Canadian Medical Research Articles

What Impact Do Medicolegal Complaints Have on Canadian Plastic Surgeons?

Background: Being named in a medicolegal complaint can be a lengthy process filled with uncertainties. Its current impact on Canadian plastic surgeons is unknown. We aim to review the impact of medicolegal complaints and provide advice for surgeons on how to prevent, minimize, and navigate through the medicolegal process. Method: An anonymous survey was sent to registered Royal College of Physicians and Surgeons of Canada certified plastic surgeon members. The survey collected data on surgeon demographics (clinical status, gender, practice type, volume), medicolegal complaint history and outcome, impact on practice, and insights into the process. Surgeons with an inactive practice and invalid contact information were excluded. Results: Out of 456 invited plastic surgeons, 100 responses were included, 73% were male, with an even distribution of practice types and years in practice. Most were Canadian Medical Protective Association (CMPA) members. A significant portion (62%) had been named in a medicolegal action, primarily related to treatment complications (42%) and poor outcomes/disease progression (34%). Factors associated with complaints were greater years in practice (P<.01), and a higher annual volume of operating room cases (P=.02). The duration of the medicolegal process varied, with the majority taking 1-2 years. Respondents predominantly agreed that CMPA provided adequate legal defence (83%, 53/64). However, most surgeons felt the process had a significantly negative impact on their mental health (75%, 48/64). After being involved in a complaint, many surgeons modified their practice pattern by increasing documentation/consent process (45%, 29/64), avoiding certain procedures (22%, 14/64), and avoiding care of high-risk patients (19%, 12/64). Conclusion: Despite legal resolution in favour of the physicians, the results of this survey indicate the medicolegal complaint process has a significant impact on plastic surgeons' practices, time, and mental health. Understanding the medicolegal process and outcome is crucial for risk mitigation.

Gender, Culture and Ethics: Confronting the Complexities of Sex-Selective Abortion in Canada

This article examines the ethical and cultural implications of sex-selective abortion, with a focus on the Indo-Canadian community. Drawing from a 2016 Canadian Medical Association Journal study and expert opinions, including a CBC radio discussion and Dr. Jen Gunter's commentary, it highlights the conflict between reproductive rights and entrenched gender biases. The piece critiques the challenges in legislating against sex-selective abortion, emphasizing the infringement on reproductive rights and privacy, and the need to address deeper societal and cultural factors behind sex selection. The analysis includes cultural perspectives, revealing how societal norms and familial pressures in the Indo-Canadian community impact reproductive decisions, often leading to coercion and loss of choice. The feminist viewpoint links sex-selective abortion to broader issues of gender inequality and misogyny. Conclusively, the article argues for a holistic approach to addressing sex-selective abortion, combining legal, educational, and cultural changes. This approach aims to cultivate a society that values gender equality and respects women’s autonomy, ensuring their decisions are free from coercion and societal prejudice.

Pilot Study on Integrating 3D-Printed Models Into Undergraduate Medical Education for Congenital Heart Disease

BackgroundThis study aimed to assess the feasibility and effectiveness of implementing 3-dimensional (3D)-printed heart models in the education of medical students in a Canadian Medical School. MethodsThree types of 3D-printed models—normal, unrepaired tetralogy of Fallot (TOF), and surgically repaired adult TOF—were provided for medical students in their second year of training after a 30-minute lecture. The repaired TOF model depicted a transannular patch, ventricular septal defect closure, and right ventricular outflow tract resection. Knowledge acquisition was measured by comparing pre- and postsession tests consisting of 5 questions. Learner satisfaction ratings were measured with questionnaires completed after the session. A statistical analysis was performed using the t test. ResultsTwenty-two medical students participated in the study with 20 students submitting complete data for analysis. The students’ score on 5 questions improved after the 3D-printed model session. The average number of correct answers in the test was 2.1 ± 1.0 before the session and 4.3 ± 0.9 after the session (P < 0.001) out of the possible total of 5. Participants reported a high level of satisfaction (86.4%), understanding (86.4%), and usefulness (90.9%) with the incorporation of 3D-printed models in the educational session. ConclusionsAn educational session that integrated 3D-printed anatomic models to teach congenital heart disease anatomy significantly enhanced knowledge outcomes. Learner assessment of the impact of the use of the 3D models was highly favourable.

Postgraduate Training: eLogbook, Entrustable Professional Activities & Co.

The transformation of time-bound and procedure-oriented specialist medical postgraduate training towards a competency-based approach (competency-based medical education, CBME) has been demanded for several years. Many frameworks, like the CANMEDs (Canadian Medical Education Directives for Specialists) describe competencies that should be acquired by each physician. In Germany, the medical council has recently obligated a competency-based postgraduate training. Although the idea of CBME emphasizes the learning process at the working place, CBME has also been criticized to be too theoretical and detached from the clinical working practice. To close this gap, the concept of Entrustable Professional Activities (EPA) has been introduced. An EPA describes concrete clinical tasks that are successively entrusted to the trainee. The decision to entrust a task is supported by the sum of workplace-based assessments.Sustainable implementation of competency-based training requires close collaboration among all involved individuals and institutions. Furthermore, continuous feedback and open dialogue are crucial for identifying challenges and areas for improvement. The success of CBME hinges on the collective effort of all stakeholders to create a framework to enhance specialty training and an overall advancement in the field. This cooperative approach is essential to successfully translate the theoretical foundations of competency-based teaching into clinical practice and ensure high-quality specialty training.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Beyond medical errors: exploring the interpersonal dynamics in physician-patient relationships linked to medico-legal complaints

BackgroundPrevious research suggests that medico-legal complaints often arise from various factors influencing patient dissatisfaction, including medical errors, physician-patient relationships, communication, trust, informed consent, perceived quality of care, and continuity of care. However, these findings are not typically derived from actual patients’ cases. This study aims to identify factors impacting the interpersonal dynamics between physicians and patients using real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints.MethodsWe conducted a retrospective study using data from closed medical regulatory authority complaint cases from the Canadian Medical Protective Association (CMPA) between January 1, 2015, and December 31, 2020. The study population included patients who experienced sepsis and survived, with complaints written by the patients themselves. A multi-stage standardized thematic analysis using Braun and Clarke’s approach was employed. Two researchers independently coded the files to ensure the reliability of the identified codes and themes.ResultsThematic analysis of 50 patient cases revealed four broad themes: (1) Ethics in physician’s work, (2) Quality of care, (3) Communication, and (4) Healthcare system/policy impacting patient satisfaction. Key sub-themes included confidentiality, honesty, patient involvement, perceived negligence, perceived lack of concern, active engagement and empathy, transparency and clarity, informed consent, respect and demeanor, lack of resources, long wait times, and insufficient time with physicians.ConclusionsThis study identifies and categorizes various factors impacting relational issues between physicians and patients, aiming to increase patient satisfaction and reduce medico-legal cases. Improving physicians’ skills in areas such as communication, ethical practices, and patient involvement, as well as addressing systemic problems like long wait times, can enhance the quality of care and reduce medico-legal complaints. Additional training in communication and other skills may help promote stronger relationships between physicians and patients.

Maud L. Menten: Pioneering Physician and Biochemist.

Dr. Maud Leanora Menten, an esteemed Canadian physician, biochemist, and organic chemist, conducted a wide range of valuable biochemistry research for over 40 years, making groundbreaking discoveries about cancer treatments, enzyme kinematics, anesthesia medicine, bacterial toxins, vitamin deficiencies, hematology, and histochemistry. Menten demonstrated intense perseverance and tenacity in her education, defying societal norms to not only become one of the first Canadian women to earn a research-intensive Doctor of Medicine (MD) degree, but to also be one of the first to earn a PhD. Although she was restricted in her work in Canada, she moved to the U.S. and published an estimated 100 research studies over her career. She is most well known for her work with Dr. Leonor Michaelis, with whom she created the Michaelis-Menten equation for the relationship between reaction rate and enzyme-substrate concentration. However, she conducted many other noteworthy research projects, such as using radium bromide for cancer treatment in rats and using electrophoretic mobility to study human hemoglobin, which allowed for a more advanced protein analysis. Her research in hemoglobinpreceded the findings of Linus Pauling by several years, however, he is often the only one credited for this work. After her death, the extent and depth of her work was better understood and appreciated by many, and she was recognized byher alma mater, the University of Toronto, and her former workplace, the University of Pittsburgh. She was also posthumously inducted into the Canadian Medical Hall of Fame.

Canadian Medical Imaging Inventory 2022–2023: Methods

The Canadian Medical Imaging Inventory (CMII) was created in 2015 to track, compare, and map trends over time related to the availability, distribution, technical specifications, and use of advanced imaging equipment in Canada. This is the fourth iteration of the CMII. The CMII collects data about availability and use of CT, MRI, PET-CT, PET-MRI, SPECT, and SPECT-CT through a survey conducted approximately once every 2 years and details the use of strategies for improving appropriate imaging, enhancing system efficiencies, reducing wait lists, and addressing other systemic challenges. Senior medical imaging decision-makers within health ministries and/or regional health authority located in each province and territory were consulted to validate unit and exam counts for consistency. Data are presented using descriptive summaries and graphs of site-level and jurisdiction-level findings. Canada’s ranking among from Organisation for Economic Co-operation and Development countries was reported. The number of units and exams in Canada was projected for the years 2025, 2030, 2035, and 2040 based on the per capita values in 2022–2023 and estimated population growth provided by Statistics Canada.

Canadian Medical Imaging Inventory 2022–2023: CT

CT is an imaging technique that uses X-rays, sensitive radiation detectors, and computer analysis to produce cross-sectional images to detect abnormalities in areas of the body. CT was reported to have the largest demand in oncology (24%), followed by neurology (16.5%) and hepatobiliary (14%) use. Applications for CT continue to expand to new clinical indications and therapeutic areas. Five hundred and sixty CT units were identified by the CMII in its 2022–2023 national survey, with all provinces and territories reporting CT capacity. Most sites are publicly funded hospitals located in urban settings. Canada has an average of 14 CT units per million people. The greatest density of units per million people is in Newfoundland and Labrador, New Brunswick, Yukon, Northwest Territories and Nunavut. Canada is positioned in the bottom 15% of OECD countries in units per million population and the top 45% of OECD countries for average volume of publicly funded CT exams per1,000 population. Approximately 6.4 million publicly funded CT examinations were performed in the 2022–2023 fiscal year. This represents a national average of 160.2 exams per 1,000 people, an increase of 9% since 2015. The average age of CT equipment in Canada is 8.2 years; 29.8% of CT units are 5 years old or newer, 36.7% are 6 to 10 years old, and 33.4% are more than 10 years old. The adoption and use of radiation safety strategies are increasing in Canada. An increasing number of CT units are now equipped with dose-management controls and patient dose recording features. Approximately 30% of CT units are reported to have dual-target imaging. CT units operate an average of 14 hours per day. Approximately 80% of sites reported CT operation on weekends and 40% of sites reported CT operation 24 hours a day.

Canadian Medical Imaging Inventory 2022–2023: MRI

MRI is a noninvasive imaging modality that uses powerful electromagnetic and radiofrequency fields to produce cross-sectional images of the body. MRI is primarily used for neurologic exams (28%), followed by musculoskeletal (23%) and oncology exams (17%). In total, 432 MRI units in 11 jurisdictions were identified by the Canadian Medical Imaging Inventory (CMII) in its 2022 to 2023 national survey. Most sites are publicly funded hospitals located in urban centres. Canada has an average of 10.8 MRI units per million people. The greatest density of units per million people is in Yukon, Quebec, and New Brunswick. Overall, 2,214,157 publicly funded MRI examinations were performed in the 2022–2023 fiscal year. This represents a national average of 55.6 exams per 1,000 people, an increase of 4.3% since 2019– Canada is positioned in the bottom 25% of Organisation for Economic Co-operation and Development (OECD) countries in units per million population and the bottom 50% of OECD countries for average volume of publicly funded MRI exams per 1,000 population. The average age of MRI equipment in Canada is 8.4 years; 62.8% of MRI units are 10 years old or newer, 23.3% are 11 to 15 years old, and 13.9% are more than 15 years old. On average, MRI units operate 15.3 hours per day and 97.4 hours per week. Overall, 76.0% of sites reported MRI operation on weekends and 17% of sites reported operating 24 hours a day.

Canadian Medical Imaging Inventory 2022–2023: Provincial and Territorial Overview

The average age of imaging equipment in Canada has increased for all imaging modalities over the past 2 decades. Most imaging equipment is more than 5 years old, and at least one-third of equipment is more than 10 years old. Investing in new equipment to meet growing demand may not increase imaging capacity without also considering staffing. There is no current international benchmark for the optimal number of imaging units per population, but there is a general assumption that too few units may limit access and increase wait times while too many units may encourage low-value imaging. Canada remains below the average for Organisation for Economic Co-operation and Development (OECD) countries and is positioned in the bottom 30% of OECD countries in units per million population for CT, MRI, and PET-CT. Canada is positioned in the bottom 50% of OECD countries for volume of publicly funded CT, MRI, and PET-CT exams per 1,000 population. Since 2012, both the overall numbers of MRI, PET-CT, and SPECT-CT units and the numbers of MRI, PET-CT, and SPECT-CT units per million people have grown. The number of units for all modalities operating in Canada has increased since 2019–2020, except for SPECT units. In most provinces, the number of SPECT units per population decreased, indicating that population growth outpaced installation. The imaging workforce is under strain. Clearing the backlog of exams deferred during the pandemic has exacerbated existing staffing shortages. New investment in radiology staffing, particularly imaging technologists, is required, including improved recruitment and retention policies. Compared to the prepandemic period, there are now fewer full-time radiology professionals in practice across Canada, with medical physicists experiencing the largest decline per million population. Wait times for medical imaging remain above the recommended maximum wait time in many jurisdictions and are influenced by a variety of factors. The adoption of supportive tools and technologies — such as clinical decision support tools, automated order entry, and AI-driven solutions — can assist the workforce, add value to imaging services, and increase access to medical imaging.

Canadian Medical Imaging Inventory 2022–2023: SPECT and SPECT-CT

SPECT is a nuclear imaging technique that provides 3D information on functional and molecular processes in the body. SPECT has been integrated with CT to combine the imaging strengths of both modalities in SPECT-CT. In total, 331 SPECT-CT units in 10 provinces and 210 SPECT units operating in 9 provinces were identified by the Canadian Medical Imaging Inventory (CMII) in its 2022–2023 national survey. There are no SPECT-CT and SPECT units operating in Yukon, Northwest Territories, and Nunavut. Canada has 8.3 SPECT-CT units per million people and 5.3 SPECT units per million people. The greatest density of units per million people for SPECT-CT is in Newfoundland and Labrador and the greatest density for SPECT are in Alberta and New Brunswick. The combined volume of SPECT-CT and SPECT exams conducted in 2022–2023 has decreased by approximately 37.5% since 2015, which is attributed to the gradual decommissioning of SPECT units and replacement of these technologies with other imaging modalities. SPECT-CT is primarily used for oncology exams, followed by cardiology exams and musculoskeletal exams. SPECT is primarily used for cardiology exams, followed by oncology and musculoskeletal exams. On average, SPECT-CT and SPECT units operate approximately 42 hours per week across jurisdictions in Canada that have capacity.

Canadian Medical Imaging Inventory 2022–2023: The Medical Imaging Team

A workforce comprising medical radiation technologists (MRTs), radiologists, nuclear medicine specialists, medical imaging physicists, and other medical staff is essential for the delivery of medical imaging services. There is wide variation in the numbers of staff in each profession in Canada, ranging from 45 positions located in 6 provinces for medical imaging physicists to 25,000 positions located across all provinces and territories for MRTs. Data from 2022–2023 suggest that the number of full-time staff has not grown at the same pace as the volume of exams. Sufficient staffing is needed to ensure the sustainable operation and delivery of medical imaging services that is supported by investment in the workforce through equitable education and training opportunities. According to a Canadian Medical Imaging Inventory (CMII) report on wait time strategies, staffing shortages may extend wait times and may lead to disruptions in service delivery. Managing the growing demand for imaging services and clearing the backlog of exams deferred during the pandemic has exacerbated existing staffing shortages and contributed to increased workloads and decreased staff well-being. The adoption of supportive tools and technologies — such as clinical decision support tools, automated order entry, and AI-driven solutions — may assist the workforce by creating efficiencies, improving image quality, and increasing access to medical imaging.

Canadian Medical Imaging Inventory 2022–2023: PET-CT and PET-MRI

PET-CT Imaging PET-CT is an advanced imaging technique that combines PET with CT to measure metabolic or biochemical activity in the human body. Sixty PET-CT units in 9 provinces were identified by the Canadian Medical Imaging Inventory (CMII) in its 2022–2023 national survey. All units are located in urban centres. Canada has 1.5 PET-CT units per million people. The greatest density of units per million people is in Quebec, New Brunswick, and Newfoundland and Labrador. Approximately 156,320 publicly funded PET-CT examinations were performed in the 2022–2023 fiscal year. This represents a national average of 3.9 exams per 1,000 people, an increase of 18.2% since 2019– PET-CT was reported to have the largest demand in oncology (66.1%), followed by cardiology (13.2%) and neurology (10.1%). Applications for PET-CT continue to expand to new clinical indications and therapeutic areas. The upfront capital and ongoing operational costs of PET-CT units, as well as the costs of radiopharmaceutical products and equipment, may act as barriers to the rapid adoption of this technology. Canada is positioned in the bottom 25% of Organisation for Economic Co-operation and Development (OECD) countries in units per million population and the bottom 50% of OECD countries for average volume of publicly funded PET-CT exams per 1,000 population. The average age of PET-CT equipment in Canada is 7.2 years; 51.5% of PET-CT units are 5 years old or newer, 21.2% are 6 to 10 years old, and 27.3% are more than 10 years old. Radiotracers are essential in PET imaging. The most commonly used PET-CT radiotracers are for oncology: 91% of sites reported using fluorodeoxyglucose F18 and 31.8% of sites reported using gallium-68 DOTA-TATE. The production of most radiotracers requires the use of a cyclotron.1 Overall, 21.7% of PET-CT sites reported local proximity to a cyclotron, reflecting a disparity in the access to and growing demand for radiotracer supply. PET-MRI Imaging PET-MRI is a technique that combines PET with MRI to produce highly detailed imaging of soft tissues in the human body. PET-MRI is almost exclusively used for research purposes in Canada; therefore, data are limited for this modality. Six PET-MRI units were identified in Canada across 3 provinces, representing a national average of 0.2 units per million people. The average age of PET-MRI equipment in Canada is 6.7 years; 2 units are 6 to 10 years old, and 1 unit is 5 years old.

Strengthening the Chain: A Continuing Medical Education Program for Test Results Follow-up.

The Canadian Medical Protective Association (CMPA)'s Commitment to Change in Test-Results Follow-Up (CTC-TRFU) program aims to provide physicians with resources to enhance their test results follow-up systems for improved patient safety. Framed around the Transtheoretical Model, the program involves a 6-month multimodal educational intervention involving individual and group coaching sessions, action planning, and reflection surveys. This study evaluates the CTC-TRFU program's impact by analyzing survey responses and course documents, focusing on three main outcomes: physicians' perceived barriers and challenges, changes in their confidence and commitment, and implemented practice changes with perceived impact on patient safety. Participants were Canadian physicians who enrolled through the CMPA's open-access registration, with a particular emphasis on those facing challenges in test result follow-up. One hundred two physicians have enrolled in the program. Of these physicians, 34 (33.3%) have successfully completed the program and 28 (27.5%) are actively enrolled. Among the 34 physicians who successfully completed the program, an overwhelming majority of 97.1% (n = 33) expressed their belief that the improvements made to their test follow-up system significantly enhance patient safety within their practice. We observed a significant increase in confidence in the robustness of the physician's follow-up system from program registration to completion (P < .001). Physicians reported catching specific missed test results (55.9%, n = 19), including various laboratory reports and diagnostic imaging like abnormal mammograms or missing MRI/CT results. Physicians who participated in the CTC-TRFU program reported meaningful practice changes, which we believe underscores the value of comprehensive, longitudinal continuing patient safety CPD initiatives. These findings indicate the potential for future studies to explore the long-term impact of similar programs and their scalability.

Evidence of Differential Attainment in Canadian Medical School Admissions: A Scoping Review.

In Canada, many groups (e.g., Black, Indigenous, rural backgrounds) have historically faced and continue to encounter systemic barriers in accessing the medical profession. These barriers often manifest in performance disparities, known as differential attainment, during medical school admissions. This scoping review summarizes the nature and extent of evidence on the association of differential attainment in medical school admissions selection tools and outcomes with applicant social identity in the Canadian context. The authors used Arksey and O'Malley's scoping review framework to summarize research studies published between 2000-2022 with empirical evidence of differential attainment in admissions selection tools and outcomes with respect to a range of applicant social identity categories. The authors recorded whether studies adopted a structuralist and/or intersectional perspective. Ultimately, 15 studies were included in the review. While the evidence on differential attainment associated with social identity in Canadian medical education was heterogeneous, numerous studies highlight differential attainment in the admissions process associated with applicant race and/or ethnicity (6 studies), age (5 studies), gender (4 studies), socioeconomic status (3 studies), geographic location (4 studies), and rural or urban background (5 studies). These attainment differences were reported at 3 phases of the admissions process (invitation to interview, offer of admission, and acceptance of offer), and were driven by several admissions selection tools, including grade point average, Medical College Admission Test score, and interview performance. The review highlights evidence that suggests systemic, structural inequities in admissions systems manifest as differential attainment in Canadian medical school admissions. Based on this evidence, those who identify as Black or Indigenous and those with low socioeconomic status or rural backgrounds were generally more adversely affected. Admission practices must be studied and improved so medical education systems can better avow equality and human dignity and achieve equity goals.

The Use of Silicone Simulators for Bile Duct Anastomosis Education in Medical Conferences for the Purpose of Improving the Canadian Medical Education Directives for Specialists (CanMEDS) Competencies.

This technical report explores the potential of including silicone bile duct simulators for the purpose of completing a bile duct anastomosis (BDA)in medical conferences. The purpose is to target the need for exposure to more surgical skills and to contribute to the Canadian Medical EducationDirectives for Specialists (CanMEDS) requirements, as per the Royal College of Physicians and Surgeons of Canada. Data collection was completed at the 2023 Canadian Conference for the Advancement of Surgical Education (C-CASE) in Montreal, Canada. For several years, the quality improvement feedback received at the end of these conferences suggested a few areas of improvement, one of which was related to the concept of return on investment (ROI). The participants spend a considerable amount of funds to travel to the conferences but feel that the only measurable gains are at a research capacityand thus only relate to two CanMEDS competencies. By leveraging C-CASE, the aim is to enhance students' educational experience during events they already intend to attend. Initially, students participated in a five-part simulation workshop and engaged in a think-aloud protocol (TAO). From there, nine participants were recruited for a focus group to further understand the perceived educational valueand feedback on both the simulators and the conference structure.

Blood far forward: A cross-sectional analysis of prehospital transfusion practices in the Canadian Armed Forces

BackgroundCanadian Armed Forces (CAF) operate in environments that challenge patient care, especially trauma. Military personnel often find themselves in remote settings without conventional healthcare facilities. Treating traumatic injuries, particularly hemorrhagic shock, often necessitates prehospital blood transfusion. This study aims to present an overview of the current CAF prehospital transfusion practices. Furthermore, the study compared current and developing protocols against expert-recommended guidelines. MethodsA cross-sectional survey design was employed to describe and compare CAF prehospital blood transfusion practices and protocols against expert recommendations. Topics included protocols, equipment, and procedures. An online survey targeted medical leadership and providers within CAF, with data collected from August 15 to December 15, 2023. Results were summarized descriptively. This study received approval from the Unity Health Toronto Research Ethics Board (REB 23–087). ResultsUnits and teams with prehospital blood transfusion capabilities were contacted, achieving a 100 % response rate. Within CAF, Canadian Special Operations Forces Command (CANSOFCOM), Mobile Surgical Resuscitation Team (MSRT), and Canadian Medical Emergency Response Team (CMERT) possess these capabilities, established between 2013 and 2018. These programs are crucial for military operations. CAF has access to standard blood components, cold Leuko-Reduced Whole Blood (LrWB), and factor concentrates from Canadian Blood Services (CBS), available for both domestic and international missions given adequate planning and favorable conditions. Key findings indicate high adherence to recommended practices, some variability in the transfusion process, and potential benefits of standardizing prehospital transfusion practices. ConclusionsThis study provided insights into CAF's implementation of prehospital transfusion practices, highlighting high adherence to national expert recommendations and the importance of structured protocols in military prehospital trauma management. Implications of key findingsCAF's approach and adoption of prehospital transfusion protocols lay a strong foundation for managing trauma patients in remote settings and for expanding prehospital transfusion capabilities across CFHS deployed assets. Further research is needed to advance military trauma care by adapting prehospital blood transfusion to dynamic tactical landscapes and evolving technologies.

Lessons Learned From a Retrospective Analysis of Medicolegal Risks for Physicians Treated Adolescents and Young Adults With Medical Complexity

PurposeAdolescent and young adult patients occupy a clinically transitional space between pediatric and adult care. Youth with chronic conditions and special healthcare needs may have trouble accessing and receiving appropriate care in this transition, which may lead to patient safety issues and medicolegal risks for physicians. The objectives of this article were to explore patient safety issues and identify medicolegal risks for physicians. MethodsA national repository was retrospectively searched for medicolegal cases (MLCs) involving complaints from youth. The study included MLCs closed at the Canadian Medical Protective Association between 2013 and 2022 involving youth. The study participants were adolescents and young adults aged ≥ 15 and ≤ 21 years with medical complexity. The frequencies and proportions of patient safety events and medicolegal risks for physicians were calculated by exploring factors that contributed to each incident using established frameworks. ResultsA total of 182 eligible MLCs were identified. Of 206 involved physicians, 55 were psychiatrists. The most common reasons for patient complaints were deficient assessment, diagnostic error, and communication breakdown with the patient and/or family. More than half of the cases were related to a harmful incident. Peer experts reviewed the cases and identified factors such as a deficient assessment, a failure to perform a test or intervention, failure to refer the patient, and insufficient provider knowledge/skill as contributing to the patient safety event. DiscussionThe impact of our findings is to identify gaps in care delivery to youth that can inform practitioners of ways to mitigate the gaps and improve patient care and health outcomes.

Conflicts of Interest of Canadian Medical School Deans: A Cross-Sectional Study.

Medical school deans wield considerable influence over research, clinical and educational missions at their institutions. This study investigates conflict of interest (COI) of Canadian medical school deans. The websites of all 17 Canadian medical schools were searched for any mention of relationships between deans and pharmaceutical or medical device companies. No COIs were discovered for 11 of the deans. Six had COIs, including participating in research funded by pharmaceutical companies and received consulting and speaker fees. A minority of deans had COIs with healthcare industry companies. Whether deans' COIs affect policies at the medical schools they lead should be the subject of further investigation.