Lesbian, gay, bisexual and transgender (LGBT) persons have specific healthcare needs, and experience unique barriers in accessing health services. Research has suggested that medical practitioners are inadequately prepared to address the needs of the LGBT population. While some strategies for training such practitioners within medical schools have been proposed, few have been evaluated, and the best approach to training physicians in LGBTfocused care has yet to be determined. The purpose of this paper is to assess the effectiveness of the LGBT-focused curriculum currently delivered at the Northern Ontario School of Medicine, specifically in terms of its perceived contribution to students' understanding of LGBT health issues. Results showed that the curriculum introduced at NOSM was effective in increasing knowledge medical students had on LGBT health issues regardless of their preexisting level of awareness of LGBT health issues. Further, the study found that the level of experience and expertise of the facilitator helping deliver the curriculum was key in achieving this educational goal. We also evaluated three assessment modalities (Multiple Choice Questions (MCQ), Objective Structured Clinical Examination (OSCE), and Clinical Decision-Making Cases (CDM)) for validity and reliability in testing the course objectives. Results indicate that outcomes can be reliably assessed by these three types of assessments.

There is a critical need to improve functional outcomes in hospitalized seniors for both the individual and their caregivers, and to plan for a sustainable healthcare system in the face of an aging population. Over 50% of acute care hospital beds in Canada are occupied by seniors; one-third of these older patients will be discharged at a significantly reduced level of functional ability. Most will never recover to their previous level of independence. This article offers perspectives on research and implementation strategies that take into account the complex, interacting challenges to improving hospital outcomes in seniors. To this end, we describe two cost-neutral strategies with demonstrated successful outcomes. One developed as a focused care strategy and related care processes on a geriatric medicine/rehabilitation unit. The other describes a change in staff-mix and hours of interdisciplinary coverage that resulted in increased hours of direct care and improved outcomes for older adults on acute care units. Both strategies demonstrated reductions in length of stay in the initial context; however, we identified a number of challenges to translating these strategies to a broader context. We contend that this difficulty is understandable given the complexity of seniors’ health, health services and organizational change. Research methods and approaches to change in health service delivery need to take complexity into account. We propose a metanarrative research methodology that combines qualitative and quantitative methods, as one way of taking complexity into account in health service research. Finally, we propose a way of thinking about organizational change that offers an alternative to typical ‘roll-out’ strategies that cannot take into account the inevitable uniqueness of each context in which a strategy may be implemented.

This chapter underscores the importance of interprofessional collaboration in the care of frail older patients. Hospital-based care is emphasized because interprofessionalism is difficult in that setting since the setting is constantly changing and since multiple healthcare professionals care for many complex, very ill patients, only some of whom are frail older people. Interprofessionalism is particularly important and challenging in teaching units in the acute care setting, where many health professionals practice and learn together and team membership changes frequently. Learning is enhanced and interprofessionalism can enhance learning by viewing the patient as a key part of the teaching team. While 'best practice' interventions have been identified for frail older adults who are hospitalized, these interventions are not easily implemented in routine hospital care. Three interdependent processes in clinical practice-representation, sense-making, and improvisation-are described, which contribute to an understanding of how practices change when implemented in a way that takes the local context into account and keeps person-centered care as the central consideration.

The purpose of this paper is to provide a narrative of our experience with community-driven change using our “Developer/Adapter” research method in Northern Ontario, Canada, so it can be explored in other First Nations contexts. The goal of our currently funded research is to identify community solutions and knowledge and implement community-developed interventions to better support older Indigenous persons, especially those in rural and remote communities, to “age in place” and remain independent in the community through timely access to relevant care. Our Developer/Adapter research method was developed in response to the community-identified need for self-determination to overcome the limitations of traditional Western approaches and effectively plan and execute change in Indigenous communities. Our approach commits to supporting a self- determining voice for Indigenous people and working collaboratively to develop wholistic care interventions. We believe this approach can generate compelling data for policy and practice change in both Canada and Australia.

No abstract