Pub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.4103/cjrm.cjrm_27_24
Druvtej Ambati, Karen Lemay, Anne Steen, Shan Jin, Jeffrey Smith, Gary E Garber
<p><strong>Introduction: </strong>Anaesthesiologist medico-legal risk is well reported in the literature, however, there is little data regarding the medico-legal risk of family practice anaesthetists (FPAs) in Canada. We aimed to describe the expert criticisms from medico-legal cases involving family physicians providing care within the scope of anaesthesia.</p><p><strong>Methods: </strong>Medico-legal cases involving FPAs providing anaesthesia-related care were identified from a national repository at the Canadian Medical Protective Association. Civil legal cases, medical regulatory authority (college) complaints and hospital complaints were included in the descriptive analysis where medical coding was available. Cases were closed between 1 January 2013 and 31 December 2022.</p><p><strong>Results: </strong>There were 50 medico-legal cases involving 50 FPAs providing anaesthesia-related care to 50 patients. At least half of the cases involved American Society of Anaesthesiologists Physical Status Classification I and II patients in an outpatient or ambulatory setting. Thirty patients experienced healthcare-related harm, of which most were classified as moderate, severe or death. Expert criticisms were mainly associated with situational awareness, clinical decision-making, documentation and communication issues with the patient, family or substitute decision-maker.</p><p><strong>Conclusion: </strong>This study presents family physicians providing anaesthesia-related care with an opportunity to increase their awareness of commonly identified expert criticisms from medico-legal cases related to their area of practice. While the medico-legal risk we report is predominantly associated with provider and team factors, the retrospective nature of medico-legal cases makes the assessment of system factors difficult and thus requires further investigation. Nonetheless, FPAs are pivotal to and growing in number in the Canadian healthcare context and, therefore, this study could contribute to developing targeted training and education programmes to promote patient safety within their scope of practice.</p><p><strong>Introduction: </strong>Les risques médico-légaux auxquels sont exposés les anesthésiologistes sont bien étayés par la littérature. En revanche, peu de données ont été publiées sur les risques médico-légaux auxquels font face les médecins de famille exerçant l'anesthésie au Canada. Dans cette étude, nous avons cherché à décrire les critiques formulées par des expertes et experts dans des dossiers médico-légaux qui mettent en cause des médecins de famille prodiguant des soins qui relèvent de l'anesthésie.</p><p><strong>Mthodes: </strong>Des dossiers médico-légaux portant sur des médecins de famille prodiguant des soins ayant trait à l'anesthésie ont été recensés dans une base de données d'envergure nationale à l'Association canadienne de protection médicale. Des actions civiles, des plaintes auprès d'organismes de réglementation de la médecine (Col
{"title":"Ten-year retrospective study on medico-legal risk of family physicians providing anaesthesia care in Canada, 2013-2022.","authors":"Druvtej Ambati, Karen Lemay, Anne Steen, Shan Jin, Jeffrey Smith, Gary E Garber","doi":"10.4103/cjrm.cjrm_27_24","DOIUrl":"10.4103/cjrm.cjrm_27_24","url":null,"abstract":"<p><strong>Introduction: </strong>Anaesthesiologist medico-legal risk is well reported in the literature, however, there is little data regarding the medico-legal risk of family practice anaesthetists (FPAs) in Canada. We aimed to describe the expert criticisms from medico-legal cases involving family physicians providing care within the scope of anaesthesia.</p><p><strong>Methods: </strong>Medico-legal cases involving FPAs providing anaesthesia-related care were identified from a national repository at the Canadian Medical Protective Association. Civil legal cases, medical regulatory authority (college) complaints and hospital complaints were included in the descriptive analysis where medical coding was available. Cases were closed between 1 January 2013 and 31 December 2022.</p><p><strong>Results: </strong>There were 50 medico-legal cases involving 50 FPAs providing anaesthesia-related care to 50 patients. At least half of the cases involved American Society of Anaesthesiologists Physical Status Classification I and II patients in an outpatient or ambulatory setting. Thirty patients experienced healthcare-related harm, of which most were classified as moderate, severe or death. Expert criticisms were mainly associated with situational awareness, clinical decision-making, documentation and communication issues with the patient, family or substitute decision-maker.</p><p><strong>Conclusion: </strong>This study presents family physicians providing anaesthesia-related care with an opportunity to increase their awareness of commonly identified expert criticisms from medico-legal cases related to their area of practice. While the medico-legal risk we report is predominantly associated with provider and team factors, the retrospective nature of medico-legal cases makes the assessment of system factors difficult and thus requires further investigation. Nonetheless, FPAs are pivotal to and growing in number in the Canadian healthcare context and, therefore, this study could contribute to developing targeted training and education programmes to promote patient safety within their scope of practice.</p><p><strong>Introduction: </strong>Les risques médico-légaux auxquels sont exposés les anesthésiologistes sont bien étayés par la littérature. En revanche, peu de données ont été publiées sur les risques médico-légaux auxquels font face les médecins de famille exerçant l'anesthésie au Canada. Dans cette étude, nous avons cherché à décrire les critiques formulées par des expertes et experts dans des dossiers médico-légaux qui mettent en cause des médecins de famille prodiguant des soins qui relèvent de l'anesthésie.</p><p><strong>Mthodes: </strong>Des dossiers médico-légaux portant sur des médecins de famille prodiguant des soins ayant trait à l'anesthésie ont été recensés dans une base de données d'envergure nationale à l'Association canadienne de protection médicale. Des actions civiles, des plaintes auprès d'organismes de réglementation de la médecine (Col","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":"31-38"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.4103/cjrm.cjrm_64_23
Aishwarya Roshan, Margot Gowans, Ian Scott
<p><strong>Introduction: </strong>Despite efforts by Canadian medical schools to recruit students who are intent on rural practice, rural communities in Canada still face disparities in their physician workforce. Our study aims to identify the variables which predict those physicians who will not only enter rural practice but will remain in rural practice.</p><p><strong>Methods: </strong>Between 2002 and 2004, 2070 Canadian 1st-year medical students were invited to participate in an entry survey delineating career choice, attitudes and sociodemographic data. Of these, 1542 were included in a 2013 analysis to assess the influences on early practice in rural family medicine (FM), and a total of 1530 were included in the current analyses to assess influences on both mid-career rural FM practice and rural FM retention. Variables identified by bivariate analyses as being associated with rural family practice were entered into backward stepwise logistic regression analyses to identify their relative predictive strength on choosing and sustaining a career in rural FM.</p><p><strong>Results: </strong>Of the 1530 physicians included in this study, where 88 (5.8%) physicians were practising in a rural setting in 2013, now 61 (4.0%) were practising rural FM with the remainder practising urban FM (n = 505; 33%) or speciality medicine (n = 964; 63%). Our study found that an early preference for rural practice, having parents with less formal education, being married or in a common-law relationship at medical school entry, coming from a smaller hometown and expressing a desire for a shorter postgraduate training on entry to medical school were predictive of mid-career rural practice location. We also found that having parents with postgraduate education and placing greater emphasis on medical lifestyle at medical school entry were predictive of a mid-career switch away from a rural practice location to a non-rural practice location.</p><p><strong>Conclusion: </strong>These characteristics can be considered by medical school leaders to support the recruitment of candidates to, and retention of, physicians in rural communities.</p><p><strong>Introduction: </strong>Malgré les efforts déployés par les facultés de médecine canadiennes pour recruter des étudiants désireux d'exercer en milieu rural, les communautés rurales du Canada sont toujours confrontées à des disparités au niveau de leurs effectifs médicaux. Notre étude vise à identifier les variables qui prédisent les médecins qui non seulement entreront dans la pratique rurale, mais y resteront.</p><p><strong>Mthodes: </strong>Entre 2002 et 2004, 2 070 étudiants canadiens en première année de médecine ont été invités à participer à un sondage d'entrée décrivant le choix de carrière, les attitudes et les données sociodémographiques. De ce nombre, 1 542 ont été inclus dans une analyse de 2013 visant à évaluer les influences sur la pratique précoce de la médecine familiale rurale (MF), et un total de 1 530 ont ét
{"title":"Predictors of sustained rural practice.","authors":"Aishwarya Roshan, Margot Gowans, Ian Scott","doi":"10.4103/cjrm.cjrm_64_23","DOIUrl":"10.4103/cjrm.cjrm_64_23","url":null,"abstract":"<p><strong>Introduction: </strong>Despite efforts by Canadian medical schools to recruit students who are intent on rural practice, rural communities in Canada still face disparities in their physician workforce. Our study aims to identify the variables which predict those physicians who will not only enter rural practice but will remain in rural practice.</p><p><strong>Methods: </strong>Between 2002 and 2004, 2070 Canadian 1st-year medical students were invited to participate in an entry survey delineating career choice, attitudes and sociodemographic data. Of these, 1542 were included in a 2013 analysis to assess the influences on early practice in rural family medicine (FM), and a total of 1530 were included in the current analyses to assess influences on both mid-career rural FM practice and rural FM retention. Variables identified by bivariate analyses as being associated with rural family practice were entered into backward stepwise logistic regression analyses to identify their relative predictive strength on choosing and sustaining a career in rural FM.</p><p><strong>Results: </strong>Of the 1530 physicians included in this study, where 88 (5.8%) physicians were practising in a rural setting in 2013, now 61 (4.0%) were practising rural FM with the remainder practising urban FM (n = 505; 33%) or speciality medicine (n = 964; 63%). Our study found that an early preference for rural practice, having parents with less formal education, being married or in a common-law relationship at medical school entry, coming from a smaller hometown and expressing a desire for a shorter postgraduate training on entry to medical school were predictive of mid-career rural practice location. We also found that having parents with postgraduate education and placing greater emphasis on medical lifestyle at medical school entry were predictive of a mid-career switch away from a rural practice location to a non-rural practice location.</p><p><strong>Conclusion: </strong>These characteristics can be considered by medical school leaders to support the recruitment of candidates to, and retention of, physicians in rural communities.</p><p><strong>Introduction: </strong>Malgré les efforts déployés par les facultés de médecine canadiennes pour recruter des étudiants désireux d'exercer en milieu rural, les communautés rurales du Canada sont toujours confrontées à des disparités au niveau de leurs effectifs médicaux. Notre étude vise à identifier les variables qui prédisent les médecins qui non seulement entreront dans la pratique rurale, mais y resteront.</p><p><strong>Mthodes: </strong>Entre 2002 et 2004, 2 070 étudiants canadiens en première année de médecine ont été invités à participer à un sondage d'entrée décrivant le choix de carrière, les attitudes et les données sociodémographiques. De ce nombre, 1 542 ont été inclus dans une analyse de 2013 visant à évaluer les influences sur la pratique précoce de la médecine familiale rurale (MF), et un total de 1 530 ont ét","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":"7-16"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.4103/cjrm.cjrm_77_24
Peter Hutten-Czapski
{"title":"Who is an author?","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_77_24","DOIUrl":"10.4103/cjrm.cjrm_77_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":"3"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.4103/cjrm.cjrm_62_24
Val Webber, Krisztina Bajzak, Diana L Gustafson
{"title":"Regarding Webber, V., Bajzak, K. and Gustafson, D. L. (2023). The impact of rurality on vulvodynia diagnosis and management: Primary care provider and patient perspectives. Canadian Journal of Rural Medicine, 28 (3), 107-115.","authors":"Val Webber, Krisztina Bajzak, Diana L Gustafson","doi":"10.4103/cjrm.cjrm_62_24","DOIUrl":"10.4103/cjrm.cjrm_62_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":"48-49"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.4103/cjrm.cjrm_76_24
Saurabh RamBihariLal Shrivastava
{"title":"Letter to the editor concerning '\"I'm on the coast and I'm on methadone:\" A qualitative study examining access to opioid agonist treatment in rural and coastal British Columbia'.","authors":"Saurabh RamBihariLal Shrivastava","doi":"10.4103/cjrm.cjrm_76_24","DOIUrl":"10.4103/cjrm.cjrm_76_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":"44-45"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-03-11DOI: 10.4103/cjrm.cjrm_6_24
Udoka Okpalauwaekwe, Carla Fehr, Taofiq Olusegun Oyedokun, Jon Witt
<p><strong>Introduction: </strong>Canada relies on international medical graduates (IMGs) to provide a significant proportion of primary care in rural communities. However, retaining IMGs in rural practices across Canada remains a challenge. We explored the literature to learn what factors influence IMGs' retention in rural practice and what has been recommended in the literature to address these factors.</p><p><strong>Methods: </strong>We focused search strategies on peer-reviewed literature sources (between 01 January 2012, and 31 December 2023) that explored and identified factors connected to the rural practice retention of IMGs in Canada (and areas transferable to the Canadian context).</p><p><strong>Results: </strong>Twenty of 1002 articles were selected. Factors were categorised as structural, professional, family, community and personal. Structural barriers identified included overall lack of support, limited access to tertiary care centres and unsustainable model of care. Professional challenges included physician burnout, limited mobility and limited scope of practice. Conversely, community integration, opportunities for spousal employment and accessible schools for children were the common facilitators of IMG retention. Key recommendations to enhance IMG retention that were identified, included: (1) providing fair contracts, funding supports, and balanced workloads; (2) having community-directed recruitment models to match physician expectations for income level, workload and spousal employment and (3) having physician-led retention support groups to help physicians adequately settle in.</p><p><strong>Conclusion: </strong>This study identified the barriers and facilitators to IMG retention in rural medicine and mapped out evidence-based recommendations for each factor. Engaging and tailoring support strategies unique to the needs of IMGs in rural communities would improve IMG retention.</p><p><strong>Introduction: </strong>Le Canada compte sur les diplômés internationaux en médecine (DIM) pour fournir une part importante des soins primaires dans les communautés rurales. Cependant, la rétention des DIM dans les pratiques rurales à travers le Canada reste un défi. Nous avons exploré la littérature pour connaître les facteurs qui influencent la rétention des diplômés internationaux en médecine (DIM) dans la pratique rurale et ce qui a été recommandé dans la littérature pour aborder ces facteurs.</p><p><strong>Mthodes: </strong>Nous avons axé nos stratégies de recherche sur des sources de documentation évaluées par des pairs (entre le 1er janvier 2012 et le 31 décembre 2023) qui exploraient et identifiaient des facteurs liés au maintien des DIM dans la pratique rurale au Canada, ainsi que les domaines transférables au contexte canadien.</p><p><strong>Rsultats: </strong>Sur 1 002 articles, vingt ont été sélectionnés. Les facteurs ont été classés en cinq catégories: structurels, professionnels, familiaux, communautaires et personnels. Les ob
{"title":"Factors influencing retention of International Medical Graduates in rural practice.","authors":"Udoka Okpalauwaekwe, Carla Fehr, Taofiq Olusegun Oyedokun, Jon Witt","doi":"10.4103/cjrm.cjrm_6_24","DOIUrl":"10.4103/cjrm.cjrm_6_24","url":null,"abstract":"<p><strong>Introduction: </strong>Canada relies on international medical graduates (IMGs) to provide a significant proportion of primary care in rural communities. However, retaining IMGs in rural practices across Canada remains a challenge. We explored the literature to learn what factors influence IMGs' retention in rural practice and what has been recommended in the literature to address these factors.</p><p><strong>Methods: </strong>We focused search strategies on peer-reviewed literature sources (between 01 January 2012, and 31 December 2023) that explored and identified factors connected to the rural practice retention of IMGs in Canada (and areas transferable to the Canadian context).</p><p><strong>Results: </strong>Twenty of 1002 articles were selected. Factors were categorised as structural, professional, family, community and personal. Structural barriers identified included overall lack of support, limited access to tertiary care centres and unsustainable model of care. Professional challenges included physician burnout, limited mobility and limited scope of practice. Conversely, community integration, opportunities for spousal employment and accessible schools for children were the common facilitators of IMG retention. Key recommendations to enhance IMG retention that were identified, included: (1) providing fair contracts, funding supports, and balanced workloads; (2) having community-directed recruitment models to match physician expectations for income level, workload and spousal employment and (3) having physician-led retention support groups to help physicians adequately settle in.</p><p><strong>Conclusion: </strong>This study identified the barriers and facilitators to IMG retention in rural medicine and mapped out evidence-based recommendations for each factor. Engaging and tailoring support strategies unique to the needs of IMGs in rural communities would improve IMG retention.</p><p><strong>Introduction: </strong>Le Canada compte sur les diplômés internationaux en médecine (DIM) pour fournir une part importante des soins primaires dans les communautés rurales. Cependant, la rétention des DIM dans les pratiques rurales à travers le Canada reste un défi. Nous avons exploré la littérature pour connaître les facteurs qui influencent la rétention des diplômés internationaux en médecine (DIM) dans la pratique rurale et ce qui a été recommandé dans la littérature pour aborder ces facteurs.</p><p><strong>Mthodes: </strong>Nous avons axé nos stratégies de recherche sur des sources de documentation évaluées par des pairs (entre le 1er janvier 2012 et le 31 décembre 2023) qui exploraient et identifiaient des facteurs liés au maintien des DIM dans la pratique rurale au Canada, ainsi que les domaines transférables au contexte canadien.</p><p><strong>Rsultats: </strong>Sur 1 002 articles, vingt ont été sélectionnés. Les facteurs ont été classés en cinq catégories: structurels, professionnels, familiaux, communautaires et personnels. Les ob","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":"17-30"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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