Postgraduate Medicine Research Articles

Mentorship Needs for Radiation Oncology Residents: Implications for Programme Design

AimsMentorship during residency guides and supports professional and personal development. Despite this, mentorship programmes within many postgraduate medicine programmes, including radiation oncology, are not standard. The objective of this qualitative study was to carry out a needs assessment to determine the perceived mentorship needs and experiences of radiation oncology residents and faculty. Materials and methodsRadiation oncology residents and faculty from a single university were invited to participate in semi-structured interviews in September 2017. Interviews were audiotaped and transcribed verbatim. An inductive thematic analysis was carried out using NVivo Pro version 11. Data collection occurred until saturation. Codes were derived and a systematic framework was applied to yield emergent themes. Trustworthiness was verified through triangulation and member checking. ResultsTwenty interviews (10 residents and 10 faculty) took place between October and December 2017, at which point thematic saturation was achieved. Four major themes emerged: (i) the perceived experiences of residents and faculty with mentorship, (ii) the evolution of mentorship needs during residency training, (iii) the mechanisms of creating mentorship relationships and (iv) peer mentorship. ConclusionsIn this study, the perceptions of mentorship from the perspective of radiation oncology residents and faculty were explored. Important areas of alignment and discordance were discovered. These insights will inform the development and implementation of a mentorship programme that can be adapted for use by other oncology training programmes.

A PATIENT WITH INFLUENZA A INFECTION AND ANCA-ASSOCIATED VASCULITIS

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitides are rare immune mediated diseases, associated with the crosstalk between an initiating event and a host’s immune response. We present a critically ill patient with ANCA-vasculitis temporarily associated with H1N1 Influenza A infection, with alveolar hemorrhage, acute respiratory distress syndrome (ARDS) and glomerulonephritis, requiring extracorporeal membrane oxygenation (ECMO) support and renal replacement therapy (RRT). CASE PRESENTATION: A 22 years old previously healthy female was admitted to a general hospital complaining about fever and productive cough for five days. On her admission, she presented with hypoxemic respiratory failure and her chest X-ray revealed bilateral opacities, consisted with ARDS. She was intubated, and prone mechanically ventilated in the intensive care unit (ICU) because of refractory hypoxemia. A multiplex polymerase chain reaction (PCR) test revealed H1N1 Influenza A virus in bronchial secretions, and oseltamivir was administered. She also developed hemoptysis and progressive anemia, consistent with alveolar hemorrhage. Moreover, she showed hematuria, while the urine sediment revealed dysmorphic red blood cells and casts. Her serologic testing was positive for cANCA and anti-proteinase 3 (PR3). Therefore, a diagnosis of cANCA vasculitis with respiratory tract and renal involvement was confirmed. The patient was treated with rituximab, cyclophosphamide and intravenous methyl prednisone. She also required veno-venous ECMO support for 12 days due to refractory hypoxemia, and RRT because of acute kidney injury. Her organ dysfunction gradually improved, permitting weaning from ECMO, mechanical ventilation and RRT, and subsequent discharge from ICU fifteen days later and from hospital on day twenty-three DISCUSSION: We presented a case of cANCA vasculitis possibly associated with Influenza A infection. The pathogenesis of this heterogeneous group of diseases remains obscure, while the responsible initiating events might be infectious, genetic of environmental. To our knowledge this is a first case of vasculitis possibly related to a viral infection. Autoimmune responses rarely leading to vasculitis, have been reported as side effects of annual influenza vaccination. The influenza antigen might trigger the autoimmune mechanism by several mechanisms including molecular mimicry: a similarity between host and microbial antigen, leading to activation of autoreactive B and T cells which stimulate the autoimmune response. Our patient responded to the immunosuppressive therapy while the ECMO and CRRT support were used as time-buying strategies. CONCLUSIONS: Influenza A infection might be a precipitating factor for ANCA-associated vasculitis in predisposed patients. Further studies are required to examine the exact role of viral infections in the pathogenesis of autoimmune diseases Reference #1: Duggal T et al. ANCA vasculitis associated with Influenza vaccination.Am J Nephrol 2013;38:174-178 Reference #2: Daoud A et al. Pulmonary Complications of influenza infection: a targeted narrative review. Postgraduate Medicine 2019 DISCLOSURES: No relevant relationships by Apostolos Armaganidis, source=Web Response No relevant relationships by Evangelia Chrysanthopoulou, source=Web Response no disclosure on file for Chryssi Diakaki; No relevant relationships by Frantzeska Frantzeskaki, source=Web Response No relevant relationships by DIMITRIOS KONSTANTONIS, source=Web Response No relevant relationships by Maria Theodorakopoulou, source=Web Response No relevant relationships by Iraklis Tsangaris, source=Web Response

The state of health advocacy training in postgraduate medical education: a scoping review.

Health advocacy is an essential component of postgraduate medical education, and is part of many physician competency frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) roles. There is little consensus about how advocacy should be taught and assessed in the postgraduate context. There are no consolidated guides to assist in the design and implementation of postgraduate health advocacy curricula. This scoping review aims to identify and analyse existing literature pertaining to health advocacy education and assessment in postgraduate medicine. We specifically sought to summarise themes from the literature that may be useful to medical educators to inform further health advocacy curriculum interventions. MEDLINE, Embase and ERIC were searched using MeSH (medical student headings) and non-MeSH search terms. Additional articles were found using forward snowballing. The grey literature search included Google and relevant stakeholder websites, regulatory bodies, physician associations, government agencies and academic institutions. We followed a stepwise scoping review methodology, followed by thematic analysis using an inductive approach. Of the 123 documents reviewed in full, five major themes emerged: (i) conceptions of health advocacy have evolved towards advocating with rather than for patients, communities and populations; (ii) longitudinal curricula were less common but appeared the most promising, often linked to scholarly or policy objectives; (iii) hands-on, immersive opportunities build competence and confidence; (iv) community-identified needs and partnerships are increasingly considered in designing curriculum, and (v) resident-led and motivated programmes appear to engage residents and allow for achievement of stated outcomes. There remain significant challenges to assessment of health advocacy competencies, and assessment tools for macro-level health advocacy were notably absent. There is considerable heterogeneity in the way health advocacy is taught, assessed and incorporated into postgraduate curricula across programmes and disciplines. We consolidated recommendations from the literature to inform further health advocacy curriculum design, implementation and assessment.

Use of the Consultation Letter Rating Scale among Geriatric Medicine Postgraduate Trainees

The implementation of competency-based evaluations increases the emphasis on in-training assessment. The Consultation Letter Rating Scale (CLRS), published by the Royal College of Physicians and Surgeons of Canada, is a tool that assesses written-communication competencies. This multisite project evaluated the tool's validity, reliability, feasibility, and acceptability for use in postgraduate geriatric medicine training. Geriatric medicine trainees provided consultation letters from the 2017-2018 academic year. Geriatricians reviewed a standardized module and completed the tool for all the deidentified letters. The reviewers recorded the time used to complete the tool for each letter and completed a survey on content validity. Trainees completed a survey on the tool's usefulness. Responses were reviewed independently by two authors for thematic content. The unweighted and the weighted κ were used to measure interrater reliability. A total of 10 of 11 (91%) eligible trainees each provided five letters that were reviewed independently by six geriatricians, leading to a total of 300 assessments. A very small portion (4% [N = 12]) of assessments was incomplete. An average of 4.82 minutes (standard deviation = 3.17) was used to complete the tool. There was high interrater agreement for overall scores, with a multiple-rater weighted κ of 83% (95% confidence interval = 76%-89%). The interrater agreement was lower for the individual components. Both raters and trainees found the comments more useful than the numerical ratings. Our results support the use of the CLRS for facilitating feedback on the quality of consult letters to improve written-communication competencies among geriatric medicine trainees. J Am Geriatr Soc 67:2157-2160, 2019.

Implementing and evaluating an e-portfolio for postgraduate family medicine training in the Western Cape, South Africa

BackgroundIn South Africa it is compulsory to submit a satisfactory portfolio of learning to gain entrance to the national exit examination of the College of Family Physicians and to qualify as a family physician. A paper-based portfolio has been implemented thus far and the need for an electronic portfolio (e-portfolio) was identified. The aim of the study was to describe and evaluate the implementation of an e-portfolio for the training of family medicine registrars in the Western Cape province of South Africa.MethodsMixed methods were used. A quasi-experimental study evaluated paper- and e-portfolios from the same 28 registrars in 2015 compared to 2016. Semi-structured interviews were conducted with 11 registrars or supervisors to explore their experiences of using the e-portfolio. Quantitative data was analysed in the Statistical Package for Social Sciences and qualitative data in Atlas.ti.ResultsMost respondents found the e-portfolio easier to use and more accessible. It made progress easier to monitor and provided sufficient evidence of learning. Feedback was made easier and more explicit. There were concerns regarding face-to-face feedback being negatively affected. It was suggested to have a feedback template to further improve feedback. Several aspects were significantly better in the e-portfolio such as feedback on the registrar’s general behaviour, alignment with learning outcomes, less feedback based on hearsay and acknowledgement of the feedback by the registrar. Although not statistically significant, there was an increase in the usage of the e-portfolio, compared to the paper portfolio.ConclusionIn general, the e-portfolio is an improvement on the paper-based portfolio. It is easier to access, more user-friendly and less cumbersome. It makes feedback and monitoring of progress and development of registrars easier and more visible and provides sufficient evidence of learning. Its implementation throughout South Africa is recommended.

Simulation curricular content in postgraduate emergency medicine: A multicentre Delphi study

There is increasing evidence to support integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum exists. Using Delphi methodology, we aimed to identify and establish content validity for adult EM curricular content best suited for simulation-based training, to inform national postgraduate EM training. A national panel of experts in EM simulation iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training. After each round, responses were analyzed. Topics scoring <2/4 were removed and remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics rated ≥ 3.5/4 were considered "core" curricular topics, while those rated 3.0-3.5 were considered "extended" curricular topics. Forty-five experts from 13 Canadian centres participated. Two hundred eighty potential curricular topics, in 29 domains, were generated from a systematic literature review, relevant educational documents and Delphi panellists. Three rounds of surveys were completed before consensus was achieved, with response rates ranging from 93-100%. Twenty-eight topics, in eight domains, reached consensus as "core" curricular topics. Thirty-five additional topics, in 14 domains, reached consensus as "extended" curricular topics. Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.

LO43: Simulation curricular content in postgraduate emergency medicine: a multicenter delphi study

Introduction: There is increasing evidence to support the integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum currently exists. Using Delphi methodology, we aimed to identify and establish content validity evidence for EM curricular content best suited for simulation-based training to inform national postgraduate EM training. Methods: A national panel of experts in EM simulation-related education iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training. After each round, responses were analyzed and topics scoring &amp;lt;2/4 were removed. Remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics that were rated ≥3.5/4 were considered core curricular topics, while those rated 3.0-3.5 were considered extended curricular topics. Results: Forty-four experts from 13 Canadian centres participated. Two hundred and eighty potential curricular topics, in 29 domains, were generated from a systematic review of the literature, analysis of relevant educational documents and a survey of Delphi panelists. Three rounds of Delphi surveys were completed before consensus was achieved, with response rates ranging from 93-100%. Twenty-eight topics, in 8 domains, reached consensus as core curricular topics. An additional 35 topics, in 14 domains, reached consensus as extended curricular topics. Conclusion: Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.

Teaching family medicine online: the experience in Cyprus.

Cyprus has an underdeveloped primary care system.1 As in many other countries in the Middle East, family medicine has never grown from its roots so the first point of contact for patients remains secondary care doctors, with paediatricians and obstetrician-gynaecologists providing care for their respective groups. Yet those physicians working as family doctors are eager to pursue postgraduate training, gain due accreditation and ultimately raise the contribution of family medicine to the nation’s health care. To meet this demand in the region, the University of Nicosia Medical School launched a postgraduate family medicine course in 2014. It already had experience of teaching an international undergraduate course in English in collaboration with St George’s Hospital Medical School in London and an MD programme developed by the University. Setting up an international academic programme with on-the-job training raised unique challenges. The …

Training in pediatric palliative care in Italy: still much to do.

This survey investigated the availability of training programs in pediatric palliative care (PPC) for Italian postgraduates specializing in pediatric medicine. Two questionnaires were developed: (i) a questionnaire addressed to the Directors of Italian postgraduate pediatric medicine programs (n = 37); and (ii) a survey to the postgraduate students in pediatric medicine at the University Hospitals of Padua and Udine (n = 127). 14 directors participated (response rate: 37.8%). In 85.7% of cases (n = 12), lectures on PPC were offered, for a supposed maximum of 90 minutes/year. 116 students responded (response rate: 91%): they stated that, approximately 40 min/year of training on PPC was provided. In total, 37% of responders stated they attended a PPC Service during their training. The majority of responders (68.1%, n = 79) did not feel ready to care for a pediatric patient with life-limiting disease. Although PPC is well-recognized as part of a pediatrician's training, it receives poor attention.

Curriculum for postgraduate medicine in Bhutan’s only medical university: time for need-based curricula, review, development and implementation

The South-East Asian Journal of Medical Education (SEAJME) is the culmination of the SEARAME's vision to bring together medical educationists in the region to promote collaborative efforts toward uplifting the standards of medical education in the region and beyond through dissemination of knowledge. This journal will be the ideal platform to disseminate research findings and stimulate discussion among experts in the field. Open access policy of the journal will facilitate this ideal.From November 2019, The South-East Asian Journal of Medical Education (SEAJME) is indexed in EuroPub

ACEM involvement in a successful African emergency medicine programme.

In the past 5 years Botswana graduated its first home-grown doctors and emergency medicine specialists for the country. The postgraduate emergency medicine specialist training arrangement between Botswana and South Africa was challenging in development, implementation and maintenance. Numerous varied supports from ACEM and its International Emergency Medicine Network were integral to these successes. This article encourages further investment of ACEM grants and scholarships in Africa by describing how ACEM supported significant advances in Botswana emergency medicine.

A Scientometric Study of the “Journal of Postgraduate Medicine”

The subject of this paper is the Scientometric analysis of 601articles printed in “Journal of Postgraduate Medicine” from 2013 to 2017. The study focuses on numerous aspects of the journal like the year wise distribution of articles, annual rate of growth, authorship pattern, authorship productivity,degreeof collaboration, and collaborative index. The maximum number of 153(25.5%) papers were published in 2017 and the minimum of 98(16.3%) in 2013. The study shows that the maximum of 201(33.4%) out of 601articles are contributed by more than four authors and the single author contribution constitute the minimum number 95(15.5%). It is analyzed that minimum AAPP as 2.12 with maximum productivity per author is 0.47 in the year 2017and maximum AAPP as 6.25 with minimum productivity per author is 0.15 within the year 2013. Overall the average degree of collaboration was 0.84, and the average collaborative index was 3.6.The range of AGR is between(31.9%) and (56.1%). This study might fecilitate people who would like to map the scientometric patterns of journals or establishments or individual.

Marking the centenary of the Fellowship of Postgraduate Medicine

The past century has seen major developments in postgraduate medicine. There have also been significant challenges to equitable provision of these medical advances into clinical services and ensuring their safe...

Towards a shared mental model of progressive competence in postgraduate medical education

Many professions have hierarchies and a promotion structure. Postgraduate medicine has a tradition of promoting residents based on time spent in a certain specialty. The military, too, may promote its personnel based on factors other than just merit. Both professions have been criticized for divorcing competence from promotion. While Competency-Based Medical Education (CBME) partly solves this problem in medicine, many models of CBME, including the Canadian one, retain distinct stages of training. We urgently need a shared mental model of what a learner in each stage looks like. Some models have been proposed but fall short.

SMART-TECHNOLOGIES INCORPORATION EXPERIENCE IN THE PREVENTIVE MEDICINE DOCTOR’S TRAINING

The article describes the activities of scientific and pedagogical staff on information technology (IT) in the modernization of the educational process in the context of health reform and the development of public health in Ukraine. The major challenges and obstacles facing the institutions of postgraduate training preventive medicine physicians have been analyzed. By surveying the trainees, the authors have investigated and summarized the needs of post-graduate students for the development of their IT skills in the workplace, methods for enhancing and supporting their motivation, their vision of how their educational institution is committed to meeting their expectations. The article considers the implementation of smart technologies from the standpoint of a practically oriented approach to modernizing of the post-graduate training. The possibilities of smart-technologies to raise cognitive activity, develop communication skills (trainee-trainee, trainee-educator), distribute individual vitagenic and professional experience in the course of training, as well as their role in adapting the training to the needs of a particular audience have been analyzed. The use of the most effective smart-technologies in each of the main stages of the pedagogical process (updating of knowledge and understanding, application of knowledge, analysis, synthesis and evaluation) has been shown. The authors have presented the algorithm for information and analytical competence development in preventive medicine physicians, including smart-technologies application, in terms of performing by pedagogical staff’s different professional roles as a manager, a change agent, a coach etc. It has been proved that one of strategic tasks of postgraduate training of preventive medicine physicians is systemic and complex implementation of smart-technologies into educational process with a perspective informatization of educational environment.

Getting with the times: anarrative review of the literature on group decision making in virtual environments and implications for promotions committees.

IntroductionConcerns around the time and administrative burden of trainee promotion processes have been reported, making virtual meetings an attractive option for promotions committees in undergraduate and postgraduate medicine. However, whether such meetings can uphold the integrity of decision-making processes has yet to be explored. This narrative review aimed to summarize the literature on decision making in virtual teams, discuss ways to improve the effectiveness of virtual teams, and explore their implications for practice.MethodsIn August 2017, the Web of Science platform was searched with the terms ‘decision making’ AND ‘virtual teams’ for articles published within the last 20 years. The search yielded 336 articles, which was narrowed down to a final set of 188 articles. A subset of these, subjectively deemed to be of high-quality and relevant to the work of promotions committees, was included in this review.ResultsVirtual team functioning was explored with respect to team composition and development, idea generation and selection, group memory, and communication. While virtual teams were found to potentially offer a number of key benefits over face-to-face meetings including convenience and scheduling flexibility, inclusion of members at remote sites, and enhanced idea generation and external storage, these benefits must be carefully weighed against potential challenges involving planning and coordination, integration of perspectives, and relational conflict among members, all of which can potentially reduce decision-making quality.DiscussionAvenues to address these issues and maximize the outcomes of virtual promotions meetings are offered in light of the evidence.

MP17: Evaluating the efficacy of the flipped classroom model in postgraduate emergency medicine training

Introduction: As the value of interactive teaching becomes increasingly recognized, the Flipped Classroom model is receiving more attention in the medical education community. In this model, learners master core declarative knowledge through self-learning prior to class and then expand upon this learning with integrative class exercises. The objective of this study was to assess the effectiveness of the new Flipped Classroom in a Canadian Emergency Medicine postgraduate program. Methods: The residents and staff were educated on the new model. An online questionnaire was sent to all EM residents and staff who had participated in the program 9 months after implementation. The survey tool assessed the participants opinions on utility, time-management, effectiveness in learning material, sustainability, collaboration with other members and overall impressions. Resident scores on national preparatory examinations including the Canadian In-Training Examination (CITE) and the American Board of Emergency medicine (ABEM) were compared before and after implementation of the new model. Results: Teaching staff were trained in the Flipped Classroom model and the majority of teaching sessions for the 2016 academic year were carried out using this paradigm. In addition, third year postgraduates received intensive training in the theory and implementation of interactive teaching techniques. A curriculum renewal committee generated objectives for each teaching session and suggested materials for learner pre-reading. Conclusion: Overall, both residents and staff physicians indicated that the flipped classroom model is a better format for EM academic day learning. Residents and staff collaborated more and felt more engaged during academic day. Residents spent more time preparing for the sessions with the new model, while staff spent less time preparing. Paired comparisons of same residency years for test exam scores using Wilcoxon signed-rank test showed an improvement in both CITE and ABEM exam test scores. In conclusion, the new flipped classroom model produced improvements in educational experience, satisfaction, and test examination scores.

Simulation curriculum evaluation and development in a postgraduate emergency medicine programme.

Simulation is a technique that holds the most value when used as an effective learning tool by trained individuals.1 Features of high-fidelity simulation that promote learning include feedback, repetition, individualisation of cases, variation of difficulty and conduction of clinical scenarios in a controlled environment.2 Having regular simulation-based educational (SBE) activities leads to skill acquisition that is transferable to real-life situations.2 Emergency medicine (EM) residents at the University of British Columbia (UBC) in Canada have a variety of SBE opportunities across the four main training sites (Vancouver, New Westminster, Victoria and Kelowna). These include junior and senior resident laboratory-based SBE on a monthly basis, a first-year resident procedural skills training day and in situ simulation conducted in the emergency department at varying intervals depending on the site. While EM residents at UBC have regular time dedicated to participating in SBE, there is variability in the delivery of the education with regard to format, facilitation, case difficulty and debriefing. A 2017 Canadian national survey regarding simulation curricula in postgraduate EM programmes found that 94% of programmes have a simulation curriculum.3 Even so, we do not know exactly what these curricula are made up of. Using Kern’s six-step model for curriculum development,4 we set out to complete step two …

Proficiency testing for admission to the postgraduate family medicine education.

Theory:In Belgium, there are no family medicine admission requirements. A three-phase admission program is developed and implemented by the collaboration of four involved universities.Hypotheses:A pilot testing of phase 2, comprising actual proficiency test, is designed as answer to two research questions: What is the validity and reliability of a multicomponent proficiency test? How does a multicomponent proficiency test proportionate to the final grades of family medicine master candidates?Methods:The population consisted of all last master-phase students applying for family medicine education in Flanders. Students completed a machine-assisted test on knowledge and situational judgment skills and evidence-based medicine appraisal.Results:In total, 322 students completed the test. A regression analysis measuring the relationship between the master grades and the test score revealed an odds ratio of 1.1. Analysis of variance showed that the differences were significant between the upper quartile and the lowest quartile of the test results. A qualitative appraisal of the test results showed that the highest and lowest quartiles of the full-test score included the students who were, respectively, known as “very good” or “very poor.”Conclusion:The test scores were in agreement with the performance and profiling of the participating students. The test succeeded in identifying poor-performing students and in confirming competences of the average- and high-performing students. In the future, retesting will add to the statements on reliability and will refine the test construction. Follow-up will address validity.

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

The ageing population ought to be celebrated as evidence for the efficacy of modern medicine, but the challenge that this demographic shift presents for 21st century healthcare systems, with increasing numbers of people living with multi-morbidity and frailty, cannot be ignored. There is therefore a need to ensure that all healthcare professionals grasp the basic principles of care of older people. In this paper, we make a case for the development of pan-European education and training standards for the field of geriatric medicine. Firstly, the challenges which face the implementation and delivery of geriatric medicine in a systematic way across Europe are described – these include, but are not limited to; variance in geriatric medicine practice across Europe, insecurity of the specialty in some countries and significant heterogeneity in geriatric medicine training programs across Europe. The opportunities for geriatric medicine are then presented and we consider how engendering core geriatric medicine competencies amongst nongeriatricians has potential to bridge existing gaps in service provision across Europe. Finally, we consider how work can proceed to teach sufficient numbers of doctors and health professionals in the core knowledge, skills and attitudes required to do this. To safeguard the future of the specialty across Europe, we contend that there is a need to strive towards harmonisation of post-graduate geriatric medicine training across Europe, through the establishment of pan-European education and training standards in the specialty.