The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Nietzsche's children : a physiological analysis of the scholar's task

Throughout Nietzsche's writings we find discussions of the proper relationship of the scholar/scientist to the philosopher, wi th the scholar of ten being presented in a derogatory light. In this thesis, I examine Nietzsche's por t rai t of the scholar through the lens of his physiological or clinical perspective as articulated by Dr. Daniel R. Ahern in his monograph entitled Nietzsche as Cultural Physician. My aim in doing so is to grasp the affirmative, creative aspect of this seemingly destructive polemic against scholars. I begin wi th a detailed discussion of Nietzsche's por t rai t of the scholar in Beyond Good and Evil. This includes an explication of Ahern's position, followed by an application of the diagnostic perspective to Nietzsche's discussion of the objective type, the skeptic, and the critic. I then look at how the characteristics of all three types are present in the Nietzschean 'free spirit.' I also discuss the physiological basis of esotericism in Nietzsche's work, as well as Nietzsche's revaluation of the scholarly vi r tue known as Red/ichkeit (or 'honesty'). I conclude wi th comments on the free spirit's relationship to the future.

Gender and Healing in the Hippocratic Corpus

Hippocratic physicians sought to establish themselves as medical authorities in ancient Greece. An examination of the deontological texts of the Hippocratic corpus reveals that the Hippocratics created a medical authority based on elite male characteristics. The key quality of the Hippocratic physician was sōphrosunē, a quality closely associated with men and used in the differentiation of genders in the Greek world. Women were not believed to innately possess this quality and so their healing activities were restricted within the Hippocratic framework. Women’s healing activities are only mentioned in the corpus when women are involved in the treatment of other women or self-treatment. The Hippocratic construction of medicine as a male domain fit within a Classical cultural framework, as the cultural anxiety concerning women healers and women’s use of pharmaka are evident in both Greek myth and literature.

John Miller letter, December 1, 1812.

John Miller (1774-1862) was a physician and politician who served in the United States Congress as a representative from New York from 1825-1827. He began his medical practice in Washington County, N.Y. in 1798. In 1801 he moved to Fabius, Onondaga County, N.Y. (now Truxton, Cortland County). He served as postmaster at Truxton from 1805-1825, a justice of the peace from 1812-1821 and in the State Assembly in 1817, 1820 and 1845. Archibald McIntire [McIntyre] (1772-1858) was a businessman and politician. He immigrated to the United States with his family and settled in New York City around 1773. He was a member of the New York State Assembly from 1798-1821 (intermittently), in the New York State Senate form 1822-1826 and was New York State Comptroller from 1806-1821.

The Association of Sleep Disorder, Obesity Status, and Diabetes Mellitus among US Adults—The NHANES 2009-2010 Survey Results

To examine the association between sleep disorders, obesity status, and the risk of diabetes in adults, a total of 3668 individuals aged 40+ years fromtheNHANES 2009-2010 withoutmissing information on sleep-related questions,measurements related to diabetes, and BMI were included in this analysis. Subjects were categorized into three sleep groups based on two sleep questions: (a) no sleep problems; (b) sleep disturbance; and (c) sleep disorder. Diabetes was defined as having one of a diagnosis from a physician; an overnight fasting glucose > 125 mg/dL; Glycohemoglobin > 6.4%; or an oral glucose tolerance test > 199mg/dL. Overall, 19% of subjects were diabetics, 37% were obese, and 32% had either sleep disturbance or sleep disorder. Using multiple logistic regression models adjusting for covariates without including BMI, the odds ratios (OR, (95% CI)) of diabetes were 1.40 (1.06, 1.84) and 2.04 (1.40, 2.95) for those with sleep disturbance and with sleep disorder, respectively. When further adjusting for BMI, the ORs were similar for those with sleep disturbance 1.36 (1.06, 1.73) but greatly attenuated for those with sleep disorders (1.38 [0.95, 2.00]). In conclusion, the impact of sleep disorders on diabetes may be explained through the individuals’ obesity status.

Orderly book, Second Regiment of U.S. Dragoons, New York, 1812-1813

The Second U.S. Regiment of Light Dragoons was formed in January 1812. In March of 1814, it merged with the First U.S. Regiment of Light Dragoons to form the Regiment of Light Dragoons.

Orderly book, Second Regiment of U.S. Dragoons, New York, 1812-1813

An orderly book of the Second Regiment of U.S. Dragoons, New York, dated August 14, 1812-July 29, 1813. The book contains orders pertaining to day-to-day military matters, such as punishments for disobedience, court-martial proceedings, camp rules and regulations, and guidelines for interacting with civilians in the vicinity of the camp. The Regiment was stationed at various locations in upstate New York and Canada, including Greenbush, Albany, Sackets Harbor, Utica, Geneva, Fort Niagara and Fort George. General Henry Dearborn originally commanded the Regiment at Greenbush. Names noted in this book include:E. Beebe, Deputy Adjt. General; William King, Capt. 15th; John Chandler, General ;W. Gamewood, Major ;James Burns, Colonel;John Woodford, Major; Andrew McDowell, Capt.; Abm. Gustis, Major; C.W. Hunter, Brigade Major; Selden, Captain; Holland, Captain; Harris, Captain; Clarkson, Lieutenant; Johnson, Lieutenant; Robert Craig, Adjt.; R.G. Hith, A.A. General. Also included with the orderly book are a monthly return form, a contract for medical services, and a bonus pay voucher for Thomas Blunt. The monthly return form is partially completed and dated January 1813 at Greenbush, New York. It is signed by Captain Jonas Holland. The contract is dated May 20, 1812, between John Dodge, physician and surgeon, and Jonas Holland. The contract describes the services required of the physician and the salary to be paid. The bonus pay voucher is dated April 25, 1813, for $8.00 paid to Thomas Blunt by Captain Jonas Holland for 'enlisting into the army of the United States for five years'.

The meaning of multiple medication use in adults: A qualitative study

Over half of prescribed medications are not taken as prescribed, resulting in health and economic consequences. Using constructivist grounded theory, 15 interviews were conducted to develop a theory on understanding the medication adherence choices of individuals, who were between the ages of 40 to 55, were diagnosed with a chronic condition, and taking three or more medications. The results indicate that participants are engaging in self-management strategies, with massive variance in adherence behaviours. Medications are sacrificed for personal and financial reasons, resonating with feelings of fear for the person’s current situation and future. Individuals are struggling with who they have become to who they once were, which becomes related to their medications. Finally, individuals are citing the impact of their physician; citing barriers to communication and Canada’s health care system. Participants’ experiences provided an understanding of the meanings individuals associate with their medications and how this impacts their decision-making.

A. C. Thorburn Prescription Ledger

The gift plate in the front of the book indicates that the book is from Walker’s Drug Store, Niagara Falls, Ontario. Walker’s Drug Company was founded in 1925 by Ivan T. Walker. The dates of this book indicate that it is more likely to have come from A.C. Thorburn, Chemist and Druggist. A.C. Thorburn purchased Smith’s Pharmacy and Pursel and Company Dry Goods Store at the corner of Main Street and Lundy’s Lane in Niagara Falls, Ontario. In 1900, Pursel moved out and Thorburn’s Drug Store came into being. Ivan T. Walker, founder of Walker’s Drugs was employed by Thorburn Drugs in his teen years. The local doctors whose prescriptions are in the book include: J. H. McGarry; F.W.E. Wilson; C. F. Abraham; W.E. Olmsted; W.W. Thompson; Dr. Robb, dentist; Horace R. Elliot, physician and surgeon and Dr. Sutherland, eye, ear nose and throat specialist

Elisha B. Sherwood letter, February 26, 1845

Elisha Barber Sherwood (1810-1905) was a Presbyterian minister. He began his career as a minister in the Church at Wilson, Niagara County, N.Y., subsequently becoming pastor at various churches in New York, Michigan, and Missouri. He is the author of Fifty Years on the Skirmish Line, a review of his ministerial work.