day hands-on orthopedics course

07:30 AM 06:30 PM Room | Salle : 520ad

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 18  

Learning Objectives:
1. discuss important orthopedic principles as they apply to caring for Emergency Department patients
2. describe the ED assessment, diagnosis and management of acute extremity injuries that are common, commonly missed and commonly mismanaged
3. perform fracture and dislocation reduction techniques with emphasis on proper splinting, moulding and positioning of various ED injuries

Description:
CASTED: Emergency is the 'hands-on' ED orthopedics course. It is a full-day, Mainpro+ and MOC accredited course, designed specifically for ED physicians and staff. Case-based lectures highlight ED orthopedic principles and clinical pearls while reviewing over 80 pediatric and adult extremity injuries. Focus is on the common, the commonly missed, and the commonly mismanaged. Over 4 hours of 'hands-on' time provides extensive demonstration and practice of reduction and casting/splinting techniques. Numerous tips are offered on splinting, moulding and reduction. Closely supervised 'hands-on' practice ensures you will have the confidence you are doing it right! By the end of the day, you will know 'red flags' to beware of; which patients need a reduction; how to properly reduce, immobilize and mould; which patients need follow-up; and how quickly they need to be seen. You are promised a day full of humour and numerous clinical pearls you will use on your next shift! Since 2008, CASTED has been presented over 200 times across the country. It has received numerous awards including the CFPC's Continuing Professional Development Award for providing 'an exceptional learning experience'.

Speakers

Emergency Medicine | Médecine d’urgence
Cardiology | Cardiologie

T164: ECGs for Family Docs: A comprehensive workshop

10:00 AM 05:00 PM Room | Salle : 511d

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 10  

Learning Objectives:
1. understand clinically relevant electrophysiology
2. use electrophysiology to identify axis, hypertrophy, block, arrhythmias, and ST changes
3. investigate and treat patients based on their ECG findings

Description:
This session will review the clinically relevant electrophysiology that will move participants beyond simple pattern recognition of ECG interpretation. Based on the physiology, participants will actively interpret groups of ECGs for axis, hypertrophy, block, arrhythmias, and ST changes in a progressive fashion. We will then use the ECG interpreation to disposition and investigate patients in an efficient and safe fashion.

Speakers

T184: Improving Quality/Safety in Family Practice: Learning and teaching from significant event analysis

01:30 PM 05:15 PM Room | Salle : 511a

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 6  

Learning Objectives:
1. identify common characteristics and examples of significant events in family practice/primary care
2. identify and use four core components of significant event analysis
3. determine and examine the family practice/primary care implications of the death of a young Albertan, Greg Price

Description:
In 2017 more than 34,000 Canadians will die at the hands of the health system. It is estimated that one Canadian dies of a preventable error every 17 minutes. Unfortunately, little will be learned or acted on because of bureaucracies, a “name, blame, and shame” culture, and inappropriate attention to confidentiality. Learning from one another’s mistakes and errors requires a willingness to discuss what happened; why it happened; what can be learned; and what to do to prevent this from happening again. Learning is essential to improving the quality and safety of Canada’s health services systems. Since most health services error data are derived from the hospital sector, Canada is blind to the realities of non-hospital error and poor performance. Dr. Kerr White’s seminal paper on the ecology of medical care suggests that for every hospital admission, approximately 28 interactions occur in the community (250:9). Family physicians have direct or indirect knowledge/responsibility concerning errors/mistakes/close calls contributing to an individual’s death, adverse experience, or poor outcome, no matter where they occur within the system. While some countries mandate/support family practice/primary care documenting and analyzing these significant events through a national database, Canada has yet to consider/establish a family practice-led initiative. This workshop introduces participants to: the essentials of the University of Alberta Department of Family Medicine’s Quality and Safety in Family Practice/Primary Care Program; the definition and documentation of significant events; the fundamentals of significant event analysis; and a family practice/primary care analysis of Greg Price’s death. Greg Price, a young Albertan, died as the result of poor follow-up and a consultation/referral system that is a shambles. Canadian family physicians can no longer turn a blind eye to their own, their colleagues’, and the system’s poor performance. It’s time to talk and share. It’s time to make a difference.

Speakers

Mental Health | Santé mentale
Health Care of the Elderly | Soins aux personnes âgées

T422: Behavioural and Psychological Symptoms of Dementia: Applying the P.I.E.C.E.S. framework for effective clinical management

01:30 PM 05:15 PM Room | Salle : 511a

Mainpro+ Group Learning certified credits / Crédits certifiés Mainpro+ d’apprentissage en groupe= 6  

Learning Objectives:
1. assess and interpret behavioural and psychosocial problems seen in patients affected by dementia living at home or in long-term care
2. present the risks, benefits, and appropriate doses of medications that are currently recommended for BPSD
3. support health-care team members in monitoring common side effects of drugs that may be used in the treatment of BPSD

Description:
Participants will access and interpret common behavioural and psychosocial problems seen in patients affected by dementia, whether they live at home in the community or in a long-term-care home. The presentation will focus on the risks, benefits, and appropriate dose ranges of medications that are currently recommended for BPSD. In addition it will support health care team members in the monitoring of common side effects of drugs that may be used in the treatment of BPSD. Furthermore, health-care team members will be knowledgeable in the utilization of the P.I.E.C.E.S. assessment framework and the application of principles outlined in U-FIRST for the implementation of non-pharmaceutical approaches. This Group Learning program has been certified by the College of Family Physicians of Canada for up to 6 Mainpro+ credits and it is part of the CPD program of the Ontario College of Family Physicians.

Speakers