Canadian medical education journal最新文献

Background: Though there are more family physicians in Canada than ever before, and residency programs are expanding, gaps in access to comprehensive care remain. This study aimed to describe and understand the role residency training experiences played in shaping practice choices, including the provision of comprehensive community-based care, among early career family physicians.

Methods: A secondary analysis of sixty-three (63) qualitative interviews was conducted on data from a larger mixed method study on practice patterns and choices of early career Canadian family physicians. We utilized Braun and Clarke's six phases of reflexive thematic analysis on portions of transcripts concerning residency training experiences.

Results: Participants described positive residency training experiences that shaped practice choice with respect to preceptors and mentorship, experiences of longitudinal care, breadth of exposure, and preparedness for comprehensive clinical practice. Woven through these four domains were "points of tension" and "hidden truths". Points of tension included: i) the promotion of an idealized professional identity and practice that was difficult to uphold, ii) lack of representation among faculty/preceptors with respect to age and gender, at some sites, and iii) frustration about the lack of opportunities for interprofessional collaborative practices that reflected training experiences. Hidden truths included: i) lack of preparation to run a business, ii) high administrative workload, iii) realities of payment models, and iv) the range of roles available for family physicians beyond the provision of comprehensive care.

Conclusions: Findings highlight opportunities for educational reform supporting the transition from residency to practice alongside the importance of addressing systemic factors beyond training which impact physicians' choices regarding comprehensive care.

Background: Extended reality technology (XR) in simulation-based medical education is becoming more prevalent. This study examined Canadian simulation centre directors' perceptions toward XR and their self-reported adoption of XR within their centres.

Methods: We conducted a national, cross-sectional survey study to examine five kinds of XR: Immersive Virtual Environments, Screen-based Virtual Worlds, Virtual Simulators, Immersive Augmented Reality, and Non-immersive Augmented Reality. An electronic survey with multiple-choice, Likert scales, and open-ended questions were developed to identify the current use, degree of satisfaction, and experienced and foreseen challenges with each XR technology. We used the Checklist for Reporting Results of Internet E-Surveys checklist to describe and justify our survey development. All twenty-three Royal College-accredited Canadian simulation centres were invited based on their Royal College membership to complete the survey. Directors and representatives of seventeen (74%) centres participated.

Results: Each XR has been used for research or simulation education by about half of the simulation centres, at minimum. The degree of satisfaction among directors with XR ranged from 30% to 45%. Directors frequently cited logistical and fidelity challenges, along with concerns over maintenance. Cost and lack of evidence, and unclear needs were cited as foreseen challenges with the future implementation of XRs.

Conclusions: This survey summarizes the status of XR in Canadian simulation centres. The pattern of use, satisfaction levels, and challenges reported by simulation centre directors varied depending on the types of XR.

Background: While the hidden curriculum (HC) is becoming recognized as an important component of medical education, ideal methods of assessing the HC are not well known. The aim of this study was to review the literature for methods of assessing the HC in the context of healthcare education.

Methods: We conducted a scoping review on methods to measure or assess the HC in accordance with the JBI Manual for Evidence Synthesis. Ovid MEDLINE, Ovid EMBASE, and ProQuest ERIC databases were searched from inception until August 2023. Studies which focused on healthcare education, including medicine, as well as other professions such as nursing, social work, pharmacy were included. We then obtained stakeholder feedback utilizing the results of this review to inform the ongoing HC assessment process within our own medical education program.

Results: Of 141 studies included for full text review, 41 were included for analysis and data extraction. Most studies were conducted in North America and qualitative in nature. Physician education was best represented with most studies set in undergraduate medical education (n = 21, 51%). Assessment techniques included interviews (n = 19, 46%), cross-sectional surveys (n = 14, 34%), written reflections (n = 7, 17%), and direct observation of the working environment (n = 2, 5%). While attempts to create standardized HC evaluation methods were identified, there were no examples of implementation into an educational program formally or longitudinally. No studies reported on actions taken based on evaluation results. Confidential stakeholder feedback was obtained from postgraduate medical learners in our program, and this feedback was then used to modify our longitudinal HC assessment process.

Conclusions: While the HC has as increasing presence in the medical education community, the ideal way to practically assess it within a healthcare education context remains unclear. We described the HC assessment process utilized at our program, which may be informative for other institutions attempting to implement a similar technique. Future attempts and studies would benefit from reporting longitudinal data and impacts of assessment results.

Competency Based Medical Education (CBME) is pushing the medical profession to be more accountable in our standards of assessment. This has led us to focus our efforts at the top of Miller's pyramid, where we aim to see what the trainee 'does' in the clinical environment. In Canadian Royal College specialty training, this has come in the form of workplace-based supervision of trainees performing Entrustable Professional Activities (EPAs). This is unfamiliar territory for many residents and faculty, and implementation of an additional assessment process into already busy clinical practice has been particularly challenging. Because EPA assessments serve as significant contributors in new programs of assessment, failure to collect high quality EPA assessments threaten the validity of this new system. Understanding the barriers to and enablers of EPA acquisition can inform faculty development initiatives to ensure success. Based on our previous work studying early experiences of EPA assessment acquisition in Emergency Medicine, we have identified eight key concepts to guide faculty development initiatives, namely: the rationale for CBME, the 'behind the scenes' of CBME, how to construct rich narrative comments, effective use of supervision scales, the tension of EPA assessments being both formative and summative, the importance of a shared responsibility between residents and faculty for EPA assessment completion, familiarity with the suite of EPAs, and tips and tricks for incorporating EPA assessment completion into busy clinical practice. These key concepts can be integrated into an overall faculty development strategy for building this now essential skill set.

Background: Archival research has unearthed processes of exclusion impacting the experiences of Black, female, and Jewish communities at Canadian medical schools. However, the history of Muslim medical students is little known. Our research is the first known study to examine when Muslim medical students with varying identities were first admitted to the University of Toronto's (UofT) Faculty of Medicine (FoM) and their experiences. Knowing this history can contribute to ongoing equity, diversity, and inclusion efforts in medical school admissions and curriculum development.

Methods: This is an exploratory case study with no clear, single set of expected outcomes. We consulted the UofT's Archive & Record Management Services and looked for students who self-identified as Muslim in primary documents from the FoM between 1887-1964, including admissions applications, correspondences from the Dean's Office, photographs, and yearbooks. We analysed the archival data for emerging themes.

Results: We found six medical school applicants who self-identified as Muslim (n = 6) and were admitted between 1945 and 1961 and graduated between 1948 and 1966. We also found four (n = 4) postgraduates from one South Asian country who may have been Muslim, and who were granted fellowships from the Canadian government.

Conclusions: Self-identified Muslim students were first admitted to the UofT's FoM in 1945 and continued to be admitted infrequently until 1964. These early students' experiences included financial hardships despite having privileged backgrounds; discrimination due to being foreign; and conditional inclusion while in medical school. We discuss the study's continuing contemporary relevance, limitations, and directions for future research.

ACCESS, a student-led mentorship program affiliated with Schulich School of Medicine & Dentistry, demonstrates a practical, effective approach to addressing inequity in medical education. ACCESS provides personalized, zero-cost mentorship to equity-deserving applicants who face social, financial, and medical barriers that result in underrepresentation in medical school. Our mentorship model showcases significant success in application and interview outcomes, as well as positive feedback from participants. Here, we offer a replicable blueprint for medical schools across Canada. This paper highlights the effectiveness of student-led initiatives in promoting diversity and inclusion in healthcare education and aims to inspire similar programs, fostering a more diverse and inclusive future healthcare workforce.

Background: Providing physical activity counselling and prescribing exercise increases patients' activity and cardiorespiratory fitness, but healthcare providers experience challenges in promoting activity to patients. Implementing educational intervention during medical training may be an effective strategy to promote physical activity and exercise counselling/prescriptions. The purpose of this review was to evaluate the impact of educational interventions on medical students' physical activity counselling and exercise prescription perceptions and practices.

Methods: Systematic review procedures were registered in PROSPERO (ID# CRD42022331755) prior to conducting the study. Studies were included if they conducted an educational intervention to medical students or residents aimed at improving activity practices. Sources were searched in May of 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (n = 3412 citations without duplicates). The National Institutes of Health quality assessment tools were used.

Results: Fifteen interventions were included. The average quality of the included controlled trials (n = 6) and pre-post studies with no control group (n = 9) were 5.0±1.5/12 and 6.2±1.3/14, respectively. Most studies (n = 4/6) that reported the total number of medical students providing activity counselling to patients before and after receiving intervention observed improvements in exercise counselling behaviours. Eleven of twelve, and ten of eleven studies reported increases in confidence and perceptions toward various features of exercise counselling and physical activity promotion, respectively.

Conclusion: Despite the heterogeneous nature of intervention designs, this review supports that relatively brief interventions using a structured lecture format incorporated into curriculum promote acute improvements in medical students' perceptions and confidence in providing exercise counselling, albeit based on low-moderate study quality.

The proliferation of health professions educator academies across Canada and the United States illustrates the value they hold for faculty and institutions. Yet, establishing and evaluating the efficacy of them through program evaluation can be challenging. Moreover, academy leadership often lack the time, bandwidth skillset and personnel to undertake rigorous program evaluation efforts. We outline a step-by-step guide for getting a grip on evaluating health professions educator academies. Developing a plan for program evaluation in advance of any new academy initiative helps to ensure the academy calibrates and re-calibrates to accomplish outcomes and meet stakeholder expectations. It also provides a mechanism for tracking academy impact, which strengthens requests for funding, promotes sustainability and encourages continued buy-in and support from institutional stakeholders. For all of these reasons, we present the following recommendations: apply the relevant program evaluation framework(s); identify resources for program evaluation; prepare to tell your academy's story; list desired program outcomes; establish a data collection plan; and obtain institutional review board approval.