Virtual breakout rooms: an effective approach to offer guidance to medical students on residency applications.

Peer mentorship on residency applications has been difficult due to recent public health measures, prompting a shift from in-person events to virtual platforms. To address gaps in career exploration, we created a virtual, non-recorded space that allowed medical students and residents to discuss the Canadian Resident Matching Service (CaRMS) process meaningfully and transparently. Attendees reported a greater understanding of the match process and reduced anxiety after the event. This model provides a virtual framework that can be adapted for various mentorship opportunities.

Le mentorat par les pairs offert aux étudiants concernant les demandes de résidence a été difficile à mettre en œuvre en raison des récentes mesures de santé publique, entraînant le transfert des activités en personne vers les plateformes virtuelles. Pour combler les lacunes dans l'exploration des carrières, nous avons créé un espace virtuel, sans enregistrement, qui a permis aux étudiants et aux résidents de discuter du processus du Service canadien de jumelage des résidents (CaRMS) de manière approfondie et transparente. Les participants ont indiqué qu'à la suite de la rencontre, ils comprenaient mieux le processus de jumelage et qu'ils étaient moins anxieux. Ce modèle virtuel peut être adapté et utilisé pour diverses activités de mentorat.

A Systematic Literature Review of Health Utility Values in Breast Cancer.

BACKGROUND: Health utility values (HUVs) are important inputs to the cost-utility analysis of breast cancer interventions. PURPOSE: Provide a catalog of breast cancer-related published HUVs across different stages of breast cancer and treatment interventions. DATA SOURCES: Systematic searches of MEDLINE, MEDLINE In-Process, EMBASE, Web of Science, CINAHL, PsycINFO, EconLit, and Cochrane databases (2005-2017). STUDY SELECTION: Studies published in English that reported mean or median HUVs using direct or indirect methods of utility elicitation for breast cancer. DATA EXTRACTION: Independent reviewers extracted data on a preestablished and piloted form; disagreements were resolved through discussion. DATA ANALYSIS: Mixed-effects meta-regression using restricted maximum likelihood modeling was conducted for intervention type, stage of breast cancer, and typical clinical and treatment trajectory of breast cancer patients to assess the effect of study characteristics (i.e., sample size, utility elicitation method, and respondent type) on HUVs. DATA SYNTHESIS: Seventy-nine studies were included in the review. Most articles (n = 52, 66%) derived HUVs using the EQ-5D. Patients with advanced-stage breast cancer (range, 0.08 to 0.82) reported lower HUVs as compared with patients with early-stage breast cancer (range, 0.58 to 0.99). The meta-regression analysis found that undergoing chemotherapy and surgery and radiation, being diagnosed with an advanced stage of breast cancer, and recurrent cancer were associated with lower HUVs. The members of the general public reported lower HUVs as compared with patients. LIMITATIONS: There was considerable heterogeneity in the study population, health states assessed, and utility elicitation methods. CONCLUSION: This review provides a catalog of published HUVs related to breast cancer. The substantial heterogeneity in the health utility studies makes it challenging for researchers to choose which HUVs to use in cost-utility analyses for breast cancer interventions.

Understanding moral empathy: A verbatim-theatre supported phenomenological exploration of the empathy imperative.

OBJECTIVES: Several studies have measured a decline in empathy during medical training, speculating that factors within the formal, informal and hidden curricula are responsible for this phenomenon. Although the medical education literature describes the moral domain of empathy as most fundamental to the empathic response, most research into the decline has examined the cognitive, affective and behavioural domains. This study distinguishes itself by focusing on how moral empathy is affected through training. METHODS: Ten medical residents from core education specialties at McMaster University participated in lightly structured interviews concerning their training experiences. Interview transcripts were analysed by way of a descriptive phenomenological approach. Analyses afforded descriptions of the way medical training influences moral empathy. These descriptions were then used to generate a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers and scholars. Following the play, audience participants completed a survey to member-check the descriptions and to glean other reflective experiences in resident training that impact moral empathy. The survey results informed revisions to the codebook that was subsequently used to re-analyse the interview transcripts. This resulted in a final, refined version of the influence of training on learner moral empathy. RESULTS: The findings suggest that a resident's sense of moral empathy relies upon the notion of an innate capacity for empathy, and is influenced by their clinical and classroom education, and specific experiences with patients during training. Importantly, these factors are rarely experienced as having a direct deleterious impact on residents' moral empathy but rather are experienced as challenges to their ability to act on their moral empathy. CONCLUSIONS: The study promotes reflection of what it means to experience empathy in the moral domain. The description offers a new perspective from which to view empathic declines that have been previously reported, while also highlighting a moral-behavioural tension that has implications for competency-based assessment and the way empathy is conceptualised in medical education.

A critical perspective on the modified personal interview.

Medical school interviews are critical for screening candidates for admission. Traditionally, the panel format is used for this process, although its drastically low reliabilities sparked the creation of the highly reliable multiple mini-interview (MMI). However, the multiple mini-interview's feasibility issues made it unappealing to some institutions, like the University of Toronto, who created the modified personal interview (MPI) as a more feasible alternative. The lack of literature about the MPI, however, prevents the medical community from determining whether this interview format achieves this goal. Therefore, evidence was compiled and critically appraised for the MPI using Kane's validity framework, which enables analysis of four levels of inference (Scoring, Generalization, Extrapolation, Implication). Upon examining each level, it was concluded that assumptions made at the 'Scoring' and 'Generalization' levels had the least support. Based on these findings, it was recommended that in-person rater training become mandatory and the number of stations increase twofold from four to eight. Moreover, the following research initiatives were suggested to improve understanding of and evidence for the modified personal interview: (1) formally blueprint each station; (2) conduct predictive validity studies for the modified personal interview, and (3) relate admission to medical school on the basis of the MPI with medical error rates. By making these changes and studying these initiatives, the MPI can become a more feasible and equally effective alternative to the MMI with more evidence to justify its implementation at other medical schools.