Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

01-12-2020 | Care | Research

Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study

Authors: Julie Massé, Sophie Dupéré, Élisabeth Martin, Martine C. Lévesque

Published in: International Journal for Equity in Health | Issue 1/2020

Login to get access

Abstract

Background

There are shortcomings in medical practitioners’ capacity to adapt to the particular needs of people experiencing circumstances of social vulnerability. Clinical traineeships create opportunities for the acquisition of knowledge, competencies, attitudes, and behaviors. However, some authors question the learnings to be made through classical clinical training pathways. This article explores the learnings gained from a traineeship experience within a community-based clinical setting intended for patients experiencing social vulnerability and operating under an alternative paradigm of care. To our knowledge, there is little research intended to identify and understand what medical trainees gain from their experience in such contexts.

Methods

This exploratory qualitative study is based on twelve interviews with practicing physicians who completed a traineeship at La Maison Bleue (Montreal, Canada) and three interviews conducted with key informants involved in traineeship management. Based on Mezirow’s theory of transformational learning, data were analyzed according to L’Écuyer’s principles of qualitative content analysis. NVivo software was used.

Results

The main learnings gained through the traineeship are related to (1) greater awareness of beliefs, assumptions and biases through prejudice deconstruction, cultural humility and critical reflection on own limitations, power and privileges; (2) the development of critical perspectives regarding the health care system; (3) a renewed vision of medical practice involving a less stigmatizing approach, advocacy, empowerment, interdisciplinarity and intersectorality; and (4) strengthened professional identity and future practice orientation including confirmation of interest for community-based practice, the identification of criteria for choosing a future practice setting, and commitment to becoming an actor of social change. Certain characteristics of the setting, the patients and the learner’s individual profile are shown to be factors that promote these learnings.

Conclusions

This article highlights how a traineeship experience within a clinical setting intended for a clientele experiencing circumstances of social vulnerability and operating under an alternative paradigm presents an opportunity for transformative learning and health practice transformation toward renewed values of health equity and social justice. Our findings suggest medical traineeships in community-based clinical settings are a promising lead to foster the development of fundamental learnings that are conducive to acceptable and equitable care for people experiencing social vulnerability.
Footnotes
1
Quebec is an eastern Canadian province. In Canada, roles and responsibilities for health care services are shared between the federal government and provincial and territorial governments. Provincial and territorial governments are responsible for the management and organization of health care services. In addition, they provide these services to their residents. In Quebec, the health system is public, with the State acting as the main insurer and administrator. Two universal regimes allow the entire population to obtain hospital and medical services at the expense of the State: the Hospitalization insurance plan (1961) and the Health insurance scheme (1970). In addition, some services are offered free of charge to specific groups, based on specific criteria. In addition, in 1997, the General drug insurance plan supplemented the public coverage of Quebec’s population. It is a universal blended plan, based on a partnership between the government and private insurers [6]
 
2
La Maison Bleue is operating under the status of a charity and non-profit organization, linked to the Quebec formal health and social services network by agreements with the CIUSSS of the territory. Three sites are in operation at the time of writing this article: La Maison Bleue de Côte-des-Neiges and La Maison Bleue de Parc-Extension which are both attached to the Centre-Ouest-de-l’Île-de-Montréal CIUSSS and then to La Maison Bleue de Saint-Michel, attached to the Est-de-l’Île-de-Montréal CIUSSS. Although they are not themselves considered FMG-U (FMG responsible for the provision of clinical training to medical learners) sites given the fact that their mission is limited to perinatal care and do not cover the whole spectrum of family care, the three Maisons Bleues are all part of a FMG-U (Maisonneuve-Rosemont for the Maison Bleue de Saint-Michel, Village Santé for the Maisons Bleues de Côte-des-Neiges and Parc-Extension). Thus, the doctors who work in the Maison Bleues are also clinical professors of the FMG-Us in the two CIUSSS.
 
3
Main front-line care organizational model within the Quebec health and social services network since 2000.
 
4
Some practices, such as those noted here, refer to symbolism, rites and customs specific to certain cultural groups. In some countries, for example, the baby’s eyebrows and eyelids are kohled to strengthen the power of the eye. Also, sometimes, dots are drawn on babies’ faces.
 
Literature
1.
Mikkonen J, Raphael D. Social determinants of health: the Canadian facts. Toronto: York University School of Health Policy and Management; 2010.
2.
Organisation Mondiale de la Santé. Combler le fossé en une génération: instaurer l’équité en santé en agissant sur les déterminants sociaux de la santé-Rapport final de le Commission des Déterminants Sociaux de la Santé. Genève: OMS; 2008.
3.
Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action. 2015;8(1):27106.PubMedCrossRef
4.
Whitehead M. The concepts and principles of equity and health. Health Promot Int. 1991;6(3):217–28.CrossRef
5.
6.
Ministère de la santé et des services sociaux. Le système de santé et de services sociaux au Québec, en bref. Québec: Gouvernement du Québec; 2017.
7.
Lasser KE, Himmelstein DU, Woolhandler S. Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. Am J Public Health. 2006;96(7):1300–7.PubMedPubMedCentralCrossRef
8.
Hutchison B. Disparities in healthcare access and use: yackety-yack, yackety-yack. Healthc Policy. 2007;3(2):10–3.
9.
Loignon C, Fortin M, Bedos C, Barbeau D, Boudreault-Fournier A, Gottin T, et al. Providing care to vulnerable populations: a qualitative study among GPs working in deprived areas in Montreal, Canada. Fam Pract. 2015;32(2):232–6.PubMedPubMedCentralCrossRef
10.
Lévesque MC. Transformer les pratiques professionnelles vis-à-vis des personnes prestataires de l’aide sociale: développement participatif et évaluation d'une formation continue en cabinet dentaire [Doctoral Thesis]. Montréal: École de santé publique de l'Université de Montréal; 2016.
11.
Levesque JF, Pineault R, Hamel M, Roberge D, Kapetanakis C, Simard B, et al. Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province. BMC Fam Pract. 2012;13:66.PubMedPubMedCentralCrossRef
12.
13.
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.PubMedPubMedCentralCrossRef
14.
Dupéré S. Rouge, jaune, vert… noir: être pauvre et s'en sortir selon des hommes en situation de pauvreté du quartier Hochelaga-Maisonneuve à Montréal. Recherches sociographiques. 2011;LII(2):255–283.
15.
Dupéré S, O'Neill M, De Koninck M. Why men experiencing deep poverty in Montréal avoid using health and social Services in Times of crisis. J Health Care Poor Underserved. 2012;23(2):781–96.PubMedCrossRef
16.
Loignon C, Hudon C, Goulet É, Boyer S, De Laat M, Fournier N, et al. Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project. Int J Equity Health. 2015;14:4.PubMedPubMedCentralCrossRef
17.
Brown JM, Patel M, Howard J, Cherry G, Shaw NJ. Changing clinical practice: significant events that influence trainees' learning. Educ Primary Care. 2011;22(1):25–31.CrossRef
18.
Allen D, Wainwright M, Mount B, Hutchinson T. The wounding path to becoming healers: medical students' apprenticeship experiences. Med Teach. 2008;30(3):260–4.PubMedCrossRef
19.
MacLeod A. Caring, competence and professional identities in medical education. Adv Health Sci Educ. 2011;16(3):375–94.CrossRef
20.
McNamara H, Boudreau JD. Teaching whole person Care in Medical School. In: Hutchinson TA, editor. Whole person care. Montréal: Springer; 2011. p. 183–200.
21.
Taylor JS, Wendland C. The hidden curriculum in Medicine's "culture of no culture". In: Hafferty FW, O'Donnell JF, editors. The hidden curriculum in health professional education. Hanover: Dartmouth College Press; 2014. p. 53–62.
22.
Frank JR, Snell L, Sherbino J. CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.
23.
Dharamsi S, Richards M, Louie D, Murray D, Berland A, Whitfield M, et al. Enhancing medical students' conceptions of the CanMEDS health advocate role through international service-learning and critical reflection: a phenomenological study. Med Teach. 2010;32(12):977–82.PubMedCrossRef
24.
25.
26.
27.
Bienkowska-Gibbs T, King S, Saunders CL, Henham M-L. New organisational models of primary care to meet the future needs of the NHS. A brief overview of recent reports. Santa Monica: RAND Corporation; 2015.
28.
29.
Lacy NL, Paulman PM, Hartman TL. The effect of preceptorship rurality on students' self-perceived clinical competency. Fam Med. 2005;37(6):404–9.PubMed
30.
Nyangairi B, Couper I, Sondzaba N. Exposure to primary healthcare for medical students: experiences of final-year medical students. S Afr Fam Pract. 2010;52(5):467–70.CrossRef
31.
Crampton PE, McLachlan JC, Illing JC. A systematic literature review of undergraduate clinical placements in underserved areas. Med Educ. 2013;47(10):969–78.PubMedCrossRef
32.
Barrett FA, Lipsky MS, Nawal LM. The impact of rural training experiences on medical students: a critical review. Acad Med. 2011;86(2):259–63.PubMedCrossRef
33.
Chin NP, Aligne CA, Stronczek A, Shipley LJ, Kaczorowski J. Evaluation of a community-based pediatrics residency rotation using narrative analysis. Acad Med. 2003;78(12):1266–70.PubMedCrossRef
34.
Loignon C, Gottin T, Valois C, Couturier F, Williams R, Roy P-M. Reflective practice and social responsibility in family medicine. Can Fam Physician. 2016;62(11):e699–704.PubMed
35.
Holmqvist M, Courtney C, Meili R, Dick A. Student-run clinics: opportunities for Interprofessional education and increasing social accountability. J Res Interprof Pract Educ. 2012;2(3):264–77.
36.
Lie D, Boker J, Gutierrez D, Prislin M. What do medical students learn from early clinical experiences (ECE)? Med Teach. 2006;28(5):479–82.PubMedCrossRef
37.
Mayer SD, Peterfy E, Crossman SH, Phipps LB, Vanderbilt AA. Patient-centeredness and empathy in a bilingual interprofessional primary care teaching clinic: a pilot study. J Multidiscip Healthc. 2016;9:395–9.PubMedPubMedCentralCrossRef
38.
Sheu LC, Zheng P, Coelho AD, Lin LD, O'Sullivan PS, O'Brien BC, et al. Learning through service: student perceptions on volunteering at Interprofessional hepatitis B student-run clinics. J Cancer Educ. 2011;26(2):228–33.PubMedCrossRef
39.
McNair R, Griffiths L, Reid K, Sloan H. Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study. BMC Med Educ. 2016;16:176.PubMedPubMedCentralCrossRef
40.
Mapukata-Sondzaba N, Dhai A, Tsotsi N, Ross E. Developing personal attributes of professionalism during clinical rotations: views of final year bachelor of clinical medical practice students. BMC Med Educ. 2014;14:146.PubMedPubMedCentralCrossRef
41.
42.
Mezirow J. Transformative dimensions of adult learning. San Francisco: Jossey-Bass; 1991.
43.
Mezirow J. Learning to think like an adult: Core concepts of transformation theory. Learn Transformation. 2000.
44.
Drisko J. Constructivist research in social work. Qual Res Soc Work. 2013:81–106.
45.
Guba EG, Lincoln YS. Paradigmatic controversies, contradictions, and emerging confluences. In: Denzin NK, Lincoln YS, editors. The Sage handbook of qualitative research. Thousand Oaks: SAGE Publications; 2005. p. 193–215.
46.
Mucchielli A. Dictionnaire des méthodes qualitatives en sciences humaines: Armand Colin; 2009.
47.
Trudel L, Simard C, Vonarx N. La recherche qualitative est-elle nécessairement exploratoire? Rech Qual. 2007:38–45.
48.
L'Écuyer R. Méthodologie de l'analyse développementale de contenu méthode GPS et concept de soi. Québec: Presses de l'Université du Québec; 1990.
49.
Drisko J, Maschi T. Content analysis: pocket guides to social work R; 2015.CrossRef
50.
Paul TJ, Mitchell A, Lagrenade J, McCaw-Binns A, Falloon D, Williams-Green P. More questions than answers? Expanding students' reflections from a community health experience. Educ Health. 2006;19(2):244–50.CrossRef
51.
Ratanawongsa N, Teherani A, Hauer KE. Third-year medical students' experiences with dying patients during the internal medicine clerkship: a qualitative study of the informal curriculum. Acad Med. 2005;80(7):641–7.PubMedCrossRef
52.
Hirsh D, Walters L, Poncelet AN. Better learning, better doctors, better delivery system: possibilities from a case study of longitudinal integrated clerkships. Med Teach. 2012;34(7):548–54.PubMedCrossRef
53.
van den Heuvel M, Au H, Levin L, Bernstein S, Ford-Jones E, Martimianakis MA. Evaluation of a social pediatrics elective transforming Students' perspective through reflection. Clin Pediatr. 2014;53(6):549–55.CrossRef
54.
Tremblay M-C, Richard L, Brousselle A, Beaudet N. Learning reflexively from a health promotion professional development program in Canada. Health Promot Int. 2014;29(3):538–48.PubMedCrossRef
55.
Loignon C, Boudreault-Fournier A, Truchon K, Labrousse Y, Fortin B. Medical residents reflect on their prejudices toward poverty: a photovoice training project. BMC Med Educ. 2014;14:1050.PubMedPubMedCentralCrossRef
56.
Loignon C, Haggerty JL, Fortin M, Bedos CP, Allen D, Barbeau D. Physicians' social competence in the provision of care to persons living in poverty: research protocol. BMC Health Serv Res. 2010;10(1):79.PubMedPubMedCentralCrossRef
57.
Tremblay M-C, Guichard A, Quinty J, Rheault C, Gravel C. Réflexi-vite. Québec: Université Laval; 2018.
58.
59.
Petty J, Metzl JM, Keeys MR. Developing and evaluating an innovative structural competency curriculum for pre-health students. J Med Humanit. 2017;38(4):459–71.PubMedPubMedCentralCrossRef
60.
Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Acad Med. 2014;89(11):1446–51.PubMedCrossRef
61.
Bearman M, Lawson M, Jones A. Participation and progression: new medical graduates entering professional practice. Adv Health Sci Educ. 2011;16(5):627–42.CrossRef
62.
Van Schalkwyk SC, Bezuidenhout J, De Villiers MR. Understanding rural clinical learning spaces: being and becoming a doctor. Med Teach. 2015;37(6):589–94.PubMedCrossRef
63.
Tamuz M, Giardina TD, Thomas EJ, Menon S, Singh H. Rethinking resident supervision to improve safety: from hierarchical to interprofessional models. J Hosp Med. 2011;6(8):445–52.PubMedCrossRef
64.
Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58.PubMedCrossRef
65.
Meili R, Ganem-Cuenca A, Leung JW-S, Zaleschuk D. The CARE model of social accountability: promoting cultural change. Acad Med. 2011;86(9):1114–9.PubMedCrossRef
Metadata
Title
Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study
Authors
Julie Massé
Sophie Dupéré
Élisabeth Martin
Martine C. Lévesque
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-01213-4

Other articles of this Issue 1/2020

International Journal for Equity in Health 1/2020 Go to the issue

Research

Intersectional equity in health care: assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden

Research

Sex differences in the management of persons with dementia following a subnational primary care policy intervention

Research

Improving public hospital efficiency and fiscal space implications: the case of Mauritius

Research

Landscapes of care and despair for rural youth – a qualitative study in the northern Swedish ‘periphery’

Letter to the Editor

“Pairing assistance”: the effective way to solve the breakdown of health services system caused by COVID-19 pandemic

Research

Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia