A brief psychoeducational intervention improves memory contentment in breast cancer survivors with cognitive concerns: results of a single-arm prospective study.

PURPOSE: One in three breast cancer survivors experiences persistent cognitive changes that can negatively impact daily functioning and quality of life. In our cancer center, the largest tertiary cancer center in Canada, patients with self-reported cancer-related cognitive dysfunction (CRCD) are offered psychoeducation intended to reduce distress about CRCD symptoms and improve everyday cognitive performance, but evidence regarding this intervention's impact is lacking. Here, we assess whether a 1-hour (h), individual psychoeducational intervention designed to promote self-management of CRCD symptoms can improve attitudes and coping with memory-related difficulties in women with breast cancer. METHODS: Breast cancer survivors with self-reported CRCD (N = 100) were assessed immediately before, immediately after, and 6 weeks following the intervention. Participants' memory contentment, knowledge of CRCD, symptom distress, and self-efficacy to cope with symptoms were measured. RESULTS: Participants showed improvements in memory contentment immediately after the intervention (Cohen's d effect size and 95% CI = 0.87 [0.58, 1.16]) and 6 weeks later (d = 0.77 [0.48, 1.05]). Significant improvements in secondary study outcomes, including knowledge of CRCD (d = 1.32 [1.01, 1.63]), symptom distress (d = - 0.82 [- 1.11, - 0.53]), and self-efficacy to cope with cognitive symptoms (d = 1.45 [1.14, 1.76]), were also observed. CONCLUSIONS: A single, 1-hour psychoeducational intervention can achieve lasting and improved adjustment to memory symptoms in breast cancer survivors with self-reported CRCD. Further investigation using a randomized controlled study design is warranted. Comparisons with previously reported psychoeducational interventions for CRCD are made, and next steps for this research are discussed.

Investigating student perceptions at an interprofessional student-run free clinic serving marginalised populations.

Many health profession schools have student-run free clinics (SRFCs), but their educational relevance has not been well studied. The aim of this study was to evaluate the learning experiences and skills developed among interprofessional healthcare students at an SRFC serving marginalised populations, in order to provide data for ongoing programme improvement and recommendations for other SRFCs based on lessons learned. Under 1:1 supervision with a preceptor, interprofessional students completed three clinical shifts at an SRFC and attended a reflection session. A total of 101 out of 105 participants answered semi-structured pre- and post-programme surveys (response rate: 96%). Descriptive statistics and descriptive thematic analyses were used for quantitative and qualitative data, respectively. Numerous skills derived from learning objectives common to many healthcare professions were addressed while participating at the SRFC. Valued programme elements included working with and learning about inner city populations in an interprofessional care model. Interprofessional SRFCs encourage student learning about resources for inner city populations and interprofessional collaboration while providing an opportunity to develop skills related to the formal curriculum. This may provide a workable strategy to address an interprofessional education gap in the healthcare professional curriculum.

Information Needs of Hepato-Pancreato-Biliary Surgical Oncology Patients.

A marked knowledge gap exists concerning the information needs of hepato-pancreato-biliary (HPB) surgical oncology patients. We investigated the comprehensive information needs of this patient population, including the type and amount of information desired, as well as the preferred method of receiving information. A questionnaire was administered to patients being treated surgically for cancers of the liver, pancreas, gallbladder, or bile ducts at Toronto General Hospital, part of the University Health Network, in Toronto, Canada. The questionnaire examined patients' information needs across six domains of information: medical, practical, physical, emotional, social, and spiritual. Among 36 respondents, the importance of information and amount of information desired differed significantly by domain (both p < 0.001). This group of patients rated information in the medical and physical domains as most important, though they also desired specific items of information from the emotional, practical, and social domains. Patients' overwhelming preference was to receive information via a one-on-one consultation with a healthcare provider. It is important for healthcare providers working with HPB surgical oncology patients to be comprehensive when providing information related to patients' cancer diagnosis, prognosis, associated symptoms, and side effects of treatment. Certain emotional, practical, and social issues (e.g., fears of cancer recurrence, drug coverage options, relationship changes) should be addressed as well. Face-to-face interactions should be the primary mode of delivering information to patients. Our findings are being used to guide the training of healthcare providers and the development of educational resources specific to HPB surgical oncology patients.

Investigating Patient and Physician Delays in the Diagnosis of Head and Neck Cancers: a Canadian Perspective.

Diagnostic delays for head and neck cancer (HNC) patients are common. Patients often disregard symptoms for long periods before seeking help, and some family physicians may not be alert to the warning symptoms and signs of HNCs. This study evaluated the factors associated with length of delays in the diagnosis of HNCs in a Canadian population. This was a mixed-method study consisting of patient interviews and surveys in an academic health center. A questionnaire requesting demographic and disease information was completed by HNC patients followed by a 30 min semi-structured interview in a private setting. Interviews were audio recorded, transcribed, anonymized, and descriptively coded for emergent themes. Twenty-eight head and neck cancer patients participated in the study. More patients experienced physician delay (71 %) than patient delay (36 %). The median physician delay and patient delay were 108 and 31 days, respectively. Two main themes regarding these delays were (1) physician lack of knowledge and (2) lack of patient awareness. Results indicate that physician delay needs to be focused on compared to patient delay, as it is more common and has longer delays. More comprehensive training in head and neck clinical examination skills during undergraduate and residency training is recommended to reduce physician delay. Patient delay could be targeted by public education programs via both physicians and dentists.

Investigating coping strategies and social support among Canadian melanoma patients: A survey approach.

Complex support needs are involved in coping with a diagnosis of melanoma. The purpose of this study was to determine the perceived social support levels and utilization of adaptive and maladaptive coping strategies by Canadian melanoma patients. The impact of social support level on coping strategy utilization was also examined. Social support and coping strategies were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS) and the 28-item Brief COPE, respectively. Perceived levels of emotional/informational support were significantly lower than affectionate support and positive social interaction. Acceptance, active coping, and use of emotional support were the most frequently utilized coping strategies. Patients with higher perceived levels of social support had significantly higher adaptive coping scores than patients with lower levels of social support. Health care professionals have an important role in promoting awareness of and access to emotional and informational support resources in order to improve perceived social support levels.

Primary Care Perspectives on Education Scholarship: A Qualitative Synthesis.

BACKGROUND AND OBJECTIVES: A significant portion of medical education takes place in primary care settings with family medicine clinician teachers that have variable backgrounds in teaching. Ernest Boyer's concept of education scholarship calls on faculty to systematically study and innovate their teaching practices. This meta-ethnographic review synthesizes the literature on primary care clinician teachers' perspectives and experiences of integrating education scholarship in practice. METHODS: We conducted an electronic database search in PubMed/Medline, Scopus, ERIC, and Web of Science for primary research articles published between January 2000 and August 2021. In the included articles, researchers studied primary care physicians' and/or residents' perspectives of clinical teaching and reported qualitative results (eg, interviews, focus groups). Of the 1,454 articles found in the search, we included 33 in the final synthesis. We used line-by-line descriptive coding of the qualitative data to develop analytical themes. RESULTS: Four main themes emerged from our synthesis: (1) perceptions of clinical teaching (lack of confidence, presumed teaching competency, lack of formal recognition); (2) clinical teaching strategies (learner-centered teaching, ad hoc teaching, role modeling, mentorship); (3) benefits of clinical teaching (shared learning experience, networking, personal interest, career satisfaction); and (4) challenges of clinical teaching (inadequate time, compensation, conflicting responsibilities). CONCLUSIONS: Clinician teachers identified several common factors regarding their scholarly roles but had difficulty describing them in relation to education scholarship. Institutional support, resources, and awareness are needed to assist family medicine clinician teachers to further implement Boyer's concept of education scholarship in practice-specifically, to study, evaluate, and innovate current clinical teaching strategies.

Residency spiral concussion curriculum design.

BACKGROUND: Resident-focused concussion curricula that measure learner behaviours are currently unavailable. We sought to fill this gap by developing and iteratively implementing a Spiral Integrated Concussion Curriculum (SICC). APPROACH: Programme elements of the concussion curriculum include academic half-days (AHDs) and three half-day clinics for first- and second-year family medicine residents. Our SICC utilises social cognitive learning principles, the constructivism paradigm and utilisation-focused evaluation. EVALUATION: A mixed-method evaluation with a pre-/post-test design and interviews was utilised. Surveys and knowledge tests were used to measure knowledge and confidence pre-AHD and 6 months post-AHD. Interviews at 6 months explored programme perception and behaviour change. Of the 141 programme attendees, 114 (80%) participated in the pre-intervention knowledge test and 33 completed the pre- and post-AHD test. Immediate pre-/post-testing demonstrated statistically significant improvement in knowledge (p = 0.042). At 6 months post-AHD, residents in Cycle 1 (n = 5) had a knowledge decrease of 3.33% (p > 0.05). Residents in Cycle 2 (n = 7) had a knowledge increase of 11.6% (p > 0.05). Both cycles of residents had an increase in confidence (Cycle 1: 65.0% [p = 0.025]; Cycle 2: 62.8% [p = 0.0014]). Residents (5 out of 6) reported positive behavioural changes at 6 months. Valued programme elements included concussion diagnosis and management, the self-study guide resource and the organised structure. IMPLICATIONS: The SICC enriched these residents' learning and fostered sustained knowledge improvement and behavioural change at 6 months post-intervention. This approach may provide a workable design for future competency-based curriculum development.

Investigating the experiences of medical students quarantined due to COVID-19 exposure.

Background: The COVID-19 pandemic profoundly impacted medical education systems worldwide. Between March 2020 and December 2021, 111 MD students at the University of Toronto completed two-week quarantines due to hospital or community exposures and experienced disrupted clinical instruction. We explored the experiences, barriers, and supports of these quarantined medical students to identify program development opportunities and improve student supports. Methods: We used a qualitative descriptive approach to explore experiences of clerkship students quarantined due to COVID-19 exposure. Methods included an online survey with open-ended questions and an audio-recorded interview. We analysed the demographic survey responses using descriptive statistics. Subsequently, we conducted descriptive thematic analysis of the narrative survey responses and transcribed interview recordings. Results: Concerns reported in surveys (n = 23, response rate 20.7%) and interviews (n = 5) included themes of illness uncertainty, racial tensions, confidentiality of COVID-19 status, unclear academic expectations, and financial burden. Supports included friends, family, and MD program administration. Recommendations related to communication, administration, equity considerations, supports, confidentiality/privacy, and academics. Conclusion: Supporting student wellbeing and learning is at the core of medical training. Enhanced understanding of health profession trainee needs during COVID can improve institutional supportive responses to students routinely and during times of crisis.

Contexte: La pandémie de la COVID-19 a eu des répercussions importantes sur les systèmes d'éducation médicale dans le monde entier. Entre mars 2020 et décembre 2021, 111 étudiants en médecine de l'Université de Toronto ont été contraints à l'auto-isolement pour une période de deux semaines après une exposition au virus à l'hôpital ou dans la collectivité, voyant du même coup leur apprentissage clinique perturbé. Nous avons exploré les expériences, les obstacles et les types de soutien que ces étudiants ont eus alors qu'ils étaient en quarantaine pour en tirer des leçons afin d'améliorer notre programme et de mieux soutenir nos étudiants. Méthodes: Nous avons utilisé une approche qualitative descriptive pour explorer le vécu des étudiants à l'externat mis en quarantaine en raison d'une exposition à la COVID-19. Les méthodes comprenaient une enquête en ligne avec des questions ouvertes et une interview enregistrée. Nous avons analysé les données démographiques à l'aide de méthodes statistiques descriptives. Par la suite, nous avons effectué une analyse thématique descriptive des réponses narratives à l'enquête en ligne et des transcriptions des entretiens. Résultats: Les préoccupations signalées dans les réponses à l'enquête en ligne (n=23, taux de réponse de 20,7 %) et les entretiens (n=5) touchaient à l'incertitude face à la maladie, aux tensions raciales, à la confidentialité du fait d'avoir été infecté , au manque de clarté quant aux attentes académiques, et au fardeau financier. Les sources de soutien citées comprenaient les amis, la famille et l'administration du programme d'études. Les recommandations concernaient la communication, l'administration, les considérations d'équité, le soutien, la confidentialité et les études. Conclusion: Le soutien au bien-être et à l'apprentissage des étudiants est au cœur de la formation médicale. Une meilleure compréhension des besoins des stagiaires des professions de la santé à l'occasion d'une infection par la COVID-19 peut améliorer le soutien institutionnel qui leur est offert en temps normal et en temps de crise.

The Companion Curriculum: medical students' perceptions of the integration of humanities within medical education.

Background: The contributions of arts and humanities to medical education are known in the medical education community, but medical schools' offerings vary. The Companion Curriculum (CC) is a student-curated set of optional humanities content for medical students at the University of Toronto. This study evaluates integration of the CC to identify key enabling conditions for medical humanities engagement. Methods: A mixed-methods evaluation gauged usage and perceptions of integration of the CC among medical students using an online survey and focus groups. Narrative data underwent thematic analysis, supported by summary statistics of quantitative data. Results: Half of survey respondents were aware of the CC (n = 67/130; 52%), and, once prompted with a description, 14% had discussed it in their tutorial groups. Of students using the CC, 80% reported learning something new regarding their roles as communicators and health advocates. Themes were the perceived value of the humanities, internal student barriers, institutional neglect of the humanities, and student critiques and recommendations. Conclusion: Despite participants' interest in medical humanities, our CC remains underused. To improve humanities' visibility in the MD curriculum, our results indicate that greater institutional support, including faculty development and early curricular integration, is required. Further study should explore reasons for gaps between interest and participation.

Contexte: L'apport des arts et des sciences humaines à la formation médicale est bien connu du milieu de l'enseignement médical, mais l'offre des programmes à cet égard varie d'une faculté à l'autre. Le Companion curriculum (CC) est un recueil de contenu facultatif en sciences humaines, préparé par des étudiants et destiné aux étudiants en médecine de l'Université de Toronto. En évaluant l'intégration du CC au programme de formation, cette étude vise à dégager les principales conditions propices à un engagement en faveur des humanités médicales. Méthodes: Une évaluation à méthodes mixtes, à l'aide d'un sondage en ligne et de groupes de discussion, a permis de mesurer l'utilisation du CC par les étudiants en médecine et leur perception quant à l'intégration de cet outil. Les données narratives ont fait l'objet d'une analyse thématique, étayée par des statistiques sommaires de données quantitatives. Résultats: La moitié des répondants au sondage connaissaient le CC (n=67/130 ; 52%) et, une fois qu'on le leur a décrit, 14 % en avaient discuté dans leurs groupes de tutorat. Parmi les étudiants qui l'avaient utilisé, 80 % ont déclaré avoir appris quelque chose de nouveau concernant leurs rôles de communicateur et de promoteur de la santé. Les thèmes abordés étaient la valeur perçue des sciences humaines, les réserves des étudiants, le manque d'intérêt envers les sciences humaines au sein des établissements d'enseignement médical, ainsi que les critiques et les recommandations formulées par les étudiants. Conclusion: Malgré l'intérêt des participants pour les humanités médicales, notre CC demeure sous-utilisé. Nos résultats indiquent que le renforcement de la visibilité des sciences humaines dans le programme d'études médicales nécessite plus de soutien de la part des établissements, y compris par une formation des enseignants et par l'intégration des sciences humaines tôt dans le cursus du programme. Une étude plus approfondie permettrait d'explorer les raisons de l'écart entre l'intérêt et la participation.

Educating future physicians for francophone official language minority communities in Canada: a case study.

Background: Over one million Francophone Canadians live in official language minority communities (OLMC) outside of Québec. Availability and accessibility of linguistically appropriate care to these OLMCs is lacking, resulting in poorer quality of care. To help address this health equity gap, the FrancoDoc program was created in 2015 to identify Francophone/Francophile medical students enrolled at medical faculties that use English as their primary language of instruction and equip them with skills to increase their medical French abilities. Little is known, however, about the affordances and limitations of this educational endeavour. Methods: Our qualitative instrumental single case study explored participants' experiences with FrancoDoc, while also examining factors shaping the delivery of linguistically appropriate healthcare services to OLMCs. We conducted semi-structured interviews with medical students from across Canada and thematically analyzed these using a reflexive, inductive approach. Results: Four main themes were derived from 12 interviews: factors facilitating French language learning; barriers to French language learning; contextual factors shaping linguistically appropriate healthcare provision; and recommendations to improve healthcare education to better prepare learners to provide care to OLMCs. Conclusions: Medical student participants are highly motivated to engage in educational activities linked to FrancoDoc. Their efforts are nonetheless frequently impeded by barriers such as time constraints, irregular event programming, lack of regular clinical learning opportunities, and lukewarm support from faculties of medicine. If medical faculties are to realize their obligations to the OLMCs that they serve, recognition of language as a specific social determinant of health and more robust institutional supports for initiatives like FrancoDoc are paramount.

Contexte: Plus d'un million de Canadiens francophones vivent dans des communautés de langue officielle en situation minoritaire (CLOSM) hors Québec. L'accessibilité de soins linguistiquement appropriés aux CLOSM est limitée. Par conséquent, la qualité des services qui leur sont offerts en souffre. Le programme FrancoDoc a été créé en 2015 pour aider à combler cette lacune sur le plan de l'équité en matière de santé. Il vise à offrir aux étudiants en médecine francophones ou francophiles dont l'anglais est la principale langue d'enseignement les moyens d'améliorer leurs compétences en français médical. Cependant, on sait peu de choses sur les possibilités et les limites de cette initiative éducative. Méthodes: Notre étude qualitative instrumentale de cas unique a exploré les expériences des participants au programme FrancoDoc, tout en examinant les facteurs qui influencent la prestation de services de santé linguistiquement appropriés aux CLOSM. Nous avons mené des entrevues semi-structurées avec des étudiants en médecine de tout le Canada et nous en avons analysé le contenu thématiquement en utilisant une approche réflexive et inductive. Résultats: Quatre thèmes principaux ont été dégagés des 12 entrevues réalisées : les facteurs facilitant l'apprentissage du français; les obstacles à l'apprentissage du français; les facteurs contextuels influençant la prestation de soins de santé linguistiquement appropriés; et les recommandations visant à améliorer l'enseignement en soins de santé de manière à préparer les apprenants à servir les CLOSM. Conclusions: Bien que très motivés par le programme FrancoDoc, les étudiants participants se heurtent à des obstacles comme les contraintes de temps, la programmation irrégulière des activités, le manque d'occasions d'apprentissage clinique régulier et la réticence des facultés de médecine. Or, pour remplir leurs obligations envers les CLOSM qu'elles servent, il est essentiel que les facultés de médecine reconnaissent la langue comme un déterminant social spécifique de la santé et qu'elles offrent un soutien solide aux initiatives comme le programme FrancoDoc.

Exploring the Barriers and Facilitators Experienced by Palliative Health Care Providers Working with Patients Experiencing Homelessness during the COVID-19 Pandemic.

Background: Patients experiencing homelessness not only have higher rates of medical complexity, comorbidity, and mortality, but also face barriers to accessing palliative care services. In structurally vulnerable populations with palliative care needs, these barriers are compounded, creating significant challenges for both patients and providers that have important health equity implications. Objective: The aim is to explore the experiences of palliative care providers working with patients experiencing homelessness during the COVID-19 pandemic and understand the barriers they faced in providing care, as well as facilitators that aided in the success of their teams. Methods: Seven health care providers from two Canadian palliative outreach teams involved in delivering palliative care services to patients experiencing homelessness during the COVID-19 pandemic participated in audio-recorded and transcribed videoconferencing interviews. Analysis was completed using generic descriptive thematic analysis. Results: Five key themes were identified: (1) factors negatively impacting patient health, (2) use of technology, (3) care provider emotions, (4) care provider education and advocacy, and (5) outreach team factors. Conclusion: Identified barriers during the pandemic included worsening of existing patient vulnerabilities, as well as challenges incorporating technology into care. Providers faced increased emotional burden, with a rise in workload, stress, fear, and grief. However, several facilitators allowed teams to provide high-quality care to this vulnerable population, including team support, interprofessional collaboration, and advocacy and education initiatives. The outreach model also proved to be a highly flexible, resilient, and adaptable model for providing care during the COVID-19 pandemic.

Teaching spirituality to Canadian medical students: students' perceptions of a spiritual history taking clinical skills session.

Spirituality involves one's sense of purpose, connection with others, and ability to find meaning in life. We implemented a three-year pilot of a spiritual history taking (SHT) clinical skills session. In small groups, medical students discussed and practiced SHT with clinical scenarios and the FICA framework and received preceptor and peer feedback. Post-session focus groups and interviews demonstrated student perceptions of improved comfort, knowledge, and awareness of discussing spirituality with patients. This innovation may support improved clinical skills teaching across other health professions institutions to better prepare students to recognize patients' spiritual needs and provide more holistic, culturally competent care.

La spiritualité touche au sentiment d'avoir une raison d'être, à la relation à l'autre et à la capacité de trouver un sens à la vie1. Nous avons mis en place, comme projet pilote de trois ans, une séance visant l'acquisition de compétences cliniques portant sur l'anamnèse spirituelle (AS). En petits groupes, les étudiants discutaient de l'anamnèse spirituelle et la mettaient en pratique au moyen de scénarios cliniques et du questionnaire d'anamnèse spirituelle FICA2, puis recevaient des commentaires de la part de leur précepteur et de leurs pairs. Les groupes de discussion et les entretiens après les séances ont montré que les étudiants se sentaient mieux informés, plus à l'aise et plus conscients de la nécessité de parler de spiritualité avec les patients. Cette innovation peut contribuer à améliorer l'enseignement des compétences cliniques dans d'autres professions de la santé pour mieux préparer les étudiants à reconnaître les besoins spirituels des patients et à fournir des soins plus holistiques et culturellement adaptés.

Investigating the impact of socioeconomic status on the effectiveness of a pamphlet on achieving and maintaining bone health in breast cancer survivors: a patient education resource development primer.

Considerable need exists to raise awareness of breast cancer (BC) treatment-induced bone loss and provide management and preventative strategies. We describe the development and evaluation process of an educational pamphlet for BC survivors on achieving and maintaining bone health. A Participatory Design approach was used. The pamphlet was first critically evaluated by interdisciplinary healthcare professionals and less vulnerable members of the target audience prior to evaluation by 45 BC survivors, who completed two questionnaires inquiring about demographics and pamphlet evaluation and satisfaction. Pamphlet effectiveness was correlated with income and education to determine differences between socioeconomic groups. Perceived knowledge increased significantly after reading the brochure for all groups. Socioeconomic status had no impact on pamphlet effectiveness. This methodological approach is presented as a blueprint to promote knowledge translation in cancer patient education contexts aiming to provide cancer patients with the best possible resources for effective self-management of their conditions.

Alleviating emotional exhaustion in oncology nurses: an evaluation of Wellspring's "Care for the Professional Caregiver Program".

A high level of burnout has been demonstrated in oncologists, nurses, and other health professionals. Interventions developed in response demonstrate mixed results. Wellspring, a community cancer support organization, has developed a 1-day session called Care for the Professional Caregiver Program (CPCP) and has delivered it to over 700 healthcare workers. The present study assessed the effects of the CPCP on three groups of oncology nurses (pediatric, surgical, and general oncology staff) and one group of nurse managers. Subjects completed the Maslach burnout inventory (MBI), the General health questionnaire (GHQ) and the short form of the Marlowe-Crowne social desirability scale (M-C) prior to receiving the intervention. They then completed the MBI and GHQ at 1-month and 7-month follow-ups. Six months after the original session, a small subset of subjects was randomly selected to participate in a 1-day CPCP booster session. At baseline, one third of the nurses showed high burnout on the MBI. The nurses demonstrated a significant decrease in emotional exhaustion and an improvement on the GHQ, at the 1-month follow-up testing (p = 0.003 and 0.001, respectively) and 7-month follow-up testing (p = 0.002 and 0.001). The booster session proved difficult to deliver because of institutional scheduling problems due to nurse shortages, so only a small percentage (22%) of the sample participated; however, it was well received. Thus, the CPCP is effective in ameliorating emotional exhaustion, an intrinsic aspect of burnout.

Towards a Postgraduate Oncology Training Model for Family Medicine: Mixed Methods Evaluation of a Breast Oncology Rotation.

BACKGROUND: Family physicians have low knowledge and preparedness to manage patients with cancer. A breast oncology clinical rotation was developed for family medicine residents to address this gap in medical education. OBJECTIVES AND METHODS: A breast oncology rotation for family residents was evaluated using a pre-post knowledge questionnaire and semi-structured interviews comparing rotation (RRs) versus non-rotation (NRRs) residents. Quantitative and qualitative data were collected via a pre-post knowledge questionnaire and semi-structured interviews, respectively. ANALYSIS: Quantitative data were analysed using descriptive statistics and paired t-tests to compare pre-post-rotation knowledge and preparedness. Qualitative data were coded inductively, analysed, and grouped into categories and themes. Data sets were integrated. RESULTS: The study was terminated early due to the COVID-19 pandemic. Six RRs completed the study; 19 and 2 NRRs completed the quantitative and qualitative portions, respectively. RRs' knowledge scores did not improve, but there was a non-significant increase in preparedness (5.3 to 8.4, p = 0.17) post-rotation. RRs described important rotation outcomes: knowledge of the patient work-up, referral process, and patient treatment trajectory; skills in risk assessment, clinical examination, and empathy, and comfort in counseling. DISCUSSION AND CONCLUSION: Important educational outcomes were obtained despite no change in knowledge scores. This rotation can be adapted to other training programs including an oncology primer to enable trainee integration of new information.

Use of wearable point-of-view live streaming technology for virtual physical exam skills training.

We piloted a virtual teaching tool comprised of a chest-mounted smartphone streaming point-of-view footage over videoconferencing software to deliver a physical exam skills session. Compared to medical students taught via third person view through pre-recorded video followed by preceptor-led discussion, a higher proportion of students taught via point-of-view wearable technology reported improved knowledge of demonstrated skills and feeling engaged, comfortable interacting with their tutor, and better able to visualize demonstrated exam maneuvers. This accessible, affordable, and easily replicable innovation can potentially enhance virtual clinical skills teaching and enable novel distant clinical learning opportunities for healthcare professions students and educators.

Nous avons mis à l'essai un outil d'enseignement virtuel, notamment pour les cours de techniques d'examen physique, qui consiste dans le fait de porter un téléphone intelligent fixé sur la poitrine pour diffuser en direct, par le biais d'un logiciel de vidéoconférence, pour réaliser un examen physique plutôt que subjectif. Comparativement aux étudiants en médecine qui pour le cours ont visionné une vidéo préenregistrée prise par caméra objective, suivie d'une discussion dirigée par un précepteur, un plus grand nombre d'étudiants ayant suivi le cours par le biais d'une technologie portable avec par le biais d'un dispositif technologique portable déclarent avoir amélioré leurs connaissances sur les techniques présentées, se sentir engagés et à l'aise pour interagir avec l'enseignant, et avoir été en mesure de bien voir les gestes d'examen montrés. Cette innovation accessible, abordable et facilement reproductible pourrait permettre d'améliorer l'enseignement virtuel des habiletés cliniques et d'offrir de nouvelles possibilités d'enseignement.

A qualitative assessment of the supportive care and resource needs of patients undergoing craniotomy for benign brain tumours.

PURPOSE: As past literature has focused on support needs of patients with malignant brain tumours, the support needs of patients with benign brain tumours have largely been overlooked. The purpose of this study was to evaluate the supportive care and resource needs of patients undergoing craniotomy for benign brain tumours. METHODS: Individual, semi-structured interviews were conducted with patients who had undergone craniotomy for a benign brain tumour within the past 2 years. Interviews were audio-recorded, transcribed, anonymized and subjected to descriptive thematic analysis by multiple investigators in the grounded theory tradition. RESULTS: Twenty-nine patients (20 women, 20-88 years of age) with World Health Organization grade I brain tumours (25 meningioma) were interviewed. Five overarching themes emerged: (1) need for formal support from diagnosis onwards; (2) complexity of supportive needs during postoperative recovery; (3) importance of regular long-term monitoring by physicians; (4) influence of psychosocial factors on supportive needs; and (5) existence of barriers to equal access to available supports. CONCLUSIONS: Patients' supportive care needs are temporally dependent on disease course and treatment, and modifiable by demographic and psychosocial factors. Findings of this study show that patients with benign tumours lacked but needed many supportive care resources currently available to cancer patients. Many of the potential solutions to this current gap in supportive care involve extending support resources already available for cancer patients to patients with benign brain tumours. We thus suggest recommendations to improve service gaps and reduce disparities in supportive care for patients with benign brain tumours.

Development and evaluation of a combined story and fact-based educational booklet for patients with multiple brain metastases and their caregivers.

The aim of our study was to design and evaluate the impact on informational satisfaction of a combined story and fact-based educational booklet designed for patients with multiple brain metastases. Phase A evaluated the preference of participants for combined, fact, or story-based writing style. Based on these results, a resource was developed using a combined story and fact-based approach. Patients with newly diagnosed brain metastases and their caregivers read the booklet. Satisfaction was evaluated using the Information Satisfaction Questionnaire and Client Satisfaction Questionnaire. Anxiety was evaluated before and after reading using the State Trait Anxiety Inventory. Ninety-one patients participated in this study. In Phase A, 51% of patients expressed a preference for the combined story and fact-based approach. In phase B, participants expressed high satisfaction for both the informational content and the overall satisfaction towards the pamphlet. The level of anxiety before reading the booklet was lower for caregivers than patients. Anxiety score was increased in the caregiver group after reading the booklet. This was unchanged in the patient group. Both patients and caregivers endorsed the resource. The increase in anxiety in caregivers suggests the tool has been effective in conveying serious prognostic implications.

First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity.

PURPOSE: Patients identifying as sexual and gender minorities (SGMs) face healthcare barriers. This problem is partly due to medical training.1 We evaluated first year medical student experiences during a novel four-hour seminar, in which students answered discussion questions, participated in peer role-plays, and interviewed two standardized patients. METHOD: A constructivist qualitative design employed audio-recorded and transcribed student focus groups. Using generic content analysis, transcripts were iteratively coded, emergent categories identified, sensitizing concepts applied, and a thematic framework created. RESULTS: Thirty-five students (71% female) participated in five focus groups. Two themes were developed: SGM bias (faculty, standardized patients [SPs], students, curriculum), and Adaptive Expertise in Clinical Skills (case complexity, learner support, skill development). SPs identifying as SGM brought authenticity and lived experience to their roles. Preceptor variability impacted student learning. Students were concerned when a lack of faculty SGM knowledge accompanied negative biases. Complex SP cases promoted cognitive integration and preparation for clinical work. CONCLUSIONS: These students placed importance on the lived experiences of SGM community members. Persistent prejudices amongst faculty negatively influenced student learning. Complex SP cases can promote student adaptive expertise, but risk unproductive learning failures. The lessons learned have implications for clinical skills teaching, learning about minority populations, and medical and health professions education in general.

OBJECTIF: Les patients qui s'identifient comme faisant partie de minorités sexuelles et de genre (MSG) se heurtent à des obstacles en matière de soins de santé.1 Ce problème est en partie attribuable à la formation des médecins. Nous avons évalué l'expérience des étudiants en première année de médecine dans un séminaire inédit de quatre heures, au cours duquel les étudiants ont répondu à des questions dans le cadre d'une discussion, ont participé à des jeux de rôle entre pairs et ont interrogé deux patients standardisés. MÉTHODE: Cette recherche à devis qualitatif constructiviste a employé des groupes de discussion d'étudiants, qui ont été enregistrés sur bande audio et transcrits. Par le biais d'une analyse de contenu générique, nous avons codé les transcriptions de manière itérative, identifié des catégories émergentes, appliqué des concepts sensibilisateurs et créé un cadre thématique. RÉSULTATS: Trente-cinq étudiants (71 % de femmes) ont participé à cinq groupes de discussion. Deux thèmes ont été développés : biais MSG (corps professoral, patients standardisés [PS], étudiants, cursus) et expertise adaptative en habiletés cliniques (complexité des cas, soutien aux apprenants, développement des habiletés). Les PS qui se sont identifiés comme faisant partie de MSG ont amené de l'authenticité et une expérience vécue à leurs rôles. Les différences entre superviseurs ont eu un impact sur l'apprentissage des étudiants. Le manque de connaissances en matière de MSG chez certains membres du corps professoral inquiétait les étudiants lorsqu'il était accompagné de préjugés négatifs. Les cas complexes de PS ont favorisé l'échec productif, l'intégration cognitive et la préparation au travail clinique. CONCLUSIONS: Les étudiants ont accordé de l'importance aux expériences vécues par les membres de la communauté MSG. Les préjugés inconscients au sein du corps professoral ont eu une influence négative sur l'apprentissage des étudiants. Les cas complexes de PS peuvent favoriser l'expertise adaptative des étudiants, mais risquent d'entraîner des lacunes concernant les apprentissages. Les leçons apprises ont des implications pour l'enseignement des habiletés cliniques, la familiarisation avec les populations minoritaires et l'éducation des professionnels de la santé et l'éducation médicale en général.

Evaluation of a pilot rural mentorship programme for and by pre-clerkship medical students.

INTRODUCTION: While medical school interventions can help address rural physician shortages, many urban Canadian medical students lack exposure to rural medicine. The Rural Mentorship Programme (RMP) is a 4-month pilot initiative designed by medical students to bridge this gap by pairing preclerkship medical students at an urban medical school with rural physician mentors to provide exposure to rural careers. METHODS: A realist-influenced methodology evaluated perceived benefits and challenges of RMP, assessed how RMP influenced mentee perceptions and intentions towards rural careers, and investigated factors leading to success. Quantitative and qualitative data were collected through evaluative pre-, post-, and 4-month post intervention surveys, mentor interviews and a mentee focus group. Likert scales assessed satisfaction, attainment of objectives and mentee changes in perceptions and intentions. RESULTS: 18/23 mentees and 11/15 mentors completed at least 1 survey; 5 mentees joined the focus group and 3 mentors were interviewed. Most mentees were of non-rural backgrounds and initially neutral about pursuing rural practice. RMP helped mentees better understand rural careers. They especially valued the mandatory community clinical visit and forming relationships with mentors. Mentors enjoyed teaching, reflecting on their careers and demonstrating the merits of rural practice. Transportation and scheduling were major programme challenges. CONCLUSIONS: This pilot suggests that structured mentorship programmes can improve understanding of, and provide exposure to, careers in rural medicine for urban medical students. Results will inform future programme development.

Résumé Introduction: Alors que les interventions des écoles de médecine peuvent contrer la pénurie de médecins en régions rurales, beaucoup d'étudiants en médecine des régions urbaines du Canada ne sont pas exposés à la médecine rurale. Le Rural Mentorship Programme (RMP) est une initiative pilote de 4 mois conçue par des étudiants en médecine pour combler cette lacune en appariant des étudiants d'une école de médecine urbaine n'ayant pas encore fait leur stage clinique à des médecins-mentors des régions rurales pour exposer les étudiants à une carrière en milieu rural. Méthodes: Une méthode influencée par la réalité a évalué les bienfaits et les difficultés perçus du RMP, a évalué comment le RMP influait sur les perceptions et intentions des mentorés envers une carrière en région rurale et s'est penchée sur les facteurs de réussite. Des données quantitatives et qualitatives ont été recueillies par enquêtes évaluatives avant, après et 4 mois après l'intervention, par entrevues avec les mentors et par un groupe cible composé de mentorés. Des échelles de Likert ont évalué la satisfaction, l'atteinte des objectifs et la variation des perceptions et intentions des mentorés. Résultats: Dans l'ensemble, 18 mentorés sur 23 et 11 mentors sur 15 ont répondu à au moins 1 enquête; 5 mentorés SE sont joints au groupe cible et 3 mentors ont été interviewés. La plupart des mentorés étaient d'origine non rurale et étaient initialement neutres à l'idée d'une pratique rurale. Le RMP a aidé les mentorés à mieux comprendre la carrière en milieu rural. Ils ont surtout apprécié la visite clinique obligatoire en communauté et la relation qu'ils ont formée avec leur mentor. Les mentors ont valorisé enseigner, réfléchir sur leur carrière et démontrer les mérites de la pratique rurale. Le transport et les horaires étaient les grands défis du programme. Conclusions: Ce projet pilote laisse croire que les programmes de mentorat structurés améliorent la compréhension des étudiants en médecine des régions urbaines à l'idée d'une carrière en médecine rurale et exposent ces étudiants à la médecine rurale. Les résultats éclaireront l'élaboration de futurs programmes. Mots-clés: Mentorat; étudiant en médecine; médecine rurale; éducation médicale de premier cycle; évaluation du programme; groupes d'intérêts d'étudiants en médecine.