Canadian Medical Education Journal

This is a valuable editorial on assertiveness!

2020-12-08T11:51:22-07:00

Patients as teachers: Evaluating the experiences of volunteer inpatients during medical student clinical skills training

2020-12-07T15:32:29-07:00

Purpose: Early patient exposure in medical education is an important element of clinical skill development. This study explores the experiences of volunteer inpatients (VIPs) participating in clinical skills training with junior medical students (JMS) solely for educational purposes.

Methods: Following first-year medical students practicing history taking and clinical examinations on VIPs at Toronto General Hospital (TGH) and Toronto Western Hospital (TWH), patients completed a questionnaire and a short audio-recorded interview. This study used a mixed methodological approach. A 5-point Likert-scaled survey queried satisfaction regarding the recruitment process, student and faculty interactions and patient demographics (e.g. age and educational background). A 10-minute follow-up interview investigated patient perspectives. Survey responses were correlated to patient demographics and descriptive thematic analysis summarized trends in patient perspectives.

Results: Of 93 consenting VIPs, 66% were male and 58% participated at TGH. The mean overall experience was positive (4.76 and 4.93 at TGH and TWH, respectively). Three themes emerging through thematic analysis were Not “Just” a Medical Student, Patient as Teacher, and Promoting Best Practices. VIPs had positive experiences when students communicated effectively through active listening and engaging patients, and when the VIP role was adequately explained during recruitment.

Conclusion: Study results provide clarity about VIP experiences with JMS and lay a foundation for improved patient satisfaction and best practices within clinical skills curricula in the health professions.

Identifying essential procedural skills in Canadian undergraduate medical education

2020-12-07T15:32:32-07:00

Introduction: We conducted a national survey to characterize current Canadian procedural skills training in Undergraduate Medical Education (UGME). The goals were to identify the most important procedures students should know upon graduation and assess clinician-educator perceptions regarding implementation of a pre-clerkship procedural program.

Methods: We distributed the survey to physician-educators across Canada’s 17 medical schools. Respondents were directed to an individualized survey that collected demographic data, physician-educator responses on essential procedural skills, as well as physician-educator opinions on the value of a pre-clerkship procedural training program.

Results: The response rate for this survey was 21% (42 out of 201 distributed surveys were completed). The top 10 most important procedures identified by physician-educators included IV Access, Airway Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery, Testing for STIs, Phlebotomy, Suturing of Lacerations, Nasogastric Tube Insertion, and Venipuncture. Physician-educators supported a pre-clerkship procedural program.

Conclusions: Identifying the most crucial procedural skills is the first step in implementing a competency-based procedural skills training program for Canadian medical students. With the list of essential skills, and the support for physician-educators in developing a pre-clerkship procedural skills curriculum, hopefully there can be future development of formalized curricula.

Residents’ perspectives: Does the Saudi general surgery residency training program apply CanMEDS competencies and prepare future leaders?

2020-12-07T15:32:34-07:00

Background: This study investigates leadership skills and Canadian Medical Education Directives for Specialists (CanMEDS) competencies acquisition within the General Surgery Residency Training Program (GSRTP). The Saudi Commission for Health Specialties (SCFHS) incorporates the CanMEDS Competency Framework into its curriculum to prepare the resident for healthcare needs.

Methods: This is a descriptive-analytical study. A questionnaire was used to collect data from 117 General Surgery residents (GS) at seven institutes in Jeddah, Saudi Arabia.

Results: The GS residents reported an acceptable self-perceived level of Clinical Leadership Skills (mean ± standard deviation). The most dominant skill was working with others (1.98 ± 1.03), followed by demonstrating personal qualities (2.07 ± 0.88), the ability to manage services (2.21 ± 1.37), improving services (2.22 ± 1.84) and last, setting directions (2.39 ± 0.95). Regarding the CanMEDS competencies, the respondents showed a generally positive perception with an “agree” level (Mean = 1.83). Of the CanMEDS competency roles, Collaborator ranked first followed by Professional and then Communicator. Leader competency ranked fourth followed by Health Advocate, Medical Expert and last, Scholar.

Conclusion: The GSRTP residents showed satisfactory self-assessed clinical leadership skills and acquirement of the CanMEDS competencies during their training, which will prepare them to lead in the future.

Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

2020-12-07T15:32:37-07:00

Background: Canadian specialty programs are implementing Competence By Design, a competency-based medical education (CBME) program which requires frequent assessments of entrustable professional activities. To be used for learning, the large amount of assessment data needs to be interpreted by residents, but little work has been done to determine how visualizing and interacting with this data can be supported. Within the University of Saskatchewan emergency medicine residency program, we sought to determine how our residents’ CBME assessment data should be presented to support their learning and to develop a dashboard that meets our residents’ needs.

Methods: We utilized a design-based research process to identify and address resident needs surrounding the presentation of their assessment data. Data was collected within the emergency medicine residency program at the University of Saskatchewan via four resident focus groups held over 10 months. Focus group discussions were analyzed using a grounded theory approach to identify resident needs. This guided the development of a dashboard which contained elements (data, analytics, and visualizations) that support their interpretation of the data. The identified needs are described using quotes from the focus groups as well as visualizations of the dashboard elements.

Results: Resident needs were classified under three themes: (1) Provide guidance through the assessment program, (2) Present workplace-based assessment data, and (3) Present other assessment data. Seventeen dashboard elements were designed to address these needs.

Conclusions: Our design-based research process identified resident needs and developed dashboard elements to meet them. This work will inform the creation and evolution of CBME assessment dashboards designed to support resident learning.

Will I publish this abstract? Determining the characteristics of medical education abstracts linked to publication

2020-12-07T15:32:41-07:00

Background: Prior studies have shown that most conference submissions fail to be published. Understanding factors that facilitate publication may be of benefit to authors. Using data from the Canadian Conference on Medical Education (CCME), our goal was to identify characteristics of conference submissions that predict the likelihood of publication with a specific focus on the utility of peer-review ratings.

Methods: Study characteristics (scholarship type, methodology, population, sites, institutions) from all oral abstracts from 2011-2015 and peer-review ratings for 2014-2015 were extracted by two raters. Publication data was obtained using online database searches. The impact of variables on publication success was analyzed using logistic regressions.

Results: Of 531 abstracts with peer-review ratings, 162 (31%) were published. Of the 9 analyzed variables, those associated with a greater odds of publication were: multiple vs. single institutions (odds ratio (OR) = 1.72), post-graduate research vs. others (OR=1.81) and peer-review ratings (OR=1.60). Factors with decreased odds of publication were curriculum development (OR=0.17) and innovation vs. others (OR=0.22).

Conclusion: Similar to other studies, the publication rate of CCME presentations is low. However, peer ratings were predictive of publication success suggesting that ratings could be a useful form of feedback to authors.

Cause for concern: Resident experience in operative trauma during general surgery residency at a Canadian centre

2020-12-07T15:32:43-07:00

Background: The ability to provide competent operative trauma care is a core objective of general surgery training but recent publications question the ability of graduates to meet this standard. To assess the adequacy of operative trauma exposure during residency, we constructed and analyzed a retrospective trauma operative case log for general surgery residents at a Canadian trauma centre.

Methods: The Hamilton General Hospital Trauma Registry was used to identify all patients from July 2008 to June 2018 who underwent a trauma operation on the neck, chest, or abdomen. Medical records were reviewed to determine procedure type and resident presence.

Results: In our study, 417 patients underwent 570 operations (422 abdominal, 103 thoracic, and 45 neck). For the 35 residents that completed their general surgery residency during the study, the median number of trauma laparotomies was 5, with only 14/35 (40%) present for ≥10 trauma operations. Only 10 residents (29%) were exposed to a neck exploration and 18 (51%) exposed to a thoracic operation for trauma.

Conclusions: Operative trauma exposure amongst general surgery residents at an academic Canadian trauma centre was limited. Cumulative operative trauma surgery exposure of a typical graduating resident was inadequate when compared to Canadian and American accrediting-body standards.

Mobile medical simulation for rural anesthesia providers: A feasibility study

2020-12-07T15:32:45-07:00

Introduction: Family practice anesthesia (FPA) providers are family physicians trained to deliver anesthesia care; they often practice in rural hospitals to facilitate surgical care. FPA providers in rural hospitals face challenges including professional isolation and limited opportunities for formal continuing education. To address needs identified by FPA providers, we piloted mobile medical simulation in rural Saskatchewan.

Methods: Using a logic model framework, we evaluated feasibility of a one-day interdisciplinary mobile simulation workshop for healthcare providers in a rural Saskatchewan hospital. As part of this mixed methods pilot study, we interviewed stakeholders to explore their perceptions of human and financial resources associated with delivering medical simulations in rural locations. Multiple simulation scenarios were utilized to train participants in clinical and professional skills. Participants completed pre- and post-workshop surveys to evaluate their experience.

Results: Financial and human resources included cost of renting, transportation of mannequins, and the time required to create the scenarios. Participants (n = 10) reported improved knowledge and found the experience valuable. The session prompted participants to reflect on their deficiencies in certain clinical procedures/skills and highlight learning strategies to address the gap.

Discussion: Mobile medical simulation brought continuing medical education (CME) to health professionals in a rural location, but the program was expensive. Our logic model may inform educators and administrators considering mobile medical simulation for physicians in rural areas when balancing resource allocation and the organization’s commitment to CME for rural physicians.

Why you should Mini-Med School: Mini-Med School as an intervention to increase health literacy

2020-12-07T15:32:49-07:00

Background: Health literacy is an increasingly important topic in healthcare given that low health literacy is widely prevalent and linked to poorer health outcomes and higher healthcare costs. We sought to determine if a Mini-Med School delivered by medical students could prove to be an effective intervention to improve health literacy in the elderly.

Methods: This study took place in the context of the University of British Columbia Medical Doctorate Undergraduate Program’s Flexible and Enhanced Learning course. It aimed to evaluate the effectiveness of a Mini-Med School lecture series as an intervention to increase health literacy in 24 volunteer participants from the University of Victoria Retirees Association. This was a cross sectional study comparing health literacy pre- and post-intervention using the validated Health Literacy Questionnaire.

Results: There was a statistically significant improvement in 7 of 9 scales of health literacy when participants repeated the Health Literacy Questionnaire 6 weeks post-intervention as well as positive outcomes from both a student learning and community outreach perspective.

Discussion: This study demonstrates that a Mini-Med School program is an effective way to increase health literacy; adds to the minimal research surrounding Mini-Med Schools; and should further encourage Canadian medical schools to use Mini-Medical Schools as method of engagement and advocacy with their communities.

Medical Assistance in Dying in health sciences curricula: A qualitative exploratory study

2020-12-07T15:32:51-07:00

Background: This paper offers insight into (1) the driving and restraining forces impacting the inclusion of medical assistance in dying (MAID) in health sciences curricula, (2) the required resources for teaching MAID, and (3) the current placement of MAID in health sciences curricula in relation to end-of-life care concepts.

Method: We conducted a qualitative exploratory study in a Canadian province using Interpretive Description, Force Field Analysis, and Change as Three Steps. We interviewed ten key informants (KI), representing the provincial health sciences programs of medicine, nursing, pharmacy, and social work. KIs held various roles, including curriculum coordinator, associate dean, or lecturing faculty. Data were analyzed via the comparative method using NVivo12.

Results: Curriculum delivery structures, resources, faculty comfort and practice context, and uncertainty of the student scope of practice influenced MAID inclusion. Medical and pharmacy students were consistently exposed to MAID, whereas MAID inclusion in nursing and social work was determined by faculty in consideration with the pre-existing course objectives. The theoretical and legal aspects of MAID were more consistently taught than clinical care when faculty did not have a current practice context. Care pathways, accreditation standards, practice experts, peer-reviewed evidence, and local statistics were identified as the required resources to support student learning. MAID was delivered in conjunction with palliative care and ethics, legalities, and professional regulation courses.

Conclusion: The addition of MAID in health sciences curricula is crucial to support students in this new practice context. Identifying the drivers and restrainers influencing the inclusion of MAID in health sciences curricula is critical to support the comprehensiveness of end-of-life education for all students.

Evaluation of the effectiveness of the Global Medical Student Partnership program in undergraduate medical education

2020-12-07T15:32:53-07:00

Background: The Global Medical Student Partnership (GMSP) is, a medical student-led international initiative to promote accessible Global Health learning. This study aims to evaluate the effectiveness of the GMSP program in meeting its learning objectives.

Methods: Canadian and international medical student pairs met online monthly (January-May 2018) to discuss global health-related medical cases. Students then reviewed cases with local GMSP peers and faculty experts. A mixed-methods study was performed to evaluate whether the objectives of the program had been achieved. 26 of 32 (81.3%) students completed a questionnaire, and 13 (40.6%) also participated in one-on-one semi-structured interviews. Descriptive statistics and thematic analysis were used to analyze students’ perspectives on skill development through GMSP.

Results: GMSP students agreed or strongly agreed that international collaboration and communication skills were more important to them following program participation (92.3%, 92.3% respectively). Many expressed that after GMSP, they knew more about their healthcare system, practices abroad and how to solve complex health issues (92.3%, 84.6%, 61.5% respectively). Qualitative data showed GMSP improved students’ communication and presentation skills, provided a foundation for international relationships, fostered appraisal of diverse health systems, and furthered students’ understanding of health advocacy.

Conclusions: Our findings demonstrate that GMSP met its original objectives by providing students with opportunities to engage in international collaborations and to further develop their skills in advocacy, communication, and health-systems research. This program may be an important addition to medical education as it makes use of technology and peer-to-peer exchange to enable global health learning.

A narrative review of ambulatory care education in Canadian internal medicine

2020-12-07T15:32:56-07:00

Background: The Canadian healthcare system faces increasing patient volumes and complexity amidst funding constraints. Ambulatory care offers a potential solution to some of these challenges. Despite growing emphasis on the provision of ambulatory care, there has been a relative paucity of ambulatory care training curricula within Canadian internal medicine residency programs. We conducted a narrative review to understand the current state of knowledge on postgraduate ambulatory care education (ACE), in order to frame a research agenda for Canadian Internal Medicine ACE.

Methods: We searched OVID Medline, Embase, and PsycINFO for articles that included the concepts of ambulatory care and medical or health professions education from 2005-2015. After sorting for inclusion/exclusion, we analyzed 30 articles, looking for dominant claims about ACE in Internal Medicine literature.

Results: We found three claims. First, ACE is considered to be a necessary component of medical training because of its distinction from inpatient learning environments. Second, current models of ambulatory care clinics do not meet residency education needs. Third, ACE presents opportunities to develop non-medical expert roles.

Conclusions: The findings of our narrative review highlight a need for additional research regarding ACE in Canada to inform optimal ambulatory internal medicine training structures and alignment of educational and societal needs.

Recent evidence on visual-spatial ability in surgical education: A scoping review

2020-12-08T10:39:25-07:00

Background: Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research.

Methods: We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review.

Results: We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training.

Conclusions: It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.

Peer mentoring in medical residency education: A systematic review

2020-12-08T10:39:55-07:00

Background: Medical residents may experience burnout during their training, and a lack of social support. This can impact their overall wellbeing and ability to master key professional competencies. We explored, in this study, the extent to which peer mentorship promotes psychosocial wellbeing and the development of professional competencies in medical residency education.

Methods: We searched six databases (MEDLINE, EMBASE, PsycINFO, Academic Research Complete, ERIC, Education Research Complete) for studies on peer mentoring relationships in medical residency. We selected any study where authors reported on outcomes associated with peer mentoring relationships among medical residents. We applied no date, language, or study design limits to this review.

Results: We included nine studies in this systematic review. We found that medical residents received essential psychosocial supports from peers, and motivation to develop academic and career competencies. Medical residents in peer-mentoring relationships also reported increased overall satisfaction with their residency training programs.

Conclusions: Peer-mentoring relationships can enhance the development of key professional competencies and coping mechanisms in medical residency education. Further rigorous research is needed to examine the comparative benefits of informal and formal peer mentoring, and identify best practices with respect to effective design of peer-mentorship programs.

Caring for refugees and asylum seekers in Canada: Early experiences and comprehensive global health training for medical students

2020-12-07T15:33:01-07:00

Medical education advances and innovations: A silver lining during the COVID-19 pandemic

2020-12-07T15:33:03-07:00

The COVID-19 pandemic has disrupted healthcare processes substantially including medical education, necessitating several changes along the spectrum of medical training. While this crisis presents major challenges to medical education, it is also an immense opportunity for innovation. In this commentary, Canadian medical students cast a spotlight on four domains of Canadian medical education which have seen substantial changes during the COVID-19 pandemic: medical school admissions, pre-clerkship content delivery, virtual care and telemedicine curricula, and the residency matching process. Using the 10 recommendations noted in the Association of Faculties of Medicine of Canada (AFMC) 2010 Future of Medical Education in Canada report as a guiding framework, we discuss why these changes represent key steps forward that should be preserved in medical education beyond the pandemic, and advocate for a continuous quality improvement approach to evaluate and implement these innovations.

Peers United in Leadership & Skills Enhancement: A near peer mentoring program for medical students

2020-12-07T15:33:05-07:00

Implication Statement

We created a near-peer mentoring program in pre-clerkship, which gave medical students the opportunity to work together, teach others, and practice their clinical skills. It uniquely connects first year “learner-mentees” and second year “instructor-mentors” in semi-structured learning environments, from October to April. Beyond supporting intrinsic motivation, skills development, and collaboration, students gained experience in teaching, an important skill for physicians.

Internal Medicine Enrichment and Development: A summer exploration program for pre-clerkship students

2020-12-07T15:33:06-07:00

Implication Statement

Medical students often have difficulty selecting a residency training program. The internal medicine clerkship rotation occurs primarily on the general internal medicine ward, making it difficult for students to experience the breadth of IM subspecialties prior to making career decisions. Herein, we describe a two-week student-led program (IMED: Internal Medicine Enrichment and Development) designed to give interested pre-clerkship students an overview of the internal medicine subspecialties in order to broaden their understanding of the opportunities within the field. We believe that medical students across the country would benefit from such exposure in order to make more informed decisions about residency.

Mental health night: A peer-led initiative

2020-12-07T15:33:08-07:00

Implication Statement:

We describe a peer-led mental health (MH) workshop that was held at the Michael G. DeGroote School of Medicine (Niagara Regional Campus) in collaboration with Student Affairs. Workshop aims included facilitating discussions among peers and engaging in case-based learning about MH experiences in medical school. Post-workshop, attendees reported increased comfort in talking to classmates about personal MH, recognizing MH crises, and asking for help from peers. We believe that engaging medical learners in MH discussions early on in medical education is critical, and that peer-led workshops may aid in decreasing future MH difficulties and burnout. Due to the low-cost of holding peer-led workshops, this event could be easily replicated at other training sites.

A smartphone app for intensive care unit rotation orientation

2020-12-07T15:33:10-07:00

Implication Statement

The Department of Critical Care at Dalhousie University developed a smartphone app to improve the quality of learner orientation to the intensive care unit (ICU). The app increased satisfaction with orientation and was perceived as useful. It was ranked as the second most valued resource for orientation after other residents. There is potential to improve the experience of learners with this popular technology.

An LGBTQ+ mentorship program enriched the experience of medical students and physician mentors

2020-12-07T15:33:11-07:00

Implication Statement

The Schulich School of Medicine and Dentistry LGBTQ+ mentorship program positively impacted the personal and professional experience of LGBTQ+ medical students and physician mentors. Mentorship delivered by LGBTQ+ physicians fostered a safe environment for self-expression, and provided mentees with experience-driven guidance in navigating the medical profession. We therefore recommend that all Canadian medical schools consider the longitudinal implementation of an LGBTQ+ mentorship program to support the personal and professional development of their LGBTQ+-identifying students.

COVID-19: An urgent opportunity to decrease financial barriers to medical school admissions

2020-12-07T15:33:13-07:00

Limitations in virtual clinical skills education for medical students during COVID-19

2020-12-07T15:33:14-07:00

The new normal: Medical education during and beyond the COVID-19 pandemic

2020-12-07T15:33:15-07:00

A plea for program evaluation in a pandemic

2020-12-07T15:33:16-07:00

Art of medicine, art as medicine, and art for medical education

2020-12-07T15:33:17-07:00

The role of medical students in the COVID-19 pandemic response: A call for ethical guidelines

2020-12-07T15:33:18-07:00

Virtually learning as we go: Reflections on medical education through COVID-19

2020-12-07T15:33:20-07:00

COVID-19, curtailed clerkships, and competency: Making graduation decisions in the midst of a global pandemic

2020-12-07T15:33:21-07:00

Resident physicians’ mental health during COVID-19: Advocating for supports during and post pandemic

2020-12-07T15:33:22-07:00

There is already considerable evidence of how this novel corona virus (COVID-19) has had a major impact on our mental health and wellbeing. We are reminded of the mental health consequences of previous infectious disease outbreaks, not only for the public, but for frontline healthcare workers. Yet the lived experiences of resident physicians are missing from this discussion despite them being essential to the COVID-19 response and continuing to provide care during this time. The author asserts that considering what is known about the mental health effects of frontline healthcare work during previous outbreaks, residents are at risk given their role as physicians. In addition to baseline systemic stressors that put residents at risk of mental distress, they also face COVID-19 related stressors that exacerbate the risk given their role as trainees too. The author acknowledges and welcomes several rapid responses to residents’ developing mental health needs from medical leaders across Canadian hospitals, programs, and resident bodies. Ultimately, however, medical leaders need to advocate for and implement changes that will support residents’ mental health now and in the long-term well after COVID-19 has left its mark.

Re: CaRMS at 50

2020-12-07T15:33:25-07:00

Response to letter to the editor “Re: ‘CaRMS at 50’”

2020-12-09T08:19:16-07:00

Re: “Medical students’ personal experiences, religion, and spirituality explain their (dis)comfort with a patient’s religious needs.”

2020-12-08T10:21:38-07:00

Reply to letter to the editor

2020-12-08T10:23:53-07:00

Relief for the exhausted post-positivist: New epistemological choices transcend positivism, relativism, and even post-positivism

2020-12-08T10:25:06-07:00

Evaluating the use of media on perceptions and behaviour during the COVID-19 pandemic

2020-12-08T10:27:01-07:00

Virtual care rotation for internal medicine residents during the COVID-19 pandemic

2020-12-08T10:28:25-07:00

Medical student stress and burnout: Before and after COVID-19

2020-12-08T10:35:06-07:00

Development and use of a Virtual Objective Structured Clinical Examination

2020-12-08T10:31:44-07:00

Symphony of healthcare: Teamwork in medicine

2020-12-08T10:33:06-07:00