Was Virtual Care as Safe as In-Person Care? Analyzing Patient Outcomes at Seven and Thirty Days in Ontario during the COVID-19 Pandemic.

In 2020, almost overnight, the paradigm for healthcare interactions changed in Ontario. To limit person-to-person transmission of COVID-19, the norm of in-person interactions shifted to virtual care. While this shift was part of broader public health measures and an acknowledgment of patient and societal concerns, it also represented a change in care modalities that had the potential to affect the quality of care provided, as well as short- and long-term patient outcomes. While public policy decisions were being made to moderate the use of virtual care at the end of the declared pandemic, a thorough analysis of short-term patient outcomes was needed to quantify the impact of virtual care on the population of Ontario.

Insulin Infusion Dosing in Pediatric Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

In children with diabetic ketoacidosis (DKA), insulin infusions are the mainstay of treatment; however, optimal dosing remains unclear. Our objective was to compare the efficacy and safety of different insulin infusion doses for the treatment of pediatric DKA. DATA SOURCES: We searched MEDLINE, EMBASE, PubMed, and Cochrane from inception to April 1, 2022. STUDY SELECTION: We included randomized controlled trials (RCTs) of children with DKA comparing intravenous insulin infusion administered at 0.05 units/kg/hr (low dose) versus 0.1 units/kg/hr (standard dose). DATA EXTRACTION: We extracted data independently and in duplicate and pooled using a random effects model. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. DATA SYNTHESIS: We included four RCTs (n = 190 participants). In children with DKA, low-dose compared with standard-dose insulin infusion probably has no effect on time to resolution of hyperglycemia (mean difference [MD], 0.22 hr fewer; 95% CI, 1.19 hr fewer to 0.75 hr more; moderate certainty), or time to resolution of acidosis (MD, 0.61 hr more; 95% CI, 1.81 hr fewer to 3.02 hr more; moderate certainty). Low-dose insulin infusion probably decreases the incidence of hypokalemia (relative risk [RR], 0.65; 95% CI, 0.47-0.89; moderate certainty) and hypoglycemia (RR, 0.37; 95% CI, 0.15-0.80; moderate certainty), but may have no effect on rate of change of blood glucose (MD, 0.42 mmol/L/hr slower; 95% CI, 1 mmol/L/hr slower to 0.18 mmol/L/hr faster; low certainty). CONCLUSIONS: In children with DKA, the use of low-dose insulin infusion is probably as efficacious as standard-dose insulin, and probably reduces treatment-related adverse events. Imprecision limited the certainty in the outcomes of interest, and the generalizability of the results is limited by all studies being performed in a single country.

A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance.

INTRODUCTION: Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence. METHODS: A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires. RESULTS: Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group. CONCLUSION: Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students' transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.

INTRODUCTION: Les cursus de pré-externat des facultés de médecine canadiennes ne prévoient pas systématiquement de formation sur les habiletés techniques avant, si bien qu'à leur arrivée à l'externat, les étudiants ont une exposition limitée aux gestes techniques. Tandis que l'amélioration des aptitudes techniques par la simulation est bien documentée, il n'y a aucune étude sur l'effet de ces simulations sur l'anxiété et la confiance malgré leur impact avéré sur la performance et l'apprentissage. Cette étude vise donc à évaluer l'effet d'une formation sur les habiletés techniques au pré-externat sur l'anxiété et la confiance des étudiants en médecine. MÉTHODES: Une formation sur les habiletés techniques a été conçue sur la base d'un modèle d'enseignement fondé sur les données probantes, par les quasi-pairs suivant une approche de classe inversée. Quatre-vingt-douze étudiants en deuxième année de médecine ont participé à l'étude sur une base volontaire. Cinquante-six d'entre eux ont été répartis au hasard dans le groupe qui devait recevoir la formation, et 36 dans le groupe contrôle. Les étudiants du groupe qui a reçu la formation ont assisté à sept tutoriels étalés sur une période de sept mois. Le groupe témoin représentait l'étudiant en médecine moyen sans formation normalisée axée sur les habiletés techniques. L'anxiété et la confiance des étudiants ont été évaluées au début et à la fin du programme à l'aide du questionnaire State Trait Anxiety Inventory (questionnaire sur l'anxiété chronique et réactionnelle) et d'un questionnaire sur la confiance. RÉSULTATS: Chez les étudiants qui ont participé au programme de formation sur les habiletés techniques, la baisse de l'anxiété et l'amélioration de la confiance en soi ont été plus importantes que chez les étudiants du groupe contrôle. CONCLUSION: La formation longitudinale axée sur les habiletés techniques en contexte de simulation a eu des effets positifs en ce qui concerne l'anxiété et la confiance chez les étudiants en médecine au pré-externat. La formation offre l'avantage supplémentaire de faciliter la transition des étudiants en médecine vers l'externat, tout en contribuant à rendre l'expérience clinique plus sûre et plus efficace. Il serait donc intéressant pour les facultés de médecine d'intégrer dans le cursus une formation normalisée axée sur les habiletés techniques au pré-externat.

Identifying essential procedural skills in Canadian undergraduate medical education.

INTRODUCTION: We conducted a national survey to characterize current Canadian procedural skills training in Undergraduate Medical Education (UGME). The goals were to identify the most important procedures students should know upon graduation and assess clinician-educator perceptions regarding implementation of a pre-clerkship procedural program. METHODS: We distributed the survey to physician-educators across Canada's 17 medical schools. Respondents were directed to an individualized survey that collected demographic data, physician-educator responses on essential procedural skills, as well as physician-educator opinions on the value of a pre-clerkship procedural training program. RESULTS: The response rate for this survey was 21% (42 out of 201 distributed surveys were completed). The top 10 most important procedures identified by physician-educators included IV Access, Airway Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery, Testing for STIs, Phlebotomy, Suturing of Lacerations, Nasogastric Tube Insertion, and Venipuncture. Physician-educators supported a pre-clerkship procedural program. CONCLUSIONS: Identifying the most crucial procedural skills is the first step in implementing a competency-based procedural skills training program for Canadian medical students. With the list of essential skills, and the support for physician-educators in developing a pre-clerkship procedural skills curriculum, hopefully there can be future development of formalized curricula.

CONTEXTE: Nous avons mené un sondage à l'échelle nationale pour caractériser les compétences procédurales canadiennes dans la formation médicale de premier cycle. L'objectif était de reconnaître les plus importantes procédures que les étudiants devaient connaître à la fin de leur formation et d'évaluer les perceptions des cliniciens éducateurs au sujet de la mise en œuvre de leur programme procédural avant les stages. MÉTHODES: Nous avons distribué le sondage à des médecins éducateurs dans les 17 écoles de médecine du Canada. Les répondants ont été dirigés vers un sondage individualisé qui recueillait les données démographiques, les réponses des médecins éducateurs sur les compétences procédurales essentielles, ainsi que les opinions des médecins éducateurs sur la valeur du programme de formation procédurale avant les stages. RÉSULTATS: Le taux de réponse à ce sondage a été de 21 % (42 des 201 sondages distribués ont été remplis). Les dix plus importantes procédures recensées par les médecins éducateurs comprenaient l'accès IV, l'assistance respiratoire, le bloc anesthésie locale/champ, le moulage de plâtre, l'accouchement spontané par voie vaginale, les tests d'ITS, la phlébotomie, la suture des lacérations, l'insertion d'une sonde nasogastrique et la ponction veineuse. Les médecins éducateurs soutenaient un programme procédural avant les stages. CONCLUSIONS: Établir les compétences procédurales les plus essentielles représente la première étape dans la mise en œuvre d'un programme de formation dans les compétences procédurales fondé sur les compétences pour les étudiants canadiens en médecine. Avec la liste de compétences essentielles et le soutien des médecins éducateurs dans le développement d'un programme de compétences procédurales avant les stages, nous espérons qu'un programme structuré sera élaboré.

Does gender influence leadership roles in academic surgery in the United States of America? A cross-sectional study.

BACKGROUND: Gender disparity remains prevalent in the field of academic surgery with an under-representation of women at senior leadership ranks. A wide variety of causes are reported to contribute to this gender-based discrimination but a current quantitative analysis in the US has significant importance. This cross-sectional study aims to document gender disparity in academic and leadership positions in surgery as well as its relationship with scholarly productivity. MATERIAL AND METHODS: The American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA), was used to identify General Surgery programs. Each institution's website was used to identify its faculty's primary profiles for data collection. Individuals with an MD or DO, and an academic ranking of Professor, Associate Professor or Assistant Professor were included. Academic productivity was quantified by recording H-index, number of publications, number of citations, and years of active research of a physician. All statistical analysis was performed on SPSS Statistics version 20.0. RESULTS: A total of 144 academic programs were including in our analysis constituting 4085 surgeons, only one-fifth (n = 873, 21%) of which were women. Furthermore, only 19% of all leadership positions were assumed by female surgeons. Leadership positions and academic rank correlated significantly with increasing research productivity. The difference in H-index between genders was statistically significant (P < 0.05) with men possessing a higher median for H-index [13] than women [9]. Transplantation Surgery [17] had the highest median H-indices for female surgeons. Male surgeons (n = 18) were twice as likely to be Departmental Chairs as their female counterparts (n = 9). However, female surgical oncologists held the highest proportion of leadership positions (31%). CONCLUSION: A significant gender-based disparity was found in leadership positions and academic ranks. Research productivity appeared to be integral for academic and leadership appointments. Institution-level measures that enhance support, mentorship, and sponsorship for women are imperative to achieve overall parity in general surgery.

Using Self-Reported Measures of Confidence and Anxiety to Determine the Efficacy of the Surgical Exploration And Discovery (SEAD) Program in Reducing Anxiety and Increasing Confidence in Performing Procedural Skills.

OBJECTIVE: Clerkship students feel increased anxiety and lack of confidence when it comes to surgery. This study assessed whether participation in Surgical Exploration And Discovery (SEAD), a 2-week intensive surgical program that includes career information, simulation workshops, and operating room observerships, would help decrease anxiety, increase confidence, and foster interest in a surgical career. SETTING: This study took place at The Ottawa Hospital in Ottawa, Ontario, Canada. DESIGN: Thirty first year medical students were randomly selected for the SEAD program and 32 were only given the program's instruction manual during the duration of the program serving as the control. At baseline and after the completion of SEAD, both groups were given a survey containing the State Trait Anxiety Inventory that measures self-reported anxiety levels with an adjunct that gauges confidence and interest in a surgical career. RESULTS: Students who participated in the program showed significant improvements in self-perceived knowledge and confidence for each surgical skill: scrubbing (p-value < 0.001, p-value < 0.001), maintaining sterility (p-value < 0.001, p-value < 0.001), and surgical assisting (p-value < 0.001, p-value < 0.001). However, there was no difference in the average state anxiety with procedural skills (p-value = 0.190) between students who participated in SEAD and those who did not. Students who completed SEAD had a notable increase in their interest in pursuing a career in surgery compared with their pretest (p-value = 0.020) and compared with the control group (p-value = 0.600). CONCLUSIONS: The SEAD program may increase medical students' confidence and interest in pursuing a surgical career. These results encourage offering medical students with similar opportunities that provide exposure to surgery in preclerkship.

Gender disparity in academic emergency radiology.

OBJECTIVE: This study is intended to better understand how academic productivity and career advancement differs between men and women emergency radiologists in academic practices. MATERIALS AND METHODS: Parameters of academic achievement were measured, including number of citations, number of publications, and h-index, while also collecting information on academic and leadership ranking among emergency radiologists in North America. RESULTS: In emergency radiology, there are significantly fewer women than men (22.2% vs 77.8%). Of these women, the greatest proportion of women held the lower academic rank of assistant professor (95.4%). Female assistant professors had a higher h-index than men at the same rank (4 vs 2), but it was not statistically significantly higher. There was no significant difference between gender and academic (p = 0.089) or leadership (p = 0.586) rankings. CONCLUSION: This study provides further evidence that gender disparity persists in emergency radiology, with women achieving less upward academic career mobility than men, despite better academic productivity in the earlier stages of their careers. The academic productivity of emergency radiologists at the rank of assistant professor is significantly higher for women than men.

Double-Valve Surgery After Cardiac Retransplantation.

We provide an update on Canada's first neonatal heart transplant recipient who, after cardiac retransplantation, underwent a mitral valve replacement and tricuspid valve repair. Twenty-seven years after his initial heart surgery and 13 years after his most recent transplant, this patient developed heart failure with severe mitral regurgitation secondary to a calcified mitral valve. The patient was highly sensitized with no evidence of allograft rejection; therefore, mitral and tricuspid surgery was performed. The patient did well perioperatively and remains well 18 months after surgery. To our knowledge, this novel case represents the first double-valve surgery in a patient who underwent cardiac retransplantation.