Innovative Insights in Curricula
RADD ART: RADiologist Developed Autonomic Rewiring Therapy
Introduction:
RADD A.R.T. 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.
This innovative knowledge translation strategy leverages the power of the arts to educate, heal, and inspire while fostering social cohesion and 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. RADD A.R.T. is a novel approach leveraging the arts to educate and demonstrate the power of heart coherence while raising money for resilience and mental health programs for communities in need.
TEDx Talk on Heart Coherence: https://youtu.be/JGxWT4EUVbs?si=kchPWDrHKaMvFY0q
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 RADD A.R.T. collection and is auctioned, sold or sponsored to raise money to deliver impactful mental health programs to communities in need.
Results:
To date, RADD A.R.T. has raised over $350K for meaningful and socially impactful initiatives resulting in the delivery of much needed heart coherence and resilience training to thousands of individuals - students and adults.
Video trailer: https://youtu.be/cp8lRcU8ezU\
Conclusion:
RADD A.R.T. is a sustainable social impact strategy that promotes heart coherence, resilience, and mental health programs. Through RADD A.R.T., Dr. Abrams transforms moments of learning and healing into tangible value to support the delivery of mental health programs for communities in need.
Development of a national needs driven Intrinsic Roles curriculum for Canadian hematology residency training programs
Mithoowani, Siraj; Fraser, Graeme; Khalife, Roy
Introduction
The “intrinsic” CanMEDS roles are centred around the Medical Expert role, and largely taught through role modeling and observership, with variable success incorporating these into the visible curriculum. We sought to explore the perceived needs for intrinsic roles teaching in hematology, with a goal of implementing a national curriculum in residency training.
Methods
An environmental scan and a needs assessment of hematology residents and program director at McMaster University were conducted to inform the delivery of a pilot workshop for intrinsic roles teaching. A focused group debrief and individual retrospective pre-post self-assessment were completed. We then conducted a national cross-sectional online survey with hematology PDs to explore existing curricula, gauge interest in a national curriculum, and understand their needs. Data were analyzed descriptively.
Results
All four McMaster Hematology residents completed the needs assessment identifying considerable milestones within the Leader, Collaborator and Scholar roles, with minimal emphasis on the Communicator and Health Advocate roles. The pilot workshop, attended by five residents, underscored the demand for a longitudinal, stage-adapted curriculum that includes interactive and in-person elements, along with pre-session materials. A notable preference for limiting topics to 1-2 per session and focusing on learner-driven interests was also highlighted. The workshop self-assessment tool showed improvement in the Leader and Scholar competencies.
The national survey of PDs, with 50% response rate, revealed a predominant focus on the Scholar role in existing curricula, and a lesser emphasis on the other intrinsic roles. PDs underscored the value of integrating teaching into daily clinical practice and expressed interest in a national curriculum, particularly emphasizing the Health Advocate role. The need for faculty development and curriculum updates based on resident feedback was also emphasized, indicating a national trend towards valuing and enhancing intrinsic role education.
Conclusion
Hematology trainees and PDs acknowledged the importance of an early and longitudinal curriculum exploring the Intrinsic Roles within Hematology residency, although there was disagreement about what should be included. Local residents valued an interactive workshop dedicated to the intrinsic roles, which may be scalable into a national curriculum.
Do Feelings Matter? Assessing Qualitative Interpretations of Embalmed Tissues with Quantitative Testing
Kim, Gyuah; Darie, Sorin; Ahmed, Esa; Li, Athena; Palombella, Andrew; Rockarts, Jasmine; DeCarlo, Brooke; Wang, Austine; Zhang, Betty; Nguyen, Laura; de SA, Darren; Wohl, Gregory; Wainman, Bruce; Brewer-Deluce, Danielle
Introduction
Soft-embalmed human donors are high-fidelity models for surgical skills training, yet a gap exists in standardization of embalming methods. Prior work has assessed the effect of various soft-embalming solutions on tissue realism using subjective domains from the McMaster Embalming Scale. This study further corroborates prior qualitative data with new quantitative biomechanical tests. By considering both measures, the MES’ construct validity across four solutions can be checked and the tissue mechanical properties relevant to perceived suitability can be determined.
Methods
MES data was collected from 25 surgical residents assessing the surgical realism of four human donors embalmed with either Saturated Salt Solution, Imperial College London, Ethanol-Phenol, or Surgical Reality Fluid. Tissue samples from the same donors underwent several forms of mechanical testing using the Instron 5967 and a Thermolyne muffle furnace. A 2-way MANOVA was used to analyze data.
Results
MES scores differed across skills and embalming solutions without interaction. Solution characteristics varied across MES domains: ICL exhibited inferior color and texture, and EP emerged as more suitable than other solutions. For skills, electrocautery earned the highest MES scores compared to chest tube insertions and bone sawing.
In mechanical testing, SRF required more force to cut, puncture, and tear, and had lower fluid content. ICL showed higher fluid content and required more force for chest tube insertions. No significant differences among the solutions were seen in electroconductivity and bone saw tests.
Conclusion
The disparity between qualitative and quantitative findings suggests that MES and mechanical testing assess samples at different levels of detail, providing clarity on the scope and validity of MES. Interestingly, despite significant quantitative differences in the mechanical characteristics of the tissues, perceived suitability for use by raters was relatively stable. This positions the MES as a valuable, more pragmatic metric by which model fidelity can be determined.
Man vs Pig: Evaluating Surrogacy of Embalmed Porcine to Human Tissues for Surgical Skills Training
Darie, Sorin; Wainman, Bruce; Wohl, Gregory; Ahmed, Esa; DeCarlo, Brooke; Palombella, Andrew; Rockarts, Jasmine; Li, Athena; Zhang, Betty; Wang, Austine; Brewer-Deluce, Danielle
Introduction:
Soft-embalmed human tissues remain the gold standard for surgical training but a common substitute is porcine tissues. The suitability for porcine surrogate use in place of human materials is understudied despite its prevalence as a surgical simulation model. This study aims to evaluate qualitative and quantitative tissue properties from comparable porcine and human tissues each embalmed with four high-performing embalming solutions.
Methods:
Four porcine and human donors were each embalmed with either Saturated Salt Solution, Ethanol-Phenol, Imperial College London, and Surgical Reality Fluid. Twenty-five surgical residents utilized the McMaster Embalming Scale to capture qualitative information regarding tissue suitability. Surveys were administered upon the completion of a surgical skill. Three tissue sets were then excised and subjected to mechanical tests evaluating properties relevant to each surgical skill: skin - puncture, incision, tearing, electrocautery, fluid content; bone - sawing; muscle - chest tube insertion. Data was analyzed via two-way ANOVAs.
Results:
Mechanical testing results demonstrated a significant difference between human and porcine tissues. Regardless of embalming, all porcine tissues required significantly more force to puncture, tear, and cut, while also containing less fluid.
MES suitability displayed a significant interaction between solution and tissue. Specifically, SRF was deemed more suitable in porcine than in human tissues while SSS was ranked lowest across both. Mechanically, SRF again demonstrated a unique trend where less force was required to puncture and tear while also holding more fluid content, but just in porcine tissues.
Conclusion:
Human and porcine tissues behaved mechanically differently on most tests and demonstrated embalming solution-specific variation. This indicates that embalming solutions differentially affect human and porcine tissues in a quantifiable way. Limited human-porcine differences in the MES suitability, however, suggest that perceived tissue suitability persists despite quantitative differences and further, that porcine tissue is a suitable surrogate for use in surgical skills training. Still, those using porcine tissue should optimize solution-tissue pairings for more refined surgical skills where fidelity is of greater importance.
Finding the sweet spot: Measuring the impact of a new, required interdisciplinary course on health science students’ readiness for interdisciplinary learning and problem solving
Nash, Jennifer V; Al-saqqar, Shahad Program, McMaster University); Howcroft, Kathleen; Ritz, Stacey; Wilson, Michael
Introduction: Interdisciplinary Questions in Health is a required course for Bachelor of Health Sciences students. It introduces interdisciplinary perspectives of health and the process of exploring complex problems through questions. The course includes a mixed pedagogical approach with large-group session, tutorials, and group work.
Methods: The study aims to explore the impact of the course on students’ readiness for interprofessional learning, ability to generate meaningful questions about interdisciplinary health topics and identify similarities/differences between in-person and virtual offerings of the course. To assess readiness for interprofessional learning students completed the Readiness for Interprofessional Learning Scale before and after the course. Students who completed the course were also invited to participate in a semi-structured interview to share their experiences. Lastly, data from an in-course, benchmarking exercise completed at the beginning and end of the course was used to assess students’ ability to ask meaningful questions.
Results: RIPLS survey data was analyzed using descriptive and inferential statistics and there was no significant difference in students’ readiness for interprofessional learning pre and post course, in any of the three cohorts or between cohorts. The interviews were transcribed and analyzed using thematic analysis. Participants shared varied preferences for virtual versus in-person learning. While online platforms are favored for information dissemination, in-person interactions are important for building connections and engaging in feedback-intensive activities like tutorials and group work. Participants’ coursework helped them develop critical skills such as self-directed learning and information literacy. The curriculum also broadened students' understanding of health, emphasizing its complexity. Students also reported that group work enhanced communication, collaboration, and conflict resolution skills. The benchmarking data is currently being analyzed.
Conclusion: This study provides insight into the evolution of a mixed-pedagogical course and an approach to course evaluation. The course's emphasis on question-asking prepares students for future endeavors by providing opportunities to develop a holistic understanding of health and a skill set which includes problem-solving and collaboration.
MERIT-Funded Research
Predictors of Success in a Graduate, Entry-Level Professional Program: From Admissions to Graduation
Wojkowski, Sarah; Smith-Turchyn, Jenna; Startford Paul; Grierson, Lawrence
Background and Purpose: Admission to health professional programs in Canada is competitive. The purpose of this study is to evaluate how factors identifiable by the admissions package may predict student success in one physiotherapy program in Canada) Program).
Subjects: Study data included candidate’s admissions’ metrics and physiotherapy student’s program data for four graduating cohorts, who were admitted into the MSc Program from 2016-2019 inclusive.
Methods: A retrospective, non-concurrent cohort study was used to estimate the relationship between applicant’s admissions data and student’s program data pertaining to academic success. Data were summarized as frequencies for categorical variables and means for continuous variables. We calculated odds ratios and probabilities of an academic or professional concern for standard scores ranging from -2 to 2. Significance was set at p<0.05.
Results: The cohorts participating in the MMI had an academic concern incidence of 14/131, as compared to the VMMI cohort whose incidence was 7/125. Students with higher MMI scores were less likely to have an academic concern, p=0.017). GPA was not significantly associated with an academic concern when combined with either MMI or VMMI. Admissions round offer was also significantly associated with an academic concern), with those beyond the initial round of offers, having an increased risk of academic concerns.
Discussion and Conclusion: Results of the study reflect the generally low event rates for incidences of academic concerns and the relative homogeneity and range restriction of most independent variables across the four cohorts of MSc students. HPP’s reflection on current admissions processes and ability to identify opportunities for change in admission processes helps ensure programs are selecting candidates who are likely to succeed. The project illuminates opportunities to improve programmatic support that increases student success.
Exploring how clinical reasoning is shaped by clinical assessment
Shankar, Sneha, Elbaz, Laura, Lubarsky, Stuart, Cummings, Beth Ann
Introduction
Clinical reasoning is considered to be the core of what it means to be a health professional and includes integrating large amounts of varied information to provide patient care. Most research work has underemphasized how health systems and processes may influence clinical reasoning ‘in the wild.’ In this current study, we explored how patient-focused clinical assessment and accompanying clinical documentation may shape clinical reasoning in practicing physicians.
Methods
Using a qualitative descriptive approach, we explored: whether physicians in practice report shifts in their clinical reasoning due to the presence of patient-focused clinical assessments and how practicing physicians describe the influence of patient-focused clinical assessments on their clinical reasoning. For data collection, we conducted focus groups with in-practice physicians in three clinical practice areas: Family Medicine, Internal Medicine, and Neurology. Content analysis guided our analytic approach and initial findings.
Results
Nine physicians participated in four focus groups co-facilitated by team members. Participants described using patient-focused assessments in various ways, but all agreed they were not a replacement for clinical judgement. Participants described the role of patient-focused assessments as aids in clinical reasoning, as gatekeepers to referral or resources, as life-altering for patients, as communication aids with patients and families, as supportive documentation for clinical decisions, and as means by which to monitor disease progression or recovery. Participants described tensions in patient-physician relationships when using patient-focused clinical assessment, and tensions between assessment scores and reasoning. Participants also wondered about the validity of scores and their use given the variety of tools, contexts, and heterogeneity of patients in practice.
Discussion/Conclusion
Early findings suggest that patient-focused clinical assessments serve a variety of purposes in practice and interact with clinical reasoning in a variety of ways. Patient-focused clinical assessments are used to support and shape reasoning, to communicate with patients and external agencies, and to provide ‘evidence’ required to access or remove resources, and to ‘defensibly’ document clinical decisions. These findings suggest that physicians in practice are interacting with assessment purposefully and strategically, suggesting clinical assessments can be key players – either helpful or cumbersome – in clinical practice.
Understanding the Experience of Postgraduate Medical Training and the Connections to Mental Health and Well-being From the Perspective of Trainees and Intimate Partners
Boutros Salama, Marina; El Gouhary, Enas; Harlock, Hayley; Acai, Anita; Munn, Catharine
Postgraduate medical training is often an exciting phase of professional and personal growth and development. However, it is also commonly associated with stresses and work demands, which impact trainee well-being, mental health, and intimate partner relationships. To date, there has been limited research on the role that intimate partners play or could play in supporting trainees and enhancing coping. This study aims to better understand, from the perspectives of trainees and their partners, their experiences of training and the connections between training, intimate partner relationships, and mental health and well-being.
This qualitative, interpretive descriptive study was conducted at McMaster University in Hamilton, Ontario from August to December 2023. An invitation to participate in 60-minute one-on-one interviews was sent to all McMaster postgraduate medical trainees and their partners. Postgraduate medical trainees and partners, selected for a diversity of experiences and identities, then participated in semi-structured interviews. All interviews were transcribed into textual data, and reflexive thematic analysis was used to analyze the data. This analytic approach involved an iterative process of data familiarization, coding, generating initial themes, developing and reviewing themes, defining and refining themes, and writing the overall thematic narrative.
Twenty-three trainees and 15 partners were interviewed. Eight preliminary themes were developed including: The unforgiving practice and culture of medicine, A lack of control over life and future, The mental and emotional toll of training, A battle of identities and responsibilities: Who shoulders the burdens?, The relationship as a “bubble”, Threats to the “bubble” and preservation strategies, Expanding the “bubble”: Family planning and other relationships, and Need for advocacy: A cry for changing the culture of medicine.
The findings of this study will inform a future experience-based co-design approach in which trainees, partners, and educators will identify and develop potential individual, dyadic, and organizational strategies to address these issues. In the future, these strategies can be implemented and tested within postgraduate medical training environments, with the goal of better preserving trainee relationships, as well as protecting and enhancing trainee and physician mental health and well-being.
Assessment in Multi-patient Environments – Evaluation of a Pilot Simulation-based approach
Bilgic, Elif; Chan, Teresa; Cheung, Jeffrey; Schwartz, Alan
Introduction
Conventional approaches to clinical medical education in clinical training focus on single patient care in series, or one patient at a time. Multi-patient care is a necessary skill of physicians in many clinical environments such as wards, intensive care units and busy emergency departments, but how this skill is taught and assessed has only recently begun to be explored. Multi-patient care is a complex construct to assess in the clinical setting owing to the different competencies necessary to carry this out effectively. This includes the ability to manage interruptions, along with efficient and accurate decision making. There is emerging literature devoted to the conceptualization of, and teaching of multi-patient care in busy clinical environments such as emergency departments but the literature on assessment of learners’ abilities in multi-patient care is limited. Some have limited their assessments to multitasking ability of learners, which is problematic given that it is only a limited part of the overall construct of multi-patient care. The actual skills required to function in a multi-patient environment include the ability to multi-task, to be efficient and to be diagnostically accurate, amongst others. Medical simulation can serve as a method for both teaching and assessment of the ability to function in a multi-patient environment.
Methods
Our primary objective is to conduct an exploratory feasibility and acceptability study of a multi-patient pediatric emergency department virtual hybrid simulation as an assessment platform for multi-patient care skills of medical learners who care for pediatric patients in a pediatric emergency department.
The study sought to obtain evidence as to the feasibility of the simulated virtual assessment platform through:
- Acceptability of the platform to learners who work in the pediatric emergency department via interview at the end of a simulated assessment
- Preliminary outcome measurements of the construct of multipatient care and measuring the possible effect sizes relative to differences in training time and other learner characteristics
The simulation itself will run similarly to a tabletop simulation with a facilitator guiding the exercise. The environment itself will involve a electronic emergency department tracker board and layout of the physical space with the facilitator providing cues to the participant, which will be done via a Powerpoint slide deck.
Results
Data collection is ongoing with preliminary results to be presented in June, 2024
Technology Enhanced Learning
Driving Iterative Development of the AI OSPE Tool Using Q Methodology
Yu, Philip; Sarada, Sriya Rajyam; Rahimpour, Layla; Mitchell, Josh P.; Bernard, Jason; Wainman, Bruce; Mezil, Yasmeen; Durham, Kristina
Introduction: The artificial intelligence objective structured practical exam is an innovative, web-based study tool that uses AI for immediate grading and spaced repetition to maximize learning. User-centric design was adopted during tool conception and incorporated throughout the refinement phases. Here the AI OSPE team describes the use of Q methodology to inform continuous and evidence-based quality improvements based on factor analysis, statement rankings, and open-text feedback.
Methods: AI OSPE tool development was an iterative process that began with a multidisciplinary focus group to ascertain tool requirements. Teams developed OSPE questions with a correct/incorrect answer key, engineered the website, and integrated decision tree AI and spaced repetition algorithms. Semiquantitative feedback on Version 1 of the AI OSPE was collected from a cohort of MSc students using Q method; study results were used to develop Version 2 of the tool. A subsequent study was conducted on Version 2 of the tool to ensure changes made to the tool were user-centric.
Results: Patterns in respondent preferences, consensus rankings, and extreme rankings paired with open-text feedback, all collected by Q methodology, were used to guide improvements made to the tool. Data from the first quality assurance study indicated significant user satisfaction with the ease-of-use and accessibility of the tool and no significant distrust towards AI. Open-text responses identified user interface and gamification as priority areas for improvement. In response, the interface was updated according to WCAG 2.0 accessibility guidelines, including an expanded user control system, and the experience was updated by implementing spaced-repetition and progress tracking features. User metrics were also collected to assess tool performance and user engagement; data from Version 2 of the tool shows that in a 6-day period where students used the tool to study for an upcoming test, questions completed per day by slightly increased from 2649 on day 1 to 2697 on day 6, indicating user retention and satisfaction.
Conclusion: Q methodology results are well-suited to understand user preferences, needs, and challenges associated with the use of study tools. Insights gained from the quality assurance studies are imperative to informing evidence-based educational tool development and highlights the value of user feedback, iterative design and real-world testing.
Enhancing Faculty Development Programs: An Evidence-Based Approach to Technology-Enhanced Learning Design with Learning Analytics
Yu, Meg; Ord, Julia; Chen, Ruth
Introduction
Technology-enhanced learning has been an integral part of health continuing education programs. Faculty developers, comprising teaching faculty, course designers, and content development specialists, have been required to adopt an evidence-based approach to inform their decisions of TEL design and improvement. Despite the increasing availability of data and learning analytics tools, faculty development programs have been slow to leverage these resources to enhance teaching. This study introduced a learning design-aware LA approach to leverage the learning data from the learning management system for stakeholders’ enquiry, feeding back into improved course design.
Methodology
This study adopted a mixed-method approach to evaluate a CPD self-paced online module that focuses on developing competency with equity, diversity, and inclusion concepts in health education and practice. With reference to the LDLA framework, this study defined three levels of analysis, course, curriculum component, and task, to provide insights of how learners interact with the TEL content.
Findings
1. Course-level
A significant portion of learners managed to complete the course within the allocated learning period. However, a subset of learners faced challenges in meeting this timeframe and over one-third of them requested extensions.
There was also a notable discrepancy in the aggregative participation patterns between the course completion and completion of all tasks, revealing a diverse range of learning paces.
2. CC-level
The examination of sequential learning patterns indicates a diversity in learners' preferences regarding both course topics and sub-topics.
3.Task-level
The average time spent on a single task reveals a more consistent pattern compared to the completion time of the entire course and all tasks.
The thematic analysis of learners' feedback—mostly in relation to resource exploration and reflection tasks—ranged in their experiences and expectations of resource and activity design, impact of learning, and the flexibility and accessibility issue.
Conclusion
This study underscores the significance of the LDLA approach to examine learner engagement in the context of online faculty development. It presents a promising pathway for evidence-based decision-making among stakeholders and can be enriched through continued data collection derived from the collective inquiry of faculty developers over time.
Spilling the tea: how students really feel about learning anatomy using virtual reality, computer-assisted modules, or 3D-printed models
Hasan, Farah Z.; Issa, Julia; Mammoliti, Alyssandra; McBride, Jennifer M.; Mitchell, Josh P.; Sonnadara, Ranil R.; Mazierski, David; Wainman, Bruce C.
Introduction: Virtual reality provides a unique opportunity to explore highly immersive and interactive anatomy outside of the laboratory. To fully appreciate the perspectives of learners, qualitative analysis is essential. The purpose of this study is to explore the subjective learning experiences associated with learning pelvic anatomy using VR, computer, or 3D-printed models.
Methods: One hundred eleven undergraduate students with no prior formal anatomy knowledge were given ten minutes to navigate through an eleven-scene module featuring a clinical scenario with multiple unique pelvis models. Feedback was collected via an electronic questionnaire asking participants to identify features of the module which they felt facilitated and limited their learning. Participants were also asked to provide suggestions to improve the learning experience and were given additional space for open feedback. Interim reflexive thematic analysis of their responses was conducted.
Results: Eight major themes were identified from the analysis. “Learning barriers” consisted of distractions and limitations that participants faced. “Contextual factors" encompassed both the presence and absence of background knowledge that influenced the learning process. “Diverse strategies for engaged learning” included the additional elements to make the module more enticing. “Impact of VR” focused on the learning experience with VR. “Cognitive strain” was related to the stress associated with the lack of time. “Interactive 3D capabilities” involved visualizing and manipulating the pelvic models from various angles. “Design elements” included improvements within the module. Lastly, “content” was related to the helpful aspects of the learning content in the module.
Conclusion: Even technologies which are meticulously designed and rigorously tested often miss out on small but important considerations that only come to light with the insight of the end-users. Involving students as partners in the design of VR learning tools with the use of qualitative feedback can help us to enhance learning tools in the classroom.
Location, Location, Location! How environment and modality interact during anatomical knowledge acquisition
Aida Esmaelbeigi; Julia Issa; Alyssandra Mammoliti; Jennifer M. McBride; Josh P. Mitchell; Ranil R. Sonnadara; David Mazierski; Bruce C. Wainman
Introduction: Creating new tools for learning anatomy requires many decisions to be made: What technologies should be used? Are digital modalities better than physical ones? Where should learning take place? This study used a 3x2 experimental design to explore the impact of modality, computer display, or virtual reality) and environment on test scores when using a pelvic anatomy learning module. Test scores were hypothesized to be highest when learning with 3DPMs and in the enriched clinical environment.
Methods: 111 participants were randomly assigned to one of six learning conditions. Participants completed a knowledge pre-test, then viewed the learning module. After, they completed the NASA Task Load Index, Simulator Sickness Questionnaire, knowledge post-test, Mental Rotations Test, and User Engagement Scale.
Results: Mean difference scores of the pre- and post-tests were compared using MRT, NASA-TLX, SSQ, and UES scores as covariates. Adjusted means for test scores by modality were 23.4%, 18.9%, and 27.0% for 3DPM, 2D, and VR, respectively. Adjusted means for test scores by environment were 26.79% and 19.42% for clinical and blackout, respectively. A two-way ANCOVA revealed a significant interaction between modality and environment [F = 4.08, p < 0.05, η2 = 0.03]. A simple main effect of environment was found within VR: test scores were significantly higher in the clinical environment than in the blackout environment. A simple main effect of modality was found within the clinical environment: test scores were significantly higher for 3DPM than for 2D and significantly higher for VR than for 2D.
Conclusion: While there seems to be some influence of context on learning, it remains to be seen whether the clinical environment facilitated learning, or if the blackout environment hindered learning. The clinical context had a rich visual background which provides cues to stereovision so the lack of difference in performance between modalities within the blackout context is unexpected, highlighting the need for further investigation on the role of the learning environment.
Medical School Admissions in a New Era of Artificial Intelligence
Zhao, Jenny; Grierson, Lawrence
Introduction: Personal statements or short answer essays are used by medical schools to assess professional qualities such as communication, motivation, and collaboration in applicants. With the rapid development of artificial intelligence, ethical concerns have been raised surrounding applicant use of AI during the admissions process, particularly in interviews or written statements. This study aims to understand the impact of AI use by applicants writing essays on essay component ratings commonly used by medical schools.
Methods: An experiment was conducted using a within-subject design. Essays were generated by four “writer” groups: aspiring medical school applicants without AI-assistance, aspiring medical school applicants with AI-assistance, non-aspiring applicant with AI-assistance, and entirely AI written essays. AIO essays were yoked to characteristics from eight essays, randomly selected from the three other groups. Each group generated eight essays to the same essay prompt, for a total of 32 essays. Eight participants were recruited to act as medical school essay raters on an Undergraduate MD Program Admissions Committee, consisting of clinical faculty, research faculty, medical school students, and community members. Raters were provided rater training and assigned eight essays to rate with an ecologically validated 7-point Likert scale. During the training, raters agreed that essays were to be rated on sentiment, suitability to the profession, personality, and coherence. Each essay was rated by two reviewers, for a total of 64 ratings.
Results: Cohen’s κ was run to determine interrater reliability. There was poor agreement between raters, κ =.105, p =.211. The mean of the two ratings for each essay was determined and used for analyses. Essays were then entered into a one-way ANOVA with group as the only factor. There were no statistically significant differences in human-rater essay score between the different writer groups.
Conclusion: Non-aspiring applicants with AI assistance, as well as AI-only essays, have the potential to write highly rated medical school essay responses. The findings from this study raises questions around the validity and fairness of essay components in medical school admissions processes. Medical schools are suggested to consider the values applicants are being selected for in short answer essay components in light of the prevalence of AI.
Health & Education Policy
Distrust of pharmaceutical companies and vaccine hesitancy: Insights from applying a commercial determinants of health lens
Burgess, Raquel
Background: The commercial determinants of health is a concept that describes how profit-seeking commercial actors and the structures that govern these actors influence population health and health equity. Lima & Galea suggested that commercial actors exert influence on health through five vehicles: the political environment, preference shaping, the knowledge environment, the legal environment, and the extra-legal environment. The CDH is a relatively new concept that may help us better understand existing, wicked public health problems, such as vaccine hesitancy. In this study, we used a CDH lens to explore the issue of vaccine hesitancy.
Methods: We conducted an explorative narrative review of qualitative literature in which participants discussed distrust of the pharmaceutical industry as a contributor to their hesitancy to be vaccinated. We qualitatively analyzed this literature by mapping participants’ reported concerns about pharmaceutical companies and their associated profit-seeking structures to Lima & Galea’s vehicles of power framework.
Results: We included 11 qualitative studies that assessed vaccine hesitancy within various countries, including Canada. Overall, participants of these studies expressed beliefs that the profit-seeking intentions of pharmaceutical companies conflict with the best interests of the people. Specific concerns included the pharmaceutical industry’s influence over governmental and regulatory agencies, healthcare professionals, and the production and publication of research. Participants also reported concerns about the lack of liability in place for pharmaceutical companies in some jurisdictions and past unethical and illegal actions of the industry.
Conclusion: Lima & Galea’s CDH framework provides a useful lens to understand how the profit-seeking structures of the pharmaceutical industry may contribute to vaccine hesitancy. We focus our discussion on the implications of these findings for health care providers and health education researchers. Specifically, we describe how health care actors can be subjected to influence by private actors in a way that has implications for the patient-provider relationship.
Social Innovations in Medical School Admissions in the Context of the COVID-19 Pandemic and Beyond: A Multiple Case Study Approach
Elma, Asiana; Okoh, Augustine; Zhao, Jenny; Boies, Sophie; Soares, Roberta de Oliveria; Leduc, Jean-Michel; Kulasegaram, Kulamakan; Profetto, Jason; Latter, David; Bourdy, Christian; Hanson, Mark; Grierson, Lawrence
Introduction: The onset of the COVID-19 pandemic in the spring of 2020 caused disruptions in admissions processes at all Canadian medical schools as in-person interviews were no longer possible. Urgent adaptations were required to matriculate the next cohort of learners. This study describes the scale, durability, and impact of admissions adaptations made by medical schools across the 2020 to 2023 admissions cycles.
Methods: A multiple case study approach was undertaken, guided by the Theory of Social Innovation. Three exploratory case studies were initially completed, which progressed to a second stage involving a fourth exploratory-explanatory case bound by the Association of Faculties of Medicine of Canada Network of Admissions. Semi-structured interviews were conducted with admissions chairs and managers at three schools in stage one, and 10 additional schools in stage two. AFMC meeting minute records were also analyzed between 2020-2023. An unconstrained approach to qualitative description was used to analyze all data within and across cases.
Results: Various adaptations were implemented, including virtual interviews, lottery systems, and other re-imagined actuarial approaches. Some schools described that decision-making occurred in close consultation with other schools in the same province, similar geographic area, and/or who had comparable applicant cohorts. Concordance was also sought by most schools with the larger pan-Canadian admissions context, particularly when concerning the interview process. There was concurrent response to other pervasive social phenomena, such as calls for greater racial equity, and the rise in accessibility of artificial intelligence technology. Schools engaged in ongoing quality improvement efforts, navigating value tensions such as resource efficiency and fairness, or academic excellence and equity. Adaptations that reflected a mutual responsiveness to pan-Canadian and local needs were the most scalable and durable.
Conclusion: Canadian medical schools faced numerous challenges and exhibited significant adaptability while managing continuous disruption. Admissions procedures have undergone significant alterations since 2020, with some expected to be durable. The medical education community should continue using a value-driven approach to balance the impact of change on applicants, aspiring medical professionals, and the profession as a whole.
Continuity of care during transition to long-term care: A scoping review
Shahu, Alfina; Gu, Regis; Howard, Michelle; Siu, Henry; Badone, Ellen; Lawrence Grierson
Introduction: As a result of the rapidly growing elderly population and increasing demand for long-term care in Canada, research into continuity of care is necessary to improve the quality of healthcare received by LTC residents. People benefit from continuous and consistent care delivered and coordinated by a designated healthcare professional – usually a family physician. Most patients who transition into LTC lose the continuous relationship with their primary care provider, as the care providers in the LTC homes assume responsibility for resident care. However, there is a dearth in knowledge regarding the conceptualization of effective LTC transition and factors that influence continuity of care during the LTC transitions.
Methods: A scoping review was conducted to identify and synthesize evidence on how effective LTC transition is conceptualized, highlighting the key factors and knowledge gaps that impact continuity of care. Multiple databases were searched systematically, and 11 peer-reviewed articles were included after two reviewers independently screened citations and the full text. Conventional content analysis was employed to categorize extracted data into themes and to develop an analytic framework that describes the perceptions, factors, knowledge gaps, and education antecedents that influence informational continuity during transitions to LTC.
Results: The findings confirm that instances of relational continuity are very few during LTC transitions; however, little attention has been given to the comprehensiveness and utility of handover notes to the quality-of-care LTC residents receive. The review also highlights factors influencing continuity including: Practice location, Physician staffing model, Physician sex/Gender influence, Location of medical education, Physician remuneration model, Physician LTC billing code, Team-based care, Patient involvement, Partners-in-care, and LTC insurance.
Conclusion: Patient values, family involvement, provider characteristics, and funding arrangements are critical to improving care continuity during the LTC transition. The location of medical education also plays a pivotal role in care providers’ preparedness for a continuity-based practice. Health professions education that better attunes new professionals to the information that best supports LTC providers can be leveraged to improve continuity during transitions.
Predictors for success and failure in international medical graduates: a systematic review of prognostic factor studies
Abdar, Meysam; Couban, Rachel; Roberts, Nia; Heneghan, Carl; Arora, Neha; Ashoorion, Vahid
Introduction
International Medical Graduates are an essential part of the international physician workforce, and exploring the predictors of success and failure for IMGs could help inform international and national physician labour workforce selection and planning.
Method
We searched 11 databases, including Medline, Embase and LILACS, from inception to February 2022 for studies that explored the predictors of success and failure in IMGs. We reported baseline probability, effect size in relative risk, odds ratio or hazard ratio and absolute probability change for success and failure across six groups of outcomes, including success in qualifying and certificate exams, successful matching into residency, retention in practice, disciplinary actions, and outcomes of IMG clinical practice.
Result
Twenty-five studies reported the association of 93 predictors of success and failure for IMGs. Female sex, English proficiency, graduation recency, higher scores in USMLE step 2 and participation in a skill assessment program were associated with success in qualifying exams. Female sex, fluency in English, previous internship and results of qualifying exams were associated with success in certification exams. Retention to work in Canada was associated with several factors, including male gender, graduating within the past five years, and completing residency over fellowships. In the UK, IMGs and candidates who attempted PLAB part 1, ≥4 times vs first attempters, and candidates who attempted PLAB part 2, ≥3 times vs first attempters were more likely to be censured in future practice. Patients treated by IMGs had significantly lower mortalities than those treated by US graduates, and patients of IMGs had lower mortalities [OR: 0.82 ] than patients of US citizens who trained abroad.
Conclusion
This study informed factors associated with the success and failure of IMGs and is the first systematic review on this topic, which can inform IMG selection and future studies.
The self-initiated development of Patient’s Medical Home practices in Canada: A qualitative multiple case study
Shnitzer, Hila; Yang, Laurie; Okoh, Augustine; Shah, Aimun Qadeer, Elma, Asiana; Howard, Michelle; Price, David; Francois, Jose; Katz, Alan; Grierson, Lawrence
Background: Access to comprehensive primary care is a challenge in Canada, with millions lacking a family physician. In response, there is growing advocacy for the postgraduate family medicine curriculum to include training on interdisciplinary team-based care. Developing this curriculum requires an understanding of how family practice leaders pursue and develop team-based practices. The Patient’s Medical Home is a set of recommendations for team-based family medicine that has been adopted by several practices across Canada. This study aimed to understand the processes that influenced the self-initiated development of PMH family practices in Canada.
Methods: Employing a multiple descriptive case study design, family physician leaders and managers from family practices across Canada were invited to participate in semi-structured interviews. Discussion prompts highlighted how practices adopted or transitioned towards team-based care, and the processes that facilitated or challenged this process. Guided by the Theory of Social Innovation, data were analyzed using an unconstrained deductive approach to qualitative description. Interview data were appraised by the research team to form an initial coding framework, which was refined through multiple iterations of analysis.
Results: A total of 17 family practices across eight provinces and territories were interviewed. Most care teams included nurses, and many incorporated a pharmacist and mental health support. The processes to establish interprofessional care teams were dependent on the provincial context. Factors that supported the transition included a practice leader who was a champion in driving change, the acquisition of physical space, technological resources, and funding. Some leaders relied on personal investment or community fundraising, while others engaged in negotiations with regional health authorities. The shift to team-based care was described as having profound benefits for patients, providers, and the health system.
Conclusions: This study revealed the complex processes of transforming family practices into interdisciplinary, team-based models. Government and health authorities should offer flexible funding and infrastructure to support the adoption of team-based family medicine, while medical education leaders and regulators should integrate training in leadership, system thinking, and interprofessional collaboration into postgraduate curricula.
Equity, Diversity, and Inclusion
Equity in Health Sciences Research: Motivations, Challenges, and Educational Imperatives
Acai, Anita; Monteiro, Sandra; Veltman, Albina
Introduction: Health sciences researchers increasingly aim to incorporate equity, diversity, and inclusion principles into their work, yet lack established practices and educational standards, resulting in only a surface-level implementation of these concepts. This knowledge gap poses risks, especially in research involving equity-deserving communities. To bridge this gap, it is crucial to understand how EDI principles are being adopted in health research, including researchers’ motivations, challenges, and desired resources. Guiding questions for this study included: 1) How are EDI principles being adopted in health sciences research?, 2) What motivates health sciences researchers to integrate EDI principles into their research?, 3) What challenges have researchers encountered?, and 4) What resources would be helpful?
Methods: This study used qualitative description, inviting researchers who self-identified as conducting EDI-related research to participate in a semi-structured interview. Participants included researchers with a range of identities and lived experiences from a variety of health research areas. Interviews were transcribed and analyzed for categories and concepts using conventional content analysis.
Results: Preliminary findings indicated that participants were motivated to integrate EDI principles into their research by both personal experiences of inequity and professional pressures. Early-career researchers were particularly motivated to integrate EDI principles into their work, but struggled with navigating power dynamics and making decisions about supervising learners wanting to conduct research on equity-related topics. Participants, even those with substantial experience in engaging with equity issues, hesitated to label themselves as “experts” in EDI and instead acknowledged how lived experiences could enrich their research. However, lived experience was not considered a substitute for formal research expertise and participants acknowledged the need for both. Participants identified numerous challenges with integrating EDI principles into their research, including systemic pressures leading to tokenism and harmful research practices, evolving terminology and practices, emotional burdens, and bureaucratic barriers. Participants strongly emphasized the need for critical reflection and a collaborative ethos when integrating EDI principles into research.
Conclusion: This study represents the initial step in addressing the gap in formal EDI research education within the health sciences—an oversight that risks harmful research practices. The outcomes from this study can be used to create resources and prompt critical reflection on the ways in which research practices in the health sciences can be improved.
Incorporating Equity, Diversity and Inclusion into the Education and Assessment of Professionalism for Healthcare Professionals and Trainees: A scoping review
Sibbald, Matthew
Introduction:
Current definitions of professionalism for healthcare trainees often do not incorporate equity, diversity and inclusion into the expectations and assessment of professionalism. While professionalism teaching is incorporated in health professionals’ training, equity-deserving groups still experience discrimination and health inequities. This necessitates interventions to reframe expectations of professionalism from learners. This scoping review systematically searches the literature to understand how EDI, cultural humility, and advocacy are incorporated in healthcare trainees' education and assessment of professionalism.
Methods:
MEDLINE, Embase & PsychINFO were searched up to March 16, 2023, with query terms related to health professionals, professionalism, EDI, cultural humility, and advocacy. Titles and abstracts and full-texts were independently screened by two reviewers. Articles meeting the following criteria were included: focused on EDI, cultural humility, or advocacy among healthcare students/trainees, and had outcomes related to professionalism. No restrictions were placed on study designs. Articles lacking formal discussion of professionalism as an outcome were excluded. Primary outcomes were independently extracted and themes were generated by mutual discussion. Disagreements at any stage were resolved by a third reviewer or consensus-based discussion. Risk of bias was assessed using the Cote and MERSQI tools.
Results:
47 articles were included in the final thematic analysis. Three predominant themes emerged from the literature: EDI-associated interventions improve professionalism. Trainee definitions and perceptions of professionalism revealed themes of EDI and cultural competency. Current standards of professionalism are perceived as non-inclusive towards historically-marginalized populations.
Conclusion:
The improvement in professionalism due to EDI interventions, the presence of EDI in student perceptions of professionalism, and the non-inclusivity of current professionalism standards creates a strong impetus to incorporate the EDI lens within professionalism frameworks healthcare education curricula.
Exploring How Undergraduate Prospective Medical Students Make Clinical Decisions Regarding 2SLGBTQIA+ Patients
Montes, Alek; Debassige, Darci; Acai, Anita
Introduction
Members of 2SLGBTQIA+ communities face poorer health outcomes compared to their heterosexual counterparts. These disparities are largely due to implicit biases among healthcare providers resulting from inadequate education about 2SLGBTQIA+ communities and their health. This study aimed to investigate how undergraduate prospective medical students make clinical decisions regarding 2SLGBTQIA+ patients.
Methods
Participants were provided with four simulated clinical scenarios, three involving 2SLGBTQIA+ patients, and were asked to describe their approach to the patient’s care. Four raters assessed participants’ written responses, generating an average inclusivity score. Participants also completed four Likert-scales assessing their knowledge, clinical preparedness, informal education, and formal education related to 2SLGBTQIA+ communities.
Results
There were high intraclass correlations across scenarios between the four raters. Inclusivity scores varied across participants. Overall, participants performed more poorly on Scenario 1 than on Scenarios 2 and 3. This might indicate that biases are more likely when the patient’s identity is not obvious or explicitly known as Scenario 1 depicted a patient whose sexual orientation was not apparent, while Scenarios 2 and 3 explicitly identified the patients as gay and transgender.
Conclusion
This study provides insight into commonly held stereotypes and misconceptions about 2SLGBTQIA+ patients and how they affect clinical decisions. This could help shape educational interventions that change harmful attitudes and behaviour, particularly in healthcare settings.
Standardized patient education focused on equity deserving groups: 10 tips for educators and programs – a qualitative study
Last, Nicole; Keuhl, Amy; Azim, Arden; Chen, Ruth; Dhir, Jasdeep; Farrugia, Patricia; Geekie-Sousa, Aaron; McCarthy, Jeffrey; Tong, X. Catherine; Monteiro, Sandra, Sibbald, Matthew
Introduction
Health professions training programs must train future healthcare providers to meet the needs of equity-deserving patient populations. Standardized patient programs, which employed trained actors to help learners develop skill, are one mechanism by which this training can occur. However, SP programs may face challenges integrating the perspectives of those from equity-deserving groups while avoiding re-traumatization, preserving fidelity, and establishing psychological safety. Our aim was to develop a set of recommendations for SP programs and educators around planning, organizing, and delivering SP-based education involving equity-deserving groups for healthcare trainees.
Methods
We undertook a qualitative analysis of interview transcripts of standardized patients, educators, and trainers involved in SP work with equity-deserving groups. Subsequently, we conducted a three-stage modified Delphi process to generate recommendations for SP programs and educators. The analytic team was diverse and incorporated the perspectives of educators, healthcare practitioners across various disciplines, SP trainers, staff involved in education, and healthcare trainees.
Results
We derived ten tips to help stakeholders improve SP-based education involving equity-deserving groups, encapsulated in three major themes. The first theme was collaborative involvement with members of equity-deserving groups, particularly in the co-creation and co-delivery of content. The second theme was consistent prioritization of the needs of SPs throughout the process, including by responding to the vulnerability required of the SP role, promoting SP psychological safety, and prioritizing informed consent, transparency, and appropriate financial compensation. The third theme was meaningful incorporation of feedback from SPs and members of equity-deserving groups into program infrastructure and case material.
Conclusions
The tips presented in this article are aimed to help educators and SP programs plan, organize, and deliver SP-based education focused around equity-deserving groups for healthcare trainees. Collaboration with members of equity-deserving groups and prioritizing the needs of SPs are recurrent themes throughout these tips. Ultimately, we hope that the application of these tips will help SP programs train future healthcare providers to effectively meet the needs of equity-deserving patient populations.
Including Community Voices In The Development Of A Data Collection Tool Studying Inclusive Anatomy Education
Soo Jin Lee, Susie; Chima, Eva; Arca, Adam; Siddique Maha; Lohit, Simran; Durham, Kristina; Brewer-Deluce, Danielle
Introduction:
Historically, anatomy education has fostered a binary view of sex and gender, inequitably excluding non-binary folx views and experiences. This exclusion may compromise gender minority healthcare quality, especially when attended to by professionals educated in environments upholding this binary paradigm. It is critical to appraise the integration of sex/gender in anatomy education to better understand successes and barriers to meaningful change. This type of research benefits from integrating community, student, and educator partners to ensure current knowledge and societal perspectives are reflected. Critically, anatomy education research with partner involvement is limited, with only 3 relevant papers identified, and only 1 regarding sex/gender.
Objectives:
The team’s larger project appraises the incorporation of sex and gender in body donation procedures, the physical anatomy lab space, and curriculum using a survey and interviews. The current abstract describes the partnered approach chosen to develop a data collection tool, thereby aligning research objectives with the priorities of those the research aims to serve.
Methods:
Two faculty members and two organizations involved in research, teaching, or advocacy in health, sex, gender, or anatomy were recruited as partners. Partners reviewed the draft data collection tool and were then asked, via a semi-structured interview, about opportunities to enhance the tool. Partner responses were thematically analyzed and integrated into the revised tool.
Results:
Key themes identified by partners included mistrust in the medical system, the impact of environment and communication in education and body donation procedures, and the need for sensitivity in discussing sex/gender. They also emphasized the importance of incorporating gender diverse member perspectives within research, and reflecting on the influence of stereotypes and biases on the research outcomes, and using inclusive language. Based on this input, 16% of the final interview questions were revised or newly created.
Conclusion:
A partnered approach aligned the study data collection tool with partner priorities by educating the research team on community values and goals. The project exemplifies integrating equity and inclusion principles into study methodology, guiding researchers in adopting a partnered approach in this context.
Learner Perspectives
The Prevalence of Imposter Phenomenon in graduate Medical Education
Sibbald, Matthew; Ruan, Brandon; Sherbino, Jonathan
Introduction
Imposter phenomenon is the feeling of inadequacy despite demonstrating external standards of success. Few studies have broadly examined the prevalence of IP in resident-physicians. This study assessed the prevalence of self-reported IP in resident-physicians, exploring the correlation of demographic risk factors and feelings of IP.
Methods
All residents, across all years of training and programs at McMaster University during the 2019-2020 academic year were recruited to complete a self-report survey. Survey items gathered demographic information and measured self-reported feelings of IP and Clance Imposter Phenomenon Scale scores.
Results
519 out of 977 individuals completed the survey. Measured by the CIPS, clinically significant IP occurred in 59.2% of participants. After completing the CIPS, participants self-reported feelings of low, medium, high, and intense IP. 64.9% of respondents felt they hid feelings of IP during residency. 62.4% of respondents were unaware of resources available to them as they struggled with feelings of IP. Only female gender was associated with IP.
Conclusions
IP is highly prevalent across a broad range of residents, independent of clinical discipline and most demographics. Educators and administrators should attend to IP by normalizing the discussion of IP and ensuring adequate access to resources for support.
Embarking on Residency: Unveiling Insights into the Transition to Residency by Contrasting Undergraduate and Transition-to-Discipline Entrustable Professional Activities
Rakoff, Jonah; Sheth, Urmi; Murphy, Bradley; Polster, Elliot; Azim, Arden; Waters, Heather; Sibbald, Matt
Introduction: Medical learners continue to enter postgraduate training feeling unprepared and seeking role clarification. Competency-based medical education aims to ease the transition to residency using entrustable professional activities for a sequenced progression. There is a need to understand how undergraduate and PGME curricula overlap to support learners across the TTR. This study investigates the overlap between UGME and PGME curricula, focusing on the 12 core EPAs from the Association of Faculties of Medicine of Canada and Transition to Discipline EPAs in Canadian residency programs.
Methods: Using qualitative direct content analysis, each TTD EPA for the 26 Royal College residency disciplines, as well as each EPA from the College of Family Physicians of Canada residency profile was compared with the 12 AFMC Core EPAs. Disciplines were categorized as a generalist or specialist discipline and as either a medical, surgical or laboratory/diagnostic discipline. TTD EPAs were then graded as having complete, partial, or no overlap with the AFMC Core EPAs. For each specialty, the percentage of EPAs having complete, partial, and no overlap was calculated for each of the 12 Core EPAs. Overlap percentages among all specialties combined were then calculated, followed by analysis for generalist, specialist, medical, surgical, and laboratory/diagnostic disciplines. Additional content analysis assessing common characteristics between disciplines is ongoing.
Results: AFMC Core EPAs 1 and 6 exhibited the highest frequency of overlap, while EPA 12 had the lowest overlap with TTD EPAs across disciplines. EPAs within medical and surgical disciplines showed significantly greater overlap with core UG EPAs when compared to those in diagnostic and laboratory specialties. Similarly, generalist discipline EPAs aligned more with core UG EPAs than their specialist counterparts.
Conclusion: Our results demonstrate significant variation in alignment between AFMC Core Undergraduate EPAs and TTD EPAs for direct-entry disciplines, depending on discipline knowledge and practice. Collaborative evaluation and EPA development involving both UGME and PGME leaders are essential to establish a resilient CBME continuum, ensuring comprehensive support for learners throughout the TTR.
Prevalence of Trauma Among MSc OT Students
Sandra VanderKaay
Introduction: The experience of trauma impacts learning at all stages of education, and can be particularly problematic at post-secondary levels and for people from equity-deserving groups. Many forms of trauma can impact learning and trauma manifests uniquely to each individual. Understanding trauma experienced by students can support effective teaching and learning. Research suggests that students who have experienced trauma may be more likely to enter healthcare professional programs. Some literature exists that explores the prevalence of trauma in healthcare professional programs such as medicine and social work. However, research specific to occupational therapy is extremely limited. The purpose of this research was to explore the prevalence of trauma among MSc OT students at McMaster University.
Method: The Childhood Trauma Questionnaire was selected for data collection. CTQ is a validated retrospective self-report tool evaluating five sub scales of trauma: physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. Respondents were year #1 or year #2 students in the MSc OT program. Minimization/denial scores were assigned to respondents through the CTQ which identified possible under-reporting of trauma. Descriptive statistics were used to analyze data as recommended by our institution’s health research methodologist.
Results: Results demonstrate varying severity of trauma with the highest level of trauma reported on the emotional abuse subscale. The mean trauma score for the remaining four subscales fell within the none to minimal classification. Results suggest a low level of trauma among MSc OT students at McMaster University. However, minimization/denial scores suggest under-reporting for 28% of respondents which must be considered.
Conclusion: Trauma can interfere with learning and can manifest in a variety of ways. Considering the potential under-reporting of childhood trauma experiences in retrospective measures, a Universal Design for Learning, based on trauma-informed pedagogical practices could be pertinent in healthcare professional programs. Applying UDL frameworks through a trauma-informed lens would involve the widespread implementation of trauma-informed pedagogical practices in all classrooms, not only addressing the needs of identified trauma survivors but similarly supporting undisclosed or underreported survivors.
Evaluating the Effectiveness of Interventions for Physician Burnout: A Systematic Review and Meta-Analysis
Vaillancourt, Sierra; Ibrahim, Rana; Trivedi, Rucha; Ilicic, Ana Maria; Boutros Salama, Marina; Sonnadara, Ranil
Introduction
Physician burnout has dire implications for patient care and personal wellbeing, making it critical that we identify interventions that can prevent and alleviate its symptoms. The purpose of this review was to examine the effectiveness of burnout interventions for practicing physicians and determine whether interventions focused on organizations and individuals yield different effects on burnout symptoms over time.
Methods
Databases were searched from inception to January 2023 for controlled intervention studies targeting burnout amongst practicing physicians. Articles were screened, data were extracted, and risk of bias was assessed in duplicate using Cochrane’s Effective Practice and Organization of Care guidelines. Random-effects models with Knapp-Hartung adjustments were used for all analyses, with Hedges G and I2 being used to quantify standardized mean differences and heterogeneity respectively. Subgroup analyses were conducted based on follow-up length and intervention typology.
Results
From the 4516 articles identified, 25 met inclusion criteria and consisted of 17 randomized controlled trials and 9 cohort studies across 2,849 physicians. There was considerable heterogeneity present across studies, which was partially explained by predefined subgroup/sensitivity analyses of intervention type, length of follow-up, and risk of bias. Physician-focused interventions were associated with small reductions in emotional exhaustion and depersonalization. When stratified based on follow-up duration, these changes were not sustained beyond a 3-month follow-up. The limited number of organization-focused interventions did not have a significant impact on burnout symptoms. No discernible effect on personal accomplishment was noted in any of the defined analyses. Most studies exhibited significant methodological issues or insufficient reporting, with all articles having at least one domain being at a high risk of bias, and nine being ranked as high risk overall.
Conclusion
Despite repeated calls to action, existing burnout interventions for physicians have not shown long lasting improvements in burnout symptoms. Future research should prioritize the development of sustainable approaches to address this issue, while ensuring the execution of rigorous methods.
From Classroom to Crisis: Investigating Factors in the Learning Environment Influencing Burnout Amongst Surgical Trainees
Trivedi, Rucha; Neill, Kestrel; Ilicic, Ana Maria; Petrisor, Bradley; Sonnadara, Ranil
Introduction
Burnout is a psychological syndrome that is widely recognized as a significant concern in medical settings. Stressors and characteristics of the learning environment can contribute to the development of burnout in surgical residents and has various detrimental impacts on their academic and clinical performance, as well as their overall wellbeing. It is important we investigate these stressors in individual institutions, so we can form context-specific and resident-informed strategies to address these issues. The purpose of this study was to investigate how social identity and characteristics of the learning environment influence burnout symptoms amongst surgical residents at McMaster University.
Methods
A cross-sectional survey was distributed to surgical trainees at McMaster over email, and collected information related to social identity, perceptions of the learning environment and self-reported symptoms of burnout. Learning environment characteristics and burnout were measured using the Diversity Engagement Survey and the Maslach Burnout Inventory, respectively. A series of multiple linear regression models were used to examine the relationship between each dimension of burnout, factors related to the learning environment, and social identity.
Results
A total of 42 surgical residents participated in the survey, consisting of 31 women and 11 men. The majority of participants did not identify as members of the 2SLGBTQ+ community, and 23 participants did not identify as a part of a racialized group. Of the 42 participants, 18 were experiencing severe burnout symptoms. Factors that were significant in influencing trainee’s emotional exhaustion included trust, respect, and gender. For depersonalization, cultural competence and trust were significant. Similarly, cultural competence, trust, appreciation, sense of belonging, respect and being racialized were all significant factors in reduced personal accomplishment.
Conclusion
This study highlights areas for improvement in surgical learning environments and contributes to creating a better understanding of how trainees experience burnout. This work will be distributed to department leaders to help address the identified issues and inform strategies to reduce burnout symptoms in this population.