Simulation and Technology
The Effect of Auditory Stimulation in Learning Anatomy Using Virtual Reality
Lohit, Simran; Ives, Rowan; Abdi, Anwar; Mu, Fei; Asaria, Ibreez; Klitovchenko, David; Reis, Isabella; Mitchell, Josh; Brewer-Deluce, Danielle; Wainman, Bruce
INTRODUCTION
What do you listen to while you learn, and does it impact your learning? Research has shown that sound is a key sense that impacts learning; however, the impact of audio on learning anatomy using virtual reality (VR) technologies has been poorly investigated. With varying noise tracks across these environments, it is important to consider how sound might impact students’ learning experiences. Our study is interested in the impact of white noise, lab noise, and passive noise cancellation on learning anatomy in VR. We used academic performance in learning anatomy as our primary outcome, and cybersickness and cognitive load as the secondary outcomes.
METHODS
Undergraduate students with no prior anatomy knowledge were recruited into this randomized cross-over study. Participants were given four minutes to learn 10 neuroanatomy landmarks in VR while listening to an audio track (white noise, lab noise, or passive noise cancelling). To assess performance, participants completed a test on the landmarks they learned. They then completed the simulation sickness questionnaire and simulation task load index to self-report their perceived cybersickness and cognitive load. Participants repeated this process three times, with each of the three distinct audiological tracks and neuroanatomy models. The study concluded with a Stereo Fly test to assess stereopsis.
RESULTS
Based on preliminary data (n = 15), performance was highest in the lab noise audio intervention, followed by the passive noise cancellation and then the white noise audio. Cognitive load and cybersickness were self-reported in all the audio tracks, with lab noise producing slightly higher reported levels than passive noise cancellation and white noise.
CONCLUSION
This study seeks to better understand the relationship between learning, cognitive load, cybersickness and sound. With the advancement of VR in anatomy education, there is a need to research and understand how modifiable factors, such as audiological landscape, affect learning outcomes. The results from this study will help clarify the effects of sound on anatomy learning and guide the development of future anatomy education, especially with emerging technologies such as VR.
Simulation Platforms to Train and Assess Pediatric Procedural Skills: A Scoping Review
Novin, Shayan; Younas, Tehrim; Xu, Jessie; Graef, Samuel; Karimi, Nima; Xu, Maggie; Petropoulos, Jo-Anne; Ngo, Quang; Bilgic, Elif
INTRODUCTION
Medical trainees rarely practice certain procedures as they are not frequently encountered in the clinical setting. Simulation-based education provides hands-on opportunities to practice these procedural technical and non-technical skills, preserving trainees’ proficiency. This scoping review identifies the simulation platforms available for the training or assessment of select pediatric procedures.
METHODS
A scoping review was conducted to determine the types of training and assessment done for intubation, lumbar puncture, intraosseous insertion, and chest tube procedures. With the help of a librarian, we developed a search strategy that was applied to 6 databases, where we retrieved articles published between 2011 to 2022. Included articles were empirical studies, included trainee population (residents, intern, medical students, fellows), focused on medical education, and training and assessment of the targeted procedures. Three reviewers performed the title/abstract and full-text screening. Prior to each screening, pilots were done amongst the reviewers to ensure an agreement rate of at least seventy-five percent. The extracted data included study characteristics, types of interventions, and types of simulations used.
RESULTS
A total of 4073 articles were retrieved, with 207 studies proceeding to full-text screening; 107 articles were eligible for data extraction. Most articles targeted intubation skills (n=77), with some focused on lumbar puncture (n=20), intraosseous insertion (n=16) and/or chest tube insertion (n=3). Most studies targeted residents (n=80) and medical students (n=39). Preliminary results show that mannequins (n=90), ex-vivo models (n=8), part-task trainers (n=3), simulated patients (n=3), objective clinical examinations (n=2), and virtual reality (n=1) were employed for teaching. Most articles included an educational intervention (n=91), majority were single group comparisons (n=53), and some were randomized group comparisons (n=15) or randomized controlled trials (n=19).
CONCLUSIONS
Most studies focused on intubation training with mannequins for the training of pediatric residents. Future research should explore (A) other pediatric procedural skills and (B) investigate other modes of simulation-based education, based on the needs of their training programs.
Learning Anatomy in Virtual Environments: Cybersickness and Cognitive Load
Sinha, Sakshi; Chan, Sachi; Lohit, Simran; Reis, Isabella; Touliopoulos, Evangelea; Ives, Rowan; Nehru, Amit; Mitchell, Josh; Brewer-Deluce, Danielle; Wainman, Bruce
INTRODUCTION
Anatomy education has historically relied on cadavers and plastic models, but technological advances have created affordable and functional alternative teaching tools. Virtual reality (VR) immerses the user in a digitally created stereoscopic environment, autostereoscopic screens (AS) provide a non-immersive stereoscopic view of images, and 3D printing creates replicas of specimens. However, the comparative education efficacy and physiological side effects, such as cybersickness and cognitive load levels, which may influence learning are not well known. This study compares the effectiveness of VR, AS, and 3D-printed physical models (PH) in learning anatomical landmarks, focusing on how cybersickness and cognitive load may affect learning in these distinct modalities.
METHODS
61 undergraduate students with no prior anatomy education were randomized and counterbalanced into one of three groups. All groups had to learn three bones (pelvic bone, zygoma, and calcaneus) in three modalities (VR, AS, and PH). Participants had four minutes to learn 10 bony landmarks on one bone, while simultaneously completing a dual-task paradigm task which measured their reaction time as a proxy for cognitive load. Participants then completed an untimed, recognition-based test on an identical 3D-printed bone with randomized landmarks. Afterwards, participants completed the Simulator Sickness Questionnaire (SSQ), which measures cybersickness, and the Paas scale and Simulation Task Load Index, both of which measure aspects of cognitive load. Stereo Fly Test and Operation Span Task, which measure stereoacuity and working memory capacity, respectively, were also completed and used as covariates.
RESULTS
All analyses accounted for demographics, stereoacuity, and working memory capacity as covariates. A one-way analysis of covariance (ANCOVA) found no significant effect of learning modality (p > 0.05) on test performance. A repeated-measures multivariate ANCOVA (MANCOVA) found a significant effect of learning modality on the overall weighted SSQ score (p < 0.05; VR > PH) and the SSQ oculomotor subscale (p < 0.05; VR > AS > PH). Another repeated-measures MANCOVA found no significant effect of learning modality (p > 0.05) on cognitive load.
CONCLUSION
Although learning modality has a significant effect on cybersickness, it does not affect skeletal anatomy learning or cognitive load. Nonetheless, mitigating cybersickness remains a key consideration for educators.
Virtual Reality Use in Anatomy Education
Varlese, Evan; Helli, Peter; Rebalka, Irena; Bayer, Ilana
INTRODUCTION
Advancements in virtual reality (VR) technology has led to increased use of VR in academic settings. Current research has demonstrated mixed findings on the efficacy and use of virtual reality (VR) when studying anatomy. This project aims to investigate the use and impact of using VR to help students visualize and learn anatomy that is difficult to see or complex to envision.
METHOD
McMaster students in an undergraduate anatomy and physiology course were given the opportunity to explore the anatomy of the respiratory and digestive systems using virtual reality technology (Oculus Quest 2TM) during their scheduled tutorial sessions. Each session began with a demonstration on how to use the VR equipment and features of the Human Anatomy Virtual Medicine application. Students then had up to fifteen minutes to explore anatomical structures and their relationships using the VR app. At the end of the tutorial, students were invited to take a slip of paper with a QR code that led them to a user experience survey. The survey contained questions on prior VR experience, followed by questions about perceived usefulness and ease of use, ease of learning/memorability, satisfaction for using VR for learning anatomy and simulator sickness.
RESULTS
Preliminary analysis of data from 137 participants that completed the survey suggests that approximately half of the participants (53%) have a history of using VR related to education and recreation. Regarding perceived usefulness, 70% of students agreed or strongly agreed that VR would be useful when learning anatomy. Overall, 89% of students stated that virtual reality was fun to use and were also satisfied with the quality of the assets. Approximately 2/3 of students (67%) agreed or strongly agreed that the VR equipment was comfortable to wear. There was variability in how easily students picked up on the controls. The top three reported symptoms in the simulator sickness questionnaire were general discomfort (65%), eye strain (58%) and difficulty focusing (58%).
CONCLUSIONS
Preliminary findings support the potential use of virtual reality in anatomy education as a tool to aid students in their learning. Subsequent analyses will be performed once full participant data is collected to confirm the findings of this preliminary analysis. These results are critical for informing teaching practices, and technology use in learning anatomy.
The developments and applications of augmented and virtual reality technology in spine surgery training: A systematic review
Muddalaru, Varun; Gandhi, Pranjan; Pahuta, Markian; Guha, Daipayan
INTRODUCTION
In recent years, there has been a growing global interest in the role of augmented reality in surgical training, accelerated by the limitations on in-person training imposed by the COVID-19 pandemic. However, it remains in its infancy, with a paucity of literature reviewing its validity. To that end, we offer a systematic review of the literature summarizing the role of virtual and augmented reality on spine surgery training.
METHOD
A systematic review of the literature was conducted on May 13th, 2022 to identify research published since database inception. PubMed, Web of Science, Medline, and Embase were reviewed for relevant studies. Studies from both orthopedic and neurosurgical spine programs were considered. There were no restrictions placed on the type of study, virtual/augmented reality modality, nor type of procedure. Qualitative data analysis was performed, and all studies were assigned a Medical education Research Study Quality Instrument (MERSQI) score.
RESULTS
The initial review identified 6748 studies, of which fourteen were deemed relevant, examining a total of seven unique augmented/virtual reality systems. These studies had a low to moderate methodological quality with a MERSQI score of 11.6 + 2.0; most studies were conducted at single-centre institutions and half the studies consisted of single cross-sectional groups. Statistical pooling of the data was limited by the heterogeneity of the study designs.
CONCLUSION
This review examined the applications of augmented and virtual reality systems for training residents in various spine procedures. As this technology continues to advance, higher-quality, multi-centre, and long-term studies are required to further the adaptation of VR/AR technologies in spine surgery training programs.
Learning Innovations
The McMaster Embalming Scale (MES) – Application of a Psychometric Scale for the Assessment of Soft Embalming Solutions for Surgical Skills Training
Zhang, Betty; Wang, Austine; Darie, Sorin; Rockarts, Jasmine; Palombella, Andrew; DeCarlo, Brooke; de SA, Darren; Nguyen, Laura; Monteiro, Sandra; Brewer-Deluce, Danielle; Wainman, Bruce
INTRODUCTION
Surgical skills training on high-fidelity models is a universal method that allows surgical residents to learn in a controlled setting without the risk and time constraints of the operating theater. Many soft-preservation solutions allow cadavers to maintain lifelike joint flexibility and tissue textures. In a pilot study, the McMaster Embalming Scale (MES) was developed for standardized assessment of the visual, tactile, and overall characteristics of tissues embalmed with various solutions. This study applies the scale by assessing four high scoring embalming solutions from the pilot study.
METHODS
Four donors from the McMaster Bequeathal Program were embalmed using Surgical Reality Fluid©™, saturated salt solution, an ethanol-based solution, or the Imperial College London soft-preservation solution (ICL). Twenty-five surgical residents were recruited via the Surgical Foundations program at McMaster University. They conducted three surgical skills on each of the cadavers, specifically chest tube insertion and anchoring, electrocautery, and bone sawing. Afterwards, they rated their experience using the MES, which follows a five-point Likert format. Thirteen residents participated on the first testing date and twelve participated on the second testing date two weeks later.
RESULTS
Repeated measures ANOVAs demonstrate insignificant differences between embalming solutions for the MES domains except in the domain of texture where ethanol performed better than ICL (p = 0.026). The similar performance of all these solutions could be due to the fact that they are high scoring ones identified by the pilot study or in the literature. All domains of the MES achieved higher scores across all embalming solutions for the skill of bone sawing (p = 0.001). This could mean that these tissues were better preserved or more in line with clinicians’ perception of live human tissue. Finally, there was no evidence that the embalming solution or the testing date affected the level of decay or odor.
DISCUSSION
Since embalming solutions did not perform differently, this suggests that institutions can choose which solution to use based on factors such as cost or resource availability. This indicates that there is either a negligible difference between solutions or that the MES is not sensitive enough to capture these differences. Future studies would involve corroborating these findings through objective mechanical testing.
Using prospective electronic journals to explore the intended and unintended consequences of competency-based medical education among pediatric residents
van Mil, Spencer; Bilgic, Elif; Zubairi, Mohammad; Acai, Anita
INTRODUCTION
Recent reports from Canadian academic institutions are providing important insights into the resident experience following competency-based medical education (CBME) implementation and have suggested important unintended consequences of CBME such as increased administrative burden. Since pediatric residency programs transitioned in July 2021, half of the residents in McMaster University’s Pediatrics Residency Program are in CBME streams and half are in non-CBME streams for the 2022-2023 academic year. With this, our objective was to compare the resident experiences in these two streams with respect to observation, feedback, and assessment.
METHODS
We studied the resident physicians within the McMaster Pediatrics Residency Program (n=37), in both CBME (n=22) and non-CBME (n=15) streams using a prospective study design. Electronic journals (e-journals) were distributed to the resident body in November 2022 and residents recorded occurrences of feedback, direct observation, and assessments for a two-week period. Residents also recorded time spent mapping, planning, sending, and following up on their Entrustable Professional Activities (EPAs) and other assessments.
RESULTS
The response rate was 56.8% (21/37) with full responses from 10 CBME and 11 non-CBME residents. Using Holm-Bonferroni-corrected Mann-Whitney U tests, the e-journal data showed that CBME residents had attempted significantly more assessments (p<.01) and had 10% more expired or incomplete assessments, although this difference was not found to be significantly different (p=.09). During the two-week period, the CBME residents spent significantly more time on their assessments than the non-CBME residents (126 minutes versus 28 minutes, respectively), p<.01.
CONCLUSION
Given the significantly increased time spent on assessments in the CBME cohorts, it is important to further investigate the administrative burden of this curriculum and its implications for resident well-being. Further research is needed to explore the changes to both the quality and quantity of feedback, observation, and assessment in the context of CBME.
Will modifying the amount of “normals” in a training set of EKGs affect knowledge acquisition?
Ahmed, Muneeb; Monteiro, Sandra; Keuhl, Amy; Norman, Geoffery; Sibbald, Matthew
INTRODUCTION
Distinguishing normal from abnormal electrocardiograms (EKGs) is an important skill. Traditionally, teaching has focused on abnormals rather than normals. The objective of this study was to understand whether integrating normals into teaching material improved novice medical students diagnostic accuracy.
METHODS
60 first-year medical students at McMaster University were randomly assigned to one of three training groups. Each group received different teaching materials and participated in four phases: introductory, training, testing, and follow-up. For the introductory phase, all students received a primer at the start of the study covering standard features of an EKG paper, including QRS complexes, T wave, P wave morphologies, and PR intervals. Participants were able to review this at their discretion, allowing them to request when to initiate the training phase. The three groups in the training phase were (1) training focused on abnormals, (2) sequential training with equal numbers of normal and abnormal ECGs, and (3) "compare and contrast" with normals shown alongside abnormals. The testing phase consisted of a test containing five abnormal and five normal EKGs. The team compared test scores using repeated-measures multivariate analyses of variance. The follow-up phase collected data on students' personal perceptions of their assigned training method.
RESULTS
Students with sequential training with normals were best able to identify normal versus abnormal (7.1±1.5 in group 1 versus 6.1±1.3 in group 2 and 6.0±1.4 in group 3, p=0.034). There was no difference between the groups in training time, training score, or ability to diagnose abnormal findings (3.7±1.9 in group 1, 4.4±1.5 in group 2, and 3.4±2.4 in group 3, p=0.14). Student personal perception showed significance towards an emphasis on incorporating more normals into their training.
CONCLUSIONS
This pilot study suggests that focusing on normal and abnormal EKGs separately may be more effective than using a "compare and contrast” strategy for identifying normal versus abnormal EKGs. Identifying normal from abnormal EKGs may be a separate skill from recognizing specific diagnoses.
Test-enhanced learning in the anesthesia clerkship: a randomized feasibility study
Xia, Sean; Cordovani, Daniel; Clark, Sandra; Simchovich, Gabriel; Yu, Janice; Ayers, Stephanie; Tidy, Toni; Levinson, Anthony
INTRODUCTION
Test-enhanced learning has the potential to be a promising addition to conventional instructional methods in undergraduate medical education. The concept is that the process of retrieving knowledge from memory in the form of “tests” can promote longer-term learning. The objective of this study was to investigate the feasibility of conducting a future randomized trial to investigate the effects of ‘blocked practice’ and ‘extra retrieval practice’ variants of test-enhanced learning within the anesthesia clerkship.
METHODS
This was a randomized, non-blinded, feasibility trial involving undergraduate medical students rotating through their two-week anesthesia clerkship. Volunteer participants providing informed consent were asked to complete an online course of 10 brief modules that cover 10 topics within anesthesia designed to reinforce their core course readings. Students were randomized to either an active control group, which received single-select multiple choice questions (MCQ) blocked by topic (3-4 MCQ per module); or an ‘extra retrieval practice’ group, who had to answer a free-text version of the question prior to each MCQ. Following completion of the course modules, participants completed a post-intervention survey regarding satisfaction, barriers to recruitment, and feasibility of course completion.
RESULTS
A total of 34 participants have been enrolled in the study to date over a study period of 6 months, with 21 course completions (n=14 for active control; n=7 for extra retrieval). Recruitment took longer than anticipated; identified barriers include timing of recruitment during clerkship and communication of intervention utility. Overall, feedback has been positive, noting that the course length is appropriate, useful for exam preparation, and that participants would recommend it to their peers. Data analysis for effectiveness of the intervention based on clerkship exit-exam scores between groups will be available upon completion of enrollment.
CONCLUSION
A randomized trial of test-enhanced learning is feasible but may require improvements in recruitment methods to target students at the start of clerkship and better communicate the value of the study for exam preparation. Free text extra retrieval practice may be a barrier to completion. A larger trial to more fully study instructional design variations is planned for the Fall.
Measuring group function in problem-based learning: development of an assessment tool
Li, Athena; Mellon, Matthew; Keuhl, Amy; Sibbald, Matthew
INTRODUCTION
Problem-based learning (PBL) is a common pedagogy involving self-directed learning in small groups around a case problem, in the presence of a group-process tutor. Uniquely group-dependent, PBL contains a social component that enriches, yet complicates, its learning outcomes. The aim of this study is to identify constructs important to group functioning in PBL and develop a literature-based and stakeholder-vetted tool to help students and tutors anchor their assessments of group function.
METHODS
Tool development unfolded in four phases: i) A literature review was conducted to identify existent evaluation tools for group function in PBL. ii) Literature findings informed the development of this new tool. iii) A group of PBL experts were consulted for engagement and feedback of the tool. iv) Four focus groups of stakeholders (medical students and tutors with lived PBL experiences) commented on the tool’s constructs, language, and perceived utility. Focus groups were recorded, transcribed, and coded by three independent coders. The tool underwent two rounds of revisions, informed by initial expert feedback and focus group discussions. All modifications to the initial tool were reported.
RESULTS
15 scales relating to group function assessment were identified in the literature, lending 18 constructs that mapped into four dimensions: Learning Climate, Facilitation and Process, Engagement and Interactivity, and Evaluation and Group Improvement. Expert reviews informed the addition of missing items. Focus group discussions allowed further fine-tuning of the organization and language of the tool. The final tool contains 17 descriptive items under the four dimensions. Users are asked to rate each dimension holistically on a 7-point Likert scale and provide open comments.
Researchers, faculty, and students highlighted three functions the tool could perform: (1) create space and structure for feedback processes, (2) act as a reference or resource, and (3) serve as a written record for longitudinal benchmarking. They commented that the tool may be particularly helpful for inexperienced and poor-functioning groups.
CONCLUSION
A four-dimension tool to measure group function in PBL was produced. Its constructs were well supported by literature and stakeholders. Researchers, faculty and students all supported the creation of this tool in addressing an acknowledged gap in group function assessment in PBL.
Admissions Selections
Aspiring medical student perceptions and behaviours concerning research experiences for selection into Canadian medical schools
Chang, Irene; Yang, Laurie
INTRODUCTION
Aspiring medical students behave based on their perception of what is valued in the selection process. While research experience is not explicitly considered in most Canadian admissions policies, it is commonly held as valuable within aspiring medical student communities. The purpose of this study is to describe the perceptions and behaviours of aspiring medical students with respect to gaining research experience in support of their medical school applications.
METHODS
We surveyed prospective applicants of Canadian medical schools between August 2021 and November 2021, compiling descriptive statistics pertaining to their perceptions and behaviours.
RESULTS
Respondents affirmed the belief that research experience is valued in medical school admissions processes. They reported spending approximately 13 h/week engaged in research, which usually did not yield publication or presentation recognition.
CONCLUSION
Aspiring medical students invest substantial time and energy in research experiences to benefit their applications. There is room for medical schools to be more transparent about the value of research experience in their admissions processes.
Talent in Medical Education: A Scoping Review
Chan, Teresa; Khan, Heba; Peever, Alex; Monteiro, Sandra
INTRODUCTION
A rapid emigration plagues the field of medicine, especially in its academic realm. This mass exodus has been associated with burnout, greater retirement, job dissatisfaction and sociocultural barriers which have been aggravated by the pandemic. This leads to an unprecedented gap between patient care and the quality of the delivery of those services.
Talent in medical education is an area that is uncharted but has great potential to bridge this gap. By leveraging talent, greater recognition and retention of individuals becomes possible. However, current knowledge has been very focalized, specialty-specific and highly focused on identifying talent during admissions.
The current study inquires: i. Can we isolate the wisdom and science from the literature to ensure we have optimized talents in medical education; ii. Can we find how we should identify, measure, develop, retain and manage talent?
METHODS
A scoping review of the literature was conducted according to Arksey and O’Malley’s framework. One investigator (HK) consulted with a librarian to develop key search terms, refine search strategies and explore three databases (OVID-Medline, PubMed, Google Scholar) in November 2021.
The Covidence literature review platform was only used to screen titles and abstracts. Full-text screening and extraction (HK, AP, TC) occurred concurrently using a customized extraction tool and conflict was resolved by a novel team member (SM). The primary question driving the inclusion of a potential study was: Is this paper about talent, high performance, excellence of a medical professional (medical student, resident, fellow, practicing physician)?
RESULTS
A total of 778 papers matched the search terms of this study. Of those, 12.2% of the papers (n=34) matched the inclusion criteria of the study and progressed to the data extraction phase.
The bulk of the literature was descriptive (42%, n=14) or conceptual (21%, n=7). There were some papers that sought to justify (15%, n=5) or clarify (15%, n=5) concepts of talent realtions. Only one (.03%) paper contained a definition of the term talent whereas the remainder of papers used related terminology.
CONCLUSION
There is a dearth of papers that define talent within the context of medical education. Further research should work to standardize the operationalization of talent and be inspired from adjacent literature to potentiate learners and retain physicians in the field.
Towards Equitable and Inclusive Admissions to Medical Schools: A Scoping Review of Bias in Selection Processes
Ngo, Thuy-Anh; Choi, Joshua; Menezes, Anjali; MacIntosh, Alexander; Profetto, Jason; Grierson, Lawrence
INTRODUCTION
Medical schools have a social accountability mandate to promote healthcare systems that are relevant, of high quality, cost-effective, and equitable. Ensuring fairness in the admissions process is a crucial component of this mandate from both moral and practical perspectives. Despite some evidence indicating that education and admissions systems in Canada may prevent some groups in the population from accessing the profession (Khan et al., 2020), there is not a comprehensive view of the available evidence. To address this gap, a scoping review was conducted to investigate the scope and nature of evidence on systemic bias in the selection methods and outcomes of admissions in medical schools across Canada.
METHODS
The scoping review analyzed published research involving Canadian medical schools in the English language from 2000 to 2022, following the methods outlined by Arksey and O'Malley (2005). The review focused on empirical evidence that demonstrated a link between applicants' social identity and their performance on medical school selection methods, and hence their ability to gain access to the medical profession.
RESULTS
Fifteen studies met the eligibility criteria to be included in the review. The majority of these studies can be described as applying perspectives that align with the foundational tenets of structuralism, emphasizing how constraints in the selection process are a function of social structures and systems rather than individuals’ merit or qualifications. The review found that research evidence of unwarranted bias exists in the admission process and is associated with applicants' social identities such as race, socioeconomic status, gender, age, and geographic origin. Biases were observed with respect to individual selection criteria such as GPA, MCAT, CASPer, and interview, resulting in unfair influence on the invitation to interview, the offer of admissions, and the acceptance of offers.
CONCLUSION
The evidence presented in this review helped to localize the degree to which biases may exist in medical school admissions systems. In light of these findings, further research is being conducted to investigate unwarranted bias concerning the selection criteria individually and their differential association with a wide array of social identities of applicants, as well as the intersections between these identities.
Promoting Diversity in the Canadian Medical Profession: Insights from a Demographic Survey of Medical School Applicants
Menezes, Anjali; MacIntosh, Alexander; Profetto, Jason; Grierson, Lawrence; Ngo, Thuy-Anh
INTRODUCTION
Despite ongoing efforts to promote diversity and inclusion within the medical profession in Canada, some groups in the population continue to be underrepresented in the profession (Khan et al., 2020). While this may be due to systemic bias in the admissions process (Razack et al., 2015), it is also possible that constraints and barriers occur earlier in the pathway, affecting some groups’ aspiration to join the profession, even before an application is made. Unfortunately, a lack of reliable identity data has made it challenging to investigate the locus of bias that reinforces structural inequity.
METHODS
To address this issue, the research team partnered with Acuity Insights, who administered the CASPer test for medical school admissions and collected applicant social identity data via a post-CASPer demographic survey which had a response rate of over 95%. The anonymized applicants’ identity data was compared to demographic data from Statistics Canada to determine how well the medical school applicants reflect the Canadian population.
RESULTS
The comparison of the diversity profile of applicants who completed the post-CASPer survey to the Canadian population reveals that there is a lack of representation among those who identify as Indigenous or mixed minority, have lower socioeconomic status, come from rural areas, or identify as persons with disabilities.
CONCLUSION
The implications of these results are discussed with regards to medical schools' responsibility to promote equity and diversity in the admissions process, as mandated by their social accountability. The findings can inform policymakers and provide a basis for further exploration of the relationship between social identity characteristics and admissions outcomes.
New Ideas
RADD ART: RADiologost Developed Autonomic Rewiring Therapy
Abrams, Mitchell
INTRODUCTION
RADDical A.R.T. (Radiologist Developed Autonomic Rewiring Therapy) is a social impact strategy created by Dr. Mitchell Abrams as his capstone thesis project for The Applied Compassion Training at Stanford School of Medicine’s Center for Compassion and Altruism Research and Education (CCARE). This innovative strategy leverages the power of the arts to educate, heal, and inspire while creating cycles of compassion to support mental health and resilience programs for communities in need, schools, and further heart coherence research.
Heart coherence is a state in which the heart, brain, and other bodily systems are synchronized, creating an optimal energetic state in which all body systems are working harmoniously. This state is associated with increased resilience and improved physical, emotional, and mental health outcomes. RADDical A.R.T. is an innovative approach that combines the arts to educate and demonstrate the power of heart coherence while raising money for resilience and mental health programs for communities in need.
METHODS
Artists who have completed Dr. Abrams heart coherence training program are invited to join him to create art during events and lectures. Dr. Abrams explores heart coherence and its relationship to stress and resilience. Embedded in these discussions are profound implications for the way we engage in self-care, manage stress and conflict, communicate, design systems, run organizations, and consume. The LIVE ART captures the themes, mood, and audience experience taking shape moment by moment. The art becomes part of the RADDical A.R.T. collection and is auctioned, sold or sponsored to raise money to deliver transformative mental health programs to communities in need.
RESULTS
To date, RADDical A.R.T. has raised thousands of dollars resulting in the delivery of much needed heart coherence and resilience training to thousands of individuals - students and adults.
CONCLUSION
RADDical A.R.T. is a sustainable social impact strategy that promotes heart coherence, resilience, and mental health programs. Through the RADDical A.R.T., Dr. Abrams will transform our moment of learning and healing together into tangible value that will be used to deliver mental health programs for communities in need.
Chronicling the Experience of Transitioning to Competence by Design in a Subspeciality Program: The Case of Geriatric Psychiatry at McMaster University
Simon, Taryn; Owais, Sawayra; Duarte, Dante; Acai, Anita
BACKGROUND
Competence by Design (CBD) is an outcome-based approach that aims to train physicians with competencies and skills to better meet the needs of patients. As the transition progresses across the country, continued assessment and monitoring are necessary to ensure successful implementation. However, existing literature only discusses the transition in the large, procedural specialties that were first to launch. Implementation of the CBD framework has yet to be assessed in the context of smaller, non-procedural programs, and especially, subspecialty programs. The objective of this study was to examine the resident and faculty perceptions and experiences transitioning to a CBD framework in a geriatric psychiatry subspeciality program.
METHODS
Video-based semi-structured interviews were conducted one-on-one with ten faculty and three residents of McMaster University’s geriatric psychiatry subspecialty program. Interviews were recorded, transcribed, and analyzed by two independent research assistants using thematic analysis steps outlined by Braun and Clarke (2006).
RESULTS
Semi-structured interviews revealed seven themes related to participants’ perceptions and experiences with the CBD transition: (1) knowledge of CBD varies by participant experience; (2) specific, frequent, and targeted feedback is beneficial; (3) aspects of CBD that are challenging for residents are viewed as beneficial by faculty; (4) competence committees are perceived positively; (5) COVID-19 affected clinical settings but not clinical practice; (6) there are benefits and drawbacks of CBD in a small subspeciality program; and (7) strategies to improve the transition.
CONCLUSIONS
Findings from this study suggest that residents and faculty perceive the transition to CBD in geriatric psychiatry to be progressing well and feel well-supported in the transition. Participants recognized the key benefits of the CBD framework for providing feedback. Some participants perceived the small program size as beneficial, as it allowed for more interactions and closer relationships with peers and supervisors. However, others perceived the program size to be an obstacle when providing feedback, as the close relationships made giving constructive or difficult feedback uncomfortable. Several suggestions were offered to improve the transition.
Understanding the Competencies Required to Provide an Effective Clinical Consultation
David, Victoria; Mithoowani, Siraj; Britto, Joanne; Ungaretti, Toni; Chan, Teresa
INTRODUCTION
Providing an effective consultation is a core task for medical specialists, yet there are no well-developed frameworks to help teach this skill. Our study aimed to identify the critical competencies required to provide a consultation in order to develop a framework on how to perform this task.
METHODS
Independent dyads of resident physicians (PGY-3 or higher) and faculty members from McMaster University’s Department of Medicine participated in a simulation session of a thrombosis medicine consultation followed by separate semi-structured interviews. Our purpose was to situate participants in a clinical consultation and then explore their perceptions on the most important principles of consultation. This was a qualitative study, using a framework analysis. Interview data was analyzed iteratively using a constant comparative method and an inductive approach. Interviews were conducted until theoretical saturation.
RESULTS
Eight resident physicians and eight faculty members (total of 16) participated. Theoretical saturation was reached following 15 interviews. Participants emphasized the importance of medical expertise, communication, teaching, triaging, and interpersonal skills to provide an effective consultation. Communication focused on the importance of understanding the reason for referral. Participants highlighted the importance of teaching the physician requesting the consultation. Interpersonal skills focused on the importance of being empathetic and supportive, recognizing that collegiality was key to being an effective consultant. Consultants operate on a continuum with respect to their involvement in direct patient care; their level of involvement influences the relative importance of each competency.
CONCLUSION
Critical competencies to provide an effective consultation included medical expertise, communication, teaching, triaging, and interpersonal skills, the relative importance of which depended on the consultant's level of involvement in direct patient care. This information will be used to develop a framework to teach trainees on providing a consultation. A limitation of our study is that only physicians within medical specialties were included.
Isabel in the ER
Sibbald, Matthew; Abdulla, Bashayer; Keuhl, Amy; Norman, Geoffrey; Monteiro, Sandra; Sherbino, Jonathan
BACKGROUND
Not thinking of a diagnosis is a leading cause of diagnostic error in the emergency department, resulting in delayed treatment, morbidity, and excess mortality. Electronic differential diagnostic support (EDS) results in small but significant reductions in diagnostic error. However, the uptake of EDS by clinicians is limited.
OBJECTIVE
The authors sought to understand physician perceptions and barriers to the uptake of EDS within the emergency department triage process.
METHOD
The authors conducted a qualitative study using a research associate to rapidly prototype an embedded EDS into the emergency department triage process. Physicians involved in the triage assessment of a busy emergency department were provided the output of an EDS based on the triage complaint by an embedded researcher to simulate an automated system that would draw from the electronic medical record. Physicians were interviewed immediately after their experience. Verbatim transcripts were analyzed by a team using open and axial coding, informed by direct content analysis.
RESULTS
In all, 4 themes emerged from 14 interviews: (1) the quality of the EDS was inferred from the scope and prioritization of the diagnoses present in the EDS differential; (2) the trust of the EDS was linked to varied beliefs around the diagnostic process and potential for bias; (3) clinicians foresaw more benefit to EDS use for colleagues and trainees rather than themselves; and (4) clinicians felt strongly that EDS output should not be included in the patient record.
CONCLUSION
The adoption of an EDS into an emergency department triage process will require a system that provides diagnostic suggestions appropriate for the scope and context of the emergency department triage process, transparency of system design, and affordances for clinician beliefs about the diagnostic process and addresses clinician concern around including EDS output in the patient record.
Teaching and Supervision
Measuring changes in undergraduate medical student radiology knowledge and perceptions following a one-week comprehensive boot camp
Burns, Levi; Caterine, Scott; Walker, Danielle; Ghumman, Zonia; Lee, Stefanie
INTRODUCTION
A one-week radiology boot camp elective for undergraduate medical students was offered for the first time in 2022. This study describes the boot camp course design and measures changes in radiology knowledge, confidence in radiology skills, and perceptions pertaining to radiology among learners.
METHODS
Pre-clerkship medical students were enrolled in a five-day comprehensive radiology elective including sessions on image interpretation, procedural skills, and appropriate image ordering. A 21-question multiple choice pre- and post-elective knowledge quiz was administered utilizing radiology questions from the validated AMSER STARS database. Questions were chosen based on the AMSER “Must See” radiology diagnoses. Additionally, a pre- and post-elective survey was administered assessing radiology career interest, confidence in radiology-based skills, and the perceived importance of radiology-based skills in specialties other than radiology. Responses from the assessments were analysed anonymously using paired t-tests.
RESULTS
15 students enrolled in the course and 14 completed all assessments. The average score on the quiz increased from 50.1% to 66.0% (p< 0.001). On the post-elective survey, most students reported increased confidence in radiographic interpretation (64.3%), ultrasound interpretation (78.6%), CT/MRI interpretation (57.1%), general radiology knowledge and procedural skills (78.6%), and in their ability to order appropriate imaging tests (71.4%) compared to the pre-elective survey. Average student satisfaction with the elective was 8.1 out of 10. 14 students (100%) agreed or strongly agreed that improving their radiology knowledge, procedural skills, and image ordering skills would benefit them on non-radiology clinical rotations.
CONCLUSION
After a one-week radiology elective, pre-clerkship medical students increased their radiology knowledge and most students demonstrated improved confidence in image interpretation, procedural skills, and appropriate ordering. The elective was well-received by learners and instructors.
Assessing Physician Assistant Competency, Integration, and Satisfaction Within Teaching Hospitals in Hamilton, Ontario, Canada
Wadie, Juliana; Burrows, Kristen
INTRODUCTION
Physician assistants (PAs) are trained healthcare professionals who are licensed to practice medicine in any specialty. PAs are valuable to the health care field because they can perform 70-96% of what a physician can accomplish and thereby, reduce wait times, and increase the rate of hospital discharge. Few studies have analyzed levels of PA competency, integration, and satisfaction in Ontario, Canada. The goal of the research was to explore and understand how the PA role is integrated across academic teaching hospitals to inform PA training modifications.
METHOD
The researchers administered a survey consisting of 30 questions to 22 PAs across a variety of specialties. These PAs were working in either the Hamilton Health Sciences Centre (HHSC) or St. Joseph’s Hospital (SJH), and had anywhere from two to 22 years of experience working as a PA.
RESULTS
The researchers validated that PAs are highly competent as they engage in a wide variety of duties, have a high level of autonomy rated with an average of 7.64 out of 10 (10 being full autonomy). The PAs stated that their PA program prepared them for the workforce with an average rating of 7.23 out of 10 (10 being fully prepared). It is evident that PAs integrate well into the healthcare system as many are involved in mentoring medical students, and all have excellent relationships with their supervising physician(s) (SPs) and allied healthcare professionals. 17 PAs indicated that their SPs trust the PAs to approach them when needed. In terms of satisfaction, 8 PAs believe they do not have an advocate to address work-related issues. The PAs expressed feelings of burnout, lack of compensation, and paucity of PA mentorship. 18% of PAs indicated that they do not believe they are supported by the HHSC or SJH.
CONCLUSION
The researchers concluded that PAs have high competency, and integrate well into the healthcare system. However, there are areas of improvement that can be made in order to reduce burnout and increase job satisfaction. This includes increasing PA mentorship, recruiting more PAs, integrating more clinical experience into PA programs, and increasing training before joining the workforce.
Assessing Asynchronous Virtual Interprofessional Education Curricula for Healthcare Professional Students
Grace, Matthew; Azim, Arden; Keuhl, Amy; Wojkowski, Sarah; Blissett, Sarah; Sibbald, Matthew
INTRODUCTION
Interprofessional education (IPE) is essential for health professions learners to develop the competencies required for collaborative practice. When traditional in-person models of IPE were strained by the COVID-19 pandemic, the necessity of asynchronous IPE became evident. Novel, asynchronous ways of delivering IPE are being explored, but little is known about whether students can truly learn “with, from and about each other” in a virtual asynchronous environment. This project aims to explore the extent to which virtual asynchronous modules achieve IPE objectives and any changes to these modules which could be undertaken to facilitate future learning.
METHODS
Students completed 5 virtual asynchronous modules developed by the McMaster Centre for Simulation-Based Learning (CSBL), covering topics including virtual care, debriefing, handover of care and feedback literacy. Participants were recruited from health professional students who attended in-person IPE workshops at the CSBL from 2019-2020. Learners completed one of the virtual modules and participated in semi-structured interviews exploring participants’ perceptions of how the module facilitated learning of the interprofessional competencies outlined by the Canadian Interprofessional Health Collaborative (CIHC). Interviews were transcribed verbatim, and the transcripts were open coded by five members of the research team. Themes on interprofessional learning and virtual module design were identified.
RESULTS
Twenty seven learners from three professions participated in the study. Participants appreciated the practicality and convenience of virtual asynchronous modules. Several participants identified that the modules facilitated effective reflection on their role in relation to other professions, while also teaching strategies for conflict resolution and interprofessional communication. Conversely, participants stated that the lack of face-to-face interaction felt isolating, leading to diminished learning of team functioning compared to in-person learning.
CONCLUSION
Asynchronous modules can effectively provide an introduction to IPE objectives. Learners are able to explore IPE concepts freely at their own pace, establishing a sense of learner safety. Considering the limited opportunities to apply these IPE concepts in a virtual asynchronous environment, these modules may be best suited to prepare students for future interprofessional learning in a synchronous setting.
Remote Proctoring: Testing the Limits of Student Performance; a Quality Improvement (QI) Study
Brewer-Deluce, Danielle
INTRODUCTION
Does proctoring matter? With the movement of courses online to support remote learning, so too did assessment, often with little consideration for the changes in administration necessitated by being online. Multiple choice question (MCQ) exams represent one important example of direct transfer that occurred from classroom to digital spaces. But does student performance change alongside the environment in which we ask them to write, and are some question levels better suited for different environments? This study set out to determine just that, using real course assessment data collected across three terms in which students completed nearly identical assessments on the same foundational content. We hypothesized that with increased proctoring, performance scores would decrease, especially for questions of lower Bloom’s Taxonomy levels.
METHODS
Midterm examination data from 3 successive cohorts in a large ugrad anatomy course were compared via a two-way repeated-measures ANOVA to analyse differences between MCQ test item performance (question difficulty and discrimination index) on varying question levels (higher and lower levels of bloom’s taxonomy) as the assessment mode changed (2020: online unproctored, 2021: online remote proctored, and 2022: in-person). Lecture content was held constant throughout the duration of the study period.
RESULTS
28 questions were repeated on the midterm exam in 2020, 2021 and 2022 and were answered by 865, 437 and 391 students respectively. 21 questions were identified as being lower level and 7 as higher level by two independent researchers (IRR = 0.89). For both question difficulty and discrimination index, there were simple main effects of cohort year (difficulty: F(2,25) = 10.984, p <0.001, discrimination: F(2,25) = 4.277, p = 0.025) with no effect of question level (p>0.05) or interaction (p>0.05) such that question difficulty increased with increased proctoring across all three cohorts (2022>2021>2020) and discrimination index increased between 2020 and 2022.
CONCLUSION
Assessment modality is an important consideration for faculty and students, especially as courses, and their assessments, look to stay online. Based on the current findings, virtual proctoring seems to increase test item difficulty while only in-person proctoring influences discrimination indices. This may indicate the need for students to write exams in person, or to offer explicitly open book-style assessments.
Faculty physicians’ approach to providing feedback on consultative skills: an opportunity for continuing professional development
David, Victoria; Mithoowani, Siraj; Britto, Joanne; Ungaretti, Toni; Chan, Teresa
INTRODUCTION
Providing an effective clinical consultation is an essential skill for medical specialists, however teaching, direct observation, and feedback to residents on their consultancy skills is lacking in the workplace. Our study aimed to understand how faculty approach feedback to trainees specifically on consultative skills.
METHODS
This was a qualitative study, using a framework analysis. Independent dyads of resident physicians and faculty members from McMaster University’s Department of Medicine participated in a simulation session of a thrombosis medicine consultation. Following the simulation, the faculty member debriefed with the trainee and provided feedback. Faculty and trainees then participated in separate semi-structured interviews. The purpose of the interview was to explore 1) faculty members’ approach to coaching trainees on consultation skills and 2) trainees’ perception on the value of this coaching. Debriefing sessions and interviews were analyzed iteratively using a constant comparative method and an inductive approach.
RESULTS
Eight simulation sessions and 16 semi-structured interviews were conducted for a total of 16 participants (8 resident physicians and 8 faculty members). Faculty members’ approach to providing feedback was guided by observing other faculty, clinical experience, or through faculty development training. Some staff reported never receiving faculty development on providing feedback. Faculty members emphasized the importance of being learner-centered, with a strong emphasis on listening to trainees. However, analysis of the debriefing sessions identified that most faculty had a one-way conversation with trainees, not soliciting their perspective. Both trainees and faculty members emphasized the importance of actionable feedback, which was commonly provided by faculty during the debriefing.
CONCLUSIONS
Faculty members recognize the importance of being learner-centered when providing feedback, however in practice do not always engage the trainee in the feedback discussion. Faculty may benefit from formal faculty development on how to provide feedback and debriefing, including incorporating a practical component to practice an approach to feedback.
Education for Professional Practice
A qualitative study on family physician perspectives on the influence of educational experiences on physician geographic disposition in Canada
Elma, Asiana; Aggarwal, Monica; Bakker, Dorothy; Johnston, Neil; Agarwal, Gina; Grierson, Lawrence
BACKGROUND
Inequities in accessing primary healthcare have left regions and patient populations across the country underserved. Family physicians have professional autonomy in arranging their professional practice according to their professional and personal interests. There are current calls for systems-level intervention; however, they do not reflect the potential of “upstream” educational interventions to address family physician maldistribution. Through this study, we aimed to understand the influence of medical education experiences on family physicians’ choice of practice location.
METHOD
We conducted 27 semi-structured interviews with early and mid-to-late career practicing Canadian family physicians. Guided by the Theory of Social Attachment, an unconstrained qualitative descriptive approach and a staged coding process were taken for analysis. Beginning with inductive coding, descriptions of participants’ practice characteristics and the factors expressed as influential in practice decisions were captured and refined through subsequent iterations of analysis. Codebook development and findings were routinely shared with the research team to gather feedback and ensure credibility and relevance.
RESULTS
Participants expressed that education experiences were strongly influential to their practice decisions. Practice preferences were shaped through training exposures to patient populations, heightened clinical responsibilities, various practice models and locations, and professional mentorships. Preferences were shaped early in training and were gradually refined as family physicians progressed into residency towards building confidence, competence, and comfort within practices that aligned with identified preferences. Notably, descriptions revealed that the family physician’s preferred practice location is intimately tied to their preferred practice scope.
CONCLUSION
Health workforce policies and interventions designed to promote equitable access to primary care should leverage the medical education system to effectively encourage family physicians to practice in underserved areas. Such interventions are potentially most effective early in medical training, while learners are still forming preferences for practice scope and location.
Reigniting the Flame in Surgery: A Mixed Methods Case Study Investigating the Drivers of Burnout in the Department of Surgery at McMaster University
McNeill; Kestrel; Vaillancourt, Sierra; Yang, Ilun; Sonnadara, Ranil
INTRODUCTION
Burnout is a psychological syndrome prevalent across surgical specialties that is associated with medical errors, depression, and suicidality. Burnout must be addressed at a departmental level given the institutional factors associated with its emergence. The goal of this study was to identify the drivers of burnout in the Department of Surgery at McMaster University to inform a strategy for change.
METHOD
This study employed convergent mixed methods approach embedded within a case-study design, which involves the simultaneous integration of quantitative and qualitative data to explore a context-specific phenomenon. A total of 52 surgeons were recruited to evaluate the prevalence of organizational stressors and burnout in the department through a cross-sectional survey; 22 provided qualitative comments through the survey, while 11 participated in interviews. A backwards stepwise approach to multiple regression was employed to evaluate which organizational, clinical, and demographic factors are related to burnout using Maslach’s Burnout Inventory. Qualitative data were analyzed using reflexive thematic analysis using the Areas of Worklife Model.
RESULTS
Of the 52 surgeons who participated, 57.8% (n=30) were classified as suffering from severe burnout symptoms. Significant stressors included control over working conditions, remuneration structure, gender, race, leadership positions, years in independent practice, as well as the percentage of time dedicated to clinical, administrative, and educational activities. Contributors identified through the qualitative analysis included difficulties providing adequate care to patients due to limited resources and time available in academic medical centres and the moral injury associated with these challenges. The inequitable remuneration associated with service roles due to the Fee-For-Service model, as well as issues of gender inequity and hostile working environments were reported as contributing factors. Participants suggested increasing engagement between staff and leadership by developing anonymous reporting avenues for departmental issues and facilitating collegial bonds as strategies for addressing burnout.
CONCLUSION
The high prevalence and negative sequalae of burnout in surgery necessitates the formation of targeted interventions to address this issue. Future work will involve engaging leaders in the department to generate an informed and data-driven strategy for addressing burnout.
Healthcare professionals’ perceptions of the disciplinary collaborations in older adults’ care during clinical practice in Nigeria: A cross-sectional study
Okoh, Augustine; Gu, Regis; Okafor, Chukwunonso; Kalu, Michael
INTRODUCTION
Older people tend to have multiple chronic health conditions that require coordinated care by more than one healthcare professional for effective care outcomes. However, there is a paucity of quantitative evidence on collaborative practice for elderly care in Nigeria. Thus, this study investigated the healthcare professionals' (HCPs) perception of disciplinary collaborations in older adults’ care during clinical practice in a tertiary hospital in the South-Eastern region of Nigeria.
METHOD
This study was an exploratory cross-sectional survey of 245 HCPs with practice experience ranging from 6 months to 15 years in the study setting. Data were analyzed descriptively and inferentially, and the level of significance was set at α = 0.05.
RESULTS
The level of awareness of disciplinary collaboration varies: intradisciplinary (65.7%), multidisciplinary (72.1%), cross-disciplinary (57.1%), Interdisciplinary (76.3%), and transdisciplinary (40.8%) collaborations. Having a bachelor’s degree and a transdisciplinary education predicted better awareness of the concepts (OR = 1.023, p = 0.010). The prevalent collaborative practice model according to the majority of the respondents was intradisciplinary (2.4%), multidisciplinary collaboration (61.6%), cross-disciplinary (2.0%), Interdisciplinary (25.3%), and transdisciplinary (6.6%) collaborations. A written description of levels of disciplinary collaboration had a superior influence over pictorial illustration in changing participants’ perceptions of the disciplinary concepts (p < 0.05). Participant changed their perception of the type of disciplinary practice in their hospital after reading the written description of disciplinary collaborations [X2 (2) = 29.747, p < 0.001]. Barriers to higher collaborative practices in the context included inequitable remuneration (p = 0.037), lack of integrated electronic medical records (p = 0.002) and the limited number of specialists (p < 0.001).
CONCLUSIONS
The lack of supportive structures and levers to encourage inter/trans-disciplinary practice constitute enormous impediments to advancements in healthcare delivery. The low to moderate awareness of the levels of disciplinary collaboration in this setting bears relevance to health professional education: especially as it indicates a need to review the educational curriculum to incorporate this knowledge and skills that promote inter/trans-disciplinary training and practice.
LEADS+ Developmental Model: Proposing a new model based on an integrative conceptual review
Ramelli, Sandra; Lal, Sarrah; Sherbino, Jonathan; Dickson, Graham; Chan, Teresa
PURPOSE
Leaders in academic health sciences centres (AHCs) must navigate multiple roles as an inherent component of their positions. Changing accountabilities, varying expectations, differing leadership competencies required of multiple leadership roles can be exacerbated by health system disruption, such as during the COVID-19 pandemic. There is a need improved models that support leaders in navigating, so they can better handle the complexity of multiple leadership roles.
METHOD
This integrative conceptual review sought to examine leadership and followership constructs and how they intersect with current leadership practices in AHCs. The goal was to develop a refined model of healthcare leadership development. The authors used iterative cycles of divergent and convergent thinking to explore and synthesize various literature and existing leadership frameworks. The authors used simulated personas and stories to test the model and, finally, the approach sought feedback from knowledge users (including healthcare leaders, medical educators, and leadership developers) to offer refinements.
RESULTS
After five rounds of discussion and reformulation, the authors arrived at a refined model: the LEADS+ Developmental Model. The model describes four nested stages, organizing progressive capabilities, as an individual toggles between followership and leadership. During the consultation stage, feedback from 29 out of 65 recruited knowledge users (44.6% response rate) was acquired. More than a quarter of respondents served as a senior leader in a health care network or national society (27.5%, n=8). Consulted knowledge users were invited to indicate their endorsement for the refined model using a 10-point scale (10=highest level of endorsement). There was a high level of endorsement: 7.93 (SD 1.7) out of 10.
CONCLUSIONS
The LEADS+ Developmental Model may help foster development of academic health centre leaders. In addition to clarifying the synergistic dynamic between leadership and followership, this model describes the paradigms adopted by leaders within health systems throughout their development journey.
Finding Interprofessional Competencies within the CanMeds framework: A Delphi process
Azim, Arden; Wojkowski, Sarah; Neville, Alan; Sherbino, Jonathan; Pardhan, Alim; Mohaupt, Jennifer; Burrows, Kristen; Sibbald, Matt
INTRODUCTION
Interprofessional education (IPE) is essential to prepare postgraduate learners for collaborative practice. However, integrating IPE within postgraduate medical education (PGME) remains a challenge. PGME is defined by physician competency frameworks, whereas distinct interprofessional competency frameworks define IPE. No blueprint exists to help educators navigate between frameworks. Previous work suggests this may lead to under-representation of interprofessional competencies in PGME. This study aimed to develop and validate a map of the intersection between the CanMEDS physician competency framework and the Canadian Interprofessional Health Collaborative’s (CIHC) National Interprofessional Competency Framework to illuminate where interprofessional competencies are situated and identify gaps in postgraduate IPE.
METHODS
A Delphi-informed approach was used to generate expert consensus on intersection between frameworks. The interprofessional study team (n = 7) and 6 expert informants mapped all 38 CIHC competency descriptors to the 7 CanMEDS roles. Consensus was defined as ≥80% agreement. Nine competency descriptors mapped to a role with consensus. Mapping was validated by a two-round Delphi process. The 9 competency descriptors and corresponding CanMEDS role were distributed by e-survey to authors of both frameworks, with 12 authors participating. Agreement was assessed as a binary. Narrative comments were collected.
RESULTS
Five of thirty-eight interprofessional competency descriptors mapped to a CanMEDS role with ≥80% agreement. Competencies mapped to either Communicator (n = 4) or Collaborator (n = 1). Only 3 of 6 CIHC domains were represented: (1) interprofessional communication (2) patient/family/community-centered care and (3) role clarification. Conflict resolution, team function and collaborative leadership did not clearly map to a CanMEDS role. Physician-provider elements of interprofessional communication were under-represented.
CONCLUSIONS
The findings demonstrate the challenges of translating interprofessional competencies to uniprofessional role standards. Most competencies mapped to watershed areas between CanMEDS roles. By attempting to encompass interprofessional competencies within the Collaborator role, competencies mapping to other roles may have been sidelined by the uniprofessional lens. The CanMEDS and CIHC frameworks align with other competency frameworks, therefore these findings may not be unique to Canadian PGME.