ABSTRACT
BACKGROUND: Visual art has been increasingly incorporated into medical education and has been shown to enhance important competencies, such as empathy. However, limited evidence on effective visual art program design and evaluation processes remain. This systematic review examines the format, content, and espoused outcomes of visual art-based training programs in undergraduate medical education. METHODS: A comprehensive literature search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ProQuestERIC on undergraduate medical education and visual arts retrieved 1703 articles published from 2014 to 2020. After reviewing inclusion and exclusion criteria, 23 articles were chosen for full review and synthesis. RESULTS: Program format and content varied, ranging from 1-day specific competency focused programs to well-structured comprehensive 6-12-week programs. 6 areas of program foci were identified: observation skills, empathy, tolerance to uncertainty, cultural sensitivity, team building and collaboration, and wellness and resiliency. Although several programs used validated measures to assess skills acquisition, they seldom addressed long-term outcomes. CONCLUSIONS: Our findings indicate that visual art-based education hold a promise to enhance important competencies in medical education, particularly empathy. Clinical observation, in particular, had the strongest evidence of its effectiveness compared to the other competencies. Future programs incorporating visual arts will benefit from a longitudinal (greater than 6 weeks) program which incorporates guided artworks, reflection exercises, and a group discussion to provide a stronger foundation for the development of core competencies. We propose using validated scales to measure outcomes in future studies and follow-up with participants to better assess Kirkpatrick Level 3 and 4 outcomes.
Subject(s)
Education, Medical, Undergraduate , Education, Medical , Clinical Competence , Cultural Competency , Empathy , HumansABSTRACT
Medical school clerkship offers third year medical students multiple opportunities to acquire clinical experience through real patient interactions and integration into the healthcare teams of different specialties. As part of the general surgery rotation, medical students are invited to scrub in to assist with surgeries-a chance to simultaneously gain medical knowledge while developing technical skills. In what is often an impersonal experience for most patients, students are encouraged to consider the patient's perspective throughout their surgical journey from the pre-operative to post-operative stages. In this reflection, a third year medical student discusses her experience on the moments before breast surgery. From the point of view of a breast cancer patient, she reflects on the impact of a mastectomy on a patient's identity and comments on the importance of empathy in helping a patient grapple with their unique illness experience.
Subject(s)
Breast Neoplasms , Clinical Clerkship , Education, Medical, Undergraduate , General Surgery , Students, Medical , Breast Neoplasms/surgery , Female , General Surgery/education , Humans , Mastectomy , Schools, MedicalABSTRACT
Medical school clerkship offers third year medical students multiple opportunities to acquire clinical experience through real patient interactions and integration into the healthcare teams of different specialities. As part of the general surgery rotation, medical students are invited to scrub in to assist with surgeries-a chance to simultaneously gain medical knowledge while developing technical skills. They learn that there is a possibility of inflicting harm to the patient at every step of any surgery; from making the first skin incision to tying up the final suture, the importance of staying alert is emphasized until the patient is transferred out of the operating room in stable condition. However, the obligation of a physician to do no harm extends beyond the surgery. In this reflection, a third year medical student discusses her experience during an hours-long Whipple procedure. She reflects on the impact of a cancer diagnosis on a patient's identity and narrative and comments on the necessity of maintaining a balance between offering medical guidance to patients and offering the space for them to express their unique illness experience.
Subject(s)
Clinical Clerkship , Education, Medical, Undergraduate , Neoplasms , Students, Medical , Clinical Competence , Female , Humans , Schools, MedicalABSTRACT
BACKGROUND: Involving patients in medical education as teachers is not a novel approach, yet it has not been widely adopted by undergraduate surgical curricula in Canada. The Patients as Teachers initiative in surgery (PAT) program, with an arts-based reflection assignment, was developed for surgical clerks with the goals of emphasizing patient-centredness in surgical practice, humanistic aspects of medicine, and to counterbalance the commonplace emphasis on technical competency in surgery. METHODS: Qualitative data was collected exploring the question: What was the experience and impact of the PAT program on patient teachers and students? Patient teachers (n = 5) were invited to participate in one-on-one interviews and students (n = 46) were invited to participate in focus groups at the end of the program. RESULTS: Findings converged around two main themes: what students/patient teachers valued about the PAT program and what they perceived was learned. While patient teachers felt a sense of emotional healing and appreciated a chance to contribute to medical education, students valued having protected time to learn in depth from the patient teachers. Students also begrudgingly came to appreciate the arts-based reflection assignment. CONCLUSION: By bringing patient voice to the forefront and encouraging reflection, the PAT program emphasized to students the compassionate and humanistic side of surgical care. Future studies could examine the mechanisms by which learning occurs and long-term impacts.
Subject(s)
Clinical Clerkship , Education, Medical, Undergraduate , Education, Medical , Students, Medical , Canada , Curriculum , Humanism , HumansABSTRACT
Summary: Surgeons are frequently perceived by medical students to be uncompassionate, resolute and individualistic. Surgical education often prioritizes teaching and learning approaches that perpetuate these perceptions. In other specialties, engaging patients in education has shown promise in refocusing attention from the technical and procedural aspects of care toward the humanistic and social aspects. Despite proven favourable outcomes for both patients and students in many clinical areas, a "patient as teacher" approach to surgical education has yet to be adopted widely in Canada. A patient as teacher program was developed for surgical clerks at the University of Toronto with the goal of emphasizing the humanity of the patient, the psychosocial impact of a surgical diagnosis of breast cancer on patients and their families, and the social and humanistic roles for surgeons in providing patient-centred care. We report on the program's development process and pilot session.
Subject(s)
Clinical Clerkship/methods , Education, Medical/methods , General Surgery/education , Program Development , Students, Medical , Canada , HumansABSTRACT
It has been 10 years since the first class of Society of Surgical Oncology (SSO) fellowship trained Breast Surgical Oncologist entered practice. To date, there has been no publications examining the effectiveness of these training programs that are today throughout North America and Europe. This evaluative review examines the effectiveness of these fellowship training programs through the lens of the Kirkpatrick Evaluation Model. An extensive review of the literature was performed, and articles were categorized to capture how fellows are reacting to the program, what they are learning, and how the program is effecting their career path and impacting their patients. We can conclude that there is both direct and indirect evidence to support the effectiveness of this training program, but there is a paucity of direct evidence as one progresses from a level 1 Kirkpatrick analysis to a level 4. This review sets the framework for program evaluation in surgical fellowships and should encourage stakeholders to constantly evaluate the impact their program is having on trainees and oncology patients.
Subject(s)
Breast Neoplasms/surgery , Clinical Competence/standards , Fellowships and Scholarships/standards , Program Evaluation , Surgical Oncology/education , Surgical Oncology/organization & administration , Education, Medical, Continuing , Educational Measurement , Female , Humans , North AmericaABSTRACT
BACKGROUND: The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation. STUDY DESIGN: Using critical qualitative inquiry and purposive sampling to ensure sex, geographical, and student or trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semistructured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by 4 analysts. RESULTS: Twenty-seven participants including 18 medical students and 9 residents, were interviewed. The results showed 3 major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation, and insufficient safe spaces as the key deterrents to program completion. The intersection with sex exponentially increased these identified barriers. CONCLUSIONS: Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.
Subject(s)
Internship and Residency , Qualitative Research , Racism , Students, Medical , Adult , Female , Humans , Male , Canada , Career Choice , General Surgery/education , Interviews as Topic , Students, Medical/psychology , Students, Medical/statistics & numerical data , Black PeopleABSTRACT
Introduction: Pre-clerkship medical students rely on various educational experiences to decide on the residency they would like to pursue. We conducted a longitudinal mixed-methods study to identify educational experiences in pre-clerkship that are associated with an interest in pursuing surgery. Methods: Pre-clerkship medical students were invited to complete an initial survey regarding their interest in surgery and educational exposures. After 10 months, a follow-up survey was sent to identify changes in their interest and the role of educational experiences they may have had in the interim. Univariate regression was used to determine associations, and thematic analysis was done. Results: Data from 218 pre-clerkship students showed that shadowing (OR = 2.7), participation in technical workshops (OR = 5.1), having a mentor (OR = 4.6) and conducting surgical research (OR = 4.6) were associated with an interest in pursuing surgery. From the students with follow-up data, thematic analysis showed that 94 %, 89 %, and 81 % of students found shadowing, research, and mentorship, respectively, as influential in the decision of pursuing a surgical specialty, respectively. Conclusions: Shadowing and mentorship were important factors for students in the decision-making process in pursuing surgery. Identifying high-yield educational experiences-for students to determine if one wants to pursue a surgical specialty is important for educators in curriculum design for resource allocation. Key message: We describe a longitudinal mixed-methods study to determine the role of early educational exposures which influence a medical student's decision to pursue a surgical specialty. Shadowing, technical skills workshops, surgical mentorship, involvement in surgical research, play an important role for student decisions.
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Introduction: The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. Methods: A novel, single question evaluation tool was created. Third year medical-students were asked to "list the top 5 attributes of a surgeon, in order of perceived importance" both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either "humanistic" or "non-humanistic," which were then analyzed using generalized linear regression models under a Bayesian framework. Results: After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. Conclusion: This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.
Introduction: L'objectif de cette étude était de déterminer si l'introduction d'une nouvelle approche d'évaluation associant la participation de Patients comme enseignants (PCE) à une Réflexion basée sur les arts (RBA) dans un stage d'externat en chirurgie permettait de mieux percevoir les qualités humanistes chez les chirurgiens. Méthodes: Un nouvel outil d'évaluation à question unique a été créé. Des étudiants en troisième année de médecine ont été invités à ''énumérer les cinq principaux attributs d'un chirurgien, par ordre d'importance perçue'', avant et après leur stage d'externat en chirurgie et le programme PCE/RBA. Les attributs identifiés par les étudiants ont été codés comme « humanistes ¼ ou « non humanistes ¼, puis analysés à l'aide de modèles de régression linéaire généralisée dans un cadre bayésien. Résultats: Après leur participation au programme PCE/RBA, la probabilité prédite moyenne que les étudiants classent un trait humaniste comme l'attribut le plus important d'un chirurgien a augmenté de 17 %, et la probabilité prédite que les étudiants classent un trait humaniste parmi les trois premiers attributs d'un chirurgien a augmenté de 21 %. Conclusion: Cette méthode d'évaluation innovante porte à croire que le programme PCE/RBA réussit en effet à favoriser une vision humaniste de la chirurgie. Cette approche peut être explorée pour évaluer d'autres activités de formation axées sur l'humanisme.
Subject(s)
Educational Personnel , Students, Medical , Surgeons , Humans , Bayes TheoremABSTRACT
PURPOSE: To determine whether smoking status (active/passive) affects recurrence events after breast cancer (BC) diagnosis among women. METHODS: A comprehensive literature search of MEDLINE, Cochrane Central, EMBASE, and Web of Science databases on smoking status and BC outcomes retrieved 5,940 articles. After reviewing the inclusion and exclusion criteria, we selected 14 articles for a full review and synthesis. RESULTS: Five studies were cohort retrospective, 6 were case-control, 2 were prospective cohort studies, and 1 was a secondary analysis of a randomized control trial. Among the 8 articles that focused on active smoking, 6 showed an increased risk of BC recurrence, and 2 showed no evidence of such an association. Studies that examined former smokers found little evidence of an increased risk of BC recurrence. This association may be dose-dependent. CONCLUSION: Given the current evidence, although limited, active smokers should quit smoking after BC diagnosis as trends indicate a positive association between active smoking and BC recurrence. More robust evidence is needed to assess such associations and examine the outcomes of quitting smoking in such patients.
ABSTRACT
OBJECTIVE: Despite greater female than male-identifying Canadian medical graduates, women continued to be underrepresented in surgical specialties. The aim of this study was to explore the role of lifestyle challenges and gender-specific considerations in career selection for first-year medical students following early exposure to surgery through an immersive surgical program. DESIGN: A single institution, qualitative study consisting of structured focus groups before and after completion of a 2-week surgical program was used to explore medical student perceptions of surgery. The program consisted of shadowing, surgeon-led talks, and surgical skills workshops in all direct-entry surgical specialties within the Department of Surgery at the University of Toronto. Six entry and exit interviews were conducted by 2 authors. Interviews were recorded, transcribed, and coded for thematic analysis. SETTING: Teaching hospitals affiliated with the University of Toronto, Canada PARTICIPANTS: Thirty first-year medical students with interest in surgery participated in the program and the focus groups. RESULTS: Four prominent themes emerged: gender imbalances in the work environment, the importance of female mentors, gender-specific challenges of parenting, and the importance of flexible work hours for both male and female students. Greater exposure to female surgeons improved the outlook of medical students on work-life balance. Medical students are concerned with the challenges of pregnancy in a surgical profession. Both male and female students consider parenting, supportive partners, and flexibility of work hours in their career selection. CONCLUSION: This study demonstrates the prevalence of gender bias in surgical specialties, raising gender-specific challenges that impact career selection for first-year medical students. In an effort to address these perceptions, this study supports efforts to implement formalized mentorship programs for women in surgery early in medical education. Furthermore, concerns surrounding childbearing further support the need for well-established parental leave policies in the Canadian postgraduate medical education system.
Subject(s)
Students, Medical , Canada , Career Choice , Female , Humans , Male , Operating Rooms , Pregnancy , SexismABSTRACT
BACKGROUND: Mammary ductoscopy allows direct visualization of ductal epithelium using a fibreoptic microendoscope. As the first centre in Canada to apply ductoscopy to surgical practice, we report our experience with this technology. METHODS: Between 2004 and 2008, 65 women with pathologic nipple discharge underwent ductoscopy before surgical duct excision under general anesthetic. Prospective data collection included cannulation and complication rates, procedure length and lesion visualization rate compared with preoperative ductography, if performed. In addition, we classified the endoscopic appearance according to Makita and colleagues and correlated it with surgical pathology. RESULTS: It took longer than 6 months to overcome technical problems before the routine use of ductoscopy in the operating room. The ductoscope was easy to use: we achieved cannulation in 63 of 66 breast ducts (95%) and we visualized a lesion in 52 of 63 breast ducts (83%). The mean procedure length was 5.1 minutes, with no complications. Lesions seen on ductography were seen endoscopically 30 of 33 (91%) times. All 3 malignancies were seen: invasive carcinoma in 1 of 62 (1.6%) and in situ disease in 2 of 62 (3.2%) patients. Surgeons found ductoscopy helpful in defining the extent of duct excision. Except for the "polypoid solitary" class, which accurately predicted a papilloma (23/23), we found poor correlation between Makita and colleague's endoscopic classification and final pathology. CONCLUSION: Ductoscopy is feasible, safe and practical. Our surgeons routinely use it to identify the location and extent of duct excision without ordering preoperative ductography. Identifying pathology based on the endoscopic appearance is unreliable unless the lesion is solitary and polypoid.
Subject(s)
Breast Diseases/diagnosis , Endoscopy , Mammary Glands, Human/surgery , Nipples/surgery , Adult , Aged , Canada , Exudates and Transudates , Female , Fiber Optic Technology , Humans , Middle AgedABSTRACT
INTRODUCTION: Management of early breast cancer in the elderly population is challenging due to different breast cancer biology and limited tolerance to aggressive treatments. The aim of this study is to evaluate whether the omission of axillary staging impacts breast cancer outcomes in elderly patients. PATIENTS AND METHODS: A systematic review and meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The electronic databases were searched in August 2014 using the following inclusion criteria: RESULTS: Two RCTs met the eligibility criteria and were included. A meta-analysis of the included RCTs of 692 patients found that axillary staging reduced the risk of axillary recurrence compared to no axillary staging (RR 0.24, 95% CI: 0.06 to 0.95, I2=0%, p=0.04). There were no differences observed in in-breast recurrence or distant recurrence (RR 1.20, 95% CI: 0.55 to 2.64, I2=62%, p=0.65, RR 1.17, 95% CI: 0.75 to 1.82, I2=0%, p=0.48, respectively). There were no differences observed in overall or breast-cancer specific mortality (RR 0.99, 95% CI: 0.79 to 1.24, I2=0%, p=0.92, RR 1.07, 95% CI: 0.72 to 1.57, I2=0%, p=0.75, respectively). DISCUSSION: Omission of axillary staging in elderly patients with clinically negative axillae results in increased regional recurrence but does not appear to impact survival.
Subject(s)
Breast Neoplasms/mortality , Early Detection of Cancer/mortality , Lymphatic Metastasis/diagnosis , Age Factors , Aged , Axilla , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Disease-Free Survival , Female , Humans , Lymph Node Excision/statistics & numerical data , Neoplasm Staging , Randomized Controlled Trials as Topic , Recurrence , Risk , Treatment OutcomeABSTRACT
As one migrates from an area of low to high incidence of breast cancer their personal risk of developing breast cancer increases. This is however not equally distributed across all races and ethnicities. This paper specifically examines Filipino migrants. A literature review was conducted to summarize breast cancer incidence, screening practices and trends in treatment amongst Filipino migrants. In addition, a retrospective cohort study was conducted specifically examining the age in which Filipino women were diagnosed with breast cancer compared to Asian and Caucasian counterparts. Filipino women are diagnosed with breast cancer at a statistically significant younger age (53.2) compared to their Asian (55.1) and Caucasian (58.4) counterparts. In addition, they are at an increased risk of developing more aggressive breast cancer with noteworthy disparities in the care they are receiving. The evidence suggest this group is worthy of special focus when diagnosing and treating breast cancer.
Subject(s)
Asian People , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Transients and Migrants , Age Factors , Canada/epidemiology , Cohort Studies , Female , Humans , Middle Aged , Philippines/ethnology , Retrospective StudiesABSTRACT
This paper is a review of the literature examining the use of medical simulations to teach our future healthcare providers how to diagnose breast cancer. MEDLINE and Embase databases were searched to identify the literature published between 1990 and 2014. In total, 113 articles were retrieved and evaluated for their relevance to the topic. Simulation methods, such as standardized patients and breast models were found to enhance students' abilities to perform patient histories and physical examinations to detect breast cancer. In addition, simulation can help trainees learn how to communicate bad news to patients effectively. There is an abundance of literature supporting the continued use of simulations in the curricula of medical schools. However, future studies based on sound theoretical frameworks are needed to evaluate the positive effects of simulation-based education on patient outcomes.