Canadian Medical Education Journal

High dives and parallel plans: relationships between medical student elective strategies and residency match outcomes

2019-10-15T11:58:14-06:00

Background: Medical students are anxious about not getting a preferred residency position. We described elective patterns of two recent cohorts and examined associated match outcomes.

Methods: We conducted a retrospective review of the final-year electives of all students who participated in the residency match (first iteration) at one school for 2017 and 2018. We categorized elective patterns and associated them with aggregated match outcomes. We examined high-demand/low-supply (HDLS) disciplines separately.

Results: We described three elective patterns: High Dive, Parallel Plan(s), and No Clear Pattern. Many students had High Dive and Parallel Plans patterns; only a few showed No Clear Pattern. Match rates for High Dive and Parallel Plan patterns were high but many students matched to Family and Internal Medicine. When we separated out HDLS predominance, the match rate remained high but a significant number matched to disciplines in which they did not have a majority of electives. Most High Dive and Parallel Plan students who went unmatched did so with HDLS discipline electives.

Conclusion: Many students chose High Dive and Parallel Plan strategies to both high-capacity and HDLS disciplines. Match rates were high for both patterns but students also matched to non-primary disciplines. Back-up planning may reside in the entire application, and not just electives selection.

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

2019-09-20T20:06:46-06:00

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.

Does watching a movie improve empathy? A randomized controlled trial

2019-10-15T14:46:40-06:00

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.

Discourses of disadvantage in an academic hospital: implications for education

2019-10-17T19:38:09-06:00

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.

Medical education reform: a catalyst for strengthening the health system

2019-09-20T23:06:50-06:00

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

2019-10-09T07:53:40-06:00

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.

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

2019-09-24T18:02:56-06:00

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.

Should I stay, or should I go?

2019-09-24T18:03:41-06:00

In this narrative, I explore the thoughts and emotions that drive the decision of whether to transfer residency programs. I focus on the difficulty of making a career decision with limited information, and the difficulty of exploring the possibility of a transfer while still remaining part of an ongoing residency program. Although residency transfers are a taboo topic, they are remarkably common. Many residents go through this process feeling alone; I hope to convey that these feelings are common. More understanding of the transfer process is needed, particularly in light of the ongoing unmatched Canadian medical graduate crisis and in light of high rates of burnout, to understand the drivers behind resident wellness and satisfaction.

A student affairs podcast as novel communication tool

2019-09-24T18:00:36-06:00

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

2019-10-15T17:38:16-06:00

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.

Student-initiated peer-to-peer information panel on the residency application process

2019-09-28T08:06:11-06:00

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Designer babies

2019-09-05T08:49:08-06:00

Should scholar be the new interprofessional competency?

2019-09-26T09:31:18-06:00

Burnout

2019-10-01T21:36:38-06:00

A definition for coaching in medical education

2019-10-02T13:06:40-06:00

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

2019-09-28T08:07:40-06:00

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

2019-09-17T11:34:16-06:00

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.

Paresthesia of right encephalon creativity secondary to residency application anxiety

2019-10-01T10:21:02-06:00

Applying to residency programs is a stressful time for any medical student. The finances, worries about the future, fear of not matching and being unable to repay loans can cause fleeting crippling moments for some students. As a residency applicant myself this year, and someone who has a fondness and passion for all things artistic, I sometimes find that the anxiety associated with application season can intermittently numb the creative side of my brain. It can even make my creative mind smaller because it is sometimes feels as though it is overtaken by more logical and practical thoughts. In addition, the lack of irises and pupils in the portrait show how far removed one’s mind can sometimes be from constructive emotion during this tough season of life.