Academic Half-Days: Facilitated Small Groups to Promote Interactive Learning.

BACKGROUND AND OBJECTIVES: Medical educators have expressed interest in using less didactic and more interactive formats for academic half-days (AHDs) in postgraduate residency training. We assessed the feasibility and effectiveness of implementing a practice-based small-group learning (PBSGL) process as one part of AHDs. METHODS: A mixed-methods approach was used. Over a two-year period, family medicine residents at the University of Calgary took part in PBSGL sessions during their AHDs, discussing clinical cases presented in evidence-based educational modules and reflecting on clinical experiences with the guidance of a trained peer facilitator. Data sources to explore experiences with the PBSGL process included an evaluation questionnaire, a practice reflection tool (PRT; documenting patient management plans) and individual interviews (n=19) with residents and faculty preceptors. RESULTS: Of 148 residents, 139 (93%) agreed to participate. Participants were divided into groups of 14-16 members to discuss 12 different module topics. Participants indicated that ongoing small-group interactions were helpful in meeting learning needs and provided opportunities to share and learn from experiences of others in a safe environment. Group facilitation by residents was successful. Level of resident participation and time to preread modules were factors contributing to successful small-group interactions. Modules were rated as effective learning tools, and sample cases were perceived as representing typical cases encountered in practice. Although participants intended to apply their learning to practice, follow through was hindered by lack of relevant clinical cases. CONCLUSIONS: Ongoing small-group learning facilitated by residents, coupled with evidence-based educational materials, was a feasible approach to AHDs.

Picking the Right Tool for the Job: A Reliability Study of 4 Assessment Tools for Central Venous Catheter Insertion.

BACKGROUND: Determining procedural competence requires psychometrically sound assessment tools. A variety of instruments are available to determine procedural performance for central venous catheter (CVC) insertion, but it is not clear which ones should be used in the context of competency-based medical education. OBJECTIVE: We compared several commonly used instruments to determine which should be preferentially used to assess competence in CVC insertion. METHODS: Junior residents completing their first intensive care unit rotation between July 31, 2006, and March 9, 2007, were video-recorded performing CVC insertion on task trainer mannequins. Between June 1, 2016, and September 30, 2016, 3 experienced raters judged procedural competence on the historical video recordings of resident performance using 4 separate tools, including an itemized checklist, Objective Structured Assessment of Technical Skills (OSATS), a critical error assessment tool, and the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Generalizability theory (G-theory) was used to compare the performance characteristics among the tools. A decision study predicted the optimal testing environment using the tools. RESULTS: At the time of the original recording, 127 residents rotated through intensive care units at the University of Calgary, Alberta, Canada. Seventy-seven of them (61%) met inclusion criteria, and 55 of those residents (71%) agreed to participate. Results from the generalizability study (G-study) demonstrated that scores from O-SCORE and OSATS were the most dependable. Dependability could be maintained for O-SCORE and OSATS with 2 raters. CONCLUSIONS: Our results suggest that global rating scales, such as the OSATS or the O-SCORE tools, should be preferentially utilized for assessment of competence in CVC insertion.

"Something is wrong with your milk": Qualitative study of maternal dietary restriction and beliefs about infant colic.

OBJECTIVE: To investigate new mothers' perceptions about the role of maternal diet in infant fuss-cry behaviour, and to explore patterns of food restriction in breastfeeding women. DESIGN: Qualitative study. SETTING: Calgary, Alta. PARTICIPANTS: Twenty-one mothers of healthy singleton infants aged 6 months and younger. METHODS: Focus groups and one-on-one interviews with a semistructured interview guide, followed by content analysis. MAIN FINDINGS: Most respondents believed that infant cry-fuss behaviour was related to abdominal pain linked to feeding and had eliminated items from their diet in an attempt to change infant behaviour. Typical targets of elimination were caffeine, cruciferous vegetables (eg, broccoli and cabbage), garlic and onions, spicy foods, gluten, and beans. Women commonly viewed elimination diets as an extension of neutral or benign choices made during pregnancy, even when it led to extreme diet restrictions. Participants reported feeling appraised by society for their infant-feeding choices, and often harshly judged. Many women reported feeling confused by conflicting sources of reliable information on breastfeeding and preferred advice from trusted friends and family to that from health care providers or the Internet. CONCLUSION: The breastfeeding women in this study believed that maternal diet influenced infant cry-fuss behaviour, in spite of scientific evidence demonstrating the contrary. An understandable desire for a calm baby, as well as to be favourably judged by friends and family, can drive breastfeeding women to restrict their diet, often to the point of hardship.

Future practice of comprehensive care: Practice intentions of exiting family medicine residents in Canada.

OBJECTIVE: To describe exiting family medicine (FM) residents' reported practice intentions after completing a Triple C Competency-based Curriculum. DESIGN: The surveys were intended to capture residents' perceptions of FM, their perceptions of their competency-based training, and their intentions to practise FM. Entry (T1) and exit (T2) self-reported survey results were compared considering the influence of the curriculum change. Unmatched aggregate-level data were reviewed. The T1 survey was administered in the summer of 2012 and the T2 survey was administered in the spring of 2014. SETTING: Six Canadian FM residency programs across 4 provinces in Canada (Alberta, Saskatchewan, Ontario, and Quebec). PARTICIPANTS: Overall, 341 entering FM residents in 2012 responded to the T1 survey and 325 exiting FM residents completing their residency programs in spring 2014 responded to the T2 survey. MAIN OUTCOME MEASURES: Self-reported data on FM residents' future practice intentions related to comprehensive care, providing care across clinical domains and settings, and providing comprehensive care individually or in teams. RESULTS: A total of 341 (71.3%) residents responded to the T1 survey and a total of 325 (71.4%) residents responded to the T2 survey. Of these, 78.7% responded that they intended to provide comprehensive FM in multiple clinical settings in their future practices, with 70.8% indicating a comprehensive care practice with a special interest and 36.6% intending to provide care in a focused practice. Overall, 92.9% reported that they intended to work in group practice environments. Ninety percent reported they intended to work in interprofessional team practices. CONCLUSION: While an upward trend toward the practice of comprehensive care was demonstrated, findings also showed an increased trend toward providing care in focused practices. Further research is needed to better determine how FM residents understand the definition of comprehensive FM and its practice models. The survey provides an opportunity to explore questions related to practice intentions that could be helpful in work force planning. As the first study to compare entry and exit data from learners who have been exposed to a Triple C competency-based approach, this survey provides important baseline data for use by many.

Extended family medicine training: Measuring training flows at a time of substantial pedagogic change.

OBJECTIVE: To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. DESIGN: Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. SETTING: Canada. PARTICIPANTS: All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. MAIN OUTCOME MEASURES: Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. RESULTS: The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. CONCLUSION: New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS-Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of extended family medicine training programs.