The paediatrician and middle childhood parenting.

The 'forgotten years' of middle childhood, from age 6 to 12, represent a critical period in child development. Emotional, social and physical development during this time have a lifelong impact on health and adult contributions to society. Mental health conditions have displaced physical illness as the leading childhood disability. Positive parenting can improve child behaviour, prevent early-onset conduct problems and provide a buffer from adverse childhood events resulting in decreased toxic stress and improved health. Medical homes can play a key role in supporting parents with positive parenting skills that are practical, evidence-based and useful in everyday life. Paediatricians need to explore the domains that promote healthy development, including caring environments, fundamental needs and nurturing relationships. Our objective is to promote high-quality positive parenting through middle childhood by identifying opportunities for paediatricians to frame parenting discussions in the context of development, behaviour and safety and to provide access to valuable parenting resources.

Les « années oubliées ¼ de la phase intermédiaire de l'enfance, entre l'âge de six et 12 ans, sont une période critique du développement de l'enfant. Pendant cette période, le développement émotionnel, social et physique a des conséquences permanentes sur la santé et l'apport de l'adulte à la société. Les troubles de santé mentale ont remplacé les maladies physiques comme principale affection de l'enfance. Des pratiques parentales positives peuvent améliorer le comportement de l'enfant, prévenir les troubles des conduites d'apparition précoce et limiter les événements indésirables de l'enfance, réduisant ainsi le stress toxique et améliorant la santé. Les milieux médicaux peuvent beaucoup contribuer à soutenir les parents afin qu'ils acquièrent des compétences parentales positives pratiques, fondées sur des données probantes et utiles dans la vie quoti- dienne. Les pédiatres doivent explorer les sphères qui favorisent un développement sain, y compris les environnements attentionnés, les besoins fondamentaux et les relations aimantes. Afin de promouvoir des pratiques parentales positives de qualité tout au long de la phase intermédiaire de l'enfance, les auteurs visent à cerner les occasions que peuvent saisir les pédiatres pour structurer les discussions avec les parents sur le développement, le comportement et la sécurité et les orienter vers des ressources intéressantes sur ce type de pratiques.

An innovative on-call system for paediatric residency programs: The alternate night float.

BACKGROUND: Night-float systems, in which residents work consecutive nights, have been increasingly adopted in paediatric programs, but may be detrimental to residents' sleep and mood. OBJECTIVE: To describe the self-reported impact of a novel system consisting of two consecutive weeks of 16 h overnight shifts every second day that was piloted at the Children's Hospital of Eastern Ontario (Ottawa, Ontario). METHODS: A survey of 28 senior paediatric residents examined their experience with the alternate night-float system in three domains (patient care, resident professional development and well-being) and their comparison of the system with the traditional overnight on-call system. RESULTS: Twenty-six of 28 residents responded. Nearly all (96%) felt familiar with important details of inpatients and that handover was effective (92%). Results were mixed for professional development, with concerns about the quality of supervisors' feedback and perceived difficulty in attending daytime teaching. All residents believed that the night-float system provided a better learning experience compared with the traditional system. Less than 35% considered fatigue to be a notable problem, although 20% increased use of sleep aids or stimulants beyond their typical use. Ninety-six percent believed their workload was appropriate. All residents felt equally or less fatigued under the night-float system compared with the traditional system. Ninety-six percent recommended that the night-float model continue as the on-call system. CONCLUSIONS: This novel night-float system is an alternative method of providing paediatric inpatient night coverage because it meets duty hour regulations and has strong resident approval. Studies to examine its impact on residents and patient care in comparison with other systems are warranted.

HISTORIQUE: Les systèmes de garde de nuit, dans le cadre desquels les résidents travaillent plusieurs nuits consécutives, sont de plus en plus fréquents dans les programmes de pédiatrie, mais ils peuvent nuire au sommeil et à l'humeur des résidents. OBJECTIF: Décrire les répercussions autodéclarées d'un nouveau système constitué de deux semaines consécutives de quarts de nuit de 16 heures tous les deux jours, piloté à Ottawa, au Centre hospitalier pour enfants de l'est de l'Ontario. MÉTHODOLOGIE: Dans un sondage auprès de 28 résidents seniors en pédiatrie, les chercheurs ont examiné l'expérience de ces résidents au sein du système de garde de nuit tous les deux jours (soins aux patients, bien-être des résidents et perfectionnement professionnel) et les comparaisons que ces résidents ont faites avec le système de garde de nuit habituel. RÉSULTATS: Vingt-six des 28 résidents ont répondu. Presque la totalité (96 %) connaissait l'information importante sur les patients hospitalisés et trouvait le transfert des soins efficace (92 %). Les résultats étaient mitigés à l'égard du perfectionnement professionnel, car les résidents se préoccupaient de la qualité de la rétroaction des superviseurs et trouvaient difficile d'assister à l'enseignement pendant la journée. Tous les résidents trouvaient que le système de garde de nuit assurait une meilleure expérience d'apprentissage que le système habituel. Moins de 35 % considéraient la fatigue comme un problème notable, même si 20 % utilisaient plus d'aides au sommeil ou de stimulants qu'à l'habitude. De plus, 96 % trouvaient leur charge de travail adéquate. Tous les résidents se sentaient aussi fatigués ou moins fatigués dans le système de garde de nuit que dans le système habituel. Enfin, 96 % recommandaient d'adopter le modèle de garde de nuit comme système de garde. CONCLUSIONS: Ce nouveau système de garde de nuit est une autre méthode pour assurer les services nocturnes auprès des enfants hospitalisés. Il respecte la réglementation sur les heures de garde et est fortement approuvé par les résidents. Des études s'imposent pour en examiner les effets sur les résidents et les soins aux patients par rapport aux autres systèmes.

Students-As-Teachers: Fostering medical educators.

BACKGROUND: While mounting evidence supports various benefits of Students-As-Teachers (SAT) curricula in preparing students to teach, limited SAT electives are offered across Canada. We developed a 4-week SAT selective for fourth-year medical students at the University of Toronto to enhance medical education knowledge and teaching skills. This study aimed to evaluate the SAT programme and its impact on students' development as educators, their experience as learners and educators, and their future plans for involvement with medical education. APPROACH: Students participated in highly interactive small group seminars and teaching opportunities in nonclinical and clinical environments. Course evaluation consisted of pre-selective and post-selective surveys and written reflections on the selective experience and future career aspirations. A theory-based evaluation approach was utilized to compare the SAT programme's theory with course outcomes. EVALUATION: Post-SAT selective, students self-reported greater knowledge and confidence in teaching methods, provision of feedback, medical education scholarship, and interest in further medical education training. Student reflections highlighted three key themes. Identity formation as educators and the importance of mentorship in medical education aligned with our programme theory, while an unexpected outcome included a shifting perception on teaching and feedback from a learner to an educator lens. IMPLICATIONS: This study's findings demonstrate the ability of SAT curricula to build capacity for future medical educators. Positive factors contributing to the programme's outcomes included cohort size, course and seminar structure, and active group participation. Future iterations may explore use of flipped classroom models, additional clinical teaching opportunities, and near-peer teaching.

Fostering Transformative Learning in a Social Pediatrics Research Summer Studentship.

PROBLEM: Teaching future doctors the skills necessary to address health disparities is a challenge for medical educators. In response, the authors developed and implemented the Social Pediatrics Research Summer Studentship (SPReSS) program for medical students at the University of Toronto. APPROACH: The curriculum incorporated research and clinical placements into a formal seminar series. Participating students were required to complete a research project and to write a reflection describing a situation that challenged their thinking. The authors and curriculum developers applied transformative learning principles not only to facilitate critical reflection and learning in the students but also as an innovative approach to program development and evaluation. The authors conducted a thematic analysis of the reflections of 23 students participating in the program in June and July 2013, 2014, and 2015 to evaluate the SPReSS program. OUTCOMES: The analysis revealed students' empathic responses to marginalized patients, and these responses acted as triggers for critical reflection. Students described feeling empowered to act as advocates and wrote that these feelings were reinforced through faculty members' role modeling. According to their reflections, students found the program both challenging and rewarding, particularly the integration of the clinical and research experiences which made broader sociopolitical phenomena introduced through assigned readings and seminar discussions concrete. NEXT STEPS: The authors are exploring models, including a fourth-year selective or multiyear longitudinal experience, to support more students. They also hope to involve more community partners and to evaluate long-term outcomes of participants.

Structure of the inositol 1,4,5-trisphosphate receptor binding core in complex with its ligand.

In a variety of cells, the Ca2+ signalling process is mediated by the endoplasmic-reticulum-membrane-associated Ca2+ release channel, inositol 1,4,5-trisphosphate (InsP3) receptor (InsP3R). Being ubiquitous and present in organisms ranging from humans to Caenorhabditis elegans, InsP3R has a vital role in the control of cellular and physiological processes as diverse as cell division, cell proliferation, apoptosis, fertilization, development, behaviour, memory and learning. Mouse type I InsP3R (InsP3R1), found in high abundance in cerebellar Purkinje cells, is a polypeptide with three major functionally distinct regions: the amino-terminal InsP3-binding region, the central modulatory region and the carboxy-terminal channel region. Here we present a 2.2-A crystal structure of the InsP3-binding core of mouse InsP3R1 in complex with InsP3. The asymmetric, boomerang-like structure consists of an N-terminal beta-trefoil domain and a C-terminal alpha-helical domain containing an 'armadillo repeat'-like fold. The cleft formed by the two domains exposes a cluster of arginine and lysine residues that coordinate the three phosphoryl groups of InsP3. Putative Ca2+-binding sites are identified in two separate locations within the InsP3-binding core.