Graduating Otolaryngology Residents’ Ideal Practice Expectations: A Longitudinal Analysis

Objective Prior literature has indicated that the number of trained otolaryngologists required to meet the need of our growing population may be insufficient. Therefore, identifying trends in the subspecialty composition of future otolaryngology practices will elucidate workforce needs. Study Design One-page anonymous questionnaire. Setting The survey was completed by examinees at the conclusion of their American Board of Otolaryngology–Head and Neck Surgery oral examination from 2011 to 2019. Methods Data included age, gender, fellowship, practice type, and ideal future practice components. Results A total of 2286 examinees were included: 58.1% were male and 57.2% completed a fellowship. Ideal practice specialties included general otolaryngology (19%), rhinology (15%), head and neck (13%), and pediatrics (11%). General and pediatric otolaryngology had a negative correlation over time ( r = −0.81, P = .01, and r = −0.75, P = .03, respectively). An overall 45% of graduates reported 1 ideal practice area ( r = 0.61, P = .10), with a statistically significant decline in the number of ideal practice areas over time ( r = −0.79, P = .018). Men more commonly reported allergy, head and neck, otology, rhinology, and sleep medicine as part of their ideal practice ( P < .05), while women more commonly reported pediatric otolaryngology ( P < .05). There was a higher mean number of ideal practice areas among men than women (2.58 vs 2.1, P < .001). Conclusion There is a growing trend for more specialized otolaryngology practices. The data demonstrate a decline in considering general and pediatrics otolaryngology as part of practices, which portends a gap in access to comprehensive otolaryngology in the future.

Organizational-Cultural Elements for Improved Workplace Performance of Disabled Individuals

This chapter embarks from the increasing number of disabled individuals in private companies and public institutions and examines the working conditions of disabled employees in these organizations. Although this case is relevant to a considerable number of international contexts, the author focuses on Turkey as a case, illustrative of countries going through similar processes. The author starts by providing an introduction followed by literature on organizational culture. Next, the author discusses the recent legislation regarding the employment of disabled individuals and discusses with literature on their workplace performance. Next, the author focuses on the relationships between the organizational culture and workplace performance of disabled employees. Finally, the author concludes by recommendations for future practice to enhance performance of disabled employees and future research to conduct robust studies in the area. The chapter assumes that organizations can enhance performance of everyone by creating an inclusive culture surrounded by elements involving positive attitudes, equity, equality, and beliefs of productivity.

Orem’s Self-Care Deficit Nursing Theory: Relevance and Need for Refinement

The purpose of this article is to highlight the relevance of Orem’s Self-Care Deficit Nursing Theory (SCDNT) in contemporary and future practice, explicitly within the global self-care movement and interprofessional healthcare. The authors discuss the relevance and important strengths within Orem’s nursing theory and recommend theoretical refinement within the context of significant societal and healthcare transformation. The constructs of global people-centered care and population health, with related social determinants of health, are identified as critical areas for development if SCDNT is to have continued relevance for nursing practice. Implications for theoretical thinking and nursing education are recommended.

Keeping doors open: A cross-sectional survey of family physician practice patterns during COVID-19, needs, and intentions

Objective: To determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors. Methods: Between March and June 2021, we conducted a cross-sectional survey using email, fax, and phone of 1,186 family doctors practicing comprehensive family medicine in Toronto, Ontario. We asked about practice patterns in January 2021, use of virtual care, and practice intentions. Results: Of the 1,016 (86%) that responded to the survey, 99.7% (1001/1004) indicated their practice was open in January 2021 with 94.8% (928/979) seeing patients in-person and 30.8% (264/856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on phone visits and an additional 5.8% on video and 7.5% on email. 17.2% (77/447) were planning to close their current practice in the next five years. There was a higher proportion of physicians who worked alone in a clinic among those who did not see patients in-person (27.6% no vs 12.4% yes, p<0.05), did not see symptomatic patients (15.6% no vs 6.5 % yes, p<0.001), and those who planned to close their practice in the next 5 years (28.9% yes vs 13.9% no, p<0.01). Interpretation: The vast majority of family physicians in Toronto were open to in-person care in January 2021 but almost one-fifth are considering closing their practice in the next five years. Policy-makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.

Who are the music student teachers in Norwegian generalist teacher education?

This study is based on data from a national survey of generalist student teachers specialising in music in the new five-year primary and lower secondary school teacher education programme in Norway. The study aims to map students’ backgrounds, experiences of the educational programme and visions for their future practice as generalist music teachers in schools. The theoretical perspective is cultural-historical activity theory (CHAT). The findings suggest that generalist teacher education music programmes reproduce patterns of inequality. These patterns should be addressed in the future development of the programmes; however, the current lack of diversity may inhibit conditions for transformation and change.

Leading through the first wave of COVID: a Canadian action research study

Purpose This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future. Design/methodology/approach The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology. Findings Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication. Research limitations/implications The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders’ views of what may be required to re-define future health systems may change as the crisis shifts over time. Practical implications The sponsoring organization of this research – the Canadian Health Leadership Network and each of its individual member partners – will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery. Social implications This research has shown that there is an immediate need to develop innovative and influential leadership action – commensurate with its findings – to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations. Originality/value An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19’s first wave using action research study design.

Pivots, pirouettes and practicalities: Actions and reactions of work-integrated learning practitioners

One impact of the global pandemic of 2020 was a rapid shift in the delivery of work-integrated learning (WIL) to remote activity among WIL practitioners, students and educators alike. Along with professional practice research in higher degrees, WIL practice, including placements and non-placements, responded actively and sometimes reactively to the challenges of sudden transition to online environments. What strategies - pivots and pirouettes - did WIL practitioners use to weather the storm of Covid-19? What does this tell us about the nature of WIL? This paper captures the seemingly overnight response to shifting work-based learning to online and other spaces. With change came the opportunity to reflect on the varying areas of WIL: from the practical processes of ensuring students are cared for to pivoting to the learning opportunities it presented in building digital literacies and adapting to the global future of work. This study is a Trans-Tasman collaboration of four WIL practitioners exploring their responsiveness to disruption in WIL contexts. We present collective autoethnographic responses to such themes as disruption, becoming resilient, pivoting to change, changing perceptions of WIL and the legacies of the pandemic. These themes apply to learners and educators alike, and our words embody the experiences of both groups. Our responses to phenomena highlighted this need for resilience and agility. Methodologically, the researchers’ micro-narrative responses to key themes structure themselves into a macro-narrative that demonstrates the lived experiences of the researchers as educators in the WIL space and explores implications for ongoing and future practice.

The COVID-19 Saga: Myths, Allegories and the Aftermath for Contemporary and Future Practice

The mythical fight of Heracles against the Hydra presents an allegory to the fight of humanity against the COVID-19 pandemic. The rational interpretation of the myth can help people understand the intricacies of the management of healthcare crises. Combined with this, the myth can also create respect for healthcare workers and inspire individuals to take positive action in the fight against COVID-19. Although myths have been regarded as a threat to public health, mythological elements and allegories can become potent tools of health promotion.

Taking the Pulse of POCUS: The State of Point-of-Care Ultrasound at a Pediatric Tertiary Care Hospital

We aim to quantify and categorize point-of-care ultrasound (POCUS) usage by pediatric practitioners and trainees at our tertiary care center, and assess the degree of interest from pediatric residents, fellows, and program leaders for integrating POCUS into their training. Data was collected via online survey, evaluating the current use of POCUS in clinical decision making, desire for further formal training, and opinions on the importance of POCUS to future clinical practice. In total, 14 program directors/assistant program directors (PD/APDs) representing 10 of 15 training programs, 30 of 95 fellows representing 9 of 15 fellowships, and 32 of 82 residents responded. From PD/APDs, only 2 of the programs reported active use POCUS for clinical decision making, but 13 of the fellows and 9 residents reported doing so. In regard to desire for a formal POCUS program, 30.8% of PD/APDs, 43.8% of fellows without current curricula, and 87.5% of residents were interested in participating in such a program. When considering specialty, some non-acute care-based PD/APDs and fellows at our institution felt that POCUS was important to future practice. Pediatric subspecialty PD/APDs and their fellows had divergent outlooks on the importance of POCUS in future practice. Finally, an overwhelming majority of residents at our institution expressed a desire to learn, and half believing it will be important to future practice. Based on the degree of interest, medicolegal considerations, and trajectory of patient care, pediatric residency and fellowship programs should strongly consider integrating POCUS education into their curricula.