Susan Lieff - Academia.edu (original) (raw)

Papers by Susan Lieff

Advances in Health Sciences Education, 2016

Demonstrating the impact of faculty development, is an increasingly mandated and ever elusive goa... more Demonstrating the impact of faculty development, is an increasingly mandated and ever elusive goal. Questions have been raised about the adequacy of current approaches. Here, we integrate realist and theory-driven evaluation approaches, to evaluate an intensive longitudinal program. Our aim is to elucidate how faculty development can work to support a range of outcomes among individuals and subsystems in the academic health sciences. We conducted retrospective framework analysis of qualitative focus group data gathered from 79 program participants (5 cohorts) over a 10-year period. Additionally, we conducted follow-up interviews with 15 alumni. We represent the interactive relationships among contexts, mechanisms, and outcomes as a ''mandala'' of faculty development. The mandala illustrates the relationship between the immediate program context, and the broader institutional context of academic health sciences, and identifies relevant change mechanisms. Four primary mechanisms were collaborative-reflection, self-reflection and

Advoc. Q., 1992

Legal standards for competence are very relevant in the light of guardianship and consent legisla... more Legal standards for competence are very relevant in the light of guardianship and consent legislative reforms proposed in Ontario (and other provinces). Legal standards for a finding of competence/incompetence determine how decisional authority is to be allocated. A ...

Canadian medical education journal, Oct 17, 2022

American Journal of Geriatric Psychiatry, 2003

The authors document the development and growth of geriatric psychiatry fellowship training in th... more The authors document the development and growth of geriatric psychiatry fellowship training in the United States (U.S.) through 2002. Methods: A cross-sectional survey of the 62 U.S. geriatric psychiatry fellowship programs was conducted in Fall 2001. They also analyzed longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, along with data from the Accreditation Council for Graduate Medical Education (ACGME). Results: Forty-six (74%) of 62 training directors (TDs) responded. The number of fellowship programs has slowly increased over the past 7 years. During 2001-2002, a total of 94 fellows were in training (all years of training). Seventy-eight percent (N‫)63ס‬ of responding programs offered only 1-year fellowship training experiences. TDs reported that application rates for fellowship positions were stable during the academic years 1999-2002, with a median number of eight applications per program for first-year positions in 2001-2002. The fill-rate for first-year geriatric psychiatry fellowship positions dropped from

Academic medicine : journal of the Association of American Medical Colleges, Jan 12, 2015

To explore the perspectives of leaders in psychiatry and continuing professional development (CPD... more To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantl...

Patient Experience Journal

Relationship-centred care (RCC) is a framework for conceptualizing health care which recognizes t... more Relationship-centred care (RCC) is a framework for conceptualizing health care which recognizes that the nature and quality of relationships in health care influence the process and outcomes of health care. Our goal was to undertake a scoping review of the peer-reviewed and grey literature on RCC in health. Using Arksey and O'Malley's scoping review methodology we identified literature about RCC in teaching, learning and clinical practice. Electronic databases were searched, and targeted searches were also conducted for grey literature to capture unpublished material. Subsequently, data abstraction tools were used with eligible studies for analysis. Sixty-nine publications originated mainly from the United States and the United Kingdom by authors from various academic disciplines, of which medicine and nursing were dominant. Thematic analysis revealed that the most commonly cited definition of RCC emerged from the Pew-Fetzer report and focused on the central role of relationships between practitioners and their patients, the community and other practitioners in providing quality care and improving outcomes. The concept of RCC was found to be influenced by theories of sociology, social psychology and psychiatry. The practice of RCC was demonstrated through organizational environments that model RCC, practice settings that focus on the patient or family in care planning, and health professional education that is based on RCC principles. RCC is important to: humanize health care and improve patient care. Our review identified three sub-categories that could add to the relational dimension of the practitionerorganization: practitioner-education, practitioner-profession, and practitioner-practice. Recommendations for future research include: outcome and process studies of health professions education and health care that focuses on RCC. The RCC approach provides a paradigm to move beyond the patient-centred care model by focusing on the central role of all relationships in the delivery and outcomes of care.

Canadian Family Physician Medecin De Famille Canadien, 2001

OBJECTIVE To outline current approaches to diagnosing and managing delirium in the elderly. QUALI... more OBJECTIVE To outline current approaches to diagnosing and managing delirium in the elderly. QUALITY OF EVIDENCE A literature review was based on a MEDLINE search (1966 to 1998). Selected articles were reviewed and used as the basis for discussion of diagnosis and etiology. We planned to include all published randomized controlled trials regarding management but found only two. Consequently, we also used review articles and recent practice guidelines for delirium published by the American Psychiatric Association. MAIN FINDINGS Clinical diagnosis of delirium can be aided by using DSM-IV criteria, the Delirium Symptom Interview, or the confusion assessment method. Management must include investigation and treatment of underlying causes and general supportive measures. Providing optimal levels of stimulation, reorienting patients, education, and supporting families are important. Pharmacologic management of delirium should be considered only for specific symptoms or behaviours, eg, aggression, severe agitation, or psychosis. Only one randomized controlled trial of tranquilizer use for delirium in medically ill people has been published. Findings support the current belief that neuroleptics are superior to benzodiazepines in most cases of delirium. Most authorities still consider haloperidol the neuroleptic of choice. Controlled trials of the new atypical neuroleptics for treating delirium are not yet available. Benzodiazepines with relatively short half-lives, such as lorazepam, are the drugs of choice for withdrawal symptoms. CONCLUSION Delirium is frequently underdiagnosed in clinical practice. It should be suspected with acute changes in behaviour. Careful investigation of the underlying cause permits appropriate management. OBJECTIF Présenter les approches courantes à l'endroit du diagnostic et de la prise en charge du délire chez les personnes âgées. QUALITÉ DES DONNÉES Une évaluation critique des ouvrages scientifiques s'est fondée sur une recension dans MEDLINE (1966 à 1998). Les articles choisis ont fait l'objet d'une analyse et ont servi de fondement à la discussion sur le diagnostic et l'étiologie. Nous prévoyions inclure tous les essais aléatoires contrôlés publiés concernant la prise en charge, mais deux seulement ont été trouvés. Par conséquent, nous avons aussi utilisé des articles critiques et les récents guides de pratique concernant le délire, publiés par l'American Psychiatric Association. PRINCIPAUX RÉSULTATS Le diagnostic clinique du délire peut être facilité par le recours aux critères DSM-IV, à l'entrevue sur les symptômes du délire ou à la méthode d'évaluation de la confusion. La prise en charge doit inclure l'investigation et le traitement des causes sous-jacentes et des mesures générales de soutien. Il importe aussi d'offrir des degrés optimaux de stimulation, de réorienter les patients, de dispenser de l'éducation et de l'appui à la famille. La pharmacothérapie contre le délire ne devrait être envisagée que pour des symptômes ou des comportements précis, comme l'agressivité, une forte agitation ou la psychose. Un seul essai aléatoire contrôlé a été publié sur l'usage des tranquillisants pour le délire chez les personnes médicalement atteintes. Les conclusions sont favorables à la croyance actuelle que les neuroleptiques sont supérieurs aux benzodiazépines dans la plupart des cas de délire. La majorité des experts considèrent toujours l'halopéridol comme le neuroleptique d'élection. Les résultats d'essais contrôlés sur les nouveaux neuroleptiques atypiques pour le traitement du délire ne sont pas encore disponibles. Les benzodiazépines avec une demi-vie relativement courte, comme le lorazépam, sont les médicaments de premier choix pour les symptômes de sevrage. CONCLUSION On omet souvent de diagnostiquer le délire dans la pratique clinique. Il devrait être suspecté lorsqu'il se produit des changements notoires dans le comportement. Une investigation approfondie des causes sous-jacentes permet sa prise en charge appropriée. This article has been peer reviewed. Cet article a fait l'objet d'une évaluation externe.

Academic Psychiatry, 2016

This study presents a mixed-methods evaluation of the first 12 years of the Association for Acade... more This study presents a mixed-methods evaluation of the first 12 years of the Association for Academic Psychiatry (AAP) Master Educator (ME) program, developed in 2003 to help academic psychiatrists hone their skills as educators. Participants attend two 3-h workshops at the annual meeting, organized in 3-year cycles, for a total of 18 h. Core topics include assessment, curriculum design, and program evaluation. Overall session rating scores from 2003 to 2014 were analyzed using descriptive statistics. A 20-question survey was sent to 58 program graduates in October 2014, exploring participant perspectives on the impact of the ME program on their careers and on the educational programs they were affiliated with. Survey responses were analyzed quantitatively (for multiple choice questions) and qualitatively (for open-ended questions). The mean overall session scores ranged between 4.1 and 4.9 (on a Likert-type scale of 1-5) for each 3-year cycle. Twenty-nine graduates completed the survey (50 % response rate). Survey responses indicated a positive perception of the impact of the ME program on participants' careers. Most respondents noted improvement in their teaching methods and curriculum development skills and being able to link educational theory with their individual practices. There was a significant increase in perceived confidence, leadership, and further contributions to their educational milieu. Fifteen (52 %) participants also reported generative behaviors that directly impacted others, such as developing new programs, enhancing existing programs at their institutions, or contributing to national educational efforts. The AAP ME program has demonstrated significant benefit over its 12 years of existence. This program represents one strategy to sustain and grow an international community of like-minded educators working to develop their own and future generations' skills in providing high-quality education in psychiatry.

Medical Teacher, 2016

Few new Residency Program Directors (PD) are formally trained for the demands and responsibilitie... more Few new Residency Program Directors (PD) are formally trained for the demands and responsibilities of the leadership aspect of their role. Currently, there are no comprehensive frameworks that describe specific leadership competencies that can inform PD self-reflection or faculty development. The authors developed a Postgraduate Program Director Competency Inventory (PPDCI) in order to frame the performance of PDs for a multisource feedback (MSF) program. The development of the PPDCI occurred in five phases which involved: development of an initial inventory, implementation of a key informant survey of national opinion leaders, execution of a validity survey with postgraduate education leaders and committee members and implementation of a further refined inventory with 17 PD and 147 raters as part of a pilot MSF program. Five distinct domains of leadership competence were identified which included: Communication and relationship management, leadership, professionalism and self-management, environmental engagement, and management skills and knowledge. The content validity of the PPDCI was endorsed by 85% of the key informants. The validity survey indicated strong endorsement of the PPDCI domains and recognition of its utility for both orientation of new PD as well as a frame for self-assessment. The pilot MSF program yielded a further refined and reduced inventory of 26 items of competence as well as recommendations for its utility. Use of this leadership inventory has the potential to ensure effective leadership of postgraduate programs.

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 1995

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2005

The authors present and discuss the theoretical and practical development of proposed core compet... more The authors present and discuss the theoretical and practical development of proposed core competencies for subspecialty training and certification in geriatric psychiatry as required by the Accreditation Council For Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology (ABPN). Changes were derived from a concern that graduate medical education programs must do a better job of ensuring that residents completing their training are competent to practice medicine and adequately prepared to practice in a rapidly changing healthcare environment. Between July 2006 and June 2011, programs will be expected to focus on data-driven measures, both internal and national, for resident and education-program performance. After July 2011, programs will begin to focus on identifying and developing educational centers of excellence.

Canadian family physician Médecin de famille canadien, 2001

To outline current approaches to diagnosing and managing delirium in the elderly. A literature re... more To outline current approaches to diagnosing and managing delirium in the elderly. A literature review was based on a MEDLINE search (1966 to 1998). Selected articles were reviewed and used as the basis for discussion of diagnosis and etiology. We planned to include all published randomized controlled trials regarding management but found only two. Consequently, we also used review articles and recent practice guidelines for delirium published by the American Psychiatric Association. Clinical diagnosis of delirium can be aided by using DSM-IV criteria, the Delirium Symptom Interview, or the confusion assessment method. Management must include investigation and treatment of underlying causes and general supportive measures. Providing optimal levels of stimulation, reorienting patients, education, and supporting families are important. Pharmacologic management of delirium should be considered only for specific symptoms or behaviours, e.g., aggression, severe agitation, or psychosis. On...

The American journal of psychiatry, 1988

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 1988

An 81 year old depressed female is described who developed catatonic-like behaviours while on the... more An 81 year old depressed female is described who developed catatonic-like behaviours while on the combination of the monoamine oxidase inhibitor phenelzine, and the neuroleptic haloperidol. Alternative etiologies, and the roles of the individual agents are discussed. It is suggested that whenever there is evidence of drug-induced catatonia, consideration should be given to stopping all medications.

doctors are no exception. Internationally, doctors are being called upon to take more active enga... more doctors are no exception. Internationally, doctors are being called upon to take more active engagement in the leadership and management of clinical services, which has led to an increased emphasis on ensuring that medical students ' learn leadership ' in their undergraduate programmes. This requires medical educators to be much more aware not only of the practice of leadership as it relates to their educational work, but also of planning and delivering education that includes leadership concepts and examples. In this chapter we focus specifi cally on medical educational leadership, but many articles and books on general leadership (drawn mainly from industry) and educational leadership (particularly in the schools sector) and a growing literature on clinical leadership are all highly relevant to medical education, which straddles both education/training and health services. A massive leadership literature has growing emphasis on whether (and if so, what) specifi c qualities, attributes, knowledge or skills are most effective in different organizational and professional contexts. Identifying specifi c issues, challenges and opportunities in medical education helps to strengthen capacity of organizations, improve individual leaders ' performance and enhance the experience for those who work within organizations and our clients or customers (i.e. students and the end users of medical education: patients). Medical education leadership involves: • Roles played out in a highly visible, regulated and complex environment: a ' crowded stage ' • Working across boundaries and organizations (higher [tertiary] education environments, community settings and complex health services) continually in a state of fl ux and reconfi guration • Producing highly skilled, socially accountable professionals. 42 Chapter Leadership theory Key features Indicative theorists Relational leadership Emerged from human relations movement. Leaders motivate through facilitating individual growth and achievement. Binney et al 2004 Servant leadership Leader serves to serve fi rst, then aspires to lead; concept of stewardship is important. Greenleaf 1977 Situational leadership Leadership behaviour needs to adapt to readiness or developmental stage of individuals or the group, e.g. directing, coaching, supporting, delegating. Attention equally on task, team, individual.