A survey of undergraduate medical students' gender awareness and bias: the Newfoundland and Labrador perspective.

Background: Female physicians and patients experience gender bias in healthcare. The purpose of this research is to explore medical students' gender bias toward physicians and patients and whether their bias varies by gender. Methods: We surveyed medical students at Memorial University between November 2020 and April 2021. We recruited participants through Facebook, email, and e-posters. We collected demographic information, including gender and class year. We used the Nijmegen Gender Awareness in Medicine Scale to measure gender sensitivity, gender role ideology toward patients, and gender role ideology toward doctors. We analyzed the data using averages and t-tests. Results: Mean gender sensitivity scores were 4/5 indicating high gender sensitivity. Gender role ideology toward doctors mean scores were 2/5 indicating that students did not hold strong stereotypical views toward doctors. Although male students scored higher than female students (p<.05), mean scores for gender role ideology toward patients were low for both male and female students (x¯ <2), indicating low stereotyping toward patients. Conclusions: We found that students held largely non-biased ideologies surrounding gender in medicine and that female students were even less biased than male students for gender role ideology toward patients.

Contexte: Les femmes médecins ou patientes sont victimes de préjugés sexistes dans les soins de santé. L'objectif de cette recherche est d'explorer les préjugés sexistes des étudiants en médecine à l'égard des médecins et des patients et de déterminer si ces préjugés varient en fonction du sexe. Méthodes: Nous avons procédé à une enquête auprès des étudiants en médecine de l'Université Memorial entre novembre 2020 et avril 2021. Nous avons recruté des participants au moyen de Facebook, du courrier électronique et d'affiches électroniques. Nous avons recueilli des données démographiques, y compris le sexe et l'année dans le programme. Nous avons utilisé l'échelle de sensibilisation au genre en médecine de Nijmegen pour mesurer la sensibilité au genre, l'idéologie du rôle du genre envers les patients et l'idéologie du rôle du genre envers les médecins. Nous avons analysé les données à l'aide de moyennes et de tests t. Résultats: Les scores moyens de sensibilité au genre étaient de 4/5, ce qui indique une grande sensibilité au genre. Les scores moyens de l'idéologie du rôle du genre à l'égard des médecins étaient de 2/5, ce qui indique que les étudiants n'avaient pas d'opinion stéréotypée à l'égard des médecins. Bien que les étudiants aient obtenu des scores plus élevés que les étudiantes (p<0,05), les scores moyens pour l'idéologie du rôle du genre à l'égard des patients étaient faibles tant pour les étudiants que pour les étudiantes (x¯<2), ce qui indique un faible niveau d'opinions stéréotypées à l'égard des patients. Conclusions: Nous avons constaté que les étudiants avaient des idéologies largement non biaisées concernant le genre en médecine et que les étudiantes étaient encore moins biaisées que les étudiants en ce qui concerne l'idéologie du rôle du genre envers les patients.

Perceptions of gender equity in emergency medicine in Canada.

INTRODUCTION: Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine. METHODS: We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements. RESULTS: A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians. CONCLUSION: In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.

RéSUMé: INTRODUCTION: Les femmes médecins urgentistes sont confrontées à une discrimination fondée sur le sexe tout au long de leur carrière. L'objectif de cette étude était d'explorer les perceptions et les expériences des médecins urgentistes en matière d'équité entre les sexes en médecine d'urgence. MéTHODES: Nous avons procédé à une analyse secondaire des données d'une enquête menée précédemment auprès des médecins urgentistes canadiens sur les obstacles à l'équité entre les sexes en médecine d'urgence. Les réponses au sondage ont été analysées à l'aide d'une régression logistique pour déterminer l'incidence que le sexe, le milieu de pratique, les années écoulées depuis l'obtention du diplôme, la race, le statut de demandeur d'équité et le statut parental avaient sur l'accord sur l'équité entre les sexes en médecine d'urgence et cinq des énoncés de problème. RéSULTATS: Au total, 710 participants ont répondu à l'enquête. La plupart d'entre eux sont des femmes (58.8 %), de race blanche (77.4 %), ont obtenu leur diplôme entre 2010 et 2019 (40 %), ont le titre de CCMF (médecine d'urgence) (47.9 %), exercent en milieu urbain (84.4 %), sont parents (62.4 %) et ne se déclarent pas en quête d'équité (79.9 %). Les médecins s'identifiant à des femmes étaient moins susceptibles de percevoir l'équité entre les sexes en médecine d'urgence, OR 0.52, IC [0.38,0.73]. Les médecins s'identifiant comme femmes étaient plus susceptibles d'être d'accord avec les déclarations sur les microagressions, OR 4.39, IC [2.66, 7.23] ; obstacles au leadership, OR 3.51, IC [2.25, 5.50] ; écart salarial entre les hommes et les femmes, OR 13.46, IC [8.27, 21.91] ; le manque de soutien pour le congé parental, OR 2.85, IC [1.82, 4.44]; et l'éducation sur l'alliance, OR 2.23 IC [1.44, 3.45] que les médecins s'identifiant comme hommes. CONCLUSION: Dans cette étude, les médecins s'identifiant à des femmes étaient moins susceptibles de percevoir qu'il y avait une équité entre les sexes en médecine d'urgence que les médecins s'identifiant à des hommes. Les femmes médecins s'accordent à dire qu'il existe davantage d'obstacles à l'avancement professionnel, notamment moins d'opportunités de leadership, un écart salarial entre les hommes et les femmes, un manque de politiques de congé parental pour favoriser le retour au travail et un manque d'éducation des hommes pour qu'ils deviennent des alliés. Les médecins s'identifiant à des hommes étaient moins conscients de ces inégalités. Les systèmes de santé doivent s'efforcer d'améliorer l'équité entre les sexes dans la médecine d'urgence, ce qui nécessitera une formation et un allié de la part des médecins qui s'identifient aux hommes.

Non-pharmacological interventions to support coronary artery bypass graft (CABG) patient recovery following discharge: protocol for a scoping review.

BACKGROUND: In Canada, approximately 15 000 people undergo coronary artery bypass grafting (CABG) each year. However, 9.5% of these patients are urgently readmitted to hospital within 30 days of surgery. Postoperative interventions following discharge play an important role in reducing readmissions and improving CABG patient outcomes. Therefore, it is important to determine effective interventions available to enhance CABG patient recovery following postoperative discharge. OBJECTIVES: Our scoping review aims to identify non-pharmacological interventions available to support recovery of patients who are discharged after CABG in the community setting. METHODS: The methodological framework described by Arksey and O'Malley will be applied to this review. Our search strategy will include electronic databases (Medline, Embase, Cochrane Library and CINAHL), and studies will be screened and reviewed by two independent reviewers. Studies looking at non-pharmacological interventions targeting patients who are discharged after CABG will be included. Preliminary searches were conducted March 2022 and following abstract screening, full-text screening was completed May 2023. Data extraction is planned to begin September 2023 with an expected finish date of October 2023. The study is expected to be completed by January 2024. ETHICS AND DISSEMINATION: This scoping review will retrieve and analyse previously published studies in which informed consent was obtained by primary investigators. Therefore, no ethical review or approval will be required. This scoping review aims to enumerate available non-pharmacological interventions to support recovery of patients who are discharged after CABG and identify gaps in postoperative recovery after discharge to support the development of innovative and targeted interventions. On completion of this review, we will ensure broad dissemination of our findings through peer-reviewed, open-access journals, conference presentations and hold meetings to engage stakeholders, including clinicians, policy makers and others.

POCUS literature primer: key papers on POCUS in cardiac arrest and shock.

OBJECTIVE: The objective of this study is to identify the top five most influential papers published on the use of point-of-care ultrasound (POCUS) in cardiac arrest and the top five most influential papers on the use of POCUS in shock in adult patients. METHODS: An expert panel of 14 members was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. The members of the panel are ultrasound fellowship trained or equivalent, are engaged in POCUS research, and are leaders in POCUS locally and nationally in Canada. A modified Delphi process was used, consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers for the use of POCUS in cardiac arrest and shock. RESULTS: The panel identified 39 relevant papers on POCUS in cardiac arrest and 42 relevant papers on POCUS in shock. All panel members participated in all three rounds of the modified Delphi process, and we ultimately identified the top five most influential papers on POCUS in cardiac arrest and also on POCUS in shock. Studies include descriptions and analysis of safe POCUS protocols that add value from a diagnostic and prognostic perspective in both populations during resuscitation. CONCLUSION: We have developed a reading list of the top five influential papers on the use of POCUS in cardiac arrest and shock to better inform residents, fellows, clinicians, and researchers on integrating and studying POCUS in a more evidence-based manner.

RéSUMé: OBJECTIF: L'objectif de cette étude est d'identifier les cinq articles les plus influents publiés sur l'utilisation de l'échographie au point de soin (POCUS) dans l'arrêt cardiaque et les cinq articles les plus influents sur l'utilisation de POCUS dans le choc chez les patients adultes. MéTHODES: Un comité d'experts composé de 14 membres a été recruté par le Comité d'échographie d'urgence de l'Association canadienne des médecins d'urgence (ACMU) et le Canadian Ultrasound Fellowship Collaborative. Les membres du comité sont formés en échographie ou l'équivalent, participent à la recherche sur le POCUS et sont des chefs de file du POCUS à l'échelle locale et nationale au Canada. Un processus Delphi modifié a été utilisé, consistant en trois séries de sondages séquentiels et de discussions pour parvenir à un consensus sur les cinq articles les plus influents pour l'utilisation de POCUS dans les arrêts cardiaques et les chocs. RéSULTATS: Le panel a identifié 39 articles pertinents sur le POCUS en arrêt cardiaque et 42 articles pertinents sur le POCUS en état de choc. Tous les membres du panel ont participé aux trois cycles du processus Delphi modifié, et nous avons finalement identifié les cinq articles les plus influents sur le POCUS en arrêt cardiaque et aussi sur le POCUS en état de choc. Les études comprennent des descriptions et des analyses de protocoles POCUS sûrs qui ajoutent de la valeur d'un point de vue diagnostique et pronostique dans les deux populations pendant la réanimation. CONCLUSION: Nous avons dressé une liste de lecture des cinq principaux articles influents sur l'utilisation du POCUS en cas d'arrêt cardiaque et de choc afin de mieux informer les résidents, les boursiers, les cliniciens et les chercheurs sur l'intégration et l'étude du POCUS d'une manière plus factuelle.

Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS.

Objective The objective of this study is to identify the top five influential papers published on renal point-of-care ultrasound (POCUS) and the top five influential papers on biliary POCUS in adult patients. Methods A 14-member expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All panel members have had ultrasound fellowship training or equivalent, are actively engaged in POCUS scholarship, and are involved with POCUS at their local site and nationally in Canada. We used a modified Delphi process consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five influential papers for renal POCUS and biliary POCUS. Results The panel identified 27 relevant papers on renal POCUS and 30 relevant papers on biliary POCUS. All panel members participated in all three rounds of the modified Delphi process, and after completing this process, we identified the five most influential papers on renal POCUS and the five most influential papers on biliary POCUS. Conclusion We have developed a list, based on expert opinion, of the top five influential papers on renal and biliary POCUS to better inform all trainees and clinicians on how to use these applications in a more evidence-based manner. This list will also be of interest to clinicians and researchers who strive to further advance the field of POCUS.

Using Kane's framework to build an assessment tool for undergraduate medical student's clinical competency with point of care ultrasound.

INTRODUCTION: Point-of-care ultrasonography (POCUS) is a portable imaging technology used in clinical settings. There is a need for valid tools to assess clinical competency in POCUS in medical students. The primary aim of this study was to use Kane's framework to evaluate an interpretation-use argument (IUA) for an undergraduate POCUS assessment tool. METHODS: Participants from Memorial University of Newfoundland, the University of Calgary, and the University of Ottawa were recruited between 2014 and 2018. A total of 86 participants and seven expert raters were recruited. The participants performed abdominal, sub-xiphoid cardiac, and aorta POCUS scans on a volunteer patient after watching an instruction video. The participant-generated POCUS images were assessed by the raters using a checklist and a global rating scale. Kane's framework was used to determine validity evidence for the scoring inference. Fleiss' kappa was used to measure agreement between seven raters on five questions that reflected clinical competence. The descriptive comments collected from the raters were systematically coded and analyzed. RESULTS: The overall agreement between the seven raters on five questions on clinical competency ranged from fair to moderate (κ = 0.32 to 0.55). The themes from the qualitative data were poor image generation and interpretation (22%), items not applicable (20%), poor audio and video quality (20%), poor probe handling (10%), and participant did not verbalize findings (14%). CONCLUSION: The POCUS assessment tool requires further modification and testing prior before it can be used for reliable undergraduate POCUS assessment.

Point of Care Ultrasound Literature Primer: Key Papers on Focused Assessment With Sonography in Trauma (FAST) and Extended FAST.

Objective The objective of this study is to identify the top five most influential papers published on focused assessment with sonography in trauma (FAST) and the top five most influential papers on the extended FAST (E-FAST) in adult patients. Methods An expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. These experts are ultrasound fellowship-trained or equivalent, are involved with point-of-care ultrasound (POCUS) research and scholarship, and are leaders in both the POCUS program at their local site and within the national Canadian POCUS community. This 14-member expert group used a modified Delphi process consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers for FAST and E-FAST. Results The expert panel identified 56 relevant papers on FAST and 40 relevant papers on E-FAST. After completing all three rounds of the modified Delphi process, the authors identified the top five most influential papers on FAST and the top five most influential papers on E-FAST. Conclusion We have developed a reading list of the top five influential papers for FAST and E-FAST that will benefit residents, fellows, and clinicians who are interested in using POCUS in an evidence-informed manner.

Priority strategies to improve gender equity in Canadian emergency medicine: proceedings from the CAEP 2021 Academic Symposium on leadership.

OBJECTIVES: Gender inequities are deeply rooted in our society and have significant negative consequences. Female physicians experience numerous gender-related inequities (e.g., microaggressions, harassment, violence). These inequities have far-reaching consequences on health, well-being and career longevity and may result in the devaluing of various strengths that female emergency physicians bring to the table. This, in turn, has an impact on patient healthcare experience and outcomes. During the 2021 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, a national collaborative sought to understand gender inequities in emergency medicine in Canada. METHODS: We used a multistep stakeholder-engagement-based approach (harnessing both quantitative and qualitative methods) to identify and prioritize problems with gender equity in emergency medicine in Canada. Based on expert consultation and literature review, we developed recommendations to effect change for the higher priority problems. We then conducted a nationwide consultation with the Canadian emergency medicine community via online engagement and the CAEP Academic Symposium to ensure that these priority problems and solutions were appropriate for the Canadian context. CONCLUSION: Via the above process, 15 recommendations were developed to address five unique problem areas. There is a dearth of research in this important area and we hope this preliminary work will serve as a starting point to fuel further research. To facilitate these scholarly endeavors, we have appended additional documents identifying other key problems with gender equity in emergency medicine in Canada as well as proposed next steps for future research.

RéSUMé: OBJECTIFS: Les inégalités entre les sexes sont profondément ancrées dans notre société et ont des conséquences négatives importantes. Les femmes médecins subissent de nombreuses inégalités liées au genre (par exemple, microagressions, harcèlement, violence). Ces inégalités ont des conséquences considérables sur la santé, le bien-être et la longévité de la carrière et peuvent entraîner la dévalorisation des différents atouts que les femmes médecins urgentistes apportent à la table. Ceci, à son tour, a un impact sur l'expérience et les résultats des soins de santé des patients. Au cours du Symposium académique 2021 de l'Association canadienne des médecins d'urgence (ACMU), une collaboration nationale a cherché à comprendre les inégalités entre les sexes en médecine d'urgence au Canada. MéTHODES: Nous avons utilisé une approche en plusieurs étapes basée sur l'engagement des parties prenantes (en utilisant des méthodes quantitatives et qualitatives) pour identifier et classer par ordre de priorité les problèmes d'équité entre les sexes en médecine d'urgence au Canada. À partir d'une consultation d'experts et d'une revue de la littérature, nous avons élaboré des recommandations visant à apporter des changements aux problèmes les plus prioritaires. Nous avons ensuite mené une consultation nationale auprès de la communauté canadienne de médecine d'urgence par le biais d'un engagement en ligne et du symposium universitaire de l'ACMU afin de nous assurer que ces problèmes prioritaires et ces solutions étaient adaptés au contexte canadien. CONCLUSION: Grâce au processus ci-dessus, 15 recommandations ont été élaborées pour traiter 5 domaines problématiques uniques. Il existe un manque de recherche dans ce domaine important et nous espérons que ce travail préliminaire servira de point de départ pour alimenter d'autres recherches. Pour faciliter ces efforts de recherche, nous avons annexé d'autres documents identifiant d'autres problèmes clés en matière d'équité entre les sexes en médecine d'urgence au Canada, ainsi que des propositions d'étapes pour de futures recherches.

The prevalence and patterns of use of point-of-care ultrasound in Newfoundland and Labrador.

INTRODUCTION: Point-of-care ultrasound (POCUS) is used for diagnostic and procedural guidance by physicians in Newfoundland and Labrador (NL). POCUS use is largely limited to urban locations and the training is variable amongst physicians. The primary aim of this study was to determine the prevalence of POCUS devices in NL and the secondary aim was to characterise the patterns of POCUS use amongst physicians in NL. METHODS: This is a mixed-methods cross-sectional study. We determined the prevalence of POCUS devices from purchase records and the patterns of POCUS use through theme-based interviews. The interviews were transcribed, coded and analysed using standardised qualitative methods. RESULTS: Ten physicians (3 females, 5 rural) participated in the interviews. The overall prevalence of POCUS devices in NL was 12.5/100,000 population. Participants in urban areas had more access to POCUS training and devices. Participants used POCUS on a daily or weekly basis to rule in or out life-threatening conditions and improve access to specialist care. The benefits of POCUS included expedited investigations, decreased radiation and increased patient satisfaction. The barriers to using POCUS were lack of training, time, devices, image archiving software, difficulty generating and interpreting images and patient body habitus. CONCLUSION: This is the first study to our knowledge to report the prevalence of POCUS devices in Canada. Physicians who practise in rural NL have limited access to POCUS devices and have identified barriers to POCUS training. Connecting physicians in rural areas with POCUS experts through a province-wide POCUS network may address these barriers and improve healthcare access.

Résumé Introduction: L'échographie ciblée est utilisée par les médecins de Terre-Neuve-et-Labrador (T.-N.-L.) pour guider le diagnostic et certaines interventions. L'échographie ciblée est grandement limitée aux régions urbaines et la formation des médecins sur son utilisation est variable. Cette étude visait en premier lieu à déterminer la prévalence des appareils d'échographie ciblée à T.-N.-L. et en deuxième lieu, à caractériser les habitudes d'utilisation de l'échographie ciblée chez les médecins de T.-N.-L. Méthodes: Il s'agit d'une étude transversale à méthodes mixtes. Nous avons déterminé la prévalence des appareils d'échographie ciblée à partir de registres d'achat, et les habitudes d'utilisation de l'échographie ciblée à partir d'entrevues thématiques. Dix médecins (3 de sexe féminin, 5 de régions rurales) ont participé aux entrevues. Les entrevues ont été transcrites, codées et analysées à l'aide de méthodes qualitatives standardisées. Résultats: La prévalence générale des appareils d'échographie ciblée à T.-N.-L. était de 12.5/100 000 populations. Les participants des régions urbaines avaient un meilleur accès à la formation sur l'échographie ciblée et aux appareils. Les participants utilisaient l'échographie ciblée tous les jours ou toutes les semaines pour inclure ou éliminer les affections potentiellement mortelles et améliorer l'accès aux spécialistes. Les bienfaits de l'échographie ciblée étaient l'accélération des examens, la réduction des rayonnements et une meilleure satisfaction des patients. Les obstacles à l'échographie ciblée étaient l'absence de formation, de temps, d'appareils et de logiciel d'archivage des images, la difficulté à générer et à interpréter les images, et les caractéristiques physionomiques du patient. Conclusion: À notre connaissance, il s'agit de la première étude à avoir rapporté la prévalence des appareils d'échographie ciblée au Canada. Les médecins qui pratiquent dans les régions rurales de T.-N.-L. ont un accès limité aux appareils d'échographie ciblée et ont identifié des obstacles à la formation sur l'échographie ciblée. Pour faire tomber ces obstacles et améliorer l'accès aux soins de santé, il serait utile de relier les médecins des régions rurales à des spécialistes d'échographie ciblée dans un réseau provincial d'échographie ciblée. Mots-clés: Échographie, examen ciblé, services de santé ruraux, formation médicale continue, cadre de compétences.

The Big Bang: A Virtual Subarachnoid Hemorrhage Simulation for Preclinical Medical Students.

Simulation-based learning is important for rare, high mortality cases, which are unlikely to be witnessed during clinical rotations but are likely to be encountered during future practice such as a subarachnoid hemorrhage. Neurology case simulations, especially those targeted at preclinical learners, are underrepresented in simulation pedagogy, and preclinical learners are underrepresented in a meta-analysis of the efficacy of simulation-based medical education. We designed a virtual simulation of subarachnoid hemorrhage for preclinical medical students, which can be implemented during restricted access to clinical learning. The simulation is 15 minutes long and requires only one standardized patient and one evaluator, which makes this simulation accessible to institutions with limited simulation resources. We adapted the validated questions from the "Simulation Evaluation Tool - Modified" for our post-simulation survey, which will detect the students' level of confidence and their perceived learning post-simulation. The analysis of student experiences using this validated tool will contribute to the literature base surrounding the efficacy of virtual simulation as a training tool for preclinical learners.

Towards gender equity in emergency medicine: a position statement from the CAEP Women in Emergency Medicine committee.

As of January 2019, over half of all doctors working in Canada under the age of 40 were women. Despite equal representation in the profession of medicine, women still experience harassment, discrimination, and pay inequity when compared to their male colleagues. Gender discrimination is present at all levels of medical training and negatively impacts women who want to become emergency physicians. The right to gender equity is part of the Canadian Charter of Rights and Freedoms. The World Health Organization states that "gender inequities are socially generated and, therefore, can be changed." CAEP recognizes that gender equity is important to its members and that it intersects with inequities experienced by other minority groups. This position statement from the committee for Women in Emergency Medicine (EM) is intended to support women and those who identify as women who have chosen EM as their career. Furthermore, it is meant to inform and support policy makers as they consider the unique challenges that women face in their pursuit of excellence in EM.

Use of three-dimensional printing for simulation in ultrasound education: a scoping review.

Background: There is a significant learning curve when teaching ultrasonography to medical trainees; task trainers can help learners to bridge this gap and develop their skills. Three-dimensional printing technology has the potential to be a great tool in the development of such simulators. Objective: This scoping review aimed to identify what 3D-printed models have been used in ultrasound education to date, how they were created and the pros and limitations involved. Design: Researchers searched three online databases to identify 3D-printed ultrasound models used in medical education. Results: Twelve suitable publications were identified for inclusion in this review. The models from included articles simulated largely low frequency and/or high stakes events, with many models simulating needle guidance procedures. Most models were created by using patient imaging data and a computer-aided design software to print structures directly or print casting molds. The benefits of 3D-printed educational trainers are their low cost, reproducibility, patient specificity and accuracy. The current limitations of this technology are upfront investments and a lack of optimisation of materials. Conclusions: The use of 3D-printed ultrasound task trainers is in its infancy, and more research is needed to determine whether or not this technology will benefit medical learners in the future.

A Post-operative Masquerade: Simulation-based Scenario Challenging Clinical Clerks to Recognize an Atypical Presentation of Myocardial Infarction.

Post-operative myocardial infarctions (MI) are a challenging diagnosis due to the alterations in the presenting complaint compared to an acute MI. Patients may be asymptomatic due to their anesthetics and sedatives from their operation which may create clinical confusion. As such, there is an increased risk for delayed administration of reperfusion therapies in this patient population which has shown to increase morbidity and mortality. It is anticipated that the difficulty of recognizing a post-operative MI would be exacerbated for clinical clerks due to their lack of clinical experience and overstimulation. Fortunately, the use of simulation-based learning has been proven to be a useful teaching tool to help clinical clerks manage medical problems in a controlled environment. This technical report describes a simulation case designed to enhance the recognition and response to a post-operative MI by a third-year clinical clerk. In this scenario, a 56-year-old male accountant presents with shortness of breath while recovering in the orthopaedic ward 12 hours following a total knee replacement (TKR). The clinical clerks are expected to conduct an independent follow-up prior to finishing their shift during which the patient begins complaining of shortness of breath. The clerk is required to order an electrocardiogram (ECG) for further analysis which reveals an anterior ST-segment elevation. Once recognized, a request for the crash cart and patient handover to the senior physician are expected.

The Canadian Medical Student Ultrasound Curriculum: A Statement From the Canadian Ultrasound Consensus for Undergraduate Medical Education Group.

OBJECTIVES: This study sought to establish by expert review a consensus-based, focused ultrasound curriculum, consisting of a foundational set of focused ultrasound skills that all Canadian medical students would be expected to attain at the end of the medical school program. METHODS: An expert panel of 21 point-of-care ultrasound and educational leaders representing 15 of 17 (88%) Canadian medical schools was formed and participated in a modified Delphi consensus method. Experts anonymously rated 195 curricular elements on their appropriateness to include in a medical school curriculum using a 5-point Likert scale. The group defined consensus as 70% or more experts agreeing to include or exclude an element. We determined a priori that no more than 3 rounds of voting would be performed. RESULTS: Of the 195 curricular elements considered in the first round of voting, the group reached consensus to include 78 and exclude 24. In the second round, consensus was reached to include 4 and exclude 63 elements. In our final round, with 1 additional item added to the survey, the group reached consensus to include an additional 3 and exclude 8 elements. A total of 85 curricular elements reached consensus to be included, with 95 to be excluded. Sixteen elements did not reach consensus to be included or excluded. CONCLUSIONS: By expert opinion-based consensus, the Canadian Ultrasound Consensus for Undergraduate Medical Education Group recommends that 85 curricular elements be considered for inclusion for teaching in the Canadian medical school focused ultrasound curricula.

Developing an Undergraduate Ultrasound Curriculum: A Needs Assessment.

Background The introduction of ultrasound into the undergraduate medical school curriculum is gaining momentum in North America. At present, many institutions are teaching ultrasound to undergraduate medical students using a traditional framework designed to instruct practicing clinicians, or have modeled the curriculum on other universities. This approach is not based on educational needs or supported by evidence. Methods Using a descriptive, cross-sectional survey of stakeholder groups, we assessed the perceived relevance of various ultrasound skills and the attitude towards implementing an undergraduate ultrasound curriculum at our university. Results One hundred and fifty survey respondents representing all major stakeholder groups participated. All medical students, 97% of residents and 82% of educators agreed that the introduction of an ultrasound curriculum would enhance medical students' understanding of anatomy and physiology. All clinical medical students and residents, 92% of preclinical medical students, and 82% of educators agreed that the curriculum should also include clinical applications of ultrasound. Participants also indicated their preferences for specific curriculum content based on their perceived needs. Conclusion An integrated undergraduate ultrasound curriculum composed of specific preclinical and clinical applications was deemed appropriate for our university following a comprehensive needs assessment. Other universities planning such curricula should consider employing a needs assessment to provide direction for curriculum need and content.