Canadian medical education journal最新文献

Point-of-care ultrasound (POCUS) is becoming increasingly used in primary care and has the potential to be accessible, reliable, and indispensable. However, few family medicine residency programs offer training in POCUS. Therefore, we have developed a two half-day training program for family medicine residents to help them acquire more knowledge in this area and improve their confidence. The sessions were highly appreciated by the residents. This project could pave the way for the development of a standardized curriculum and its widespread dissemination.

Physician wellness is a critical yet unresolved challenge in medical education. Burnout, emotional distress, and systemic barriers undermine the sustainability of the healthcare workforce, with negative consequences for both physicians and patients. Despite widespread recognition, existing interventions often fall short, hindered by fragmented approaches and resistance to change. This article identifies five key challenges that will need to be overcome if we are to make meaningful progress in advancing physician wellness: (1) inconsistent definitions and flawed methodologies in assessing wellness, (2) overemphasis on individual-focused interventions, (3) the absence of unified, evidence-based frameworks, (4) ethical and methodological problems with wellness surveys, and (5) the commercialization of wellness. Each challenge represents deeply ingrained barriers within healthcare institutions that impede meaningful progress. I advocate for a paradigm shift toward evidence-based, systems-level strategies, focusing on Canadian and US medical education. By integrating theoretical frameworks like Self-Determination Theory (SDT) and the Job Demands-Resources (JDR) model into accreditation standards and institutional practices, healthcare organizations can address the root causes of physician distress.

Background: Progress testing provides residents with an opportunity to identify strengths and weaknesses, encouraging self-directed learning. The University of Toronto's Department of Family & Community Medicine administers the Family Medicine Mandatory Assessment of Progress (FM-MAP) biannually to track resident competency and medical knowledge. Our aim was to determine the impact of virtual learning on Family Medicine residents.

Methods: We administered previous iterations of the FM-MAP to the virtual learning cohort and compared scores to those of the in-person cohort between October 2020 - Spring 2022.

Results: There were no statistically significant differences between in-person and virtual cohorts of first- and second-year postgraduate family medicine trainees regarding their overall FM-MAP score. Second-year family medicine trainees outperformed first year trainees in both cohorts.

Conclusion: The study found no significant effect on the scores of first- and second-year family medicine trainees caused by the shift to virtual learning, suggesting medical curricula can incorporate virtual learning without compromising trainee progress, offering flexibility in medical education. Future studies could explore its applicability across different residency programs and long-term effects on clinical performance.

Polarization and incivility are on the rise, negatively affecting collegiality, workplace relationships, morale, and performance at work. The authors argue for the need for civil discourse in medicine and for embracing complexity as an essential component of that civil discourse, facilitating nuanced thinking, respectful dialogue, and greater understanding of other perspectives. This principle of embracing complexity is congruent with the attitude of physicians, who are trained to tolerate uncertainty and to hold and appreciate multiple perspectives in making diagnoses and choosing and proposing treatment plans. This understanding of civil discourse does not amount to moral relativism, whataboutism, or an embracing of both sides of an argument universally, nor does it serve as a cudgel to silence or to perpetuate hegemonic power. Instead, the principles of civil discourse clarify multiple aspects of the boundaries of professional conduct, outlining how physicians can engage in advocacy for patients and communities while maintaining collegial relationships and the perception that they will be safe providers for all patients. The rights of citizens in democracies, including to engage in peaceful protest and to say anything within the bounds of their country's laws governing free speech, do not extend unabbreviated into the lives of professionals, who are limited by the privileges afforded to them and by the responsibilities they have to their patients and colleagues. By embracing complexity and nuance over simplism and slogans, physician colleagues who disagree with one another can communicate respectfully, advocate professionally, and be safe and effective care providers to all patients.

Peer coaching is a form of faculty development in which faculty improve their teaching skills through collaborative work or peer observation of teaching. As a tool grounded in experiential learning, peer coaching promotes targeted feedback, reflection on action, and collegial exchange to improve teacher self-efficacy and trainee learning outcomes. Nevertheless, faculty developers face challenges in creating sustainable, effective peer coaching programs as faculty fear scrutiny of their teaching practices. Additionally, to promote collegial exchange, faculty (the person observed and peer coach) must trust one another and accept vulnerability. Without attending to trust, faculty developers may find themselves on black ice, designing and implementing ineffective peer coaching programs. In this Black Ice article, we underscore the role of trust in peer coaching and present five ways to help faculty developers get a grip by incorporating trust into the design and implementation of peer coaching programs, optimizing its efficacy.

Background: An ever-increasing range of simulation devices are available for direct ophthalmoscopy. However, the effectiveness of simulation design and components have not been evaluated. This systematic review aims to describe and evaluate direct ophthalmoscopy simulation models and highlight components that have been found to be effective, and challenges faced when using simulation models.

Methods: A systematic review of the literature was conducted according to the PRISMA statement in four online databases: Medline, Embase, Cochrane Library and Web of Science. Citation searching using Google Scholar and Citationchaser was also undertaken. Validity and effectiveness were assessed using a validated scale based on Messick's modern validity framework and McGaghie's proposed levels of simulation-based translational outcomes respectively.

Results: A total of 1,275 titles and abstracts were screened. A total of 37 studies were included in the final analysis. Physical models, digital models and virtual reality direct ophthalmoscopy models were described in studies. A plastic cannister design was the most common in the literature, followed by a sphere with a painted fundus and the EyeSi Direct Ophthalmoscope Simulator (VRmagic, GmbH, Mannheim, Germany). Simulation was effective in its ability to allow students to engage in repeated practice without patient discomfort. The lack of realism was the most noted limitation of simulation practice.

Conclusion: While more robust evidence is needed to support simulation design efficacy in direct ophthalmoscopy, simulation-based teaching of direct ophthalmoscopy will likely be increasingly effective as technological advancements support improved realism and affordability.