"When in Doubt, Ask the Patient": A Quantitative, Patient-Oriented Approach to Formative Assessment of CanMEDS Roles.

Introduction: Since the introduction of competency-based frameworks into postgraduate medical curricula, educators have struggled to implement robust assessment tools that document the progression of necessary skills. The global movement towards competency-based medical education demands validated assessment tools. Our objective was to provide validity evidence for the Ottawa CanMEDS Competency Assessment Tool (OCCAT), designed to assess clinical performance in the communicator, professional, and health advocate CanMEDS roles. Methods: We developed the OCCAT, a 29-item questionnaire informed by specialty-specific Entrustable Professional Activities and consultation with stakeholders, including patients. Our sample included nine neonatal-perinatal medicine and maternal fetal medicine fellows rotating through antenatal high-risk clinics at the Ottawa Hospital. Following 70 unique encounters, the OCCAT was completed by patients and learners. Generalizability theory was used to determine overall reliability of scores. Differences in self and patient ratings were assessed using analyses of variance. Results: Generalizability analysis demonstrated that both questionnaires produced reliable scores (G-coefficient > 0.9). Self-scores were significantly lower than patient scores across all competencies, F(1, 6) = 13.9, p = .007. Variability analysis demonstrated that trainee scores varied across all competencies, suggesting both groups were able to recognize competencies as distinct and discriminate favorable behaviors belonging to each. Discussion: Our findings lend support to the movement to integrate self-assessment and patient feedback in formal evaluations for the purpose of enriched learner experiences and improved patient outcomes. We anticipate that the OCCAT will facilitate bridging to competency-based medical education.

Placenta pathology in recipient versus donor oocyte derivation for in vitro fertilization in a setting of hypertensive disorders of pregnancy and IUGR.

INTRODUCTION: Assisted reproductive technology including in vitro fertilization (IVF) and oocyte donation (OD) may increase risk for placenta-mediated diseases. Comprehensive analysis of histopathological placental lesions according to source of oocytes used in the IVF procedure - recipient derived (RD-IVF) vs oocyte donation (OD-IVF), has not been conducted in a population with a hypertensive disorder of pregnancy (HDP) and/or intrauterine growth restriction (IUGR). METHODS: A retrospective cohort study of archived placenta specimens from RD-IVF and OD-IVF pregnancies affected by HDP and/or IUGR was conducted with blinded histopathological placental examination. Three categories of lesions were differentiated and defined as main outcomes: maternal vascular malperfusion (MVM), chronic inflammation, and fetal vascular malperfusion (FVM). To determine the relationship between conception method and placental lesions, multivariable regressions were performed with maternal age, gestational age, HDP, birth and placental weight percentiles as model covariates. RESULTS: 115 placentas were included 83 (72.2%) RD-IVF, 32 (27.8%) OD-IVF. Adjusted OR (aOR) for conception method was 5.05 (95%CI 0.58-43.90, p=0.142) for MVM, 1.87 (95%CI 0.68-5.15, p=0.228) for chronic inflammatory and 0.61 (95%CI 0.15-2.37, p=0.471) for FVM lesions. Multiple gestation demonstrated borderline association with MVM (aOR=0.24, 95%CI 0.04-1.51, p=0.129) and total pathology score (aRR=0.79, 95%CI 0.62-1.01, p=0.058). Subgroup analysis suggested greater odds of villitis of unknown etiology (VUE) for OD-IVF (aOR=2.98, 95%CI 1.12-7.93, p=0.029). DISCUSSION: Source of oocyte derivation demonstrated no evidence of association with main outcomes in cases of HDP and/or IUGR. Subgroup analysis demonstrated increased rates of inflammatory lesions for OD-IVF. Multiple gestation may be associated with decreased MVM and total lesions.

Abnormal placental pathological findings and adverse clinical outcomes of oocyte donation.

We sought to assess chronic inflammatory responses in patients who achieved pregnancy by oocyte donation and non-oocyte donation-assisted reproductive technology and delivered at The Ottawa Hospital. Data describing maternal health, obstetrical outcomes, neonatal outcomes, and placental pathology were collected and analyzed from electronic medical records. An increased frequency of adverse obstetrical outcomes was observed. In the oocyte donation-assisted reproductive technology group, placental pathology data demonstrated increased frequency of fetal vascular malperfusion (p = 0.02) and placenta accreta (p < 0.001), representing a chronic inflammatory response. Placental pathology reflecting dysregulated immune processes and vasculopathy is associated with oocyte donation.