Peer-support writing group in a community family medicine teaching unit: Facilitating professional development.

PROBLEM ADDRESSED: Aspiring physician writers need an environment that promotes self-reflection and can help them improve their skills and confidence in writing. OBJECTIVE OF PROGRAM: To create a peer-support writing group for physicians in the Markham-Stouffville community in Ontario to promote professional development by encouraging self-reflection and fostering the concept of physician as writer. PROGRAM DESCRIPTION: The program, designed based on a literature review and a needs assessment, was conducted in 3 sessions over 6 months. Participants included an emergency physician, 4 family physicians, and 3 residents. Four to 8 participants per session shared their projects with guest physician authors. Eight pieces of written work were brought to the sessions, 3 of which were edited. A mixed quantitative and qualitative evaluation model was used with preprogram and postprogram questionnaires and a focus group. CONCLUSION: This program promoted professional development by increasing participants' frequency of self-reflection and improving their proficiency in writing. Successful elements of this program include creating a supportive group environment and having a physician-writer expert facilitate the peer-feedback sessions. Similar programs can be useful in postgraduate education or continuing professional development.

Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics.

There is a lack of definitive evidence that preventative, in-home medical care provided by highly trained community paramedics reduces acute health care utilization and improves the overall well-being of patients suffering from chronic diseases. The Expanding Paramedicine in the Community (EPIC) trial is a randomized controlled trial designed to investigate the use of community paramedics in chronic disease management (ClinicalTrials.gov ID: NCT02034045). This case of a patient randomized to the intervention arm of the EPIC study demonstrates how the added layer of frequent patient contact by community paramedics and real-time electronic medical record (EMR) correspondence between the paramedics, physicians and other involved practitioners prevented possible life-threatening complications. The visiting community paramedic deduced the need for an electrocardiogram, which prompted the primary care physician to order a stress test revealing abnormalities and thus a coronary artery bypass graft was performed without emergency procedures, unnecessary financial expenditure or further health degradation such as a myocardial infarction.

The safety of testosterone therapy in women.

Hypoactive sexual desire disorder (HSDD), a subset of female sexual dysfunction, causes personal distress for surgically and naturally postmenopausal and premenopausal women. HSDD has a multi-factorial etiology, including psychosocial factors such as relationship issues and medical factors such as medications, chronic illnesses, and hormonal effects. Although no androgen therapies for female sexual dysfunction are currently approved for use in Canada, clinical trials support the efficacy and short-term safety of testosterone therapy for HSDD. We review the scientific evidence for the safety of testosterone therapy for HSDD.

Family Medicine Journal Club: To Tweet or Not to Tweet?

BACKGROUND AND OBJECTIVES: Online journal clubs have recently become popular, but their effectiveness in promoting meaningful discussion of the evidence is unknown. We aimed to understand the learner experience of a hybrid online-traditional family medicine journal club. METHODS: We used a qualitative descriptive study to understand the experience of medical students and residents at the University of Toronto with the hybrid online-traditional family medicine journal club, including perceived useful and challenging aspects related to participant engagement and fostering discussion. The program, informed by the literature and needs assessment, comprised five sessions over a 6-month period. Learners led the discussion between the distributed sites via videoconferencing and Twitter. Six of 12 medical students and 33 of 57 residents participated in one of four focus groups. Thematic data analysis was performed using the constant comparison method. RESULTS: While participants could appreciate the potential of an online component to journal club to connect distributed learners, overall, they preferred the small group, face-to-face format that they felt produced richer and more meaningful discussion, higher levels of engagement, and a better learning opportunity. Videoconferencing and Twitter were seen as diminishing rather than enhancing their learning experience and they challenged the assumption that millennials would favor the use of social media for learning. CONCLUSIONS: Our study demonstrates that for discussion-based teaching activities such as journal club, learners prefer a small-group, face-to-face format. Our findings have implications for the design of curricular programs for distributed medical learners.

Breastfeeding During Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Canadian residents' breastfeeding experiences have only been reported in studies that broadly explored pregnancy and parenthood. We sought to fully explore Canadian family medicine resident mothers' breastfeeding experiences, and identify strategies to support workplace breastfeeding for future trainees. METHODS: Using an online survey, University of Toronto family medicine residents who gave birth from 2010 through 2016 were queried about their exclusive and overall breastfeeding duration, barriers, and facilitators to workplace breastfeeding, and strategies to improve the breastfeeding experience for future resident mothers. Data were downloaded from Qualtrics software and descriptive statistical analyses were conducted using IBM SPSS Statistics v.24.0. Subjective comments were examined and linked to quantitative findings. RESULTS: Fifty-six of 179 eligible residents completed the survey (31% response rate). More than three-quarters of residents were on maternity leave for 7 to 12 months. All initiated breastfeeding, and 54% breastfed exclusively for 6 months. The median breastfeeding duration was 10 to 12 months. Almost two-thirds of residents were breastfeeding upon return to work, and all experienced barriers to workplace breastfeeding including lack of time, private space, and refrigeration for expressed milk. Lack of a workplace breastfeeding policy and inadequate support from supervisors or program directors were additional barriers. Peer mentorship and more breastfeeding education were identified as strategies to support future residents' breastfeeding goals. CONCLUSIONS: Addressing long-standing barriers to workplace breastfeeding, and providing peer and educational supports were identified as strategies that could inform program policies to support future trainees' breastfeeding goals and experiences.

Sight of conspecifics as reward in associative learning in zebrafish (Danio rerio).

Large amount of genetic information has been accumulated for zebrafish. Learning and memory have also been investigated with zebrafish but the number of learning paradigms is limited. Here we present a simple associative task and investigate a novel reinforcer. We show that visual access to a group of conspecifics has rewarding properties and that this reinforcer can support associative learning in zebrafish. We discuss the advantages of this rewarding stimulus and make recommendations for its use in high throughput behavioral screens.