Creating space for leadership education in undergraduate medical education in Canada.

The need for effective leadership by physicians is clear, yet the design/delivery of curricula, and assessment of leadership competencies, in Undergraduate Medical Education (UGME) continues to need work. In reappraising their UGME assessment strategies, the Medical Council of Canada (MCC) invited position papers across diverse lenses, including the CanMEDS Intrinsic Roles. This article is foundational work derived from the report on leadership assessment to the MCC. Using Kern's Model of Curriculum development as a guide, we reviewed the landscape of Canadian UGME leadership education through an environmental scan of the published and grey literature, Canadian leadership frameworks and resources, and consultation with learner and faculty leadership. Leadership education across programs was highly variable and learners were often unaware of available opportunities. In response, we have suggested processes for curricular development, including strategies for key content, teaching and assessment, and program evaluation considerations. Leadership education cannot remain another checkbox on a list of UGME experiences. Such training necessitates focused attention and investment to foster ongoing identity formation toward becoming a good doctor.

Même si le besoin d'un leadership médical efficace est clair, la conception et l'implantation d'un cursus et de stratégies d'évaluations sur la compétence de leadership en éducation médicale prédoctorale demeure à optimiser. Dans le cadre de l'examen de ses stratégies d'évaluation de la formation médicale prédoctorale, le Conseil médical du Canada (CMC) a sollicité des énoncés de position portant sur divers aspects, y compris sur les rôles CanMEDS intrinsèques. Cet article s'appuie sur la soumission des auteurs concernant l'évaluation du leadership faite pour le CMC. Prenant le modèle de développement de cursus de Kern comme guide, nous avons examiné le paysage de l'enseignement du leadership dans la formation prédoctorale au Canada par le biais d'une analyse environnementale de la littérature scientifique et grise, des cadres et des ressources de leadership canadiens et d'une consultation avec des leaders parmi les étudiants et le corps professoral. L'enseignement du leadership dans les programmes est très variable et bien souvent, les apprenants ne sont pas au courant des possibilités offertes. En conséquence, nous suggérons des processus d'élaboration de cursus, y compris des stratégies d'enseignement en lien avec les sujets importants, l'enseignement, l'évaluation des apprenants et l'évaluation de programme. La formation au leadership ne peut pas demeurer un élément de la liste «à faire¼ pour l'éducation médicale prédoctorale. Une telle formation nécessite une attention et un investissement ciblés afin de favoriser la construction continue de l'identité de futurs bons médecins.

Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study.

BACKGROUND: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. OBJECTIVE: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. DESIGN: Retrospective cohort study from a registry of patients with COVID-19. SETTING: Three community and 3 academic hospitals. PATIENTS: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. MEASUREMENTS: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. METHODS: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. RESULTS: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). LIMITATIONS: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. CONCLUSIONS: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. TRIAL REGISTRATION: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

Virtual Reality for Vestibular Rehabilitation: A Systematic Review.

INTRODUCTION: Vertigo is a debilitating symptom, leading to increased healthcare utilization and lost patient productivity. Vestibular rehabilitation is used to manage the symptomatic manifestations of vestibular disease. However, vestibular rehabilitation is limited by accessibility and time commitment. Recently, virtual reality has been described as a vestibular rehabilitation tool that may circumvent these barriers to treatment. Despite this, the efficacy of virtual reality for vestibular rehabilitation remains unclear. This study aims to review and summarize the current literature on the effectiveness of virtual reality-based vestibular rehabilitation. METHODS: A systematic review of the MEDLINE, EMBASE, and Alternative and Complementary Medicine databases was conducted for prospective studies describing virtual reality-based vestibular rehabilitation. RESULTS: Our search identified 382 unique articles. Six randomized controlled trials and four other studies were ultimately included. Study sample sizes ranged from 13 to 70 participants and varied in diagnoses from any unilateral peripheral vertigo to specific pathologies. Different virtual reality interventions were used. Comparator groups ranged from supervised vestibular rehabilitation to independent Cawthorne-Cooksey exercises. Outcomes consisted of validated questionnaires, objective clinical tests, and measurements of balance or reflexes. CONCLUSION: The studies reviewed in this study are preliminary evidence to suggest the benefit of virtual reality-based vestibular rehabilitation. However, these studies are limited by their inclusion criteria, heterogeneity, comparator design, and evidence-based clinical outcomes. Further research should address these limitations.

Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis.

BACKGROUND: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy is challenging. Double-balloon enteroscopy (DBE) has been shown to be safe and efficacious for ERCP in these patients but attempts to synthesize existing data are limited. The purpose of this study was to conduct a systematic review and meta-analysis to evaluate the safety and efficacy of DBE-ERCP in surgically altered anatomy. METHODS: We searched MEDLINE, EMBASE, and CENTRAL databases through March 2020 for studies that conducted DBE-ERCP in patients with surgically altered gastrointestinal anatomy. Primary outcomes were enteroscopic, diagnostic, and procedural success rates of DBE-ERCP. Secondary outcomes were adverse events after DBE-ERCP. Random effects meta-analysis of proportions was performed when appropriate. The Newcastle-Ottawa scale was used to evaluate risk of bias. Heterogeneity was assessed using the inconsistency (I2) statistic. RESULTS: 24 studies involving 1523 patients were included. The pooled enteroscopic, diagnostic, and procedural success rates of DBE-ERCP were 90% (95% confidence interval (CI), 84-94%), 94% (95% CI 88-98%), and 93% (95% CI 88-97%). Adverse events were reported in 4% (95% CI 3-6%) of cases. Subgroup analysis of short-scope DBE-ERCP (< 200 cm) and long-scope DBE-ERCP (200 cm) did not demonstrate substantial difference in outcomes. CONCLUSION: DBE is safe and efficacious for facilitating ERCP in patients with surgically altered gastrointestinal anatomy, but RCTs or comparative studies are required to clarify its role compared to other modalities in surgically altered anatomy.

Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review.

BACKGROUND: The COVID-19 pandemic has disrupted surgical practice worldwide. There is widespread concern for surgeon and provider safety, and the implications of hospital lockdown on patient care during epidemics. METHODS: Medline, EMBASE, CENTRAL, and PubMed were systematically searched from database inception to July 1, 2020 and ongoing monthly surveillance will be conducted. We included studies that assessed postoperative patient outcomes or protection measures for surgical personnel during epidemics. RESULTS: We included 61 studies relevant to the COVID-19 pandemic and past epidemics. Lockdown measures were noted globally including cancellation of elective surgeries and outpatient clinics. The pooled postoperative complication rate during epidemics was 21.0% among 2095 surgeries. 31 studies followed the health of surgical workers with the majority noting no adverse outcomes with proper safety measures. CONCLUSIONS: This review highlights postoperative patient outcomes during worldwide epidemics including the COVID-19 pandemic and identifies specific safety measures to minimize infection of healthcare workers.