Efficacy and Safety of Four Psychedelic-Assisted Therapies for Adults with Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

There has been a resurgence in psychedelic research for managing psychiatric conditions in recent years. This study aimed to present a comprehensive review of the current state of the field by applying a systematic search strategy for articles on the effectiveness and tolerability of four psychedelic-assisted therapies (psilocybin, lysergic acid diethylamide [LSD], 3,4-Methylenedioxymethamphetamine [MDMA], and ayahuasca) for adults with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Psychometric scores and adverse events were pooled using random-effects meta-analysis models with Hedges' g bias-corrected standardized mean differences (g) and rate ratios (RR) with 95% confidence intervals (CI). Bias evaluation followed PRISMA and Cochrane guidelines. Eighteen studies were identified, which suggested that psychedelic therapies were well tolerated and presented a large effect size for the management of depression symptoms in a transdiagnostic population with psilocybin (g = -1.92, 95% CI, -2.73 to -1.11) and MDMA (g = -0.71; 95% CI, -1.39 to -0.03). These are promising results that complement the current literature. However, evidence certainty was low to very low due to methodological limitations, small sample size, blinding, study heterogeneity, and publication bias. These results also highlight the need for more adequately powered studies exploring these novel therapies.

Cognitive load theory in action: e-learning modules improve performance in simulation-based education. A pilot study.

PURPOSE: Learners participating in simulation-based education may experience cognitive overload with potential detrimental effects to learning and performance. Multiple strategies have been proposed to mitigate this detrimental response. However, these strategies have not fully considered the potential benefits of using online platforms, such as accessibility, cost-effectiveness, efficiency, and scalability. Addressing this gap in the literature, preparatory online modules were developed by applying concepts from cognitive load theory and simulation-based education. This study assessed whether using preparatory online modules to deliver weekly pre-briefing content could impact cognitive load and performance. The participants were first-year postgraduate medical trainees participating in a simulation-based resuscitation curriculum. METHODS: Fifty-three trainees were allocated to receive preparatory online modules (online modules group, n = 27) or not (control group, n = 26) during the course component of a simulation-based resuscitation curriculum. Then, these trainees participated in a simulation-based objective structured clinical examination (OSCE). Sources of cognitive load (intrinsic, extraneous, and germane) were measured using a modified cognitive load questionnaire. Performance was assessed using the Ottawa Surgical Competency Operating Room Evaluation. Data were analyzed with descriptive statistics, and principal component analysis. RESULTS: During the course component, the online modules group was found to have higher intrinsic and germane cognitive load, and lower extraneous cognitive load compared to the control group. During the OSCE, the online modules group scored significantly higher in performance scores (p = 0.0077, d = 0.39, 95% confidence interval = 0.10;0.68) compared to the control group. Principal component analysis supported the results obtained with the modified cognitive load questionnaire. CONCLUSION: Trainees using preparatory online modules during the course component of a simulation-based resuscitation curriculum experienced cognitive load changes consistent with cognitive optimization. This may have contributed to their superior performance in the subsequent OSCE. Future research should explore the long-term impacts of online preparatory training and consider potential barriers to implementation in diverse healthcare environments.

RéSUMé: OBJECTIF: Les personnes apprenantes qui participent à un enseignement basé sur la simulation peuvent éprouver une surcharge cognitive pouvant avoir des effets néfastes sur l'apprentissage et le rendement. Plusieurs stratégies ont été proposées pour atténuer cette réaction préjudiciable. Toutefois, ces stratégies n'ont pas pleinement tenu compte des avantages potentiels de l'utilisation de plateformes en ligne, comme l'accessibilité, la rentabilité, l'efficience et l'évolutivité. Pour combler cette lacune dans la littérature, des modules préparatoires en ligne ont été développés en appliquant les concepts de la théorie de la charge cognitive et de l'éducation basée sur la simulation. Cette étude a évalué si l'utilisation de modules en ligne préparatoires pour fournir un contenu de pré-briefing hebdomadaire pourrait avoir un impact sur la charge cognitive et la performance. Les participants étaient des étudiants en médecine de troisième cycle de première année participant à un programme de réanimation par simulation. MéTHODES: Cinquante-trois stagiaires ont reçu des modules préparatoires en ligne (groupe de modules en ligne, n = 27) ou non (groupe témoin, n = 26) au cours de la composante de cours d'un programme de réanimation par simulation. Ces stagiaires ont ensuite participé à un examen clinique objectif structuré basé sur la simulation (OSCE). Les sources de charge cognitive (intrinsèque, étrangère et pertinente) ont été mesurées à l'aide d'un questionnaire sur la charge cognitive modifiée. Le rendement a été évalué à l'aide de l'évaluation de la salle d'opération des compétences en chirurgie d'Ottawa. Les données ont été analysées à l'aide de statistiques descriptives et d'une analyse en composantes principales. RéSULTATS: Au cours de la composante de cours, le groupe des modules en ligne s'est avéré avoir une charge cognitive intrinsèque plus élevée et une charge cognitive étrangère plus faible par rapport au groupe témoin. Au cours de l'OSCE, le groupe des modules en ligne a obtenu des scores de performance significativement plus élevés (p = 0,0077, d = 0,39, intervalle de confiance à 95 % = 0,10;0,68) que le groupe témoin. L'analyse en composantes principales a appuyé les résultats obtenus avec le questionnaire sur la charge cognitive modifiée. CONCLUSION: Les stagiaires utilisant des modules préparatoires en ligne pendant la composante de cours d'un programme de réanimation basé sur la simulation ont subi des changements de charge cognitive compatibles avec l'optimisation cognitive. Cela peut avoir contribué à leur performance supérieure dans l'OSCE ultérieure. Les recherches futures devraient explorer les impacts à long terme de la formation préparatoire en ligne et examiner les obstacles potentiels à la mise en œuvre dans divers environnements de soins de santé.

Radiation Oncology Fellowship: a Value-Based Assessment Among Graduates of a Mature Program.

The University of Toronto - Department of Radiation Oncology (UTDRO) has had a well-established Fellowship Program for over 20 years. An assessment of its graduates was conducted to evaluate training experience and perceived impact on professional development. Graduates of the UTDRO Fellowship Program between 1991 and 2015 were the focus of our review. Current employment status was collected using online tools. A study-specific web-based questionnaire was distributed to 263/293 graduates for whom active e-mails were identified; questions focused on training experience, and impact on career progression and academic productivity. As a surrogate measure for the impact of UTDRO Fellowship training, a comparison of current employment and scholarly activities of individuals who obtained their Fellow of the Royal College of Physicians of Canada (FRCPC) designation in Radiation Oncology between 2000 and 2012, with (n = 57) or without (n = 230) UTDRO Fellowship training, was conducted. Almost all UTDRO Fellowship graduates were employed as staff radiation oncologists (291/293), and most of those employed were associated with additional academic (130/293), research (53/293), or leadership (68/293) appointments. Thirty-eight percent (101/263) of alumni responded to the online survey. The top two reasons for completing the Fellowship were to gain specific clinical expertise and exposure to research opportunities. Respondents were very satisfied with their training experience, and the vast majority (99%) would recommend the program to others. Most (96%) felt that completing the Fellowship was beneficial to their career development. University of Toronto, Department of Radiation Oncology Fellowship alumni were more likely to hold university, research, and leadership appointments, and author significantly more publications than those with FRCPC designation without fellowship training from UTDRO. The UTDRO Fellowship Program has been successful since its inception, with the majority of graduates reporting positive training experiences, benefits to scholarly output, and professional development for their post-fellowship careers. Key features that would optimize the fellowship experience and its long-term impact on trainees were also identified.