Notes

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The adoption of competency-based medical education (CBME) by Canadian postgraduate training programs has created a storm of excitement and controversy. Implementing the system-wide Competency by Design (CBD) project initiated by the Royal College of Physicians & Surgeons of Canada (RCPSC), is an ambitious transformative change challenge. Not surprisingly, tensions have arisen across the country around the theoretical underpinnings of CBME and the practicalities of implementation, resulting in calls for evidence justifying its value. Assumptions have been made on both sides of the argument contributing to an atmosphere of unhealthy protection of the status quo, premature conclusions of CBME's worth, and an oversimplification of risks and costs to participants. We feel that a renewed effort to find a shared vision of medical education and the true value proposition of CBME is required to recreate a growth-oriented mindset. Also, the aspirational assertion of a direct link between CBME and improved patient outcomes requires deferral until further implementation and study has occurred. However, we perceive more concrete and immediate value of CBME arises from the societal contract physicians have, the connection to maintaining self-regulation, and the potential customization of training for learners.Entering into health education leadership with clear intentions can help guide a new career. While being asked, or simply considering, an educational leadership position is exciting, it is important to consider your motivation for this position and how this position will mesh with your life and what you want to achieve in this position. In addition, it is important to look to mentors for advice and consider other avenues of professional development. Our six tips provide insight into the consideration, negotiation and selection of a health education leadership career that can yield numerous rewards both personally and professionally.Promotion within an academic institution is often a key component of a career; however, there are often barriers to successful applications. A streamlined and transparent process can assist faculty members in their goals of obtaining promotion, leading to greater security and satisfaction. This paper describes a methodology designed at a local level to maximize opportunities for success, in the hope that others may learn from the experience and advocate for similar changes within their own institutions.We underutilize the knowledge and skills of Instructional Design and Technology (IDT) professionals, despite the frequent challenges in implementing learning technologies in medical education. This is largely due to a lack of understanding among stakeholders regarding the expertise of IDT professionals and their role in technology implementation processes. We seek to improve technology implementation outcomes by explaining the IDT field's foundational tenets of a systems perspective and disciplined approach, clarifying the role that IDT professionals can play in educational technology initiatives, and providing guidance on how to foster productive collaborations in pursuit of effective technology-enhanced learning.
Current curriculum guidelines for addiction training in psychiatry need to be adapted to the competency by design framework to integrate clinical skills in addiction.

We conducted a systematic review to identify curricular and educational interventions to build competency among psychiatry residents and fellows in addiction psychiatry.

We followed the PRISMA guidelines, searching five databases from inception to August 2020 for relevant evaluation-type studies exploring addiction psychiatry competency among psychiatry residents and fellows. We appraised study quality using the Joanna Briggs Institute's risk of bias tool for observational designs.

From 1600 records, 17 studies met inclusion criteria. Addiction psychiatry competencies spanned themes involving core knowledge development; attitudinal, communication and leadership skills; screening, assessment, diagnosis; management; and special populations. Examples of effective educational interventions to enhance addiction competency include specific modk of studies measuring sustained competence over a longer-term follow-up period and the absence of randomized controlled trials limit the overall strength of evidence in this review. Current psychiatry entrustable professional activities (EPAs) involving addiction only partly overlap with curriculum training guidelines and studies identified in this review. These EPAs need to be better identified for training programs, competence in those EPAs better delineated for residents and preceptors, and evaluations should be done to ensure that adequate competence in addictions is attained and sustained.Peer-provided services exist in many different domains and professions. However, there is a knowledge gap in the existing programs' descriptions and grouping that hinders creating new high-quality peer support programs. The objectives of this article are two-fold in describing existing peer support programs published in the literature in the medical field and evaluating their descriptive quality. Six electronic databases, grey literature, and reference lists were systematically searched. Studies reporting the existence of a support program delivered by peers and its description or methodology were included. Studies targeting patients and children were excluded. 11 articles were included in the qualitative synthesis and explored in detail. A total of 2155 peers participated in support programs in the fields of medicine, nursing, or both. Programs in other professional fields were not found. Programs were described in five different countries. Three methods of peer support delivery were found in person, online, and mixed varying in their goals, duration, peer training supervision and participant demographics and number. Program descriptions were rated as good, fair, or poor using a verified rating scale. There are numerous well-described programs varying in their methodology and type of delivery. Thus, the emergence of new programs can be based on such models that have been well-described in the literature.
Rehearsal simulations are patient-specific case- matched tasks performed immediately prior to the actual task, with the objective of improving performance.

How does rehearsal simulation for antenatal consults impact how residents learn to engage in difficult conversations with families?

Residents in the NICU performed case-matched video recorded rehearsal simulations, followed by actual antenatal consults. The purpose of antenatal consults is to prepare parents expecting a complication with their baby before birth. Questionnaires assessed changes in resident confidence and self-assessment of communication skills. Residents were interviewed for qualitative data to explore the overall impact of rehearsal simulation on their learning and performance.

Thirteen residents participated. Rehearsal simulation improved confidence with a more organized approach of medical content and better communication techniques, allowing for a shift of focus from a checklist approach to building rapport and displaying empathy.

While rehearsal simulation did not prepare residents for unexpected parent responses, trainees' increased confidence with medical content organization and communication techniques created space for reflection-in-action and compassionate approaches.
While rehearsal simulation did not prepare residents for unexpected parent responses, trainees' increased confidence with medical content organization and communication techniques created space for reflection-in-action and compassionate approaches.
With the transition to a Competence by Design (CBD) curriculum, Fellow of the Royal College of Physicians in Emergency Medicine (FRCP-EM) training has created guidelines on experiences residents should have before progressing. We sought to quantify adult medical resuscitations and clinical procedures completed by PGY1 FRCP-EM residents to compare them to CBD requirements with the aim to identify areas of limited exposure requiring curriculum revisions prior to nation-wide CBD implementation.

Twenty-two PGY1 residents from four FRCP-EM programs recorded their activities from July 2017 to June 2018 in an online log that tracked resuscitations and procedures along with role assumed, supervision, and level of comfort.

In total 515 resuscitations were logged with the median number per resident 15 (range 0 to 98). The most frequent resuscitation was altered mental status and the least was unstable dysrhythmia. 557 total procedures were logged with the median number 75 (range 8 to 273). The most frequent procedure done was simple laceration repair and the least frequent was intraosseous access.

Unstable dysrhythmias and cardiorespiratory arrest along with intraosseous access and arthrocentesis are low event clinical exposures. In the era of CBD, the misalignment of entrustrable professional activity (EPA) targets and curriculum delivery should be monitored/reviewed to ensure expectations are realistic and that sufficient exposures are available.
Unstable dysrhythmias and cardiorespiratory arrest along with intraosseous access and arthrocentesis are low event clinical exposures. In the era of CBD, the misalignment of entrustrable professional activity (EPA) targets and curriculum delivery should be monitored/reviewed to ensure expectations are realistic and that sufficient exposures are available.
Canadian medical school curriculums have undergone major restructuring during the COVID-19 pandemic. This study's goal was to assess the perceived impact of COVID-19 on medical students' education and wellbeing.

An online survey was distributed to Canadian medical students. selleck chemical Descriptive analyses and ANOVAs were used to assess changes in mental health, health habits and quality of education during the pandemic.

248 medical students from 13 schools across Canada participated in this study. 74% reported a reduction in the quality of their education since COVID-19. 58% of students found online to be inferior to in-person teaching. 65% of students had more time for wellness and leisure activities, about half of the cohort felt more depressed (48%) and lonelier (52%). Student's overall health habits worsened after the start of the pandemic (F=37.4,
< 0.001). Alcohol drinking, time spent seated, and screen time also increased since the pandemic (
< 0.001). During the pandemic, students with a prior history of depression or anxiety expressed increased depressive symptoms (66% vs. 42%,
=0.003), increased anxiety (69% vs. 41%,
< 0001), worse sleep quality (34% vs. 18%,
= 0.031), and poorer quality of life (55% vs. 65%,
= 0.024) versus those with no prior history.

Canadian medical student's education and wellbeing has been negatively impacted during the pandemic.
Canadian medical student's education and wellbeing has been negatively impacted during the pandemic.
Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration.

This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis.

Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group.
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