Anti-oppression pedagogy in health professions: a scoping review.

Health professional learners are increasingly called to learn about health inequity to reduce inequities and improve patient care and health outcomes. Anti-oppression pedagogy (AOP) addresses the need for health professional learners to understand multiple health inequities and the structures and systems that produce inequities. However, the inclusion of AOP in health professions education varies and there is a lack of clarity in its conceptualization and integration. A scoping review was conducted to address this gap and to understand how AOP is conceptualized and integrated in health professions education. Thirty-six articles met the inclusion criteria. The articles demonstrated that AOP is not commonly utilized terminology within health professions education. When AOP is integrated, it is not consistently conceptualized but is generally viewed as a broad concept that focuses on antiracism; decoloniality; intersectionality; and supporting learners to understand, critically reflect on, and act against structural and systemic forms of oppressions. In addition, there is variation in the integration of AOP in health professions education with the most common methods consisting of discussions, cases, reflection, learning through lived experiences, and the incorporation of humanities within a longitudinal curriculum. The results of this scoping review highlight the need for health professions education to develop one clear concept that educators use when teaching about anti-oppression, which may reduce working in silos and allow educators to better collaborate with each other in advancing this work. In addition, this review suggests that health professional programs should consider incorporating AOP in curricula with a broad and longitudinal approach utilizing the common methods of delivery. To better support programs in including AOP in curricula, further research is required to emphasize the benefits, provide clarity on its conceptualization, and determine the most effective methods of integration.

Individual differences in working memory capacity and visual search while reading.

Individual differences in working memory capacity are related to variations in a wide range of cognitive tasks. Surprisingly, effects of individual differences in working memory capacity are somewhat limited in visual search tasks. Here we tested the hypothesis that such an effect would be robust when search was one component of a dual task. Participants were presented strings of letters using rapid serial visual presentation and were required to detect all instances of a particular target letter. In Experiment 1, participants performed the letter search task in three contexts, while: (a) reading a prose passage, (b) processing a stream of random words, or (c) processing a random stream of non-words. In the absence of the dual task of reading prose, and in line with much of the literature on individual differences in working memory capacity and visual search, search performance was unaffected by working memory capacity. As hypothesized, however, higher working memory capacity participants detected more target letters than lower capacity participants in the "true" dual task (searching while reading prose). The hypothesized results from the prose passage were replicated in Experiment 2. These results show that visual search efficiency is dramatically affected by working memory capacity when searching is combined with another cognitive task but not when it is performed in isolation. Our findings are consistent with recent suggestions that visual search efficiency will be affected by working memory capacity so long as searching is embedded in a context that entails managing resource allocation between concurrent tasks.

Including patients and caregivers in assessment in the pediatric competence by design curriculum: A national consensus study.

Although evidence supports diverse assessment strategies, including patient/caregiver involvement in Competency-Based Medical Education (CBME), few residency programs formally include patients/caregivers in assessment. We aimed to determine the milestones for which patient/caregiver inclusion would be valuable in the Canadian Pediatric Competence By Design (CBD) curriculum.Program directors from 17 Canadian pediatric residency programs were invited to participate in a Delphi study. This Delphi included 209 milestones selected by the study team from the 320 milestones of the draft pediatric CBD curriculum available at the time of the study. In round 1, 16 participants representing 13 institutions rated the value of including patients/caregivers in the assessment of each milestone using a 4-point scale. We obtained consensus for 150 milestones, leaving 59 for re-exposure. In round 2, 14/16 participants rated remaining items without consensus. Overall, 67 milestones met consensus for 'valuable,' of which 11 met consensus for 'extremely valuable.' The majority of these milestones related to communication skills.Patient/caregiver assessment is valuable for 21% of milestones in the draft pediatric CBD curriculum, predominantly those relating to communication skills. This confirms the perceived importance of patient/caregiver assessment of trainees in CBME curricula; formal inclusion may be considered. Future directions could include exploring patients/caregivers' perspectives of their roles in assessment in CBD.

The perceptions and experiences of medical students in a pediatric buddy program: a qualitative study.

BACKGROUND: Partnership programs between medical students and patients provide students with non-clinical experiences that enhance medical learning, especially with respect to humanistic care. We explored the perceptions and experiences of medical students in a pediatric oncology buddy program. METHODS: Using a basic interpretive qualitative approach, we conducted interviews with 15 medical students at three time points: before meeting his/her buddy (pre-interview), four months into the partnership (4-month interview), and at the end of the partnership (post interview). We then conducted a thematic analysis of the interview data. RESULTS: All students in the program who met the study criteria (N = 15/16) participated. The medical students highlighted that: (a) providing support to buddies and their families is important; (b) providing care to children with serious illnesses is emotionally difficult; (c) developing deep connections with buddies and their families is rewarding; and (d) gaining empathy and personal fulfillment from buddies and their families is inevitable. CONCLUSIONS: This study provides an understanding of medical students' perceptions and experiences in a pediatric oncology, non-clinical buddy program. Tailored one-on-one partnerships between medical students and pediatric oncology patients play an important role in medical education and contributes to the teaching of humanistic care.

Patients' and parents' perspectives of and experiences with assessing nursing students' paediatric clinical practice.

PURPOSE: To explore patients' and parents' involvement in the formative assessment of undergraduate nursing students' paediatric clinical practice. METHODS: We conducted semi-structured interviews with paediatric patients between 14 to 18 years old and parents who received care from a nursing student while admitted to a paediatric tertiary care hospital in Canada. We analysed the data using qualitative content analysis as well as Lincoln and Guba's criteria for establishing trustworthiness. The Consolidated criteria for reporting qualitative studies (COREQ) checklist was completed for the quality appraisal of this article. FINDINGS: Three categories emerged from the data: 1) how patients and parents are currently involved in the formative assessment of nursing students' paediatric clinical practice; 2) how patients and parents would prefer to be involved in the formative assessment of nursing students' paediatric clinical practice; and 3) the potential benefits and challenges of involving patients and parents in the formative assessment of nursing students' paediatric clinical practice. CONCLUSION: This study provided an understanding of patients' and parents' past encounters with nursing students and the elements of care that they have assessed as well as those that they would prefer to assess and provide feedback on, while considering the potential benefits and challenges of their involvement. The findings of this study will assist clinical instructors in determining how and when to involve patients and parents in the assessment of nursing students. Academic institutions offering nursing programmes should consider the study findings when improving or changing formative assessment strategies.

Resident duty hours: Families' knowledge and perceptions in the paediatric intensive care unit.

BACKGROUND AND OBJECTIVES: Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members' perspectives on duty hours in the paediatric context. This study aimed to explore family members' knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency. METHODS: We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours. RESULTS: One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively). CONCLUSIONS: Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient-provider relationships, and further study is warranted.

Exploring residents' reactions to and use of parent feedback in a pediatric emergency department: A grounded theory study.

BACKGROUND: Competency-based medical education (CBME) involves workplace-based assessment. In pediatrics, patients' parents can participate in this assessment and generate feedback for residents. Prior to routinely collecting parent feedback, it is important to investigate residents' perspectives on it. AIM: To explore residents' reactions to and use of written parent feedback. METHODS: Using a grounded theory approach, we interviewed residents who received written parent feedback at the mid- and end-points of a pediatric emergency training rotation. RESULTS: Twenty-five residents participated. The residents reacted positively to the feedback. They thought that it complements educators' feedback, can elucidate parents' perspectives and needs, and is something that residents want and need. Although the residents thought that non-specific negative parent feedback is not useful, they believed non-specific positive and constructive parent feedback to be encouraging and useful. They delineated how they use non-specific positive parent feedback to boost their self-confidence and reassure themselves that parents perceive their clinical practices as appropriate. They also elucidated how they use constructive parent feedback to understand what is important to parents, become aware of their own behaviors, and modify their clinical practices. CONCLUSIONS: The findings encourage educators in pediatrics to include parents in resident assessment, especially in the CBME era.

Digital storytelling in health professions education: a systematic review.

BACKGROUND: Digital stories are short videos that combine stand-alone and first-person narratives with multimedia. This systematic review examined the contexts and purposes for using digital storytelling in health professions education (HPE) as well as its impact on health professionals' learning and behaviours. METHODS: We focused on the results of HPE studies gleaned from a larger systematic review that explored digital storytelling in healthcare and HPE. In December 2016, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, and ERIC. We included all English-language studies on digital storytelling that reported at least one outcome from Levels 2 (learning) or 3 (behaviour) of The New World Kirkpatrick Model. Two reviewers independently screened articles for inclusion and extracted data. RESULTS: The comprehensive search (i.e., digital storytelling in healthcare and HPE) resulted in 1486 unique titles/abstracts. Of these, 153 were eligible for full review and 42 pertained to HPE. Sixteen HPE articles were suitable for data extraction; 14 focused on health professionals' learning and two investigated health professionals' learning as well as their behaviour changes. Half represented the undergraduate nursing context. The purposes for using digital storytelling were eclectic. The co-creation of patients' digital stories with health professionals as well as the creation and use of health professionals' own digital stories enhanced learning. Patients' digital stories alone had minimal impact on health professionals' learning. CONCLUSIONS: This review highlights the need for high-quality research on the impact of digital storytelling in HPE, especially on health professionals' behaviours. PROSPERO REGISTRATION NUMBER: CRD42016050271 .

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments.

BACKGROUND: Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. METHODS: We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. RESULTS: Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. CONCLUSIONS: The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and

The hidden and informal curriculum across the continuum of training: A cross-sectional qualitative study.

PURPOSE: The hidden and informal curricula refer to learning in response to unarticulated processes and constraints, falling outside the formal medical curriculum. The hidden curriculum has been identified as requiring attention across all levels of learning. We sought to assess the knowledge and perceptions of the hidden and informal curricula across the continuum of learning at a single institution. METHODS: Focus groups were held with undergraduate and postgraduate learners and faculty to explore knowledge and perceptions relating to the hidden and informal curricula. Thematic analysis was conducted both inductively by research team members and deductively using questions structured by the existing literature. RESULTS: Participants highlighted several themes related to the presence of the hidden and informal curricula in medical training and practice, including: the privileging of some specialties over others; the reinforcement of hierarchies within medicine; and a culture of tolerance towards unprofessional behaviors. Participants acknowledged the importance of role modeling in the development of professional identities and discussed the deterioration in idealism that occurs. CONCLUSIONS: Common issues pertaining to the hidden curriculum exist across all levels of learners, including faculty. Increased awareness of these issues could allow for the further development of methods to address learning within the hidden curriculum.

The hidden and informal curriculum across the continuum of training: A cross-sectional qualitative study.

PURPOSE: The hidden and informal curricula refer to learning in response to unarticulated processes and constraints, falling outside the formal medical curriculum. The hidden curriculum has been identified as requiring attention across all levels of learning. We sought to assess the knowledge and perceptions of the hidden and informal curricula across the continuum of learning at a single institution. METHODS: Focus groups were held with undergraduate and postgraduate learners and faculty to explore knowledge and perceptions relating to the hidden and informal curricula. Thematic analysis was conducted both inductively by research team members and deductively using questions structured by the existing literature. RESULTS: Participants highlighted several themes related to the presence of the hidden and informal curricula in medical training and practice, including: the privileging of some specialties over others; the reinforcement of hierarchies within medicine; and a culture of tolerance towards unprofessional behaviors. Participants acknowledged the importance of role modeling in the development of professional identities and discussed the deterioration in idealism that occurs. CONCLUSIONS: Common issues pertaining to the hidden curriculum exist across all levels of learners, including faculty. Increased awareness of these issues could allow for the further development of methods to address learning within the hidden curriculum.

A qualitative exploration of which resident skills parents in pediatric emergency departments can assess.

BACKGROUND: Residents must strive for excellence in their nontechnical skills (NTS). However, NTS have not traditionally been well-assessed in pediatric emergency departments (EDs). One underutilized assessment strategy is to have parents assess the residents caring for their children. Prior to involving parents in resident assessment, it is essential to identify which NTS parents in pediatric EDs can assess. AIM: To explore which resident NTS parents in pediatric EDs can assess. METHODS: An exploratory qualitative study design was used. It included interviews with faculty members involved in the supervision and assessment of residents in a pediatric ED and residents who had experience working in a pediatric ED, as well as focus groups with parents who had visited a pediatric ED at least twice in the past year. RESULTS: Participants in this study suggested that parents, if provided with the opportunity, can assess residents' communication skills, comfort in a pediatric setting, adaptability, and collaboration. CONCLUSIONS: This study demystifies how parents can become involved in the assessment of residents' NTS. The findings will inform the development of assessment strategies and could be used to develop assessment instruments that enable parents to become actively involved in the assessment of residents in pediatric EDs.

Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety.

BACKGROUND: Pediatric residents must become proficient with performing a lumbar puncture (LP) during training. Residents have traditionally acquired LP skills by observing the procedure performed by a more senior resident or staff physician and then attempting the procedure themselves. This process can result in variable procedural skill acquisition and trainee discomfort. This study assessed changes in resident procedural skill and self-reported anxiety when residents were provided with an opportunity to participate in an interactive training session and practice LPs using a simulator. METHODS: All pediatric residents at our institution were invited to participate. Residents were asked to report their post-graduate year (PGY), prior LP attempts and self-reported anxiety scores as measured by the standardized State-Trait Anxiety Inventory - State Anxiety Scale (STAI-S) prior to completing an observed pre-test using an infant-sized LP simulator. Staff physicians observed and scored each resident's procedural skill using a previously published 21-point scoring system. Residents then participated in an interactive lecture on LP technique and were given an opportunity for staff-supervised, small group simulator-based practice within 1 month of the pre-test. Repeat post-test was performed within 4 months. RESULTS: Of the pediatric residents who completed the pre-test (N = 20), 16/20 (80 %) completed both the training session and post-test. Their PGY training level was: PGY1 (38 %), PGY2 (25 %), PGY3 (25 %) or PGY4 (12 %). Procedural skill improved in 15/16 residents (paired t-test; p < 0.001), driven by a significant improvement in skill for residents in PGY1 (P = 0.015) and PGY2 (p = 0.003) but not PGY3 or PGY4. Overall anxiety scores were higher at baseline than at post testing (mean ± SD; 44.8 ± 12.1 vs 39.7 ± 9.4; NS) however only PGY1 residents experienced a significant reduction in anxiety (paired t-test, p = 0.04). CONCLUSION: LP simulation training combined with an interactive training session may be a useful tool for improving procedural competence and decreasing anxiety levels, particularly among those at an earlier stage of residency training.

Connecting medical education to patient outcomes: The promise of contribution analysis.

This article presents a promising program evaluation approach, contribution analysis, which can be used to demonstrate the link between medical education programs and patient outcomes. Contribution analysis is a theory-based evaluation approach. It views programs as a part of causal packages that work together with other factors, interventions, and influences to bring about changes in specific outcomes. Although this approach is well suited for evaluating medical education programs, it has not yet been used in this area.

Pediatric caregiver involvement in the assessment of physicians.

BACKGROUND: Given the growth and benefits of consumerist and family-centred approaches to pediatric health care, there is a need to involve pediatric caregivers in the assessment of their children's physicians. DISCUSSION: We present interconnected questions that are important to address in order to facilitate pediatric caregiver involvement in the assessment of their children's physicians. Pediatric caregivers can be valuable assessors of physicians' non-technical skills. It is important to conduct additional research on caregiver involvement in assessment activities and create a reflective discourse on this topic. To ensure that pediatric caregivers' assessments of physicians are formally recognized and advantageous, it is important to understand: (a) what pediatric caregivers can assess; (b) what assessment tools exist for pediatric caregivers;

Neurophobia inception: a study of trainees' perceptions of neurology education.

OBJECTIVES: We wanted to examine the extent to which "neurophobia" exists among medical students and determine if students' perceptions of neurology differ by year of study while exploring the factors that contribute to the development of "neurophobia". METHODS: We used a two-phase, sequential, mixed-methods explanatory design in this single centre study. Phase 1 involved the collection and analysis of a questionnaire administered to students in the first three years of medical school. Phase 2 involved focus groups of a subgroup of students who demonstrated evidence of neurophobia in Phase 1. RESULTS: In total, 187 (39 %) undergraduate medical trainees responded to the questionnaire (response rates of 37%, 44% and 19% for first-, second- and third-year students, respectively). 24% of respondents indicated that they were afraid of clinical neurology and 32% were afraid of the academic neurosciences. Additionally, 46% of respondents thought that clinical neurology is one of the most difficult disciplines in medicine. Phase 2 findings revealed that many students reported negative preconceptions about neurology and commented on neurology's difficulty. Some experienced changes in these conceptions following their neurology block. Past clinical, educational, and personal experiences in neurology impacted their comfort level. CONCLUSIONS: This study shows that the level of comfort towards clinical neurology increases following students' participation in second-year neurology blocks, but that third-year students continue to show signs of neurophobia with lower comfort levels. It provides insight into why neurophobia exists amongst medical students and sheds light on pre-existing and emerging factors contributing to this sense of neurophobia.

Confusion of fear and surprise: a test of the perceptual-attentional limitation hypothesis with eye movement monitoring.

Of the basic emotional facial expressions, fear is typically less accurately recognised as a result of being confused with surprise. According to the perceptual-attentional limitation hypothesis, the difficulty in recognising fear could be attributed to the similar visual configuration with surprise. In effect, they share more muscle movements than they possess distinctive ones. The main goal of the current study was to test the perceptual-attentional limitation hypothesis in the recognition of fear and surprise using eye movement recording and by manipulating the distinctiveness between expressions. Results revealed that when the brow lowerer is the only distinctive feature between expressions, accuracy is lower, participants spend more time looking at stimuli and they make more comparisons between expressions than when stimuli include the lip stretcher. These results not only support the perceptual-attentional limitation hypothesis but extend its definition by suggesting that it is not solely the number of distinctive features that is important but also their qualitative value.

The h-index in medical education: an analysis of medical education journal editorial boards.

BACKGROUND: Disciplines differ in their authorship and citation practices, thus discipline-specific h-index norms are desirable. Thus the goal of this study was to examine the relationship between the h-index and academic rank in the field of medical education, and the differences in the h-index between MD's and PhD's in this field. METHODS: Due to the absence of a formalized registry of medical educators, we sampled available editorial board membership (considered a proxy for identifying 'career' medical educators) to establish h-index values. These were determined using Web of Science (WoS) and Google Scholar (GS), and internet searching was used to determine their academic rank. The correlation between authors' h-indices derived from WoS and GS was also determined. RESULTS: 130 editors were identified (95 full professors, 21 associate professors, 14 assistant professors). A significant difference was noted between the h-indices of full professors and associate/assistant professors (p < .001). Median h-indices equaled 14 for full professors (Interquartile range [IQR] =11); 7 for associate professors (IQR =7) and 6.5 for assistant professors (IQR = 8). h-indices of MD's and PhD's did not differ significantly. Moderate correlation between GS and WOS h-indices was noted R = 0.46, p < .001. CONCLUSIONS: The results provide some guidance as to the expected h-indices of a select group of medical educators. No differences appear to exist between assistant professor and associate professor ranks or between MD's and PhD's.

Knowledge of paediatric concussion among front-line primary care providers.

OBJECTIVE: To assess the knowledge of paediatric concussion diagnosis and management among front-line primary care providers. METHODS: Experts from the Concussions Ontario Diagnosis and Early Education Working Group developed a 34-item survey incorporating case vignettes with the collaboration of experts in medical education. Electronic surveys were distributed via FluidSurveys using a modified version of Dillman's tailored design method. The survey was distributed to five Ontario professional associations. The target participants were front-line health care providers (family physicians, emergency medicine physicians, general paediatricians, nurse practitioners and physician assistants) in Ontario; only providers who diagnose and/or manage paediatric concussions were eligible to participate. RESULTS: The survey was fully completed by 577 health care providers who treat paediatric concussion. Of the respondents, 78% (95% CI 74% to 81%) reported diagnosing ≥5 concussions annually. Physicians and nonphysicians equally recognized concussion (90% [95% CI 86% to 92%]; 85% [95% CI 77% to 90%], respectively). Only 37% (95% CI 32% to 41%) of physicians correctly applied graduated return to play guidelines. Return to learn recommendations were also insufficient: 53% (95% CI 49% to 58%) neglected to recommend school absence and 40% (95% CI (35% to 44%) did not recommend schoolwork accommodations. Only 26% (95% CI 22% to 30%) of physicians reported regular use of concussion scoring scales. CONCLUSIONS: Considerable gaps in knowledge exist in front-line primary care providers with inadequate application of graduated return to play and return to learn following concussion, as demonstrated by the present broad population-based survey. Consistent application of best evidence-based management using comprehensive guidelines may help to reduce the impact of concussion and persistent postconcussive problems in children and adolescents.

OBJECTIF: Évaluer les connaissances des dispensateurs de soins de première ligne au sujet du diagnostic et de la prise en charge des commotions cérébrales en pédiatrie. MÉTHODOLOGIE: Avec l'aide d'experts en formation médicale, des experts du groupe de travail sur le diagnostic et l'éducation précoce de Concussions Ontario ont préparé un sondage de 34 questions incluant des capsules cliniques. Les sondages électroniques, inspirés d'une version modifiée du modèle conceptuel adapté de Dillman, ont été distribués à cinq associations professionnelles de l'Ontario par l'entremise de FluidSurveys. Les dispensateurs de soins de première ligne (médecins de famille, urgentologues, pédiatres généralistes, infirmières praticiennes et auxiliaires médicaux) de l'Ontario étaient ciblés. Seuls les dispensateurs qui diagnostiquent ou prennent en charge les commotions cérébrales en pédiatrie pouvaient y participer. RÉSULTATS: Ont entièrement répondu au sondage 577 dispensateurs de soins qui soignent les commotions cérébrales en pédiatrie. De ce nombre, 78 % (95 % IC 74 % à 81 %) ont déclaré en diagnostiquer au moins cinq par année. Les médecins et les non-médecins dépistaient tout autant les commotions (90 % [95 % IC 86 % à 92 %]; 85 % [95 % IC 77 % à 90 %], respectivement). Seulement 37 % (95 % IC 32 % à 41 %) des médecins appliquaient correctement les directives sur le retour au jeu graduel. Les recommandations sur la reprise de l'apprentissage étaient également insuffisantes : 53 % (95 % IC 49 % à 58 %) négligeaient de recommander de s'absenter de l'école et 40 % (95 % IC (35 % à 44 %) ne recommandaient pas d'aménagements des travaux scolaires. Seulement 26 % des médecins (95 % IC 22 % à 30 %) déclaraient utiliser régulièrement les échelles de notation des commotions cérébrales. CONCLUSIONS: Les dispensateurs de soins de première ligne présentaient d'importantes lacunes sur le plan des connaissances. En effet, comme le démontre le présent vaste sondage en population, ils n'appliquaient pas correctement les règles de retour au jeu et de reprise de l'apprentissage graduels après une commotion. L'utilisation généralisée de modes de prise en charge exemplaires tirés de directives détaillées pour-rait contribuer à réduire les conséquences des commotions et des problèmes persistants qui en découlent chez les enfants et les adolescents.