Canadian Medical Education Journal

Coming to terms with the languages we use in medical education: hidden meanings and unintended consequences

2021-05-01T08:22:21-06:00

Reused Reviews: the CMEJ announces a new policy to recycle peer reviews

2021-04-30T17:31:59-06:00

First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity

2021-04-30T17:31:59-06:00

Purpose: Patients identifying as sexual and gender minorities (SGMs) face healthcare barriers. This problem is partly due to medical training.¹ We evaluated first year medical student experiences during a novel four-hour seminar, in which students answered discussion questions, participated in peer role-plays, and interviewed two standardized patients

Method: A constructivist qualitative design employed audio-recorded and transcribed student focus groups. Using generic content analysis, transcripts were iteratively coded, emergent categories identified, sensitizing concepts applied, and a thematic framework created.

Results: Thirty-five students (71% female) participated in five focus groups. Two themes were developed: SGM bias (faculty, standardized patients [SPs], students, curriculum), and Adaptive Expertise in Clinical Skills (case complexity, learner support, skill development). SPs identifying as SGM brought authenticity and lived experience to their roles. Preceptor variability impacted student learning. Students were concerned when a lack of faculty SGM knowledge accompanied negative biases. Complex SP cases promoted cognitive integration and preparation for clinical work.

Conclusions: These students placed importance on the lived experiences of SGM community members. Persistent prejudices amongst faculty negatively influenced student learning. Complex SP cases can promote student adaptive expertise, but risk unproductive learning failures. The lessons learned have implications for clinical skills teaching, learning about minority populations, and medical and health professions education in general.

Physician engagement in regularly scheduled rounds

2021-04-30T17:32:01-06:00

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS.

Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS.

Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS.

Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designs

Technology readiness of medical students and the association of technology readiness with specialty interest

2021-04-30T17:32:03-06:00

Background: Technology readiness (TR) is a construct which characterizes an individual’s propensity to utilize new technology. Despite increased technology use in healthcare, limited data exists on medical student TR and the relation of TR with specialty interest. This study assesses the TR of 2^nd year medical students and its association with specialty interest.

Methods: Respondents completed a survey assessing their most preferred specialty, specialty interests, and technology readiness using a 5-point Likert scale. Using Chi-square analysis, we examined the relation between demographics, TR, and specialty interest.

Results: This study obtained a 45.7% (n = 53/116) response rate demonstrating that 79.2% (n = 42/53) of students were “technology ready.” Male students were more likely to be technology ready (95.2%, n = 20/21, vs 68.8%, n = 22/32, p = 0.02) when compared to female students. Technology ready students were associated with being more interested in “Technology-Focused” specialties compared to students who were not technology ready (88.5%, n = 23/26 vs 70.4%, n = 19/27, p = 0.104).

Conclusions: As a cohort, most medical students were technology ready. It is inconclusive if technology ready students are more likely to be interested in technology-focused specialties due to the limited sample size of this study, although with an increased sample size, an improved understanding on technology readiness and its potential impact on student specialty interest may be obtained. Furthermore, knowledge of TR may aid in developing targeted technology-based education programs and in improving remedial approaches for students who are less comfortable with new technology.

Exploring resident perceptions of initial competency based medical education implementation

2021-04-30T17:32:05-06:00

Background: Competence by design (CBD) is a nationally developed hybrid competency based medical education (CBME) curricular model that focuses on residents’ abilities to promote successful practice and better meet societal needs. CBD is based on a commonly used framework of five core components of CBME: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction and programmatic assessment. There is limited literature concerning residents’ perceptions of implementation of CBME.

Objective: We explored resident perceptions of this transformation and their views as they relate to the intended framework.

Methods: We recruited residents enrolled in current CBME implementation between August 2018 and January 2019. We interviewed residents representing eight disciplines from the initial two CBME implementation cohorts. Inductive thematic analysis was used to analyse the data through iterative consensus building until saturation.

Results: We identified five themes: 1) Value of feedback for residents; 2) Resident strategies for successful Entrustable Professional Activity observation completion; 3) Residents experience challenges; 4) Resident concerns regarding CBME; and 5) Resident recommendations to improve existing challenges. We found that while there was clear alignment with residents’ perceptions of the programmatic assessment core CBME component, alignment was not as clear for other components.

Conclusions: Residents perceived aspects of this transformation as helpful but overall had mixed perceptions and variable understanding of the intended underlying framework. Understanding and disseminating successes and challenges from the resident lens may assist programs at different stages of CBME implementation.

Utilization of evidence-based tools and medical education literature by Canadian postgraduate program directors in the teaching and assessment of the CanMEDS roles

2021-04-30T17:32:07-06:00

Background: Researchers have shown that clinical educators feel insufficiently informed about how to teach and assess the CanMEDS roles. Thus, our objective was to examine the extent to which program directors utilize evidence-based tools and the medical education literature in teaching and assessing the CanMEDS roles.

Methods: In 2016, the authors utilized an online questionnaire to survey 747 Canadian residency program directors (PD’s) of Royal College of Physicians and Surgeons of Canada (RCPSC) accredited programs.

Results: Overall, 186 PD’s participated (24.9%). 36.6% did not know whether the teaching strategies they used were evidence-based and another third (31.9%) believed they were “not at all” or “to a small extent” evidence-based. Similarly, 31.8% did not know whether the assessment tools they used were evidence-based and another third (39.7%) believed they were “not at all” or “to a small extent” evidence-based. PD’s were aware of research on teaching strategies (62.4%) and assessment tools (51.9%), but felt they did not have sufficient time to review relevant literature (72.1% for teaching and 64.1% for assessment).

Conclusions: Canadian PD’s reported low awareness of evidence-based tools for teaching and assessment, implying a potential knowledge translation gap in medical education research.

Factors influencing rheumatology residents’ decision on future practice location

2021-04-30T17:32:09-06:00

Background: There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents’ postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations.

Methods: An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ² test.

Results: A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%).

Conclusions: The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists.

Dedicated Assessors: description of an innovative education intervention to facilitate direct observation in the clinical setting

2021-04-30T17:32:10-06:00

Background: The Department of Pediatrics at Queen’s University undertook a pilot project in July 2017 to increase the frequency of direct observations (DO) its residents received without affecting the patient flow in a busy hospital-based pediatric ambulatory care clinic. Facilitating DO for authentic workplace-based assessments is essential for assessing resident’s core competencies. The purpose of this study was to pilot an innovative education intervention to address the challenge of implementing DO in the clinical setting.

Methods: The project allowed for staff physicians to act as “dedicated assessors” (DA), a faculty member who was scheduled to conduct direct observations of trainees’ clinical skills, while not acting as the attending physician on duty. At the end of the project, focus group interviews were conducted with faculty and residents, and thematic analysis was completed.

Results: Participants reported an increase in the overall quality of feedback received during the observations performed by a DA, with more specific feedback and a broader focus of assessment. There seemed to be little disruption to patient care. Some residents described the observations as anxiety-provoking.

Conclusions: Overall, this project provides insight into an educational approach that medical residency programs can apply to increase the frequency of workplace-based DO and boost the quality of feedback residents receive while maintaining the flow of already busy ambulatory care clinics.

Mindfulness-based stress reduction for medical students: a narrative review

2021-04-30T17:32:13-06:00

Background: Medical students are at high risk of depression, distress and burnout, which may adversely affect patient safety. There has been growing interest in mindfulness in medical education to improve medical student well-being. Mindfulness-based stress reduction (MBSR) is a commonly used, standardized format for teaching mindfulness skills. Previous research has suggested that MBSR may be of particular benefit for medical students. This narrative review aims to further investigate the benefits of MBSR for undergraduate medical students.

Methods: A search of the literature was performed using MedLine, Embase, ERIC, PSYCInfo, and CINAHL to identify relevant studies. A total of 102 papers were identified with this search. After review and application of inclusion and exclusion criteria, 9 papers were included in the study.

Results: MBSR training for medical students was associated with increased measures of psychological well-being and self-compassion, as well as improvements in stress, psychological distress and mood. Evidence for effect on empathy was mixed, and the single paper measuring burnout showed no effect. Two studies identified qualitative themes which provided context for the quantitative results.

Conclusions: MBSR benefits medical student well-being and decreases medical student psychological distress and depression.

Ten ways to get a grip on designing and implementing a competency-based medical education training program

2021-04-30T17:32:15-06:00

Background: Globally there is a move to adopt competency-based medical education (CBME) at all levels of the medical training system. Implementation of a complex intervention such as CBME represents a marked paradigm shift involving multiple stakeholders.

Methods: This article aims to share tips, based on review of the available literature and the authors’ experiences, that may help educators implementing CBME to more easily navigate this major undertaking and avoid “black ice” pitfalls that educators may encounter.

Results: Careful planning prior to, during and post implementation will help programs transition successfully to CBME. Involvement of key stakeholders, such as trainees, teaching faculty, residency training committee members, and the program administrator, prior to and throughout implementation of CBME is critical. Careful and selective choice of key design elements including Entrustable Professional Activities, assessments and appropriate use of direct observation will enhance successful uptake of CBME. Pilot testing may help engage faculty and learners and identify logistical issues that may hinder implementation. Academic advisors, use of curriculum maps, and identifying and leveraging local resources may help facilitate implementation. Planned evaluation of CBME is important to ensure choices made during the design and implementation of CBME result in the desired outcomes.

Conclusion: Although the transition to CBME is challenging, successful implementation can be facilitated by careful design and strategic planning.

Six ways to get a grip on teaching medical trainees on the convergence of Indigenous knowledges and biomedicine, within a culturally-safe Indigenous health curriculum

2021-04-30T17:32:16-06:00

As Indigenous knowledges and biomedicine come together in healthcare today, to improve health outcomes and strengthen cultural identity among Indigenous Peoples, it is vital for physicians to learn about this convergence during their training. This narrative review article aims to provide practical advice for educators when implementing teaching regarding this topic, using examples from the research literature, and pedagogical and practice-based methods used at the University of Toronto (UofT). The methodology on obtaining the research literature included a search of a computer database called Medline. Moreover, the medical school curriculum information specific to UofT, was obtained through the formal curriculum map and UofT’s Office of Indigenous Medical Education. The following six recommendations provide a way to successfully implement the teachings on Indigenous knowledges and biomedicine, within a culturally-safe Indigenous health curriculum.

An equity-oriented admissions model for Indigenous student recruitment in an undergraduate medical education program

2021-06-04T14:55:22-06:00

Background: With the 2015 publication of the Truth and Reconciliation Commission of Canada’s calls to action, health professional schools are left grappling with how to increase the recruitment and success of Indigenous learners. Efforts to diversify trainee pools have long looked to quota-based approaches to recruit students from underserved communities, though such approaches pose dilemmas around meaningfully dismantling structural barriers to health professional education. Lessons shared here from developing one multi-layered admissions strategy highlight the importance of equity—rather than equality—in any recruitment for learners from medically underserved communities.

Summary: The promotion of fairness in the recruitment of future practitioners is not just a question of equalizing access to, in this case, medical school; it involves recognizing the wider social and structural mechanisms that enable privileged access to the medical profession by members of dominant society. This recognition compels a shift in focus beyond merely giving the disadvantaged increased access to an unfair system, towards building tools to address deeper questions about what is meant by the kind of excellence expected of applicants, how it is to be measured, and to what extent these recruits may contribute to improved care for the communities from which they come.

Conclusion: Equity-based approaches to student recruitment move health professional schools beyond the dilemma of recruiting students from marginalized backgrounds who happen to be most similar to the dominant student population. Achieving this requires a complex view of the target population, recognizing that disadvantage is experienced in many diverse ways, that barriers are encountered along a spectrum of access, and that equity may only emerge when a critically, socially conscious approach is embedded throughout institutional practices.

Implementation and evaluation of “I-Guide,” a pilot near-peer Internal Medicine mentorship program

2021-04-30T17:32:19-06:00

Implication Statement

An Internal Medicine (IM) specific, near-peer mentorship program was initiated at the University of Ottawa (uOttawa) in 2017. Medical students were paired with IM resident mentors in an effort to improve career decision-making. Additionally, residents had the opportunity to formally teach mentees various high-yield IM topics. Program evaluation was completed using data from three participant cohorts, and showed that the program had a positive impact on students’ career decision making. Given the program’s flexible nature and ease of implementation, it is well suited for adaptation at other institutions.

Development of a medical education podcast in obstetrics and gynecology

2021-06-04T14:57:07-06:00

Implication Statement:

Podcasts are used in medical education to supplement conventional teaching methods such as lectures and reading. We identified a lack of Canadian medical education podcasts covering obstetrics and gynecology (Ob/Gyn) content and created a podcast specific for Canadian medical students and residents. The podcast called “OB-G in YEG” is freely available and currently has fourteen episodes that cover common topics in Ob/Gyn. We describe the process for creating a high-quality medical education resource that is widely accessible to learners that readers may be able to replicate in their own discipline.

Teaching bone marrow procedures at pelvic and sternal sites: a high fidelity anatomy simulation

2021-04-30T17:32:22-06:00

Implication Statement:

The bone marrow aspirate and biopsy procedure are fundamental to the diagnosis of many hematologic pathologies. We describe a hands-on, anatomy-based workshop that allows learners to practice bone marrow procedures on cadavers. Notably, participants learned how to perform sternal aspirates: a procedure rarely performed in real-life practice. Learners valued the experience and described increased comfort with the procedure after the workshop. This workshop provides a valuable opportunity for trainees to learn a procedural skill in a safe, high fidelity environment. Given its hands-on nature, residency training programs could also adapt it for direct observation and trainee assessment.

Impact of COVID 19 pandemic on the academics and psychology of final year medical students

2021-04-30T17:32:22-06:00

Inspiration amidst crisis: e-learning in a medical school of Nepal during COVID-19 pandemic

2021-04-30T17:32:23-06:00

The Coronavirus disease (COVID-19) pandemic continues to shut down colleges and universities including medical schools all over the world, thus pushing medical schools to seek e-learning to maintain continuity of curriculum. Although developed countries are comfortable learning through the internet, low-income countries like Nepal with limited experience in e-learning have used this lockdown as an opportunity to develop online classes. This crisis has clearly revealed the importance of e-learning in for medical educators in Nepal to disseminate knowledge beyond the restrictions of geography and other barriers.

How have digital resources been utilised in times of COVID-19? Opinions of medical students based in the United Kingdom.

2021-04-30T17:32:24-06:00

The COVID-19 outbreak halted medical education in its tracks, with medical students across all years finding their upcoming placements and in-person teaching cancelled in a bid to abide to social distancing regulations, for the safety of staff, students and patients alike. As United Kingdom (UK)-based medical students, we have witnessed our medical school’s attempts to preserve our education by turning to digital technology, allowing for remote teaching over the four months. This article describes some of the steps taken across the UK to uphold education during such uncertain times and provides an insight into UK medical students’ perspectives on the prolonged and increased reliance on learning via digital technology, highlighting perceived benefits and areas for improvement. In doing so, we hope to contribute to the discussion of how digital technology may best be used in medical education in the future.

The ongoing need for feminism in medicine

2021-04-30T17:32:25-06:00

Virtual education revolution during the COVID-19 pandemic: the introduction of national educational rounds in sport and exercise medicine

2021-04-30T17:32:26-06:00

Pandemic productivity: competitive pressure on medical students during the COVID-19 pandemic

2021-04-30T17:32:26-06:00

Clinical teaching culture in hospital pharmacy and medicine

2021-04-30T17:32:27-06:00

Re: Development of a medical education podcast in obstetrics and gynecology

2021-04-30T17:32:27-06:00

Changes to pediatric resident medical education during COVID-19

2021-04-30T17:32:28-06:00

Internal medicine residents’ and program directors’ perception of virtual interviews during COVID-19: a national survey

2021-06-04T14:57:38-06:00

Assessing online learning readiness and perceived stress among first year medical students during COVID-19 pandemic: a multi-country study

2021-06-04T14:58:32-06:00

We are all on the same team: the impact of COVID-19 on small businesses in Canada

2021-04-30T17:32:30-06:00

Life in the pandemic

2021-04-30T17:32:30-06:00

Canadian Conference on Medical Education 2021 Abstracts

2021-04-30T17:32:31-06:00