Not in the file: How competency committees work with undocumented contributions.

INTRODUCTION: Competence committees (CCs) centre their work around documentation of trainees' performance; undocumented contributions (i.e. informal, unrecorded material like personal judgements, experiential anecdotes and contextual information) evoke suspicion even though they may play a role in decision making. This qualitative multiple case study incorporates insights from a social practice perspective on writing to examine the use of undocumented contributions by the CCs of two large post-graduate training programmes, one in a more procedural (MP) speciality and the other in a less procedural (LP) one. METHODS: Data were collected via observations of meetings and semi-structured interviews with CC members. In the analysis, conversations were organised into triptychs of lead-up, undocumented contribution(s), and follow-up. We then created thick descriptions around the undocumented contributions, drawing on conversational context and interview data to assign possible motivations and significance. RESULTS: We found no instances in which undocumented contributions superseded the contents of a trainee's file or stood in for missing documentation. The number of undocumented contributions varied between the MP CC (six instances over two meetings) and the LP CC (22 instances over three meetings). MP CC discussions emphasised Entrustable Professional Activity (EPA) observations, whereas LP CC members paid more attention to narrative data. The divergent orientations of the CCs-adding an 'advis[ing]/guid[ing]' role versus focusing simply on evaluation-offers the most compelling explanation. In lead-ups, undocumented contributions were prompted by missing and flawed documentation, conflicting evidence and documentation at odds with members' perceptions. Recognising other 'red flags' in documentation often required professional experience. In follow-ups, purposes served by undocumented contributions varied with context and were difficult to generalise; we, therefore, provide deeper analysis of two vignettes to illustrate. CONCLUSIONS: Our data suggest undocumented contributions often serve best efforts to ground decisions in documentation. We would encourage CC practices and policies be rooted in more nuanced approaches to documentation.

Consumer rejection threshold, acceptability rates, physicochemical properties, and shelf-life of strawberry-flavored yogurts with reductions of sugar.

BACKGROUND: There is an increasing demand for reduced-sugar products due to the worldwide prevalence of obesity, diabetes, and cardiovascular diseases. The aim of this study was to evaluate the effects of sugar (sucrose) reductions on the acceptability, preference, and quality of strawberry-flavored yogurts. A consumer rejection threshold test and an acceptability test (N = 53) were conducted using six yogurt samples with decreasing concentrations of sugar (12-5/100 g). Additional physicochemical tests (pH, °Brix, water-holding-capacity, viscosity, and color) were conducted to examine the quality and shelf-life of strawberry-flavored yogurts with reductions of sucrose during 28 days of storage at 4 °C. RESULTS: Reduction of sucrose affected the acceptability and physicochemical characteristics of yogurts. The consumer rejection threshold showed that sucrose in strawberry-flavored yogurts could be reduced to 5.25/100 g from an initial concentration of 12/100 g without affecting the preferences of consumers. The 71%-sucrose (8.50/100 g of yogurt) was perceived as the most liked (6.27 using a nine-point hedonic scale) and the most preferred (rank sum = 127.50) yogurt sample. For the physicochemical properties of yogurts, the viscosity (3263-5473 cP) decreased, and the color lightness (80.98-85.44) increased during 28 days of storage at 4 °C. CONCLUSION: Physicochemical properties and preferences were affected by the reduction of sugar. The consumer rejection threshold analysis showed that sucrose can be reduced to less than half of the initial concentration. These findings are useful to understand consumers' acceptability and shelf-life of yogurts with reduced-sugar formulations in the developing of new products. © 2020 Society of Chemical Industry.

Pediatric Investigators Collaborative Network on Infections in Canada Study of Respiratory Syncytial Virus-associated Deaths in Pediatric Patients in Canada, 2003-2013.

Background: Respiratory syncytial virus (RSV) is a major cause of pneumonia and bronchiolitis in children. Mortality rates in previously healthy children hospitalized with RSV are <0.5%, but up to 37% in patients with underlying medical conditions. The objective of this study was to characterize factors associated with deaths among children hospitalized with RSV infection in Canadian pediatric centers. Methods: A retrospective case series of children aged ≤18 years with RSV-associated deaths at centers affiliated with the Pediatric Investigators Collaborative Network on Infections in Canada from 2003­2013, inclusive, was performed [corrected]. Cases were identified using RSV-specific International Classification of Diseases codes to capture deaths where a diagnosis of RSV infection was present. Results: Eleven centers reported 79 RSV-associated deaths. RSV was regarded as primarily responsible for death in 32 cases (40.5%). Median age at death was 11 months (range, <1 month to 16 years). Thirty-nine patients (49.4%) were male. Fourteen patients (17.7%) had no known risk factors for severe RSV infection. Healthcare-associated RSV infections (HAIs) accounted for 29 deaths (36.7%), with RSV judged to be the primary cause of death in 9 of these cases. Conclusions: RSV-associated deaths were predominantly associated with chronic medical conditions and immunocompromised states among infants; however, 1 in 5 deaths occurred among patients with no known risk factors for severe RSV. Mortality associated with HAI accounted for over a third of cases. These findings highlight patient groups that should be targeted for RSV prevention strategies such as infection control practices, immunoprophylaxis, and future vaccination programs.

Multi-phase implementation of automated external defibrillator use by nurses during in-hospital cardiac arrest and its impact on survival.

OBJECTIVE: We sought to evaluate the impact of a medical directive allowing nurses to use defibrillators in automated external defibrillator-mode (AED) on in-hospital cardiac arrest (IHCA) outcomes. METHODS: We completed a health record review of consecutive IHCA for which resuscitation was attempted using a pragmatic multi-phase before-after cohort design. We report Utstein outcomes before (Jan.2012-Aug.2013;Control) the implementation of the AED medical directive following usual practice (Sept.2013-Aug.2016;Phase 1), and following the addition of a theory-based educational video (Sept.2016-Dec.2017;Phase 2). RESULTS: There were 753 IHCA with the following characteristics (Before n = 195; Phase 1n = 372; Phase 2n = 186): mean age 66, 60.0% male, 79.3% witnessed, 29.1% noncardiac-monitored medical ward, 23.9% cardiac cause, and initial ventricular fibrillation/tachycardia (VF/VT) 27.2%. Comparing the Before, Phase 1 and 2: an AED was used 0 time (0.0%), 21 times (5.7%), 15 times (8.1%); mean times to 1st analysis were 7 min, 3 min and 1 min (p < 0.0001); mean times to 1st shock were 12 min, 10 min and 8 min (p = 0.32); return of spontaneous circulation (ROSC) was 63.6%, 59.4% and 58.1% (p = 0.77); survival was 24.6%, 21.0% and 25.8% (p = 0.37). Among IHCA in VF/VT (n = 165), time to 1st analysis and 1st shock decreased by 5 min (p = 0.01) and 6 min (p = 0.23), and ROSC and survival increased by 3.0% (p = 0.80) and 15.6% (p = 0.31). There was no survival benefit overall (1.2%; p = 0.37) or within noncardiac-monitored areas (-7.2%; p = 0.24). CONCLUSIONS: The implementation of a medical directive allowing for AED use by nurses successfully improved key outcomes for IHCA victims, particularly following the theory-based education video and among the VF/VT group.

Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest.

OBJECTIVE: We sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge. METHODS: We completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA. RESULTS: There were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052). CONCLUSIONS: The COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival.

Impact of Unexpected Death in a Simulation Scenario on Skill Retention, Stress, and Emotions: A Simulation-Based Randomized Controlled Trial.

Introduction The simulation of patient death remains controversial in simulation-based education. We investigated the effect of simulated patient death on learners' skill retention, stress levels, and emotions. Methods After ethics approval, we recruited residents at two Canadian universities. Participants were randomized to manage a simulated cardiac arrest ending with either the unexpected death (intervention group) or survival (control group) of the simulated patient (i.e., manikin). Three months later, all participants performed the same scenario but with the opposite outcome. Blinded video raters assessed participants' non-technical and technical crisis resource management (CRM) skills at both time points. Stress levels (represented by anxiety level, salivary cortisol concentration, and cognitive appraisal) and emotional valence were measured. Outcomes were analyzed using analysis of covariance (ANCOVA) or generalized estimating equations as appropriate. Results The analysis included 46 participants (intervention: n=24; control: n=22). Simulated death neither affected retention of non-technical CRM skills (mean retention Ottawa Global Rating Scale score in the death group [29.4, 95% CI: 27.0, 31.8] versus control group [29.4, 95% CI: 26.8, 32.0; p=0.87]) nor technical CRM skills (mean retention task-specific checklist score in the manikin death group [11.8, 95% CI: 10.5, 13.0] versus the control group [12.5, 95% CI: 11.3, 13.7; p=0.69]). The simulated death had negative effects on participants' anxiety levels, cognitive appraisal, and emotions. Conclusion Simulated patient death did not affect the retention of non-technical or technical CRM skills but led to greater levels of short-term anxiety, stress, and negative emotions among learners.

Is Routine Therapeutic Drug Monitoring of Anti-Retroviral Agents Warranted in Children Living with HIV?

OBJECTIVE: The utility of routine therapeutic drug monitoring (TDM) in children living with HIV has not been extensively studied. The purpose of this study was to assess this strategy. METHODS: This was a single-center, prospective observational study of routine TDM for protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and integrase strand transfer inhibitors (INSTIs) in children living with HIV who were receiving antiretroviral therapy (ART) between February and December 2014. Outcome measures included the proportion of serum antiretroviral (ARV) medication concentrations in the therapeutic range (target values extrapolated from adult data) and the effect of serum concentrations on virologic control, medication adherence, and toxicity. RESULTS: Forty-eight children with a median age of 13 years (interquartile range, 3-18) were included. Median viral load (VL) and CD4% were <40 copies/mL (range, <40-124) and 37.4% (range, 8.4-47.9), respectively. Adherence was considered excellent in 95.8% of patients. Of the 50 serum trough concentrations (PI n = 19 [38%]; NNRTI n = 27 [54%]; INSTI n = 4 [8%]), 66% (n = 33) were in the therapeutic range, 12% (n = 6) were subtherapeutic, and 22% (n = 11) were supratherapeutic. There was no statistically significant correlation between serum ARV concentrations and patient demographics, VL, CD4%, or adherence. No clinically significant adverse events were noted. One dose adjustment was made for a subtherapeutic serum raltegravir concentration, likely attributable to interaction with ritonavir. CONCLUSIONS: This study does not support routine TDM in healthy children living with HIV who are well controlled on antiretroviral medication regimens. A more targeted strategy, such as when adherence is questioned or when there are suspected drug interactions, may be more appropriate.

Nursing Orientation During the COVID-19 Pandemic.

Traditional in-person delivery of nursing orientation programs at a large academic hospital could not occur because of the COVID-19 pandemic, with the need to limit group sizes and adhere to physical distancing guidelines. A nurse educator team pivoted the orientation program to a virtual model combined with the review of select clinical skills and buddy shifts. This model effectively met the nurses' needs required to practice safely on an inpatient environment.

An unusual case of abdominal pain and splenomegaly in a paediatric patient.

Fusobacterium species are members of the oral microbiota and have been found to cause a wide spectrum of opportunistic infections. We describe the case of a previously healthy teenager with a large splenic abscess secondary to Fusobacterium nucleatum, successfully managed with percutaneous drainage and intravenous antibiotics. Identification of the organism was achieved using anaerobic culture of the aspirated fluid and matrix-assisted laser desorption/ionization time of flight, later confirmed by 16S ribosomal RNA metagenomic sequencing of the fluid. Fusobacteria are typically associated with oropharyngeal infections but are very rarely implicated in splenic abscesses. Aerobic and anaerobic blood cultures should be drawn when an intra-abdominal infection is suspected in a paediatric patient, and empiric antimicrobial therapy should be administered with coverage for gram-positive, gram-negative, and anaerobic bacteria.

The role of previously undocumented data in the assessment of medical trainees in clinical competency committees.

INTRODUCTION: The clinical competency committee (CCC) comprises a group of clinical faculty tasked with assessing a medical trainee's progress from multiple data sources. The use of previously undocumented data, or PUD, during CCC deliberations remains controversial. This study explored the use of previously undocumented data in conjunction with documented data in creating a meaningful assessment in a CCC. METHODS: An instrumental case study of a CCC that uses previously undocumented data was conducted. A single CCC meeting was observed, followed by semi-structured individual interviews with all CCC members (n = 7). Meeting and interview transcripts were analyzed iteratively. RESULTS: Documented data were perceived as limited by inaccurate or superficial data, but sometimes served as a starting point for invoking previously undocumented data. Previously undocumented data were introduced as summary impressions, contextualizing factors, personal anecdotes and, rarely, hearsay. The purpose was to raise a potential issue for discussion, enhance and elaborate an impression, or counter an impression. Various mechanisms allowed for the responsible use of previously undocumented data: embedding these data within a structured format; sharing relevant information without commenting beyond one's scope of experience; clarifying allowable disclosure of personal contextual factors with the trainee pre-meeting; excluding previously undocumented data not widely agreed upon in decision-making; and expecting these data to have been provided as direct feedback to trainees pre-meeting. DISCUSSION: Previously undocumented data appear to play a vital part of the group conversation in a CCC to create meaningful, developmentally focused trainee assessments that cannot be achieved by documented data alone. Consideration should be given to ensuring the thoughtful incorporation of previously undocumented data as an essential part of the CCC assessment process.

Virtual reality videos for training and protocol dissemination during a pandemic.

This article was migrated. The article was marked as recommended. Preparations for the COVID-19 pandemic required healthcare teams to practice known skills, such as intubation, with renewed consideration for safety, as well as develop new Standard Operating Procedures (SOPs) for health care delivery. In these conditions, translational simulation based-education (SBE) is a well-known tool that supports health care teams to improve the system using design thinking methods such as walkthroughs and team-based simulation. However, the pandemic has introduced two stressors on translational SBE simultaneously. Firstly, the need for rapid upskilling of front-line staff and rapid change to SOPs. Secondly, the need for social or physical distancing at work, such that it quickly became inappropriate for large groups of individuals to practice in-situ SBE and debrief together in close proximity. An educational approach that brings the best of translational SBE while minimizing contact and maximizing experiential learning is needed. Digital learning has been rapidly adopted by much of medical education during the pandemic. Focusing on a strong alignment between learning goals with intended clinical performance change outcomes we sought to leverage a digital education format that allowed for low barriers to adoption, yet supported the experiential, dynamic reality of translational SBE. In the absence of the ability to quickly train large numbers of people due to the need for social distancing, an immersive experience that can only be provided by virtual reality (VR) videos was the next best thing. VR, using 360-degree video, supported the creation of instructional videos from SBE events in the hospital which allow the learner to immerse and explore multiple points within the scenario. We describe how the very act of recording a video assisted in the rapid development of SOPs through translational simulation. We then describe the use of VR to stay true to the spirit of simulation for experiential learning and nearly hands-on training.

Review of pediatric encephalitis and encephalopathy cases following immunization reported to the Canadian Immunization Monitoring Program Active (IMPACT) from 1992 to 2012.

BACKGROUND: Neurological adverse events following immunization (AEFI) remain poorly characterized. Our objective was to describe pediatric acute and chronic encephalopathy and encephalitis cases following immunization reported via active sentinel surveillance from 1992 to 2012. METHODS: This case series provides a descriptive analysis of encephalopathy/encephalitis admissions reported to the Canadian Immunization Monitoring Program ACTive (IMPACT). Acute cases were reported if symptom onset (seizures, decreased level of consciousness, change in mental status) occurred 0-7 days after tetanus or pertussis-containing vaccines, 0-15 days after other inactivated vaccines, or 5-30 days after live vaccines. Chronic cases of subacute sclerosing panencephalitis or subacute progressive rubella encephalitis were reported at any interval after vaccination. Clinical data were examined to identify possible causes for encephalopathy/encephalitis other than vaccination. RESULTS: Sixty-one cases of encephalopathy/encephalitis following immunization were reported to IMPACT over 21 years; 57 (93.4%) were classified as acute and 4 (6.6%) were chronic cases of subacute sclerosing panencephalitis. Most patients (73.8%) were previously healthy and immunocompetent. The vaccines most frequently administered prior to presentation were diphtheria-tetanus-pertussis, measles-mumps-rubella, and influenza. At discharge, 38 patients (62.3%) had normal neurological status or were expected to recover. Forty patients (70.2%) with acute encephalopathy/encephalitis had a more likely alternate etiology besides vaccination based on neuroimaging, symptoms suggestive of infection, laboratory-confirmed non-vaccine-related infection, or clinical diagnosis. No cases of encephalitis were causally associated with pertussis or influenza vaccines. Two patients (50%) with subacute sclerosing panencephalitis had known wild-type measles infection prior to immunization. Three deaths were reported during hospitalization (4.9%); all were acute encephalitis/encephalopathy cases and none were confirmed to be vaccine-related. CONCLUSIONS: Encephalopathy/encephalitis following immunization remains a rare but serious adverse event. Most cases had another more likely etiology than vaccination. Continued monitoring and analysis of AEFI is paramount to ensure the safety of immunization programs.

My Throat is Itchy! An In-situ Simulation for Interprofessional Healthcare Education.

In-situ simulation occurs in the clinical environment. This allows healthcare providers greater access to the educational session while providing the opportunity to test systems or protocols in place. Anaphylaxis is a rare and life-threatening event. As such, many healthcare providers are uncomfortable managing it. The use of simulation as an educational methodology allows the learners to practice rare, high-risk scenarios in a low-risk environment. There is no negative impact to an actual patient when an in-situ simulation education session is provided. Usually there are positive results due to increased staff awareness and improved process. In the spring of 2015, stakeholders at the outpatient antibiotic therapy program (OPAT) at The Ottawa Hospital (TOH) approached the nurse educator team to develop an education session around anaphylaxis management. The nurse educators chose to design and implement an in-situ simulation scenario involving the inter-professional clinic team. Through the use of inter-professional in-situ simulation the team was able to clarify roles, identify equipment issues and rectify those issues as this technical report describes.

D-Tagatose as a Sucrose Substitute and Its Effect on the Physico-Chemical Properties and Acceptability of Strawberry-Flavored Yogurt.

Sugar not only provides the desirable sweetness but its reduction can also alter the physico-chemical properties of foods. The objective of this study was to evaluate the effects of tagatose as a sugar substitute on selected physico-chemical properties and sensory acceptability of strawberry-flavored yogurts. Six yogurt samples with decreasing concentrations of sucrose (8.50 to 1.70 g/100 g) and increasing concentrations of tagatose (0.00 to 9.24 g/100 g) were evaluated. Physico-chemical tests (pH, lactic acid (%), °Brix, water-holding capacity (WHC), viscosity, and color) were conducted to examine the quality and shelf-life of yogurts during 28 days of storage at 4 °C. An acceptability test (n = 55) was conducted to evaluate the sensory characteristics of yogurts. Sucrose reductions by the replacement of up to 80% tagatose showed marginal effects on the selected physico-chemical properties; however, the loss of red color (a*) and increase in yellowness (b*) of the tagatose-substituted samples were significant. Strawberry yogurts with tagatose replacements had similar acceptability scores for all attributes. Sucrose reduction showed a positive effect on the purchase intent of the strawberry yogurts (an increase of 3-30%). These findings can be used to understand the effects of tagatose/sucrose formulations on the acceptability and physico-chemical properties of yogurts.

Case Report: Central Nervous System Strongyloidiasis: Two Cases Diagnosed Antemortem.

Central nervous system (CNS) strongyloidiasis is a known but rare form of disseminated infection. The diagnosis is often made postmortem, with only five published cases of an antemortem diagnosis. We report two fatal cases of CNS strongyloidiasis diagnosed antemortem, with Strongyloides stercoralis larvae visualized in the CNS sample in one case. Risk factors for disseminated strongyloidiasis common to both cases included origination from the Caribbean, underlying human T-lymphotropic virus-1 infection, and recent prednisone use. Both cases occurred in Canada, where the occurrence of Strongyloides is uncommon, and serve as a reminder to maintain a high index of suspicion in patients with epidemiologic or clinical risk factors for dissemination.

Successful Treatment of High-Level Aminoglycoside-Resistant Enterococcus faecalis Bacteremia in a Preterm Infant with Ampicillin and Cefotaxime.

Enterococcal bloodstream infections are usually treated with single-agent antibiotics. In persistent infections, synergistic combination therapy is often required with a beta-lactam and an aminoglycoside antibiotic. High-level aminoglycoside-resistant (HLAR) enterococci are increasingly prevalent and preclude the use of this combination. The use of ampicillin with a third-generation cephalosporin to treat endovascular HLAR Enterococcus infections is becoming more established in the adult population; however, the literature on treatment of such infections in children remains scarce. We report a preterm neonate with persistent HLAR Enterococcus faecalis bacteremia from day of life 9 to 17 despite treatment with ampicillin and vancomycin. On day of life 17, antibiotic treatment was switched to ampicillin and cefotaxime, with subsequent clearance of blood cultures on day of life 20. To our knowledge, this is the first report illustrating the use of ampicillin and cefotaxime for an HLAR E. faecalis infection in a neonate.

Alice's Delirium: A Theatre-based Simulation Scenario for Nursing.

As an educational methodology, simulation has been used by nursing education at the academic level for numerous years and has started to gain traction in the onboarding education and professional development of practicing nurses. Simulation allows the learner to apply knowledge and skills in a safe environment where mistakes and learning can happen without an impact on patient safety. The development of a simulation scenario to demonstrate the benefits of simulation education methodologies to a large group of nurse educators was requested by nursing education leadership at The Ottawa Hospital (TOH). Since the demonstration of this scenario in the fall of 2016, there has been significant uptake and adaptation of this particular scenario within the nursing education departments of TOH. Originally written to be used with a simulated patient (SP), "Alice" has since been adapted to be used with a hi-fidelity manikin within an inpatient surgery department continuing professional development (CPD) program for practicing nurses, orientation for nurses to a level 2 trauma unit and at the corporate level of nursing orientation using an SP. Therefore, this scenario is applicable to nurses practicing in an area of inpatient surgery at varying levels, from novice to expert. It could easily be adapted for use with medicine nursing education programs. The case presented in this technical report is of the simulation scenario used for the inpatient surgery CPD program. Varying adaptations of the case are included in the appendices.

A Child With Limb Pain: A Case-Based Learning Module and Teaching Resource for Pediatric Infectious Diseases.

INTRODUCTION: While case-based learning is an effective method, teaching resources in pediatric infectious diseases are limited. Thus, we developed a case-based learning module for a common pediatric infectious diseases topic, osteomyelitis. METHODS: This module contains two resource files, both meant to be printed. The case file contains questions with blank spaces for the trainee (medical student, junior resident) to complete. The case answers file is used as a guide by the teacher (attending physician, fellow, senior resident) and/or the trainee after working through the case. This resource may be used in one-to-one sessions, in a small-group setting, or as self-directed learning. The session is estimated to take 60-90 minutes. A suggested reading list is included. RESULTS: This resource was used in a small-group format with the pediatric residents of the Hospital for Sick Children in Toronto for an academic half-day session in November 2015. Twenty-eight learner evaluations were received. The session was rated a 4.8 out of 5 (with 5 = outstanding) and ultimately voted by the residents to be the best academic half-day session of the year. Compared to delivering a didactic lecture on the same topic, the facilitators found preparation time was reduced and interactions with the trainees were more engaging. All were willing to facilitate a similar session again. DISCUSSION: This resource was effective and popular from the perspective of both learners and teachers. Additional modules are currently under preparation in order to create a case-based teaching resource for pediatric infectious diseases.