Curricula
Optimizing Implementation of Family Violence Education for Health Professionals: A Sequential Exploratory Mixed Method Study
10:40 - 11:45 AM, Presentation 1 of 5
MDCL 1016
Howcroft, Kathleen; Acai, Anita; Vanstone, Meredith; Collin-Vezina, Delphine; Dimitropoulos, Gina; Stewart, Donna; Kimber, Melissa.
Introduction: Effective educational approaches for preparing health professionals to recognize and respond to all forms of family violence in clinical practice remain unclear, as are the optimal strategies for the uptake, sustainability, and impact of family violence educational interventions. Unsurprisingly, health professionals lack confidence in recognizing and responding to family violence, reporting absent or inconsistent training. Informed by the Active Implementation Framework this sequential exploratory mixed method study aimed to characterize the learning and implementation needs and preferences related to improving the uptake, effectiveness, and sustainability of family violence education among physicians, social workers, social work students, and medical residents in Canada.
Methods: Data collection occurred between July 20, 2020, and April 30, 2021. Qualitative description guided the first strand; 102 semi-structured interviews were completed with trainees (n = 42) and physicians and social workers (n = 56) in the Canadian provinces of Alberta (n = 38), Ontario (n = 38), and Quebec (n = 26). The quantitative strand utilized a cross-sectional design to survey trainees and practicing professionals (n = 350) across Canada to corroborate and expand the findings.
Results: Participants reported continued learning needs related to family violence. Integration of data strands validated the need for additional family violence education for all participants; measures indicated a readiness for incorporating new learning about family violence into practice. Key incentives for continuing education included opportunities for engagement, accreditation, low cost, and availability of in-person and virtual learning options.
Conclusion: Regardless of provider discipline or experience, training preferences consistently emphasized situated learning with constructive debriefing and opportunities for reflection and reflexivity as essential formative learning experiences for addressing family violence. Health professionals felt more prepared to recognize and respond to child maltreatment compared to intimate partner violence, perhaps due to differences in mandatory reporting and availability of resources. This gap highlights the need for comprehensive training that equips providers to recognize and respond to all forms of family violence, not only to enhance their confidence but also to play a critical role in reducing the rates of family violence in Canada.
Bridging the Gap: A National Needs Assessment of Thrombosis Education in Canadian Internal Medicine Residency Programs
10:40 - 11:45 AM, Presentation 2 of 5
MDCL 1016
Luk, Vanessa; Adesina, Oluwabukunmi; Barsanti-Innes, Brianna; Britto, Joanne; Ladha, Danyal; Crowther, Mark; Mithoowani, Siraj
Introduction
The educational needs of Canadian Internal Medicine (IM) residents in Thrombosis Medicine are poorly understood. Knowledge gaps are likely to widen with expanding indications for anticoagulation and a rapidly growing evidence base for managing venous thromboembolism (VTE). We aimed to assess IM residents’ perceived and unperceived knowledge gaps in prevention, diagnosis and management of VTE.
Methods
An online survey was distributed to all Canadian IM residents (PGY 1-3) between June-December 2024. The study team developed the survey questions, which were validated by a content expert and piloted with seven McMaster PGY-3 IM residents. The survey covered demographics, perceived educational needs, confidence in managing key clinical scenarios, existing curriculum, and knowledge-testing questions to identify unperceived gaps. Data were summarized descriptively, and differences across PGY levels were analyzed using Kruskal-Wallis tests with Holm’s correction for multiple comparisons (significance threshold: p < 0.05). The study was approved by HiREB (#14354).
Results
A total of 100 residents (58 female) from 15 of 17 Canadian medical schools responded to the survey (PGY-1: n=24, PGY-2: n=31, PGY-3: n=45). Thirty residents had completed at least one block rotation in Thrombosis Medicine.
Over 90% of respondents considered it quite important or essential to learn about VTE diagnosis/management, high-risk pulmonary embolism, and indications for combining anticoagulants with antiplatelets, with no significant differences across PGY levels.
Residents reported low confidence in managing inherited thrombophilia (60%), VTE in pregnancy/postpartum (59%), unusual site VTE (48%), and antiphospholipid syndrome (40%). Confidence generally increased with training level (p < 0.05 for 9/18 clinical scenarios).
Knowledge testing revealed gaps in anticoagulant-antiplatelet combination therapy (27% answered correctly) and managing VTE in pregnancy (59% answered correctly). Median knowledge scores were 4/7 for PGY-1, 5/7 for PGY-2, and 6/7 for PGY-3 residents (p < 0.001).
Conclusions
Canadian IM residents recognize the importance of thrombosis education but report low confidence in managing complex VTE scenarios, with knowledge gaps persisting across training levels. These findings highlight the need for enhanced thrombosis training within IM residency programs. Future efforts will triangulate these results with input from Thrombosis and IM faculty to inform the development of a learner-centered curriculum that addresses key educational gaps.
Reimagining Evidence-Based Medicine Education: Addressing Challenges and Building a Robust Curriculum for Medical Students
10:40 - 11:45 AM, Presentation 3 of 5
MDCL 1016
Chambers, Larry; Lewis, Kim; Alexander, Thomas; Jones, Aaron; Valani, Rahim; Weera, Seddiq
Introduction
Evidence-Based Medicine (EBM) is essential for improving clinical decision-making, standardizing patient care, and fostering lifelong learning among healthcare professionals. Recognizing its importance, our regional campus introduced EBM Primer Rounds for medical students. An EBM primer is an optional once monthly series of one-hour lectures delivered by faculty that aims to deliver core EBM content. The initiative was paused to identify and address its effectiveness. This report outlines the evaluation process and the steps taken to reimagine EBM education, to ensure it meets needs of both students and faculty.
Methods
To evaluate the EBM Primer Rounds, we drew on insights from a recent systematic review and a report outlining recommended topics for EBM education. Additionally, we are surveying Canadian medical schools to gather information on their approaches to EBM education. Our evaluation aims to identify barriers and develop targeted strategies for improvement. In collaboration with MD education program planners, we identified key areas for enhancement, including integration of EBM into curriculum components and broadening its scope to encompass aspects of medical decision-making. The curriculum changes will be implemented in the 2025-2026 academic year, with evaluation of their impact, including monitoring student performance on EBM-related questions in the Medical Council of Canada Qualifying Examination.
Results
The EBM Primer sessions, led by EBM-trained faculty, faced challenges: ineffective teaching methods, faculty dominating discussions and limiting student engagement. Over time, participation declined, and student feedback was mixed, reflecting dissatisfaction with the format and delivery. Research learning leads (e.g., KL, LC, AJ, SW, RV) collaborated with MD program planners (e.g., TA) to review where EBM was included in the curriculum. This led to refined learning objectives and content aligned with the skills needed to identify, appraise, and apply evidence in patient care and population health. Opportunities were identified to integrate EBM principles into classroom, clerkship, and real-world scenarios.
Conclusion
Our goal is to equip students with skills for evidence-based decision-making and to promote lifelong learning. Through curriculum refinement and its evaluation, we are committed to advancing EBM education and preparing our graduates with knowledge and skills needed to deliver high-quality, evidence-based care.
Embarking on Residency: The Role of Entrustable Professional Activities in the Transition from Undergraduate to Postgraduate Training
10:40 - 11:45 AM, Presentation 4 of 5
MDCL 1016
Sheth, Urmi; Dunn, Nicholas; Rakoff, Jonah; Sibbald, Matthew
Introduction: The transition from undergraduate medical education (UGME) to postgraduate medical education (PGME) presents unique challenges for learners, who often feel underprepared. Both UGME and PGME have adopted competency-based medical education (CBME) approaches, which emphasize learner-centered measurement of entrustable professional activities (EPAs). The extent to which CBME approaches facilitate this transition remains unclear. This study explores first-year residents' experiences and examines the role of CBME, with a particular focus on EPAs, in supporting their successful transition from undergraduate to postgraduate training.
Methods: Semi-structured interviews were conducted with five first-year residents at McMaster University. Participants shared insights on their transition to residency and the role of CBME in facilitating this process. They also reflected on data showing the overlap between UGME and PGME EPAs. Qualitative data analysis was informed by direct content analysis.
Results: Residents identified that alignment between UGME and PGME competency frameworks formed a continuum that eased their transition. UGME EPAs helped residents develop the skills to acquire EPAs, including seeking out opportunities, approaching faculty for feedback, and refining their understanding of the value of EPAs. EPAs were viewed as a mechanism to standardize expectations and prompt reflection on the increasing independence and responsibility of residency. Challenges included variability in EPA observation systems, variability in institutional cultures including UGME-PGME differences, and transitioning into disciplines with less EPA overlap between UGME and PGME. Overlap maps between UGME and PGME EPAs were perceived as more helpful in facilitating reflection and the transition to residency in disciplines with higher alignment than in those with less alignment.
Conclusions: Commonalities in the EPA approaches of UGME and PGME can enhance the transition to residency by improving residents’ preparedness and confidence, reducing cognitive load, and standardizing expectations. These findings highlight the potential for CBME frameworks to support learners during the transition to residency.
Shaping Perceptions of Family Medicine: A Discourse Analysis of the Hidden Curriculum in Undergraduate Medical Education
10:40 - 11:45 AM, Presentation 5 of 5
MDCL 1016
Fu, Nicole; Shah, Aimun Q.; Risdon, Cathy; Sibbald, Mathew; Neighbour, Helen; Bal, Sharon; Kinzie, Sarah; Vanstone, Meredith; Bracken, Keyna; Grierson, Lawrence
Introduction: Primary care serves as the cornerstone of an effective healthcare system. Amidst Canada’s primary care crisis, undergraduate medical education (UGME) serves as a pivotal point in shaping student perceptions of family medicine (FM). However, concerns persist that FM may be inadequately represented in UGME curricula. This study examines McMaster University’s UGME curriculum to assess how explicit and implicit curricular elements contribute to students’ conceptualizations of family medicine.
Methods: A discourse analysis was conducted on formal curricular documents, including core curriculum components (e.g. mission statements), instructional resources, and active learning materials. Analysis assessed the extent to which these curricular elements reflected the four principles of FM, focusing on the representation of key values such comprehensive, continuous care, and the promotion of preventive medicine. Additionally, the curriculum’s structure was examined to identify implicit messaging regarding the role of FM in relation to other specialties.
Results: Core curriculum components, such as strategic plans and mission statements, explicitly valorized FM principles. However, inconsistencies emerged between stated objectives and their representation within curricular components. A significant number of tutorial cases in the Medical Foundations curriculum are situated in emergency settings, where acute presentations frequently lead to subspecialist care, bypassing FM as the initial point of contact. When FM is referenced, its role is primarily framed in terms of diagnosis and prescribing, with limited emphasis on the longitudinal and patient-centered dimensions of care. Additionally, hospital-based settings are frequently portrayed as team-based and well-resourced, whereas FM contexts often depict physicians working in relative isolation with reduced or delayed access to resources.
Conclusion: Enhancing the integration of FM’s core values in the UGME curriculum is essential to ensuring students develop a comprehensive understanding of FM and its foundational role in patient care. While core documents affirm FM’s principles, their inconsistent curricular representation may contribute to an undervaluation of its contributions. Integrating FM principles more explicitly into UGME will help future physicians develop a clearer understanding of its crucial role as a specialist in generalist medicine and a key collaborator in the healthcare system.
Equity, Diversity & Inclusion
Needs Assessment: Understanding the Experience of Marginalized Populations - Focus on Indigenous Populations: A Survey of Patients Attending McMaster Fracture Clinic
10:40 - 11:45 AM, Presentation 1 of 5
MDCL 1009
Farrugia, Patricia; Bolis, Matt; Chak, Celine; Tomczyk, Kristine; Peterson, Devin; Kishta, Waleed; Jain, Mya
Colonization, the residential school system, and negative care experiences are just a few systemic barriers causing reluctance for Indigenous populations in Canada to seek medical care in fear of experiencing anti-Indigenous consequences, including those involved in the death of Joyce Echaquan and Heather Winterstein.
Upholding OCAP® (Ownership, Control, Access, and Possession) principles protecting Indigenous data sovereignty, McMaster University led the first study of its kind in Canada to understand instances of anti-Indigenous racism as described by self-identifying Indigenous patients and their families. This study also aimed to understand socioeconomic and cultural barriers, providing the opportunity for patients to advocate for culturally relevant resources and actions to enhance healthcare services.
A two-row-wampum technique was used to co-design an exploratory quantitative survey with self-reported thematic analysis through collaborating with impacted communities, including McMaster’s Indigenous Health Learning Lodge and The Indigenous Health Network. In-person surveys were distributed in an orthopedic fracture clinic at McMaster University from September 2023 to February 2024. The survey emphasizes non-forced identification, empowering participants to self-identify as Indigenous without pre-screening.
Results from 403 surveys reveal travel distances reaching 50-110 km for 29% of participants, extended wait times (21.1%) and financial burdens (13.0%). Patient-reported factors contributing to anti-Indigenous racism include the underrepresentation of Indigenous staff and inadequate cultural sensitivity training. Respondents call on leadership to address racial prejudice, proposing traditional healers and culturally-based spaces and revising policies with an anti-racism, health equity lens.
In alignment with Calls to Action 18-24 of the Truth and Reconciliation Commission of Canada prioritizing reconciliation within the healthcare system, this project aims to use a knowledge translation approach to discuss strategies with hospital and community stakeholders to shed light on providing accessible and culturally safe care for Indigenous patients visiting the McMaster Pediatric Fracture Clinic. By collaborating on strategies to improve Indigenous Health services, this project aims to foster more equitable care for a population that has traditionally been, and still is, experiencing the impacts of colonization through anti-Indigenous racism.
Bridging Medical and Community Knowledge: A Curriculum for Gender-Affirming Care and Marginalized Populations
10:40 - 11:45 AM, Presentation 2 of 5
MDCL 1009
Hart, Avery
Trans healthcare is under systemic attack. In the U.S., over 20 states have banned gender-affirming care for minors, criminalizing providers and patients alike. In Canada, similar shifts are occurring. Alberta has banned gender-affirming surgeries for minors and imposed strict limitations on hormone therapy, requiring parental consent and psychiatric evaluation. Saskatchewan has implemented similar policies.
These legislative attacks are fueled by a surge in cisgender-led medical research that misrepresents gender-affirming care under the guise of evidence-based medicine. Institutions that once ignored trans health are now publishing studies distorting rates of regret and detransition to justify restrictions. This research is weaponized by policymakers to strip away trans rights, erasing decades of community-led medical knowledge in favor of fear-based decision-making.
Physicians are now the last line of defense between trans patients and systemic erasure. Medical institutions have an ethical obligation to ensure trainees receive real, community-driven, patient-informed education. Traditional medical curricula fail to prepare providers for this crisis. It is not enough to teach trans identities in theory—developing physicians must learn from trans-led, patient-centered sources. The Transgender Health Bootcamp was developed by the author—a transmasculine medical student—to fill this gap, providing student physicians with tangible, patient-centered skills.
Methods: The bootcamp was designed using a lived-experience and community-informed approach, integrating expertise from transgender healthcare providers, patients, advocacy groups, and cisgender allies. The curriculum included interactive stations covering hormone therapy prescribing and injection training, binding and tucking safety, navigating systemic barriers, and direct patient storytelling.
Results: Educators gained the knowledge and structure to replicate the bootcamp, embedding these competencies into medical curricula. By centering trans voices in medical education, the program challenges traditional hierarchies, ensuring lived experiences directly inform clinical practice.
Conclusion: As anti-trans policies escalate, medical professionals must be equipped to provide safe, affirming care. This bootcamp offers a scalable, community-driven model for addressing critical training gaps, ensuring future physicians can meet the urgent healthcare needs of marginalized patients.
The Intersection of Indigenous Peoples in Canada and Medical Assistance in Dying (MAID): A Scoping Review of the Current Literature
10:40 - 11:45 AM, Presentation 3 of 5
MDCL 1009
Rosen, Nancy Paris; Bae, Grant; Farrugia, Patricia; Banfield, Laura
Introduction: Medical Assistance in Dying (MAID) was legalized in Canada in 2016, creating a significant shift in end-of-life care. However, Indigenous populations face unique challenges with MAID due to historical mistreatment, cultural differences, and systemic barriers within the healthcare system. Since past Canadian health policies have mistreated Indigenous populations and current policies fail to consult Indigenous voices, the objective of this scoping review was to address the critical gap in understanding Indigenous perspectives and experiences with the new policy of MAID.
Methods: A scoping review methodology was employed, following Arksey and O'Malley's framework. Eight databases were searched and search dates were from database inception until April 30, 2024. 539 publications were identified from the electronic databases as potentially relevant and ten were finally marked for inclusion.
Results: Four key themes were identified, including the need for cultural sensitivity and safety, the importance of community and family involvement, communication barriers, and policy and legislative considerations. The ten articles included in this review varied in geographic focus and methodological approach. Six studies were conducted in Canada and examined First Nations, Métis, and Inuit perspectives on end-of-life care and cultural safety. The remaining four studies originated from New Zealand and Australia and focused on Māori and Indigenous Australian perspectives on assisted dying. While these four studies were not Canada-specific, they provided valuable insights into how Indigenous communities worldwide navigate MAID and end-of-life care.
Conclusion: The results indicate a limited number of studies focusing specifically on Indigenous experiences with medically assisted death, highlighting a gap in the literature. Future research should explore how international approaches can be adapted to strengthen Indigenous engagement in Canadian MAID policy. Interviews and surveys with Indigenous community members in Canada could also be held to better understand this population’s perceptions and experiences related to MAID. There is an urgent need for this research to ensure that MAID services are considerate of Indigenous values and needs.
Redefining Anatomy Education: A Descriptive Analysis of Current Views and Future Approaches on the Incorporation of Inclusive Sex and Gender Practices
10:40 - 11:45 AM, Presentation 4 of 5
MDCL 1009
Lee, Susie Soo Jin; Chima, Eva; Siddique, Maha; Abousifien, Marfy; Arca, Adam; Lohit, Simran; Durham, Kristina K.; Brewer-Deluce, Danielle
Introduction: As evidenced by predominant depictions of male bodies and a lack of intersex representations in learning materials, anatomy education has largely adhered to binary portrayals of sex and gender. As a foundational science to healthcare professions programs, limited representation may hinder learners’ ability to provide culturally competent care as future clinicians to sex and gender-diverse individuals. This calls for further insight into the attitudes and practices surrounding sex and gender in anatomy education.
Objective: To investigate sex and gender inclusivity within Schools of Anatomy in Ontario, Canada, identifying obstacles and proposing actionable steps towards equitable anatomy education.
Methods: After completion of an anonymous survey, participants (faculty and staff with roles in body donation procedures, physical lab space, and teaching) were invited to participate in a 1-on-1 semi-structured interview to expand on their positions and their institutions’ practices. Interview data was analyzed by thematic analysis.
Results & Discussion: 35% (n=11) of survey participants (n=31) completed interviews, revealing five major themes: 1) differences in conceptualizing sex and gender, 2) factors influencing conceptualization, 3) varied perceptions of donor respect, 4) barriers to incorporating sex and gender inclusivity, and 5) existing inclusive practices. Interviewees’ definitions of "sex" and "gender" were heterogeneous, with ambiguity between the noun (e.g. male, female, intersex) and verb (e.g. intercourse) uses of "sex." Influencers of conceptualization ranged from cultural norms to personal introspection. Opinions on using a donor's preferred gender in educational settings were split, seen either as respectful or objectifying. Barriers to inclusivity included generational gaps, reluctance to adapt, and doubts about the relevance of inclusivity in anatomy education.
Despite these barriers, most participants felt comfortable navigating sex and gender topics, suggesting recommendations for practical improvements like revising donor forms and promoting inclusive language across educational platforms.
Conclusion: Exploring sex and gender inclusivity in anatomy education highlights potential areas for improvements in current practices. Establishing anti-oppressive guidelines can create inclusive environments, better preparing students to provide culturally safe care to sex and gender-diverse people.
Professioanalims Challenges Experienced by Racialized International Medical Graduates in Anesthesiology Residency Programs in Canada
10:40 - 11:45 AM, Presentation 5 of 5
MDCL 1009
Reddy, Desigen; Monteiro, Sandra
Background
In PGME, we have problems with prognosing, diagnosing, predicting, preventing, remediating, and punishing professionalism problems. A notable gap in this literature is the lack of acknowledgement of the harm inflicted on some trainees by oppressive, conflicting, or misinterpreted definitions of professionalism. In 2010, the International Ottawa Conference Working Group on Professionalism made nine recommendations to further the discussion. One suggestion was to "Consider what happens when expectations at the individual level conflict with those at the societal or institutional level and what the resolution signifies for professional assessment." The Working Group reconvened in 2019, and despite numerous publications on professionalism in that decade, this particular area remained unaddressed.
This proposal outlines a research study investigating particular conflicting intersections of individual and organizational expectations that may give rise to discrimination or harm against racialized IMG residents and fellows.
Introduction
Significant challenges persist despite extensive research and publications on professionalism in medical education. One of the most critical issues revolves around its definition, which is complex and can vary among countries, cultures, institutions, and medical disciplines within a faculty. To complicate matters, it is seldom static and evolves with socio-political contextual factors. This has considerable implications for its assessment, teaching, and remediation. Due to these challenges, professional lapses or individuals labelled as 'unprofessional' are disproportionately experienced by groups that are systemically excluded.
The most comprehensive exploration of defining professionalism landed on three domain areas. (Hodges et al., 2019): Individual trait – can be learned or ingrained [this implies that we can establish standards, acceptable and unacceptable behaviours and expectations of individuals]
Relationship processes must be co-created; this indicates that we need a curriculum to support faculty. However, concepts of professionalism vary across cultures (Consorti et al., 2019). A comparison among Italian, Canadian, and Taiwanese individuals revealed differences in their engagement with the complaints process, as well as in how they prioritized their own needs against those of others and interpreted individual and group behaviour differently.
This highlights the necessity of exploring cultural differences in civil or professional behaviour that may result in conflict or misunderstanding. Importantly, our North American concept of professionalism reinforces harmful stereotypes. While there are multiple scales for assessing professionalism supported by psychometric evidence, there are risks associated with their incorporation into any evaluation or faculty development programme. Specifically, no single instrument can capture all facets of professionalism; thus, using anyone will disproportionately emphasize one aspect while diverting attention from others. Most importantly, existing instruments that evaluate professionalism require redesign and revalidation to eradicate bias against other cultures. Relying on current literature and definitions of professionalism risks weaponizing the concept against individuals with acceptable yet diverse attitudes, behaviours, or appearances.
The contention of several authors is not about what professionalism encompasses in its definition; more importantly, it concerns who defines it and why. Traditionally, it has been viewed as rooted in Anglo-Saxon norms, which marginalize those who do not fit into these categories. Embracing this norm without flexibility or contextual influences leads to a form of social control (Larson) and entrenches inequities. A study by Maristany et al. found that interviewing 49 underrepresented trainees in medicine reveals that professionalism can be oppressive, homogenising, and damaging to learners' mental health and education.
Understand/identify opportunities to experience pride – a potentially qualitative study exploring pride, reward and punishment in academic medicine – potentially experimental and qualitative studies of the influence of manipulating pride, reward and punishment.
Ultimately, the most effective response to an individual's lapse in professionalism may involve gaining knowledge about remedial practices and understanding the organisational responses to the information regarding such practices already possessed by the institution. (Papadakis et al., 2012)
Research Question
How do racialised IMGs training in anaesthesiology residency programmes in Canada navigate the challenges of being referred for concerns about professionalism and clinical competence?
Methods
In this study, we will:
1) conduct a literature review
2) interview Program Directors in Anesthesiology in Canada
3) Interview systematically excluded groups of International Medical Graduates (IMG) in anaesthesia training.
Potential outcomes and implications of this research for:
Policy and Process
Faculty Development
Scholarship and Innovation
Innovation in Education & Research
Mixing it Up: The Essential Role of Integration in Mixed Methods Research for Health Professions Education
10:40 - 11:45 AM, Presentation 1 of 5
MDCL 1010
Lee, Mark; Poth, Cheryl; Monteiro, Sandra; Brandt Vegas, Daniel; Bilgic, Elif; Sherbino, Jonathan
Introduction:
Health Professions Education (HPE) research draws from a range of disciplines, often necessitating varied methodologies to address complex problems that lack definitive and simple solutions. Mixed Methods Research (MMR) has emerged as a promising approach to address these multifaceted research questions by integrating qualitative and quantitative methodologies. MMR is not simply the parallel reporting of sub-studies with different data types. This study describes desirable evidence of integration, the distinguishing characteristic of MMR, using the HPE context. It synthesizes recent HPE research studies to illustrate how integration is reported and operationalized at key stages.
Methods:
A literature review was conducted on studies published from January 2023 to June 2024 in five leading HPE journals. The review focused on identifying how integration was described at three stages: study design, data collection, and analysis. A total of 43 primary research studies were included after screening.
Results:
The review revealed that integration needs to be more adequately described and represented in MMR studies within HPE. Only a minority of studies (n=2) provided explicit rationales for integrating different methodologies. At the data collection stage, few studies (n=18) detailed the sequencing and synthesis of data collection methods. Finally, at the analysis stage, explicit descriptions of how sub-analyses were combined were limited (n=14), rarely including joint data displays to illustrate integration.
Conclusions:
These findings highlight a gap in the application and reporting of integration in MMR within HPE. Guidelines and exemplars are needed to ensure that integration is included in HPE research identified as MMR.
Advancing Anatomy Knowledge through Collaborative Learning with Human Dissections
10:40 - 11:45 AM, Presentation 2 of 5
MDCL 1010
Quach, Shirley; Michalenko, Ethan; Stodola, Trinity; Wainman, Bruce; Wojkowski, Sarah; Durham, Kristina; Mezil, Yasmeen
Introduction: At McMaster University, an 8-week human anatomy dissection elective is offered as an interprofessional educational (IPE) activity to students in the Faculty of Health Sciences (FHS). This elective brings together first-year FHS students from various health professional programs, fostering interaction and collaborative learning through human dissections. Over the last few years, this IPE elective was shown to be effective at improving IPE readiness and collaboration. However, previous assessments have not examined its impact on students’ anatomical knowledge. Therefore, the objective of this study was to evaluate the changes in students' anatomical knowledge before and after participating in the IPE elective.
Methods: Students enrolled in the 8-week IPE anatomy dissection elective in 2024 were invited to complete an anatomy knowledge test before and after, delivered through a virtual platform called “Artificial Intelligence – Objective Structured Practical Examination (AI-OSPE)”. The AI-OSPE consisted of 30 questions across 10 anatomical topics with 3 questions in each. Percentage scores were generated for each topic and overall, reported as means (standard deviation). Pre and post scores were analyzed using paired t-tests, with p<0.05 as statistically significant. All data analyses were completed on STATA B/E 18.0.
Results: A total of 35 students enrolled into this elective and were invited to participate. Twenty-one students (60%) completed the AI-OSPE at both timepoints. There was a statistically significant increase in post-elective mean scores (63% [14%]) compared to pre-elective (48% [15%]), p<0.003. Although post-elective mean scores for each of the anatomical topics improved, only two subtopics reached statistical significance. These were: neurology (pre 66% [24%] vs post 87% [17%]) and reproductive (pre 16% [31%] vs post 53% [33%]), both p<0.01.
Conclusions: Using the AI-OSPE, students demonstrated an enhanced understanding of gross anatomy, particularly in a few specialized topics. This evaluation demonstrates that the IPE elective can improve students’ anatomical knowledge while enhancing their IPE readiness for future collaborations. As resources become increasingly limited, it is essential to develop and deliver activities that effectively address multiple educational needs.
The Clinician Educator Program - How Does an Innovation Establish Itself - From the Perspective of Eco-Normalization
10:40 - 11:45 AM, Presentation 3 of 5
MDCL 1010
Tong, Catherine; Chopra, Sonaina; Chan, Teresa; Hamza, Deena; Purcell, Laura; Sherbino, Jonathan; Ngo, Quang
Background
Competency-based, time-variable, portfolio-driven programs are rare; however, Areas of Focused Competence (AFCs) lie at the interface of Continuing Professional Development (CPD) and Competency-based Medical Education. One of the earliest AFC programs in Canada was the Clinician Educator (CE) AFC, established at McMaster University in 2014 and has grown from its first small cohort to dozens of graduates and is now recognized as an incubator for future CE’s.
Innovations often fail to be long lasting due to the complexities of change in a complex ecosystem, with little attention paid to factors in design, implementation and evaluation. Eco-normalization provides a framework to understand how the values and practices of an innovation become embedded individually and at the level of an ecosystem. Understanding how the CE AFC has established itself is imperative to the success of similar programs. Thus, we sought to understand how the CE program has established itself within a large healthcare community using the framework of Eco-normalization.
Methods
This was a qualitative exploration using reflexive thematic analysis with purposive sampling of key stakeholders in the CE program. Snowball sampling was then used to identify stakeholders not identified initially. Semi-structured interviews of program learners, teachers and leaders, followed by file reviews of program learners were done to understand program outcomes.
Outcomes
25 individuals were interviewed. Integration of the CE program was found to be variable across departments. Within departments, alignment of purpose, motivation and outcomes was foundational to successful integration, both for individuals and the institution. CEP’s aspirations to professionalize medical education were aligned with individuals whose motivations were linked to career development, participation in communities of practice and intrinsic motivation in medical education. The institution benefited from talent identification. Deliverables from the CEP included leadership development, scholarship and curricular innovation. Strengths of the program included structure and flexibility, access to community and the practical applications of the program. Integration has been heterogeneous depending on the micro-ecosystem within each department – where the program has been less successfully integrated, lack of resources, lack of recognition, and lack of sponsorship often broke the chain of purpose – motivation – outcome.
Revealing the Role of Medical Trainees’ Peer Networks in Clinical Decision Making
10:40 - 11:45 AM, Presentation 4 of 5
MDCL 1010
Clifford-Rashotte, Matthew; Nimmon, Laura
Introduction: The literature exploring how and why medical residents seek clinical decision making advice in the workplace has primarily considered the formal relationship between resident and supervisor, with the informal role of peers remaining underexplored. The authors sought to develop a deep understanding of how and why medical trainees seek advice from peers in clinical decision making.
Method: The authors employed a constructivist grounded theory (CGT) methodology, purposively sampling ten Internal Medicine and General Internal Medicine residents from a Canadian medical school from April-June 2023. The authors conducted semi-structured interviews with participants, exploring how and why advice was sought from peers. The authors analyzed data iteratively until theoretical sufficiency was achieved, incorporating critical theory into the analysis to attend to themes of hierarchy and agency.
Results: Ten residents participated in the study. Participants described peer advice seeking as a widespread phenomenon, which was usually performed quietly, without disclosure to supervisors. Peer advice was primarily sought in situations of clinical uncertainty, wherein patient safety was not felt to be immediately threatened. Advice from peers was valued because of their non-hierarchical position. As a result, participants described how peers were able to create a psychologically safe dynamic, which allowed the residents to both exercise agency in their decision making and maintain credibility with their supervisors.
Conclusions: Medical trainees in this study frequently seek advice from informal peer networks when navigating uncertainty in clinical situations. Peer advice appeared to be used as a strategy both for managing uncertainty and for maintaining credibility with supervisors. The ubiquity of peer advice seeking complicates the normative construct of “progressive independence” as the goal of clinical training. Future research can identify how supervisors may model and respond to peer advice seeking, and how peer networks might function for individuals from groups that are socially marginalized in medicine.
Educational AI Chatbots: Supporting and Personalizing Student Learning in Anatomy and Physiology Education
10:40 - 11:45 AM, Presentation 5 of 5
MDCL 1010
Bayer, Ilana; Lee, Victoria; Amarakoon, Buddhisha; Khan, Hamza
Introduction:
The use of generative AI is increasingly being used in educational contexts to generate multimedia materials, answer questions, and provide interactive support in the form of conversational agents (e.g., reflective activities) (Chang, 2023). Some of the emerging use cases in anatomy education include development of AI-tools for the creation of anatomical images, AnatomyGPT to answer learner questions, and use of generative AI-based virtual assistants in immersive virtual reality environments (Collins, 2024; Chheang, 2024). This study aims to evaluate the development and implementation of custom educational chatbots to help learners navigate physical and online resources in an undergraduate anatomy & physiology course.
Methods:
Two educational AI chatbots were developed using a no-code online tool. The Anatomy Spacebot was developed an orientation AI-assistant to facilitate exploration of the physical anatomy lab. The MacAnatomy Bot was developed as an AI-assistant search bot to facilitate searching content on MacAnatomy – the education portal for anatomy education at McMaster University. Participants will test the Anatomy Spacebot as they navigate the physical lab space. The MacAnatomy Bot will be tested using a think aloud protocol to guide specific search-related tasks. Participants will also complete user experience surveys and participate in focus group sessions.
Results:
The think aloud prototype testing results are expected to reveal how participants interact with the chatbots. Data from the user experience surveys and focus groups will provide further insight into the learner experience with chatbots including what worked well, what needs to change, unanswered questions and new ideas to try, as well as student perspectives on the use of generative AI.
Discussion:
This pilot study will guide further development of the chatbots for use in an educational context as well as provide insight into student perceptions and use of generative AI as learning tools.
Significance & Implications:
This pilot study will guide further development of the chatbots for use in an educational context. It will also contribute to existing literature and the broader discussion on the use of generative AI tools for teaching and learning in higher education. While this project is based on anatomy education, the findings may be relevant to other areas of health sciences and medical education.
Assessment
Defining Principles of Expert Performance During Medical Procedures in Pediatrics: Optimizing Assessment Criteria of Procedural Skills
1:15 PM - 2:20 PM, Presentation 1 of 5
MDCL 1010
Dhanoa, Jasmin; Ngo, Quang; Acai, Anita; Sharma, Ruchika; Bilgic, Elif
Background/Purpose: The Royal College of Physicians and Surgeons of Canada (RC) has outlined entrustable professional activities (EPAs) that focus on procedural skills that pediatric residents are assessed on for competency. However, current understanding of skill domains in performing medical procedures is thought of in simpler terms, focusing on domains such as psychomotor skills and knowledge for decision-making. Hence, there are limitations in our ability to accurately assess resident procedural performance.
Dr. Amin Madani and colleagues have defined and developed a framework of principles that guide intraoperative decisions and behaviours of expert surgeons. However, there could be differences in procedural expertise for OR-external pediatrics procedures.
The purpose of this study is to define expert performance during pediatric medical procedures and modify the above-mentioned framework to include procedural expertise outside the OR, and guide assessment criteria for procedural skills.
Methods: Semi-structured interviews will be conducted with physicians, with procedural experiences, from the Department of Pediatrics. Reflexive thematic analysis will be performed.
Results: We have recruited 18 experts nationally from pediatric emergency medicine, neonatology, pediatric critical care, and pediatric gastroenterology. Based on the initial analysis, we identified the following themes as important for procedural expertise.
• Deciding to perform the procedure
• Knowledge of indications, contraindications and complications
• Communication with team
• Situational awareness
Conclusion: Our study will help better understand the skills crucial in performing medical procedures in pediatrics. Additionally, we will modify Dr. Madani’s framework to include expertise of medical procedures across settings and optimize training and assessment criteria used by the Royal College and programs.
Defining the Key Skills Required to Perform in Challenging Pediatrics Procedures
1:15 PM - 2:20 PM, Presentation 2 of 5
MDCL 1010
Howcroft, Julia; Ngo, Quang; Duff, Jonathan; Bilgic, Elif
Introduction
Procedural skills are essential in pediatric care but are challenging for residents due to their infrequency in the clinical setting. Under Competence-by-Design (CBD), pediatric residents must achieve competence in entrustable professional activities (EPAs), including procedural skills. However, studies highlight gaps between the perceived importance of certain procedures and residents’ self-reported competence, particularly in chest tube insertion (CTI) and intraosseous (IO) insertion. Hence, this study aims to identify key skills for performance of CTI and IO, and the most challenging aspects of these procedures for trainees, addressing: (1) What essential knowledge and skills are required for CTI and IO? (2) Which aspects of the procedures are most challenging for trainees?
Methods
The project is funded by a Royal College of Physicians and Surgeons of Canada, Medical Education Research Grant. This study employs an interpretive descriptive design within a social constructionist framework, and is guided by the Core Components Framework for Evaluating Implementation of CBD Programs. Participants include pediatric residents, subspecialty residents, and faculty from programs across Canada. Following the completion of a demographics survey, semi-structured interviews are conducted to explore participant experiences performing IO and CTI. Data will be analyzed using inductive reflexive thematic analysis.
Results
To date, 12 participants have been interviewed—four faculty and eight residents from multiple Canadian institutions and specialties including pediatrics, pediatric emergency medicine, and neonatology. Recruitment will continue until thematic sufficiency is reached. Preliminary findings suggest that key skills for both procedures include knowledge of anatomy, landmarking, and indications, and decision-making across procedural stages (e.g., deciding what equipment to use). For IO, residents report the greatest challenge in decision-making regarding when to perform the procedure and inserting the needle until the correct depth. For CTI, residents struggle most with the psychomotor aspects of insertion, particularly depth perception and achieving correct needle positioning. Thematic analysis will further explore these patterns.
Conclusion
By identifying specific challenges that residents face when learning procedural skills, this study will inform curriculum development and assessment strategies, enhancing residents’ competence in IO and CTI.
Tracking Emotional and Perspective Shifts: How Faculty and Residents’ Perceptions of EPA Assessments changed Over Two Years?
1:15 PM - 2:20 PM, Presentation 3 of 5
MDCL 1010
Sonaina Chopra, Jasmin Dhanoa, Cynthia Youssef, Jason M Harley, Anita Acai, Quang Ngo, Jonathan Sherbino, Elif Bilgic
Introduction: Residents generally perceive entrustable professional activity (EPA) assessments negatively. Given that negative emotions can impair performance, this study explores how emotions experienced by residents and faculty have changed over two years.
Methods: Participants from General Surgery, Pediatrics, and Emergency Medicine were recruited. The Medical Emotions Scale (MES), a standardized questionnaire measuring 20 emotions on a 5-point Likert scale (categorized as positive or negative), was used to assess emotions regarding EPA assessments. Descriptive statistics (mean and standard deviation) were calculated and compared Year 1 to Year 2 data.
Results: One hundred and twenty-one participants (47 faculty, 74 residents) completed the survey. Consistent with Year 1 findings, both groups reported more negative emotions regarding EPA assessments. Additionally, residents reported higher negative emotions (M=2.71, S.D.=.181) than faculty (M=2.013, S.D.=.144). While some emotional shifts were observed across years, none were statistically significant. Open-ended responses revealed increased frustration with the following: administrative burden, subjective and inconsistent feedback and grading, declining faculty engagement and EPA assessment completion by faculty.
Conclusion: Negative emotions surrounding EPA assessments persist over two years, with growing resident dissatisfaction and frustration. The persistent and increasing negative emotions towards specific assessment experiences may guide programs to implement specific strategies to optimize EPA assessment processes. This study was conducted at single institute which may restrict the generalizability. Second, these finds are based on quantitative investigations; conducting qualitative investigation would help with gaining a deeper understanding of these emotions.
Tests that Should Make You Think: Testing Prior Knowledge to Promote Future Learning
1:15 PM - 2:20 PM, Presentation 4 of 5
MDCL 1010
Binks, Sally; Woods, Nicole; Brydges, Ryan; Kulasegaram, Kulamakan
Introduction: Testing prior basic science knowledge may activate prior knowledge and it may induce a specific kind of cognitive processing--distinctive processing--that may be beneficial for future learning. Distinctive processing entails noticing both similarities and differences between facts, concepts or entities. In a previous study, we designed two versions of a multiple-choice question (MCQ) basic science test. One version had similar, plausible or “competitive” incorrect response options (distractors) and the other version had less plausible or non-competitive distractors. We found that the “competitive” version elicited more distinctive processing of prior knowledge than the “non-competitive” version. In the current study, we report the effect of test type (competitive versus non-competitive) and test schedule (pre- or post-) on retention and transfer of learning about a new clinical topic.
Methods: Canadian medical students (n=68) were recruited to participate in a two-part, online study. Participants received either the competitive or non-competitive basic science MCQ either prior to or after receiving instruction on a new clinical topic. After seven days, they completed a retention test and a transfer test on the new topic.
Results: Contrary to our hypothesis, the non-competitive, post-instruction group outperformed the other three conditions on the transfer test. There was no significant difference in scores between groups on the retention test.
Conclusions: We believe that correct response options were more salient in the non-competitive condition such that there was an advantage over the competitive group, particularly over those with lower levels of prior knowledge. When stratified according to performance on the basic science test, the competitive group showed a positive correlation between prior knowledge and performance on the transfer test. In the absence of correct answer feedback, participants with medium and low levels of prior basic science knowledge may not have been able to activate and/or distinctively process their knowledge such that it benefited new learning.
Evaluating Test Formats: The Reliability of Open and Closed Book Assessments
1:15 PM - 2:20 PM, Presentation 5 of 5
MDCL 1010
Monteiro, Sandra; Chopra, Sonaina; Keuhl Amy; Sibbald, Matthew; Norman, Geoff; Sherbino, Jonathan, Pugh, Debra; Morin, Maxim
Introduction
Open and closed book tests have been studied in the context of student perceptions in an education environment. In this study we add to this literature by evaluating the reliability of open and closed test formats in a high stakes medical licensing context.
Methods
We worked with family medicine consultants to identify common clinical presentations of cardiovascular disease, which were transformed into 12 multiple-choice questions (MCQ) and 15 short answer questions (SAQ). Test format was defined by access to online resources: Open (any internet source), Closed (no access), and Partial (online textbook only). Scores for MCQs and SAQs were converted to a percentage and submitted to a univariate ANOVA with two between groups factors of clinical practice level and test condition.
Results
Our participants (N=170) were medical students, international medical graduates, Canadian medical graduates, and licensed primary care physicians to facilitate an evaluation of contrasting group level performance. The study was powered (𝛽= 0.8) to detect an average group difference of ~3.5%. We found a significant difference between practice levels, p < 0.01, η2 = 0.9, but there was no difference between the 3 test conditions, p > 0.5. Internal consistency was slightly higher for Open (0.68), compared to Closed (0.62), and Partial (0.60).
Conclusion
Performance differences were noted across clinical practice levels, but not between the test conditions, with no cost to internal consistency. These findings highlight the potential for high stakes open book testing.
Health Education Policy
How do they decide? Exploring how child life internship programs make decisions about prospective interns
1:15 PM - 2:20 PM, Presentation 1 of 5
MDCL 1016
Sohanlal, Allison; Kahlke, Renate
Child life specialists are skilled pediatric psychosocial care professionals who support children, youth and families through stressful and life-changing events. Within the academic and clinical training landscape, the process of applying for and securing a child life internship in Canada is a stressful, time-consuming and competitive process for prospective interns. The process for matching interns is primarily decided by individual internship programs, and application requirements vary widely; some internship applications require only a resume, while others involve intricate documentation and a maze of different application materials. Further, the processes that internship programs use to rank applicants is a mystery to most who apply, to academic programs, and to other internship programs. This study used a generic qualitative approach to explore how child life internship programs across Canada, make decisions during the internship application, selection, and matching process. This study has three phases. Phase one consists of virtual, one-to-one or group semi-structured interviews of child life internship program leaders across Canada, examining retrospective experiences with internship placement decision making. Phase two involves a subset of participants who will engage in journaling exercises with prompts for each stage of the process via an online form. Journaling was chosen as an elicitation technique to further explore participant thoughts, impressions and experiences during real-time application, selection and matching for fall 2025 internships. Phase three is an opportunity for ‘member reflection’ (Tracy, 2010) where participants offer feedback on the key elements of emerging analysis presented to them in the format of a focus group. This study is in progress so this presentation will provide an update on the emerging results of this research study. At the time of the presentation, a summary of results from phase one and phase two will be available. Without transparency around the process of internship placement decisions, interns struggle to navigate different written and unwritten requirements and cannot prioritize sites where they are most likely to achieve a match that will further their career goals. With the information collected from this study, there is an opportunity to transparently share data that will enhance internship programs across the country and better support future interns by helping them understand the process to generate the best application packages possible.
Family physicians’ views on informational continuity during patient transitions into long-term care in Ontario, Canada: A qualitative descriptive study
1:15 PM - 2:20 PM, Presentation 2 of 5
MDCL 1016
Okoh, Augustine; Lin, Christine; Caswell, Caroline; Gupta, Paranshi; Dharia, Naisha; Shah, Aimun; Siu, Henry; Howard, Michelle; Badone, Ellen; Grierson, Lawrence
Background/objective: The growing elderly population significantly impacts care continuity, particularly during transitions to long-term care (LTC). Many lose contact with their family physicians as new providers take over their care. To address this, comprehensive patient handover notes are vital for ensuring continuity. In Ontario, family physicians share healthcare information during LTC transitions, but its effectiveness is under-researched. This study explores current and desired communication activities to enhance informational continuity during LTC transitions.
Approach: Using qualitative descriptive design, 10 conducted semi-structured interviews were conducted with community family physicians with a continuity-based community practice in Ontario. Maximum variation was sought with respect to age, gender, years of practice, practice location (urban, suburban, rural), and funding model (for e.g., fee-for-service, capitation). Data were analyzed using unconstrained deductive approach.
Results: Participants normally complete the LTC-Health Assessment Form when their patients move to LTC as a means of transfer of care and important patient information to the LTC providers. They believed the document only contained the minimum information. To support informational continuity, some participants went the extra lengths to provide additional documentations, engage in bidirectional communication, educate families in the build-up to the LTC admission. and believed it could be better. Individual levels factors – related to education/practice experience in LTC, implicit rules, information standard, and redundancies – and organisational level factors – related to remunerative model, professional scope, access to information, and rurality – influence their continuity-bases practice.
Conclusion: Effective LTC transitions rely on comprehensive documentation, efficient communication, and multi-stakeholder collaboration. Promoting LTC related educational opportunities and enabling practice features may enhance family physicians’ ability to support informational continuity during LTC transitions.
Learning on the job: experiences of moral distress in ICU professionals navigating shifts in professional scopes of care during the COVID-19 pandemic
1:15 PM - 2:20 PM, Presentation 3 of 5
MDCL 1016
Shah; Aimun Qadeer; Molinaro, Monica L; Elma, Asiana; Scholes, Alison; Pinto, Nicole; Leslie, Myles; Brown, Allison; Cook, Deborah; Niven, Daniel; Fiest, Kirsten; Peter, Elizabeth; Grierson, Lawrence; Vanstone, Meredith.
Introduction: The Intensive Care Unit (ICU) is a high-pressure environment where healthcare professionals frequently face ethical challenges, such as managing limited resources and making decisions around life-or-death. During the COVID-19 pandemic, these pressures intensified as ICUs had to quickly adapt to increasing care demands. ICU professionals, accustomed to specific skills and patient populations, were sometimes reassigned to unfamiliar tasks or redeployed to areas outside their expertise. These shifts in professional scope may have led to moral distress, as providers were constrained in their ability to deliver optimal patient care. This study explores the impact of these shifts in professional on healthcare professionals in the ICU during the pandemic.
Methods: A qualitative case study approach was employed to examine the experiences of healthcare professionals in one ICU in Ontario, and one ICU in Alberta, Canada. Semi-structured interviews were conducted with ICU staff, and institutional and government documents were reviewed to provide context. The data were analyzed to identify common themes within and across cases.
Results: Thirty-six healthcare professionals, including nurses, physicians, and administrative staff, participated. Participants reported that resource shortages—such as staffing, personal protective equipment, and time—were significant barriers to providing optimal care. In response to resource challenges, professionals were redeployed to unfamiliar environments or asked to expand their roles without adequate training. For example, staff without pediatric training were tasked with caring for pediatric ICU patients, and non-critical care staff were reassigned to critical care units. These role shifts often resulted in moral distress, as healthcare providers felt unable to provide the standard of care they were trained for, which may have contributed to adverse patient outcomes.
Conclusion: Working outside their established scope during the pandemic created a disconnect between healthcare professionals' formal education and the immediate, high-pressure demands they faced, resulting in experiences of moral distress. This emphasizes the need for health professions education that adequately prepares professionals for crisis situations that require role versatility and adaptability, to ultimately improve both staff wellbeing and patient care in high-pressure scenarios.
‘Just a Checkbox’: Exploring the Impact of Organizational Structures on Informal Interprofessional Learning in Postgraduate Medical Education
1:15 PM - 2:20 PM, Presentation 4 of 5
MDCL 1016
Azim, Arden; Kocaqi, Etri; Barker, Megan; Sibbald, Matthew; Stalmeijer, Renee
Introduction: Preparation of physician trainees for collaborative practice occurs primarily through informal interprofessional learning (IPL). However, tensions between the uniprofessional framing of postgraduate medical education (PGME) and the interprofessional perspective required for informal IPL may hinder its effectiveness. The organizational structures within PGME may play a critical but underexplored role in shaping informal IPL. The hidden curriculum provides a helpful conceptual lens to explore their covert influences on informal IPL, defining organizational structures as the policies, evaluations, resource allocation and institutional slang within PGME. This study aimed to explore, using the conceptual lens of the hidden curriculum, how the organizational structures within PGME facilitate and constrain informal IPL among physician trainees.
Methods: This was a descriptive qualitative study using semi-structured individual interviews with ten internal medicine residents at a Canadian institution. The interview guide was sensitized by the four areas of the hidden curriculum’s institutional-organizational domain: (1) policies, (2) evaluation/assessment, (3) resource allocation, and (4) institutional slang. Data collection and analysis occurred iteratively, using reflexive thematic analysis.
Results: Participants consistently reported a lack of formal attention paid to IPL within organizational structures. Three main themes were identified through which organizational structures shaped trainees’ engagement in informal IPL: (1) conflation of interprofessionalism with professionalism, (2) lack of robust attention to IPL within evaluations, and (3) reliance on senior peer and supervisor role modeling. This led trainees to favour superficial interprofessional interactions over authentic collaboration and imposed a physician-centric approach to informal IPL.
Conclusions: The lack of explicit attention to IPL within organizational structures increases its vulnerability to hidden curricular influences, hindering trainees’ engagement in authentic interprofessional learning in the workplace. Refining institutional language around interprofessionalism, strengthening evaluation processes and clarifying expectations may help informal IPL meet its potential.
A scoping review of the upstream impacts of medical school admissions policies on applicants: Don’t hate the player, hate the game
1:15 PM - 2:20 PM, Presentation 5 of 5
MDCL 1016
Huang, Angela; Caswell, Caroline; Ritz, Stacey; Grierson, Lawrence
Introduction: Medical school admissions are highly competitive. Anecdotal evidence from university faculty and educational leaders suggests that medical school admissions policies are driving aspirant behavior in unintended ways. While these behaviours are often described pejoratively by medical educators, they are actually rational, reflecting an admissions economy with a limited number of spots and a high degree of competition. The aim of this paper is to review the existing literature for empiric evidence and characterization of admission policies’ upstream impact on applicant behavior.
Methods: Arksey and O’Malley’s scoping review methodology was used to summarize results of research studies published between 1980-2024 written in English with empirical evidence of medical school applicants’ behaviors being driven by admissions policies. Data extraction was recorded on a data collection chart detailing which admissions policies and behaviors were explored.
Results: Of 2349 studies initially screened, 16 were included in this review. Three categories of similar behaviors were noted in response to specific admissions policies including: (1) grade point averages (GPA) and standardized testing (2) reporting activities from curricula vitae (CV) and (3) ratings of applicants’ professional and interpersonal skills; including assessments of essay and personal statement submissions, interview responses, and letters of recommendation. Analysis of the included studies also revealed the potential impact of pressures outside of purely what is stated in admissions criteria, but personal interpretation of the policies or the inputs of other aspirants. Stress and uncertainty were also found to be pervasive parts of the applicant experience. Medical school admissions policies have considerable influence on the behaviours of aspiring medical students. The behaviours promoted result in careful curation of personal academic and non-academic activities and intense engagement that demands considerable time, energy, and resources.
Conclusion: The harmful normative culture established in the admissions process may have lasting downstream effects, contributing to high rates of burnout and intent-to-leave within the medical profession. Medical school admission committees should consider the unintended consequences of their policies that may incentivize students to “game the system” and create policies that align values of the profession with aspirant wellness simultaneously.
Technology-Enhanced Learning
Understanding the Role of Generative Artificial Intelligence in Developing Communication and Clinical Skills in Undergraduate Medical Education
1:15 PM - 2:20 PM, Presentation 1 of 5
MDCL 1009
Sheth, Urmi; Lo, Margret; McCarthy, Jeffrey; Baath, Navjeet; Last, Nicole; Monteiro, Sandra; Sibbald, Matthew
Introduction: Effective patient interviews are critical for clinical decision making. However, opportunities for medical students to practice these skills are resource-limited. Generative AI, including OSCE-GPT, represents a potentially scalable tool to allow students to practice taking histories and develop their communication skills. This study aims to understand the utility of OSCE-GPT in improving history-taking and communication skills amongst medical students.
Methods: Medical students at McMaster University used OSCE-GPT to conduct simulated patient interviews based on problem-based learning cases. Participants were asked to complete pre- and post-simulation surveys with Likert scale and open-ended questions to assess the value of using OSCE-GPT in taking a focused history. Quantitative data were numerically summarized and qualitative data were analyzed for emergent themes.
Results: Twenty-three participants provided 70 total responses over five simulations. On average, respondents reported a 0.77 point increase (out of 5) in comfort with a medical topic after simulating a history with OSCE-GPT. Ninety-four percent of participants agreed or strongly agreed that an AI simulation would improve their history taking skills, and 86% agreed or strongly agreed that an AI simulation would improve their communication skills. Qualitative comments discussed that OSCE-GPT’s feedback was often more comprehensive than clinical skills preceptors’ or standardized patients’ feedback, and that access to the tool was helpful for self-paced practice. However, participants noted limitations, including that it lacked the emotive abilities of a human and the small contextual nuances in human conversation.
Conclusion: This study demonstrates the feasibility and perceived value of integrating generative AI into clinical skills education. Participants overwhelmingly found the tool useful as a mechanism for skill development. The results of this study highlight the potential of AI to be a supplemental resource within the clinical skills curriculum, allowing for personalized and repeat practice. Future work can explore the utility of AI-driven tools in enhancing other aspects of medical education.
Impact of Digital Reality on Education of Anatomical Muscles in Motion
1:15 PM - 2:20 PM, Presentation 2 of 5
MDCL 1009
Hasaneini, Fatemeh; Mahamud, Kadija; Rassam, Salwan; Patel, Harsh; Yang, Leon; Warrier, Anish; Forbes, Lukas; Bayer, Ilana
Introduction
For learners in movement-based sciences, visualizing anatomical structures through movement helps in understanding the musculoskeletal system. This study evaluated the effectiveness of Virtual Reality (VR) at facilitating knowledge acquisition and application of functional movement when compared to non-immersive videos & static 3D models.
Methods
Undergraduate students with no university-level anatomy education (n = 69) were recruited to learn about specific muscles (deltoid, gluteus medius, sartorius) through 3 different modalities: VR, video and 3D models. Participants were randomly allocated to 1 of 3 groups (n = 23 per group), such that each participant interacted with each modality and muscle group once. Knowledge and application of learning was assessed using multiple choice questions (MCQ) and demonstration of movements targeting the muscles respectively. Visuospatial ability and depth perception were assessed using the Mental Rotation test and Stereo Fly test, respectively, for any confounding effect. Surveys were completed evaluating user experience with each modality.
Results
Knowledge acquisition was assessed by MCQ responses. Mean accuracy across all 3 muscles was 83.09% for video compared to 70.53% for VR. For application-based questions, videos demonstrated a mean accuracy of 74.20%, while VR showed 72.90% success. For total scores, video had higher mean accuracy than VR, respectively scoring 80.13% and 71.32% for each modality. The 3 modalities had similar ratings for being the most suitable for learning about muscle structure and function. However, for learning about the functional motion of a muscle, VR was rated most suitable by over half of the participants (63%), while only 6% voted for 3D model. Participants rated the effectiveness of VR (7.13/10) and video (7.74/10) higher than 3D models (6.69/10) for enabling them to grasp anatomy concepts. Similarly, participants had greater satisfaction with VR (3.9/5) and video (3.9/5) modalities compared to 3D models (3.46/5).
Conclusion
Based on mean scores, video-based learning demonstrated the highest overall accuracy in knowledge acquisition, outperforming VR in MCQ and total scores, while application-based question performance was similar across modalities. Overall, video and VR were rated more effective and satisfactory than 3D models. This data may guide implementation of different modalities for learning about muscles and functional motion in anatomy and movement-based curricula.
To Play or Not to Play? Assessing the Impact of an Anatomy Card Game vs. Slide Review on Student Performance and Motivation
1:15 PM - 2:20 PM, Presentation 3 of 5
MDCL 1009
Issa, Julia; Naveed, Aamna; Lee, Victoria; Wainman, Bruce; Mezil, Yasmeen
INTRODUCTION
Game-Based Learning (GBL) enhances student engagement through active learning principles. In anatomy education, where content is complex and memorization-intensive, GBL creates a simple way of learning, making it a valuable tool to supplement traditional methods. However, limited empirical evidence exists on its impact on undergraduate anatomy students and whether it is an efficient means of studying.
This study examines the effectiveness of ORGAN-IZE, a student-designed card game, in reinforcing renal anatomy. The game employs active recall, repetition, and collaborative play to enhance knowledge retention and learning experience. It is hypothesized that students playing ORGAN-IZE will show greater improvements in motivation and performance compared to those using traditional study methods.
METHODS
Participants are undergraduate students currently enrolled in an anatomy course. Participants review a pre-recorded module on renal filtration, mirroring content delivery in their courses. They are randomly assigned to one of four conditions (2x2 design): playing ORGAN-IZE (10 or 20 min) or slides/notes review (10 or 20 min). In the study session, participants take a pre-test, complete the activity in pairs, then complete the validated Intrinsic Motivation Inventory (IMI), open-ended questions, and a final post-test.
RESULTS
Interim analysis using a two-way ANOVA revealed a significant effect of instructional method on motivation (p = 0.0016), with students in the game condition reporting higher motivation than those in the slides condition. However, no significant effects were found for study duration (10 min vs. 20 min) or for instructional method on student performance (p > 0.5). Open-ended responses indicated an overall positive experience with the game.
CONCLUSION
These preliminary findings suggest that while GBL may enhance motivation, it does not necessarily translate to improved performance in anatomy education. However, its engaging nature suggests it could be a valuable supplement to conventional study methods. Future research should explore its long-term impact on retention and learning outcomes.
PEDIATRIC CODE WHITE! – Collaboratively learning to manage youths with agitation
1:15 PM - 2:20 PM, Presentation 4 of 5
MDCL 1009
Quach, Shirley; Azim, Arden; Leung, James; Sohanlal, Allison; Patterson, Sarah; Wang, Bingxian; Wojkowski, Sarah
Background
Agitation, an emotional state of increased restlessness, may manifest and exacerbate in patients under stressful circumstances, including youths. Navigating and resolving these high-risk situations require healthcare professionals to effectively collaborate within an interprofessional team to address the patients’ needs and concerns. Pre-licensure students often feel unprepared to mitigate these situations. A collaboration between the Center for Simulation-based learning and the Program for Interprofessional Practice, Education and Research developed Pediatric Code White! - an interprofessional educational (IPE) simulation experience to address this need.
Methods
Pediatric Code White is a 2h in-person, IPE workshop, where learners alternate between observing and participating in a simulated scenario of caring for a youth who was agitated. After each simulation, learners debriefed with IPE facilitators on means to improve interprofessional collaboration and situation management. Pre and post simulation surveys collected learner demographics, preparedness and comfort levels in collaborating to work with youth who are agitated. The survey questions were informed by the workshop objectives and 2024 Canadian Interprofessional Health Collaborative IPE Framework. Surveys utilized 5-point Likert scales (1 =not very prepared; 5 = very prepared) and open-text questions. Quantitative responses were reported as medians with ranges , counts and proportions, where appropriate. Open text feedback was compiled and analyzed to identify subthemes to describe learners’ experiences.
Results
Ten learners from five disciplines (nursing, physician assistant, child life, occupational therapy and physiotherapy) participated and completed all surveys. Learners were in their first (n=7) or upper years of study (n=3). The proportion of learners who felt prepared to recognize signs of agitation, maintain personal safety and de-escalate increased after the workshop, as did preparedness for interprofessional collaboration. The global change scores for all participants were all rated positive to demonstrate their improved perceptions in handling these situations.
Conclusion
Caring for youths who are agitated can be a challenge. This simulation experience offered learners a safe space to build their knowledge and skills in providing youth psychosocial care. The findings highlight the increasing value of simulation as a tool to prepare learners to de-escalate situations and work collaboratively, using a patient-centered approach to enhance care.
Design and Evaluation of a Virtual Emergency Department Simulation Space
1:15 PM - 2:20 PM, Presentation 5 of 5
MDCL 1009
Del Sordo, Luigi; Shaikh, Iffah; Cai, Charles; Callisto, Demi; Chan, Teresa; Bayer, Ilana
Background: Simulation-based education is used to develop healthcare professional learners' skills, however, there are few accessible environments where learners can easily emulate patient care spaces to improve or redesign systems. This project aims to design and evaluate a quasi-immersive, 3D virtual emergency department (ED) where learners can simulate the care of multiple patients and learn and interact with hospital systems.
Methods: A design-based research approach was used to engage stakeholders (e.g., trainees, clinicians, educators) to guide design of a virtual ED simulation space. Design blueprints and 3D assets were created and used to develop the space using the SoWork® platform. Simulation-based testing of the virtual ED will consist of planned case-based simulations within the space, followed by post-simulation surveys and focus group interviews with our participants.
Results: Stakeholder input informed the development and refinement of 3D assets for patient care spaces (e.g., triage office, resuscitation room, intermediate and rapid assessment zones) and a blueprint for the virtual ED. The virtual ED was built in the SoWork® virtual platform. Stakeholder feedback will be analyzed to refine the simulation space and case-based patient scenarios. Observational, survey and focus group data from participants will provide information on virtual simulation interactions, user experience, and affordances and limitations of the virtual ED.
Discussion/Conclusion: Our user-driven approach has led to a prototype of a virtual clinical space with the required elements to engage in a multi-patient, interprofessional simulation. This design and development process could be used for the digital prototyping of clinical spaces/systems before costly physical implementation or renovations.
Funded Research
Tackling Difficulty in Anatomy Education
2:30 PM - 3:15 PM, Presentation 1 of 3
MDCL 1102
Brewer-Deluce, Danielle; Phan, Ryan; Siddique Maha; Agarwal, Aditi; Li, Harry; Kennedy, Olivia; Li, Lily; Shen, Vivianne; Mitchell, Josh; Norman, Geoff; Akhtar-Danesh, Noori; Wainman Bruce
Presented by: Danielle Brewer-Deluce, Harry Li, Lily Li
Introduction: Think about the last time you tried to learn something new – is there something that made it difficult? What would have happened if that difficulty was eased? Identifying learning issues and addressing them is what we educators do, because how content is encountered can change a students’ trajectory. In anatomy, a foundational subject known for being “difficult”, optimizing learning can be challenging both because we do not know what is challenging and, since the content is fixed, there is little subject matter variability to target through educational interventions. Tackling this issue has required a multi-pronged approach to:
1) Establish student and instructor opinions on anatomy learning difficulty (Q-methodology),
2) Review empirically tested teaching/learning strategies in anatomy (scoping review) and,
3) Develop and evaluate targeted approaches to anatomy education (quantitative study)
Methods: In our Q-methodology study, instructors and students of anatomy across Ontario were invited to rank 34 statements pertaining to anatomy learning difficulty, relative to each other. Data was analyzed via by-person factor analysis with varimax rotation.
Our scoping review followed PRIMSA - ScR guidelines. A literature search (key words: anatomical education and quantitative measures of student performance) was conducted on Medline, Web of Science, ERIC, EMBASE, and EMCARE databases and grey literature from December to January 2025. Title, abstract (n = 3612 articles), full-text screening, and data extraction (n ≈ 150) were completed by eight independent reviewers via Covidence.
Results: Preliminary results from both studies suggest that instructors and students differentially characterize anatomy learning difficulty, and that the gap between these two perspectives may account for the variably successful anatomy education interventions reviewed in the literature.
Conclusion: The ambiguity around anatomy learning difficulty necessitates investigation which will lead to educational interventions. We cannot change anatomical content, but we can apply evidence-based interventions to mitigate the inherent challenges. Further, this research represents a template of how to address other “difficult” disciplines.
When the White Coat Only Comes in One Size Anti-Fat Bias in Medical Education
2:30 PM - 3:15 PM, Presentation 2 of 3
MDCL 1102
Kahlke, Renate; Nicula, Maria; Bell, Amanda; Brandt-Vegas, Daniel; Monteiro, Sandra; Ostrega, Jessica; LaDonna, Kori; Jones, Ian Glyn Russell
Presented by: Renate Kahlke
Introduction:
Despite growing attention to EDI in medical education, one critical aspect has been overlooked – the problem of anti-fat bias experienced by fat medical learners. The scant evidence available confirms that discrimination threatens the well-being of fat learners, and often excludes them from full participation in their education. To address this threat, we need to know about the experiences of fat medical learners, and the impact that anti-fat bias has on their careers. Armed with this information, we can begin to address the forces that threaten fat learners’ ability to succeed, undermining equity, diversity, and inclusion in medicine.
Methods
A generic qualitative approach was used to explore the experiences of fat medical learners. In early interviews, five medical residents who identified as fat, overweight, plus-sized, or obese participated in 1-hour interviews. An initial inductive analytic approach was used to develop the themes below.
Results
Data generation and analysis are ongoing. Initial findings suggest that fat learners’ experiences are shaped by a pervasive sense of fear of discrimination and lack of belonging, worrying that their size influenced perceptions of their competence. They also navigated omnipresent microagressions present in everyday practices, such as scrub distribution systems designed with smaller sizes in mind and constant curricular messaging about the dangers of existing in a fat body. Interestingly, participants personally encountered little overt discrimination in training – overt discrimination was generally perpetrated by patients and against patients.
To mitigate these threats, participants identified strategies used to make themselves less noticeable; for example, they talked about holding their breath to avoid appearing out of breath and hiding their scrub size, as well as “little logistics things,” such as calling ahead to make sure a placement will have their scrub size and finding time for extra skills training when the tight, crowded spaces of clinical training limited their access to learning.
Conclusion
There is a need to address interpersonal and systemic microagressions that send a clear message to fat medical learners – that their bodies do not belong in medicine. To manage systemic microagressions, learners appear to be doing significant parallel labour to ensure that they can participate in their training, likely at the expense of time devoted to advancing their learning, careers, or wellness.
Evaluating AI-Generated Concept Application Exercises (CAE) in Medical Education
2:30 PM - 3:15 PM, Presentation 3 of 3
MDCL 1102
Morjaria, Leo; Bracken, Keyna; Levinson, Anthony; Ngo, Quang; Sibbald, Matthew
Presented by: Leo Morjaria
Introduction
Since the release of ChatGPT in November 2022, applications of artificial intelligence (AI) in medical education have increasingly been pursued. While there has been significant work exploring these large language models’ ability to pass various medical assessments, their application to short-answer question generation remains under-investigated. Concept Application Exercises (CAEs) are formative assessments in the McMaster undergraduate medical education program, consisting of 4–6 short-answer questions designed to test higher-order thinking and clinical reasoning. This study evaluates the quality and efficiency of AI-generated CAE questions and their corresponding answer keys, compared to human-developed questions.
Methods
Using best assessment practices, numerous process iterations and a standardized prompt, 12 CAE questions and answer keys were developed based off of 12 “testable concepts” created by subject matter experts. Using 9, human written CAE questions from previous assessment, a total of 21 CAE questions were evaluated, spanning broad sections of the pre-clerkship curriculum. Four expert faculty reviewers, blinded to question origin, rated each item on a 1 to 5 scale based on predefined criteria for high-quality CAE questions, including medical accuracy, clarity, clinical relevance, cognitive demand, and curricular alignment. Free text comments were also gathered for qualitative thematic analysis.
Results
Faculty reviewers rated AI-generated questions and answer keys significantly higher in quality, with a mean rating of 4.3 (SD = 0.2) compared to 2.5 (SD = 0.9) for human-authored questions. Furthermore, AI-generated questions demonstrated greater consistency in quality, with scores ranging from 4.0 to 4.5, while human-authored questions varied widely, with scores ranging from 1.5 to 4.0. Thematic analysis of the free text comments also showed that AI-generated questions and answer keys were clearer, tested higher order thinking, better aligned with UGME objectives, and more clinically relevant.
Conclusion
AI-generated CAE questions not only meet but surpass the quality of human-authored questions, while also offering significant gains in terms of efficiency, scalability and reductions in faculty workload. Not only does this have the potential to improve assessment practices, but it also opens up numerous other possibilities that were previously cost-prohibitive, such as large-scale test banks for student practice, dynamic assessments, and more.