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To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

ObjectivesA large number of Canadians spend time in correctional facilities each year, and they are likely to have poor health compared to the general population. Relatively little health research has been conducted in Canada with a focus on people who experience detention or incarceration. We aimed to conduct a Delphi process with key stakeholders to define priorities for research in prison health in Canada for the next 10 years.SettingWe conducted a Delphi process using an online survey with two rounds in 2014 and 2015.ParticipantsWe invited key stakeholders in prison health research in Canada to participate, which we defined as persons who had published research on prison health in Canada since 1994 and persons in the investigators’ professional networks. We invited 143 persons to participate in the first round and 59 participated. We invited 137 persons to participate in the second round and 67 participated.Primary and secondary outcome measuresParticipants suggested topics in the first round, and these topics were collated by investigators. We measured the level of agreement among participants that each collated topic was a priority for prison health research in Canada for the next 10 years, and defined priorities based on the level of agreement.ResultsIn the first round, participants suggested 71 topics. In the second round, consensus was achieved that a large number of suggested topics were research priorities. Top priorities were diversion and alternatives to incarceration, social and community re-integration, creating healthy environments in prisons, healthcare in custody, continuity of healthcare, substance use disorders and the health of Aboriginal persons in custody.ConclusionsGenerated in an inclusive and systematic process, these findings should inform future research efforts to improve the health and healthcare of people who experience detention and incarceration in Canada.

Our study presents expert consensus-derived ultrasound competencies that should be considered during the design and implementation of procedural skills training for learners.

Background The rapid expansion of genetic knowledge, and the implications for healthcare has resulted in an increased role for Primary Care Providers (PCPs) to incorporate genetics into their daily practice. The objective of this study was to explore the self-identified needs, including educational needs, of both urban and rural Primary Care Providers (PCPs) in order to provide genetic care to their patients. Methods Using a qualitative grounded theory approach, ten key informant interviews, and one urban and two rural PCP focus groups (FGs) ( n = 19) were conducted. All PCPs practiced in Southeastern Ontario. Data was analyzed using a constant comparative method and thematic design. The data reported here represent a subset of a larger study. Results Participants reported that PCPs have a responsibility to ensure patients receive genetic care. However, specific roles and responsibilities for that care were poorly defined. PCPs identified a need for further education and resources to enable them to provide care for individuals with genetic conditions. Based on the findings, a progressive stepped model that bridges primary and specialty genetic care was developed; the model ranged from PCPs identifying patients with genetic conditions that they could manage alone, to patients who they could manage with informal or electronic consultation to those who clearly required specialist referral. Conclusions PCPs identified a need to integrate genetics into primary care practice but they perceived barriers including a lack of knowledge and confidence, access to timely formal and informal consultation and clearly defined roles for themselves and specialists. To address gaps in PCP confidence in providing genetic care, interventions that are directed at accessible just-in-time support and consultation have the potential to empower PCPs to manage patients’ genetic conditions. Specific attention to content, timing, and accessibility of educational interventions is critical to address the needs of both urban and rural PCPs. A progressive framework for bridging primary to specialty care through a ‘stepped’ model for providing continuing medical education, and genetic care can was developed and can be used to guide future design and delivery of educational interventions and resources.

Objectives: Emergency physicians who work in academic settings enjoy an expanding number of roles beyond that of the skilled clinician. Faculty development (FD) encompasses the broad range of activities that institutions use to renew skill-sets and assist faculty members in these multiple roles. This study seeks to define the current FD needs and interests of Canadian academic emergency physicians (AEPs). Methods: An online survey was administered to 943 AEPs in eight centers across Canada to determine their current FD activities, provide a detailed understanding of their FD needs and interests, elucidate the perceived barriers to and motivation for engaging in FD, and identify preferred methods of delivery for FD activities. Results: This national, cross-sectional survey was completed by 336 respondents. It shows that need for FD is universally high, particularly in traditional domains of scholarship, leadership and education (79%, 80%, 87% overall interest, respectively). However, the study also suggests that there is increasing need for FD in areas where current participation is lowest, namely research and social accountability (12% and 13% more interest, respectively). Senior and junior faculty evince equivalent overall FD interest (p > 0.05), whereas female AEPs expressed greater overall FD needs in leadership (1.82 vs 1.44 activities, p = 0.003) than males. Continued participation in FD activities is best promoted by offering relevant topics, at convenient times and locations. Conclusions: This study reports the first comprehensive national FD needs assessment of Canadian academic emergency physicians. Résultats: Au total, 336 participants ont répondu à l'enquête transversale, menée à l'échelle nationale. Les résultats ont révélé que les besoins de formation étaient grands partout, notamment dans les champs traditionnels de la mission professorale, de la direction et du pouvoir d'influence ainsi que de la formation (79 %, 80 % et 87 % respectivement, dans l'ensemble). Toutefois, l'étude semble également indiquer un besoin accru de FCP dans des champs où la participation est très faible, soit la recherche et la responsabilité sociale (augmentation de l'intérêt: 12 % et 13 % respectivement). Les membres du personnel, chevronnés comme débutants, ont fait état, dans l'ensemble, d'un intérêt comparable en matière de FCP (p > 0,05), tandis que les femmes MU qui enseignent en milieu universitaire ont exprimé, dans l'ensemble, des besoins plus grands de formation en matière de direction et de pouvoir d'influence que les hommes (activité: 1,82 contre 1,44; p = 0,003). Les activités de FCP qui suscitent le plus de participation, et ce, de manière continue, sont celles qui portent sur des sujets pertinents et qui se donnent au bon moment et au bon endroit. Conclusion: L'étude décrite ici fait état de la première évaluation globale, menée à l'échelle nationale, des besoins de formation des MU qui enseignent en milieu universitaire, au Canada.

A prospective long-term study of a general working-age population (16-74 yr) showed that the overall incidence of carpal tunnel syndrome over a 66-month period was 103 per 100 000 people per year (95% confidence interval [CI] 87-119), based on a clinical definition (i.e., clinical symptoms and signs).1 Among the high-risk occupational groups, "skilled trades" and "administrative and secretarial," the incidences were 136 (95% CI 115-158) and 82 (95% CI 64-99) per 100 000 people per year, respectively.

Background: The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990's resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen years, the Queen's University Family Medicine Development Program in Bosnia and Herzegovina played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited Bosnia and Herzegovina (B-H) 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, Health Center Directors and Association Leaders. Methods: Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes were analyzed using an interpretative phenomenological approach to identify major themes and subthemes. Results: Overall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1)