Medical Learners Research Articles

Interventions to improve the well-being of medical learners in Canada: a scoping review.

Background:Medical education affects learner well-being. We explored the breadth and depth of interventions to improve the well-being of medical learners in Canada.Methods:We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to July 11, 2020, using the Arksey–O’Malley, 5-stage, scoping review method. We included interventions to improve well-being across 5 wellness domains (i.e., social, mental, physical, intellectual, occupational) for medical learners in Canada, grouped as undergraduate or graduate nonmedical (i.e., health sciences) students, undergraduate medical students or postgraduate medical students (i.e., residents). We categorized interventions as targeting the individual (learner), program (i.e., in which learners are enrolled) or system (i.e., higher education or health care) levels.Results:Of 1753 studies identified, we included 65 interventions that aimed to improve well-being in 10 202 medical learners, published from 1972 through 2020; 52 (80%) were uncontrolled trials. The median year for intervention implementation was 2010 (range 1971–2018) and the median length was 3 months (range 1 h–48 mo). Most (n = 34, 52%) interventions were implemented with undergraduate medical students. Two interventions included only undergraduate, nonmedical students; none included graduate nonmedical students. Most studies (n = 51, 78%) targeted intellectual well-being, followed by occupational (n = 32, 49%) and social (n = 17, 26%) well-being. Among 19 interventions implemented for individuals, 14 (74%) were for medical students; of the 27 program-level interventions, 17 (63%) were for resident physicians. Most (n = 58, 89%) interventions reported positive well-being outcomes.Interpretation:Many Canadian medical schools address intellectual, occupational and social well-being by targeting interventions at medical learners. Important emphasis on the mental and physical well-being of medical learners in Canada warrants further exploration.

Current Status and Directions of Professional Identity Formation in Medical Education

Professional identity formation (PIF) is an essential concept in professional education. Many scholars have explored conceptual frameworks of PIF and conducted empirical studies to advance an understanding of the construct in medical education. Despite its importance, it is unclear what educational approaches and assessment practices are actually implemented in medical education settings. Therefore, we conducted a literature review of empirical studies reporting educational practices for medical learners’ PIF. We searched the Web of Science database using keywords and chose 37 papers for analysis based on inclusion and exclusion criteria. Thematic analysis was conducted. Most empirical papers (92%) were from North America and Western Europe and used qualitative research methods, including mixed methods (99%). The papers reported the use of reflection activities and elective courses for specific purposes, such as art as an educational activity. Patient and healthcare experiences were also found to be a central theme in medical learners’ PIF. Through an iterative analysis of the key themes that emerged from the PIF studies, we derived the following key concepts and implications: (1) the importance of creating informal and incidental learning environments, (2) ordinary yet authentic patient experiences, (3) a climate of psychosocial safety in a learning environment embracing individual learners’ background and emotional development, and (4) the reconceptualization of PIF education and assessment. In conclusion, research on PIF should be diversified to include various cultural and social contexts. Theoretical frameworks should also be diversified and developed beyond Kegan’s developmental framework to accommodate the nonlinear and dynamic nature of PIF.

INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees.

Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the “INteractive Virtual Expert-led Skills Training” (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities.Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality.Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality.Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.

Incidence of a negative hidden curriculum, cynicism, and burnout within pharmacy resident education: A nationwide survey

IntroductionThe term “hidden curriculum” (HC) is a set of ethical, moral, and value-based teachings communicated in a non-explicit manner. Recent literature has described increasing awareness of the prevalence of the HC and potential negative impact on medical learners; however, this information is lacking in pharmacy resident education. Consequently, we conducted a survey study of United States pharmacy residents to learn their perceptions concerning the HC in pharmacy residency training. MethodsA nationwide survey of pharmacy residents was conducted in June 2019. The survey assessed the following: presence of negative HC (score 0 to 80), cynicism (score 0 to 25), burnout via Maslach Burnout Inventory depersonalization (MBI-D) (range 0 to 30), and emotional exhaustion via Maslach Burnout Inventory emotional exhaustion (MBI-EE) (range 0 to 54). Higher scores represent increased occurrences of each domain. ResultsThe mean HC score was 20 (SD 14.7), mean cynicism score was 9 (SD 5.5), MBI-D was 5.5 (SD 4.5), and MBI-EE was 24.2 (SD 12.4). Of those completing an MBI score, 40.4% (82/203) reported burnout in one area, while 15.8% (32/203) reported burnout in both areas. Residents reporting burnout had higher mean HC and cynicism scores. ConclusionsAwareness to develop and grow cultures that minimize the presence of a negative HC is essential to improve postgraduate pharmacy training.

Understanding the lived experiences of medical learners in a narrative medicine course: a phenomenological study

BackgroundReflection and various approaches to foster reflection have been regarded as an indispensable element in enhancing professional practice across different disciplines. With its inherent potential to engage learners in reflection and improvement, narrative medicine has been adopted in various settings. However, the relevance and effectiveness of reflection remains underexplored in the context of narrative medicine, specifically in regard to the concern about variability of learner acceptance and the way learners really make sense of these reflective activities. This study aimed to explore what medical learners experience through narrative medicine and the meanings they ascribe to the phenomenon of this narrative-based learning.MethodsUsing a transcendental phenomenology approach, twenty medical learners were interviewed about their lived experiences of taking a narrative medicine course during their internal medicine clerkship rotation. Moustakas’ phenomenological analysis procedures were applied to review the interview data.ResultsSix themes were identified: feeling hesitation, seeking guidance, shifting roles in narratives, questioning relationships, experiencing transformation, and requesting a safe learning environment. These themes shaped the essence of the phenomenon and illustrated what and how medical learners set out on a reflective journey in narrative medicine. These findings elucidate fundamental elements for educators to consider how narrative approaches can be effectively used to engage learners in reflective learning and practice.ConclusionAdopting Moustakas’ transcendental phenomenology approach, a better understanding about the lived experiences of medical learners regarding learning in narrative medicine was identified. Learner hesitancy should be tackled with care by educators so as to support learners with strategies that address guidance, relationship, and learning environment. In so doing, medical learners can be facilitated to develop reflective capabilities for professional and personal growth.

A Qualitative Study of the Barriers and Benefits to Resident Education in Ambulatory Surgical Centers

As Ambulatory Surgical Centers (ASCs) become more common in academic medical centers, large hospital systems must determine how to shift resident education from inpatient to outpatient surgical centers. This study aims to define stakeholders' views regarding the integration of surgical residents into ASCs. Long-form interviews lasting 30 to 60 minutes were conducted. Interviews were hand-transcribed and analyzed by qualitative analysis to determine benefits of learning in ASCs for residents, challenges that arise from integrating residents, and recommendations to improve resident incorporation. Interviews were conducted using a video conferencing platform. Residency program directors, attending surgeons, graduate medical learners, and a nursing manager were interviewed. Twenty-one total interviews were conducted, representing ten different departments. Stakeholders agreed that residents benefit from being placed in ASCs because the fast, surgical pace allows the residents to engage in more cases. However, different stakeholders highlighted different challenges, all centered around the notion of inter-stakeholder conflict due to conflicting priorities among residents, attending physicians, and administration. Likewise, recommendations differed by stakeholder group-faculty members sought more defined learning objectives and enhanced communication, whereas residents desired that ambulatory surgical time be more structured. Despite the pressures of rapid case turnover, stakeholders agreed that there are many benefits to resident education in ASCs. Findings related to challenges and recommendations support the need to strengthen communication between stakeholder groups and better plan for resident integration into ASCs.

Challenges for Family Medicine Residents in Attaining the CanMEDS Professional Role: A Thematic Analysis of Preceptor Field Notes.

Among the roles of the competent physician is that of a professional, according to the Canadian Medical Education Directives for Specialists (CanMEDS) framework, which describes the abilities physicians require to effectively meet the health care needs of the people they serve. Through examination of preceptor field notes on resident performance, the authors identified aspects of this role with which family medicine residents struggle. The authors used a structured thematic analysis in this qualitative study to explore the written feedback postgraduate medical learners receive at the University of Toronto Department of Family and Community Medicine. Seventy field notes written between 2015 and 2017 by clinical educators for residents who scored "below expectation" in the CanMEDS professional role were analyzed. From free-text comments, the authors derived inductive codes, amalgamated the codes into themes, and measured the frequency of the occurrence of the codes. The authors then mapped the themes to the key competencies of the CanMEDS professional role. From the field notes, 7 themes emerged that described reasons for poor performance. Lack of collegiality, failure to adhere to standards of practice or legal guidelines, and lack of reflection or self-learning were identified as major issues. Other themes were failure to maintain boundaries, taking actions that could have a negative impact on patient care, failure to maintain patient confidentiality, and failure to engage in self-care. When the themes were mapped to the key competencies in the CanMEDS professional role, most related to the competency "commitment to the profession." This study highlights aspects of professional conduct with which residents struggle and suggests that the way professionalism is taught in residency programs-and at all medical training levels-should be reassessed. Educational interventions that emphasize learners' commitment to the profession could enhance the development of more practitioners who are consummate professionals.

Japanese medical learners\u2019 achievement emotions: Accounting for culture in translating Western medical educational theories and instruments into an asian context

Medical learners’ achievement emotions during educational activities have remained unexamined in Asian cultural contexts. The Medical Emotion Scale (MES) was previously developed to assess achievement emotions experienced by North American medical learners during learning activities. The goal of this study was to create and validate a Japanese version of the Medical Emotion Scale (J-MES). We translated the MES into Japanese and conducted two initial validation studies of the J-MES. In the first pilot study, we asked five, native-Japanese, second-year medical students to assess their emotions with the J-MES during a computer-based clinical reasoning activity. Each participant was then interviewed to assess the clarity and suitability of the items. In a second, larger study, 41 Japanese medical students were recruited to assess the psychometric properties of the J-MES. We also conducted individual, semi-structured interviews with ten of these participants to explore potential cultural features in the achievement emotions of Japanese students. The first pilot study demonstrated that the J-MES descriptions were clear, and that the scale captured an appropriate range of emotions. The second study revealed that the J-MES scale’s profiles and internal structure were largely consistent with control-value theory. The achievement emotions of pride, compassion, and surprise in the J-MES were found to be susceptible to cultural differences between North American and Japanese contexts. Our findings clearly demonstrated the scoring capacity, generalizability, and extrapolability of the J-MES.

733 PTSD and Sleep Disorders in Medical Learners and Healthcare Providers

Abstract Introduction Medical student mental health and wellness has been an increasingly hot topic over the past decade. Much of the research, however, has remained focused more on anxiety and depression and less on other less common but just as detrimental mental health disorders such as PTSD, bipolar disorder, OCD and others. In addition to the more traditional psychological stresses medical students experience, they also experience physical consequences of their training, often with sleep patterns suffering most initially. Methods The questionnaire consists of thirty-five questions, compromising of demographic questions, questions relating to USMLE exams and education, the STOP-Bang Questionnaire, Epworth Sleepiness Scale, Fatigue Severity Scale and PTSD DSM-V Questionnaire. This survey was sent out between March and April of 2020 and was distributed to all medical students and residents with an LSU Health Shreveport email address via RedCAP, an encrypted electronic survey tool. Results A total of 78 participants responded to our survey, with 91.1% identifying as medical students and the rest as residents. 64.1%, identified as female, 34.6% identified as male and 1.3% declined to answer. While 43% of our participants found their educational experience emotionally traumatizing, 75% of them felt that preparing and/or taking USMLE exams was emotionally traumatizing. In regards the portions of our questionnaire that served as sleep disorder screening questions, the average score for the STOP-Bang was 1.48 (SD +/- 1.15) the average score for the ESS was 6.85 (SD +/- 4.72) and the average score for the FSS was 32.04 (SD +/- 11.99). It should be noted that, while the average score of the PTSD screening portion was 20.34 (SD +/- 17.47), 18 participants scored above 38, the minimum score needed to qualify for a PTSD diagnosis. Conclusion These results suggest some correlations that warrant further future study. It is worrisome that while less than half of our participants stated their educational experience as harrowing, 75% stated preparing for and/or taking these required exams was emotionally traumatizing. The possible connections suggested here between USMLE exams and an increase in fatigue, lack of motivation and PTSD symptoms urge us to look more closely at the impact of the USMLE. Support (if any):

809 Innovative electronic sleep mitigation tool for medical trainees

IntroductionThe ACGME (Accreditation Council for Graduate Medical Education) has been advocating for training of medical learners in sleep and fatigue mitigation, in attempt to enhance their wellbeing. While some educational programs include a one-time sleep didactic, prone to being overlooked, there is need for an educational resource which can be accessible to the learners throughout their training span. The trainees’ needs and readiness to learn may vary from time to time, therefore, continued access to educational resources can be very beneficial.MethodsAn electronic tool was created on Coggle, comprising of educational resources and content on the basic tenets of sleep quality, regulation, effects of deprivation and strategies to mitigate these effects. Links to free resources made available by AASM, such as “Choose Sleep,” were also included. The sleep resources were then incorporated in the overall continuum of Graduate Medical Education (GME) resources available to trainees, and was advertised in newsletters, incorporated in orientations (n=324) and wellness sessions (n=254). The GME Institutional Quality of Life data was obtained in 2018–2019 and in 2020 to ascertain baseline and post-intervention measures of wellness, workload and burn-out in trainees.ResultsData collected in 2020, after introduction of Coggle, demonstrated: 1) A 4% increase of residents (n=1041) would rate their workload as “just right.” 2) A 9% increase of residents (n=1040) said their personal health and wellbeing was “very good” and “good.” 3) A 12% decrease of residents (n=1040) said they felt burned out at work. 4) A 5% decrease of residents (n=1037) said they felt they had become more calloused towards people since they first started training.ConclusionThe analysis of learners’ feedback demonstrated that access to sleep training resources on a continuous, on-demand basis improved trainees’ personal health and wellbeing. The positive impact was sustained despite unprecedented stress caused by the COVID-19 pandemic. Future steps include: 1) Moving the electronic tool to a more advanced platform with analytical capabilities. 2) Obtaining longitudinal data to assess the impact of the electronic tool on medical trainees’ sleep parameters. 3) Sharing the electronic tool with other organizations to improve wellbeing of all medical trainees and health professionals.Support (if any):

Combining Science and Humanities to Assess and Promote the Development of Visual‐Spatial Skills in Medical Learners

Skillful observation and interpretation of visual information is key to practicing medicine, not only in specialties that emphasize anatomy but also for effective physical examination and recognizing patients’ emotional states and needs. Since visual analysis appears to depend heavily on tacit knowledge, often it is difficult for learners to develop and educators to teach appropriate skills. Recently, efforts to integrate the humanities into medical training have generated interest in using pedagogical methods adapted from visual art practices to teach medical learners how to analyze and interpret visual information. Such efforts are predicated on the idea that cognitive processes involved in analyzing visual information are to some extent independent of the specific nature of the visual information. As part of our ongoing efforts to develop novel approaches to promote the development of visual analysis skills in medical students, one current goal is to test whether facility in analyzing medically relevant images covaries with facility in analyzing art images and whether pedagogical approaches that are used to teach art students can increase the ability of medical learners to analyze medically relevant images. We developed a custom assessment of visual spatial ability that is based on a simple task in which subjects must identify the two similar images in groups that include two similar images and one dissimilar image. Half of the questions use histological images, while the other half of the questions use images representing fine art or furniture design (Figure 1). Sixteen experienced (3rd and 4th year) medical students completed the assessment in an initial study. The results from this cohort revealed significant, positive correlations between the subjects’: 1) past performance in 1st- and 2nd-year biomedical science courses or anatomy practical examinations and their scores on histology-based questions, 2) self-reported level of previous art instruction and time spent taking the assessment, and 3) time spent taking the assessment and overall score. Thus, as expected, in this group of experienced medical learners, those who previously demonstrated stronger performance in biomedical science courses and specifically on anatomy examinations performed better when analyzing medically relevant images. Previous experience with art instruction increased the time subjects spent taking the study assessment, and taking more time increased overall performance on the assessment. In ongoing studies, the performance of early and advanced medical learners and art students will be compared to test the effects of experience in art- and medical curricula on the ability to analyze similar and disparate images. The early medical learners will be retested after completing the histology discipline in the medical curriculum, and half of those learners also will receive explicit training in evaluation of visual images using methods drawn from art education. This will test directly the effects of 1) experience with the histology curriculum and 2) adding explicit, art-based training on visual analysis skills.

Social Media Usage in Improving English Language Proficiency from the Viewpoint of Medical Students.

BackgroundIn the world today, many people use various communication technologies, like as computer-aided equipment, the internet, and so on. In information communication technologies, people use social media as one of the tools with which to exchange their ideas in everyday communications. Hence, the present study aimed at examining social media usage in improving English language proficiency from the viewpoint of medical students among Ethiopian public university students.MethodsA descriptive survey design was employed since the purpose of this study was to gain detail information about social media usage in improving English language proficiency from the viewpoint of medical students. Hence, the researchers intended to use a quantitative approach. This is because a quantitative methodology helps researchers calculate the results more easily and avoid the difficulties which a qualitative approach might entail.ResultsThe reports obtained from respondents showed that social media (SM) platforms have many advantages in improving medical learners’ English understanding in the process of EFL learning. It positively affects them in improving their level of English proficiency. Gender not only influenced the attitude of students in using social media for learning English but also improved their proficiency in the process of language learning. Even if gender differences exist in nature, significant differences in the viewpoint of male and female students regarding social media (SM) usage in enhancing their English proficiency were not observed. The majority of the respondents strongly agreed that social media use plays a dominant role in improving English proficiency.ConclusionIn the English language learning–teaching process, social media platforms have many advantages in enhancing medical students’ English proficiency in their own learning and teaching practices. Gender did not influence the attitude of students in using social media for learning English or improve their proficiency in the process of language learning.

Medical Student POCUS Peer-to-Peer Teaching: Ready for Mainstream

Background: Point of care ultrasound (POCUS) is changing the face of clinical practice and medical education. Worldwide consensus based on expert opinion has advocated for POCUS teaching in undergraduate medical school curricula. Significant barriers, including lack of available instructors and limited resources, prevents medical learners from acquiring core competencies at most institutions. Here, we describe a peer-to-peer learning POCUS workshop and advocate for the use of this type of training to meet the demands of POCUS learning.
 Methods: A two-day POCUS workshop was held in Toronto, Ontario with twenty-six medical student participants. The workshop was structured according to a graduated model of POCUS skill development, beginning with didactic teaching, then progressing to hands-on peer-to-peer teaching, and finishing with competency evaluation by POCUS experts. Participants completed pre-and post-workshop surveys regarding prior POCUS teaching and exposure, self-reported skill development, and feedback on the workshop itself.
 Results: Of the 20 respondents to the questionnaire, 70% had prior POCUS exposure, with 85% of these individuals having less than 5 hours of prior POCUS education. Eighty-five percent of students reported that the organization of the course allowed them to participate fully, and 95% of participants indicated that peer-to-peer learning was effective.
 Conclusion: These findings suggest that peer-to-peer POCUS teaching is an effective learning method to acquire and consolidate well-established POCUS competencies. This initiative is scalable and could be applied to all learners in various disciplines. As such, we recommend medical schools consider integration of peer-to-peer POCUS teaching into longitudinal clerkship training programs, and transition-to-residency courses.

Supporting the Development of Physician-scientists

In the last decade, there has been a discrepancy between the increasing recognition for research involvement in medical training and the stagnation in the number physician-scientists. Health research funding cutbacks, inadequate mentorship, heavy schedules, and unfamiliarity with scientific methodology are obstacles that limit research interest amongst junior medical learners and cause attrition of promising physician-scientist in training. This article outlines five strategies to promote and facilitate the development of physician-scientists with the understanding that research is integral to clinical excellence. Some of the ways the undergraduate and postgraduate medical curricula can better lend themselves to producing clinicians with the skillset to address clinical uncertainties through an evidence-based approach are: partnerships between healthcare and academia, increasing admission to MD/PhD and Clinical Investigator programs, establishing fundamentals of scientific thinking, long-term research mentorship, facilitating knowledge translation.

Web-Based Radiology Learning Module Design: The Author Perspective

Over recent years, e-learning has become an integral component of radiology education. While demands for innovative, interactive e-learning resources have increased, the availability of viable solutions have not kept pace. As a result, many educators are authoring their own e-learning content. This study describes the six-year experience of faculty clinician educators and residents who participated in this authoring process. From 2014 to 2020, 62 radiology faculty and residents created a total of 89 peer reviewed web-based learning modules. Authors were given instructions and materials to support their design process. Following completion of their module(s), authors were asked to complete an anonymous and voluntary survey on their perspective. Hundred percent of survey respondents reported that they enjoyed creating their module and 97.8% would recommend the experience to others. Reported educational value of authoring a learning module was 4.18 per 5, with 65% of resident authors reporting that they felt more likely to retain the information they learned through authoring a module rather than reading a chapter on the same topic. A total of 77.3% of respondents reported that the experience would make them more likely to teach medical students in the future. With the appropriate resources and support, radiology faculty and residents succeed in authorship of innovative e-learning modules for medical student learners. In addition to enhancing subject matter knowledge and satisfying Accreditation Council for Graduate Medical Education requirements for teaching and scholarly activity, authorship provides mentoring opportunities and cultivates interest in medical student education.

Using Videos to Teach Medical Learners How to Address Common Breastfeeding Problems.

IntroductionThough breast milk is the recommended first food, only 84% of mothers try breastfeeding, and 19% of those babies are supplemented with formula by the second day of life. Mothers often fall short of their breastfeeding goals, which has been traced in part to primary care physicians’ discomfort and lack of confidence in assisting breastfeeding mothers. A video-based educational intervention was developed to enhance learner comfort and confidence in supporting breastfeeding.MethodsPrior to watching the videos, two separate groups of learners (25 primary care residents and 40 medical students) were given two assessments to assess their baseline knowledge and self-perceived comfort and confidence with breastfeeding based on the American Academy of Pediatrics residency breastfeeding curriculum. We gave the learners a checklist to guide their observations while watching the videos. The learners repeated the assessments after watching the videos.ResultsStudents who participated showed a statistically significant increase in breastfeeding knowledge and self-perceived comfort and confidence in assisting mothers with common breastfeeding problems. Additionally, residents increased their knowledge and confidence, but not their comfort with breastfeeding.DiscussionThe videos seem to have been most helpful in assisting learners with confidence with helping breastfeeding mothers and knowledge of breastfeeding. The videos also improved student comfort but were less effective in increasing residents’ comfort as residents generally self-rated their comfort level as high preceding the video curriculum. These videos provide an effective way to begin sensitizing learners to the importance of breastfeeding, common challenges, and potential solutions for new mothers.

Teaching Advocacy Through Community-Based Service Learning: A Scoping Review.

Advocacy has been identified as a core element within the practice of medicine and thus a key component to medical education. However, there are challenges regarding teaching and evaluation of advocacy within medical education. Community-based service learning (CBSL) has emerged as a valuable educational tool to foster knowledge and skills related to advocacy. CBSL is particularly relevant to psychiatry, given the extent of engagement with underserved communities and opportunities to advance learning in these environments. A scoping review was conducted to identify current educational strategies and outcomes related to advocacy training among medical learners in the context of CBSL. Between July and October 2019, the authors searched PsycINFO, MEDLINE, Embase, ERIC, Web of Science, Scopus, and ProQuest for English language literature with no date limits and retrieved 2,813 articles and abstracts; 68 were included in this review. Two reviewers independently screened articles and extracted data. Data were then charted, analyzed, and discussed with the research team. Seven key themes related to approaches to advocacy education were identified: (1) type of community partner; (2) populations served; (3) program participants; (4) program structure; (5) evaluation of learner outcomes; (6) sustainability; and (7) challenges and limitations. This scoping review provides insights into the variety of CBSL-based advocacy program formats and evaluation methods, which is of particular importance to psychiatry. There is heterogeneity in the methodology by which CBSL is implemented and how outcomes are measured. A list of recommendations for future areas of inquiry is provided.

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions.

BackgroundOn March 11, 2020 the World Health Organization declared the novel coronavirus SARS-CoV-2 disease (COVID-19) a global pandemic. We sought to understand impact of COVID-19 on learner wellness at a large tertiary care academic institution to inform the future development of learner wellness interventions during the COVID-19 pandemic.MethodsA cross-sectional, internet-based survey collected quantitative and qualitative data from learners April-June 2020. Descriptive statistics and univariate analyses were reported for quantitative data. Open-ended, qualitative responses were analyzed deductively using thematic analysis.ResultsTwenty percent of enrolled learners in that faculty of medicine (540/2741) participated including undergraduate [Bachelor’s] students (25.7%), graduate [science] students (27.5%), undergraduate medical students (22.8%), and postgraduate resident physicians (23.5%). We found that learner wellness across all stages of training was negatively impacted and the ways in which learners were impacted varied as a result of their program’s response to the COVID-19 pandemic.ConclusionsLearners in health sciences and medical education report worsening well-being because of the programs and the systems in which they function with the added burden of the COVID-19 pandemic. Future interventions would benefit from a holistic framework of learner wellness while engaging in systems thinking to understand how individuals, programs and respective systems intersect. The importance of acknowledging equity, diversity and inclusion, fostering psychological safety and engaging learners as active participants in their journey during a pandemic and beyond are key elements in developing wellness interventions.

Modifying the psychiatric evaluation for older adults: at tool for medical learners

<h3>Introduction</h3> The population of the United States is aging rapidly. The most recent estimate from 2019 data is that 16.3% of the US population is over 65, totaling over 52 million people. In parallel, cases of dementia are increasing, with an expected increase to 13.8 million US citizens affected by 2050. At the same time, there exists a serious shortage of geriatric psychiatrists, thus necessitating that non-psychiatrist physicians possess some basic skills in the assessment of their older patients' mental health needs. Standard medical school curriculum includes limited training on mental health needs of older adults and those with cognitive disorders. A general psychiatric interview as taught to most medical learners may not be adequate for many older adults, particularly if there is an element of cognitive impairment. Also, the addition of family members or other collateral sources may be necessary when interviewing older adults which is distinctly different from the psychiatric interview of younger adults. Because of these needs, we set about to develop an educational tool for students and residents to use when performing a psychiatric evaluation on an older adult. <h3>Methods</h3> We contrasted the elements of the standard psychiatric interview of adult patients with that used by a panel of experienced geriatric psychiatrists to identify unique aspects of the interview that are age specific. Then, we developed an interview guide for older adults with the target audience being a learner, student or resident. While this would likely be used primarily in a psychiatry clerkship or residency, it has broader applicability to any provider addressing mental health needs in an older adult. <h3>Results</h3> After reviewing the interview elements that need to be emphasized when performing a psychiatric evaluation in a geriatric patient, we identified the following areas most likely needing to be adapted in this population. Introductions and identifying the chief complaint – Patients, especially if they have a cognitive concern, may lack insight about the purpose of the appointment. Clarifying roles and the purpose of the visit is appropriate to set the tone. Collaboration with collateral sources (CS) – Patients may present to clinic with a friend or family member who is eager to share their concerns about the patient. Setting ground rules for how these sources will be asked to contribute that information at the beginning of the interview is helpful, to allow for the addition of this vital information while respecting the dignity and autonomy of the patient. Screening for common psychiatric illness – Depression and anxiety, two of the most common psychiatric syndromes experienced by older patients, may present with a different symptom profile in the older adult, particularly in the presence of cognitive impairment. Focusing mood questions on dysphoria, sleep and appetite changes, feelings of guilt and suicidality may increase the depression screening specificity given that loss of interest, decreased attention and low energy are frequently seen in persons with dementia without depression. Likewise, symptoms of generalized anxiety disorder are much more common than OCD or panic disorder in this population. Psychotic symptom screening needs to occur with the recognition that specific delusions are common in dementia, and that visual hallucinations are a core symptom of dementia with Lewy bodies. Cognitive screening with a standardized test, such as the MOCA or MMSE, as well as assessing for functional impairment, is important to evaluate for dementia. Medication and medical history review – While this is an important part of any psychiatric interview, it takes on increased importance in older adults who are at greater risk for adverse events and are more likely to be prescribed inappropriate medications as outlined by the Beers Criteria. Social history – Because older adults are more likely to have significant medical co-morbidities and disabilities, clarification of sources of social support becomes more important. Physical exam – A focused neurologic exam can be exceptionally helpful in the differential diagnosis of dementia sub-types as well as medical etiologies of psychiatric syndromes. Wrap up discussion – Due to the breadth of the geriatric psychiatric evaluation, the effective interview concludes with an interim summary and plan that is shared with the patient and family members. Depending on the initial impression, laboratory testing and neuroimaging may be necessary to refine the differential diagnosis and provide a treatment plan. <h3>Conclusions</h3> The psychiatric evaluation in older adults, particularly those with cognitive disorders, needs to be modified to recognize the specific needs and common disorders of late life. Use of an interview guide that recognizes these differences can help students and residents focus on the specific issues which concern this patient population and better prepare them to assist their future older adult patients. <h3>Funding</h3> Not applicable.

Twelve tips for adapting grand rounds for contemporary demands

Grand rounds have evolved since inception in the early 1900s and subsequently, there has been a continual debate surrounding the best purpose for the time-honoured event. However, the purpose of grand rounds can be broadened to meet the needs of the medical community today, especially at a time where there is great distribution of medical practitioners and learners geographically and events such as COVID-19, which prevent the community from physically gathering. Using the evidence and lessons available from the literature we developed a grand rounds series with goals and objectives suited to our context. In this guide we provide twelve tips covering goal planning, logistics, presentation preparation and presentation delivery in order to illustrate how one could organize an informed grand rounds which is successful contextually.