COVID Abstracts
An Iterative Approach to Promoting Departmental Wellbeing During COVID-19
Acai, Anita; Gonzalez, Andrea; Saperson, Karen, on behalf of the DPBN COVID-19 Wellness Working Group
Introduction: Addressing wellbeing needs among learners, faculty, and staff during the COVID-19 pandemic is a challenge for many clinical and academic departments. Continued and systemic supports are urgently needed to ensure that departments are able to carry out their clinical, educational, and research missions. To ensure uptake, supports should be based on an accurate picture of departmental needs.
Methods: Beginning in March 2020, the Plan-Do-Study-Act (PDSA) quality improvement cycle was used to inform an iterative approach to conducting a needs assessment and implementing a COVID-19-related wellness initiative in a psychiatry department. Key elements of the intervention included the establishment of a Wellness Working Group, the curation of educational materials on the Department’s website, and the deployment of regular, monthly surveys (to date, N = 3) that informed the creation of further supports, such as a weekly online drop-in support group.
Results: Survey response rates ranged from 22% to 32% (n = 90 to 127) throughout the intervention. Across multiple surveys, approximately 80% of respondents reported feeling supported or very supported by the Department, and 90% were satisfied or very satisfied with the quantity and quality of information provided. The online support group and educational materials were accessed by nearly one-quarter and one-third of participants, respectively, with satisfaction rates of 81% or higher. Consistent with the Department’s mandate, ensuring equity was a key focus of the Working Group throughout its operations.
Conclusion: Ensuring wellbeing during the COVID-19 pandemic is critical for ensuring the sustainability of the healthcare workforce and the medical education community, more broadly. There is potential for this initiative to be scaled up to create a faculty-wide, institution-wide, or regional approach to addressing wellbeing. This model is adaptable to other departments seeking to address wellbeing needs during a time of crisis.
Faculty wellness needs assessment and impact of COVID-19 in the Pediatrics Department at McMaster University
Enas El Gouhary; Joyce Obeid; Emma Wyatt; Robert Yates
Background: Burnout is a grave concern for physician wellbeing, and is exacerbated by COVID-19. Despite extensive wellness research, no clear strategies yield measurable improvements in wellness. Our objective is to conduct a wellness survey to identify determinants of burnout and psychological safety, and impact of COVID-19.
Methods: A cross-sectional wellness survey captured quantitative and qualitative data including demographics, burnout (abbreviated Maslach Burnout Inventory), psychological safety (A. Edmondson scale), factors impacting and strategies to improve wellness. Responses were analyzed as frequencies and proportions, differences in proportions were assessed using chi-square. Thematic analysis was used for qualitative data.
Results: In October-November 2020, 81/148 of physicians (55%) in McMaster University Pediatrics Department completed a wellness survey. Overall, 38% reported burnout, with no difference by gender (χ2=0.20, p=0.66). Burnout was higher in mid-career faculty (50%) versus early-career and established faculty (35%, χ2=6.25, p=0.04), and in clinically-focused (42% ) versus research-focused faculty (17%, χ2=15.0, p<0.001). Only 36% reported a high level of psychological safety. Workplace inefficiencies, workload and work-life interference significantly impacted wellness. COVID-19 further affected childcare, family physical and mental health. Highly-rated strategies included peer support, faculty engagement in system change and fostering a culture of respect and autonomy.
Conclusion: Our robust wellness needs assessment identified specific determinants of burnout locally. We reported higher burnout in mid-career and clinically-focused faculty, supporting that competing demands and workload are leading factors for burnout. An effective wellness framework should ensure safety culture, leadership training, stakeholder engagement and team building to address system-level issues and effect cultural change.
Professional identity development in the COVID-19 era
Akbary, Roya; Hamann, Karyssa; Yu, Joshua; McPherson, Isla
Introduction: Community and clinical exposure are critical components of how medical students develop their professional identity. In response to the COVID-19 pandemic, McMaster’s Michael G. DeGroote School of Medicine pulled pre-clerkship medical students from all clinical and in-person learning environments in March 2020. For the class of 2022 pre-clerkship students, the curriculum rapidly shifted: all components were moved online and in-person pre-clerkship electives and clinical skills sessions were temporarily cancelled. The impact of online learning and lack of clinical exposure on students’ socialization in medicine and development of a professional identity is not well characterized. We aimed to explore how medical students have perceived and adapted to the new online curriculum, and how the lack of in-person experiences have impacted pre-clerk medical students’ professional identity development.
Methods: An anonymous and voluntary online survey was distributed to McMaster medical students in the class of 2022 (n = 203). Data underwent descriptive analysis for major themes.
Results: A total of 75 students participated in the survey. Overall, most students felt the pandemic negatively impacted their learning, with emphasis on the limitations of online learning and interactions. Since the pandemic, students have felt increased pressure from their social responsibility as future physicians, and are more aware of the ethical and moral responsibilities of physicians. In addition, most are willing to return to the clinical environment despite acknowledgement of COVID-19 risks. Lastly, students identified areas for improvement in McMaster’s curriculum for maintaining students’ connection to medicine and professional identity development.
Conclusion: The shift to online learning and suspension of clinical activities has negatively impacted students’ perception of their learning and competency. However, it has also increased students’ awareness of the professional responsibilities of a physician. These gaps in McMaster’s curriculum are opportunities for medical educators to better support students’ professional identity development.
Using Q Methodology to Evaluate Online Anatomy Education: Learning in a COVID-19 Context
Saini, Jessica; Brewer-Deluce, Danielle; Akhtar-Danesh, Noori; Saraco, Anthony; Bayer, Ilana; Pitt, Courtney; Wainman, Bruce
Introduction: Anatomy education traditionally relies on in-person learning and experiential skill development. However, the COVID-19 pandemic has forced many courses to adopt online modes of delivery, and anatomy is no exception. The question now is whether anatomy education has successfully transitioned to the digital space, particularly with respect to the perception of learners.
Objective: The current study seeks to understand how students view an online, introductory anatomy and physiology course. Traditional methods of course evaluation include Likert scales and open-ended responses; however, such methods fail to consider the diversity of learners and the need for course-specific feedback. Thus, the emerging area of Q methodology was used as a tool for course evaluation.
Methods: Q methodology can be used to identify groups of learners with shared perceptions, allowing educators to better understand and respond to the needs of students. Studies consist of three phases: survey instrument development, data collection, and analysis/interpretation. First, a list of opinion-based statements regarding anatomy education are selected. Next, students rank statements based on their level of agreement. Finally, rankings undergo a by-person factor analysis to categorize students into distinct groups with shared perceptions.
Results: Data was collected from 106 students at McMaster University. Factor analysis revealed three subgroups within the cohort. Group 1 (n = 45) felt they needed more time on their evaluations and lectures did not cover an appropriate amount of content. Group 2 (n = 30) did not enjoy synchronous tutorials or labs. Group 3 (n = 21) overall was satisfied with course delivery. Certain perceptions were also shared across all groups. Students generally disliked online learning compared to in-person learning, with particular concern surrounding virtual specimens and bellringer exams. Students, however, appreciated the availability of asynchronous lectures.
Conclusion: The results recognize similar strengths/limitations noted in in-person classes (e.g., value of in-person labs and assessment concerns reported elsewhere), but also highlight areas of strength (asynchronous lectures) and limitation (digital resources) specific to the online environment, which will be important considerations for future online offerings. Next steps include repeating the evaluation to see if opinions are stable across groups of learners and individual students.
Virtual Delivery of Simulation Education to Undergraduate Medical Students During the COVID-19 Pandemic
Wu, Kay; Chan, Alex; Pandey, Avinash; Panchal, Puru; Khalid, Maroof; Bala, Sudarshan; Shah, Samveg; Miller, Matthew
Introduction: The COVID-19 pandemic has restricted the delivery of in-person clinical training sessions for undergraduate medical students. Concurrently, an increasing number of healthcare practices have adapted by shifting to virtual patient care, a clinical setting to which learners have had limited exposure. A promising tool to introduce learners to the virtual clinic environment is simulation-based teaching.
Methods: MacSim is an innovative, student-led simulation workshop for medical students to develop clinical competencies. In this study, the impacts of MacSim and student perspectives regarding simulation-based teaching during COVID-19 were assessed. A comprehensive case with decision pathways, representative of a real virtual outpatient scenario, was delivered to 42 pre-clerkship medical students via video conferencing. In pairs, participants obtained a history, triaged, and implemented an assessment and plan for a simulated patient. Participants ordered and viewed labs and imaging via an interactive document. Upon completion, feedback was delivered by physician adjudicators. Participants completed surveys before and after participating in MacSim and interviews were conducted with 12 randomly selected participants. Survey data was analyzed using the Wilcoxon signed-ranks test. Interview transcript data was qualitatively analyzed by two authors.
Results: Survey data (n=24) showed that after participating in MacSim, students felt significantly more prepared to take histories, make clinical decisions, collaborate, and communicate with patients in a virtual clinic setting. 92% of respondents agreed that MacSim was a valuable experience for their learning and 96% agreed more simulation-based learning should be integrated into the curriculum. Themes that emerged in the qualitative analysis included 1) the value of simulation fidelity, 2) the value of physician feedback on students’ performance in MacSim, and 3) the effectiveness of MacSim for improving students' clinical knowledge and skills in a virtual context.
Conclusion: This is the first study to characterize the value of a student-designed simulation workshop for teaching virtual care competencies to medical students in the COVID-19 era. These findings suggest the importance of integrating more simulation-based teaching focused on virtual care into undergraduate medical curricula as virtual clinics will continue to play a prominent role in medical practice.
Simulation Abstracts
Educating family medicine residents in the acute care setting: the role of simulation in behavioural team training
Dong, Junghwan Kevin; Hanel, Erich
Family Medicine (FM) residents in Canada participate in simulation-based training in limited and variable amounts, depending on the residency program. Simulation offers a safe environment to apply and develop knowledge and skills necessary in acute care, as well as crisis resource management (CRM). In preparation for the 2019 Simulation Olympiad competition (Vancouver, BC), participating FM residents at McMaster University took part in a series of simulations in a collaborative effort between staff and resident physicians from the CCFP(EM) and CCFP residency programs. We describe the principles used in preparing FM residents to participate in a simulation competition. Feedback collected from participating residents indicated that participants would like more simulation incorporated into their postgraduate training as part of improving competence and confidence in various settings, not limited to the emergency department. Residents also stressed the importance of debriefing in simulation, a tool for reflective learning and developing skills in CRM.
Simulation Roadshow - in situ simulation for regional continuing professional development
Kim, Leanne; Nagji, Alim; Caners, Kyla; Wang, Bingxian; Sibbald, Matt
Introduction: In situ simulation (ISS) has been shown to improve care provider’s knowledge and technical skills, strengthen collaboration between interdisciplinary teams, and lead to identification of latent safety threats (LST).1 However, community hospitals often lack the dedicated resources and skilled personnel to run regular ISS. A simulation roadshow for supporting simulation activity across a geographically dispersed blend of academic and community hospitals was demonstrated to facilitate resource sharing, peer mentorship, faculty development and LST identification.
Methods: An in-person simulation roadshow which brought together over 70 interdisciplinary simulation experts and participants from seven hospitals was hosted at the Joseph Brant Hospital. An ethics exemption was granted by Hamilton Integrated Research Ethics Board. The simulation centered around an emergent delivery, a neonatal resuscitation and a postpartum hemorrhage that followed the patients from the emergency department to the operating room and the intensive care unit. Thirty individuals participated in the ISS in the assigned location, while 40 individuals watched the live-streamed simulation. This was followed by a post-simulation survey, separate debriefing sessions for ISS participants and observers, and a combined faculty development workshop. The debriefing sessions focused on detecting LST and for non-local participants, lessons they could transfer to their own settings.
Results: The post-simulation survey demonstrated that the event was well-received by the 30 ISS participants. In fact, 100% (n = 20) indicated satisfaction with teaching, process, and debriefing of the simulation. Furthermore, 95% (n = 20) agreed that the content was relevant to their practice and another 95% (n = 19) stated that the simulation helped generate discussions on possible LST in their own institution. LST detected largely centered around medications, communication (including documentation), and equipment.
Conclusion: The Covid-19 pandemic has highlighted the need for rapid regional adoption of guidelines, staff training and unified approaches. Social distancing guidelines would preclude bringing together so many participants; however, the same digital technologies and conferencing solutions could be utilized to livestream ISS to participants at home, and to offer peer mentorship, debriefing, and pooled resources for LST identification and training.
Quality in standardized patient training and delivery: Retrospective document analysis of trainer and instructor feedback
Uzelli Yilmaz, Derya; Last, Nicole; Harvey, Janice; Norman, Leigh; Monteiro, Sandra; Sibbald, Matthew
Introduction: The quality improvement culture in Standardized Patient Program (SPP) is essential for the growth, integrity, and safe application of standardized patient (SP)-based educational endeavours. It is clear that timely and effective quality assurance necessitates training, monitoring, and evaluating SPs on a regular basis. Despite this, SP performance studies are rare and limited in scope. The aim of this study is to provide a worked example on how programmatic SP quality improvement can be constructed.
Methods: This retrospective study was conducted at the Centre for Simulation-Based Learning at McMaster University. The previous 6 years of SP feedback forms completed by trainers and instructors in the scope of quality assurance were reviewed and analyzed. The forms scored on a 5-point Likert type scale (1: needs to be retrained, 5: excellent). There are also open-ended sections for feedback on the form. Descriptive statistics were utilized to analyze the ratings. Qualitative analysis of open-ended sections was informed by thematic analysis. 138 completed forms were included in this analysis.
Results: The mean score of the SPs’ feedback by instructors was 4.56±0.59. Instructors' rating related to the SP professionalism was 4.77±0.81. The mean score of the SPs’ knowledge of case information by trainers was 4.84±0.64. Trainers' rating related to the SP’ appropriate responses was 4.86±0.35 and the mean of the rating for SP' effect was 4.71±0.76. Four key themes emerged from the written feedback regarding the quality of SP’s application by trainers and instructors included non-verbal behaviours in simulation activity or feedback sessions, providing feedback from the patients’ lens, consistency with role portrayal and the scenario and adapting easily to changing situations.
Conclusion: The previous 6 years of analysis of SP scoring findings, it can be seen that the evaluation levels of the SP performance given by trainers and instructors were high. Component scoring on SP performance did not discriminate against all the issues well, but qualitative comments identified some specific issues. Additional research is necessary to establish standards for continuing SPP quality improvement and to evaluate the consistency of performance, effectiveness of feedback to learners, and reliability of grading.
Handover of Care: A Novel Interprofessional Workshop for Junior Learners
Azim, Arden; Uzelli-Yilmaz, Derya; Sibbald, Matt
Introduction: Interprofessional handover of care is crucial for patient safety. Structured handover tools and interprofessional communication skills improve the delivery of safe effective handover. Simulation-based interventions may be effective in improving interprofessional handover readiness among health care trainees. In this study, we describe a novel simulation-based interprofessional handover workshop for undergraduate healthcare trainees, delivered both in-person and virtually.
Methods: Medical and nursing students attended either virtual or in-person sessions of a 2-hour simulation-based handover workshop. Students received brief didactic instruction on the SBAR (situation, background, assessment, recommendation) structured handover tool, then rotated through four simulated stations in interprofessional groups, followed by a facilitator-led debrief. Workshop content was the same for both virtual and in-person sessions. Objectives on interprofessional communication, conflict resolution and role clarification competencies were integrated throughout the workshop. Students were asked to rate their satisfaction with the workshop, and their pre and post-workshop perceived confidence participating in interprofessional handover.
Results: Eighteen medical students and twelve nursing students attended in-person sessions of the handover workshop. Six medical students and four nursing students attended a virtual workshop session. Medical students participants were in their 1st and 2nd years of training, and nursing students were between their 2nd to 4th year. In-person participants’ self-reported confidence participating in interprofessional handover increased from 1.8 to 4.1 on a 5-point scale (p = 0.019). Virtual workshop participants’ self-reported confidence participating in interprofessional handover increased from 1.7 to 4.4 on a 5-point scale (p <0.0001). Participant satisfaction scores were similar (p= 0.5) for the in-person (4.6 on a 5-point scale) and virtual workshops (4.5 on a 5-point scale). A majority of students identified direct feedback from interprofessional peers on interprofessional communication skills as a useful element of both the in-person and virtual sessions.
Conclusion: A novel simulation-based SBAR-structured workshop improved perceived level of confidence participating in interprofessional handover among junior learners. Preliminary data suggests that a virtual alternative may be similarly effective and acceptable to learners.
Immersive Virtual Reality for Surgical Training: A Systematic Review
Mao, Randi Q.; Lan, Lucy; Kay, Jeffrey; Lohre, Ryan; Ayeni, Olufemi R.; Goel, Danny P.; de SA, Darren
Introduction: Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic adjuncts in time and financially constrained training programs. With increasing utilization of this technology, its effect on global skill acquisition should be clarified. This systematic review examines the current literature on the effectiveness of iVR for surgical skills training.
Methods: A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and May 13, 2020 on the use of iVR to develop technical surgical skills. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results were qualitatively synthesized, and descriptive statistics were calculated. Where possible, standardized mean differences (SMD) were calculated using a random effects model.
Results: The literature search yielded 8,939 citations, with 13 articles included for qualitative synthesis. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled SMD =-1.11 [95% CI=-1.66 to -0.57, I2 =1%, p<0.0001]). Two of four controlled trials that used task-specific checklists found iVR groups completed significantly more steps than control post-intervention. Four studies reported on implant placement accuracy. In two studies by Xin et al., iVR groups placed significantly more successful grade I/A pedicle screws compared to controls (89.6% vs. 60.4%, and 69.6% vs. 55.4%). The mean MERSQI score was 11.88±1.60.
Conclusion: Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.
Curricula Abstracts
Bridging the gap in clinical skills: Investigating the use of respiratory clinical examination skills in practice.
Sophia Kerzner, Randi Mao, Janhavi Patel, Shreyas Sreeraman, Jason Profetto
Introduction: There is a paucity of literature that explores whether students use the clinical skills learned during medical school in practice. This study aims to fill this gap, as a greater understanding of clinically relevant examination skills may better focus studying, increase clinical competence, and ease student anxiety.
Methods: We disseminated a 10-minute online anonymized survey to residents and physicians using an open recruitment strategy with convenience and snowball sampling. This survey sought to determine the practical use of respiratory examination skills in the McMaster Clinical Skills guide. We conducted basic quantitative analysis and descriptive content analysis to evaluate results.
Results: From a total of 161 respondents, 148 completed the entire survey. The majority of respondents found all 12 inspection skills to be useful in practice. Tracheal deviation was the only palpation skill found useful (68.63%). No percussion or auscultation skills were seen as useful by a majority, except for auscultating for breath sounds (100% useful). In qualitative analysis, the major theme was that skills should be taught despite minimal use as they help teach disease pathophysiology, help in limited resource settings, and have usefulness in particular situations (e.g., traumas or different specialties).
Conclusions: There is a discrepancy between the clinical skills taught to students and the ones actually used in practice. Despite this, there is still utility in teaching these skills to medical students. Rather than removing skills from the curriculum, a better avenue would be to emphasize maneuvers that are clinically important to help guide preparation for clinical settings.
Geriatric Oncology Needs Assessment: A National Survey of Hematology Residents Across Canada
David, Victoria; Hsu, Tina; Fraser, Graeme; Mian, Hira
Introduction: With the aging population, the incorporation of a geriatric oncology curriculum into hematology and oncology residency training has been recognized as a priority to improve the care of older adults with cancer. A survey of Canadian radiation oncology residents reported that 49% of trainees lacked confidence in managing unique aspects of care of older patients. There is a paucity of data on the inclusion of geriatric oncology into hematology training in Canada. The purpose of this study was to conduct a needs assessment to understand residents’ views and needs for a geriatric oncology curriculum during hematology residency in Canada.
Methods: We conducted a cross-sectional study of Canadian hematology residents. Seventy residents were eligible to participate. The survey was developed in discussion with nurses, geriatricians, oncologists and hematologists. The survey was piloted with three non-hematology residents and revised. The survey used a combination of Likert scale, multiple-choice and open-ended questions. Outcome variables included current state of geriatric oncology training, interest in a geriatric oncology curriculum, and curriculum objectives. The survey, open June 2-30 2020, was distributed electronically via program directors. Descriptive statistics were used for data analysis. Ninety-five percent confidence intervals were calculated.
Results: Twenty-nine hematology residents (41.4% response rate) participated. Most residents have not received geriatric oncology teaching (58.6%, CI:38.9%-76.5%, n=17) and have never been taught geriatric oncology assessment tools (72.4%, CI:52.8%-87.3%, n=21). Most residents (96.6%, CI:82.2%-99.9%, n=28) felt their program should deliver a geriatric oncology curriculum. Topics most residents wished to learn: assessment prior to chemotherapy decision (86.2%, CI:68.3%-96.1%, n=25), assessment to predict chemotherapy toxicity (82.8%, CI:64.2%-94.2%, n=24), and ethical issues regarding treatment initiation, continuation or termination (79.3%, CI:60.3%-92.0%, n=23).
Conclusion: There is a lack of geriatric oncology training for Canadian hematology residents. This study highlights the need for a dedicated geriatric oncology curriculum integrated into hematology training.
Introduction to interdisciplinary curriculum & readiness for interprofessional learning in BHSc (Hons) Program
Nash, Jennifer V; Oliveira, Ana; Wojkowski, Sarah
The Bachelor of Health Sciences (Honours) Program (BHSc) is an undergraduate program that admits students directly from secondary school. The program is grounded in inquiry-based and experiential learning. Due to the shift to online learning for the 2020 cohort, video introductions for all courses were created and links shared with incoming students prior to course start dates, providing students entering the program an opportunity to learn about the course content, objectives and meet the instructors prior to starting each course. In the HTHSCI 1G02: Interdisciplinary Problem Solving in Health introductory video the four co-instructors discussed their own roles, experiences and interdisciplinary perspectives on health. This retrospective study explores differences in readiness for interprofessional learning between students from the 2019 and 2020 cohorts.
As part of a Faculty of Health Sciences (FHS) wide initiative to measure readiness for IPE learning, incoming BHSc students were invited to complete the Readiness for Interprofessional Learning Scale (RIPLS) in 2019 and 2020 (n=435). One-way ANCOVA compared the cohorts controlling for age, gender and previous IPE experience.
88 students from 2019 (26♀; 18.0±0.2 years old; 88 no IPE experience; 42% response rate) and 153 students from 2020 (94♀ 18.1±0.6 years old; 149 no IPE experience; 68% response rate) cohorts participated. The 2019 cohort presented higher scores than the 2020 cohort for total RIPLS (mean diff. 8.7 95% CI 5.8 to 11.9), team and teamwork & collaboration (mean diff. 7.3 95% CI 5.5 to 9.2) and positive professional identity (mean diff. 3.3 95% CI 2.1 to 4.3) sub-scales; and significantly lower scores for roles & responsibilities sub-scale (mean diff. -1.5% CI -2.0 to -1.0). No significant differences were found between cohorts for the negative professional identity sub-scale (mean diff. -0.3% CI -0.7 to 0.2).
We believe that the COVID-19 pandemic may have contributed to the decrease in scores in all RIPLS subscales except roles & responsibilities; and that the newly added introductory video for HTHSCI 1G02 may have contributed to an increase in students’ perceptions about roles and responsibilities in health in the 2020 cohort. Further analyses are planned to explore RIPLS scores before and after completion of this course and prospectively with new student cohorts to better understand the impact of early exposure to interdisciplinary education in the BHSc Program.
Development of theory- and evidence-based Do-Live-Well workshops for Canadian occupational therapists
Kim, Sungha; Gewurtz, Rebecca; Bayer, Ilana; Larivière, Nadine; Letts, Lori
Introduction: The Do-Live-Well (DLW) framework was developed by Canadian occupational therapists (OTs) to promote health and wellness amongst Canadians. This is a relatively new framework and learning opportunities were needed to share the framework with OTs through workshops. There was interest amongst OTs for both online and in-person learning opportunities, to translate concepts and strategies from the framework into practice. The purpose of this project was to develop theory- and evidence-based in-person and online educational workshops for OTs.
Methods: We incorporated three different phases to develop theory- and evidence-based DLW workshops.
Phase 1. We interviewed four Canadian OTs about their use of the framework and their training needs. The interviews were transcribed and analyzed using thematic analysis.
Phase 2. We developed identical content for online and in-person workshops based on the findings from Phase 1. We incorporated problem-based learning (PBL) fundamental principles to develop a learner-centred environment.
Phase 3. We created a learning website for the online workshop. We asked four experts to complete a usability test of the online workshop website to improve online delivery.
Results:
Phase 1. We identified three main themes about the OTs’ perspectives of and experiences using the DLW framework: 1) DLW helps their clients reflect upon their daily activities; 2) OTs struggle with the DLW application; 3) OTs need a DLW learning opportunity.
Phase 2. We created PowerPoint slides with written scripts to ensure equivalent online and in-person workshops. We created case scenarios because OTs at Phase 1 wanted to learn more about applying the DLW framework in practice. Eight critical principles of PBL were incorporated (e.g., self-directedness was incorporated by asking learners to set learning goals).
Phase 3. The overall usability score of the online workshop website ranged from 85–91%. Qualitative findings from the free-text answers suggested: 1) the website was easy to access and navigate; 2) the visual design should be user-friendly; and 3) terms, resources, and activities need to be clarified.
Conclusion: This study provided a detailed description of how to develop theory- and evidence-based learning opportunities for OTs by incorporating three different phases of workshop development. We hope this project functions as an “audit trail” of educational intervention development.
The Development of a Master of Public Health Course During the COVID-19 Pandemic: Application of the Salmon Model
Kuganathan, Ann; Slifierz, Mackenzie; Anderson, Laura; Alvarez, Elizabeth; Apatu, Emma
Coronavirus Disease 2019 (COVID-19) has highlighted the need for well- trained public health workers to interpret evidence, make informed decisions and disseminate information to the general public. As public health courses in Ontario Universities have moved online due to this pandemic, instructors were required to simulate their teaching online whilst maintaining student engagement. Previous research has shown that there is a lack of description for the development of online public health courses. As such, the objective of this paper is to outline the development and layout of a Professional Development Studio (PDS) course offered in the Masters of Public Health program at McMaster University, Hamilton Ontario. We use the Salmon model, previously described by Salmon et. al., 2013, to form the course outline. The Salmon model provides a 5-stage framework for the development of a concise, engaging and impactful online course. Based on student feedback, we found that the Salmon model positively shaped the development of the course by aiding the formulation of a course layout that was easily accessible, discussion threads to communicate in an inclusive and safe space and relevant assessments requiring the use of tools to make judgments and appropriately disseminate information publicly. We conclude that the Salmon model is a helpful framework to use in developing an engaging online public health course. Further assessments based on student feedback should be completed to continually evolve the online course to better tailor the needs and interests of public health students preparing them for the public health workforce.
Health Policy Abstracts
Registered Nurses’ Experiences as Preceptors for Newly Hired Registered Nurses in Acute Pediatric Clinical Settings
Alostaz, Nasrin
Background: The responsibilities of frontline registered nurses (RNs) include providing patient care as well as precepting students and new staff nurses. The preceptor role has been acknowledged as demanding and challenging in the acute healthcare setting. The importance of nurse preceptors to the new nurses’ transition to practice has also been discussed in the literature. However, less is known about nurses’ experiences as preceptors, particularly in specialized clinical areas, such as pediatrics. Therefore, the purpose of this study is to explore the experience of nurse preceptors in the acute pediatric setting.
Method: An interpretive descriptive design guided the research process. Semi-structured one-on-one interviews, both in-person and virtual, were carried out with five nurse preceptors employed at a specialized pediatric unit in Ontario. The real-life experiences of participants were reported using their rich descriptions of events. Data collection and analysis were conducted concurrently and informed by the Braun and Clark (2006) framework.
Results: Findings were grouped into the following three themes: the duality of the role of the pediatric nurse; the experiences of the pediatric nurse preceptor; and the needs of the pediatric nurse preceptors.
Implications: This study found that the preceptor role is diverse and demanding. Preceptors require support from various stakeholders to ensure that their dual role is carried out effectively. Recommendations are made for future practice, education, and research.
One of the IHI strategic priority is to educate FHS students, staff, and faculty members about Indigenous cultural safety, which is imperative as many of the national accreditation bodies have identified improving Indigenous health as a key priority (AFMC, 2017; CNA 2014). Through the IHI, San’yas Indigenous Cultural Safety (ICS) training is offered to ~200 staff and faculty members across FHS. This training is designed to increase knowledge and enhance self-awareness of health professionals to examine how their own culture and bias shape their health practice. This 8-week training helps learners understand the diversity of Indigenous people within Ontario; colonial policies specific to Residential Schools and Indian Hospitals; the impact of colonization on current Indigenous health care issues; significance of health disparities to health care providers; and ways in which assumptions and stereotypes affect the level of care within a healthcare setting.
The goal of this project is to assess how inter-professional learners benefit from Core Indigenous Cultural Safety training as it relates to their clinical practice and professional duties. Furthermore, using the results from this evaluation, the project team is planning to develop a sustainable and adaptable FHS specific Indigenous Cultural Safety training program for students, staff, and faculty members.
The Impact of Gender on Postgraduate Resident Experiences in Psychiatry
Lopes, Jillian; Harms, Sheila; Acai, Anita
Introduction: Women encounter various types of gender-based discrimination within their clinical, academic, and research experiences. In this study, we sought to understand how gender impacts residents’ training experiences. The methods used to explore this phenomenon were: 1) interviews with residents and 2) an analysis of written comments received during clinical evaluations.
Methods: All PGY2-5 residents (n=40) in McMaster University’s Postgraduate Psychiatry Training Program were invited to participate in semi-structured qualitative interviews. Interviews were transcribed and analyzed using thematic analysis. Qualitative content analysis was conducted on resident narrative comments from in-training assessment reports (ITARs) to better understand how gender impacts resident evaluations. Comments were rated using a previously validated tool (the McMaster Narrative Comment Rating System) and analyzed qualitatively for gender-related differences. This multi-method approach was leveraged to better appreciate all facets of a trainee’s experiences in their simultaneous roles of clinician and learner.
Results: Five of 40 eligible psychiatry residents (four women, one man) consented to participate in an interview. Additionally, 13 of 40 residents (seven women, six men) consented to participate in the narrative comments portion of the study, resulting in 146 narrative comments for analysis. Participants identified numerous gender-related challenges encountered by women, including feeling the need to prove their competence, and repercussions of challenging gender-stereotyped roles. Analysis of the narrative comments revealed that comments written about men appeared to focus more on behaviours, while comments about women focused more on personality traits. This finding is supported by literature and illuminates how potential implicit gender biases may be present in narrative comments.
Conclusion: While equal representation in terms of numbers is often cited as a metric to assess equity, the findings of this study note that balanced proportions alone do not equate to equity. Women trainees continue to experience gender-related differences that seem to be inherently woven into their experiences, which appear to be qualitatively different than that of men. Institutions are encouraged to adopt a gender-informed lens when educating and evaluating learners in order to mitigate the impact of potential biases and better accommodate trainees’ unique experiences.
Trainee perceptions of resident duty hour restrictions: A qualitative study of online discussion forums.
Doja, Asif ; Clarkin, Chantalle
Introduction: Resident duty hour (RDH) restrictions in post-graduate medical education is a controversial, yet important topic for study. Trainee perceptions, both before and after implementation of RDH restrictions, contribute vital perspectives with the potential to inform evaluation and future planning. Online forums are a widely accessible yet under-utilized resource for insight into trainee perceptions and experiences surrounding duty hour limits.
Methods: Our team analyzed a total of 6630 posts from 161 discussion threads using inductive content analysis; comprising 429 posts in 14 threads from Premed101 (Canadian forum), and 6201 posts in 147 threads from Student Doctor Network (SDN) (American forum). Data were analyzed iteratively, within and across forums, using Nvivo for data management. The trustworthiness of our analysis was enhanced through co-coding, consensus-based decision making, peer debriefing, and maintaining an audit trail.
Results: Key findings distilled across both forums include: the relationship between hours worked and competence, the inapplicability of blanket RDH restrictions to all specialties, interrelationships between fatigue, handover and patient safety, and the multifactorial nature of resident well-being. Discussions of RDH restriction compliance and perceived consequence for the reporting of violations also featured predominantly in threads on the American SDN forum.
Conclusion: The findings of this study suggest that trainees seek to be fundamentally valued as a participant in RDH regulation setting. Furthermore, given the diversity of training needs across specialties and even within programs, the environmental context proves to be an important decision pillar of RDH restrictions. Lastly, if RDH restrictions are implemented, there must be a robust, transparent, and psychologically safe violation reporting system.
A Nationwide Survey of Parental Leave Policies in Canadian Surgical Training Programs
Cui, Sherry; Lin, Lanyi
Introduction: For decades, there have been calls to implement parental leave policies for physicians. Although some progress has been made, policies are highly variable across sites, and many are unclear or unspecific. Taking parental leave can be especially challenging in surgical specialties, which are lengthy and have fewer residents per program to cover for those on leave. Of the studies that have examined parental leave policies at academic sites in Canada, few have focused on surgical specialties and non-childbearing (e.g., paternity) leave. The present study examined parental leave policies (both childbearing and non-childbearing) at Canadian academic surgical centres, as well as perspectives on these policies and the effects of becoming a parent in a surgical career.
Methods: An online survey adapted with permission from Hariton and colleagues (2018) was sent to 16 surgical department chairs across Canada, who were asked to distribute it to all surgical residents, fellows, faculty, and program directors (PDs) within their respective institutions, as well as to complete it themselves. The survey contained both closed- and open-ended questions that probed participants’ opinions on parental leave, parental leave policies, and the effects of becoming a parent. 182 responses were received between January and May 2019. Quantitative findings were analyzed using descriptive statistics.
Results: Findings showed that the ideal amount of time to be taken off for childbearing parental leave was between 9 months and 1 year; however, the actual time taken off was considerably less. Participants were split in their opinions about the ideal amount of time to be taken off for non-childbearing parental leave. Furthermore, PDs and chairs perceived that residents and faculty took more time off for parental leave than what was reported by residents and faculty themselves. The perceived effect of becoming a parent on wellbeing was poorer for residents than for faculty. Across all roles, respondents reported a lack of knowledge about parental leave, breastfeeding, and return-to-work policies.
Conclusion: Currently, Canadian surgical programs do not present clear policies regarding parental leave, and the amount of time taken off is much less than desired. Further research into the socioeconomic barriers that prevent residents and faculty from taking leave and on ways of more effectively integrating new parents back into the workforce is needed.
Education influences on the geographic disposition of Family Physicians
Grierson, Lawrence; Mahmud, Meera; Bakker, Dorothy; Johnston, Neil; Aggarwal, Monica; Agarwal Gina
Introduction: The distribution of Family Physicians to ensure equitable access to healthcare in both urban and rural areas has been a Health Canada focus for decades. While there are few levers to encourage physicians to arrange their practices in a way which ameliorates maldistribution, Canadian medical education does present some opportunities. Our team has created a database that links information about the education and practice patterns of McMaster-graduated physicians in independent practice across Canada and is conducting research that scrutinizes two educational policies that are held up as promising in influencing the geographic disposition of physicians: the selection of medical school candidates from particular regions and the establishment of clinical education in underserved areas.
Methods: This is a two-stage explanatory sequential mixed-methods study. The first stage involves a retrospective observational study that develops models of association between personal and education metrics and the geographic distribution of Family Physicians who graduated McMaster University’s Undergraduate MD Program medical graduates in regions across Canada as indexed by available markers of socio-economic, health status, and degree of physician need. The second stage involves a qualitative descriptive study which examines more deeply the personal and educational factors that influence the locations in which Family Physicians choose to practice.
Results: At the time of abstract submission, we have developed a database that maps the training and practice locations of 347 Family Physicians and the process of indexing locations is underway. We anticipate being able to report models of association between indices of disposition by the time of presentation. The second study stage will begin thereafter.
Conclusions: This project will result in knowledge about the training factors that influence practice location as well as descriptions of the way individual Family Physicians make the choice of practice location. The study will conclude with the development of policy-relevant recommendations pertaining to the selection of medical school applicants from particular regions, and the training of medical students throughout distributed medical education networks; providing significant evidence for those interested in predicting and influencing Family Physician workforce patterns.
Evaluation & Assessment Abstracts
Global Perceptions on Social Accountability and Outcomes: A Survey of Medical Schools
Chahine, Saad; Leppink, Jimmie; van der Vleuten, Cees
Introduction: Social accountability is central to medical education, yet despite repeated international calls for stronger evidence of institutional effectiveness, programs struggle to demonstrate social accountability. This study explores institutional practices and administrative perceptions of social accountability in medical schools, globally.
Methods: An online survey was emailed to a purposeful sample of academic deans and program directors/leads of English-speaking medical schools that offer an undergraduate medical program from 245 institutions in 14 countries. Survey items were developed using previous literature and categorized using context-input-process-products (CIPP) evaluation model as an organizational framework. Exploratory Factor Analysis (EFA) using principal axis factor analysis with oblique rotation was used to assess the inter-relationships among survey items. Reliability and internal consistency of items were evaluated using McDonald’s omega. Analysis of variance (ANOVA) and post hoc analyses were used to examine differences in institutional practices of social accountability.
Results: Findings from 103 deans and program directors/leads from 80 medical schools in 14 countries collected between February and June 2020 are presented. Common perceptions that contribute to the social accountability were identified. However, institutional nuances were observed. EFA demonstrated excellent internal consistency and reliability. Five-factors were extracted, accounting for 68% of the variance: community partnerships; institutional mandates; selection and recruitment; institutional activities; and community responsibility. McDonald’s Omega reliability estimates for subscales ranged from 0.76-0.91. Differences among subscales were observed.
Conclusion: This study explored institutional practices and administrative perceptions of social accountability, globally. While, most medical schools expressed an institutional commitment to social accountability, the effects of their outcomes on the community remain unknown and not evaluated. Observed country level differences suggests institutional practices of social accountability focus predominatly on inputs and processes and lack product outcomes. Overall, this paper offers programs and educators a psychometrically supported tool to aid in the operationalization and reliability of evaluating social accountability.
Engagement and learning in a novel spaced repetition intervention for a paediatrics academic half day curriculum
Johnston, Bronte; Darling, Liz; Malott, Anne; Bernacci, Carol; Thomas, Laura; Murray-Davis, Beth
Background: In 2018, the College of Midwives of Ontario expanded the scope of practice for registered midwives to include performing point of care ultrasound (POCUS) which can aid clinical assessments during obstetrical examinations. This project evaluated learner knowledge and skill acquisition following an innovative POCUS curriculum developed for midwives.
Methods: Concurrent triangulation with mixed methods was used. There were two components of this study: Surveys were used to collect data across four time points including before and after the intervention. Five- and seven-point Likert scale questions were analyzed through descriptive statistics. Open-ended questions were qualitatively analyzed using thematic analyses. Interviews- Semi-structured interviews were conducted to better understand their attitudes and clinical behaviours. Interviews were coded and analyzed using a combination of Corbin and Strauss as well as Charmaz constructive approaches to grounded theory.
Results: The findings demonstrated how there was a positive increase in learner comfort with POCUS and a desire to continue using it during clinical practice. The frequency of POCUS use within antenatal clinic increased with common applications including fetal presentation and assessment of pregnancy viability. Interviews highlighted five themes: facilitating learning, improving care, refining the role of the midwife, serving community, and maintaining competency. Access to clinical placements and the cost of a device were identified as barriers to promoting POCUS skill sets. Participants who have access to a device and completed the clinical practicum are continuing to use it within their clinics to provide more comprehensive client care.
Conclusion: This project demonstrates how POCUS training can positively aid midwives particularly with aiding clinical decision making regarding fetal viability and presentation. However, the challenges with obtaining a clinical practicum to ensure competency and the cost and access to a device, it is currently minimally integrated within community practices.
Midwifery Student and Resident Understanding, Learning and Application of Shared Decision Making: A Grounded Theory Study
Furnivall, Meagan., Darling, Liz., Murray Davis, Beth., Monteiro, Sandra
Purpose: Childbirth is an important time in a patient’s life. The pregnant patient or client seeks to obtain as much control over their circumstance as possible. The more perceived control in childbirth by the patient, the better the outcomes are for the patient-newborn dyad. One way that patients obtain control during childbirth is by participating in clinical decision making with their healthcare providers. This control can reduce rates of childbirth post-traumatic stress disorder. This research intended to study the ways in which OB residents and midwifery students engaged in the understanding, learning and application of shared decision making with clients and patients.
Method: This study utilized a constructivist grounded theory approach to obtain data and formulate a theory using semi-structured interviews with five senior obstetrical residents and five senior midwifery students from Ontario in the year 2020. Participants were interviewed until saturation was achieved.
Results: Qualitative data revealed four themes. Our theory describes the way residents and students absorb, mirror, and perform shared decision making through an informal process of observation and experience throughout their training. Our theory further describes how support for students and residents creates the foundation for learning shared decision making. Support includes how the mentor minimizes the impacts of the hierarchy of power in medical and midwifery education, as well as increasing psychological safety for the learner.
Conclusions: The study results support the exploration of future methods for the teaching of shared decision making to obstetrical residents and midwifery students. Midwifery students and obstetrical residents highlighted various ways in which they would appreciate learning shared decision making and some of the barriers to their learning and assessment. In addition to the importance of psychological safety, our theory highlights how Bandura’s Social Cognitive Theory plays an important role in the clinical learning environment in shared decision making. Participants of this study agreed that more training is needed for shared decision making, as well as training for the mentor and preceptor to ensure learners are optimizing their experience. Further training needs to be available for mentors to help reduce the negative impacts of the hierarchy of power, and to increase psychological safety for the learner.
Factors influencing readiness for interprofessional education in health science students
Oliveira, Ana; Brewer-Deluce, Danielle; Wojkowski,
Interprofessional education (IPE) in health-science programs have been shown to improve health practitioners’ collaborative team behavior, reduce clinical errors and increase patient satisfaction. IPE is only effective however, if students are willing and ready to engage in cooperative learning with others. Factors influencing students’ IPE readiness are unknown, which limits educators’ opportunities to target IPE experiences for the most appropriate audience. We investigated if age, gender, level of learner (graduate vs. undergraduate), previous IPE experience and cohort year (i.e., 2019 vs. 2020) significantly affected IPE readiness.
Two consecutive cohorts of first year students from the Faculty of Health Sciences (n=2069) were invited to complete the Readiness for Interprofessional Learning Scale (RIPLS). Multiple linear regressions with stepwise model were conducted using the total RIPLS score and its sub-scales as dependent variables. Age, gender, level of learner (graduate vs. undergraduate), previous IPE experience and cohort year (i.e., 2019 vs. 2020) were included as independent variables.
In total, 885 students participated between the two cohorts (60% female; age = 21.7±4.7; 72% undergraduate; 66% in 2020-2021 cohort; 43% response rate). Together, level of learner and cohort year explained 21%, 2.7% and 23% (p<0.001) of the variance in the Total RIPLS score, negative and positive professional identity subscales, respectively. Together, level of learner, cohort year and age explained 25% and 15% (p<0.001) of the variance in the teamwork & collaboration and roles & responsibilities subscales, respectively. The RIPLS total score was a mean of 9.94 points lower in the 2020/2021 cohort (p<0001) and 4.64 points higher in graduate students (p<0.001). Gender and previous IPE experience did not account for variability in the total RIPLS score and subscales (p>0.05).
Overall, older and graduate-level students typically express a greater readiness for IPE learning. It is unclear how online learning (specific to the 2020-2021 cohort) may have affected IPE readiness. These results provide insight on when and how IPE activities might be best integrated into health science curricula. Nevertheless, the variability explained by the factors in the model was less than 30% and thus, other factors not accounted for (e.g., prior healthcare/health sciences degrees or experience) may also influence IPE readiness and should be further explored.
Musculoskeletal Knowledge Assessment of Medical Trainees and the Impact of Clinical Experience
McNeill, Kestrel; Peterson, Devin; Bryant, Dianne; Sonnadara, Ranil
Introduction: Musculoskeletal (MSK) instruction in undergraduate medical education has been identified as being inadequate across the globe. Previous qualitative work conducted at the DeGroote School of Medicine identified perceptions of deficits in medical student MSK knowledge as well as gaps in the medical foundations MSK curriculum. The purpose of this research is to assess student MSK knowledge at the beginning and end of their orthopedic clerkship rotation in order to determine whether clinical exposure to MSK conditions impact student MSK knowledge, and to validate previous qualitative findings.
Methods: A one group pre-test post-test design was utilized. Two validated MSK question sets (The Freedman and Bernstein Examination and the MSK30) were used to construct the pre-test and the post-test assessments. Each assessment was composed of multiple choice and short answer questions and covered topics from both orthopedics and primary-care settings. This included common soft tissue injuries, fractures and dislocations, emergencies requiring immediate orthopedic referral, and basic anatomical knowledge necessary for the diagnosis of MSK conditions. A dependent groups t-test was used to examine differences between the pre- and post-test scores, and a score of 71.3% was considered to demonstrate basic competency in MSK medicine as per previous literature on this topic.
Results: There were 44 medical students captured within the MSK assessments from January to March of 2021 during the orthopedic clerkship rotation. The average score of the MSK pre-test was 57.56% (SD, 9.62%). Of the 44 students, 40 (91%) failed to demonstrate basic competency in MSK medicine before their rotation. Post-test scores revealed an average of 80.76% (SD, 8.98%), with 39 (89%) of the 44 students scoring achieving basic competency. The dependent groups t-test was statistically significant (p<0.00), with the mean difference between the pre-test and the post-test being -23.20% (95% CI, -26.81 to -19.60).
Conclusion: With the rising burden of MSK conditions on our healthcare system, it is critical that students receive adequate instruction in order to effectively diagnose and treat these conditions. Baseline MSK knowledge scores reveal substantiative gaps in medical student MSK knowledge and confirm the findings of previous qualitative work. The orthopedic clerkship positively impacts medical student MSK knowledge, affirming the importance clinical exposure to MSK conditions.
Technology Abstracts
Enhancing diagnostic hypotheses with electronic differential diagnosis support: A multi-center experimental study of ISABEL
Sibbald, Matthew; Monteiro, Sandra; Sherbino, Jonathan; LoGiudice, Andrew; Friedman, Charles; Norman, Geoffrey
Importance: Diagnostic errors unfortunately remain common. Electronic differential diagnosis support (EDS) systems might help, but it is unclear how to best integrate them into the diagnostic process.
Objective: To explore whether or when EDS improves diagnostic accuracy, and whether EDS should be used early (after the chief complaint) or late (after the complete history and physical is available) in the diagnostic process.
Setting: 6 Canadian medical schools.
Participants: Volunteer sample of medical students, residents in internal medicine or emergency medicine, and practicing internists or emergency medicine physicians.
Intervention: Participants were randomized to make use of EDS either early or late in the diagnostic process while solving each of 16 written cases.
Main outcomes: We measured the number of diagnoses proposed and presence of the correct diagnosis within the differential.
Results: Participants included 67 students, 62 residents, and 61 practicing physicians. Overall, EDS increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis being present in the differential. Whereas early use of EDS increased the number of diagnostic hypotheses, particularly for students and residents, late use of EDS increased the likelihood of the correct diagnosis being present in the differential, irrespective of experience level.
Conclusions and relevance: Diagnostic hypotheses improved with EDS. Clinician experience is an important factor for determining when EDS should be incorporated into the diagnostic process.
Trauma 101: A virtual case-based trauma conference as an adjunct to medical education
Eva, Liu; Randi, Mao; Takhliq, Amir; Lucy, Lan; Simon, Farquharson; James, Yan; Kevin, Singh; Alexandra, Allard-Coutu;
Background: COVID-19 has impacted medical curricula, limiting simulation-based trauma education and surgical rotations. Virtual learning has been integrated as an alternative, however, its effectiveness for teaching critical concepts in trauma has not been validated. Small-group sessions are an effective pedagogical model, yet it is unclear how they translate to online learning.
Methods: Medical students were invited to attend a two-day virtual trauma conference organized by student interest groups at McMaster University and promoted on social media. A total of 360 students from over 17 medical schools in five countries registered. The event included nine interactive presentations by physicians and residents in five specialties, followed by small-group case discussions. A peak of 167 simultaneous connections during presentations and 68 connections during small-group discussions was recorded. A best-match algorithm assigned students to preferred small-group sessions. Participants completed pre- and post-conference testing and feedback questionnaires. Results were analyzed using paired t-tests and descriptive content analysis.
Results: 131 students (36%) completed the pre-test with a mean score of 3.4/10 (SD=2.04). 86 (24%) completed the post-test, with a mean score of 6.3/10 (SD=2.3, p<0.001). 73 students (20%) completed both tests. Paired t-test analysis revealed improvement by 2.7/10 (SD= 2.3, 95% CI=2.17 to 3.23, p<0.001). No correlations between education/school attended and performance were found. Social media engagement resulted in 147 posts. 37.4% were participant-generated. Live polling and moderated chats improved participation. 74% of participants agreed sessions were interactive. 95.2% agreed the online platform was effective and 78.3% endorsed the conference as helpful preparation for clerkship.
Conclusion: With high participant satisfaction and significantly improved post-test results, this model for virtual trauma education is an effective pedagogical adjunct. Virtual small-group case-based discussions and social media enhanced participant engagement.
The Anesthesia Clerkship Pocket Guide for Medical Students – Promoting Free Open Medical Education Resources in Anesthesia
Xu, Grace M.; Latchford, Kevin; Cordovani, Daniel
Introduction: Anesthesia is a mandatory two-week clerkship rotation in most Canadian medical schools, yet student exposure and anesthesia-specific teaching remains low in undergraduate medical education.
Objective: To create a free anesthesia-specific resource specifically for clinical clerks designed to maintain accessibility during the clinical day to enhance experiential learning.
Methods: We used the McMaster anesthesia clerkship learning objectives to guide scope. Each section was authored by a medical student and underwent an iterative review process involving clinical clerks, anesthesia residents, and staff anesthesiologists. The resource was disseminated through social media and outreach to the Association of Canadian University Departments of Anesthesia. A confidential user survey is required prior to initial electronic access.
Results: The first edition of “Anesthesia: A Clerkship Pocket Guide” (https://mcmasteracp.ca) includes eight chapters and 45 drug reference charts. From its online publication on 13 April 2020 to 16 February 2021, there have been 731 survey respondents from across 16 medical schools in Canada and abroad. The majority of survey respondents were from three programs that have incorporated into their anesthesia clerkship materials: McMaster University (n=298; 41%), the University of Ottawa (n=222; 31%), and the University of British Columbia (n=91; 12%). Most students indicated their intent to use this resource for their core rotation (n = 508) and self-study (n=425) versus during a clinical elective (n=130). The majority of students (n=372; 51%) were not interested in pursuing anesthesia while 27% (n=200) remained undecided. Notably, the majority of students (n=375; 51%) felt either “unprepared” or “very unprepared” for their anesthesia rotation, while only 11% (n=77) felt “prepared” or “very prepared”.
Discussion: These survey results correspond with previous research highlighting the lack of significant pre-clerkship exposure and teaching despite anesthesia being a mandatory rotation in the curriculum of most Canadian medical schools. Next steps to improve student learning includes eliciting specific topics that cause students to feel unprepared entering their anesthesia rotation and creating objectives that address them in a pre-clinical foundation.
Why do residents create? Using a podcast to explore the resident experience during creation of teaching presentations
Merali, Zahra; Carayannopoulos, Kallirroi Laiya; Brandt Vegas, Daniel; Lai, Alison
Introduction: Teaching presentations such as journal clubs, grand rounds or other educational formats are commonly mandated within internal medicine training programs. Despite this, there is a lack of data exploring the resident experience during the creation process. This qualitative study examines the creation experiences of residents who voluntarily developed a podcast for “The Intern at Work,” a learner-generated podcast series, in comparison to mandated teaching presentations.
Methods: Purposive sampling was used to recruit residents who wrote a podcast for “The Intern at Work.” Focus groups were completed using semi-structured interviews and were recorded, transcribed, and coded by two researchers. Using constructivist grounded theory, a schema explaining the key factors leading to learner motivation and engagement in teaching presentations was developed.
Results: Three focus groups were conducted. Residents (n=12) described three key factors of the podcast project that fostered learner motivation and engagement: (1) Intrinsic Motivator: Residents were excited to use a novel, creative outlet to teach near peers. (2)
Self-Directed Process: The opportunity to collaborate with attending physicians, flexibility in topic selection and production timeline were cited as favourable aspects of the podcast process. (3) Tangible Benefit: Residents described appreciable self-gains, including strengthening their teaching skills, direct mentorship and a widely-disseminated product. Some factors were paralleled in the residents’ experiences creating mandated teaching presentations, but most were unique to this novel initiative.
Conclusion: Our framework of intrinsic motivator, self-directed process and tangible benefit represents key factors that increase learner motivation and engagement when creating a podcast for “The Intern at Work.” Future research should be directed to see whether this framework applies to existing or new teaching presentations.
Yelp for HPE Literature: The Library of Essential Papers and Resources
Yilmaz, Yusuf; Martin, Leslie; Brandt Vegas, Daniel; Rahat Qureshi, Aljeena; Keuhl, Amy; Applewhaite, Samantha; Nickson, Christopher Peter; Sherbino, Jonathan
Introduction: Literature in health professional education (HPE) grows exponentially each year. While citations and altmetrics describe the impact of a specific manuscript, early career researchers and educators struggle with where to enter the broad HPE literature. This study introduces a crowdsourced, digital library for HPE, and provides preliminary data about the scope of content and user functionality.
Methods: An initial list of papers and resources was drafted by a team of HPE subject matter experts and subsequently curated. The data was grouped into categories with select papers and resources labelled as “must read” and “should read.” The database is hosted on a web app hpeworld.com. This platform allows the global HPE community to browse, search, rate and comment on papers and resources within the database. It also includes a suggestion feature, leveraging crowdsourcing to improve the database. The database was analyzed descriptively and Google analytics data for the first two-weeks of the launch was collected.
Results: “The Library” launched with 417 articles across 10 main categories and 59 sub-categories on February 18, 2021. There are 46 “must read” and 87 “should read” papers and resources. Analysis of user data in the two weeks following the launch revealed that 629 unique users accessed The Library from 42 different countries with the highest number of visitors from the United States (n=184), Mexico (n=110), Canada (n=104), Portugal (n=75), and Australia (n=26). Total page views were 1,850, suggesting a single user viewed three papers or resources on average. After the initial launch of The Library, the global HPE community suggested 15 new papers and resources, and requested a new category: reflective writing. Initial ratings of papers are limited.
Discussion: The Library is an open-access, searchable, categorized resource of over 400 curated key HPE papers and resources. It uses crowdsourcing to rank and solicit additional papers and resources. Analysis of the launch showed that The Library has received considerable international engagement. Future scholarship should focus on the impact of expert versus crowdsourced recommendations of key papers and resources.