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Article ; Online: Productive struggle and failing safely: implications for developing adaptive expertise in communication.

Lynch, Jessica / Orsino, Angela / Kawamura, Anne

Advances in health sciences education : theory and practice

2022 Volume 27, Issue 5, Page(s) 1331–1344

Abstract: Navigating difficult conversations is a complex task that requires flexible and adaptive approaches. Residents developing this skill may initially struggle or fail, and require support. However, this experience may prepare residents for future learning ... ...

Abstract	Navigating difficult conversations is a complex task that requires flexible and adaptive approaches. Residents developing this skill may initially struggle or fail, and require support. However, this experience may prepare residents for future learning which is essential to adaptive expertise. Limited understanding of how residents learn from failure in the workplace restricts the ability to maximize its potential benefits. The purpose of this study was to explore the role failure plays in learning to navigate difficult conversations during workplace learning. A constructivist grounded theory study was conducted using semi-structured interviews of 13 physicians (subspecialty residents and newly graduated physicians) from a Division of Developmental Paediatrics between 2017 and 2018. The authors used constant comparative analysis to identify themes iteratively. Themes were identified both inductively and deductively using the conceptual framework of adaptive expertise. Through independently leading difficult conversations, physicians were able to recognize that the failure that occurred in these encounters, prompted them to generate new knowledge which led to deeper conceptual understanding, thus supporting development of adaptive expertise. However, participants indicated that staff physicians often protect residents from difficult conversations, which limits their opportunity to receive feedback and engage in learning. Residents participate in difficult conversations that challenge them to go beyond their existing knowledge. Providing residents with opportunity to lead difficult conversations with patients and families while being supported by staff supervisors, allows for struggling through learning, which leads to a deeper conceptual understanding and supports development of adaptive expertise.
MeSH term(s)	Child ; Humans ; Internship and Residency ; Physicians ; Communication ; Workplace ; Grounded Theory
Language	English
Publishing date	2022-11-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1352832-4
ISSN	1573-1677 ; 1382-4996
ISSN (online)	1573-1677
ISSN	1382-4996
DOI	10.1007/s10459-022-10175-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Navigating Challenging Conversations: The Interplay Between Inquiry and Knowledge Drives Preparation for Future Learning.

Kawamura, Anne A / Brown, Leah / Orsino, Angela / Zubairi, Mohammad S / Mylopoulos, Maria

Perspectives on medical education

2023 Volume 12, Issue 1, Page(s) 304–314

Abstract: Introduction: While some physicians hone their skills through informal learning in clinical practice, others do not. There is a lack of understanding of : Methods: This qualitative observational study involved over 100 hours of observation of eight ... ...

Abstract	Introduction: While some physicians hone their skills through informal learning in clinical practice, others do not. There is a lack of understanding of Methods: This qualitative observational study involved over 100 hours of observation of eight pediatric rehabilitation physicians as they interacted with patients and families at an academic teaching hospital in 2018-2020. Detailed field notes of observations, post-observation interviews, and exit interviews were the data sources. Data collection and analysis using a constructivist grounded theory approach occurred iteratively, and themes were identified through constant comparative analysis. Results: Through their daily work, experienced physicians employ 'habits of inquiry' by constantly seeking a better understanding of how to navigate challenging conversations in practice through monitoring and attuning to situational and contextual cues, taking risks and navigating uncertainty while exploring new and varied ways of practicing, and seeking why their strategies are successful or not. Discussion: Engaging in communication challenges drives physician learning through an interplay between habits of inquiry and knowledge: inquiry into how to improve their communication supported by existing conceptual knowledge to generate new strategies. These 'habits of inquiry' prompt continual reinvestment in problem solving to refine existing knowledge and to build new skills for navigating communication challenges in practice.
MeSH term(s)	Child ; Humans ; Physicians ; Communication ; Learning ; Physician-Patient Relations ; Data Collection
Language	English
Publishing date	2023-07-28
Publishing country	Netherlands
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2670231-9
ISSN	2212-277X ; 2212-277X
ISSN (online)	2212-277X
ISSN	2212-277X
DOI	10.5334/pme.949
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Article: Anxiety in children and youth: Part 2-The management of anxiety disorders.

Bobbitt, Susan / Kawamura, Anne / Saunders, Natasha / Monga, Suneeta / Penner, Melanie / Andrews, Debra

Paediatrics & child health

2023 Volume 28, Issue 1, Page(s) 52–66

Abstract: Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of ... ...

Abstract	Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.
Language	French
Publishing date	2023-02-28
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxac104
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Article: Les soins complets de l'enfant ayant la paralysie cérébrale et capable de marcher (GMFCS I et II) : une perspective canadienne.

Kawamura, Anne / Makino, Amber / McLeod, Scott

Paediatrics & child health

2020 Volume 25, Issue 6, Page(s) 397–398

Abstract: La paralysie cérébrale (PC), qui est l'incapacité physique la plus fréquente au Canada, touche de deux à trois personnes sur 1 000. Au cours de leur carrière, les pédiatres verront et soigneront à coup sûr des enfants ayant la PC et leur famille. Le ... ...

Abstract	La paralysie cérébrale (PC), qui est l'incapacité physique la plus fréquente au Canada, touche de deux à trois personnes sur 1 000. Au cours de leur carrière, les pédiatres verront et soigneront à coup sûr des enfants ayant la PC et leur famille. Le pédiatre général joue un rôle crucial dans les soins de l'enfant ayant la PC, qu'il s'agisse de poser le diagnostic ou d'assurer l'accès à une maison médicale (
Language	English
Publishing date	2020-09-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxaa101
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Article: Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): A Canadian perspective.

Kawamura, Anne / Makino, Amber / McLeod, Scott

Paediatrics & child health

2020 Volume 25, Issue 6, Page(s) 397–398

Abstract: In Canada, cerebral palsy (CP) is the most common physical disability, affecting approximately 2 to 3 per 1,000 individuals. Paediatricians are sure to encounter and care for children with CP and their families. The role of the general paediatrician in ... ...

Abstract	In Canada, cerebral palsy (CP) is the most common physical disability, affecting approximately 2 to 3 per 1,000 individuals. Paediatricians are sure to encounter and care for children with CP and their families. The role of the general paediatrician in caring for a child with CP is crucial, from diagnosis to providing a 'medical home', and from ensuring care coordination to delivering anticipatory guidance and preventive health and wellness care. The CP Health and Wellness Record that accompanies this practice point can assist both practitioners and children's families by exploring key areas of health, function, participation, and wellness. This record may be used alongside other evidence-based health promotion guides, such as the Rourke Baby Record and the Greig Health Record, to prompt clinicians caring for ambulatory children with CP (Gross Motor Function Classification System [GMFCS] levels I and II) on specific health issues and domains.
Language	English
Publishing date	2020-09-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxaa100
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Article: La promotion de l'évolution optimale de la santé mentale chez les enfants et les adolescents.

Arruda, Wilma / Bélanger, Stacey A / Cohen, Janice S / Hrycko, Sophia / Kawamura, Anne / Lane, Margo / Patriquin, Maria J / Korczak, Daphne J

Paediatrics & child health

2023 Volume 28, Issue 7, Page(s) 417–436

Abstract: Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex., l'accès à une équipe ... ...

Abstract	Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex., l'accès à une équipe multidisciplinaire) ni la formation nécessaires pour procéder à leur dépistage ou à leur prise en charge. Le présent document de principes conjoint décrit les principaux rôles et les principales compétences à maîtriser pour évaluer et traiter les problèmes de santé mentale chez les enfants et les adolescents, de même que les facteurs qui optimisent le plus possible l'évolution de la santé mentale dans ces groupes d'âge. Il contient des conseils fondés sur des données probantes à propos du dépistage des préoccupations en matière de santé mentale chez les jeunes et leur famille ainsi qu'à propos des échanges sur le sujet. Les interventions préventives et thérapeutiques dont l'efficacité est démontrée en milieu communautaire sont abordées. Le présent document de principes, qui est fondamental, traite également des changements à l'enseignement de la médecine ainsi qu'aux systèmes et aux politiques de santé qui s'imposent pour améliorer la pratique clinique et les efforts de revendications au Canada, y compris les modèles de rémunération appropriés, les approches des soins abordées étape par étape, le financement gouvernemental ciblé, l'enseignement et la formation professionnelle.
Language	English
Publishing date	2023-10-25
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxad033
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Article: Promoting optimal mental health outcomes for children and youth.

Arruda, Wilma / Bélanger, Stacey A / Cohen, Janice S / Hrycko, Sophia / Kawamura, Anne / Lane, Margo / Patriquin, Maria J / Korczak, Daphne J

Paediatrics & child health

2023 Volume 28, Issue 7, Page(s) 417–436

Abstract: While paediatric care providers are often the first point of contact for children or youth experiencing mental health challenges, they may lack the resources (e.g., access to a multidisciplinary team) or training to adequately identify or manage such ... ...

Abstract	While paediatric care providers are often the first point of contact for children or youth experiencing mental health challenges, they may lack the resources (e.g., access to a multidisciplinary team) or training to adequately identify or manage such problems. This joint statement describes the key roles and competencies required to assess and address child and youth mental health problems, and the factors that optimize outcomes in this age group. Evidence-informed guidance on screening for and discussing mental health concerns with young people and families is provided. Preventive and therapeutic interventions with demonstrated efficacy in community care settings are discussed. This foundational statement also focuses on the changes to medical education, health systems, and health policy that are needed to improve clinical practice and advocacy efforts in Canada, including appropriate remuneration models, stepped-care approaches, targeted government funding, and professional training and education.
Language	English
Publishing date	2023-10-25
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxad032
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Article ; Online: Examining the Impact of Dialogic Learning on Critically Reflective Practice.

Boyd, Victoria A / Woods, Nikki N / Kumagai, Arno K / Kawamura, Anne A / Orsino, Angela / Ng, Stella L

Academic medicine : journal of the Association of American Medical Colleges

2022 Volume 97, Issue 11S, Page(s) S71–S79

Abstract: Purpose: While research is beginning to reveal the potential of dialogue in sparking critical reflection (critically reflective ways of seeing), additional research is needed to guide the teaching of critical reflection toward enabling critically ... ...

Abstract	Purpose: While research is beginning to reveal the potential of dialogue in sparking critical reflection (critically reflective ways of seeing), additional research is needed to guide the teaching of critical reflection toward enabling critically reflective practice (critically reflective ways of seeing and doing). An experimental study was conducted to investigate the impact of dialogic learning on critically reflective practice, compared to discussion-based learning. The dialogic intervention integrated the theory of Mikhail Bakhtin with the theory of critical reflection and critical disability studies. Method: In interprofessional groups of 4, medical, occupational therapy, and speech-language pathology students were randomly assigned to a learning condition that used a reflective discussion or critically reflective dialogue about a pediatric patient case. All participants were then randomly assigned a clinical report for a novel pediatric patient and asked to write a hypothetical clinical letter to the child's school. Hierarchical logistic regression models were constructed to estimate the probabilities of sentences and letters being critically reflective. Results: The probability of sentences being critically reflective was significantly higher for the dialogue condition (0.26, 95% CI [0.2, 0.33]), compared to the discussion condition (0.11, 95% CI [0.07, 0.15]). Likewise, the probability of letters being critically reflective was significantly higher for the dialogue condition (0.26, 95% CI [0.15, 0.4]), compared to the discussion condition (0.04, 95% CI [0.01, 0.16]). In both conditions, the probability of a letter being critically reflective was positively associated with the proportion of critically reflective sentences. Conclusions: The results demonstrate dialogic learning prepared students to enact critically reflective practice when writing mock clinical letters. Students who participated in a dialogue engaged in a collaborative process of critical reflection and subsequently applied that way of seeing in the individual act of writing a letter. This study highlights how Bakhtin's theory of dialogue can advance critical pedagogy.
MeSH term(s)	Humans ; Child ; Learning ; Writing ; Clinical Competence ; Students
Language	English
Publishing date	2022-08-09
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	96192-9
ISSN	1938-808X ; 1040-2446
ISSN (online)	1938-808X
ISSN	1040-2446
DOI	10.1097/ACM.0000000000004916
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Article ; Online: Exploring How Pediatric Residents Develop Adaptive Expertise in Communication: The Importance of "Shifts" in Understanding Patient and Family Perspectives.

Kawamura, Anne / Harris, Ilene / Thomas, Karen / Mema, Briseida / Mylopoulos, Maria

Academic medicine : journal of the Association of American Medical Colleges

2019 Volume 95, Issue 7, Page(s) 1066–1072

Abstract: Purpose: Communication with patients and families can be complex, especially in challenging discussions. To communicate effectively, expert physicians must often use flexible approaches. This innovative use of knowledge to handle complexity is an ... ...

Abstract	Purpose: Communication with patients and families can be complex, especially in challenging discussions. To communicate effectively, expert physicians must often use flexible approaches. This innovative use of knowledge to handle complexity is an essential capability of adaptive expertise. Despite its importance for effective communication and implications for medical education, little is known about how adaptive expertise develops in trainees. The purpose of this study was to explore how pediatric residents developed adaptive expertise in communication. Method: A constructivist grounded theory study, using observations of physician-patient communication and semistructured interviews as data sources and purposeful sampling of 10 pediatric subspecialty residents at the University of Toronto, was conducted in 2016-2017. Data collection and analysis occurred iteratively, and themes were identified through the research team's constant comparative analysis. Results: Residents navigated challenging discussions with patients and families by enabling them to express their own narratives and integrating these with their medical knowledge to provide care. At times, a "shift" in the residents' understanding of the families' perspectives was needed to effectively navigate the discussion. Residents used this shift purposefully to create new communication strategies, resulting in an opportunity for learning. Conclusions: "Shifts" are defined as adjustments in the resident's understanding of a family's perspective that affect clinical care. Analysis suggests that these "shifts" can be understood to support development of adaptive expertise. The workplace learning environment promoted this development by providing opportunities that prepared residents for future learning through active experimentation, offering multiple perspectives and enhancing deeper conceptual learning.
MeSH term(s)	Communication ; Family ; Grounded Theory ; Humans ; Internship and Residency/methods ; Knowledge ; Learning/physiology ; Narration ; Ontario/epidemiology ; Pediatrics/education ; Physician-Patient Relations/ethics ; Physicians/statistics & numerical data ; Qualitative Research ; Universities/standards ; Workplace/statistics & numerical data
Language	English
Publishing date	2019-10-09
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	96192-9
ISSN	1938-808X ; 1040-2446
ISSN (online)	1938-808X
ISSN	1040-2446
DOI	10.1097/ACM.0000000000002963
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Article ; Online: Genetic and metabolic investigations for neurodevelopmental disorders: position statement of the Canadian College of Medical Geneticists (CCMG).

Carter, Melissa T / Srour, Myriam / Au, Ping-Yee Billie / Buhas, Daniela / Dyack, Sarah / Eaton, Alison / Inbar-Feigenberg, Michal / Howley, Heather / Kawamura, Anne / Lewis, Suzanne M E / McCready, Elizabeth / Nelson, Tanya N / Vallance, Hilary

Journal of medical genetics

2023 Volume 60, Issue 6, Page(s) 523–532

Abstract: Purpose and scope: The aim of this position statement is to provide recommendations for clinicians regarding the use of genetic and metabolic investigations for patients with neurodevelopmental disorders (NDDs), specifically, patients with global ... ...

Abstract	Purpose and scope: The aim of this position statement is to provide recommendations for clinicians regarding the use of genetic and metabolic investigations for patients with neurodevelopmental disorders (NDDs), specifically, patients with global developmental delay (GDD), intellectual disability (ID) and/or autism spectrum disorder (ASD). This document also provides guidance for primary care and non-genetics specialists caring for these patients while awaiting consultation with a clinical geneticist or metabolic specialist. Methods of statement development: A multidisciplinary group reviewed existing literature and guidelines on the use of genetic and metabolic investigations for the diagnosis of NDDs and synthesised the evidence to make recommendations relevant to the Canadian context. The statement was circulated for comment to the Canadian College of Medical Geneticists (CCMG) membership-at-large and to the Canadian Pediatric Society (Mental Health and Developmental Disabilities Committee); following incorporation of feedback, it was approved by the CCMG Board of Directors on 1 September 2022. Results and conclusions: Chromosomal microarray is recommended as a first-tier test for patients with GDD, ID or ASD. Fragile X testing should also be done as a first-tier test when there are suggestive clinical features or family history. Metabolic investigations should be done if there are clinical features suggestive of an inherited metabolic disease, while the patient awaits consultation with a metabolic physician. Exome sequencing or a comprehensive gene panel is recommended as a second-tier test for patients with GDD or ID. Genetic testing is not recommended for patients with NDDs in the absence of GDD, ID or ASD, unless accompanied by clinical features suggestive of a syndromic aetiology or inherited metabolic disease.
MeSH term(s)	Humans ; Child ; Autism Spectrum Disorder/diagnosis ; Autism Spectrum Disorder/genetics ; Canada ; Neurodevelopmental Disorders/diagnosis ; Neurodevelopmental Disorders/genetics ; Genetic Testing/methods ; Intellectual Disability/diagnosis ; Intellectual Disability/genetics ; Physicians
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	220881-7
ISSN	1468-6244 ; 0022-2593
ISSN (online)	1468-6244
ISSN	0022-2593
DOI	10.1136/jmg-2022-108962
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