Facilitating admissions of diverse students: A six-point, evidence-informed framework for pipeline and program development.

INTRODUCTION: Several national level calls have encouraged reconsideration of diversity issues in medical education. Particular interest has been placed on admissions, as decisions made here shape the nature of the future physician workforce. Critical analysis of current practices paired with evidence-informed policies may counter some of the barriers impeding access for underrepresented groups. METHODS: We present a framework for diversity-related program development and evaluation grounded within a knowledge translation framework, and supported by the initiation of longitudinal collection of diversity-related data. We provide an illustrative case study for each component of the framework. Descriptive analyses are presented of pre/post intervention diversity metrics if applicable and available. RESULTS: The framework's focal points are: 1) data-driven identification of underrepresented groups, 2) pipeline development and targeted recruitment, 3) ensuring an inclusive process, 4) ensuring inclusive assessment, 5) ensuring inclusive selection, and 6) iterative use of diversity-related data. Case studies ranged from wording changes on admissions websites to the establishment of educational and administrative offices addressing needs of underrepresented populations. CONCLUSIONS: We propose that diversity-related data must be collected on a variety of markers, developed in partnership with stakeholders who are most likely to facilitate implementation of best practices and new policies. These data can facilitate the design, implementation, and evaluation of evidence-informed diversity initiatives and provide a structure for continued investigation into 'interventions' supporting diversity-related initiatives.

Candidates' and interviewers' perceptions of multiple-mini interviews for admission to an occupational therapy professional program.

Multiple-Mini Interviews (MMIs) were used to assess professional attributes of candidates seeking admission to an occupational therapy professional entry-level master's program. Candidates and interviewers were invited to complete a questionnaire comprised of quantitative and open-ended questions following the MMIs. The MMIs were perceived to be fair, enjoyable, and capable of capturing professional attributes. Descriptive analysis of candidates' data revealed perceptions regarding logistics, interview station content, process, and interviewers. Interviewers commented on the positive and challenging aspects of the scenarios and the MMI process. Admissions committees need to consider several logistical, content, and process issues when designing and implementing MMIs as a selection tool.

A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer.

OBJECTIVES: To assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover. METHODS: This study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotation using a written handover cognitive aid (intervention) or standard practice (control). Before rounds, an investigator generated a reference standard of the handover event by completing a handover aid. Resident handovers were then audio-recorded and transcribed by a blinded research assistant. The content of this transcript was inserted into a blank handover aid. A blinded content expert scored the quantity and accuracy of the information in this aid according to predetermined criteria and these information scores (ISs) were compared with the reference standard. The same expert also blindly scored the transcripts in five domains of clinical reasoning and effectiveness: (i) effective summary of events; (ii) expressed understanding of the care plan; (iii) presentation clarity; (iv) organisation; (v) overall handover effectiveness. Differences between intervention and control groups were assessed using the Mann-Whitney test and multivariate linear regression. RESULTS: The intervention group had total ISs that more closely approximated the reference standard (81% versus 61%; p < 0.01). The intervention group had significantly higher clinical reasoning scores when compared by total score (21.1 versus 15.9 points; p = 0.01) and in each of the five domains. No difference was observed in the duration of handover between groups (7.4 versus 7.7 minutes; p = 0.97). CONCLUSIONS: Using a novel scoring system, our simple handover cognitive aid was shown to improve information transfer and resident expression of clinical reasoning without prolonging the handover duration.

Handover after pediatric heart surgery: a simple tool improves information exchange.

OBJECTIVE: To improve the quality of handover of complex patients after pediatric cardiac surgery through the use of a simple handover tool. DESIGN: Prospective, pre-/postinterventional. SETTING: A tertiary care, pediatric intensive care unit in North America. SUBJECTS: Thirty-three consenting healthcare providers from pediatric cardiac anesthesia, critical care, and cardiothoracic surgery participating in 31 handovers. INTERVENTION: A fill-in-the-blank, one-page tool was developed to guide the information transmitted by the surgeon and anesthesiologist to the pediatric intensive care unit team during handover of postcardiac surgery patients. MEASUREMENTS AND MAIN RESULTS: Total handover score, four subscores, handover duration, and postoperative high-risk events were measured before and after introducing the tool into clinical practice. The patients in both the pre- and postintervention groups were similar at baseline. The total handover score (maximum 43 points) improved significantly after the implementation of the handover tool (28.2 of 43 ± 4.6 points vs. 33.5 of 43 ± 3.7 points, p = .002). There was also a significant improvement in the medical (8.3 ± 2.6 vs. 10.3 ± 2.1 points, p = .024) and surgical (7.5 ± 1.4 vs. 9.3 ± 1.6 points, p = .002) intraoperative information subscores. Use of the tool did not prolong handover duration (8.3 ± 4.6 vs. 11.1 ± 3.9 mins, p = .1). There was a trend toward more patients being free from high-risk events in the postintervention group (31.2% vs. 6.7%), but this did not reach statistical significance (p = .1). CONCLUSIONS: Use of a simple tool during handover of pediatric postcardiac surgery patients resulted in a more complete exchange of critical information with no significant prolongation of the handover duration.