Adolescents on an inpatient unit and their healthcare providers: what's working and what's not.

OBJECTIVES: Adolescents admitted to hospital can face unique medical and psychosocial challenges, and may be treated by healthcare providers who do not recognize or adequately address these needs. Our goal was to better understand the experiences of both patients and providers at a local level. METHODS: We designed a cross-sectional survey-based study of two participant groups: (1) adolescent patients (aged 10-19) admitted to general medical wards at a tertiary pediatric hospital and (2) pediatric healthcare providers representing multiple disciplines. RESULTS: A total of 65 individuals participated: 25 adolescents (mean age 14.6; range 11-17) and 40 multidisciplinary healthcare providers. Most adolescents reported being treated respectfully (88 %) and taken seriously (92 %) by their providers. Several identified structure and routine, a break from daily stressors, and quality time with loved ones as positive aspects to hospitalization, while the use of correct gender pronouns, privacy, and age-appropriate leisure activities were cited areas for improvement. The majority of providers reported enjoying caring for adolescents (82 %) and forging therapeutic connections with them (87 %). Several areas of discomfort were noted, including gender and sexuality, substance use, and suicidality. Identified care gaps included inadequate training/education, suboptimal ward environments, and lack of community resources. CONCLUSIONS: Hospitals should recognize adolescent patients' needs for privacy, youth-centered communication, and developmentally-appropriate spaces. Pediatric healthcare professionals generally enjoy providing care to adolescents in the in-patient setting, however, often have insufficient training in addressing adolescent-specific health and psychosocial issues.

Practicing Confidence: An Autoethnographic Exploration of the First Years as Physicians.

Phenomenon: Every year is heralded with a cohort of newly-minted medical school graduates. Through intense residency training and supervision, these learners gradually develop self-assurance in their newfound skills and ways of practice. What remains unknown, however, is how this confidence develops and on what it is founded. This study sought to provide an insider view of this evolution from the frontline experiences of resident doctors. Approach: Using an analytic collaborative autoethnographic approach, two resident physicians (Internal Medicine; Pediatrics) documented 73 real-time stories on their emerging sense of confidence over their first two years of residency. A thematic analysis of narrative reflections was conducted iteratively in partnership with a staff physician and a medical education researcher, allowing for rich, multi-perspective input. Reflections were analyzed and coded thematically and the various perspectives on data interpretation were negotiated by consensus discussion. Findings: In the personal stories and experiences shared, we take you through our own journey and development of confidence, which we have come to appreciate as a layered and often non-linear process. Key moments include fears in the face of the unknown; the shame of failures (real or perceived); the bits of courage gained by everyday and mundane successes; and the emergence of our personal sense of growth and physicianship. Insights: Through this work, we - as two Canadian resident physicians - have ventured to describe a longitudinal trajectory of confidence from the ground up. Although we enter residency with the label of 'physician,' our clinical acumen remains in its infancy. We graduate from residency still as physicians, but decidedly different in terms of our knowledge, attitudes, and skills. We sought to capitalize on the vulnerability and authenticity inherent in autoethnography to enrich our collective understanding of confidence acquisition in the resident physician and its implications for the practice of medicine.

Unintentional cannabis exposures in children pre- and post-legalization: A retrospective review from a Canadian paediatric hospital.

Objectives: Canada legalized recreational cannabis in October 2018. Cannabis is increasingly available in numerous forms-especially edibles-that make children vulnerable to unintentional intoxication. We sought to: determine the frequency of visits due to cannabis intoxication pre- and post-legalization; characterize the clinical features and circumstances of cannabis intoxication in the paediatric population; and create greater awareness among healthcare providers about this issue. Methods: We performed a retrospective chart review of Emergency Department visits at the Children's Hospital of Eastern Ontario (Ottawa, ON) between March 2013 and September 2020. Inclusion criteria were: age <18 years; unintentional cannabis ingestion, identified by ICD-10 codes T40.7 and X42. We assessed basic demographics, clinical signs and symptoms, exposure details, investigations, and patient disposition. Results: A total of 37 patients (22 male) met inclusion criteria, mean age 5.9±3.8 years. Most visits (32; 86%) occurred in the 2-year period after legalization. Altered levels of consciousness, lethargy/somnolence, tachycardia, and vomiting were the most common presenting signs and symptoms. The majority of exposures were to edibles (28; 76%) in the home setting (30; 81%). Poison control and child protective services were involved in 19 (51%) and 22 (59%) of cases, respectively. Twelve patients (32%) required admission to the hospital, the majority of whom stayed <24 h. Conclusions: Our data confirm increased paediatric hospital visits related to unintentional cannabis exposures post-legalization. Consideration of this clinical presentation is critical for acute care providers. Advocacy for safe storage strategies and appropriate enforcement of marketing/packaging legislation are imperative for public health policymakers.

Capturing the Moments: An Autoethnographic Exploration of Self-Preservation in Clerkship.

PhenomenonFor most medical students, clerkship represents a transitional phase into the 'real world' of medicine. This transition is often accompanied by significant mental stressors, burnout, and empathy decline. Educator led resilience curricula designed to support students during this critical period often focus on teaching generalized strategies to promote wellness and lack the student input and perspective in their development. Thus, they may be of minimal value when learners are faced with acute moments of challenge and distress in their day-to-day work. The following project seeks to provide an insider view on the experience, interpretation, and response to these moments of challenge and distress from the frontline perspective of clinical clerks. Approach: Using collaborative autoethnography, two medical students documented 85 reflections on their emerging professional identity over the course of a core clerkship year. A narrative analysis was conducted iteratively in partnership with a staff internist and a medical education researcher experienced in autoethnography, allowing for robust multi-perspective input. Reflections were analyzed and coded thematically; disagreements were resolved by consensus discussion. Findings: A key theme of the reflections was self-preservation, conceptualized within two principal contexts: (i) Clerk-patient relationships, wherein we found ourselves in emotionally difficult situations; and (ii) Clerk-preceptor relationships, in which self-preservation manifested through a series of self-protective mechanisms. Insights: The practice of self-preservation is understood as the conscious act of boundary-setting and psychological defense in situations that pose a real (or perceived) threat to the clerk's wellbeing. At best, self-preservation serves as a temporary compromise to the stressors and burnout of clerkship. We speculate, however, that, left unchecked, acts of self-preservation may lead to habitual selfishness and apathy, qualities that are in diametric opposition to those expected of future physicians, and may manifest later (when these learners progress through the hierarchy) as the unprofessional behaviors that perpetuate the cycle of the hidden curriculum.

Online Lectures in Undergraduate Medical Education: Scoping Review.

BACKGROUND: The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools-including online lectures-before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes. OBJECTIVE: The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design. METHODS: This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education. RESULTS: In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use. CONCLUSIONS: Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential.

Patient Narratives as a Teaching Tool: A Pilot Study of First-Year Medical Students and Patient Educators Affected by Intellectual/Developmental Disabilities.

PROBLEM: People with intellectual and developmental disabilities (IDD) face complex biopsychosocial challenges and are medically underserved. This is in part due to insufficient resources and supports but can also be attributed to a lack of adequate physician training in addressing the unique needs of this population. INTERVENTION: This study aimed to introduce 1st-year medical students to the IDD population using a blended educational experience that included video narratives of and direct interactions with people affected by IDD. The goal of this intervention was to promote person-centered attitudes and communication among early medical trainees. CONTEXT: The study recruited 27 first-year medical students and randomly assigned each to 1 of 2 groups. The control group received an introductory video lecture about IDD healthcare, followed by a quiz. The narrative group received the same lecture, followed by reflective discussion of videos featuring people living with IDD sharing their perspectives and stories. All students then participated in 4 simulated clinical encounters with patient educators (PEs) who have lived experiences of IDD. Focus groups were conducted with students following the simulated encounters to explore their experiences and perceptions of this blended learning activity. Moreover, secondary quantitative data were collected to assess students' performance in the clinical encounters, along with self-reports of comfort, confidence, and competence of interacting with people with IDD (pre- and postparticipation). OUTCOME: All students thought that the blended educational experience was valuable and enjoyable, commenting on the importance of adaptable language and engagement of people with IDD, as well as the merits of reflecting on patient narratives. Students also discussed feelings of discomfort stemming from a lack of knowledge and previous exposure to IDD and how this discomfort might motivate them to learn more and develop their skills further. In addition, descriptive analyses revealed that students in the narrative group showed greater self-rated measures of comfort, confidence, and competence compared to control; they also had higher mean performance scores across all PE interview stations. LESSONS LEARNED: PEs add a powerful real-life dimension to communication skills teaching and have been shown to be a valuable educational modality. Moreover, exposure to and reflection on video-based patient narratives are useful ways of teaching medical students about patients' lived experiences and promoting person-centered communication, both within and beyond IDD.