Was it all worth it? A graduating resident perspective on CBME.

BACKGROUND: Our institution simultaneously transitioned all postgraduate specialty training programs to competency-based medical education (CBME) curricula. We explored experiences of CBME-trained residents graduating from five-year programs to inform the continued evolution of CBME in Canada. METHODS: We utilized qualitative description to explore residents' experiences and inform continued CBME improvement. Data were collected from fifteen residents from various specialties through focus groups, interviews, and written responses. The data were analyzed inductively, using conventional content analysis. RESULTS: We identified five overarching themes. Three themes provided insight into residents' experiences with CBME, describing discrepancies between the intentions of CBME and how it was enacted, challenges with implementation, and variation in residents' experiences. Two themes - adaptations and recommendations - could inform meaningful refinements for CBME going forward. CONCLUSIONS: Residents graduating from CBME training programs offered a balanced perspective, including criticism and recognition of the potential value of CBME when implemented as intended. Their experiences provide a better understanding of residents' needs within CBME curricula, including greater balance and flexibility within programs of assessment and curricula. Many challenges that residents faced with CBME could be alleviated by greater accountability at program, institutional, and national levels. We conclude with actionable recommendations for addressing residents' needs in CBME.

A review of stereotactic ablative radiotherapy for nonmetastatic renal cell carcinoma.

Renal cell carcinoma (RCC) is an uncommon malignancy whose incidence has been increasing over the past few decades, posing treatment challenges for elderly or infirm patients who are not surgical candidates. Stereotactic ablative radiotherapy (SABR) has emerged as a promising non-invasive treatment modality for RCC. The high dose-per-fraction used in SABR overcomes some of the mechanisms of radioresistance that has hindered the effective treatment of RCC with conventional radiotherapy. For primary RCC, local control rates for SABR exceed 90%, with typically minimal grade 3 or higher toxicities, offering a viable alternative for inoperable patients and those not eligible for or unable to tolerate radiofrequency or cryotherapy ablation. SABR can also be used in patients with a solitary kidney as a strategy for renal preservation to avoid need for dialysis. Given its excellent local control rates, low toxicity and preservation of renal function, SABR offers an attractive alternative to more invasive modalities for treatment of localized RCC.

Development and dissemination of structured hashtags for radiation oncology: Two-Year trends.

Purpose: For radiation oncology, social media is a favored communication platform, but it uses non-structured hashtags, which limits communication. In this work, we created a set of structured hashtags with key opinion leaders in radiation oncology, and we report on their use after two years post-deployment. Materials/Methods: Hashtags were created, voted on, and refined by crowdsourcing 38 international experts, including physicians, physicists, patients, and organizations from North America, Europe, and Australia. The finalized hashtag set was shared with the radiation oncology community in September 2019. The number of tweets for each hashtag was quantified via Symplur through December 2021. For the top five tweeted hashtags, we captured the number of yearly tweets in the pre-deployment and post-deployment periods from 09/01/2019 to 08/31/2021. Results: The initial 2019 list contained 39 hashtags organized into nine categories. The top five hashtags by total number of tweets were: #Radonc, #PallOnc, #MedPhys, #SurvOnc, and #SuppOnc. Six hashtags had less than 10 total tweets and were eliminated. Post-deployment, there was an increase in the yearly tweets, with the following number of tweets by the second year post-deployment: #RadOnc (98,189 tweets), #MedPhys (15,858 tweets), and #SurvOnc (6,361 tweets). Two popular radiation oncology-related hashtags were added because of increased use: #DEIinRO (1,603 tweets by year 2) and #WomenWhoCurie (7,212 tweets by year 2). Over the two years, hashtags were used mostly by physicians (131,625 tweets, 34.8%). Conclusion: We created and tracked structured social media hashtags in radiation oncology. These hashtags disseminate information among a diverse oncologic community. To maintain relevance, regular updates are needed.

Tailored Mentorship for the Underrepresented and Allies in Radiation Oncology: The Association of Residents in Radiation Oncology Equity and Inclusion Subcommittee Mentorship Experience.

PURPOSE: There are limited opportunities for mentorship for underrepresented in medicine (URM) trainees and physicians in radiation oncology (RO). The purpose of this study was to create and evaluate a formal mentorship program open to URMs and allies with interests in diversity, equity, and inclusion. METHODS AND MATERIALS: A mentorship program incorporating a virtual platform was designed by the Association of Residents in Radiation Oncology Equity and Inclusion Subcommittee. It was structured to include 6 sessions over 6 months with matched mentor-mentee pairs based on responses to a publicized online interest form. A compilation of evidence-based guidelines was provided to optimize the mentorship relationship. Linked pre- and postprogram surveys were administered to collect demographic data, define baseline goals and level of support, and evaluate program satisfaction. RESULTS: Thirty-five mentor-mentee pairs were matched; 31 mentees completed the preprogram survey and 17 completed the postprogram survey. Preprogram, only 3 mentees (9.7%) reported satisfaction with current mentorship and 5 (16%) reported mechanisms or mentorship in place at their program to support URMs. On the postprogram survey, mentees reported high satisfaction with areas of mentorship, mentor attributes, and the program overall. Opportunities for improvement include implementation of mechanisms to enhance communication with mentor-mentee pairs and maintain longitudinal engagement. CONCLUSIONS: In the first tailored mentorship program in RO for URMs and those with diversity, equity, and inclusion interests, our results demonstrate that there is self-reported interest for better mentorship for URMs in RO, and that a nationwide structured mentorship program can address participants' goals with high satisfaction. Program expansion could provide URMs and allies in RO more opportunities for career development and promote a greater sense of community and inclusion within the field.

Time management: Improving the timing of post-prostatectomy radiotherapy, clinical trials, and knowledge translation.

BACKGROUND: Management of prostate cancer after surgery is controversial. Past studies on adjuvant radiotherapy (aRT) for higher-risk features have had conflicting results. Through the collaborative conversations of the global radiation oncology Twitter-based journal club (#RadOnc #JC), we explored this complex topic to share recent advances, better understand what the global radiation oncology community felt was important and inspire next steps. METHODS: We selected the recent publication of a landmark international randomized controlled trial (RCT) comparing immediate and salvage radiotherapy for prostate cancer, RADICALS-RT, for discussion over the weekend of January 16 to 17, 2021. Coordination included open access to the article and an asynchronous portion to decrease barriers to participation, cooperation of study authors (CP, MS) who participated to share deeper insights including a live hour, and curation of related resources and tweet content through a blog post and Wakelet journal club summary. DISCUSSION OF RESULTS: Our conversations created 2,370,104 impressions over 599 tweets with 51 participants spanning 11 countries and 5 continents. A quarter of the participants were from the US (13/51) followed by 10% from the UK (5/51). Clinical or Radiation Oncologists comprised 59% of active participants (16/27) with 62% (18/29) reporting giving aRT within the last 5 years. Discussion was interdisciplinary with three urologists (11%), three trainees (11%), and two physiotherapists (7%). Four months after the journal club its article Altmetric score had increased by 7% (214 to 229). Thematic analysis of tweet content suggested participants wanted clarification on definitions of adjuvant (aRT) and salvage radiotherapy (sRT) including indications, timing, and decision-making tools including guidelines; more interdisciplinary and cross-sectoral collaboration including with patients for study design including survivorship and meaningful outcomes; more effective knowledge translation including faster clinical trials; and more data including mature results of current trials, particular high-risk features (Gleason Group 4+, pT4b+, and margin-positive disease), implications of newer technologies such as PSMA-PET and genomic classifiers, and better explanations for practice pattern variations including underutilization of radiotherapy. This was further explored in the context of relevant literature. CONCLUSION: Together, this global collaborative review on the postoperative management of prostate cancer suggested a stronger signal for the uptake of early salvage radiation treatment with careful PSA monitoring, more sensitive PSA triggers, and expected access to radiotherapy. Questions still remain on potential exceptions and barriers to use. These require better decision-making tools for all practice settings, consideration of newer technologies, more pragmatic trials, and better use of social media for knowledge translation.

Impact of a global radiation oncology scholarship for trainees: An evaluation of early outcomes.

Global Oncology capacity in Radiation Oncology (RO) needs development. We report on early outcomes of a Canadian Global Oncology elective scholarship program for trainees (2014-2019). The number of global oncology electives increased. Academic deliverables and collaborations were observed. There was evidence of personal and professional development.

COVID-19: Global radiation oncology's targeted response for pandemic preparedness.

As the global COVID-19 pandemic escalates there is a need within radiation oncology to work to support our patients in the best way possible. Measures are required to reduce infection spread between patients and within the workforce. Departments need contingency planning to create capacity and continue essential treatments despite a reduced workforce. The #radonc community held an urgent online journal club on Twitter in March 2020 to discuss these issues and create some consensus on crucial next steps. There were 121 global contributors. This document summarises these discussions around themes of infection prevention, rationalisation of workload and working practice in the presence of infection.

Thou shalt not tweet unprofessionally: an appreciative inquiry into the professional use of social media.

BACKGROUND: Social media may blur the line between socialisation and professional use. Traditional views on medical professionalism focus on limiting motives and behaviours to avoid situations that may compromise care. It is not surprising that social media are perceived as a threat to professionalism. OBJECTIVE: To develop evidence for the professional use of social media in medicine. METHODS: A qualitative framework was used based on an appreciative inquiry approach to gather perceptions and experiences of 31 participants at the 2014 Social Media Summit. RESULTS: The main benefits of social media were the widening of networks, access to expertise from peers and other health professionals, the provision of emotional support and the ability to combat feelings of isolation. CONCLUSIONS: Appreciative inquiry is a tool that can develop the positive practices of organisations and individuals. Our results provide evidence for the professional use of social media that may contribute to guidelines to help individuals realise benefits and avoid harms.

Painful cervical lymphadenopathy: An unusual presentation of chikungunya.

Chikungunya is an arboviral disease transmitted by Aedes mosquito that represents a major public health burden worldwide including India. The disease presents as sudden onset of high-grade fever, severe arthralgias, and rash. Here, we describe a case of a patient who presented with cervical lymphadenopathy, fever, and myalgia and later was diagnosed as chikungunya. Lymphadenopathy has been described before as a less common symptom of chikungunya. But this is probably, the first case of chikungunya with cervical lymphadenopathy as a presenting feature.

Small intestinal submucosa as a graft to increase rectum diameter.

BACKGROUND: The purpose of our study was to assess the biocompatibility of the porcine small bowel submucosa and its ability to increase the rectal diameter compared with a formal transverse coloplasty. METHODS: We assigned 36 New Zealand male rabbits to four experimental groups: groups C1 and C2 were treated with transverse coloplasty and groups S1 and S2 were treated with a patch of a porcine small intestine submucosa. We killed the animals in the C1 and S1 groups on the 7th postoperative day, and the animals in the C2 and S2 groups on the 30th postoperative day. We evaluated outcomes on the basis of animal survival, clinical course, anastomosis bursting pressures, morphometric examination, and histologic and immunohistochemical assessment. RESULTS: Morphometric examination showed a significant increase in colonic diameter in animals in the S2 group. We found no statistical difference regarding anastomosis bursting pressure between the C1 and S1 groups, and the C2 and S2 groups. On the 30th postoperative day, histologic examination showed total epithelium coverage of the grafts, and the immunohistochemical study showed an organized smooth muscular layer covering the graft. The higher concentration of collagen ticker fiber, type I, was seen in the S2 and C2 groups, but there was no statistical difference between them. CONCLUSIONS: The implanted graft proved superior to transverse coloplasty regarding the increase in distal colon diameter. Remarkable regeneration, marked fibroplasia, and epithelium coverage occurred throughout the graft on the 30th postoperative day.

Are we there yet? Preparing Canadian medical students for global health electives.

PURPOSE: To understand the current landscape and the evolution of predeparture training (PDT) in Canadian medical education. METHOD: The authors surveyed one faculty and one student global health leader at each of Canada's 17 medical schools in February 2008 and May 2010 to assess the delivery of and requirements for PDT at each institution. The authors then used descriptive statistics to compare responses across schools and years. RESULTS: In 2008, one faculty and one student representative from each of the 17 Canadian medical schools completed the survey; in 2010, 17 faculty and 16 student representatives responded. The number of medical schools offering PDT grew substantially from 2008 to 2010 (11/17 [65%] versus 16/17 [94%]). Three of the five new programs in 2010 were student run. The number of schools with mandatory PDT nearly doubled (6/17 [35%] versus 11/17 [65%]). However, institutional funding remained scarce, as 10 of 16 programs had budgets of less than $500 in 2010. PDT content, frequency, and format varied from school to school. CONCLUSIONS: Medical students have been responsible for organizing the majority of new PDT. To ensure quality and sustainability, however, faculty must play a more central role in the planning and implementation of such training programs. Medical schools must continue to reevaluate how best to maximize global health electives for trainees and the communities in which they study. PDT offers one avenue for schools to ensure that students are safe and socially accountable during their time abroad.

Can vitamin B-complex aggravate the carbamazepine induced toxic epidermal necrolysis?

Toxic Epidermal Necrolysis (TEN), which is also known as Lyell's syndrome, is a widespread, life-threatening, mucocutaneous disease that is particularly observed secondary to drugtaking and less commonly secondary to infections and immunization. Carbamazepine is associated with benign pruritic rash in 10-15% of the patients, but the life threatening dermatological syndromes like exfoliative dermatitis, erythema multiforme, the Stevens-Johnson Syndrome (SJS) and TEN are rarely seen with the carbamazepine treatment. The 32 year old female suffering from chronic backache, who was prescribed carbamazepine along with an intravenous combination of vitamin B-complex and calcium, developed fever, cough and mucocutaneous manifestations of TEN after 15 days of the treatment. She was treated in the hospital with systemic steroids, intravenous immunoglobulins, antibiotics, intravenous fluids and supportive care. In spite of the above treatment, the patient could not survive for more than seven days.