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Background: Although essay questions are used in the admissions process in many medical schools, there has been little research on how applicants respond to essay questions. Aims: The purpose of this study was to explore how applicants to medical school approach essay questions used in the selection process. Methods: Qualitative analysis was conducted on 240 randomly selected essays written by individuals applying to a single Canadian medical school in 2007 using a modified grounded theory approach to develop a conceptual framework which was checked in interviews with applicants. Results: Three core variables were identified: 'balancing service and reward,' 'anticipating the physician role,' and 'readiness.' We described the overall approach of applicants as 'taking stock,' writing about their journeys to the selection process, their experiences of the process itself, and about their anticipated future in medicine. Conclusion: Our findings suggest a disconnect between the approach of the applicants (to 'show themselves' and be selected as individuals) and the stated intent of the process (to select applicants based on 'objective' criteria). Our findings raise important questions about how applicants represent themselves when applying for medical school and suggest that it is important to understand the applicant's point of view when developing questions for selection processes. [ABSTRACT FROM AUTHOR]

Abstract: Context: North American studies have documented practice variations and deficiencies in end-of-life (EOL) cancer care, such as trends toward treating dying patients aggressively and disparities in access to palliative care or hospice services. Objectives: To assess the frequency of aggressive health care usage at the EOL and identify factors associated with receiving aggressive care among patients who died of colorectal cancer. Methods: Data from the Alberta Cancer Registry, in/outpatient hospital records, and cancer electronic medical records were linked. Death in an acute care hospital, chemotherapy use in the last 14 days of life, more than one emergency room (ER) visit, more than one hospital admission, and any intensive care unit (ICU) admission in the last 30 days of life were used as indicators of aggressive care. Logistic regression was used to identify risk factors associated with each indicator. Results: A total of 2074 patients were included: 50.1% died in an acute care hospital; 3.7% received chemotherapy in the last 14 days of life; and 12.5% had multiple ER visits, 9.5% had multiple hospitalizations, and 2.2% had an ICU admission during the last 30 days of life. Age had the strongest association with chemotherapy use. Geographical region of residence had the strongest association with multiple ER visits and hospitalizations and dying in an acute care hospital. Tumor stage and duration of disease were associated with the ICU admission. Conclusion: The percentage of patients who died in an acute care hospital is higher than the 17% U.S. benchmark. Other indicators of receiving aggressive EOL care are consistent with existing care quality benchmarks. The considerable regional variation, however, indicates potential for system improvements. [Copyright &y& Elsevier]

Introduction: Lifelong learning requires sustained motivation for learning. Employing a motivational theory framework, we investigated the relationships of psychological need satisfaction, clinical teaching involvement, and lifelong learning of physicians at different career stages and in various medical specialties. We also examined the associations of physician lifelong learning with stress, burnout, teaching enjoyment, and life satisfaction, all of which are essential for physician well-being and, ultimately, for the provision of quality patient care. Methods: This was a cross-sectional study. Using survey methodology, quantitative data were collected from 202 practicing physicians in Canada. The questionnaire contained validated scales of physician lifelong learning and psychological need satisfaction, measures of clinical teaching (involvement and enjoyment), stress level, burnout frequency, and life satisfaction. Analysis of covariance and correlational analysis were performed. Results: On average, participants reported moderate to moderately high levels of lifelong learning, psychological need satisfaction, teaching enjoyment, and life satisfaction. Irrespective of career stage and specialty, physicians' psychological need satisfaction and involvement in clinical teaching were significant in relation to lifelong learning. That is, physicians who experienced greater psychological need satisfaction at work and those who were involved in clinical teaching had, on average, higher lifelong learning scores. Physician lifelong learning had significant associations with life satisfaction and teaching enjoyment but not with stress level and burnout frequency. Discussion: Fulfilling physicians' basic psychological needs at work and supporting them in their teaching roles is likely to enhance physician lifelong learning and, ultimately, quality of patient care. [ABSTRACT FROM AUTHOR]