A qualitative study of resident and early-career family physicians’ focused practice choices in Canada

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. Aim: We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Design and Setting: We analyzed a subset of qualitative interview data from a study across British Columbia, Ontario, and Nova Scotia. Method: A total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practice in a focused area were included in our analysis. We compared participant types, provinces, and the degree of focused practice while identifying themes related to factors influencing the pursuit of focused practice. Results: We identified three key themes of factors contributing to choices of focused practice: self-preservation within the current health care system, support from colleagues, and experiences in medical school and/or residency. Minor themes included alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. Conclusion: Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the health care system. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce.

The epidemiological impact of the Canadian COVID Alert App

We analyzed the effectiveness of the Canadian COVID Alert app on reducing COVID-19 infections and deaths due to the COVID-19 virus using two separate, but complementary approaches, were taken. First, we undertook a comparative study to assess how the adoption and usage of the COVID Alert app compared to those of similar apps deployed in other regions. Next, we used data from the COVID Alert server and a range of plausible parameter values to estimate the numbers of infections and deaths averted in Canada using a model that combines information on number of notifications, secondary attack rate, expected fraction of transmissions that could be prevented, quarantine effectiveness, and expected size of the full transmission chain in the absence of exposure notification. The comparative analysis revealed that the COVID Alert app had among the lowest adoption levels among apps that reported usage. Our model indicates that use of the COVID Alert app averted between 6,284 and 10,894 infections across the six Canadian provinces where app usage was highest during the March - July 2021 period. This range is equivalent to 1.6%-2.9% of the total recorded infections across Canada in that time. Using province-specific case fatality rates, 57-101 deaths were averted during the same period. The number of cases and deaths averted was greatest in Ontario, whereas the proportion of cases and death averted was greatest in Newfoundland and Labrador. App impact measures were reported so rarely and so inconsistently by other countries that the relative assessment of impact is inconclusive. While the nationwide rates are low, provinces with widespread adoption of the app showed high ratios of averted cases and deaths (upper bound was greater than 60% of averted cases). Our findings suggest that the COVID Alert app, when adopted at sufficient levels, can be an effective public health tool for combatting a pandemic such as COVID-19.

Evaluating the impacts of non-pharmaceutical interventions on the transmission dynamics of COVID-19 in Canada based on mobile network

The COVID-19 outbreak has caused two waves and spread to more than 90% of Canada’s provinces since it was first reported more than a year ago. During the COVID-19 epidemic, Canadian provinces have implemented many Non-Pharmaceutical Interventions (NPIs). However, the spread of the COVID-19 epidemic continues due to the complex dynamics of human mobility. We develop a meta-population network model to study the transmission dynamics of COVID-19. The model takes into account the heterogeneity of mitigation strategies in different provinces of Canada, such as the timing of implementing NPIs, the human mobility in retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, and residences due to work and recreation. To determine which activity is most closely related to the dynamics of COVID-19, we use the cross-correlation analysis to find that the positive correlation is the highest between the mobility data of parks and the weekly number of confirmed COVID-19 from February 15 to December 13, 2020. The average effective reproduction numbers in nine Canadian provinces are all greater than one during the time period, and NPIs have little impact on the dynamics of COVID-19 epidemics in Ontario and Saskatchewan. After November 20, 2020, the average infection probability in Alberta became the highest since the start of the COVID-19 epidemic in Canada. We also observe that human activities around residences do not contribute much to the spread of the COVID-19 epidemic. The simulation results indicate that social distancing and constricting human mobility is effective in mitigating COVID-19 transmission in Canada. Our findings can provide guidance for public health authorities in projecting the effectiveness of future NPIs.

Charting the Rise of School Choice across Canadian Provinces: A Policy Index

This article introduces and discusses the findings of the Canada School Choice Policy Index (CSCPI). This is the first index of its kind that measures the development of school choice policies across the Canadian provinces from 1980 to 2020 using eight unique indicators of choice. In contrast to other countries in the Organisation for Economic Co-operation and Development (OECD), the CSCPI reveals that although Canada has witnessed an increase in school choice over time, this increase has largely been contained within public education systems rather than in the expansion of private education options. Our findings raise the importance of future research to address growing choice in public education systems across the provinces, in addition to choice in the private sphere.

Online Remote Proctoring Software in the Neoliberal Institution: Measurement, Accountability, and Testing Culture

As COVID-19 spread in early 2020, a lockdown was implemented across Canadian provinces andterritories, resulting in the shuttering of physical post-secondary campuses. Universities quicklypivoted to remote learning, and faculty members adjusted their instructional and assessmentapproaches to align with virtual environments. Presumably to aid with this process, a number ofinstitutions acquired licenses to remote online proctoring services. This paper examines theresearch around online remote proctoring, examining the justification offered for the adoption ofonline remote proctoring, and contemporary research on assessment practices in higher education.Throughout the paper, I demonstrate a lack of research that speaks to the efficacy of this mode ofassessment while also acknowledging shifts in the testing environment, and an increase in studentanxiety. I argue that online remote proctoring is not only embedded within neoliberalism and auditculture, but supports a continued reliance on testing culture. It concludes with a discussion ofassessment culture, offering some alternative assessment approaches that might disrupt the veryneed for online remote proctoring. Keywords: Online remote proctoring, assessment, testing

COVID-19 Vaccination Mandates and Vaccine Uptake

We evaluate the impact of government mandated proof of vaccination requirements for access to public venues and non-essential businesses on COVID-19 vaccine uptake. We find that the announcement of a mandate is associated with a rapid and significant surge in new vaccinations (more than 60% increase in weekly first doses) using the variation in the timing of these measures across Canadian provinces in a difference-in-differences approach. Time-series analysis for each province and for France, Italy and Germany corroborates this finding, and we estimate cumulative gains of up to 5 percentage points in provincial vaccination rates and 790,000 or more first doses for Canada as a whole as of October 31, 2021 (5 to 13 weeks after the provincial mandate announcements). We also find large vaccination gains in France (3 to 5 mln first doses), Italy (around 6 mln) and Germany (around 3.5 mln) 11 to 16 weeks after the proof of vaccination mandate announcements.JEL codes: I18, I12, C23