Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool.

BACKGROUND: Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings. METHODS: The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility. RESULTS: Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%). INTERPRETATION: Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study's findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.

Investigating Patient Experience, Satisfaction, and Trust in an Integrated Virtual Care (IVC) Model: A Cross-Sectional Survey.

To improve access to primary care in underserved communities, we established a hybrid model of delivering team-based, comprehensive primary care using both in-person and virtual care options with family physician leadership. Using a cross-sectional online survey (n = 121), results showed high levels (90%) of patient satisfaction. Our findings suggest that a similar hybrid model for primary care delivery can provide levels of patient satisfaction comparable to traditional in-person models of primary care. This can be achieved regardless of whether patients had previously been attached to the same family physician before receiving care through the hybrid model.Annals "Online First" article.

An undergraduate medical education framework for refugee and migrant health: Curriculum development and conceptual approaches.

BACKGROUND: International migration, especially forced migration, highlights important medical training needs including cross-cultural communication, human rights, as well as global health competencies for physical and mental healthcare. This paper responds to the call for a 'trauma informed' refugee health curriculum framework from medical students and global health faculty. METHODS: We used a mixed-methods approach to develop a guiding medical undergraduate refugee and migrant health curriculum framework. We conducted a scoping review, key informant interviews with global health faculty with follow-up e-surveys, and then, integrated our results into a competency-based curriculum framework with values and principles, learning objectives and curriculum delivery methods and evaluation. RESULTS: The majority of our Canadian medical faculty respondents reported some refugee health learning objectives within their undergraduate medical curriculum. The most prevalent learning objective topics included access to care barriers, social determinants of health for refugees, cross-cultural communication skills, global health epidemiology, challenges and pitfalls of providing care and mental health. We proposed a curriculum framework that incorporates values and principles, competency-based learning objectives, curriculum delivery (i.e., community service learning), and evaluation methods. CONCLUSIONS: The results of this study informed the development of a curriculum framework that integrates cross-cultural communication skills, exploration of barriers towards accessing care for newcomers, and system approaches to improve refugee and migrant healthcare. Programs should also consider social determinants of health, community service learning and the development of links to community resettlement and refugee organizations.

Impact of interactive multi-media learning for physicians in musculoskeletal education - a pilot study.

BACKGROUND: The aim of this educational study was to investigate the use of interactive case-based modules relating to the screening and identification of early-stage inflammatory arthritis in both online technology (OLT) and paper (PF) formats with identical content. METHODS: Forty learners from family medicine or rheumatology residency programs were recruited. Content pertaining to a "Sore Hands, Sore Feet" (SHSF) and Gait Arms Legs Spine (GALS) screening tool modules were selected, reviewed and developed based on a validated curriculum from the World Health Organization and Canadian Curriculum for MSK conditions. Both the SHSF module and GALS screening tool were assessed via a randomized control trial. Assessments were completed during an orientation with all learners; then prior to the intervention (T1); at the end of the module (T2) and 3 months following the modules (T3) to assess retention. Focus groups were conducted to determine learners' satisfaction with the different learning formats. Baseline data was collated, and analysis performed after randomization into the PF (control) and OLT (experimental) groups. Repeated measures ANOVA was used for statistical analyses. RESULTS: Forty participants were recruited and randomized into the PF or OLT group (n = 20 each). At 3 months, there were n = 31 participants for SHSF (PF n = 19, OLT n = 12) and n = 32 for GALS (PF n = 19, OLT n = 13). There was no significant difference between the OLT and PF groups in both analyses. A significant increase in scores from Pre- to Post-Module in SHSF (F (1, 18) = 24.62. p < .0001) and GALS (F (1, 30) = 40.08, p < .0001) were identified to suggest learning occurred with both formats. The repeated measures ANOVA to assess retention revealed a significant decrease in scores from Post-Module to Follow-up for both learning format groups for SHSF (F (1, 29) = 4.68. p = .039), and GALS (F (1, 30) = 18.27. p < .0001) suggesting 3 months may be too long to retain this educational information. CONCLUSIONS: Both formats led to residents' ability to screen, identify and initially manage inflammatory arthritis. The hypothesis is rejected because both OLT and PF groups demonstrated significant learning during the process regardless of format. It is important to emphasize that from T1 (pre-module) to T2 (post-module), the residents demonstrated learning regardless of group to which they were assigned. However, learning retention declined from T2 (post-module) to T3 (three-month follow-up). Regular review of knowledge may be required earlier than 3 months to retain information learned. This study may impact educational strategies in MSK health. TRIAL REGISTRATION: This study did not involve "patients" rather learners and as such it was not registered.

Does spaced education improve clinical knowledge among Family Medicine residents? A cluster randomized controlled trial.

Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. METHOD: We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. RESULTS: Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. CONCLUSION: Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

Capturing the impact of cultural differences in residency.

BACKGROUND: Postgraduate training is a period in which residents develop both their medical competency and their professional identity in an environment of apprenticeship. As situated learning suggests, a critical dimension of such apprenticeship is the mode through which trainees can legitimately participate in the practice before they become experts, in this case physicians. One source of barriers to participation is cultural difference between learner and the clinical environment. OBJECTIVE: To assess the extent cultural differences create barriers for residents, particularly but not exclusively for international medical graduates (IMGs). METHODS: In 2014-15 a questionnaire was developed with subscales assessing areas such as sense of hierarchy, individuality versus teamwork, and risk tolerance. We refined the instrument by subjecting it to a review panel of experts in postgraduate education followed by "think aloud" sessions with residents. RESULTS: Piloting this instrument yielded a Cronbach's alpha of 0.675. When administered to a larger group of residents and faculty representing many specialties, the Impact of Cultural Differences on Residency Experiences (ICDRE) questionnaire revealed a few items for which the Canadian Medical Graduates and International Medical Graduates differed in their mean opinion. The groups were not substantially different overall, but we did observe an interesting diversity of cultural beliefs within each group. CONCLUSIONS: We suggest that the ICDRE may be useful in identifying beliefs which may present challenges to an individual resident or in capturing trends in a resident population so that a specialty program can address the trends proactively. The instrument also provides language with which to anchor preceptors' evaluations of residents' professionalism and may serve as an interventional coaching tool.

A comparison of teaching opportunities for rural and urban family medicine residents.

CONTEXT: Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians. Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents-as-teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences. METHODS: Year-1 and Year-2 family medicine residents at seven Canadian institutions participated in a mixed-methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi-squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed. RESULTS: Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ2 (4, n = 242) = 45.26, P < .000, Bonferroni's adjusted P < .000. Thematic analysis centred around determining factors influencing teaching opportunities and identified that the academic context, personal factors and programme factors were key dimensions. Within these dimensions, the number of medical students, a desire to be an educator and administrative support were cited as influences on teaching opportunities. CONCLUSIONS: The lack of teaching opportunities for rural trainees is attributable to a combination of practical and organisational factors revealed through thematic analysis. If rural graduates are not comfortable balancing the demands of service and teaching, this could compound the already prevalent issue of rural preceptor recruitment. It is essential to develop a rural-focused RaT curriculum to close this gap and produce competent educators who are ready to inspire generations of rural physicians.

Key factors for national spread and scale-up of an eConsult innovation.

BACKGROUND: Expanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada. METHODS: We conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research. RESULTS: This study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes. CONCLUSIONS: Efforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond.

Improving family medicine resident training in dementia care: An experiential learning opportunity in Primary Care Collaborative Memory Clinics.

Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.

HEIA tools: inclusion of migrants in health policy in Canada.

This paper introduces the Migrant Populations Equity Extension for Ontario's Health Equity Impact Assessment (HEIA) initiatives. It provides a mechanism to address the needs of migrant populations, within a program and policy framework. Validation of an equity extension framework using community leaders and health practitioners engaged in HEIA workshops across Ontario. Participants assessed migrants' health needs and discussed how to integrate these needs into health policy. The Migrant Populations Equity Extension's framework assists decision makers assess relevant populations, collaborate with immigrant communities, improve policy development and mitigate unintended negative impacts of policy initiatives. The tool framework aims to build stakeholder capacity and improve their ability to conduct HEIAs while including migrant populations. The workshops engaged participants in equity discussions, enhanced their knowledge of migrant policy development and promoted HEIA tools in health decision-making. Prior to these workshops, many participants were unaware of the HEIA tool. The workshops informed the validation of the equity extension and support materials for training staff in government and public health. Ongoing research on policy implementation would be valuable. Public health practitioners and migrant communities can use the equity extension's framework to support decision-making processes and address health inequities. This framework may improve policy development and reduce health inequities for Ontario's diverse migrant populations. Many countries are now using health impact assessment and health equity frameworks. This migration population equity extension is an internationally unique framework that engages migrant communities.

Evaluation of an electronic consultation service in psychiatry for primary care providers.

BACKGROUND: This study explores the effectiveness of an electronic consultation (eConsult) service between primary care providers and psychiatry, and the types and content of the clinical questions that were asked. METHODS: This is a retrospective eConsult review study. All eConsults directed to Psychiatry from July 2011 to January 2015 by Primary care providers were reviewed. Response time and the amount of time reported by the specialist to answer each eConsult was analyzed. Each eConsult was also categorized by clinical topic and question type in predetermined categories. Mandatory post-eConsult surveys for primary care providers were analyzed to determine the number of traditional consults avoided and to gain insight into the perceived value of eConsults. RESULTS: Of the 5597 eConsults, 169 psychiatry eConsults were completed during the study period. The average response time for a specialist to a primary care provider was 2.3 days. Eighty-seven percent of clinical responses were completed by the psychiatrist in less than 15 min. The primary care providers most commonly asked clinical questions were about depressive and anxiety disorders. 88.7% of PCPs rated the eConsult service a 5 (excellent value) or 4. CONCLUSIONS: This study indicates that an eConsult psychiatry service has tremendous potential to improve access to psychiatric advice and expand the capacity to treat mental illness in primary care. Future research may include follow-up with PCPs regarding the implementation of specialist advice.

Future practice of comprehensive care: Practice intentions of exiting family medicine residents in Canada.

OBJECTIVE: To describe exiting family medicine (FM) residents' reported practice intentions after completing a Triple C Competency-based Curriculum. DESIGN: The surveys were intended to capture residents' perceptions of FM, their perceptions of their competency-based training, and their intentions to practise FM. Entry (T1) and exit (T2) self-reported survey results were compared considering the influence of the curriculum change. Unmatched aggregate-level data were reviewed. The T1 survey was administered in the summer of 2012 and the T2 survey was administered in the spring of 2014. SETTING: Six Canadian FM residency programs across 4 provinces in Canada (Alberta, Saskatchewan, Ontario, and Quebec). PARTICIPANTS: Overall, 341 entering FM residents in 2012 responded to the T1 survey and 325 exiting FM residents completing their residency programs in spring 2014 responded to the T2 survey. MAIN OUTCOME MEASURES: Self-reported data on FM residents' future practice intentions related to comprehensive care, providing care across clinical domains and settings, and providing comprehensive care individually or in teams. RESULTS: A total of 341 (71.3%) residents responded to the T1 survey and a total of 325 (71.4%) residents responded to the T2 survey. Of these, 78.7% responded that they intended to provide comprehensive FM in multiple clinical settings in their future practices, with 70.8% indicating a comprehensive care practice with a special interest and 36.6% intending to provide care in a focused practice. Overall, 92.9% reported that they intended to work in group practice environments. Ninety percent reported they intended to work in interprofessional team practices. CONCLUSION: While an upward trend toward the practice of comprehensive care was demonstrated, findings also showed an increased trend toward providing care in focused practices. Further research is needed to better determine how FM residents understand the definition of comprehensive FM and its practice models. The survey provides an opportunity to explore questions related to practice intentions that could be helpful in work force planning. As the first study to compare entry and exit data from learners who have been exposed to a Triple C competency-based approach, this survey provides important baseline data for use by many.

Health care providers' roles and responsibilities in management of polypharmacy: Results of a modified Delphi.

BACKGROUND: Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. OBJECTIVES: To identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. METHODS: Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. The sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the Canadian Interprofessional Health Collaborative. The resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method. RESULTS: Round 1 was completed by 98 survey respondents and round 2 by 72. There was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary. DISCUSSION: Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management. CONCLUSION: Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.

Building capacity for medical education research in family medicine: the Program for Innovation in Medical Education (PIME).

BACKGROUND: Despite the apparent benefits to teaching, many faculty members are reluctant to participate in medical education research (MER) for a variety of reasons. In addition to the further demand on their time, physicians often lack the confidence to initiate MER projects and require more support in the form of funding, structure and guidance. These obstacles have contributed to a decline in physician participation in MER as well as to a perceived decay in its quality. As a countermeasure to encourage physicians to undertake research, the Department of Family Medicine at the University of Ottawa implemented a programme in which physicians receive the funding, coaching and support staff necessary to complete a 2-year research project. The programme is intended primarily for first-time researchers and is meant to serve as a gateway to a research career funded by external grants. Since its inception in 2010, the Program for Innovation in Medical Education (PIME) has supported 16 new clinician investigators across 14 projects. METHODS: We performed a programme evaluation 3 years after the programme launched to assess its utility to participants. This evaluation employed semi-structured interviews with physicians who performed a research project within the programme. RESULTS: Programme participants stated that their confidence in conducting research had improved and that they felt well supported throughout their project. They appreciated the collaborative nature of the programme and remarked that it had improved their willingness to solicit the expertise of others. Finally, the programme allowed participants to develop in the scholarly role expected by family physicians in Canada. CONCLUSION: The PIME may serve as a helpful model for institutions seeking to engage faculty physicians in Medical Education Research and to thereby enhance the teaching received by their medical learners.

Practice simulated office orals as a predictor of Certification examination performance in family medicine.

OBJECTIVE: To determine if performance on practice simulated office orals (SOOs) conducted during residency training could predict residents' performance on the SOO component of the College of Family Physicians of Canada's (CFPC's) final Certification examination. DESIGN: Prospective cohort study. SETTING: University of Ottawa in Ontario. PARTICIPANTS: Family medicine residents enrolled in the University of Ottawa's Family Medicine Residency program between July 1, 2012, and June 30, 2014, who were eligible to write the CFPC Certification examination in the spring of 2014 and who had participated in all 4 practice SOO examination sessions; 23 residents met these criteria. MAIN OUTCOME MEASURES: Scores on practice SOO sessions during fall 2012, spring 2013, fall 2013, and spring 2014; and the SOO component score on the spring 2014 administration of the CFPC Certification examination. RESULTS: Weighted least squares regression analysis using the 4 practice SOO session scores significantly predicted the final Certification examination SOO score (P < .05), with an adjusted R2 value of 0.29. Additional analysis revealed that the mean scores for the cohort generated at each time point were statistically different from each other (P < .001) and that the relationship over time could be represented by either a linear relationship or a quadratic relationship. A generalizability study generated a relative generalizability coefficient of 0.63. CONCLUSION: Our results confirm the usefulness of practice SOOs as a progress test and demonstrate the feasibility of using them to predict final scores on the SOO component of the CFPC's Certification examination.

The Interprofessional Collaborative Competency Attainment Survey (ICCAS): A replication validation study.

This study replicates a validation of the Interprofessional Collaboration Competency Attainment Survey (ICCAS), a 20-item self-report instrument designed to assess behaviours associated with patient-centred, team-based, collaborative care. We appraised the content validity of the ICCAS for a foundation course in interprofessional collaboration, investigated its internal (factor) structure and concurrent validity, and compared results with those obtained previously by ICCAS authors. Self-assessed competency ratings were obtained from a broad spectrum of pre-licensure, health professions students (n = 785) using a retrospective, pre-/post-design. Moderate to large effect sizes emerged for 16 of 20 items. Largest effects (1.01, 0.94) were for competencies emphasized in the course; the smallest effect (0.35) was for an area not directly taught. Positive correlations were seen between all individual item change scores and a separate item assessing overall change, and item-total correlations were moderate to strong. Exploratory factor analysis was used to understand the interrelationship of ICCAS items. Principal component analysis identified a single factor (Cronbach's alpha = 0.96) accounting for 85% of the total variance-slightly higher than the 73% reported previously. Findings suggest strong overlaps in the proposed constructs being assessed; use of a total average score is justifiable for assessment and evaluation.

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

BACKGROUND: An entrustable professional activity describes a professional task that postgraduate residents must master during their training. The use of simulation to assess performance of entrustable professional activities requires further investigation. QUESTIONS/PURPOSES: (1) Is simulation-based assessment of resident performance of entrustable professional activities reliable? (2) Is there evidence of important differences between Postgraduate Year (PGY)-1 and PGY-4 residents when performing simulated entrustable professional activities? METHODS: Three entrustable professional activities were chosen from a list of competencies: management of the patient for total knee arthroplasty (TKA); management of the patient with an intertrochanteric hip fracture; and management of the patient with an ankle fracture. Each assessment of entrustable professional activity was 40 minutes long with three components: preoperative management of a patient (history-taking, examination, image interpretation); performance of a technical procedure on a sawbones model; and postoperative management of a patient (postoperative orders, management of complications). Residents were assessed by six faculty members who used checklists based on a modified Delphi technique, an overall global rating scale as well as a previously validated global rating scale for the technical procedure component of each activity. Nine PGY-1 and nine PGY-4 residents participated in our simulated assessment. We assessed reliability by calculating the internal consistency of the mean global rating for each activity as well as the interrater reliability between the faculty assessment and blinded review of videotaped encounters. We sought evidence of a difference in performance between PGY-1 and PGY-4 residents on the overall global rating scale for each station of each entrustable professional activity. RESULTS: The reliability (Cronbach's α) for the hip fracture activity was 0.88, it was 0.89 for the ankle fracture activity, and it was 0.84 for the TKA activity. A strong correlation was seen between blinded observer video review and faculty scores (mean 0.87 [0.07], p < 0.001). For the hip fracture entrustable professional activity, the PGY-4 group had a higher mean global rating scale than the PGY-1 group for preoperative management (3.56 [0.5] versus 2.33 [0.5], p < 0.001), postoperative management (3.67 [0.5] versus 2.22 [0.7], p < 0.001), and technical procedures (3.11 [0.3] versus 3.67 [0.5], p = 0.015). For the TKA activity, the PGY-4 group scored higher for postoperative management (3.5 [0.8] versus 2.67 [0.5], p = 0.016) and technical procedures (3.22 [0.9] versus 2.22 [0.9], p = 0.04) than the PGY-1 group, but no difference for preoperative management with the numbers available (PGY-4, 3.44 [0.7] versus PGY-1 2.89 [0.8], p = 0.14). For the ankle fracture activity, the PGY-4 group scored higher for postoperative management (3.22 [0.8] versus 2.33 [0.7], p = 0.18) and technical procedures (3.22 [1.2] versus 2.0 [0.7], p = 0.018) than the PGY-1 groups, but no difference for preoperative management with the numbers available (PGY-4, 3.22 [0.8] versus PGY-1, 2.78 [0.7], p = 0.23). CONCLUSIONS: The results of our study show that simulated assessment of entrustable professional activities may be used to determine the ability of a resident to perform professional tasks that are critical components of medical training. In this manner, educators can ensure that competent performance of these skills in the simulated setting occurs before actual practice with patients in the clinical setting.

Progress testing in family medicine--A novel use for simulated office oral exams.

BACKGROUND: Simulated office orals (SOOs) are used by the College of Family Physicians of Canada as a method to evaluate family medicine resident readiness for clinical practice. The use of SOOs as a progress test would provide residency programs with useful information to determine resident readiness for challenging the certification exam. The data from a progress test could then be easily manipulated to generate a risk assessment plot. METHODS: During a prospective cohort study conducted at the University of Ottawa, the feasibility of using practice SOO sessions, a structured clinical exam, as a progress test was explored. Twenty-three residents participated in all four practice SOO sessions and their results were entered into a risk assessment plot. RESULTS: Repeated measures analysis of the data using ANOVA demonstrated that the residents' scores at each time point were statistically different from each other, generating an F(3, 66) = 27.52, p < 0.001, η(2) = 0.55.and that the relationship over time was linear with an F(1, 22) = 123.80, p < 0.001, η(2) = 0.85. At the final time point, a risk assessment resulted in no learners mapping to quadrants III or IV. CONCLUSIONS: Our results demonstrate the feasibility of utilizing a SOO exam, a clinical exam, as a progress test. In addition, we propose generating a risk assessment plot, using the data from the Fall 2013 and Spring 2014 practice SOO sessions, as a means of identifying residents at risk. Further studies will be needed to confirm the utility of this analysis. Combined with other measures acquired during in-training evaluation, the utilization of practice SOOs as a progress test will provide program directors with valuable information on resident progression.

Mobile technologies in medical education: AMEE Guide No. 105.

Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.

Extended family medicine training: Measuring training flows at a time of substantial pedagogic change.

OBJECTIVE: To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. DESIGN: Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. SETTING: Canada. PARTICIPANTS: All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. MAIN OUTCOME MEASURES: Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. RESULTS: The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. CONCLUSION: New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS-Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of extended family medicine training programs.