Advancing equity, diversity, inclusivity, and accessibility in primary care: The development of an integrated educational experience model.

This article presents the development of the Equity, Diversity, Inclusivity, and Accessibility (EDIA) Cross-Cutting Theme Project within the Team Primary Care (TPC) initiative, aimed at addressing systemic inequities through innovative educational strategies. Grounded in the social accountability of health professions framework, this project aims to equip primary care teams with the knowledge, skills, and attitudes necessary to promote health equity. The EDIA Integrated Educational Experience (IEE) model includes a self-assessment tool, digital learning space, and national mentorship network, providing a comprehensive approach for primary care teams to promote health equity. The IEE model utilizes a layered micro, meso, and macro approach to support cultural transformation within highly complex healthcare environments. Key lessons learned involve trust- and relationship-building processes to help dismantle historical silos and encourage open dialogue. Future efforts focus on implementation, ensuring adaptability, scalability, and sustainability, positioning the model as a catalyst for equitable primary care delivery.

Optimizing the integration of family caregivers in the delivery of person-centered care: evaluation of an educational program for the healthcare workforce.

BACKGROUND: While family caregivers provide 70-90% of care for people living in the community and assist with 10-30% of the care in congregate living, most healthcare providers do not meaningfully involve family caregivers as partners in care. Recent research recommends that the healthcare workforce receive competency-based education to identify, assess, support, and partner with family caregivers across the care trajectory. OBJECTIVE: This paper reports a mixed-methods evaluation of a person-centered competency-based education program on Caregiver-Centered Care for the healthcare workforce. METHODS: This foundational education was designed for all healthcare providers and trainees who work with family caregivers and is offered free online (caregivercare.ca). Healthcare providers from five healthcare settings (primary, acute, home, supportive living, long-term care) and trainees in medicine, nursing, and allied health were recruited via email and social media. We used the Kirkpatrick-Barr health workforce training evaluation framework to evaluate the education program, measuring various healthcare providers' learner satisfaction with the content (Level 1), pre-post changes in knowledge and confidence when working with family caregivers (Level 2), and changes in behaviors in practice (Level 3). RESULTS: Participants were primarily healthcare employees (68.9%) and trainees (21.7%) and represented 5 healthcare settings. Evaluation of the first 161 learners completing the program indicated that on a 5-point Likert scale, the majority were satisfied with the overall quality of the education (Mean(M) = 4.69; SD = .60). Paired T-tests indicated that out of a score of 50, post-education changes in knowledge and confidence to work with family caregivers was significantly higher than pre-education scores (pre M = 38.90, SD = 6.90; post M = 46.60, SD = 4.10; t(150) = - 16.75, p < .0001). Qualitative results derived from open responses echoed the quantitative findings in satisfaction with the education delivery as well as improvements in learners' knowledge and confidence. CONCLUSION: Health workforce education to provide person-centered care to all family caregivers is an innovative approach to addressing the current inconsistent system of supports for family caregivers. The education program evaluated here was effective at increasing self-reported knowledge and confidence to work with family caregivers.

Assessment of Resident Physicians' Communicator and Collaborator Competencies by Interprofessional Clinicians: A Mixed-Methods Study.

Phenomenon: As we move toward competency-based medical education, greater emphasis is being placed on assessing a more comprehensive skill set, including the ability to communicate and collaborate effectively in the workplace. Nonphysician members on interprofessional (IP) teams have valuable perspectives on actual resident performance and are often not adequately engaged in the provision of feedback to residents. Based on the educational theories of collaborative evaluation and social constructivism, this research examined the ability of IP clinicians to provide feedback to residents. The aim of this study was to examine IP clinicians' perceptions of their ability to provide formative feedback, through their observations and assessments of developmental pediatric residents, compared to physician supervisors on the rotation, and to qualitatively explore potential barriers to the feedback process from their perspective. APPROACH: This explanatory, sequential mixed-methods design study first examined which and how many of the CanMEDS Communicator and Collaborator training objectives (N = 40) were considered to be observable and assessable by IP clinicians and physicians. A comparison of the mean number of objectives that were observed and practically assessed by (a) each group (IP clinicians vs. physicians) and (b) clinical service teams during the core developmental pediatrics rotations, were examined using independent t tests. Second, a thematic qualitative analysis of focus groups was used to develop a contextual understanding of the factors that influenced this process. Data were analyzed using three levels of open coding and descriptive qualitative analysis techniques. FINDINGS: Physicians reported they could observe (M = 33.3, SD = 5.2, 83.3%) and assess (M = 31.5, SD = 7.3, 79%) a larger number of objectives compared to the IP clinician group (M = 24.7, SD = 8.6, 61.8% and M = 20.3, SD = 10.6, 51%, respectively). There were no differences between the clinical service teams (i.e., preschool/school-age and pediatric rehabilitation). The objective that was most observable and assessable by the IP clinicians was "Demonstrates a respectful attitude towards other colleagues and members of an interprofessional team." Four themes identified by the IP clinicians provided more in-depth qualitative information: (a) assessment requires more than simple observation, (b) assumptions and indirect observation influence assessment, (c) clinic culture and structure shapes observation and assessment, and (d) specific assessment criteria are required by IP clinicians. Insights: IP clinicians have the desire and ability to provide formative feedback to residents. Formalized processes with specific evaluation criteria would facilitate meaningful feedback from IP clinicians in the assessment of residents as they journey toward competence.

Confounding Effect in Clinical Research of Otolaryngology and Its Control.

Confounding effect is a critical issue in clinical research of otolaryngology because it can distort the research's conclusion. In this review, we introduce the definition of confounding effect, the methods of verifying and controlling the effect. Confounding effect can be prevented by research's design, and adjusted by data analysis. Clinicians would be aware and cautious about confounding effect in their research. They would be able to set up a research's design in which appropriate methods have been applied to prevent this effect.They would know how to adjust confounding effect after data collection. It is important to remember that sometimes it is impossible to eliminate confounding effect completely, and statistical method is not a master key. Solid research knowledge and critical thinking of our brain are the most important in controlling confounding effect.

Genetic Effects on Sensorineural Hearing Loss and Evidence-based Treatment for Sensorineural Hearing Loss.

In this article, the mechanism of inheritance behind inherited hearing loss and genetic susceptibility in noise-induced hearing loss are reviewed. Conventional treatments for sensorineural hearing loss (SNHL), i.e. hearing aid and cochlear implant, are effective for some cases, but not without limitations. For example, they provide little benefit for patients of profound SNHL or neural hearing loss, especially when the hearing loss is in poor dynamic range and with low frequency resolution. We emphasize the most recent evidence-based treatment in this field, which includes gene therapy and allotransplantation of stem cells. Their promising results have shown that they might be options of treatment for profound SNHL and neural hearing loss. Although some treatments are still at the experimental stage, it is helpful to be aware of the novel therapies and endeavour to explore the feasibility of their clinical application.

A Randomized Controlled Study Addressing Dexamethasone Tolerability in the Treatment of Acute Asthma in Children: Mary Poppins on Trial!

AimEmesis of oral medications continues to be a problem in the management of acute pediatric asthma exacerbations; therefore, we set out to assess whether smaller volumes of oral dexamethasone resulted in better tolerability. Methods: Children aged 2-14 years, presenting to the emergency department with acute asthma exacerbation, were enrolled in this open, prospective randomized controlled trial. Participants received 0.3 mg/kg of dexamethasone in either its concentrated volume (10 mg/mL) or mixed with Ora Sweet (1 mg/mL). Tolerability was measured by vomiting within 45 minutes of receiving dexamethasone, with stratification, a priori, for prior vomiting. Results: 430 participants were enrolled. 23/213 (11%) in the 10 mg/mL group vomited dexamethasone compared to 16/217 (7%) in the 1 mg/mL group (P = .29). 11/179 (6%) in the 10 mg/mL group vomited compared to 8/183 (3%) in the 1 mg/mL group (.61). For those 68 stratified with prior vomiting, 12/34 (35%) in the 10 mg/mL group vomited compared to 8/34 (24%) in the 1 mg/mL group (P = .43). None of these results were statistically different. Prior vomiting increased the risk of vomiting, regardless of the formulation given (P < .001). Conclusions: Volume does not play a significant role in the tolerability of dexamethasone. Therefore, palatability should not be sacrificed for a smaller volume of dexamethasone to improve tolerability.

The 4C's of influence framework: fostering leadership development through character, competence, connection and culture.

PURPOSE: The purpose of this paper is to describe the 4C's of Infuence framework and it's application to medicine and medical education. Leadership development is increasingly recognised as an integral physician skill. Competence, character, connection and culture are critical for effective influence and leadership. The theoretical framework, "The 4C's of Influence", integrates these four key dimensions of leadership and prioritises their longitudinal development, across the medical education learning continuum. DESIGN/METHODOLOGY/APPROACH: Using a clinical case-based illustrative model approach, the authors provide a practical, theoretical framework to prepare physicians and medical learners to be engaging influencers and leaders in the health-care system. FINDINGS: As leadership requires foundational skills and knowledge, a leader must be competent to best exert positive influence. Character-based leadership stresses development of, and commitment to, values and principles, in the face of everyday situational pressures. If competence confers the ability to do the right thing, character is the will to do it consistently. Leaders must value and build relationships, fostering connection. Building coalitions with diverse networks ensures different perspectives are integrated and valued. Connected leadership describes leaders who are inspirational, authentic, devolve decision-making, are explorers and foster high levels of engagement. To create a thriving, learning environment, culture must bring everything together, or will become the greatest barrier. ORIGINALITY/VALUE: The framework is novel in applying concepts developed outside of medicine to the medical education context. The approach can be applied across the medical education continuum, building on existing frameworks which focus primarily on what competencies need to be taught. The 4C's is a comprehensive framework for practically teaching the leadership for health care today.

Fostering a Health-Promoting Learning Environment in Medical Education: Adapting the Okanagan Charter for Administrators and Medical Educators.

Medical students enter medical school with similar or even better well-being than their age-matched peers in other educational programs, but there is predictable erosion of their well-being following matriculation. Interventions to counter this erosion predominantly focus on the individual level; however, significant systemic issues persist that thwart meaningful change. Effectively reforming the learning environment and more broadly targeting problematic aspects of the culture of medical education are essential steps to advance efforts to improve medical learner well-being. Although a healthy environment may allow learners to be well in the educational setting, a health-promoting learning environment strives to promote and embed well-being across all aspects of the learner's experience. Health-promoting learning environments operate by infusing health principles into all aspects of operations, practices, mandates, and businesses. The Okanagan Charter is a widely adopted international framework with principles for best practices of adoption. This charter has the recent endorsement of the Association of Faculties of Medicine of Canada, representing all faculties of medicine in Canada, and serves as a framework for reassessing work on well-being in medical education. In response to this endorsement, the authors have adapted the 5 strategies from the charter for pragmatic integration into the medical education environment and added a sixth strategy: (1) embed health in all policies; (2) develop sustainable, supportive spaces; (3) create thriving medical communities and culture; (4) encourage, support, and sustain meaningful personal development; (5) review, develop, and strengthen faculty-level health services; and (6) collaborate and invest in continuous improvement and evaluation. For each of these 6 strategic directions, actionable steps for implementation in academic medicine are provided to create sustainable and meaningful change.

All of Residency's a Stage: Fostering Authenticity and Individuality Among Learners.

Understanding the process of professional identity formation, and its susceptibility to the hidden curriculum, is of increasing importance in medical education. Through a lens of performance, this commentary explores the impact of the culture, the hidden curriculum, and the socialization process of the medical training environment on the professional identity formation of learners. We emphasize the need to train physicians with diverse interests and skills, capable of creative problem solving in response to the rapidly evolving challenges facing the profession and society more broadly. Opportunities for learners to drive cultural change and promote authenticity and unique professional identity formation are identified.

Parent experience with ankle-foot orthoses for their young children with cerebral palsy: a qualitative study.

PURPOSE: This study explored the experiences of parents of young children with cerebral palsy who used Ankle-Foot Orthoses (AFOs). MATERIALS AND METHODS: Parents of children with cerebral palsy (n = 11; age range 2-6 years) who used solid or hinged AFOs participated. Interpretive Description, a qualitative methodological approach focused on the application of findings to clinical practice, was used. Semi-structured interviews were conducted, and themes were developed using thematic analysis. RESULTS: Four themes described parent experience with their children's AFOs: 1) "Hear what I am saying": Collaborative decision-making with families, 2) "Is my child going to be excluded because of AFOs?": Parent and child adjustment was a journey, 3) AFOs created financial and practical challenges, 4) The perceived benefits of AFO use. CONCLUSIONS: Adjusting to AFOs was a challenging and time-consuming process for parents and children, which may have resulted in lower frequency and duration of use than anticipated by clinicians. Clinicians must be aware of the physical and psychosocial adjustment process as children and families adapt over time and work with families to ensure AFO use is optimized and individualized.

IMPLICATIONS FOR REHABILITATIONClinical practice will be enhanced by understanding  parent experience with their children's receipt and use of Ankle-Foot Orthoses (AFOs).Clinicians should work with families to establish and monitor individualized wear-time schedules that align with family routines.Information about AFOs, including appearance and alternative clothing requirements, should be provided to families in advance of receiving AFOs.

Informing evidence-based clinical practice guidelines for children with cerebral palsy at risk of osteoporosis: a systematic review.

AIM: The aim of this systematic review was to inform evidence-based clinical practice guidelines for children with cerebral palsy (CP) and low bone mineral density (BMD). METHOD: A computer-assisted literature search was focused on low BMD in children with CP, and was limited to the following interventions: weight-bearing activities, bisphosphonate use, and vitamin D or calcium supplementation. Articles were classified according to American Academy of Neurology guidelines and recommendation classifications were given based on the evidence for the intervention increasing BMD and decreasing fragility fractures. Studies were included if they were English-language full-text studies, focused on children with CP, and included at least 10 participants receiving the studied interventions. RESULTS: Twenty-one articles underwent full-text review and data abstraction, including seven studies of weight-bearing activities, five studies of vitamin D or calcium supplementation, and nine studies of bisphosphonates administration. Overall, the evidence that bisphosphonates administration increases BMD was assessed as level B (probable) while the evidence that vitamin D or calcium supplementation does so was assessed as level C (possible); there was insufficient evidence to suggest that weight-bearing activities are an effective intervention to improve BMD. The evidence that bisphosphonates help to prevent fragility fractures was assessed as level C (possible); there was inadequate evidence to support the use of weight-bearing activities or vitamin D or calcium supplementation to decrease fragility fractures. INTERPRETATION: Evidence-based clinical practice guidelines were created outlining the suggested role of weight-bearing activities, vitamin D and calcium supplementation, and bisphosphonate use for children with CP with low BMD at risk of fragility fractures.

Building Capacity for Community Pediatric Autism Diagnosis: A Systemic Review of Physician Training Programs.

OBJECTIVES: Training primary care providers to provide diagnostic assessments for autism spectrum disorder (ASD) decreases wait times and improves diagnostic access. Outcomes related to the quality of these assessments and the impacts on system capacity have not been systematically examined. This systematic review identifies and summarizes published studies that included ASD diagnostic training for primary care providers (PCPs) and aims to guide future training and evaluation methods. METHODS: Systematic searches of electronic databases, reference lists, and journals identified 6 studies that met 3 inclusion criteria: training for PCPs, community setting, and training outcome(s) reported. These studies were critically reviewed to characterize (1) study design, (2) training model, and (3) outcomes. RESULTS: All studies were either pre-post design or nonrandomized trials with a relatively small number of participants. There was considerable heterogeneity among studies regarding the training provided and the program evaluation process. The most evaluated outcomes were access to autism diagnosis and accuracy of diagnosis. CONCLUSION: Training PCPs to make ASD diagnoses can yield high diagnostic agreement with specialty teams' assessments and reduce diagnostic wait times. Current data are limited by small sample size, poor to fair quality study methodology, and heterogenous study designs and outcome evaluations. Evidence is insufficient to draw conclusions about the overall effects of training PCPs for ASD diagnostic assessments. Since further research is still needed, this review highlights which outcomes are relevant to consider when evaluating the quality of ASD assessments across the continuum of approaches.

Creating space for leadership education in undergraduate medical education in Canada.

The need for effective leadership by physicians is clear, yet the design/delivery of curricula, and assessment of leadership competencies, in Undergraduate Medical Education (UGME) continues to need work. In reappraising their UGME assessment strategies, the Medical Council of Canada (MCC) invited position papers across diverse lenses, including the CanMEDS Intrinsic Roles. This article is foundational work derived from the report on leadership assessment to the MCC. Using Kern's Model of Curriculum development as a guide, we reviewed the landscape of Canadian UGME leadership education through an environmental scan of the published and grey literature, Canadian leadership frameworks and resources, and consultation with learner and faculty leadership. Leadership education across programs was highly variable and learners were often unaware of available opportunities. In response, we have suggested processes for curricular development, including strategies for key content, teaching and assessment, and program evaluation considerations. Leadership education cannot remain another checkbox on a list of UGME experiences. Such training necessitates focused attention and investment to foster ongoing identity formation toward becoming a good doctor.

Même si le besoin d'un leadership médical efficace est clair, la conception et l'implantation d'un cursus et de stratégies d'évaluations sur la compétence de leadership en éducation médicale prédoctorale demeure à optimiser. Dans le cadre de l'examen de ses stratégies d'évaluation de la formation médicale prédoctorale, le Conseil médical du Canada (CMC) a sollicité des énoncés de position portant sur divers aspects, y compris sur les rôles CanMEDS intrinsèques. Cet article s'appuie sur la soumission des auteurs concernant l'évaluation du leadership faite pour le CMC. Prenant le modèle de développement de cursus de Kern comme guide, nous avons examiné le paysage de l'enseignement du leadership dans la formation prédoctorale au Canada par le biais d'une analyse environnementale de la littérature scientifique et grise, des cadres et des ressources de leadership canadiens et d'une consultation avec des leaders parmi les étudiants et le corps professoral. L'enseignement du leadership dans les programmes est très variable et bien souvent, les apprenants ne sont pas au courant des possibilités offertes. En conséquence, nous suggérons des processus d'élaboration de cursus, y compris des stratégies d'enseignement en lien avec les sujets importants, l'enseignement, l'évaluation des apprenants et l'évaluation de programme. La formation au leadership ne peut pas demeurer un élément de la liste «à faire¼ pour l'éducation médicale prédoctorale. Une telle formation nécessite une attention et un investissement ciblés afin de favoriser la construction continue de l'identité de futurs bons médecins.

To lead or to influence?

One skill set identified within the CanMEDS Framework (CanMEDS) as essential to training future physicians is the Leader role. Arguably however, the term Leader carries certain connotations that are inconsistent with the abilities outlined by CanMEDS as necessary for physicians. For example, the term Leader may connote hierarchical authority and formalized responsibilities, while de-emphasising informal day-to-day influencing. This CanMEDS role was first labelled Manager, but was re-named Leader in 2015. Perhaps the focus of this CanMEDS role should be further refined by adopting a more representative term that reflects the concept of intentional influence. Through this lens, learners can discern significant opportunities to influence positively each of the clinical and non-clinical environments they encounter. We suggest that reframing the Leader role as an Influencer role will be more comprehensive and inclusive of its full scope and potential. Accordingly, given the potential for broader applicability and resonance with learners, collaborators, and the populations we serve, consideration should be given to re-characterizing the CanMEDS role of Leader as that of Influencer.

Le rôle de Leader est une des compétences du Référentiel CanMEDS jugées essentielles dans la formation des futurs médecins. Cependant, on peut soutenir que la notion de leadership comporte certaines connotations qui sont incompatibles avec les compétences exigées dans CanMEDS. Par exemple, le terme « leader ¼ peut évoquer une autorité hiérarchique et des responsabilités formelles, tout en minimisant l'influence informelle exercée au quotidien. Avant 2015, ce rôle était désigné par le mot « gestionnaire ¼. Peut-être l'orientation de ce rôle CanMEDS devrait-elle être redéfinie et une appellation correspondante choisie pour refléter la notion d'influence intentionnelle. Une telle reformulation inciterait les apprenants à cerner les occasions importantes d'influencer positivement les environnements cliniques et non-cliniques dans lesquels ils travaillent. Nous sommes d'avis qu'un recadrage du rôle de leader en influenceur engloberait toute la portée et tout le potentiel auxquels le rôle renvoie. Le rôle d'Influenceur promet une applicabilité et une résonance plus larges auprès des apprenants, des collaborateurs et des populations que nous servons, d'où la pertinence de la redéfinition du rôle CanMEDS actuel.

Six ways to get a grip by calling-out racism and enacting allyship in medical education.

Actively addressing racism in our faculties of medicine is needed now, more than ever. One way to do this is through allyship, the practice of unlearning and re-evaluating, in which a person in a position of privilege and power seeks to operate in solidarity with a traditionally marginalized group. In this paper, we provide practical tips on how to practice allyship, giving educators and leaders background understanding and important tools on how to actively promote equity and diversity. We also share tips on how to promote inclusivity to more accurately reflect the communities we serve. Through six broad actions of being, knowing, feeling, doing, promoting, and acting, we can empower individuals to become allies and address racism in medical education and beyond. Creating psychologically safe spaces, educating ourselves on our complex histories and how they influence the present, recognizing racism, and advocating for change, augments awareness from which we can pivot conversations. Acknowledging potential feelings of shame, guilt, and embracing our loss of privilege, allow necessary, but challenging, personal growth to occur. Finally, dismantling the racist structures that exist within medicine, moving us beyond individual interventions, will address the systemic nature of racism in medicine. Everyone can find a starting place within this guide, as simple, consistent actions foster change in our spheres of influence; and the ripple effect of these changes will impact attitudes and behaviours broadly.

Il est plus que jamais nécessaire de s'attaquer activement au racisme dans les facultés de médecine. Une des stratégies qu'on peut adopter à cette fin est celle de l'allié, désignée en anglais par le terme allyship. Il s'agit de la pratique du désapprentissage et de la réévaluation, par laquelle une personne en position de privilège et de pouvoir s'efforce d'agir en solidarité avec un groupe marginalisé. Cet article vise à proposer aux enseignants et aux responsables des conseils pratiques sur la façon d'agir en alliés, notamment en offrant les informations nécessaires à une compréhension générale de la problématique en toile de fond, ainsi que des outils importants pour promouvoir activement l'équité et la diversité. Nous partageons également des stratégies pour encourager l'inclusivité afin de représenter plus fidèlement les populations auxquelles nous offrons nos services. Grâce à une démarche à six volets (être, savoir, ressentir, faire, promouvoir et agir), nous pouvons donner aux personnes les moyens de devenir des alliées dans la lutte contre le racisme de façon générale et dans l'enseignement médical en particulier. La création d'espaces psychologiquement sûrs, la sensibilisation aux vécus complexes et à leur influence sur le présent des individus, la reconnaissance du racisme et le plaidoyer pour le changement contribuent à une prise de conscience qui permet d'orienter le dialogue. La croissance personnelle, aussi difficile que nécessaire, passe par la reconnaissance des sentiments de honte et de culpabilité et par la renonciation au privilège. Enfin, le démantèlement des structures racistes présentes dans le monde médical permettra de s'attaquer à la nature systémique du racisme dans le milieu de la santé, au-delà des interventions au cas par cas. Tout un chacun trouvera un point de départ dans ce guide, car ce sont les actions simples et cohérentes qui favorisent le changement dans les sphères d'influence; l'effet d'entraînement que produisent les actions individuelles se traduira par un changement général des mentalités et des comportements.

Ankle foot orthoses for young children with cerebral palsy: a scoping review.

AIM: To describe research on outcomes associated with early Ankle Foot Orthosis (AFO) use, AFO use patterns, and parent and clinician perspectives on AFO use among young children with cerebral palsy. METHOD: Arksey and O'Malley's five-stage method was used to conduct a scoping review. MEDLINE (Ovid), PubMed, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, PEDro, Web of Science and Scopus were searched for studies evaluating AFO use with children under the age of six years. Descriptive information was extracted and outcomes categorized according to the International Classification of Functioning, Disability and Health (ICF). Quality assessments were conducted to evaluate methodological rigor. RESULTS: Nineteen articles were included in the review; 14 focused on body functions and structures, seven on activity level outcomes and no studies addressed participation outcomes. Evaluations of the effects of AFOs on gross motor skills other than gait were limited. Overall, the body of evidence is comprised of methodologically weak studies with common threats to validity including inadequate descriptions of study protocols, AFO construction, and comparison interventions. CONCLUSION: Research evaluating the effects of AFOs on age-appropriate, functional outcomes including transitional movements, floor mobility and participation in early childhood settings is needed to inform practice regarding early orthotic prescription. Implications for rehabilitationLack of rigorous evidence about the effects of AFOs in young children limits the ability of research to guide practice in pediatric rehabilitation.More rigorous research that evaluates a broader range of age-appropriate outcomes, including those focused on participation in meaningful activities, could further inform clinical practice.While clinicians often discuss expectations and goals with individual families, qualitative research that provides more insight into the experiences of families could guide AFO prescription and monitoring practices.

Pre-school traumatic brain injury and its impact on social development at 8 years of age.

OBJECTIVE: To confirm the clinical impression that younger pre-school children (<4 years at time of injury) who are referred to a tertiary care centre for management with moderate-to-severe traumatic brain injury (TBI) have poorer social, cognitive, physical and emotional outcomes compared to older pre-schoolers (4-6 years at time of injury) and to describe the prevalence and severity of their social impairment at 8 years of age. METHODS: This is a retrospective review of pre-schoolers with moderate-to-severe TBI from 1995-2009. Their social, cognitive, physical and emotional outcomes were assessed at 8 years of age using the Mayo-Portland Adaptability Inventory-Paediatric. RESULTS: Of 130 pre-schoolers enrolled in the database who sustained a TBI < 6 years, 93 were seen at 8 years of age (57 males, 36 females). Younger pre-schoolers (n = 61, mean 2.6 years) had inferior social outcomes (p = 0.04) and cognitive abilities (p = 0.006), trended toward poorer physical outcomes (p = 0.1), with no difference for emotional outcomes (p = 0.2), compared to older pre-schoolers (n = 32, mean 5.0 years). Overall, 19/93 had normal social function, 38/93 had mild impairment, 21/93 had moderate impairment and 15/93 had severe impairment to social function. CONCLUSIONS: Children <4 years at the time of moderate-to-severe TBI have poorer social, cognitive and physical outcomes compared to older pre-schoolers.

From Spark to Flame -- Radical Innovations from Cataclysmic Events in Medical Education.

This article was migrated. The article was marked as recommended. We all knew it was coming. We just didn't realize it would all come at once. No, we are not talking about the zombie apocalypse, but rather the emergence of virtual teaching and virtual healthcare delivery pervading every aspect of life as we now know it. In the context of COVID-19 and marked shifts in how and where we teach medical learners, the staggering number of new ideas, adaptations, and innovations has been inspiring. This game-changing pandemic is a spark, a lightning bolt if you will, that has created solutions, where previous barriers may have been in virtual teaching and healthcare provision. It is impossible to even consider going "back to normal", as they say. We believe the torrent of ideas and possibilities for medical education, brought by COVID-19, cannot and should not be stopped. We explore the nuances of virtual teaching and virtual care and seek readers to consider what their actionable frameshift can mean for medical education in their teaching realm moving forward. We believe that this is the time to innovate: the time to radically change our traditional medical education practices. To sustain these innovations, institutional support, participant buy-in, and assessment and outcome data will be invaluable to harness these new opportunities.