COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp.

OBJECTIVE: To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. METHODS: An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. RESULTS: Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. CONCLUSIONS: This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.

Therapy services for children and youth living in rural areas of high-income countries: a scoping review.

PURPOSE: To identify and describe therapeutic services provided to children and youth with disabilities living in rural areas of mid- and high-income countries and to summarize the benefits, positive outcomes, and challenges related to these services. METHODS: This scoping review involved a systematic search of four academic electronic databases: MEDLINE, EMBASE, CINAHL, and Psych INFO, using a combination of subject headings and keywords related to (1) child disabilities; (2) rehabilitation: occupational therapists, speech-language pathologists, physiotherapists, audiologists, and recreation therapists; (3) multidisciplinary care team; (4) rural areas. Charting involved an iterative process whereby the full text articles meeting the inclusion criteria were abstracted using the charting form by two independent reviewers. RESULTS: Thirty-seven articles from seven high-income countries were included in the analysis. Twenty-seven articles reported on in-person services, and 19 on telepractice (nine evaluated in-person and telepractice). In person services included outreach programs and specialized on-site programs. Positive outcomes and challenges of in person and telepractice services in rural areas are described. CONCLUSIONS: Findings of this review highlight the need for further research on service delivery models offered in rural areas of upper middle and high-income countries, especially those focusing specifically on the rural communities, with a clear description of services. IMPLICATIONS FOR REHABILITATIONThis scoping review helps to advance the understanding of how therapy services are offered in rural areas of high-income countries.Telepractice was found to enhance ease of access to services for families living in rural areas.The findings of this review suggest that telepractice may be an effective means of providing therapy services to children and youth with disabilities living in rural areas of high-income countries, pending families' access to technology.

Developing a Curriculum for Addressing the Opioid Crisis: A National Collaborative Process.

BACKGROUND: The burgeoning use of opioids and the lack of attention to the safe prescribing, storage, and disposal of these drugs remains a societal concern. Education plays a critical role in providing a comprehensive response to this crisis by closing the training gaps and empowering the next generation of physicians with the knowledge, skills, and resources needed to diagnose, treat and manage pain and substance use. Curricular Development: The Association of Faculties of Medicine of Canada (AFMC) developed a competency-based, bilingual curriculum for undergraduate medical students to be implemented in all Canadian medical schools. The authors describe the principles and framework for developing a national curriculum. The curriculum design process was situated in the Knowledge to Action theoretical framework. Throughout the development of this curriculum, different stakeholder groups were engaged, and their needs and contexts were considered. CONCLUSION: The curriculum ensures that consistent information is taught across all medical schools to educate future physicians on pain management, opioid stewardship and substance use disorder.

A systems approach for institutional CBME adoption at Queen's University.

The Royal College of Physicians and Surgeons of Canada (RCPSC) has begun the transition to Competency by Design (CBD), a new curricular model for residency education that 'ensure[s] competence, but teaches for excellence'. By 2022, all Canadian specialty programs are anticipated to have completed the CBD cohort process which includes workshops facilitated by a Royal College Clinician Educator. Queen's University in Ontario, Canada, was granted approval by the RCPSC to embark upon an accelerated path to competency-based medical education (CBME) for all our postgraduate specialties. This accelerated path allowed us to take an institutional approach for CBME implementation and ensure that all specialities were part of a system-wide change. Our unique institution-wide approach to CBD is the first of its kind across Canada. From both a theoretical and practical perspective we undertook CBME using a systems approach that allowed us to build the foundations for CBME, implement the change, and plan for sustainability. This has created opportunities to bridge and connect the various programs involved in the implementation of CBME on Queen's campus. The systems approach was an essential part of our strategy to develop a community dedicated to ensuring a successful CBME implementation.

Using outcome harvesting: Assessing the efficacy of CBME implementation.

RATIONALE: In 2015, Queen's University embarked on an institution-wide transition to a competency-based medical education (CBME) curriculum for all 29 postgraduate medical education programmes. On 1 July 2017, this goal was accomplished. With this mass transition came the requirement to assess the efficacy of implementation through a programme evaluation process, which included the use of outcome harvesting (Wilson-Grau). Outcome harvesting identified the intended and unintended outcomes of CBME implementation, which helped us understand how the intervention was achieved and how the relationship between behaviours and stakeholders contributed to the successful transition. METHODS: A systematic approach to document analysis was used to categorize the eight identified areas of implementation: governance, scholarship, faculty development, resident leadership, curriculum, assessment, communications, and technology. Documents (N = 443) were organized per project area and then coded thematically. Documents were then categorized for attribution to outcomes using the outcome harvesting approach. Outcomes were validated via interrater reliability and substantiated by stakeholders to verify accuracy of formulation and plausibility of its influence on the outcome. RESULTS: The harvest produced 38 outcomes, either intended or unintended, that can be attributed to CBME implementation at Queen's University. CONCLUSION: Using outcome harvesting to assess the efficacy of CBME implementation produced a robust set of themes and resultant outcomes that can be categorized as requirements for success of implementation of any curricular innovation. Emergent themes included collaboration, community of practice, and stakeholder commitment. More unique observations noted through the harvest process included new policy development, creation of learner ownership, and an increase in the output of scholarly activity involving CBME.

Accreditation Improves Quality of Oncology Education in Low- and Middle-Income Countries: Perspectives of African Oncologists.

The purpose of this study is to understand the perspectives of African Oncologists on the role of accreditation and on global standards. We developed a survey that addressed African oncologists' opinions on the role of accreditation. The survey also included 187 standards from World Federation of Medical Education Postgraduate medical education (PGME) standards, American Council of Graduate Medical Education (ACGME)-I standards for hematology/oncology, and the Royal College of Physician and Surgeons of Canada Medical Oncology standards. A 3-point scale was employed for each standard: 1 = not important, 2 = important but not essential, 3 = essential. The survey was sent to 79 physicians, 38 responded. Eighty-seven percent agreed that accreditation ensures quality. Forty-five percent agreed it will not increase migration of qualified doctors. Twenty-two individuals who completed the entire survey were analyzed for the standards. Five standards received the highest ratings of 3 (essential) from all respondents. One standard received a rating of < 2.0. The majority of standards had ratings between 2.6 and 2.94 indicating African oncologists found most standards to be useful. Ratings < 2.6 were mostly related to resource constraints. Most African Oncologists believed that accreditation ensures quality of education, and most standards were considered important. This data is useful for developing and adapting accreditation standards in resource-constrained settings.

Student Reflections on the Queen's Accelerated Route to Medical School Programme.

CONTEXT: Since its inception more than 150 years ago, the School of Medicine at Queen's University has aspired 'to advance the tradition of preparing excellent physicians and leaders in health care by embracing a spirit of inquiry and innovation in education and research'. As part of this continuing commitment, Queen's School of Medicine developed the Queen's University Accelerated Route to Medical School (QuARMS). As Canada's only 2-year accelerated-entry premedical programme, QuARMS was designed to reduce training time, the associated expense of medical training, and to encourage a collaborative premedical experience. Students enter QuARMS directly from high school and then spend 2 years enrolled in an undergraduate degree programme. They then are eligible to enter the first-year MD curriculum. The 2-year QuARMS academic curriculum includes traditional undergraduate coursework, small group sessions, and independent activities. The QuARMS curriculum is built on 4 pillars: communication skills, critical thinking, the role of physician (including community service learning [CSL]), and scientific foundations. Self-regulated learning (SRL) is explicitly developed throughout all aspects of the curriculum. Medical educators have defined SRL as the cyclical control of academic and clinical performance through several key processes that include goal-directed behaviour, use of specific strategies to attain goals, and the adaptation and modification to behaviours or strategies that optimize learning and performance. Based on Zimmerman's social cognitive framework, this definition includes relationships among the individual, his or her behaviour, and the environment, with the expectation that individuals will monitor and adjust their behaviours to influence future outcomes. OBJECTIVES: This study evaluated the students' learning as perceived by them at the conclusion of their first 2 academic years. METHODS: At the end of the QuARMS learning stream, the first and second cohorts of students completed a 26-item, 4-point Likert-type instrument with space for optional narrative details for each question. A focus group with each group explored emergent issues. Consent was obtained from 9 out of 10 and 7 out of 8 participants to report the 2015 survey and focus group data, respectively, and from 10 out of 10 and 9 out of 10 participants to report the 2016 survey and focus group data, respectively. Thematic analysis and a constructivist interpretive paradigm were used. A distanced facilitator, standard protocols, and a dual approach assured consistency and trustworthiness of data. RESULTS: Both analyses were congruent. Students described experiences consistent with curricular goals including critical thinking, communication, role of a physician, CSL, and SRL. Needs included additional mentorship, more structure for CSL, more feedback, explicit continuity between in-class sessions, and more clinical experience. Expectations of students towards engaging in independent learning led to some feelings of disconnectedness. CONCLUSIONS: Participants described benefit from the sessions and an experience consistent with the curricular goals, which were intentionally focused on foundational skills. In contrast to the goal of SRL, students described a need for an explicit educational structure. Thus, scaffolding of the curriculum from more structured in year 1 to less structured in year 2 using additional mentorship and feedback is planned for subsequent years. Added clinical exposure may increase relevance but poses challenges for integration with the first-year medical class.

The Development and Implementation of New Assessment Tools for the Surgical Clerkship Rotation.

This article was migrated. The article was marked as recommended. Innovation: We developed two new rubrics with explicit behavioural anchors to assess students in the Queen's undergraduate medical education (UGME) surgery clerkship rotation. These rotation rubrics, complemented by a new ambulatory clinic encounter card, improved the quality, consistency, and timeliness of feedback for clerks from faculty preceptors. This innovation was introduced during a comprehensive workplace-based assessment re-design being undertaken in the Department of Surgery as part of the transition to a post-graduate competency-based medical education (CBME) system for post-graduate education (PGME). The core UGME working group, comprised of a faculty surgeon, assessment consultant, and a surgical resident, selected terminology and designed the tool visual structure to be similar to the new post-graduate assessment tools, since most preceptors supervise learners in both programs. This consistency enhanced buy-in from faculty and ensured a smooth transition to the use of the new UGME tools. Development: The new assessment process was developed and piloted in three phases: (1) development of an assessment system based on rubrics with explicit behavioural descriptors as the key assessment tools; (2) implementation of a pilot study to establish the acceptability and feasibility of the use of these rubrics, with iterative revisions based on stakeholder feedback; and (3) development of a validity argument for the use of these assessment tools. The latter is scheduled for 2018. Outcomes: The use of these rotation behaviour-anchored rubrics and corresponding ambulatory clinic encounter card has greatly improved the mid- and final-rotation feedback provided to students on the Surgery Clerkship. The concrete, descriptive information provided by the rubrics allows the course director to provide specific feedback during rotation exit meetings. The course director has the ability to clearly articulate to students the areas where they have met (or exceeded) the expected level of competency, as well as areas which require additional attention.