Canadian Medical Education Journal

Some of the best articles of our first 10 years (and perhaps some of the best of the next decade)

2021-02-26T08:20:59-07:00

Improving the LGBTQ2S+ cultural competency of healthcare trainees: advancing health professional education.

2021-02-25T19:26:01-07:00

Background: Lesbian, Gay, Bisexual, Trans, Queer, and Two-spirit (LGBTQ2S+) populations experience worse health outcomes compared to age-matched heterosexual and cisgender peers. Health professionals’ deficient knowledge and negative attitudes can contribute to these inequities. Healthcare trainees report insufficient LGBTQS2+ cultural competence training.

Methods: In this prospective, mixed-methods pre-post design, Atlantic Canadian health students were tested on knowledge, attitudes and self-reported behaviours towards LGBTQ2S+ populations in healthcare settings. Assessment included psychometric measurements and clinical cases involving normative and non-normative fictional patients. Participants were randomised to intervention or control groups. The intervention consisted of three training sessions lead by LGBTQ2S+ experts and elders from the community. The control group continued with usual training. Full assessment was repeated after training. We also held focus group discussions with students and faculty.

Results: The intervention group significantly improved attitudes toward and knowledge of LGBTQ2S+ populations and changed relevant aspects of their performance in the simulated clinical situations. Focus groups identified key gaps in current local training.

Conclusions: Integrating specific training related to LGBTQ2S+ health within health professions programs is an important step toward improving these populations’ accessibility to a competent, exhaustive and nurturing healthcare. Additional research on innovative means to expand and broaden the scope of our training is warranted.

Patients’ perspectives on the extent of resident participation in the operating room for total hip or knee arthroplasty

2021-02-25T19:26:03-07:00

Introduction: Previous work suggests that patients do not understand the extent of trainee involvement in their care and are uncomfortable with trainee involvement.

Methods: We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant’s knowledge of trainee level of education and confidence of trainee involvement in their surgery as a function of supervision.

Results: Participants’ mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of resident experience (p < 0.05). 11.1% of participants did not want trainees involved in their treatment. 60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows.

Conclusion: Patient confidence in trainees performing part or all of their surgery increases with resident experience and supervision. Most patients do not understand the hierarchy in education of medical trainees and would like to know more about the education level of the trainee involved in their care. Further work should explore how we can help patients better understand trainee involvement in their surgical care.

Feedback on feedback: a two-way street between residents and preceptors

2021-02-25T21:15:14-07:00

Background: Workplace-based assessment (WBA), foundational to competency-based medical education, relies on preceptors providing feedback to residents. Preceptors however get little timely, formative, specific, actionable feedback on the effectiveness of that feedback. Our study aimed to identify useful qualities of feedback for family medicine residents and to inform improving feedback-giving skills for preceptors in PGME training program.

Methods: This study employed a two-phase exploratory design. Phase 1 collected qualitative data from preceptor feedback given to residents through Field Notes (FNs) and quantitative data from residents who provided feedback to preceptor about the quality of the feedback given. Phase 2 employed focus groups to explore ways in which residents are willing to provide preceptors with constructive feedback about the quality of the feedback they receive. Descriptive statistics and a thematic approach were used for data analysis.

Findings: We collected 22 FNs identified by residents as being impactful to their learning; analysis of these FNs resulted in five themes. Functionality was then added to the electronic FNs allowing residents to indicate impactful feedback with a “Thumbs Up” icon. Over one year, 895 out of 8,496 FNs (11%) had a “Thumbs up” added, divided into reasons of: confirmation of learning (28.6%), practice improvement (21.2%), new learning (18.8%), motivation (17.7%), and evoking reflection (13.7%). Two focus groups (12 residents, convenience sampling) explored residents’ perception of constructive feedback and willingness to also provide constructive feedback to preceptors.

Conclusion: Adding constructive feedback to existing positive feedback choices will provide preceptors with holistic information about the impact of their feedback on learners, which, in turn, should allow them to provide more effective feedback to learners. However, power differential, relationship impact, and institutional support were concerns for residents that would need to be addressed for this to be optimally operationalized.

Impact of an urban regional medical campus: perceptions of community stakeholders

2021-02-25T19:26:07-07:00

Background: Regional medical campuses (RMC) have shown promise in addressing physician shortages. RMCs have been positively evaluated in rural/remote communities, however, it is unclear whether this model will be as beneficial in underserved urban areas. This study evaluated the impact of a RMC on a midsized urban city (Windsor, Ontario). We compare our results with a similar study conducted in a remote community in British Columbia (BC).

Methods: A broad array of community stakeholders representing different sectors were consulted using a semi-structured interview format replicated from the BC Northern Medical Program (NMP) study. Thematic analysis based on the resulting rich data was conducted within a grounded theory context.

Results: Twenty-three participants (52% male) representing healthcare, education, business, community and government/politico sectors were consulted. Their views regarding the Windsor Regional Medical Campus (WRMC) aligned around several themes: improved healthcare, enhanced community reputation, stimulated economic/community development, expanded training opportunities and an engaged community regarding the WRMC. These results were compared to the main findings of the NMP study with both similarities (e.g. increased community pride) and differences (e.g. resource concerns) discussed.

Conclusion: Community stakeholders provided strong support for the WRMC through their perceptions of its positive impact on this urban region. These findings are consistent with similar RMC studies in rural/remote areas. Those interested in developing a RMC might benefit from considering these findings.

Investigating the importance of clinical topics for developing a curriculum on gastroenterology for pediatric residents

2021-02-25T19:26:10-07:00

Background: Focused objectives provide effective learning. Pediatric residents in Canada follow objectives set by the Royal College of Physicians and Surgeons of Canada (RCPSC) with the goal of becoming competent general pediatricians. During the gastroenterology rotation, it remains unclear as to what clinical problems listed in the aforementioned objectives are crucial to understand as part of general pediatric practice. The purpose of this study was to identify the gastroenterological conditions of most importance to incorporate into a focused curriculum for pediatric residents.

Methods: All pediatricians across four Canadian Atlantic provinces were surveyed by a mailed questionnaire. Questions included demographics and ranking of the 14 clinical problems currently listed in the RCPSC objectives along with six more generated after input was gained from pediatric gastroenterologists.

Results: Of the 234 pediatricians surveyed, 132 (56%) responded, 48% of whom were general pediatricians. Celiac disease, gastroesophageal reflux, and obesity (currently not on the RCPSC list) were identified as important/very important conditions to understand by 94.4%, 96.1%, and 96.0% of respondents, respectively. There were no significant differences in rankings between general pediatricians and subspecialists. Most (75.6%) recommended that a rotation in gastroenterology be mandatory during pediatric residency.

Conclusions: A survey of Canadian pediatricians provided an overview of the importance of different diseases to use in developing a gastroenterology curriculum for core pediatric residency training. Such information is crucial as it can identify gaps in RCPSC learning objectives. Ongoing input from practicing general pediatricians can help keep medical schooling curricula updated.

Bridging the gap: improving CASPer test confidence and competency for underrepresented minorities in medicine through interactive peer-assisted learning

2021-02-25T19:26:11-07:00

Background: The Computer-based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgement test (SJT) adopted by medical schools to assess applicants’ interpersonal skills. CASPer applicants must compose their responses to ethical dilemmas, thereby highlighting the applicant’s rationale for ethical decision-making. Minority applicants usually lack access to a network of individuals who can offer guidance and expertise on ethical decision-making. As such, this study investigated the impact of a CASPer coaching program designed for minority applicants.

Methods: A free online intervention was designed to help minority applicants prepare for the CASPer test. The program consisted of 35 learners and three medical student tutors. Important attributes of the 4-week program included free access to a medical ethics book, feedback provision to in-class and homework student responses, and facilitation of a mock CASPer. Course feedback was collected. Additionally, a pre and post-program survey was administered to assess learners’ competence and confidence surrounding CASPer test-taking.

Results: Our pre and post-program survey showed significant student improvement in familiarity with the test, increased competence, confidence and preparedness, as well as reduced anxiety (p < 0.05).

Conclusions: Through peer-to-peer teaching and access to medical student mentors, our program addresses socioeconomic barriers that several minority applicants face when applying to medical school.

The perceived contributions of non-physician team members to residents’ interprofessional education during a critical care rotation

2021-02-25T19:26:13-07:00

Background: During rotations, post-graduate medical residents must learn about interprofessional teamwork and collaboration. Our study examined the role of non-physician healthcare team members in such education, from the perspectives of both residents and team members themselves.

Methods: This qualitative study took place in the intensive care unit (ICU) of a teaching hospital in a Canadian city. We conducted semi-structured individual and focus group interviews with both residents (n = 6) and the team members with whom they collaborated: pharmacists, nurses, respiratory therapists, and a social worker (n = 19).

Results: We developed a number of themes about interprofessional education (IPE) in this context from the data, including the presence of planned, unplanned, and tacit teaching; the influence of contextual factors like ICU culture, work demands, resident motivation, power hierarchies, and perceptions of ‘good’ and ‘bad’ residents; the gap between team member perceptions of their contribution to residents’ IP education and residents’ own perceptions; and concerns about the transferability of IPE to other contexts.

Conclusions: The influence of non-physician team members on residents’ IPE in the clinical environment is an understudied topic. While our study was limited to one ICU, the themes that emerged may be of interest to others in similar contexts.

Seven tips for clinical supervision in the time of COVID 19

2021-02-25T19:26:16-07:00

Virtual care (VC) rapidly has become the preferred care model in family medicine settings during the COVID-19 pandemic. Both residents and preceptors must rapidly adapt and develop new skills to provide and supervise virtual care. The College of Family Physicians of Canada (CFPC) created a VC supervision guide for family medicine residents and preceptors by quickly mobilizing a consensus driven approach leveraging existing CFPC educational committees, representing a broad range of teachers and residents in the country. The guide can be adapted to other settings and is provided in the hopes of being helpful to all preceptors providing VC and (virtual) supervision during the pandemic.

Seven ways to get a grip on facilitating bedside team rounding

2021-02-25T19:26:17-07:00

Although classically considered a cornerstone of inpatient care, rounding at patients’ bedsides is increasingly being replaced by rounding in workrooms. Workroom rounds may provide a sense of efficiency and comfort, however bedside rounds have multiple benefits for patients, trainees and staff physicians. Alongside its benefits, there are human and institutional challenges when incorporating bedside rounding. This article aims to draw on our own experience of implementing bedside rounding at Kingston Health Sciences Centre, to guide staff physicians and institutions on how to implement bedside rounding effectively while overcoming its challenges. The following seven tips provide a framework to avoid pitfalls when implementing bedside team rounding on inpatient services.

Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic.

2021-02-25T19:26:18-07:00

The COVID-19 pandemic has had a tremendous effect on education programs worldwide, including medical education. Particularly, International Medical Graduates (IMGs) planning to pursue residency training in Canada have been profoundly impacted. Cancellation of away electives, as well as changes to the format, timeline, and requirements of mandatory medical licensing exams has left IMG residency applicants in uncharted territory. Given that IMGs comprise up to 25% of the Canadian healthcare force, and often are based in underserviced areas, the licensure and eligibility of IMGs to continue to enter the Canadian healthcare force is of the utmost importance in the midst of the COVID-19 pandemic. As the pandemic evolves, it is imperative that key decision makers and stakeholders continue to consider the downstream effect for IMGs and their eligibility to practice in Canada.

Inside the skin of a patient with diabetes: fostering cognitive empathy through insulin pump simulation

2021-02-25T19:26:19-07:00

Implication Statement

In order to best treat a patient, the carer must be able to clearly see their point of view. In the case of the complexities of insulin pump therapy, physicians may not fully understand the common challenges that drive patients to non-adherence. The author undertook a three-day simulation using wearable technology to explore this experience. This form of simulation represents a simple yet effective means by which to foster cognitive empathy in undergraduate and postgraduate medical education settings alike.

Teaching mindfulness-based stress management techniques to medical learners through simulation

2021-02-25T19:26:21-07:00

Implication Statement

Acutely traumatic clinical events can exacerbate stress and burnout amongst healthcare providers. The Simulated Training for Resilience in Various Environments (STRIVE) course may provide a useful framework for medical educators to teach stress management skills to promote resilience amongst physician trainees. The course introduces the Big Four+ techniques (goal setting, visualization, self-talk, progressive muscular relaxation, attention control and tactical breathing) created by the Canadian Armed Forces using clinical scenarios. This framework can be easily adapted across other training contexts to equip future clinicians with a foundational skill set to optimize their response and recovery following critically stressful incidents.

Engaging medical trainees in resource stewardship through resident-led teaching sessions: a choosing wisely educational initiative

2021-02-25T19:26:22-07:00

Implication statement:

Overuse of healthcare resources is prevalent, including among medical trainees. As front-line clinicians and near-peers, residents are well-positioned to teach resource stewardship to medical students and address barriers students may face while trying to “choose wisely.” We describe the implementation of two resident-led, case-based teaching sessions for medical students that focus on resource stewardship. Similar teaching models can be adapted by residents at their own institutions to enhance resource stewardship proficiency amongst trainees.

Rethinking licensing exams in the time of COVID-19

2021-02-25T19:26:23-07:00

COVID 19 pandemic: an opportunity to investigate medical professionalism

2021-02-25T19:26:24-07:00

Locker (operating) room talk: gender equity and the medical student’s perspective

2021-02-25T19:26:25-07:00

Building relationships: reimagining the community placement for medical students

2021-02-25T19:26:25-07:00

The COVID-19 crisis: aligning Kotter's steps for leading change with health care quality improvement

2021-02-25T19:26:26-07:00

Challenges facing medical education in psychiatry during the COVID-19 pandemic

2021-02-25T19:26:27-07:00

Remote proctoring provides candidates a safe way to continue the path to licensure

2021-02-25T19:26:28-07:00

Book Review: Mindful Medical Practitioners: A Guide for Clinicians and Educators

2021-02-25T19:26:29-07:00

The authors of Mindful Medical Practitioners: A Guide for Clinicians and Educators, Patricia Lynn Dobkin and Craig Stephen Hassed, experienced teachers of mindfulness, describe in detail how mindfulness is being taught to medical students, residents and practicing professionals in their respective settings. The book provides guidance and addresses potential questions for clinicians and educators who wish to develop and integrate programs to teach mindfulness within their institutions. It is an invaluable resource that is informative, comprehensive and readable.

“Peering into the looking glass": professionalism and professional identity formation in health professions education

2021-02-25T19:26:30-07:00

2020 Virtual International Conference on Residency Education

2021-02-25T19:26:30-07:00

Exploring the perceived educational impact of COVID-19 on postgraduate training in oncology: impact of self-determination & resilience

2021-02-25T19:26:31-07:00

Residents’ burnout in COVID 19 pandemic environment

2021-02-25T19:26:32-07:00

Personal protective equipment coaching in the pediatric and adult emergency departments: a pilot project for health sciences students during COVID-19

2021-02-25T19:26:33-07:00

A critical discourse analysis of face masks and its association with health construction in medical education

2021-02-25T19:26:33-07:00

Early adaptation of urology residency programs during COVID-19 clinical and gathering restrictions

2021-02-25T19:26:34-07:00

The COVID-19 pandemic and undergraduate medical student teaching-learning and assessment

2021-02-25T19:26:35-07:00

Growing mind

2021-02-25T19:26:35-07:00

Managing patients with substance use disorders: reflections of a medical trainee

2021-02-25T19:26:36-07:00