Off-Script, Online: Virtual Medical Improv Pilot Program for Enhancing Well-being and Clinical Skills among Psychiatry Residents.

OBJECTIVE: Clinical interactions demand a balance of structure and flexibility in response to unpredictable situations. Medical improv is a form of experiential learning that applies techniques from improvisational theater to the healthcare setting, deliberately targeting clinical skills of communication, teamwork, and cognitive abilities. Psychiatry Education through Play and Talk (PEP Talks) is a novel medical improv program designed specifically for psychiatry residents with the goal of improving communication, teamwork, and conflict resolution skills, as well as enhancing residents' well-being and capacity for self-reflection. METHODS: PEP Talks was delivered virtually by an experienced medical improv facilitator in spring 2021 to a self-selected group of psychiatry residents at a Canadian university. Aligned with the context-input-process-product (CIPP) evaluation model, outcomes were assessed through mixed methods surveys, recorded debriefings, and a focus group. RESULTS: PEP Talks enhanced residents' self-reported well-being, reflective capacity, and communication skills. Participants made qualitative connections between PEP Talks and their well-being, inter- and intra-personal skills, and clinical experiences in psychiatry. Processes in PEP Talks that led to these outcomes included the following: joy, building community, personal reflection and discovery, going off-script, immersion, and virtual engagement. CONCLUSIONS: Virtual medical improv offers an innovative solution to the pedagogical challenges of training psychiatrists to be proficient communicators, collaborators, and professionals capable of reflective practice. Additionally, this innovation demonstrates that medical improv can be delivered in a virtual format and may offer a unique solution to support resident well-being and foster connection amid remote learning during a global pandemic.

Smoking cessation counselling training in the pre-clerkship curriculum of Canadian medical schools: A national survey.

BACKGROUND: Cigarette use is Canada's leading cause of preventable disease, disability, and death. The Medical Council of Canada requires that physicians be able to address tobacco-use, however smoking cessation counselling (SCC) training remains largely neglected in the pre-clerkship curricula of many Canadian medical schools. METHODS: Between July and October of 2015, Canada's 17 medical schools were invited to participate in an administrative survey: The Canadian Medical School Assessment of Smoking Cessation Counselling in the Pre-Clerkship Curriculum. Each was asked to comment on the presence of 28 tobacco-related topics in their curricula, including: time devoted to source material; year(s) of training during which medical students were exposed to related content; methods of teaching and examination; and, the attitudes, policies, and barriers relevant to the presence of smoking cessation counselling (SCC) training in the curriculum.A second short survey: Assessing Medical Students Attitudes toward Smoking Cessation Education was distributed to 100 University of Ottawa medical students to assess comfort level and perceived confidence toward addressing smoking cessation with patients. RESULTS: Eleven of 17 medical schools completed the administrative survey. The results demonstrated substantial deficits and inconsistencies in the delivery of SCC training in the pre-clerkship curricula of Canada's medical schools. The short survey revealed perceived discomfort regarding smoking cessation discussion, consistent with the potential curriculum deficits suggested in the larger national survey. CONCLUSION: The results of both surveys suggest an unfortunate oversight given the devastating impact of tobacco-related diseases. Institutional commitment and enhanced inter-university collaboration could facilitate the development of a national undergraduate medical education program to enhance the delivery of SCC training within the pre-clerkship curricula of Canadian medical schools.

Mesenchymal stem cells transmigrate between and directly through tumor necrosis factor-α-activated endothelial cells via both leukocyte-like and novel mechanisms.

Systemically administered adult mesenchymal stem cells (MSCs), which are being explored in clinical trials to treat inflammatory disease, exhibit the critical ability to extravasate at sites of inflammation. We aimed to characterize the basic cellular processes mediating this extravasation and compare them to those involved in leukocyte transmigration. Using high-resolution confocal and dynamic microscopy, we show that, like leukocytes, human bone marrow-derived MSC preferentially adhere to and migrate across tumor necrosis factor-α-activated endothelium in a vascular cell adhesion molecule-1 (VCAM-1) and G-protein-coupled receptor signaling-dependent manner. As several studies have suggested, we observed that a fraction of MSC was integrated into endothelium. In addition, we observed two modes of transmigration not previously observed for MSC: Paracellular (between endothelial cells) and transcellular (directly through individual endothelial cells) diapedesis through discrete gaps and pores in the endothelial monolayer, in association with VCAM-1-enriched "transmigratory cups". Contrasting leukocytes, MSC transmigration was not preceded by significant lateral migration and occurred on the time scale of hours rather than minutes. Interestingly, rather than lamellipodia and invadosomes, MSC exhibited nonapoptotic membrane blebbing activity that was similar to activities previously described for metastatic tumor and embryonic germ cells. Our studies suggest that low avidity binding between endothelium and MSC may grant a permissive environment for MSC blebbing. MSC blebbing was associated with early stages of transmigration, in which blebs could exert forces on underlying endothelial cells indicating potential functioning in breaching the endothelium. Collectively, our data suggest that MSC transmigrate actively into inflamed tissues via both leukocyte-like and novel mechanisms.