Canadian Health Care Professionals Research Articles

Taking action towards climate-resilient, low-carbon, health systems: Perspectives from Canadian health leaders and healthcare professionals.

Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving "net zero" health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals' and health leaders' perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.

Mental Health and Well-being of Healthcare Professionals Amid the COVID-19 Pandemic in Canada

Introduction: The COVID-19 pandemic posed unique challenges to healthcare professionals (HCPs) with increased risk of mental health and well-being globally. However, the psychological impact of the pandemic on the mental health and well-being of HCPs in Canada is not fully understood. This paper critically reviews broadly available literature on the mental health and psychosocial status of HCPs amid the COVID-19 pandemic in Canada. Methods: A comprehensive online search was conducted using the guidelines outlined by the Centre for Reviews and Dissemination for combining the findings of diverse primary studies within a single review. Online search was conducted through databases such as AMED (Allied and Complementary Medicine), Embase, Global Health, Ovid Healthstar, Mental Measurements Yearbook, EBM Reviews - ACP Journal Club, EBM Reviews - Cochrane Database of Systematic Reviews, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review, and Google Scholar for the period between March 2020 and May 2023. Twenty-two studies met the inclusion criteria and were analyzed systematically using a thematic analysis approach to identify the main themes across studies. Results: The analysis uncovers three key themes: 1) HCPs face diverse mental health impacts during the pandemic; 2) HCPs are dissatisfied with organizational approaches to COVID-19; and 3) HCPs express concerns about personal well-being and the safety of others during the pandemic. Conclusion: These findings emphasize the need for HCPs to cope effectively with stressors for their own, their patients, and their families' well-being. Therefore, future research should prioritize the ways in which HCPs can maintain their emotional, mental, and psychological well-being.

Ageism Healthcare: Implications for the Psychological Well-Being of Atlantic Canadian Healthcare Professionals.

Ageism in healthcare is related to poor outcomes for older patients. The objective of this study was to evaluate the relationships between ageism and various aspects of the psychological well-being of healthcare professionals in Atlantic Canada. In 2023, an online survey of 294 healthcare professionals from various disciplines was conducted. This survey included items to measure expectations of aging, stress, burnout, emotional dissonance, and well-being. Results indicated that aging expectations were significantly related to burnout, perceived stress, well-being, and emotional dissonance. With the use of a path analysis, emotional dissonance partially mediated relationships between burnout and well-being with stress. However, aging expectations did not significantly predict emotional dissonance. Differences were found across professional groups on ageism. Conclusions support the need for increased awareness to the relationship between ageist attitudes and professionals' well-being, as well as the need for education and interventions to reduce false expectations about the aging process.

A235 INFLAMMATORY BOWEL DISEASE AND PREECLAMPSIA: A PHYSICIAN SURVEY

Abstract Background Preeclampsia is a disorder of pregnancy recognized as the second cause of maternal mortality worldwide. The association between IBD and preeclampsia remains unclear, but the significant comorbid profile, and lack of treatment aside from urgent delivery, make primary prevention a priority. Aspirin was shown to halve preeclampsia rates and is recommended for primary prevention for women at risk. Despite high-quality evidence supporting Aspirin use and its well tolerated side effect profile, studies in non-IBD patients have demonstrated a knowledge-to-practice gap. Aims While there are no studies reported in women with IBD, prescribing rates may be even lower in this population, given that it may be incorrectly perceived to increase the risk of an IBD flare. Understanding physician perceptions could allow for a targeted educational approach to increase patient and physician awareness of the indications for Aspirin prophylaxis and its safety profile. Methods This is a cross-sectional survey study assessing physician perceptions and Aspirin prescribing patterns for preeclampsia prevention conducted from Mount Sinai Hospital. Demographic information, information on perceptions of preeclampsia risk in pregnant women with IBD, and on the perceived clinical benefit and risk of Aspirin prescribing were collected. Results A total of 38 Canadian healthcare professionals (HCPs) (15 Gastroenterologists, 14 Obstetricians, 5 General Practitioners, 2 General Internists, 1 nurse practitioner, and 1 midwife) were surveyed. Most HCPs were practicing for over 10 years (71%). In total, 68% of HCPs were comfortable with pregnancy-specific management of IBD. Most HCPs correctly identified all comorbidities associated with a high risk of preeclampsia including a history of preeclampsia (95%), renal disease (87%), and autoimmune disease (68%). A total of 55% of HCPs believed that pregnant patients with IBD were at increased risk of placental related diseases, and 56% agreed that these patients were at increased risk of preeclampsia specifically. Thirty-five percent of HCPs believed that IBD in remission, in the absence of other risk factors, was an indication for Aspirin prophylaxis. More so, 45% believed that IBD, with poor disease control, was an indication. Only 8% of HCPs believed that Aspirin, when used for preeclampsia prevention, was associated with an IBD flare. In patients whom Aspirin prophylaxis was indicated, 77% agreed with its use, even in patients in whom disease control was poor. Finally, 63% agreed that the Aspirin dose should be 162 mg daily, and more than half (58%) agreed that the prescriber should be the patient’s obstetrician. Conclusions Most HCPs agreed that IBD was a risk factor for preeclampsia and that Aspirin prophylaxis was effective and safe for primary prevention. High quality studies are needed to evaluate risk of preeclampsia in IBD, especially in patients with active disease. Funding Agencies CAG

Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective

ObjectiveApproximately 150,000 Canadian women live with epilepsy, a population that presents with unique challenges. Our objective was to capture demographic and real-world practice characteristics of Canadian healthcare professionals providing care for women with epilepsy (WWE) with specific focus on reproductive considerations to identify potential gaps in knowledge and care. MethodsA questionnaire developed by the Canadian League Against Epilepsy WWE workgroup was distributed to Canadian healthcare professionals from February 2021 to October 2022 to capture participant demographic characteristics and practice patterns in key areas of the reproductive cycle in WWE. ResultsA total of 156 participants completed the questionnaire, most being physicians (81.4%), epilepsy specialists (69.0%), and those who cared for adult patients (86.5%), with a significant proportion based at an academic center (65.4%). The majority of participants counselled on folic acid supplementation (89.7%). Participants selected lamotrigine and levetiracetam most frequently for either focal or generalized epilepsies during pregnancy. Additionally, 85.9% performed therapeutic drug monitoring during pregnancy. Almost all practitioners always or often counseled WWE on valproic acid on the benefits of switching to a less teratogenic medication (96.2%). Some geographic variability in practice patterns was noted with valproic acid being one of the top three medications selected for patients with generalized epilepsies in Western regions, although participants in Eastern regions had brivaracetam more commonly included as one of their top three agents for this population. SignificanceThis is the first report of real-world Canadian practices in epilepsy care for women in pregnancy. Overall, our study reports that Canadian practice patterns conform well to current evidence and best-practice guidelines. Important variations in antiseizure medication selection across different regions were identified.

Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update.

In Canada, more than 2 million people live with osteoporosis, a disease that increases the risk for fractures, which result in excess mortality and morbidity, decreased quality of life and loss of autonomy. This guideline update is intended to assist Canadian health care professionals in the delivery of care to optimize skeletal health and prevent fractures in postmenopausal females and in males aged 50 years and older. This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and quality assurance as per Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards. Primary care physicians and patient partners were represented at all levels of the guideline committees and groups, and participated throughout the entire process to ensure relevance to target users. The process for managing competing interests was developed before and continued throughout the guideline development, informed by the Guideline International Network principles. We considered benefits and harms, patient values and preferences, resources, equity, acceptability and feasibility when developing recommendations; the strength of each recommendation was assigned according to the GRADE framework. The 25 recommendations and 10 good practice statements are grouped under the sections of exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring. The management of osteoporosis should be guided by the patient's risk of fracture, based on clinical assessment and using a validated fracture risk assessment tool. Exercise, nutrition and pharmacotherapy are key elements of the management strategy for fracture prevention and should be individualized. The aim of this guideline is to empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture risk throughout older adulthood. Identification and appropriate management of skeletal fragility can reduce fractures, and preserve mobility, autonomy and quality of life.

Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States

ObjectiveTo synthesise and appraise the design and impact of peer-reviewed evaluations of Indigenous cultural safety training programmes and workshops for healthcare workers in Australia, Canada, New Zealand and/or the United...

Canadian Healthcare Professionals' Views and Attitudes toward Risk-Stratified Breast Cancer Screening.

Given the controversy over the effectiveness of age-based breast cancer (BC) screening, offering risk-stratified screening to women may be a way to improve patient outcomes with detection of earlier-stage disease. While this approach seems promising, its integration requires the buy-in of many stakeholders. In this cross-sectional study, we surveyed Canadian healthcare professionals about their views and attitudes toward a risk-stratified BC screening approach. An anonymous online questionnaire was disseminated through Canadian healthcare professional associations between November 2020 and May 2021. Information collected included attitudes toward BC screening recommendations based on individual risk, comfort and perceived readiness related to the possible implementation of this approach. Close to 90% of the 593 respondents agreed with increased frequency and earlier initiation of BC screening for women at high risk. However, only 9% agreed with the idea of not offering BC screening to women at very low risk. Respondents indicated that primary care physicians and nurse practitioners should play a leading role in the risk-stratified BC screening approach. This survey identifies health services and policy enhancements that would be needed to support future implementation of a risk-stratified BC screening approach in healthcare systems in Canada and other countries.

Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians’ perspectives

BackgroundAs a result of the public health measures put in place during the COVID-19 pandemic in Canada, many health services, including those for the treatment of eating disorders, were provided at a distance. This study aims to describe the adaptations made in specialized pediatric eating disorder programs in Canada and the impact of these adaptations on health professionals’ experience of providing care.MethodsA mixed-methods design was used to survey healthcare professionals working in specialized pediatric eating disorder programs about adaptations to treatment made during the pandemic and the impact of these adaptations on their experience of providing care. Data were collected between October 2021 and March 2022 using a cross-sectional survey comprising 25 questions and via semi-structured interviews. Quantitative data were summarized using descriptive statistics and qualitative data were interpreted using qualitative content analysis.ResultsEighteen healthcare professionals in Canada completed the online survey, of whom six also participated in the semi-structured interviews. The cross-sectional survey confirmed that, unlike in pre-pandemic times, the majority of participants provided medical care (15/18) and mental health care (17/18) at a distance during the pandemic, with most participants using telephone (17/18) and videoconferencing (17/18). Most (16/18) health professionals indicated that virtual care would continue to be used as a tool in pediatric ED treatment after the pandemic. Participants used a combination of virtual and in-person care, with most reporting weighing patients both in clinic (16/18) and virtually (15/18). Qualitative content analysis generated five themes: (1) responding to increased demand with insufficient resources; (2) adapting to changes in care due to the COVID-19 pandemic; (3) dealing with uncertainty and apprehension; (4) virtual care as an acceptable and useful clinical tool, and (5) optimal conditions and future expectations. Most interview participants (5/6) had globally positive views of virtual care.ConclusionsProviding virtual multidisciplinary treatment for children and adolescents with eating disorders seemed feasible and acceptable to professionals during the pandemic. Moving forward, focusing on health professionals’ perspectives and providing appropriate training in virtual interventions is essential given their central role in successful implementation and continued use of virtual and hybrid care models.

96 Evidence to impact: Developing a workforce of translational research professionals

OBJECTIVES/GOALS: The goal of the Translational Research Program (TRP) at the University of Toronto is to provide structured and adaptive competency-based training around the translation, mobilization, implementation, and commercialization of research for the current and future Canadian healthcare workforce. METHODS/STUDY POPULATION: Guided by the Toronto Translational Framework, the TRP is a two-year hybrid master’s degree program that integrates courses, case-studies, mentorship, and experiential learning to facilitate real-world student-led translational projects. Focusing on skills development and competency-based assessment, the curriculum emphasizes ongoing reflection, interprofessional collaboration, and multidisciplinary problem-solving using human-centered principles. Learners identify problems using contextual inquiry to define unmet needs and frame design requirements. Systematic ideation is used to generate, select, and validate promising concepts for further iterative prototyping and evaluation. RESULTS/ANTICIPATED RESULTS: Throughout the program, students demonstrate a range of collaborative skills and activities around developing, assessing, and implementing new health interventions. Learners apply the Toronto Translational Framework and refine their professional competencies during the final year of the program in a student-led Capstone project. The unconventional combination of a guided framework and a learner-driven curriculum has produced over 120 graduates in a variety of careers within government, industry, clinical settings, and start-ups. The program’s focus on problem-solving and lifelong learning is growing Canada’s translational workforce and advancing translational health science education. DISCUSSION/SIGNIFICANCE: The TRP addresses the need to educate healthcare professionals in Canada about translational research and accelerate the transformation of scientific discoveries into tangible interventions that benefit human health, improve clinical medicine, and enhance patient care.

Contemplating the Impacts of Canadian Healthcare Institutions That Refuse to Provide Medical Assistance in Dying: A Framework-Based Discussion of Potential Health Access Implications.

Following the historic Canadian legislation on medical assistance in dying (MAiD) in 2016, many implementation challenges and ethical quandaries have formed the focus of further scholarly investigation and policy revisions. Of these, conscientious objections held by some healthcare institutions have involved relatively less scrutiny, despite indicating possible hurdles to the universal availability of MAiD services in Canada. In this paper, we contemplate potential accessibility concerns that pertain specifically to service access, with the hope to trigger further systematic research and policy analysis on this frequently overlooked aspect of MAiD implementation. We organize our discussion using two important health access frameworks: Levesque and colleagues' Conceptual Framework for Access to Health and the Provisional Framework for MAiD System Information Needs (Canadian Institute for Health Information). Our discussion is organized along five framework dimensions through which institutional non-participation may generate or exacerbate inequities in MAiD utilization. Considerable overlaps are revealed across framework domains, indicating the complexity of the problem and the need for further investigation. Conscientious dissensions on the part of healthcare institutions form a likely barrier to ethical, equitable, and patient-oriented MAiD service provision. Comprehensive, systematic evidence is urgently needed to understand the nature and scope of resulting impacts. We urge Canadian healthcare professionals, policymakers, ethicists, and legislators to attend to this crucial issue in future research and in policy discussions.

Canadian Health Care Professionals' Familiarity with Chronic Cough Guidelines and Experiences with Diagnosis and Management: A Cross-Sectional Survey.

Educational programs on chronic cough may improve patient care, but little is known about how Canadian physicians manage this common debilitating condition. We aimed to investigate Canadian physicians' perceptions, attitudes, and knowledge of chronic cough. We administered a 10-min anonymous, online, cross-sectional survey to 3321 Canadian physicians in the Leger Opinion Panel who managed adult patients with chronic cough and had been in practice for > 2years. Between July 30 and September 22, 2021, 179 physicians (101 general practitioners [GPs] and 78 specialists [25 allergists, 28 respirologists, and 25 ear/nose/throat specialists]) completed the survey (response rate: 5.4%). In a month, GPs saw a mean of 27 patients with chronic cough, whereas specialists saw 46. About one-third of physicians appropriately identified a duration of > 8weeks as the definition for chronic cough. Many physicians reported not using international chronic cough management guidelines. Patient referrals and care pathways varied considerably, and patients frequently experienced lost to follow-up. While physicians endorsed nasal and inhaled corticosteroids as common treatments for chronic cough, they rarely used other guideline-recommended treatments. Both GPs and specialists expressed high interest in education on chronic cough. This survey of Canadian physicians demonstrates low uptake of recent advances in chronic cough diagnosis, disease categorization, and pharmacologic management. Canadian physicians also report unfamiliarity with guideline-recommended therapies, including centrally acting neuromodulators for refractory or unexplained chronic cough. This data highlights the need for educational programs and collaborative care models on chronic cough in primary and specialist care.

Advancing Pediatric Oncology Rehabilitation: Survey Findings of Health Professionals' Perceptions of Barriers to Care and a Framework for Action.

To explore pediatric oncology referral practices, gather healthcare providers' perspectives of barriers to access and provision of rehabilitation service across Canada, and inform a framework for action to optimize rehabilitation care and inform future research. A cross-sectional survey was conducted with Canadian healthcare professionals (HCPs) working in pediatric oncology. A total of 54 responses were received, and 34 corresponded to HCPs who refer children with cancer to rehabilitation services. Results suggest that approximately 25% of children are referred to rehabilitation services, primarily when the child presents with, or is at risk of, significant functional disability due to surgery. A primary barrier to service provision identified across HCPs included a lack of funding and resources. Medical professionals further identified a lack of specialized pediatric oncology rehabilitation services, whereas rehabilitation professionals identified the lack of pediatric oncology specific space and equipment. Identified themes from open-ended survey questions include the need for (1) dedicated funding and resources, (2) improved access, and (3) the need for specialized pediatric oncology rehabilitation services. Several barriers exist in the Canadian healthcare context that impact the delivery of rehabilitation services for children with cancer. We propose a framework for action to advance clinical care and guide future research.

Cultural Competency Education for Health Care Providers: A Literature Review to Guide Canadian Pharmacy Residency Programs.

The need for cultural competency education has been emphasized for health care professionals in Canada. According to the Canadian Pharmacy Residency Board accreditation standards, pharmacy residents must be able to provide culturally competent care for their patients, further building upon the education received during their undergraduate pharmacy programs. Although these standards exist, guidance for their implementation in pharmacy residency programs is lacking. To review the available literature and develop recommendations for pharmacy residency coordinators and directors on cultural competency training for pharmacy residents. A literature search was conducted to explore the literature concerning cultural competency education for pharmacy residents. The search was expanded to encompass literature involving pharmacy students and medical residents for information that could be applied to pharmacy residents. The initial literature search did not yield any results for cultural competency education provided to pharmacy residents. The expanded search yielded information about methods used to educate pharmacy students and medical residents, including didactic lectures, online modules, experiential learning rotations, seminars, workshops, patient simulations and case discussions, and guest lectures by experts in the field or by patients. It is recommended that interactive education methods be used to train pharmacy residents in cultural competency, to match the experiential learning structure of residency training programs. Methods that could be implemented include offering online modules or readings, arranging for guest speakers, contacting local experts and community members for guidance on creation of a suitable curriculum, and providing immersive rotations focused on diverse populations.

Breast cancer risk prediction models’ adoption by Canadian providers - an in-depth qualitative comparative analysis

The use of risk prediction models (RPMs) for breast cancer (BC) is expected to increase in the near future and is essential for BC risk stratification, which makes it crucial to better understand their adoption. To identify the conditions that impact the use of BC RPMs by Canadian healthcare professionals (HPs), a database of the clinical activities of 176 providers was used to perform statistical bivariate tests and qualitative comparative analysis. The results showed that training in BC genetics is essential for the use of BC RPMs, the proximity of genetic services is a relevant factor for users, and extended clinical experience impedes the use of such models. To increase the use of BC RPMs, two main solutions have emerged: targeting non-users and offering them training and more opportunities for inter-professional collaborations, and targeting experienced HPs with tools that provide them with a significant added value over the risk calculation.

Food for thought, feeding the medical soul: COVID-19 pandemic lessons and reflections

It has been 2½ years since the emergence of a calamitous pandemic driven by a novel coronavirus. With our counterparts across the world, Canadian public health and health care professionals continue to address the impacts of the longest and most unprecedented emergency response in modern memory and

Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey

ABSTRACT Background Continuing professional development is an important means of improving access to effective patient care. Although pain content has increased significantly in prelicensure programs, little is known about how postlicensure health professionals advance or maintain competence in pain management. Aims The aim of this study was to investigate Canadian health professionals’ continuing professional development needs, activities, and preferred modalities for pain management. Methods This study employed a cross-sectional self-report web survey. Results The survey response rate was 57% (230/400). Respondents were primarily nurses (48%), university educated (95%), employed in academic hospital settings (62%), and had ≥11 years postlicensure experience (70%). Most patients (>50%) cared for in an average week presented with pain. Compared to those working in nonacademic settings, clinicians in academic settings reported significantly higher acute pain assessment competence (mean 7.8/10 versus 6.9/10; P < 0.002) and greater access to pain specialist consultants (73% versus 29%; P < 0.0001). Chronic pain assessment competence was not different between groups. Top learning needs included neuropathic pain, musculoskeletal pain, and chronic pain. Recently completed and preferred learning modalities respectively were informal and work-based: reading journal articles (56%, 54%), online independent learning (44%, 53%), and attending hospital rounds (43%, 42%); 17% had not completed any pain learning activities in the past 12 months. Respondents employed in nonacademic settings and nonphysicians were more likely to use pocket cards, mobile apps, and e-mail summaries to improve pain management. Conclusions Canadian postlicensure health professionals require greater access to and participation in interactive and multimodal methods of continuing professional development to facilitate competency in evidence-based pain management.

Spasticity Management Teams, Evaluations, and Tools: A Canadian Cross-Sectional Survey.

The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity. A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database. Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%). Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.

Experiences of LGBTQIA+ migrants with nurses and other healthcare professionals in Canada.

LGBTQIA+ migrants may have experienced discrimination and victimization related to ethnicity, culture, and race over the course of their migration journey, as well as in relation to their sexual orientation, gender identity and expression. Despite the work of some nurses in education, practice, policy, and research, there is a scarcity of literature investigating the experiences of LGBTQIA+ migrants with nurses and healthcare professionals in Canada. By utilizing Gadamerian hermeneutics research methodology with intersectional analysis, this study draws on 16 semi-structured individual interviews with LGBTQIA+ migrants who received care from nurses and other healthcare professionals (NHCPs) in Canada. Two overarching areas of intersecting experiences were identified: (a) challenges and (b) supports. Four interwoven interpretations emerged from experiences of challenges: (a) unwanted visibility, (b) hearing a dead name and being misgendered, (c) cultural stigma, and (d) being asked intrusive hetero-cis-normative questions. Supportive experiences were evident when NHCPs accepted the unique needs of LGBTQIA+ migrants and acted as advocates. Nursing interactions should not be traumatic for LGBTQIA+ migrants, but rather should be encounters where care providers ask relevant nonhetero-cis-normative questions, offer inclusive safe sex education for people's diverse identities, avoid dead naming and misgendering, and provide supportive and affirming care. To support the provision of safe care and mitigate trauma, systemic changes in nursing practice must include the experiences of LGBTQIA+ migrants.

Hands-On Training in a Digital World: A Novel Simulation-Based Virtual Training Program for Placement and Removal of the Subdermal Contraceptive Implant

ObjectiveThe COVID-19 pandemic necessitated a shift from traditional in-person instruction for learning new technical skills to virtual delivery of medical education training. The objectives of this study were to develop and evaluate a virtual simulation-based training program for Canadian health care professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant. MethodsA scientific committee of Canadian family planning experts developed a 2-part virtual training program during the COVID-19 pandemic. Core educational content (part 1) was provided in an asynchronous, self-directed, online format. Part 2 consisted of synchronous, simulation-based training using web conferencing. The HCPs were provided with model arms and placebo applicators; the trainers demonstrated implant insertion and removal techniques, and trainees received individual feedback. All trainees were asked to complete an online evaluation upon completion of the program. ResultsBetween September 22, 2020, and December 31, 2021, 83 trainers conducted 565 virtual training sessions. A total of 3162 HCPs completed part 1 of the training program, of whom 2740 had completed part 2 by December 31, 2021. Participants reported high levels of satisfaction with virtual simulation-based training; 96.5% of respondents (1570/1627) agreed that the virtual format was effective. Additional training prior to inserting the implant in clinical practice was requested by 4.5% of respondents (75/1671). ConclusionVirtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online training for implant use can be scaled, as needed, to reach professionals in remote or underserved locations. This virtual training approach may be appropriate for other technical or minor surgical procedures.