Medical students' perspectives on and understanding of anesthesiology: a Canadian cross-sectional survey.

PURPOSE: In Canada, three out of 17 medical schools do not mandate an anesthesia rotation in their clerkship curriculum. Understanding the effects of a mandatory anesthesiology rotation is important in determining its value to the specialty and guiding decision-making for medical educators. We sought to determine whether a mandatory anesthesia rotation affected students' understanding of anesthesiology, as well as their perspectives on anesthesia. METHODS: We conducted an anonymous cross-sectional survey of Canadian medical students graduating in 2021. Our survey consisted of 46 questions related to student's perspectives of anesthesiology, understanding of anesthesia, their interest in the specialty, and participant's demographics. This included 16 Likert-scale questions, 19 quiz-style questions, four free-text response questions, and seven demographics questions. The survey was hosted by SurveyMonkey® (SurveyMonkey Inc., San Mateo, CA, USA) and distributed to the participants by each individual institution. RESULTS: We collected a total of 331 responses across 13 different Canadian medical schools, representing a 17.3% response rate of students surveyed and 11.7% of all graduating medical Canadian students in 2021. A mandatory rotation in anesthesiology was associated with a more positive perspective (P = 0.01) but not understanding (P = 0.07) of the specialty. A mandatory rotation was not related to students' application to anesthesiology at a statistically significant level (P = 0.06). CONCLUSIONS: The results of this national survey study show the benefits of including a mandatory clerkship rotation in anesthesiology, namely on increasing positive perceptions of the specialty, while also revealing avenues for future research and insights on how to further optimize a mandatory anesthesiology rotation in clerkship.

RéSUMé: OBJECTIF: Au Canada, trois facultés de médecine sur 17 n'exigent pas de stage clinique en anesthésie dans leur programme. Il est important de comprendre les effets d'un stage obligatoire en anesthésiologie afin de déterminer sa valeur pour la spécialité et d'orienter la prise de décision en matière d'éducation médicale. Nous avons cherché à déterminer si un stage obligatoire en anesthésie affectait la compréhension de l'anesthésiologie par les étudiant·es, ainsi que leurs points de vue sur l'anesthésie. MéTHODE: Nous avons mené un sondage transversal anonyme auprès d'étudiant·es en médecine qui ont obtenu leur diplôme en 2021 au Canada. Notre sondage comportait 46 questions portant sur leur point de vue sur l'anesthésiologie, leur compréhension de l'anesthésie, leur intérêt pour la spécialité et les caractéristiques démographiques des personnes interrogées. Le sondage comprenait 16 questions sur l'échelle de Likert, 19 questions courtes de type quiz, quatre questions à réponse libre et sept questions démographiques. Le sondage était hébergé par SurveyMonkey® (SurveyMonkey Inc., San Mateo, Californie, États-Unis) et a été distribué aux participant·es par chaque institution. RéSULTATS: Nous avons recueilli un total de 331 réponses dans 13 facultés de médecine canadiennes différentes, ce qui représente un taux de réponse de 17,3 % des étudiant·es interrogé·es et de 11,7 % de tous les étudiant·es en médecine diplômé·es en 2021 au Canada. Un stage obligatoire en anesthésiologie était associé à une perspective plus positive (P = 0,01) mais pas à une meilleure compréhension (P = 0,07) de la spécialité. Un stage obligatoire n'était pas lié aux demandes d'admission en anesthésiologie à un niveau statistiquement significatif (P = 0,06). CONCLUSION: Les résultats de cette enquête nationale montrent les avantages de l'inclusion d'un stage obligatoire en anesthésiologie, notamment pour accroître les perceptions positives de la spécialité, tout en révélant des pistes de recherche futures et des idées sur la façon d'optimiser davantage un stage clinique obligatoire en anesthésiologie.

Feminizing hormone therapy in a Canadian cohort of transgender women with and without HIV.

BACKGROUND: Potential bidirectional drug-drug interactions between feminizing hormone therapy (FHT) and antiretroviral therapy (ART) are of concern for trans women with HIV and their healthcare providers. This study aimed to characterize patterns of FHT and ART among trans women with HIV and to compare serum hormone levels to trans women without HIV. METHODS: Charts of trans women were reviewed at seven HIV primary care or endocrinology clinics in Toronto and Montreal from 2018 to 2019. ART regimens, FHT use, serum estradiol, and serum testosterone levels were compared on the basis of HIV status (positive, negative, missing/unknown). RESULTS: Of 1495 trans women, there were 86 trans women with HIV, of whom 79 (91.8%) were on ART. ART regimens were most commonly integrase inhibitor-based (67.4%), many boosted with ritonavir or cobicistat (45.3%). Fewer (71.8%) trans women with HIV were prescribed FHT, compared to those without HIV (88.4%) and those with missing/unknown status (90.2%, p < 0.001). Among trans women on FHT with recorded serum estradiol (n = 1153), there was no statistical difference in serum estradiol between those with HIV (median: 203 pmol/L, IQR: 95.5, 417.5) and those with negative (200 mol/L [113, 407]) or missing/unknown HIV status (227 pmol/L [127.5, 384.5) (p = 0.633). Serum testosterone concentrations were also similar between groups. CONCLUSIONS: In this cohort, trans women with HIV were prescribed FHT less often than trans women with negative or unknown HIV status. There was no difference in serum estradiol or testosterone levels of trans women on FHT regardless of HIV status, providing reassurance regarding potential drug-drug interactions between FHT and ART.