Surgery and the Subtype of Inflammatory Bowel Disease Impact the Risk of Venous Thromboembolism After Hospital Discharge.

BACKGROUND: Surgery for inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolism (VTE) during hospitalization. It is unclear whether this association persists after hospital discharge. AIMS: We assessed the association between surgery and VTE following hospital discharge in IBD. METHODS: We conducted a population-based cohort study between 2002 and 2016 in Ontario, Canada. Adults with IBD hospitalized for ≥ 72 h who underwent an intra-abdominal surgery were compared to hospitalized, nonsurgical IBD patients. Multivariable Cox proportional hazard models were used to compare VTE risk within 12 months of discharge. RESULTS: A total of 80,445 hospital discharges were analyzed: 60% Crohn's disease (CD) and 40% ulcerative colitis (UC). The median time to VTE was three times longer for nonsurgical patients with CD and 1.6 times longer for nonsurgical patients with UC. Compared with nonsurgical patients, surgery for CD was associated with a lower cumulative risk of VTE in the 2 weeks after discharge and persisted through to 12 months after discharge (adjusted HR 0.24; 95% CI 0.15-0.40). In contrast, urgent surgery for UC was associated with an increased risk of VTE. The increased risk was greatest at 2 weeks after discharge (aHR, 1.80; 95% CI 1.26-2.57) and declined progressively over the course of 12 months. CONCLUSIONS: Surgery was associated with a greater risk of VTE after hospital discharge in UC but not CD. In patients with UC who have undergone urgent surgery, healthcare providers should consider an extended period of prophylaxis after hospital discharge.

Twelve tips to center social accountability in undergraduate medical education.

As the intersections of social identities and health become increasingly evident, the need for medical schools to center their education on social accountability becomes critical. Medical schools have a responsibility to direct their curriculum to ensure graduates become competent physicians in identifying and intervening for their community's needs. These topics have historically been taught in a didactic fashion, but there lacks adequate translation of this teaching style to clinical and community health advocacy. Active learning strategies must be used to engage students to critically think and act on the inter-relationships of social issues and health. We provide 12 recommendations to optimize medical education to effectively immerse students in social accountability through the use of experiential learning within a spiral curriculum. These recommendations are based on reviews of the literature and an environmental scan of curricular activities across Canadian medical schools.

Implementing experiential learning logs addressing social accountability into undergraduate medical clerkship education.

Medical schools have a responsibility to ensure students meet and advocate for the needs of the community. However, addressing the social determinants of health is not always emphasized in clinical learning objectives. Learning logs are useful tools that can engage students to reflect on clinical encounters and direct students in their learning to target the development of highlighted skills. Despite their efficacy, the use of learning logs in medical education is largely applied towards biomedical knowledge and procedural skills. Thus, students may lack competence to address the psychosocial challenges involved in comprehensive medical care. Social accountability experiential logs were developed for third year medical students at the University of Ottawa to address and intervene on the social determinants of health. Students completed quality improvement surveys and results demonstrated this initiative to be beneficial to their learning and contributed to greater clinical confidence. Experiential logs in clinical training can be adapted across other medical schools and tailored to fit the needs and priorities of each institution's local communities.

Les facultés de médecine ont la responsabilité de s'assurer que les étudiants répondent aux besoins de la collectivité et militent pour leurs intérêts. Or, les objectifs d'apprentissage clinique ne sont pas toujours axes sur les déterminants sociaux de la santé. L'utilité des carnets d'apprentissage est d'inciter les étudiants à réfléchir sur les rencontres cliniques et de les orienter dans leur apprentissage vers le développement des compétences ciblées. Malgré leur efficacité, les carnets d'apprentissage sont surtout appliqués aux connaissances biomédicales et aux compétences procédurales. Par conséquent, les étudiants pourraient ne pas disposer des compétences nécessaires pour relever les enjeux psychosociaux, qui sont à considérer aux fins d'une prise en charge médicale globale. Des carnets d'apprentissage expérientiel portant sur la responsabilité sociale ont été élaborés pour les étudiants en médecine de troisième année de l'Université d'Ottawa afin d'aborder et d'intervenir sur les déterminants sociaux de la santé. Les étudiants ont participé à des sondages sur l'amélioration de la qualité et les résultats de ceux-ci ont montré que cette initiative était bénéfique pour leur apprentissage et qu'elle contribuait à améliorer leur confiance en eux en tant que cliniciens. Les carnets expérientiels en formation clinique peuvent être adaptés par les diverses facultés de médecine pour qu'ils correspondent aux besoins et aux priorités des collectivités locales qu'elles desservent.