Canadian Medical Education Journal

Closing out 10 years

2019-12-12T08:40:37-07:00

Does watching a movie improve empathy? A cluster randomized controlled trial

2019-12-20T10:20:25-07:00

Background: We studied if watching a movie about the patient physician encounter alone or in combination with a communication skills training workshop could improve empathy score of medical students. Methods: One hundred and thirty three medical students participated in one of the following four groups of the study. Group A: a three hour workshop (42 students); group B: watching the movie “The Doctor” (23 students); group C: watching the movie “The Doctor”, then, participating in a three hour workshop the next day (22 students); group D: control group with no intervention (46 students). Participants completed Jefferson Scale of Empathy (JSE), Student Version to assess empathy score before and after the intervention, and one month later. A linear mixed effect model analyzed the effect of intervention across groups considering the effects of other significant variables. Results: All of the three interventions had an immediate improving effect on empathy scores compared to control group. However, the improvement effect remained significant only in groups A (p=.015) and C (p=.001) one month later. Conclusions: Watching selected movies has a significant but transient effect on empathy of students. Combining two methods of watching the movie and communication skills workshop, seems to add the beneficial effects.

Medical Assistance in Dying (MAiD): the opinions of medical trainees in Newfoundland and Labrador. A cross-sectional study.

2019-12-20T10:20:00-07:00

Background: Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. As future physicians, medical trainees will face decisions regarding MAiD. Although many publications exist internationally, Canadian data is limited in the peer-reviewed literature. The purpose of this study is to determine the opinions of medical trainees in Newfoundland and Labrador regarding MAiD, and the factors that impact these views.

Methods: A survey was distributed to all medical trainees at Memorial University (N=570). The survey collected demographic information and opinions regarding MAiD. Respondents were divided into groups based on demographic characteristics, and their responses analyzed using non-parametric statistics.

Results: The survey was completed by 124 trainees. Ninety percent of respondents agreed with the legalization of MAiD in Canada and nearly 60% stated they would perform the procedure for their patients. Several factors influenced the opinions of medical trainees, including level of training and religious affiliation. Trainees also favored detachment from the MAiD process.

Interpretation: Canadian medical trainees are largely in favor of MAiD, which will likely be requested more frequently in the future. This highlights the importance of emphasizing MAiD within medical curricula, so that trainees are adequately informed and prepared to handle this new aspect of medical care upon joining independent practice.

“Disadvantaged patient populations”: A theory-informed education needs assessment in an urban teaching hospital

2019-12-20T10:19:35-07:00

Recent calls in medical education and health care emphasize equitable care for disadvantaged patient populations (DPP), with education highlighted as a key mechanism to move toward this goal. However, in order to develop effective education strategies we must first better understand the DPP concept.

We conducted a theory-informed needs assessment to explore the concept of DPP as understood in our hospital. Using an interpretive qualitative approach informed by principles of critical discourse analysis we conducted focus groups with trainees and staff across professions and groups, as identified in the hospital’s strategic plan, representing “patients experiencing disadvantage.”

We identified three main perceptions about DPP: 1) disadvantaged patients require care above and beyond what is normal; 2) the system is to blame for failures in serving disadvantaged patients; and 3) labelling patients is problematic and stigmatizing. In response, patients wanted to be first seen as valuable human beings rather than as a burden or category. Patients appreciated that the DPP concept opened up better access to care, but also felt ‘othered’ by the concept. As a result, patients felt they were not accessing the same level of care in terms of compassion and respect.

Our findings suggest potential for three, theory-informed educational approaches to help improve care for patients experiencing disadvantage: 1) sharing authentic and varied stories; 2) fostering dialogue; and 3) aligning assessment approaches with educational approaches. Additionally, we suggest a need to define access beyond the ability to receive services; according to our participants, access must also engender a sense of common humanity and respect.

Providing quality feedback to general internal medicine residents in a competency-based assessment environment

2019-12-20T10:19:10-07:00

Construct: Competence Based Medical Education (CBME) is designed to use workplace-based assessment (WBA) tools to provide observed assessment and feedback on resident competence. Moreover, WBAs are expected to provide evidence beyond that of more traditional mid- or end-of-rotation assessments [e.g., In Training Evaluation Records (ITERs)]. In this study we investigate competence in General Internal Medicine (GIM), by contrasting WBA and ITER assessment tools.

Background: WBAs are hypothesized to improve and differentiate written and numerical feedback to support the development and documentation of competence. In this study we investigate residents’ and faculty members’ perceptions of WBA validity, usability, and reliability and the extent to which WBAs differentiate residents’ performance when compared to ITERs.

Approach: We used a mixed methods approach over a three-year period, including perspectives gathered from focus groups, interviews, along with numerical and narrative comparisons between WBA and ITERs in one GIM program.

Results: Residents indicated that the narrative component of feedback was more constructive and effective than numerical scores. They perceived the focus on specific workplace-based feedback was more effective than ITERs. However, quantitative analysis showed that overall rates of actionable feedback, including both ITERs and WBAs, were low (26%), with only 9% providing an improvement strategy. The provision of quality feedback was not statistically significantly different between tools; although WBAs provided more actionable feedback, ITERs provided more strategies. Statistical analyses showed that more than half of all assessments came from 11 core faculty.

Conclusions: Participants in this study viewed narrative, actionable and specific feedback as essential, and an overall preference was found for written feedback over numerical assessments. However, quantitative analyses showed that specific actionable feedback was rarely documented, despite qualitative emphasis from both groups of its importance for developing competency. Neither formative WBAs or summative ITERs clearly provided better feedback, and both may still have a role in overall resident evaluation. Participant views differed in roles and responsibilities, with residents stating that faculty should be responsible for initiating assessments and vice-versa. These results reveal a disconnect between resident and faculty perceptions and practice around giving feedback and emphasize opportunities for programs adopting and implementing CBME to address how best to support residents and frontline clinical teachers.

Managing cognitive load in simulations: exploring the role of simulation technologists

2019-12-20T10:18:46-07:00

Background: Facilitating simulation is a complex task with high cognitive load. Simulation technologists are often recruited to help run scenarios and lower some of the extraneous load. We used cognitive load theory to explore the impact of technologists on instructors, identifying sources of instructor cognitive load with and without technologists present.

Methods: Data was collected from 56 simulation sessions for postgraduate emergency medicine residents. Instructors delivered 14 of the sessions without a technologist. After each session, the instructor and simulation technologist (if present) provided quantitative and qualitative data on the cognitive load of the simulation.

Results: Instructors rated their cognitive load similarly regardless of whether simulation technologists were present. However, the composition of their cognitive load differed. Instructors experienced less cognitive load related to the simulator and technical resources when technologists were present. Qualitative feedback from instructors suggested real consequences to these differences in cognitive load in (1) perceived complexities in running the scenario, and (2) observations of learners.

Conclusions: We provide evidence that simulation technologists can remove some of the extraneous load related to the simulator and technical resources for the instructor, allowing the instructor to focus more on observing the learner(s) and tailoring the scenario to their actions.

Medical education reform: a catalyst for strengthening the health system

2019-12-20T10:18:21-07:00

Key points:

Medical education reform of Canadian specialist doctors presents a unique opportunity for designing parallel health systems interventions.

Applying a Health System Framework reveals wider implications of Competence by Design (CBD) and provides impetus for health system strengthening.

CBD implications may include staffing shortages in academic hospitals, annual variation in medical education financing needs, new roles for clinician teachers, and greater demand for human health resource surveillance and patient outcome monitoring and analysis.

Each implication provides an opportunity to strengthen Governance and Leadership processes, namely by increasing coordination, harmonization, and system responsiveness.

Supporting early academic family medicine careers with the clinician scholar enhanced-skills program

2019-12-20T10:17:56-07:00

Context:

The Clinician Scholar Program (CSP) is an enhanced-skills (R3) residency program to train clinician researchers/educators/leaders for academic family practice. This article intends to share Laval University’s CSP development and evaluation strategy, and provide recommendations for similar innovations in other disciplines/settings.

Methods

This article uses Kern’s model to present the program development, and a program-oriented approach for program evaluation, carried from 2011 to 2017 using descriptive data. Questionnaires, reflexive texts and an Objective Structured Teaching Exam supported data collection.

Results

7 CSP graduates and 14 controls participated in the program evaluation. Residents were highly satisfied with the program, nevertheless suggested allowing training later in career. The CSP enriched knowledge, skills and attitudes about academic practice. CSP increased residents’ entrustment level about academic competencies. All graduates joined an academic practice within five years of program completion.

Conclusions

Key recommendations to implement similar programs include academic medicine core training, project-based learning with learner-centered objectives, relevant and authentic learning and assessment, and multi-level program evaluation approach. Programs should consider concomitant graduate studies and opportunity to offer such training after a few years of clinical practice to meet other needs at a timely stage of career.

Status of global health fellowship training in the United States and Canada

2019-12-20T10:17:32-07:00

Background: Increasing numbers of residency graduates desire global health (GH) fellowship training. However, the full extent of training options is not clear.

Objective: To identify clinical GH fellowships in all specialties in the U.S. and Canada and to describe their demographics, innovative features, and challenges.

Methods: The authors surveyed program directors or designees from GH fellowships with a web-based tool in 2017. Program directors reported demographics and program characteristics.

Results: The authors identified 85 potential programs. Fifty-four programs (63.5%) responded confirming 50 fellowships. The number of U.S. GH fellowship programs increased by 89.7% since 2010. One-third of fellowships accepted graduates from more than one specialty. The most common single-specialty programs were Emergency Medicine or Family Medicine. Fellowship duration was most commonly 24 months. Median size was one fellow per year. Funding and lack of qualified applicants were significant challenges. Most programs were funded through fellow billing for patient care or other means of self-support.

Conclusions: The number of U.S. and Canadian GH fellowship programs has nearly doubled since 2010. Programs reported lack of funding and qualified applicants as their most significant challenges. Consensus amongst stakeholders regarding training requirements may improve outcomes for future fellows, their employers, and the patients they serve.

Transitioning to competency-based medical education: impact of educational interventions on resident understanding

2019-12-20T10:17:07-07:00

In this paper, we describe our efforts to improve resident understanding of Competency-Based Medical Education (CBME) in an Internal Medicine residency program that launched CBME earlier than most of the country's programs. We also share the resources we have developed to address this issue with the intent of helping other programs have a successful launch.

A student affairs podcast as novel communication tool

2019-12-20T10:16:42-07:00

Podcasts are prevalent within medical education, but not within medical student affairs. Our Office of Student Affairs (OSA) created a podcast focusing on topics relevant to the medical student experience. There have been over 20,000 downloads thus far. Survey responses and feedback have been positive and highlight the podcast’s utility as a communication tool, with 96% of respondents saying they would recommend this podcast to others. Given the mission of student affairs offices to advise, mentor, and educate students, a student affairs podcast is an exciting innovation for medical schools to consider.

A resident-led clinic that promotes the health of refugee women through advocacy and partnership

2019-12-20T10:16:17-07:00

Implication Statement

Longitudinal global health experiences promote cultural competency and a commitment to caring for underserved populations beyond residency. This paper describes a longitudinal, co-curricular local global health experience. Obstetrics and gynaecology residents have partnered with the Family Medicine-led Halifax Newcomer Health Clinic to provide education and clinical well woman care to refugee women. This resident-led initiative meets the care needs of an underserved population while promoting resident engagement in health advocacy.

Should scholar be the new interprofessional competency?

2019-12-20T10:15:52-07:00

Burnout

2019-12-20T10:15:28-07:00

A definition for coaching in medical education

2019-12-20T10:15:03-07:00

Few more hidden variables which would fortify person centred approach of self-regulated learning

2019-12-20T10:14:37-07:00

Upon reading the original article on person centred approach in self regulated learning, I felt that few more hidden variables tend to operate in the process of self-regulated learning. The motivation level of students and its regulation determines the willingness of students invested towards the process and it is imperative for the educators to gauge this process during mentoring sessions. Similarly, understanding the role of epistemological beliefs could also be considered as a pertinent role player in person centred apporach. I hope that this letter, penned from the existing literature and from personal experiences, would serve as an effective adjuvant to the original article.

Head

2019-12-20T10:14:13-07:00

To fully understand something you must break it down to its simplest form. This is especially true for medicine. In order to appreciate challenging concepts, you need to have a basic comprehension of all components. I completed this piece as a medical student where I was confronted with new information that relied on my prior learning to build a bigger picture. This piece was constructed by adding small strips of paper folded in distinct patterns that as a collection form an overall image.