Canadian Medical Education Journal

Being a post-positivist is exhausting: The daunting commitment to an uncertain truth

2020-09-23T08:17:22-06:00

Exercise is medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level

2020-09-22T21:08:35-06:00

Background: Educational workshops help physicians (MDs) include physical activity and exercise (PAE) content in more patient appointments. It is unclear if MDs with varying degrees of self-confidence discussing PAE with their patients equally benefit from such training. We evaluated whether MDs’ initial self-confidence affects the impact of an educational PAE workshop.

Methods: MDs (n = 63) across Canada completed self-reflection questionnaires initially and 3-months following a PAE workshop. MDs were divided into low-confidence [self-efficacy score (out of 100%): <40%; n = 21], medium-confidence (40-60%; n = 19) and high-confidence (>60%; n = 23).

Results: PAE counselling self-efficacy increased in all groups (relative increase: Low=~40%, Medium=~20%, High=~10%). Training increased the low-confidence group’s knowledge, awareness of guidance/resources and perception of their patients’ interest in lifestyle management (~30% change; all p < 0.001). Compared to baseline, a greater proportion (all p < 0.001) of MDs reported prescribing exercise at 3-month follow-up in each of the low-confidence (10% to 62%) medium-confidence (16% to 89%) and high-confidence (57% to 87%) groups.

Conclusion: PAE training favorably improved MDs’ self-confidence, perceived impact of many barriers and the proportion of MDs prescribing exercise, at each level of confidence. An educational workshop particularly assisted MDs with low-confidence (i.e., those who needed it the most) integrate PAE into their practice.

National survey of Canadian residents and program directors regarding parental leave during residency

2020-09-22T21:08:36-06:00

Background: Despite the advantages of having a child as a medical resident, the transition back to residency after parental leave can be challenging. This study is the first to investigate this issue using a nation-wide Canadian sample of both residents and program directors.

Method: A questionnaire was developed and made available online. Respondents included 437 female residents, 33 male residents, and 172 residency program directors. The mean length of parental leave was nine months for female residents and six weeks for male residents. Almost all female residents (97.5%) breastfed with an average duration of 12 months. The top challenges reported by residents were feeling guilty for being away from their family, long and unpredictable work hours, sleep deprivation, and finding time to study. When female residents and program directors were matched to both school and program (N = 99 pairs), there was no difference in the total number of challenges reported, but program directors reported offering significantly more accommodations than female residents reported being offered, t(196) = 13.06, p < .001.

Results: Our data indicate there is a need for better communication between resident parents and program directors, as well as clear program-specific parental leave policies, particularly for supporting breastfeeding mothers as they return to work.

Resident perceptions of Competency-Based Medical Education

2020-09-22T21:08:37-06:00

Background: Residency training programs in Canada are undergoing a mandated transition to competency-based medical education (CBME). There is limited literature regarding resident perspectives on CBME. As upper year residents act as mentors and assessors for incoming cohorts, and are themselves key stakeholders in this educational transition, it is important to understand how they view CBME. We examined how residents who are not currently enrolled in a competency-based program view that method of training, and what they perceive as potential advantages, disadvantages, and considerations regarding its implementation.

Methods: Sixteen residents volunteered to participate in individual semi-structured interviews, with questions focussing on participants’ knowledge of CBME and its implementation. We used a grounded theory approach to develop explanations of how residents perceive CBME.

Results: Residents anticipated improved assessment and feedback, earlier identification of residents experiencing difficulties in training, and greater flexibility to pursue self-identified educational needs. Disadvantages included logistical issues surrounding CBME implementation, ability of attending physicians to deliver CBME-appropriate feedback, and the possibility of assessment fatigue. Clear, detailed communication and channels for resident feedback were key considerations regarding implementation.

Conclusions: Resident views align with educational experts regarding the practical challenges of implementation. Expectations of improved assessment and feedback highlight the need for both residents and attending physicians to be equipped in these domains. Consequently, faculty development and clear communication will be crucial aspects of successful transitioning to CBME.

Health research methodology education in Canadian emergency medicine residency programs: A national environmental scan

2020-09-22T21:08:38-06:00

Objectives: Our objective was to describe the variability of research methodology teaching among English-speaking Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) residency programs. We also aimed to identify barriers to teaching research methodology curricula.

Methods: An electronic survey was sent by email to program directors and residents of English-speaking RCPSC-EM training programs countrywide. Reminder emails were sent after 2, 4, and 8 weeks. Quantitative, descriptive statistics were prepared, and qualitative data and themes were identified.

Results: We received a total of 7 responses from the possible 12 program directors (response rate = 58.3%). Out of 354 potential resident respondents, 82 (23.2%) completed the survey. There was disparity between resident and program director responses with respect to the existence of curricula, preparation for Royal College exams, and usefulness for future practice. Barriers to teaching a research methodologies curriculum included lack of time, support, educated faculty, and finances.

Conclusion: This survey demonstrates that Canadian EM residency programs vary with respect to research methodology curriculum, and discrepancies exist between residents’ and program directors’ perceptions of the curriculum. Given the lack of a standardized research methodology curriculum for these programs, there is an opportunity to improve training in research methodology.

Rapid, collaborative generation and review of COVID-19 pandemic-specific competencies for family medicine residency training

2020-09-22T21:08:39-06:00

Background: In March 2020, the COVID-19 pandemic disrupted competency-based medical education in Family Medicine programs across Canada. Faculty and residents identified a need for clear, relevant, and specific competencies to frame teaching, learning, supervision and feedback during the pandemic.

Methods: A rapid, iterative, educational quality improvement process was launched. Phase 1 involved experienced educators defining gaps in our program’s existing competency-database, reviewing emerging public health and regulatory guidelines, and drafting competencies. Phase 2 involved translation, member-checking, and anonymous feedback and editing of draft competencies by residents and other educational leaders. Phase 3 involved wider dissemination, collaborative editing and feedback from residents and faculty throughout the department.

Results: A total of 44 physicians including residents and faculty from multiple contexts provided detailed feedback, review, and editing of an ultimate list of 33 competencies organized by CanMEDS-FM roles. Broad agreement was obtained that the competencies form reasonable learning outcomes during the COVID-19 pandemic.

Conclusions: These competencies represent learning objectives reflecting the initial educational mindsets of a wide range of teachers and learners experiencing a global pandemic. The project illustrates a novel collaboration across educational portfolios as a rapid educational response to a public health crisis.

A national survey of burnout amongst Canadian Royal College of Physicians and Surgeons of Canada emergency medicine residents

2020-09-22T21:08:40-06:00

Background: In recent years, there has been growing interest in the field of physician wellness and burnout. The prevalence of burnout is non-uniform between medical specialties and is most prevalent amongst emergency medicine physicians. Importantly, burnout can be observed amongst individuals early in their medical careers, including medical students and residents. Despite ample studies in other populations, there is no national perspective of burnout amongst Canadian Royal College of Physicians and Surgeons of Canada (RCPSC)Emergency Medicine (EM) residents.

Methods: Our study surveyed Canadian residents undergoing EM training though the RCPSC via local program directors using an anonymous electronic form. Basic demographic characteristics and residents’ contemplation of suicide were surveyed. The Maslach Burnout Inventory – Human Services Survey (MBI-HSS) for medical personnel was used to assess burnout on three dimensions (emotional exhaustion, depersonalization and personal accomplishment).

Results: A total of 65 valid responses were collected from eight of 14 eligible institutions (response rate = 30%). Respondents are primarily male (58%) and in their postgraduate year (PGY) 1-3 (71%). Overall, 62% of residents met the threshold for burnout according to a widely cited definition of burnout using the MBI-HSS. Additionally, 14% contemplated suicide during their training. There was no statistical significance in burnout rates between male and female responders or between residents in different stages of training.

Conclusion: Our results suggest significant burnout amongst Canadian EM residents. These results point to an important opportunity to better support EM residents during their training to improve wellness and reduce burnout.

Determinants of mental health professionals’ attitudes towards recovery: A review

2020-09-22T21:08:40-06:00

Objective: The attitudes of mental health professionals towards consumers’ recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals.

Methods: A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included.

Results: From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals’ pessimistic attitudes towards recovery.

Conclusions: This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers.

Fostering intergenerational education: An experiential learning program for medical students and older adults

2020-09-22T21:08:41-06:00

Educational initiatives providing intergenerational, experiential learning opportunities can engage students of various education levels and disciplines. All persons can benefit from initiatives with older adults because our aging population suggests more of these interactions will occur across sectors. While students pursuing an education in health or medical fields are primarily identified as benefiting from intergenerational education to gain skills and knowledge to effectively care for the elderly, these teachings are invaluable regardless of one’s age, education, or career background. The program delivery and evaluation criteria can be adapted to assess competencies essential to different education or career paths.

“It unsticks your mind”: Using a musicians’ masterclass to introduce oncology faculty and trainees to the practice of direct observation and coaching

2020-09-22T21:08:42-06:00

Bringing faculty to a realization of the importance of direct observation is a major task during the transition to competency-based medical education. Musicians generally already endorse a strong coaching culture. We included a live cello masterclass in an oncology faculty and trainee workshop in order to demonstrate coaching and feedback. Based on participant post-event interviews, the musical masterclass was a highly effective catalyst for self-reflection in regards to teaching practices and lead to new and revised perspectives on observation and coaching in medicine. With just a musician-trainee, music coach, and faculty moderator, this effective demonstration can be easily replicated.

The Patient and Family Narratives seminars at the University of Saskatchewan connect health professions students with patient experiences

2020-09-22T21:08:42-06:00

The Patient and Family Narratives (PFN) seminars make patient perspectives part of the education of students from healthcare professions. These sessions consist of a story shared by a patient, interdisciplinary small group discussions, and a question and answer period. Based on the findings of our evaluation, we will modify the orientation exercise and small group sessions. The simple design of these seminars makes their implementation suitable for other institutions as a way of sharing patient stories in an interprofessional setting. However, the success of a PFN program may depend on a lack of authentic patient contact in the pre-existing curriculum.

Virtual Ice Cream Rounds: Addressing medical clerk wellness during COVID-19

2020-09-22T21:08:43-06:00

Ice Cream Rounds (ICRs) are used by residency and clerkship programs across Canada to provide trainees with a safe space to debrief difficult situations, connect with peers, and promote wellness. At the Niagara Regional Campus of the Michael G. DeGroote School of Medicine, ICRs are held often and are well-received by learners. In light of the COVID-19 pandemic, we adapted and facilitated the first virtual ICR. Post-session, students reported an increase in nearly all domains of their perceived wellness. Due to the uncertainty associated with this unprecedented time, this event could help learners at other institutions support each other.

Five ways to get a grip on evaluating and improving educational continuity in health professions education programs

2020-09-22T21:08:44-06:00

Presence of educational continuity is essential for progressive development of competence. Educational continuity appears to be a simple concept, but in practice, it is challenging to implement and evaluate because of its multifaceted nature. In this Black Ice article, we present some practical tips to help avoid misunderstandings and irregularities in implementation for those involved in evaluating and improving educational continuity in health professions education programs.

Seven ways to get a grip on implementing Competency-Based Medical Education at the program level

2020-09-22T21:08:44-06:00

Competency-based medical education (CBME) curricula are becoming increasingly common in graduate medical education. Put simply, CBME is focused on educational outcomes, is independent of methods and time, and is composed of achievable competencies.¹ In spite of widespread uptake, there remains much to learn about implementing CBME at the program level. Leveraging the collective experience of program leaders at Queen’s University, where CBME simultaneously launched across 29 specialty programs in 2017, this paper leverages change management theory to provide a short summary of how program leaders can navigate the successful preparation, launch, and initial implementation of CBME within their residency programs.

The physician as person: The missing foundation in the CanMEDS roles

2020-09-22T21:08:45-06:00

Unexpected turn of events: Completing residency in the COVID-19 era

2020-09-22T21:08:45-06:00

Fostering trust, collaboration, and a culture of continuous quality improvement: A call for transparency in medical school accreditation

2020-09-22T21:08:46-06:00

Medical schools provide the foundation for a physician’s growth and lifelong learning. They also require a large share of government resources. As such, they should seek opportunities to maintain trust from the public, their students, faculty, universities, regulatory colleges, and each other. The accreditation of medical schools attempts to assure stakeholders that the educational process conforms to appropriate standards and thus can be trusted. However, accreditation processes are poorly understood and the basis for accrediting authorities’ decisions are often opaque.

We propose that increasing transparency in accreditation could enhance trust in the institutions that produce society’s physicians. While public reporting of accreditation results has been established in other jurisdictions, such as Australia and the United Kingdom, North American accrediting bodies have not yet embraced this more transparent approach. Public reporting can enhance public trust and engagement, hold medical schools accountable for continuous quality improvement, and can catalyze a culture of collaboration within the broader medical education ecosystem. Inviting patients and the public to peer into one of the most formative and fundamental parts of their physicians’ professional training is a powerful tool for stakeholder and public engagement that the North American medical education community at large has yet to use.

It takes a team: Generating evidence to define and foster collective competence in health professions education

2020-09-22T21:08:46-06:00

Command economies, graduated responsibility, and Competence-Based Medical Education

2020-09-22T21:08:47-06:00

Competence-Based Medical Education (CBME) rightly emphasizes that residents are adult learners who should actively take charge of their own education by ensuring they are progressing towards competence in an array of Entrustable Professional Activities (EPAs). Ironically, many CBME curricula then dictate exactly how this is to happen by listing a multitude of variables that must be checked off regarding the specifics of cases encountered. This is burdensome and unrealistic as well as contrary to the spirit of CBME. We want residents to know how to learn so they can problem solve in new situations. This is not achieved by dictating that they see nearly everything during their residency. Command economies with complete and rigid planning from above do not work. This also applies to residency training.

Educating the bystander: How contributing to ward rounds as a junior doctor or medical student can be helpful in preparation for clinical responsibilities.

2020-09-22T21:08:47-06:00

COVID-19 pandemic and medical education: A medical student’s perspective

2020-09-22T21:08:48-06:00

The specific impact of the COVID-19 pandemic on medical education remains elusive and evolving. Clinical teaching opportunities have become limited with the shift in focus of supervising physicians away from trainees and towards the care of the sick and vulnerable. The presence of medical students in hospitals has come to represent an added strain on vital resources, and the added risk of viral dissemination into communities has left medical students eager to help observing from only the sidelines. The present article provides a medical student’s perspective on this unique, evolving situation, and identifies several learning opportunities that medical students may reflect upon and carry forth into their careers ahead. By exploring the current and future impact of this pandemic on clerkship, pre-clerkship and post-graduate medical training, specific challenges and future direction for both medical students and educators are discussed.

Wearable technology and live video conferencing: The development of an affordable virtual teaching platform to enhance clinical skills education during the COVID-19 pandemic

2020-09-22T21:08:48-06:00

Impact of the COVID-19 pandemic on anesthesia residency education

2020-09-22T21:08:49-06:00

The clinical role of anesthesia residents during the COVID-19 pandemic has not been well described. As qualified physicians trained in airway management, anesthesia residents could be considered essential personnel. Given the uncertain supply of protective equipment, decision-makers must consider the welfare of trainees in any decision to deploy anesthesia residents. This national survey of Canadian anesthesia residents will develop our understanding of medical education, safety, and perceptions towards training in the context of the COVID-19 pandemic. Our results may inform the Royal College of Physicians and Surgeons, program directors, and health officials in optimizing anesthesia residency training during future pandemic conditions.

“COVID-19 as the equalizer”: Evolving discourses of COVID-19 and implications for medical education.

2020-09-22T21:08:49-06:00

Residency redeployment during a pandemic: Lessons for balancing service and learning

2020-09-22T21:08:50-06:00

Teaching an educational simulation elective outside the simulation center

2020-09-22T21:08:51-06:00

Modern day superheroes

2020-09-22T21:08:51-06:00