Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol.

INTRODUCTION: There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. METHODS: Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. DISCUSSION: Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.

Zoomification of medical education: can the rapid online educational responses to COVID-19 prepare us for another educational disruption? A scoping review.

Introduction: In response to the COVID-19 pandemic, educators have increasingly shifted delivery of medical education to online/distance learning. Given the rapid and heterogeneous nature of adaptations; it is unclear what interventions have been developed, which strategies and technologies have been leveraged, or, more importantly, the rationales given for designs. Capturing the content and skills that were shifted to online, the type of platforms used for the adaptations, as well as the pedagogies, theories, or conceptual frameworks used to inform the adapted educational deliveries can bolster continued improvement and sustainability of distance/online education while preparing medical education for future large-scale disruptions. Methods: We conducted a scoping review to map the rapid medical educational interventions that have been adapted or transitioned to online between December 2019 and August 2020. We searched MEDLINE, EMBASE, Education Source, CINAHL, and Web of Science for articles pertaining to COVID-19, online (distance) learning, and education for medical students, residents, and staff. We included primary research articles and reports describing adaptations of previous educational content to online learning. Results: From an initial 980 articles, we identified 208 studies for full-text screening and 100 articles for data extraction. The majority of the reported scholarship came from Western Countries and was published in clinical science journals. Cognitive content was the main type of content adapted (over psychomotor, or affective). More than half of the articles used a video-conferencing software as the platform to pivot their educational intervention into virtual. Unfortunately, most of the reported work did not disclose their rationale for choosing a platform. Of those that did, the majority chose technological solutions based on availability within their institutions. Similarly, most of the articles did not report the use of any pedagogy, theory, or framework to inform the educational adaptations.

Introduction: En réponse à la pandémie de la COVID-19, l'enseignement médical a été progressivement déplacé vers l'espace virtuel. Compte tenu de la rapidité et de l'hétérogénéité des adaptations opérées, nous n'avons qu'une idée peu précise des activités éducatives élaborées, des stratégies et des technologies mobilisées et, plus important encore, des raisons avancées pour les motiver. Une meilleure connaissance du contenu et des compétences dont l'enseignement a été transféré en ligne, du type de plateformes utilisées pour le virage, ainsi que des pédagogies, des théories ou des cadres conceptuels utilisés pour guider les activités éducatives adaptées soutiendrait une amélioration continue et la pérennité de l'enseignement à distance, tout en préparant la formation médicale à de futures perturbations d'envergure. Méthodes: Nous avons effectué une revue exploratoire pour recenser les activités éducatives en médecine qui ont été expéditivement adaptées ou transposées en ligne entre décembre 2019 et août 2020. Nous avons interrogé les bases de données MEDLINE, EMBASE, Education Source, CINAHL et Web of Science à la recherche d'articles portant sur la COVID-19, sur l'apprentissage en ligne (à distance) et sur la formation des étudiants en médecine, des résidents et du personnel enseignant. Nous avons inclus des articles de recherche originale et d'autres décrivant l'adaptation de contenus éducatifs à l'apprentissage en ligne. Résultats: Des 980 articles trouvés, nous avons sélectionné 208 études pour un examen du texte intégral et 100 articles pour une extraction de données. La plupart des travaux provenaient de pays occidentaux et ont été publiés dans des revues médicales. Le type de contenu adapté était principalement cognitif, dans une moindre mesure psychomoteur ou affectif. Plus de la moitié des articles présentaient un logiciel de visioconférence comme plateforme utilisée pour transposer des activités éducatives en mode virtuel. Malheureusement, la plupart des études ne précisaient pas les raisons justifiant le choix de plateforme. Celles qui l'ont fait indiquaient majoritairement que les solutions technologiques avaient été choisies en fonction de leur disponibilité au sein de l'établissement. De la même manière, seulement une poignée d'articles font état de l'utilisation d'une pédagogie, d'une théorie ou d'un cadre pour guider les adaptations pédagogiques.

Interventions for intimate partner violence during the perinatal period: a scoping review protocol.

INTRODUCTION: Globally, the prevalence and incidence of perinatal intimate partner violence (IPV) are well documented and substantiated; however, there is an urgent need to identify interventions to prevent recurrence or revictimisation, and decrease the harms of perinatal IPV. This scoping review is designed to broadly capture all potential interventions for the secondary prevention of IPV, review them in detail, and assess what can reduce revictimisation and foster improvements in both maternal and neonatal outcomes. METHODS AND ANALYSIS: With the structure of the Joanna Briggs Institute and Arksey and O'Malley methodology for scoping reviews, the search will be conducted in: MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), Cochrane Central Register of Controlled Trials (OvidSP), Web of Science, and Applied Social Sciences Index & Abstracts (ProQuest). A manual search of the reference lists of the retrieved articles will be conducted to capture all relevant studies for potential inclusion. A year limit of January 2000-June 2022 will be applied to retrieve most current peer-reviewed articles. No search filters or language limits will be used, but only publications in English and French will be eligible for inclusion. Interventions include but are not limited to: psychotherapy, educational sessions, home visitation, etc. Outcomes include but are not limited to: (1) harms of IPV among survivors (eg, revictimisation) and (2) adverse perinatal outcomes (eg, preterm birth). Interventions will be excluded if they target the perpetrator or child(ren) alone. Titles and abstracts of included studies will be screened in duplicate. Full-text documents will be extracted and reviewed by two independent reviewers. Conflicts between reviewers will be resolved by a third independent reviewer. Findings will be presented with descriptive statistics and narrative synthesis. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review. The results will be disseminated through peer-reviewed publication and conference presentations. STUDY REGISTRATION: Open Science Framework (OSF) registry (https://osf.io/e294r) in Centre for Open Science (OSF) on 27 May 2022.

Characteristics of Canadian physicians and their associations with practice patterns: a scoping review.

Background: Physician characteristics such as education and sociodemographic attributes are associated with particular practice patterns, such as practice in rural settings. Understanding the Canadian context of such associations can inform medical school recruitment and health workforce decision-making. Objective: The objective of this scoping review was to report the nature and extent of the literature on associations between characteristics of physicians in Canada and physicians' practice patterns. Eligibility criteria: We included studies reporting associations between 1) the education or sociodemographic attributes of practicing physicians or residents in Canada and 2) practice patterns, including career choice, practice setting, and populations served. Methods: We searched five electronic databases (MEDLINE (R) ALL, Embase, ERIC, Education Source and Scopus) for quantitative primary studies and reviewed reference lists of included studies for additional studies. Data were extracted using a standardized data charting form. Results: Our search yielded 80 studies. Sixty-two examined education, evenly divided between undergraduate and postgraduate. Fifty-eight examined physicians' attributes, most focusing on sex/gender. The majority of studies focused on the outcome of practice setting. We found no studies examining race/ethnicity or socioeconomic status. Conclusion: Many studies in our review found positive associations between (i) rural training or rural background and rural practice setting and (ii) location of training or physicians' origin and practice in that location, consistent with previous literature. Associations for sex/gender were mixed, suggesting it may be a less useful target for workforce planning or recruitment aiming to address gaps in health care provision. More research is needed on the association of characteristics, particularly race/ethnicity and socioeconomic status, with career choice and populations served.

Contexte: Il existe un lien entre les caractéristiques des médecins, comme leur formation et leur profil sociodémographique, et des cadres de pratique particuliers, comme la pratique en milieu rural. La compréhension de ces liens dans le contexte canadien peut éclairer les stratégies d'admission dans les facultés de médecine et la planification de la main-d'œuvre dans le secteur de la santé. Objectif: L'objectif de cette revue exploratoire était de faire état de la nature et de l'étendue de la littérature sur les liens entre les caractéristiques des médecins au Canada et leurs cadres de pratique. Critères de sélection : Nous avons inclus les études établissant des liens entre 1) la formation ou le profil sociodémographique des médecins ou des résidents en exercice au Canada et 2) les cadres de pratique, y compris le choix de carrière, le milieu de pratique et les populations desservies. Méthodes: Nous avons effectué des recherches dans cinq bases de données électroniques (MEDLINE (R) ALL, Embase, ERIC, Education Source et Scopus) pour trouver des études quantitatives primaires et avons examiné les listes de références bibliographiques des articles retenus pour repérer d'autres études. Les données ont été extraites à l'aide d'un formulaire normalisé. Résultats: Notre recherche a permis de recenser 80 études. Soixante-deux d'entre elles portaient sur l'éducation, réparties de manière égale entre le premier cycle et le cycle de spécialisation. Cinquante-huit examinaient les caractéristiques des médecins, la plupart portant sur le sexe/genre. La majorité des études étaient focalisées sur le critère du milieu de pratique. Nous n'avons trouvé aucune étude portant sur la race/ethnicité ou le statut socio-économique. Conclusion: En accord avec des travaux antérieurs de nombreuses études de notre revue trouvent des associations positives entre (i) la formation en milieu rural ou l'origine rurale et un cadre de pratique rural et entre (ii) le lieu de formation ou l'origine du médecin et une pratique dans ce lieu. Les associations relatives au sexe/genre étaient mitigées, ce qui porte à croire qu'il s'agit peut-être d'une cible moins utile pour la planification ou le recrutement d'une main-d'œuvre visant à combler les lacunes dans la prestation des soins de santé. Des travaux supplémentaires sont nécessaires sur les liens entre le profil des médecins, en particulier la race/ethnie et le statut socio-économique, d'une part, et le choix de carrière et les populations desservies d'autre part.

Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review.

BACKGROUND: Immigrant students face various challenges in high-income countries that can contribute to the decline of their mental well-being upon arrival in their host country. Despite the growing population of these students in several high-income countries, there is inadequate attention given to their mental health needs and their access to mental health services. Thus, this systematic scoping review aimed to identify gaps in existing research relating to the barriers and facilitators associated with access to and use of mental health services in high-income countries. METHODS: Following the PRISMA-ScR checklist as guidance we systematically searched Ovid Medline, APA PsycInfo, Education Source, CINAHL, Web of Science databases for peer reviewed articles related to barriers and facilitators of mental health service use among immigrant students. We conducted a narrative evidence synthesis to highlight barriers and facilitators to the use of mental health services. RESULTS: Out of the 2407 articles initially found, 47 studies met the inclusion criteria and were considered for this review. The increasing attention towards the mental health concerns of immigrant students and their access to mental health services is evident. However, various barriers like stigma, insufficient knowledge, or adherence to traditional gender roles (such as masculinity) hinder their utilization of these services. On the other hand, factors such as being a woman, having a strong sense of cultural adaptation, or possessing adequate mental health literacy serve as facilitators for accessing mental health services. CONCLUSION: These students have unique experiences, and their needs are often unmet. To improve their mental health and use of mental health services, it is important to consider the barriers they face and their unique experience in their specific life context and to develop tailored prevention and intervention programs.

Definitions and factors associated with emergency physician productivity: a scoping review.

PURPOSE: There currently exists no standard productivity measure for emergency physicians. The objectives of this scoping review were to synthesize the literature to identify components of definitions and measurements of emergency physician productivity and to evaluate factors associated with productivity. METHODS: We searched Medline, Embase, CINAHL, and ProQuest One Business from inception to May 2022. We included all studies that reported on emergency physician productivity. We excluded studies that only reported departmental productivity, studies with non-emergency providers, review articles, case reports, and editorials. Data were extracted into predefined worksheets and a descriptive summary was presented. Quality analysis was performed with Newcastle-Ottawa Scale. RESULTS: After screening 5521 studies, 44 studies met full inclusion criteria. Components of the definition for emergency physician productivity included: number of patients managed, revenue generated, patient processing time, and a standardization factor. Most studies measured productivity using patients per hour, relative value units per hour, and provider-to-disposition time. The most studied factors influencing productivity included scribes, resident learners, electronic medical record implementation, and faculty teaching scores. CONCLUSION: Emergency physician productivity is heterogeneously defined, but includes common elements such as patient volume, complexity, and processing time. Commonly reported productivity metrics include patients per hour and relative value units that incorporate patient volume and complexity, respectively. The findings of this scoping review can guide ED physicians and administrators to measure the impact of QI initiatives, promote efficient patient care, and optimize physician staffing.

RéSUMé: OBJECTIF: Il n'existe actuellement aucune mesure de productivité standard pour les médecins urgentistes. L'objectif de cet examen de la portée était de synthétiser la littérature afin d'identifier les composantes des définitions et des mesures de la productivité des médecins urgentistes et d'évaluer les facteurs associés à la productivité. MéTHODES: Nous avons effectué des recherches dans Medline, Embase, CINAHL et ProQuest One Business depuis le début jusqu'à mai 2022. Nous avons inclus toutes les études portant sur la productivité des médecins urgentistes. Nous avons exclu les études qui ne faisaient état que de la productivité du service, les études portant sur des prestataires de soins non urgents, les articles de synthèse, les rapports de cas et les éditoriaux. Les données ont été extraites dans des feuilles de travail prédéfinies et un résumé descriptif a été présenté. L'analyse de la qualité a été réalisée à l'aide de l'échelle de Newcastle-Ottawa. RéSULTATS: Après la sélection de 5521 études, 44 études répondaient à tous les critères d'inclusion. Les éléments de la définition de la productivité des médecins urgentistes comprenaient : le nombre de patients pris en charge, les revenus générés, le temps de traitement des patients et un facteur de normalisation. La plupart des études ont mesuré la productivité en utilisant le nombre de patients par heure, les unités de valeur relative par heure et le temps de prise en charge par le prestataire. Les facteurs influençant la productivité les plus étudiés comprenaient les scribes, les apprenants résidents, la mise en œuvre du dossier médical électronique et les scores d'enseignement de la faculté. CONCLUSION: La productivité des médecins urgentistes est définie de manière hétérogène mais comprend des éléments communs tels que le volume de patients, la complexité et le temps de traitement. Les indicateurs de productivité couramment utilisés sont le nombre de patients par heure et les unités de valeur relative qui intègrent respectivement le volume et la complexité des patients. Les résultats de cette étude de la portée peuvent aider les médecins et les administrateurs des urgences à mesurer l'impact des initiatives d'amélioration de la qualité, à promouvoir l'efficacité des soins aux patients et à optimiser la dotation en personnel médical.

Protocol for an extended scoping review on the use of virtual nominal group technique in research.

INTRODUCTION: Consensus group methods such as the Nominal Group Technique (NGT) and Delphi method are commonly used in research to elicit and synthesize expert opinions when evidence is lacking. Traditionally, the NGT involves a face-to-face interaction. However, due to the COVID-19 pandemic, many in-person meetings have moved to online settings. It is unclear to what extent the NGT has been undertaken in virtual settings. The overarching aim of this scoping review is to explore the use of the virtual NGT in research. Our specific objectives are to answer the following questions: To what extent has the NGT been used virtually? What modifications were made to accommodate this online format? What advantages and disadvantages were noted by authors in comparison with the face-to-face mode of the technique? MATERIALS AND METHODS: This scoping review will follow the steps outlined by Arksey and O'Malley and the PRISMA-ScR guidelines. Several pilot searches were completed to refine inclusion and exclusion criteria. Media Synchronicity Theory will provide a conceptual framework to inform the research, including data extraction and summarizing results. As an additional extension to the literature review, online interviews with corresponding authors will be conducted to gather further information.

Role of statins in the prevention of post-thrombotic syndrome after a deep vein thrombosis event: a systematic review and meta-analysis.

BACKGROUND: Post-thrombotic syndrome (PTS) is the most frequent long-term complication of deep vein thrombosis. Apart from anticoagulation, there are no medications, procedures, devices, or lifestyle changes that effectively prevent PTS. There is a growing interest in the potential protective effects of statins for the prevention of PTS. OBJECTIVE: To conduct a systematic review and meta-analysis on the role of statins to prevent PTS after a DVT event. METHODS: We searched the MEDLINE(R) ALL, Embase, Cochrane Central Register of Controlled Trials, and Scopus from inception to April 5, 2022. The main concepts searched were "statins" and "post thrombotic syndrome." There was no language restriction. The main outcome measure was the incidence rate ratio (IRR) for PTS associated with exposure to statins. RESULTS: Of 1971 screened records, 5 studies were included in the meta-analysis (2 retrospective cohorts and 3 randomized controlled trials [RCTs]). The pooled incidence of PTS was 34.8% per patient-year (95% CI, 9.5-127.4) in patients receiving a statin and 41.6% per patient-year (95% CI, 13.2-132) in controls. Exposure to statins was associated with a significantly decreased risk of PTS (IRR, 0.78; 95% CI, 0.63-0.96, I2 = 0%). Meta-analysis of the 2 retrospective cohorts found a significant reduction in the risk of developing PTS (IRR, 0.68; 95% CI, 0.51-0.91), whereas meta-analysis of RCTs showed no reduction in PTS occurrence (IRR, 0.92; 95% CI, 0.68-1.25). CONCLUSIONS: Although this systematic review suggests that statins may reduce PTS incidence by 22% after deep vein thrombosis, meta-analysis of RCTs showed no risk reduction. Confirmation of the efficacy of statins on the prevention of PTS should be assessed in larger RCTs.

Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review.

The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.

The evidence base for interprofessional education within health professions education: A protocol for an update review.

Interprofessional education (IPE) interventions aiming to promote collaborative competence and improve the delivery of health and social care processes and outcomes continue to evolve. This paper reports on a protocol for an update review that we will conduct to identify and describe how the IPE evidence base has evolved in the last 7 years. We will identify literature through a systematic search of the following electronic databases: Medline, Embase, CINAHL, Education Source, ERIC, and BEI. We will consider all IPE interventions delivered to health professions students and accredited professionals. Peer-reviewed empirical research studies published in any language from June 2014 onwards will be eligible for inclusion. The outcomes of interest are changes in the reaction, attitudes/perceptions, knowledge/skills acquisition, behaviors, organizational practice, and/or benefits to patients. We will perform each task of screening, critical appraisal, data abstraction, and synthesis using at least two members of the review team. The review will enable an update and comprehensive understanding of the IPE evidence base to inform future IPE developments, delivery and evaluation across education and clinical settings.

Social accountability in undergraduate medical education: A narrative review.

Background: Medical schools have been increasingly called upon to augment and prioritize their social accountability (SA). Approaches to increasing SA may include reorienting and focusing curricular activities on the priority health needs of the region that they serve. To inform the undergraduate medical education (UGME) curriculum renewal at our school, we examined how SA has been expressed in medical education across several countries and the impacts of SA activities on medical student experience and community-level outcomes. Methods: We conducted a narrative literature review using two electronic databases and searched for studies that reported on SA UGME activities implemented in Canada, Australia, New Zealand, the United States, and the United Kingdom. Studies were screened for inclusion based on predetermined eligibility criteria. Results: We included 40 studies for descriptive analysis and categorized UGME activities into five categories: (1) distributed medical education and community-specific placements/services (32; 80%), (2) community engagement and advocacy activities (23; 58%), (3) international elective preparation and experiences (8; 20%), (4) classroom-based learning of SA-related concepts (17; 43%), and (5) student engagement in SA UGME activities (6; 15%). We categorized impact into four main outcomes: student experience (21; 53%), student competencies (11; 28%), future career choice/practice setting (15; 38%), and community feedback (7; 18%). Student experience was most frequently examined, followed by future career choice/practice setting. Discussion: SA was primarily expressed in UGME activities through placement/service activities and most frequently assessed through student experiences. Student experiences of SA UGME activities have been reported to be largely positive, with benefits also reported for student competencies and influences on future career choice/practice setting. The expression of SA through community engagement in the development of curricular activities indicates a positive shift from social responsibility to SA, but a highly socially accountable curriculum would increasingly consider measures of community impact.

Gender differences in emergency medicine resident assessment: A scoping review.

Background: Growing literature within postgraduate medical education demonstrates that female resident physicians experience gender bias throughout their training and future careers. This scoping review aims to describe the current body of literature on gender differences in emergency medicine (EM) resident assessment. Methods: We conducted a scoping review which adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included research involving resident physicians or fellows in EM (population and context), which focused on the impact of gender on assessments (concept). We searched seven databases from the databases' inception to April 4, 2022. Two reviewers independently screened citations, completed full-text review, and abstracted data. A third reviewer resolved any discrepancies. Results: A total of 667 unique citations were identified; 10 studies were included, and all were conducted within the United States. Four studies reported differences in EM resident assessments attributable to gender within workplace-based assessments (qualitative comments and quantitative scores) by both attending physicians and nonphysicians. Six studies investigating clinical competency committee scores, procedural scores, and simulation-based assessments did not report any significant differences attributable to gender. Conclusions: This scoping review found that gender bias exists within EM resident assessment most notably at the level of narrative comments typically received via workplace-based assessments. As female EM residents receive higher rates of negative or critical comments and discordant feedback documented on assessment, these findings raise concern about added barriers female EM residents may face while progressing through residency and the impact on their clinical and professional development.

Medical student wellness assessment beyond anxiety and depression: A scoping review.

BACKGROUND: A significant increase in distress and mental health illnesses has been identified in medical students during their training. As a result, medical schools have attempted to understand factors linked to well-being. Wellness questionnaires present a useful approach to identifying students with risk factors for mental health to provide appropriate resources for support and referrals. This study aims to identify validated questionnaires in the literature that measure medical student wellness. METHODS: A scoping review methodology was selected and an exhaustive search of MEDLINE, Embase, CINAHL, APA PsycInfo, EPIC, and Education Source, was performed from 1999 to May 27, 2021. A compilation of validated wellness evaluation tools, surveys and questionnaires assessing wellness beyond depression and anxiety was reviewed. All validated methods of wellness assessment for medical students were included. RESULTS: 5,001 studies were identified once duplicate records were removed. After applying inclusion and exclusion criteria, 23 articles were included in a qualitative synthesis and explored in detail. The following six validated questionnaires measuring the wellness of medical school students are reported and discussed: the Medical Student Stress Profile (MSSP), the Medical Student Stress Questionnaire (MSSQ), the Medical Student Well-Being Index (MSWBI), the Perceived Medical School Stress (PMSS), the Perceived Stress Scale for Medical Students (PSSMS), and the Oldenburg Burnout Inventory-Medical Student Version (OLBI-MS). These validated questionnaires provide various aspects to the assessment of wellbeing. CONCLUSIONS: Wellbeing evaluations are reliable in identifying medical students who are at risk for mental health illnesses but must be chosen carefully based on contexts, academic environment and student population. A direct comparison between validated questionnaires for student wellbeing is not possible and individual medical schools must determine the appropriateness and validity of such tools based on population-specific characteristics and demands.

Mobile app use by medical students and residents in the clinical setting: an exploratory study.

Introduction: Mobile devices and mobile applications facilitate access to clinical evidence at the point-of-care. Medical libraries play an important role in medical trainees' education, by subscribing to quality resources and by providing help and guidance on what apps to use. This study's goal was to explore medical trainees' mobile applications use in the clinical setting to help inform collection development's decisions and to provide insight on educational outreach. Perceived barriers and benefits of medical app use by clinical trainees was also explored. Methods: A brief online survey (English and French) was sent to all University of Ottawa clerkship medical students and residents. The questionnaire consisted of multiple choices, Likert-scale, and open-ended questions. Results: 208 English and 9 French responses were received. UpToDate was the most frequently used app, followed by MedCalc, Spectrum (CHEO) and Medscape. Respondents used medical apps mostly before and after meeting with patients and rarely while interacting with patients. Main benefits identified of medical app use were helping with decision-making, quick access to trustworthy clinical information, help with diagnosis and treatment options (e.g. medication dosage, drug interaction). Main barriers identified were costs, appearing unprofessional, lack of Canadian content and spotty hospital WiFi. Conclusion: Libraries' involvement in providing access to trustworthy clinical resources to medical trainees is important to help shape trainees' development as medical professionals. Outreach to learners in the clinical setting is crucial to educate on what apps are available to them through the library collection.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review.

Background: Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards. Methods: We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature. Results: We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers. Conclusions: The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Contexte: Depuis 31 ans, nous sommes témoins d'efforts institutionnels visant à offrir aux cliniciens enseignants une plus grande reconnaissance et à récompenser leur travail. Cependant, d'après leur perception, la valorisation de leurs réalisations en matière d'enseignement clinique demeure insuffisante. Cette revue narrative a un double objectif : d'une part, repérer les qualités qui sont prises en considération en vue de l'octroi d'une reconnaissance officielle ou de l'attribution de récompenses (prix) aux cliniciens enseignants et d'autre part recenser les éléments qui empêchent certains candidats de se voir accorder une telle reconnaissance ou récompense. Méthodes: Nous avons effectué des recherches dans OVID Medline, Embase, Education Source et Web of Science pour repérer les articles pertinents publiés entre 1990 et 2020. Le contenu des résultats des 43 articles sélectionnés a ensuite été analysé pour dégager les principales tendances et questions abordées. Résultats: La plupart des articles pertinents se rapportaient au contexte des États-Unis. En revanche, peu d'articles pertinents concernaient celui du Canada. Sur le plan international, la question des qualités des cliniciens enseignants et des éléments qui peuvent les empêcher d'obtenir la reconnaissance ou une récompense suscite moins d'intérêt depuis 2010. Le fait « d'offrir de la rétroaction ¼, d'avoir « d'excellentes habiletés de communication ¼, d'assurer une « bonne supervision ¼, et un bon « sens de l'organisation ¼ sont des compétences cognitives souvent considérées pour l'octroi de la reconnaissance et l'attribution de récompenses. Parmi les compétences non cognitives, on note le fait d'être « stimulant ¼, d'être « passionné et enthousiaste ¼ et de « créer un environnement offrant du soutien ¼. La dévalorisation de l'enseignement, le manque de critères clairs et l'utilisation de mesures d'évaluation peu fiables sont les principaux obstacles à l'octroi de la reconnaissance ou à l'attribution d'une récompense aux cliniciens enseignants. Conclusions: Les résultats de notre revue narrative mettent en évidence la nécessité de mener des recherches empiriques localement en matière de reconnaissance et de récompense afin d'éclairer les réformes locales des politiques et des pratiques dans le milieu spécifique où elles sont appliquées.

Interventions Promoting Child Sexual and Reproductive Health and Rights in LMICs: A Systematic Review.

OBJECTIVE: Middle childhood is a critical period for physical, social, behavioral, and cognitive changes. A positive and healthy sexual and reproductive health and rights (SRHR) foundation can minimize SRHR risks, leading to better outcomes. Our objective is to identify effective educational interventions promoting or supporting the SRHR of school-age children in low and middle-income countries. DATA SOURCES: Medline, Embase, CINAHL, APA PsycInfo, ERIC, Cochrane Central Register of Controlled Trials, Education Source, Web of Science, SciELO Citation Index, Global Health, and Sociological Abstract were searched from 2000 to December 2020. STUDY SELECTION: Eligible articles had a sample mean age between 5 and 10 years, quantitatively tested the effects of educational interventions against a comparison group, and measured SRHR related outcomes. DATA EXTRACTION: Data extracted from the 11 eligible articles were study methods, participant characteristics, interventions and comparisons, outcome measures, and results. RESULTS: The review found evidence of significant intervention effects on protective knowledge, attitudes, behaviors, and skills for preventing sexual violence and HIV infection. The strongest evidence was for significant improvements in children's knowledge of child sexual abuse prevention concepts and strategies. LIMITATIONS: A meta-analysis could not be performed because most studies lacked randomization, included no information on the magnitude of effects, and had inadequate follow-up evaluations to truly assess retention. Only a few studies contributed to findings on protective attitudes, behaviors, and skills against child sexual abuse, gender-based violence, and human immunodeficiency virus infection, as well as physiologic outcome. CONCLUSIONS: The educational interventions demonstrated significant improvements in primary school children's protective capacities, especially in their protective knowledge against sexual abuse.

Oral Anticoagulant Use in Patients with Morbid Obesity: A Systematic Review and Meta-Analysis.

OBJECTIVES: Obesity is associated with increased risks of atrial fibrillation (AF) and venous thromboembolism (VTE) for which anticoagulation is commonly used. However, data on the efficacy and safety of oral anticoagulants in patients with morbid obesity are limited. METHODS: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for AF or VTE in patients with morbid obesity. RESULTS: We included three randomized controlled trials (5 studies) and 18 observational studies in adult patients with a body weight ≥120 kg, body mass index ≥40 kg/m2, or classified as morbid obesity who received DOACs or VKAs for AF or VTE (N = 77,687). The primary efficacy outcome was stroke/systemic embolism or recurrent VTE, and the primary safety outcome was major bleeding. DOACs were associated with a pooled incidence rate of stroke/systemic embolism of 1.16 per 100 person-years, compared to 1.18 with VKAs. The incidence of recurrent VTE on DOACs was 3.83 per 100 person-years, compared to 6.81 on VKAs. In both VTE and AF populations, DOACs were associated with lower risks of major bleeding compared to VKAs. However, all observational studies had moderate to serious risks of bias. CONCLUSION: Patients with morbid obesity on DOACs had similar risks of stroke/systemic embolism, lower rates of recurrent VTE, and major bleeding events compared to those on VKAs. However, the certainty of evidence was low given that studies were mostly observational with high risk of confounding.

Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis.

BACKGROUND: Medical training poses significant challenge to medical student wellbeing. With the alarming trend of trainee burnout, mental illness, and suicide, previous studies have reported potential risk factors associated with suicidal behaviours among medical students. The objective of this study is to provide a systematic overview of risk factors for suicidal ideation (SI) and suicide attempt (SA) among medical students and summarize the overall risk associated with each risk factor using a meta-analytic approach. METHODS: Systemic search of six electronic databases including MEDLINE, Embase, Education Source, Scopus, PsycInfo, and CINAHL was performed from database inception to March 19, 2021. Studies reporting original quantitative or epidemiological data on risk factors associated with SI and SA among undergraduate medical students were included. When two or more studies reported outcome on the same risk factor, a random-effects inverse variance meta-analysis was performed to estimate the overall effect size. RESULTS: Of 4,053 articles identified, 25 studies were included. Twenty-two studies reported outcomes on SI risk factors only, and three studies on both SI and SA risk factors. Meta-analysis was performed on 25 SI risk factors and 4 SA risk factors. Poor mental health outcomes including depression (OR 6.87; 95% CI [4.80-9.82] for SI; OR 9.34 [4.18-20.90] for SA), burnout (OR 6.29 [2.05-19.30] for SI), comorbid mental illness (OR 5.08 [2.81-9.18] for SI), and stress (OR 3.72 [1.39-9.94] for SI) presented the strongest risk for SI and SA among medical students. Conversely, smoking cigarette (OR 1.92 [0.94-3.92]), family history of mental illness (OR 1.79 [0.86-3.74]) and suicidal behaviour (OR 1.38 [0.80-2.39]) were not significant risk factors for SI, while stress (OR 3.25 [0.59-17.90]), female (OR 3.20 [0.95-10.81]), and alcohol use (OR 1.41 [0.64-3.09]) were not significant risk factors for SA among medical students. CONCLUSIONS: Medical students face a number of personal, environmental, and academic challenges that may put them at risk for SI and SA. Additional research on individual risk factors is needed to construct effective suicide prevention programs in medical school.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review.

BACKGROUND: A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME. METHODS: We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool. RESULTS: Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups. CONCLUSIONS: Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Romantic Relationships in Young People with Long-Term Health Conditions: A Scoping Review.

OBJECTIVE: Forming and maintaining romantic relationships is an important developmental task in adolescence and young adulthood. This scoping review seeks to explore how young people with long-term physical health conditions understand and experience romantic relationships. METHODS: Using Arksey and O'Malley's scoping review framework, a systematic search of five databases was conducted (PsychINFO, Cinahl, MEDLINE, Embase, and Web of Science). Studies were eligible for inclusion in the review if they were published in peer-reviewed journals, used primary data collection methods, and adopted quantitative, qualitative, or mixed-methods approaches to study romantic relationships in 11-25 year olds with long-term physical health conditions. Using a data extraction form, data pertaining to demographic characteristics of young people with long-term physical health conditions and relationship engagement were extracted from eligible papers. RESULTS: Searches returned 4645 papers after duplicate removal, with a two-stage screening process resulting in 111 full-text papers being reviewed. Thirty-three eligible papers were included across a range of long-term physical health conditions. Findings identified that living with a long-term physical health condition impacted young people's perceptions and experiences of romantic relationships across the relationship lifespan, from envisaging future relationships, to forming relationships, and sustaining relationships. Issues around body confidence and self-esteem were identified as challenging in terms of perceptions and experiences of romantic relationships. CONCLUSIONS: Findings demonstrate that young people wish to engage with romantic relationships, yet many report particular challenges associated with forming and sustaining relationships due to the constraints of their condition and treatment. Future research should consider nonheterosexual relationships.