Canadian Residents Research Articles

Anesthesia environmental sustainability programs-a survey of Canadian department chiefs and residency program directors.

Anesthesia-related activities contribute to operating room waste impacting climate change.The aim of this study was to ascertain 1) the current existence and scope of department and education programs concerned with anesthesia "green" practice; and 2) perceived barriers to environmental sustainability efforts among Canadian anesthesia department chiefs and residency program directors. Association of Canadian University Departments of Anesthesia-affiliated anesthesiology department chiefs (n = 113) were invited to complete an online survey ascertaining current efforts in, and barriers to, environmentally sustainable anesthesia practice. Similarly, Canadian anesthesiology residency program directors (n = 17) were invited to complete an online survey delineating current educational programs on environmental sustainability and identifying interest in, and barriers to, developing a Canada-wide curriculum. The response rates for department chiefs and program directors were 23% (26/113) and 41% (7/17), respectively. Department chiefs indicated that their departments participate in sustainability efforts such as donating medical equipment (65%) and recycling (58%). Despite interest in environmental sustainability, department chiefs identified inadequate funding (72%), lack of a mandate (64%), and inadequate knowledge (60%) as barriers to implementing environmentally sustainable practices. Only 29% of responding Canadian anesthesiology programs include environmental sustainability in their curriculum. Responding residency program directors believe residents would benefit from more teaching on the topic (86%) but identified barriers including a lack of faculty expertise (100%) and time constraints (71%). Respondents (71%) also indicated an interest in developing a Canadian curriculum on the topic. Our results highlight current attitudes, gaps, and barriers to environmentally sustainable anesthesiology practice among departmental and educational leadership. Furthermore, this study identifies potential opportunities to develop cross-Canada collaborative educational programs in this field.

Other diplomacies and Canadianness: Hong Kong-resident Canadians and the Occupy Central and Umbrella Movement protests

ABSTRACT This study examines the diplomatic practices of Hong Kong-resident Canadian nationals responding to the 2014 Occupy Central and Umbrella Movement. One of Hong Kong’s largest “foreign” populations and the second largest concentration of Canadians abroad, this population was mostly Hong Kong-born, dual nationals/residents and class privileged. Using an “other diplomacies” framework, the analysis examines how they represented Canadianness and identified/interpreted foreignness, practices with diplomatic characteristics even when performed by non-state actors. Drawing from 50 semi-structured interviews, the study found that in-betweenness and class shaped diplomatic practices. Interviewees often represented Canadianness as transnational/multi-jurisdictional, embodying liberal democratic values shared with Hong Kong and other jurisdictions/societies. Despite PRC government allegations that foreign forces and powers fomented the protests, most interviewees identified Canadian residents as politically non-foreign in Hong Kong and were broadly pro-protest. However, some disagreed with each other and the Canadian government over the reconciliation of business interests with representations of Canadianness. The findings, although tentative given data limitations, provide a rare glimpse of overseas Canadians’ diplomatic practices during Hong Kong’s ongoing, intensifying cycle of anti-government demonstrations. They suggest potential diplomatic and foreign policy challenges for the Canadian government confronting a rising PRC and underscore the need for more research on the political dimensions of Canadians abroad.

Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): A phenomenological study.

BackgroundEach year, a number of medical students are unmatched in the Canadian Residency Matching Service (CaRMs) match. Blog posts from previous unmatched students suggest that being unmatched is associated with significant stress. However, no studies have explored the collective experiences of candidates who are unmatched. This study seeks to explore the experiences of Canadian students who were unmatched in the first iteration of their CaRMS applications.MethodsThis was an interview-based qualitative study using a phenomenology approach to explore the perspectives of 15 Canadian participants from seven universities who had previously experienced being unmatched between 2011 and 2017 in CaRMS. Telephone interviews were conducted using a semi-structured guide focusing on the experiences in the following domains: the overall unmatched experience; perceived reasons leading to their unmatched status; resources employed; barriers experienced; recommendations; and, their eventual career outcomes. Field notes were analyzed independently by all authors using thematic analysis and authors independently identified major themes. To reconcile divergent impressions and better situate qualitative impressions of our participants, we used publicly available quantitative data from CaRMS to calculate relevant odds ratios.ResultsOur participants universally reported negative emotions, concerns regarding privacy and confidentiality breaches, and stigma faced. Systemic challenges faced by our participants included: lack of information, pressures perceived from undergraduate medical education to apply in the second iteration to specialties that they did not want, and logistical issues such as financial challenges, licensing and scheduling issues. The utility of peer support differed for individual participants, but all those who had support from other unmatched candidates felt that to be useful.ConclusionsOur participants reported significant challenges faced after being unmatched. Based on these experiences, we identified key areas of support needed for candidates through their unmatched journey.

Leadership proficiency in surgery: lessons from the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. We discuss the merits of leadership training for surgical residents and future directions for implementing a leadership curriculum for Canadian residency programs in the competency by design era.

Identifying visible minorities or racialized persons on surveys: can we just ask?

Visible minorities are a group categorized in health research to identify and track inequalities, or to study the impact of racialization. We compared classifications obtained from a commonly used measure (Statistics Canada standard) with those obtained by two direct questions-whether one is a member of a visible minority group and whether one is perceived or treated as a person of colour. A mixed-methods analysis was conducted using data from an English-language online survey (n = 311) and cognitive interviews with a maximum diversity subsample (n = 79). Participants were Canadian residents age 14 and older. Agreement between the single visible minority item and the standard was good (Cohen's Κ = 0.725; 95% CI = 0.629, 0.820). However, participants understood "visible minority" in different and often literal ways, sometimes including those living with visible disabilities or who were visibly transgender or poor. Agreement between the single person of colour item and the standard was very good (Κ = 0.830; 95% CI = 0.747, 0.913). "Person of colour" was more clearly understood to reflect ethnoracial background and may better capture the group likely to be targeted for racism than the Statistics Canada standard. When Indigenous participants who reported being persons of colour were reclassified to reflect the government definition of visible minority as non-Indigenous, this measure had strong agreement with the current federal standard measure (K = 0.851; 95% CI = 0.772, 0.930). A single question on perception or treatment as a person of colour appears to well identify racialized persons and may alternately be recoded to approximate government classification of visible minorities.

National survey of Canadian residents and program directors regarding parental leave during residency.

BackgroundDespite the advantages of having a child as a medical resident, the transition back to residency after parental leave can be challenging. This study is the first to investigate this issue using a nation-wide Canadian sample of both residents and program directors.MethodA questionnaire was developed and made available online. Respondents included 437 female residents, 33 male residents, and 172 residency program directors. The mean length of parental leave was nine months for female residents and six weeks for male residents. Almost all female residents (97.5%) breastfed with an average duration of 12 months. The top challenges reported by residents were feeling guilty for being away from their family, long and unpredictable work hours, sleep deprivation, and finding time to study. When female residents and program directors were matched to both school and program (N = 99 pairs), there was no difference in the total number of challenges reported, but program directors reported offering significantly more accommodations than female residents reported being offered, t(196) = 13.06, p < .001.ResultsOur data indicate there is a need for better communication between resident parents and program directors, as well as clear program-specific parental leave policies, particularly for supporting breastfeeding mothers as they return to work.

Apheresis education in Canadian residency programs: A needs assessment

Indications for therapeutic and donor apheresis continue to increase and expand into new domains of therapy. The level and amount of apheresis education in residency programs remains heterogeneous, which may translate into varying degrees of clinical confidence in providing care. The purpose of this study was to assess Canadian clinicians' perceptions of their apheresis training in order to help demonstrate a need for a concrete apheresis education in residency curricula. A 22-question survey was distributed to Canadian graduates who recently completed training (2013–2017) in the following specialties: hematology, nephrology, transfusion medicine, and hematologic pathology. Questions regarding clinician perception of their training were asked using a Likert scale. Fifty-seven survey responses (32% response rate) were obtained from recent graduates from hematology (29/57, 51%), nephrology (21/57, 37%), hematologic pathology (4/57, 7%) and transfusion medicine (3/57, 5%). Although most respondents (68%) received some form of apheresis exposure during residency, only 23% reported a formal apheresis rotation. Only 40% felt that the amount of time devoted to apheresis education was sufficient, and only four respondents (7%) felt confident providing independent apheresis care at the end of training. Overall, these findings suggest that a common, dedicated apheresis curriculum in these training programs could possibly increase knowledge and competence of trainees, and provide a more solid foundation in apheresis for future practice.

Taking the Leap Toward Cost-Conscious Education in Obstetrics and Gynaecology: A Preliminary Randomized Controlled Trial.

Residents have a professional obligation with respect to the stewardship of health care resources, yet there is a paucity of research on how to improve residents' cost-awareness. Rising health care expenditures highlight a critical need to improve education related to this competency. This study aimed to test if an educational module can teach residents to make cost-conscious decisions and reduce health care spending. All Canadian obstetrics and gynaecology residents in 2017 were eligible to participate in this randomized controlled trial. The study was administered online via REDCap. Interested residents were enrolled, stratified by level of training, and block randomized. Residents completed a survey to determine their management of 4 obstetrical scenarios. The intervention group reviewed an educational module on cost-effective ordering prior to completing the survey; the control group was given the option to review the module afterward. The primary outcome was mean total expenditures, compared between the 2 groups using the t test. Eighty-five residents were enrolled between August and November 2017, and 63 residents from 13 Canadian residency programs completed the study requirements (33 control and 30 intervention). Mean total expenditure was CAD$291.03 (95% CI 259.38-322.68) versus CAD$192.98 (95% CI 170.67-215.29) for the control and intervention groups, respectively. These figures corresponded to a 33.69% or CAD$98.05 reduction in total expenditures (P=0.0001). This educational module decreased expenditures by Canadian obstetrics and gynaecology residents managing hypothetical obstetrical cases. This introduces a potential curriculum innovation to improve resident education in judicious use of health care resources.

Does lacking a car put the brakes on activity participation? Private vehicle access and access to opportunities among low-income adults

Abstract Private vehicle travel entails costs to society. However, in a world designed around the automobile, adults who lack access to a vehicle for economic reasons may experience a significant handicap due to constrained mobility and accessibility. This paper examines whether private vehicle access is associated with the quantity and quality of out-of-home activities in which low-income individuals participate. We use pooled data from multiple time use surveys drawn from the Netherlands, Canada, Spain, and the United Kingdom, and employ Cragg two-part hurdle modeling to determine whether there is an association between household vehicle access and participation in twelve out-of-home activity types. As a robustness check, we also estimate multiple discrete continuous extreme value (MDCEV) models. Further, we examine travel time by mode for those with and without vehicles. Finally, we use American Time Use Survey data and fixed-effects panel models to determine the subjective well-being that is associated with our out-of-home activity types. A lack of private vehicle access is associated with significantly less frequent out-of-home activity participation, both in the aggregate and for seven of the twelve individual activities. Moreover, the activities most likely to be foregone are generally associated with high subjective well-being, suggesting that constrained mobility comes with significant emotional costs. We find a greater “activity penalty” for rural residents and for Canadian residents without vehicle access; urbanites without vehicles in the U.K. are the only geographic group which do not exhibit an activity penalty. Finally, respondents with vehicle access spend more total time traveling, although those without private vehicles partially offset spending less time in them with higher use of alternative modes. Overall, the findings suggest that the lack of a private vehicle is deleterious for quality of life, raising troubling questions about inequity possibly arising when people are denied access to vehicles for economic reasons.

P023: Development of a Canadian Global Health Emergency Medicine (GHEM) Certificate Program based on established best practices

Innovation Concept: Global health fieldwork is valuable for Canadian residents, but is often trainee-organized, short-term, unsupervised, and lacking in preparation and debriefing. In contrast, we have developed a Certificate Program which will be offered to University of Toronto (UofT) emergency medicine (EM) trainees in their final year of residency. This 6-month Program will complement the Transition to Practice stage for residents interested in becoming leaders in GHEM. Methods: We completed a multi-phase needs assessment to inform the structure and content of a GHEM Certificate Program. Phase 1 consisted of 9 interviews with Program Directors (PDs), Assistant PDs, and past fellows from existing GH fellowships in Canada and USA to understand program structure, curriculum, fieldwork and funding. In Phase 2 we interviewed 4 PDs and fellows from UofT fellowship programs to understand local administrative structures. In Phase 3 we collected feedback from 5 UofT residents and 7 faculty with experience in global health to assess interest in a local GHEM Program. All interview data was reviewed and best practices and lessons learned from key stakeholders were summarized into a proposed outline for a 6-month GHEM Certificate Program. Curriculum, Tool, or Material: The Program will comprise of 1) 3 months of preparatory work in Toronto followed by 2) 3 months of fieldwork in Addis Ababa, Ethiopia. Fieldwork will coincide with activities under the Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). The GHEM trainee's work will support TAAAC-EM activities. Preparatory months will include training in specific competencies (POCUS, teaching, tropical medicine, QI) and meetings between the trainee and a UofT mentor to design an academic project. During fieldwork, the trainee will do EM teaching (75% of time) and complete their academic project (25% of time). A UofT supervisor will accompany, orient and supervise the trainee for their first 2 weeks in Addis. Throughout fieldwork, the trainee will be required to debrief with their UofT mentor weekly for academic and clinical mentoring. One AAU faculty member will be identified as a local supervisor and will participate in all evaluations of the trainee during fieldwork. Conclusion: This Program will launch with a call for applications in July 2021, expecting the first trainee to complete the Program in 2022-23. We anticipate that this Program will increase the number of Canadian EM trainees committed to global health projects and partnerships throughout their career.

MP18: Pre-departure and post-elective requirements for global health electives: a survey of Canadian Royal College emergency medicine programs

Introduction: Participation in Global Health (GH) electives can improve resourcefulness, cultural and ethical insight, and personal development. Risks to trainees, hosts and institutions may be minimized through pre-departure and post-elective training. In 2016 such training was mandatory in only 3 Canadian residency programs, however there is no published data specific to Canadian Emergency Medicine (EM) programs. This study sought to identify current GH elective requirements and related perceived gaps among Royal College EM programs. Methods: We conducted two cross-sectional surveys in 2019 (one each for Royal College EM PDs and residents) via email regarding training requirements for GH electives. Additionally, a survey link was distributed in the CAEP EM resident newsletter. We also contacted university PGME and/or global health offices to understand and collate university-wide requirements and resources. Results: Nine PDs responded, with 78% reporting having 1-5 residents participate in GH electives yearly. Many PDs were unsure of the requirements surrounding GH electives; two reported that pre-departure training was required, while none reported requiring post-departure debriefs. Overall, 67% of PDs felt that their residents were moderately prepared for GH electives and 33% felt they were unprepared to some degree. Thirty-three percent believed that improvements should be made to either pre-departure training or both pre- and post-departure training, while 56% were unsure if improvements were needed. Forty-seven out of an estimated 380 residents responded. Thirty-five percent of residents had completed a GH elective during residency. Of residents who participated in a GH elective, only one (6%) reported feeling very prepared; 18 residents (43%) reported there was a need to improve trainings. Residents reported a number of challenges during electives (lack of resources, inadequate supervision, safety issues) and identified priority topics for training. Conclusion: Although EM residents are participating in GH electives, the majority of EM residency programs do not require pre- or post-departure training. Some PDs and residents report varying levels of preparedness, and residents acknowledge a variety of challenges during GH electives. This information can be used to inform pre-departure/post-elective GH training or to encourage EM residents to access university-wide training.

MP26: The simulated newsroom: a novel educational intervention to teach advocacy skills to resident physicians

Innovation Concept: Advocacy is a key competency of Canadian residency education, yet physicians seldom engage with supra-clinical advocacy efforts upon completion of training. Emergency medicine (EM) residency training may not equip graduates with the knowledge and skills required to engage as physician-advocates in their communities. Focused writing workshops may increase the confidence and ability of EM trainees to engage as health advocates. Methods: Following a literature review, simulated newsroom workshops were developed by two EM physicians with graduate-level journalism training and workplace experience. Participants were invited to participate in an audio-recorded focus-group and to submit their opinion editorial. Twelve participants registered for the workshops and six attended both sessions and the focus group; four submitted written work. Focus group transcripts and written work were qualitatively analysed to understand acceptability, feasibility, and how students might engage as future health advocates. Curriculum, Tool, or Material: The simulated newsroom consisted of participants acting as journalists and the expert facilitator acting as a news editor. The first workshop provided a framework for news judgement in a didactic session, followed by interactive exercises including: prioritization of news pitches, a simulated editorial meeting, and analysis of published news articles. The participants then drafted their own pitches for in situ feedback from peers and facilitators. Two-weeks later, participants brought their completed articles for peer and expert review before submitting their final article. Conclusion: The innovation bolstered resident physician confidence in advocacy through the popular press, and provided demonstrable skills in opinion writing. Participants felt challenged to develop compelling narratives and differentiate this form of advocacy communication from academic writing or prior media training. Participants valued the workshop as a voluntary component of residency education led by peer experts. Through their writing, residents demonstrated an understanding of structural factors that impact patient health and health systems. Future engagement as physician advocates may be tempered by fears of professional repercussions for public engagement; the impact of physician advocacy on population health outcomes is not yet known.

Analysis of factors affecting Canadian medical students' success in the residency match.

BackgroundIn North America, there is limited data to support deliberate application strategies for post-graduate residency training. There is significant interest in determining what factors play a role in Canadian medical graduate (CMG) matching to their first choice discipline and heightened concern about the number of students going unmatched altogether.MethodsWe analyzed matching outcomes of CMGs based on seven years (2013-2019) of residency application data (n= 13,499) from the Canadian Residency Matching Service (CaRMS) database using descriptive and binary logistic regression modeling techniques.ResultsThe sample was 54% female, with 60% between the ages of 26 and 29, and 60% attended medical schools in Ontario. Applicants who received more rankings from residency programs were more likely (OR = 1.185, p < 0.001) to match. Higher research activities (OR = 0.985, p < 0.001) and number of applications submitted (OR = 0.920, p < 0.001) were associated with a reduced likelihood of matching. Number of volunteer activities and self-report publications did not significantly affect matching. Being male (OR = 0.799, p < 0.05) aged <25 (OR = 0.756, p < 0.05), and from Eastern (OR = 0.497, p < 0.01), or Western (OR = 0.450, p < 0.001) Canadian medical schools were predictors of remaining unmatched.ConclusionsThis study identified several significant associations of demographic and application factors that affected matching outcomes. The results will help to better inform medical student application strategies and highlight possible biases in the selection process.

Fundamental trends within falling match rates: Insights from the past decade of Canadian residency matching data.

BackgroundThe number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over the last decade. To identify long-term solutions to this problem, an understanding of the factors contributing to these rising unmatched rates is critical.MethodsUsing match and electives data from 2009-2019, we employed machine learning algorithms to identify three clusters of disciplines with distinct trends in match and electives behaviours. We assessed the relationships between unmatched rates, competitiveness, rates of parallel planning, and program selection practices at a discipline level.ResultsAcross Canada, growth in CMGs has outpaced growth in residency seats, narrowing the seat-to-applicant ratio. Yet not all disciplines have been affected equally: a subset of surgical disciplines experienced a consistent decline in residency seats over time. Applicants to these disciplines are also at disproportionate risk of becoming unmatched, and this is associated with lower rates of parallel planning as quantified through clinical electives and match applications. This, in turn, is associated with the program selection practices of these disciplines.ConclusionLong-term solutions to the unmatched CMG crisis require more nuance than indiscriminately increasing residency seats and should consider cluster specific match ratios as well as regulations around clinical electives and program selection practices.

Does exposure to anatomy education in medical school affect surgical residency applications? An analysis of Canadian residency match data

The time dedicated to teaching gross anatomy, including cadaveric dissection, has been decreasing in North American medical schools. The impact of this trend on surgical residency applications is unknown. We sought to identify trends in surgical residency applications in Canada and to determine if medical schools with more gross anatomy instruction and mandatory cadaveric dissection produced more applicants ranking surgical residency programs as their first choice. Canadian Resident Matching Service (CaRMS) data from 1997 to 2016 were analyzed. A questionnaire was distributed to Canadian medical schools requesting current and historic information on their anatomy curricula and the number of hours of anatomy instruction. The survey response rate was 35% (6 of the 17 Canadian medical schools responded); partial data were available for 16 (94%) of the 17 Canadian medical schools. A total of 4.3% of graduating students ranked general surgery as their first choice in the CaRMS match and 17.2% ranked any surgical program first. Over time, the percentage of graduating students who ranked surgical programs as their first choice decreased (p < 0.001). Three schools were significantly more likely than the others to produce graduates ranking general surgery as their first choice. Between 2012 and 2016 the percentage of graduating students ranking surgical programs first was significantly higher (2.2%, p = 0.024) in schools with mandatory cadaver dissection. There was no correlation between the number of hours of gross anatomy instruction and the percentage of graduates ranking any surgical program or a general surgical program first. The number of applications to surgical programs has decreased in Canada over the past 20 years. Certain schools are more likely than others to produce graduates ranking general surgery as their first choice. Programs with mandatory cadaver dissection produced more graduates favouring surgical programs.

Proportion of female recipients of resident-selected awards across Canada from 2000 to 2018: a retrospective observational study.

Female physicians have been shown to receive fewer awards from medical societies than their male colleagues. We examined the sex distribution of recipients of Canadian residency association awards. We conducted a retrospective observational study of the sex of staff and resident physician recipients of resident-selected awards from provincial and national residency associations using data from 2000-2018. We classified awards into professionalism, advocacy and wellness awards, and education and teaching awards based on award names and descriptions, and compared the proportion of male and female recipients in these categories. We identified 314 recipients of staff physician awards and 129 recipients of resident physician awards. Male staff and resident physicians had higher odds of receiving awards than their female counterparts (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.13-1.89 and OR 1.70, 95% CI 1.18-2.46, respectively). There was a reduction in the odds of male residents' receiving an award over the study period (OR 0.94, 95% CI 0.90-0.98). Male physicians had higher odds of receiving education and teaching awards than female physicians as staff but not as residents (OR 3.21, 95% CI 1.72-5.95 and OR 1.96, 95% CI 0.84-4.60, respectively). Male staff and resident physicians in Canada had higher odds of receiving awards from provincial and national residency associations between 2000 and 2018 than their female counterparts. Given this disparity, it would be prudent for organizations that distribute awards to physicians, residents and medical students to examine their nomination criteria and processes for potential bias.

Knowledge and confidence level of Canadian urology residents toward biostatistics: A national survey.

Adequate knowledge of biostatistics is essential for healthcare providers to stay up to date with medical advances and maintain an evidence-based practice. However, training in clinical research in Canadian residency programs varies considerably. Our study aimed to determine Canadian urology trainees' knowledge of biostatistics and interpretation of the scientific literature. We conducted a national survey of all Canadian urology residents and fellows, which assessed experiences with biostatistics, self-reported confidence with statistical questions, and knowledge of biostatistical concepts. Out of 201 urology trainees, 74 (36.8%) responded to the survey. The majority of respondents disagreed or strongly disagreed with the fact that they had sufficient training in biostatistics in medical school (67.6%) or that their current knowledge was sufficient for the rest of their career (66.1%). If given the chance, 82.3% of respondents would like to learn more about biostatistics. About half of respondents were able to correctly identify ordinal variables (51.5%), discrete variables (52.9%), or interpret adjusted odds ratios (50.0%). Despite senior residents reporting more confidence on biostatistical questions, our results did not demonstrate significant differences in overall knowledge according to level of training or experience with biostatistics. Our results identified important knowledge gaps among current Canadian urology trainees. Most trainees do not believe they have sufficient training in biostatistics. Knowledge of basic statistical concepts was lower than expected and did not significantly differ according to level of training. Our results highlight the need for structured, dedicated training in biostatistics for urology trainees within the new Competence by Design teaching framework.

Resident physician burnout: insights from a Canadian multispecialty survey

BackgroundBurnout results from chronic exposure to stress: comprising emotional exhaustion (EE), depersonalisation (DP) and a reduced sense of personal achievement (PA). Only a few studies have examined burnout in Canadian...

Solid organ donation after death in the United States: Data-driven messaging to encourage potential donors.

US deceased donor solid organ transplantation (dd-SOT) depends upon an individual's/family's altruistic willingness to donate organs after death; however, there is a shortage of deceased organ donors in the United States. Informing individuals of their own lifetime risk of needing dd-SOT could reframe the decision-making around organ donation after death. Using United Network for Organ Sharing (UNOS) data (2007-2016), this cross-sectional study identified (1) deceased organ donors, (2) individuals waitlisted for dd-SOT (liver, kidney, pancreas, heart, lung, intestine), and (3) dd-SOT recipients. Using US population projections, life tables, and mortality estimates, we quantified probabilities (Pr) of (1) becoming deceased organ donors, (2) needing dd-SOT, and (3) receiving dd-SOT. Lifetime Pr (per 100000 US population) for males and females of becoming deceased organ donors were 212 and 146, respectively, and of needing dd-SOT were 1323 and 803, respectively. Lifetime Pr of receiving dd-SOT was 50% for males, 48% for females. Over a lifetime, males were 6.2 and females 5.5 times more likely to need dd-SOT than to become deceased organ donors. Organ donation is traditionally contextualized in terms of charity toward others. Our analyses yield a new tool, in the form of quantifying an individual's own likelihood of needing dd-SOT, which may assist with reframing motivations toward deceased donor organ donation.

Survey of Canadian urology programs: Which aspects of the Canadian Residency Matching Service (CaRMS) application are the most important?

For medical students, determining which aspects of the Canadian Residency Matching Service (CaRMS) application are the most important when applying to residency programs can be challenging. Due to the lack of current and reliable information on the selection criteria of Canadian urology residency programs, we surveyed each program about which criteria are the most important when selecting future residents in order to provide medical students with more transparency and programs with a better idea of how their criteria compare to those of others. An electronic survey was sent to all 13 Canadian urology residency programs (both program directors and selection committee members). It asked respondents to rate each aspect of the application on a five-point Likert scale. Following a 100% response rate from program directors, the same survey was sent to selection committee members. A numeric mean score was calculated for each individual aspect surveyed to create an overall rank list of the components. Independent samples t-tests (two groups) were used to compare the scores of program directors vs. program committee members and of francophone programs vs. anglophone programs. Forty-three urologists involved in the application process answered. The three most important aspects were rotation performance at the respondent's institution (4.95±0.21), quality of reference letters from a urologist (4.60±0.62), and interview performance (4.49±0.63). There were no statistically significant differences between program directors and committee members for mean score of any aspect surveyed. Compared to anglophone programs, francophone programs gave statistically more significant importance to French proficiency (p<0.001) and pre-clinical academic performance (p=0.0272), while giving less importance to English proficiency (p<0.001). Canadian urology residency programs are similar in that they rank "clinical performance during a rotation at their school" as the most important selection criteria when choosing a future urology trainee. Graduate degrees, career plans, and reference letters from non-urologists have less impact when choosing future urology residents. Francophone schools and anglophone schools differ in the importance of language proficiency and preclinical grades as selection criteria for urology residency. This study will provide future urology applicants with more information and transparency when applying to urology programs in Canada and be of use to urology residency programs that must now publish their selection criteria.