Providing comparison normal examples alongside pathologic thoracic radiographic cases can improve veterinary students' ability to identify abnormal findings or diagnose disease.

Learning by comparison is a frequently employed education strategy used across many disciplines and levels. Interpreting radiographs requires both skills of perception and pattern recognition, which makes comparison techniques particularly useful in this field. In this randomized, prospective, parallel-group study, students enrolled in second and third-year radiology veterinary courses were given a case-based thoracic radiographic interpretation assignment. A cohort of the participants was given cases with side-by-side comparison normal images while the other cohort only had access to the cases. Twelve cases in total were presented to the students, with 10 cases depicting examples of common thoracic pathologies, while 2 cases were examples of normal. Radiographs of both feline and canine species were represented. Correctness of response to multiple choice questions was tracked, as was year and group (group 1: non compare, Control; group 2: compare, Intervention). Students assigned to group 1 had a lower percentage of correct answers than students assigned to group 2 (45% Control vs. 52% Intervention; P = 0.01). This indicates that side-by-side comparison to a normal example is helpful in identifying disease. No statistical significance was noted for the correctness of responses according to the year of training (P = 0.90). The overall poor performance on the assignment, regardless of group or year, shows that students in the early years of undergraduate veterinary radiology training struggle with the interpretation of common pathologies, likely a result of a lack of exposure to a multitude of cases and normal variants.

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure.

BACKGROUND: Pharmacists' roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists' care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere. OBJECTIVES: The aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances. METHODS: A focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit. RESULTS: Two rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit. CONCLUSION: A Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.

Comparing Two Resources Used to Teach Pulmonary Patterns for a Flipped Veterinary Radiology Course.

The flipped classroom has been gaining momentum within medical education circles. Pre-class assignments are an important component of this pedagogical approach. In this study, a section of the introductory course to veterinary medical imaging was taught using a flipped classroom, and the effectiveness of two different pre-classroom assignments was evaluated. The pre-classroom assignments consisted of either short videos or readings. Both had similar content, which included basic information about pulmonary patterns of disease on chest radiographs. Learning outcomes were assessed by in-classroom and final examination questions. Student learning self-assessments and student satisfaction were also evaluated via an online survey. Students in the video group answered more of the in-classroom questions correctly (71% video vs. 63% reading group; p = .01) and had higher scores on the final examination (83% video vs. 75% reading group; p = .02). There was also a higher student satisfaction with the videos versus the reading assignment. However, we found no significant difference in the student self-assessments of learning or participation in class. An additional finding of this study related to the ongoing difficulties students were having with the learning objectives, including differentiating a pathological process from a normal, or normal variant, recognizing the different pulmonary patterns, and developing a differential diagnoses list, despite the pre-classroom assignments and large group learning sessions. This speaks to the difficulty in developing confidence in pulmonary pattern recognition on chest radiographs, a skill that requires considerable training and time investment.

From Theory to Practice: The Enacted Curriculum of a Successful Master's Program in Quality Improvement and Leadership.

INTRODUCTION: Blended learning has taken on new prominence in the fields of higher and continuing education, especially as programs have shifted in response to teaching in a global pandemic. The faculty at the Jönköping Academy's Masters in Quality Improvement and Leadership program has been offering a blended learning curriculum, based on four core design principles, since 2009. We studied key features of the enacted curriculum to understand conditions that can support an effective blended learning model. METHODS: We used a case study approach underpinned by interactive research. Document analysis, a focus group, individual interviews, and stimulated recall interviews were used for data collection. Themes were identified through qualitative content analysis and data reduction, data display, and conclusion drawing. RESULTS: We grouped data into six emergent themes that clarify the enacted curriculum of an established Master's program: focusing on a common purpose, developing technical and relational knowledge and skills, linking theory and practice in the workplace, leveraging collaboration for mutual benefit, concentrating on leadership and coaching, and applying a blended and interprofessional learning model. CONCLUSION: Educators faced with increased demands to be flexible and to offer opportunities for distance education can learn from this case example of effective teaching of quality improvement and leadership in a blended format.

The longitudinal elderly person shadowing program: outcomes from an interprofessional senior partner mentoring program.

The University of Saskatchewan's Longitudinal Elderly Person Shadowing (LEPS) is an interprofessional senior mentors program (SMP) where teams of undergraduate students in their first year of medicine, pharmacy, and physiotherapy; 2nd year of nutrition; 3rd year nursing; and 4th year social work partner with community-dwelling older adults. Existing literature on SMPs provides little information on the sustainability of attitudinal changes toward older adults or changes in interprofessional attitudes. LEPS students completed Polizzi's Aging Semantic Differential and the Interdisciplinary Education Perception Scale. Perceptions of older men and women improved significantly and changes were sustained after one year. However, few changes were seen in interprofessional attitudes.

Five ways for facilitators to get a grip on small group learning.

Successful groups do not happen by chance, and they do not depend solely or even mainly on the interpersonal skills of the group members. Cooperative learning (CL) theory tells us that small groups are successful when facilitators structure and organize the small group to include each one of the five elements of cooperative learning. In this article, we have described each of these five elements as a way to get a grip on small group learning: positive interdependence, promotive interaction, group and individual accountability, interpersonal and small group skills, and group processing. To help our readers remember the five key elements of CL, the five ways to get a grip on small group facilitation, we have created an infographic.

La réussite du travail en groupe n'est pas le fruit du hasard et ne dépend pas uniquement, ni même principalement, des compétences interpersonnelles des membres du groupe. D'après la théorie de l'apprentissage coopératif (l'AC), le travail en petits groupes est efficace lorsque les facilitateurs structurent et organisent le petit groupe de manière à inclure chacun des cinq éléments de l'apprentissage coopératif. Dans cet article, nous avons décrit chacun de ces cinq éléments comme un moyen de maîtriser l'apprentissage en petit groupe : l'interdépendance positive, l'interaction engagée, la responsabilisation du groupe et de l'individu, les habiletés interpersonnelles et liées au fonctionnement en petit groupe, et l'évaluation du groupe. Pour aider nos lecteurs à se souvenir des cinq éléments clés de l'AC, les cinq façons de maîtriser l'animation de petits groupes, nous avons créé une infographie.

The effect of case nodes in problem-based learning on the length and quality of discussion: a 2x2 factorial study.

Background: Problem-based learning (PBL) relies heavily on case structure for their success. To make more meaningful cases, faculty introduced a "case node" that requires students to make a group decision on the action they will take at a given point in the case. The purpose of this study was to determine whether case nodes enhance PBL discussions. Methods: Two PBL cases were designed with and without a node. In 2011, 2012, and 2015, first-year medical students were assigned one PBL case with a node and one without a node. In total, 26 groups processed cases with a node while 27 groups processed the same cases without the node. All sessions were audio recorded and analyzed to determine the length and quality of discussions. Results: Groups with a node, regardless of case (M = 25.62, SD = 12.25) spent significantly more time in discussion on the node topic than those without a node (M = 16.54, SD = 10.33, p=.005, d = .80). Groups with a node, regardless of case (M = 14.38, SD = 8.04) expressed an opinion significantly more frequently than those without a node (M = 6.07, SD = 5.80, p < .001, d = 1.19). Conclusions: Case nodes increased both the length and depth of discussion on a topic and may be an effective way to enhance case-based instruction.

Contexte: Le succès de l'apprentissage par problèmes (APP) repose en grande partie sur la structure des cas. Pour rendre les cas plus significatifs, les membres du corps professoral ont introduit dans les scénarios un «nœud¼, ou un point nodal, marquant un moment où les étudiants doivent prendre une décision de groupe quant à l'action à entreprendre. L'objectif de cette étude était de déterminer si les cas comportant de tels points nodaux amélioraient la discussion dans le cadre de l'APP. Méthodes: On a conçu deux cas d'APP en deux versions, l'une comportant un nœud, l'autre non. En 2011, 2012 et 2015, on a soumis à des étudiants en première année de médecine un cas d'APP avec un nœud et un cas sans nœud. Au total, 26 groupes ont travaillé sur le cas avec un nœud et 27 groupes sur le cas sans nœud. Toutes les séances ont été enregistrées et analysées afin de déterminer la durée et la qualité des discussions. Résultats: Les groupes qui ont travaillé sur un cas comportant un nœud, quel que soit le cas (M = 25.62, SD = 12.25), ont consacré significativement plus de temps à la discussion que ceux qui avaient un cas sans nœud (M = 16.54, SD =1 0.33, p = .005, d = .80). Les premiers ont également exprimé des opinions significativement plus fréquemment, quel que soit le cas (M = 14.38, SD = 8.04), que les seconds (M = 6.07, SD = 5.80, p < .001, d = 1.19). Conclusions: Les nœuds introduits dans les cas ont entraîné des discussions à la fois plus longues et plus approfondies sur le sujet abordé. Par conséquent, ils constitueraient un moyen efficace d'améliorer l'enseignement fondé sur l'étude de cas.

Engaging medical education scholars with a Twitter conference on professionalism and professional identity formation.

The Education Innovation Institute (EII) of Medical College of Georgia, Augusta University, hosted a conference on Twitter about Professional Identity Formation (PIF), #MCGConf2021PIF, on February 25, 2021. The conference featured five presentations by 15 authors from Canada and the U.S. A Twitter conference is a versatile, affordable, and accessible digital option for medical education groups interested in diversifying conference offerings and reaching a broader audience. It was low-cost, organized in six months, and garnered over 9,000 Twitter impressions. Small networks and interest groups can organize Twitter conferences for their constituencies and larger conference organizations can host online mini-conferences to supplement in-person events.

Le 25 février 2021, l'Educational Innovation Institute (EII) du Medical College of Georgia de l'Université Augusta a tenu une conférence sur la construction de l'identité professionnelle sur le réseau social Twitter (#MCGConf2021PIF). Cinq communications y ont été présentées par 15 chercheurs du Canada et des États-Unis. Elle a été organisée en six mois, à coût modeste, et elle a recueilli plus de 9000 impressions sur Twitter. La conférence Twitter s'avère être une option numérique polyvalente, abordable et accessible pour les membres du milieu de l'éducation médicale désireux de diversifier leur offre de symposiums et de toucher un public plus large. Twitter offre aux petits réseaux et groupes d'intérêt la possibilité de convier leurs membres à des conférences restreintes et aux organisateurs de conférences plus importantes la possibilité de tenir des mini-conférences en ligne pour compléter leurs activités en personne.

Warning: medical education is hazardous to your mental health. Medical students should make an informed decision to begin and continue training.

For decades there has been ample evidence that training to become a physician and practicing medicine is hazardous to one's health and wellness. In the face of the extremely high rates of suicide, substance abuse, depression and burnout in the medical student, resident, and physician populations, it would be dishonest to suggest medical education and practice is all gain and no pain. This article is directed to members of the medical education community and challenges stakeholders to view their teaching and training of medical students as an intervention requiring free and informed consent. We hope this exercise shifts the paradigm of educators and enables students to enter medical training from a free and informed position.

Depuis des décennies, il existe amplement de preuves à l'effet que la formation t et la pratique de la médecine peuvent compromettre la santé et le bien-être de la personne. Face aux taux extrêmement élevés de suicide, de toxicomanie, de dépression et d'épuisement professionnel tant chez les étudiants, les résidents que les médecins, il serait faux de prétendre qu'on est ou qu'on devient médecin sans faire de sacrifice. Cet article s'adresse aux acteurs du milieu de l'éducation médicale pour les inciter à considérer la formation qu'ils donnent aux étudiants en tant qu'intervention nécessitant le consentement libre et éclairé de ces derniers. Nous espérons que cet exercice amènera les enseignants à changer de paradigme et les étudiants à entreprendre leur formation médicale de façon libre et informée.

Rethinking the basis of medical knowledge.

CONTEXT: Twentieth-century medical education constructed medicine as biomedical science. Although bioscientific knowledge has brought large benefits to clinical practice, many have questioned the appropriateness of its domination of the medical curriculum. As the content of that curriculum is itself a historically mediated social construct, it can be changed to fit current descriptions of the competent doctors medical schools are expected to produce. Such doctors are expected not only to have biomedical expertise, but also to carry out multiple other roles as described in competency frameworks such as that of CanMEDS. Many of these other roles are socio-culturally based and thus not supported by bioscientific knowledge. METHODS: We designed a thought experiment to delineate the need to identify and integrate the range of foundational knowledges required to support the development of doctors capable of performing all the roles described in the competency frameworks. We specified assumptions and demarcated our scope. To illustrate our ideas, we selected examples from the medical curriculum that linked to non-Medical Expert roles and outlined the disciplines that supported them. RESULTS: Students educated in the foundational knowledge necessary for competence in all doctor roles would need to be exposed to ideas and ways of thinking from a wide array of disciplines outside the traditional biomedical sciences. These would need to be introduced in context and in ways that would support future medical practice. They would also broaden students' understanding of the nature of legitimate medical knowledge. CONCLUSIONS: There are currently major gaps between the goals and objectives of competency frameworks such as CanMEDS and the actual contents of medical curricula. Addressing these will require curricular transformation to add knowledges, in context and in ways that positively affect practice, from disciplines not currently present within the medical school. In order to accomplish this, we will need to engage with colleagues throughout the university.

Does the format residents use to give and receive feedback about teaching affect the usefulness of the feedback?

PURPOSE: An important element in each teaching workshop for resident doctors at the University of Saskatchewan is the microteaching sessions, including feedback. We set out to test our observations that one condition for organizing the feedback increased the quality of feedback. In one condition, residents provide and receive feedback in all areas listed on our feedback form; while in the other condition, they provide and receive feedback in some areas. METHODS: Over 115 residents participated in the teaching workshop in the 2019-2020 academic year. Each resident experienced both conditions for giving and receiving feedback-about half with one condition first and the other half in the opposite order. We developed and tested a simple survey that asked about the usefulness of the feedback. RESULTS: We used the Mann-Whitney U test for differences between some areas or all areas. We found a statistically significant difference with small to moderate effect sizes (Cohen's d) favouring the some areas condition. CONCLUSION: Residents found the usefulness of feedback given or received using the feedback condition in some areas greater than all areas. We will now only use the some areas condition and recommend that other teaching workshops that use microteaching practice sessions consider using this condition.

OBJECTIF: Les séances de micro-enseignement, y compris la rétroaction, constituent un élément important des ateliers de formation en enseignement destinés aux médecins résidents de l'Université de Saskatchewan. Nous avons vérifié l'observation selon laquelle la qualité de la rétroaction fournie dans un format qui ne couvre que certains domaines est meilleure que celle qui couvre tous les domaines figurant sur le formulaire de rétroaction. MÉTHODES: Au cours de l'année universitaire 2019-2020, plus de 115 résidents ont participé à l'atelier d'enseignement. Chaque résident a expérimenté les deux modèles de rétroaction. Ils étaient divisés en deux groupes, le premier groupe utilisant d'abord le modèle de rétroaction couvrant tous les domaines un modèle, le deuxième groupe suivant d'abord le modèle couvrant certains domaines, et vice-versa. Nous avons réalisé et administré un sondage simple interrogeant les participants sur l'utilité de la rétroaction. RÉSULTATS: Nous avons utilisé le test U de Mann-Whitney pour les différences entre le modèle comprenant certains domaines et celui englobant tous les domaines. Nous avons trouvé une différence statistiquement significative avec des tailles d'effet petites à modérées (d de Cohen) favorisant le format de rétroaction dans certains domaines seulement. CONCLUSION: Les résidents ont trouvé que le format de rétroaction partielle était plus utile que le format global. Par conséquent, nous n'utiliserons désormais que le premier et nous conseillons aux responsables d'autres ateliers comprenant des séances de microenseignement de l'envisager également.

Qualitative assessment of patients' perspectives and needs from community pharmacists in substance use disorder management.

BACKGROUND: Non-medical use of psychoactive substances is a common harmful behavior that leads to the development of Substance Use Disorders (SUDs). SUD is a significant health concern that causes adverse health consequences and elevates the economic burden on the health care system. SUD treatment plans that utilize a patient-centered approach have demonstrated improved treatment outcomes. It is essential for health care providers, including community pharmacists, to understand patients' needs and prioritize them. Therefore, this study was conducted to explore the perspective of patients living with SUDs or who used substances non-medically regarding community pharmacist services and the delivery of services in a community pharmacy setting. The study took place in Saskatoon, a small urban center of Saskatchewan, Canada. METHODS: Qualitative methodology was used for this research inquiry. Four focus groups were conducted, with a total of 20 individuals who had experienced substance use and accessed community pharmacy services. The discussion of the four focus groups was transcribed verbatim and analyzed independently by two researchers. Agreement on the emergent themes was reached through discussion between the two researchers. RESULTS: Data analysis resulted in four themes that described participants' perspectives about community pharmacists. The four emergent themes are: 1) conflicted experiences with community pharmacists, 2) lack of knowledge concerning community pharmacists' extended services, 3) negative experiences in Opioid Agonist Therapy (OAT) program, and 4) needs from community pharmacists. CONCLUSION: There is significant potential for the patient-pharmacist relationship to address the varying needs of patients who use substances and improve their overall health care experience. Patients who use substances are receptive to pharmacists' services beyond dispensary; however, respectful communication, provision of drug-related information, and counseling are among the primary demands. Future research should focus on studying the impact of meeting the needs of patients on their treatment outcomes.

Interprofessional culinary education workshops at the University of Saskatchewan.

Implication Statement If you want to offer your students an enjoyable and worthwhile interprofessional activity to learn about issues in community nutrition, your university can cook up these interprofessional culinary education workshops. Start with a few enthusiastic students from various health professional programs who can organize, promote, and lead. Include faculty and/or staff to support the students and apply for internal funding. Find workshop facilitators (e.g., chefs), and arrange for program evaluation. It is best to choose workshop topics and themes relevant to your local situation. Ensure workshops are structured to facilitate cooperative and experiential learning. Students will find these sessions informative, practical, and enjoyable. Énoncé des implications de la recherche Les ateliers culinaires sont une activité interprofessionnelle agréable et intéressante que votre université peut proposer aux étudiants qui souhaitent se familiariser avec les enjeux de la nutrition communautaire. Il suffit de réunir, pour commencer, quelques étudiants motivés issus de divers programmes de santé pour organiser, promouvoir et diriger les ateliers. Il s'agit ensuite de trouver les enseignants ou le personnel pour les soutenir, et de s'assurer d'un financement interne. Il faut ensuite trouver des animateurs d'ateliers (par exemple, un chef) et planifier l'évaluation du programme. Il est préférable d'axer les ateliers sur des thèmes adaptés à votre milieu. Les ateliers doivent être structurés de manière à faciliter l'apprentissage coopératif et expérientiel. Les étudiants trouveront ces séances instructives, pratiques et agréables.

Five ways to get a grip on grouped self-assessments of competence for program evaluation.

Self-assessments conducted by individuals when taken together (grouped) provide valid and accurate measures of learning outcomes of the group. This is useful for program evaluation. Grouped self-assessments are simple to understand and construct, easy to implement, relatively accurate, and do not require extensive and complex pre-post testing measures. However, group self-assessments have the potential to be misused. To examine how group self-assessments have been used in medical education, we conducted a search of journal articles published in 2017 and 2018 from eight prominent medical education journals. Twenty-seven (n = 27) articles that used self-assessments for program evaluation were selected for data extraction and analysis. We found three main areas where misuse of self-assessments may have resulted in inaccurate measures of learning outcomes: measures of "confidence" or "comfort", pre-post self-assessments, and the use of ambiguous learning objectives. To prevent future misuse and to build towards more valid and reliable data for program evaluations, we present the following recommendations: measure competence instead of confidence or comfort; use pre-test self-assessments for instructional purposes only (and not for data); ask participants to do the post-intervention self-assessments first followed by retrospective pre-intervention self-assessments afterwards; and use observable, clear, specific learning objectives in the educational intervention that can then be used to create the self-assessment statements.

Les auto-évaluations effectuées individuellement, quand mises en commun(regroupées) fournissent des mesures valides et précises des résultats de l'apprentissage du groupe. Ceci s'avère utile dans le cadre d'évaluation de programme. Les auto-évaluations groupées sont faciles à comprendre, à créer et à mettre en œuvre. De plus, elles sont relativement précises et ne requièrent pas de mesures exhaustives et complexes avant et après l'évaluation. Cependant, il est possible de mal utiliser les auto-évaluations de groupe. Afin d'examiner de quelle façon les auto-évaluations de groupe ont été utilisées dans la formation médicale, nous avons dépouillé des articles de huit revues médicales importantes publiées en 2017 et 2018. Vingt-sept (n=27) articles ayant utilisé les auto-évaluations à des fins d'évaluation de programme ont été sélectionnés pour être analysées. Nous avons trouvé trois domaines principaux où la mauvaise utilisation des auto-évaluations a peut-être occasionné des mesures inexactes des résultats de l'apprentissage : mesures de « confiance ¼ ou d'« aisance ¼, auto-évaluations pré/post et l'emploi d'objectifs d'apprentissage ambigus. Afin de prévenir l'utilisation future incorrecte et de miser sur des données plus valides et fiables à des fins d'évaluation de programme, nous présentons les recommandations suivantes : mesurer la compétence au lieu de la confiance ou l'aisance; utiliser les auto-évaluations prétest à des fins d'enseignement seulement (et non comme données); demander aux participants de faire les auto-évaluations post-intervention d'abord suivies par les auto-évaluations préintervention rétrospectives après; utiliser des objectifs d'apprentissage observables, clairs et spécifiques lors de l'intervention de formation qui peuvent servir de base aux items d'auto-évaluation.

Neuroanatomy: a single institution study of knowledge loss.

BACKGROUND: Most of the literature on neuroanatomy education has focused on its instructional method. Little is known about the retention of acquired knowledge in the basic neurosciences upon graduation from medical school. METHODS: Twenty-four graduating medical students at the University of Saskatchewan, Canada answered 20 multiple-choice questions from the original first year neuroanatomy midterm examination, 33 months after the original exam date. The course involved 58 instructional hours in the dissecting lab and classroom during the first year of medical school. RESULTS: Relative knowledge loss in this cohort was 60%, and the mean multiple-choice exam score dropped from 82% to 33%. Two students received passing grades on the retest (50% and 55%) and the rest failed. CONCLUSIONS: Most graduating medical students were unable to pass a first year exam in the basic neurosciences. Lack of knowledge reinforcement and poor applicability to the clinical setting may be to blame, and suggests that teaching foundational concepts, useful for general practice, are more worthwhile.