Training In Canada Research Articles

Are early career family physicians prepared for practice in Canada? A qualitative study

BackgroundIn Canada, the College of Family Physicians of Canada (CFPC) introduced Competency Based Medical Education to prepare and train family medicine residents to be competent to enter and adapt to the independent practice of comprehensive family medicine. Despite its implementation, the scope of practice is narrowing. This study aims to understand the degree to which early career Family Physicians (FPs) are prepared for independent practice.MethodA qualitative design was used for this study. A survey and focus groups were conducted with early-career FPs who completed residency training in Canada. The survey and focus groups examined the degree of preparedness of early career FPs in relation to 37 core professional activities identified by the CFPC’s Residency Training Profile. Descriptive statistics and qualitative content analysis were conducted.ResultsSeventy-five participants from across Canada participated in the survey, and 59 participated in the focus groups. Early career FPs reported being well prepared to provide continuous and coordinated care for patients with common presentations and deliver various services to different populations. FPs were also well prepared to manage the electronic medical record, participate in team-based care, provide regular and after-hours coverage, and assume leadership and teaching roles. However, FPs reported being less prepared for virtual care, business management, providing culturally safe care, delivering specific services in emergency care hospitals, obstetrics, self-care, engaging with the local communities, and conducting research activities.ConclusionsEarly career FPs do not feel fully prepared for practice in all 37 core activities in the Residency Training Profile. As part of the introduction of the three-year program by the CFPC, the postgraduate family medicine training should consider providing more exposure to learning opportunities and developing curricula in the areas where FPs are unprepared for practice. These changes could facilitate the production of a FP workforce better prepared to manage the dynamic and complex challenges and dilemmas faced in independent practice.

Applicant and Match Trends to Geriatric-Focused Postgraduate Medical Training in Canada: A Descriptive Analysis.

Physicians with postgraduate training in caring for older adults-geriatricians, geriatric psychiatrists, and Care of the Elderly family physicians (FM-COE)-have expertise in managing complex care needs. Deficits in the geriatric-focused physician workforce coupled with the aging demographic necessitate an increase in training and clinical positions. Descriptive analyses of data from established matching systems have not occurred to understand the preferences and outcomes of applicants to geriatric-focused postgraduate training. This study describes applicant and match trends for geriatric-focused postgraduate training in Canada. In this retrospective cohort study, data from the Canadian Resident Matching Service and FM-COE program directors were analysed to examine program quotas, applicants' preferences, and match outcomes by medical school and over time. Based on their first-choice specialty ranking, applicants to geriatric medicine and FM-COE signalled a preference to pursue these programs and tended to match successfully. The proportion of unfilled training positions has increased in recent years, and the number of applicants has not increased consistently over time. There is a disparity between applicants to geriatric-focused training and the health human resources to meet population-level needs. Garnering interest among medical trainees is essential to address access and equity gaps.

Mentorship Programs in Residency: A Scoping Review.

Mentorship during residency training is correlated with improved outcomes. Many residency programs have implemented formal mentorship programs; however, reported data for these programs have not been previously synthesized. Thus, existing programs may fall short on delivering effective mentorship. To synthesize current literature on formal mentorship programs in residency training in Canada and the United States, including program structure, outcomes, and evaluation. In December 2019, the authors performed a scoping review of the literature in Ovid MEDLINE and Embase. The search strategy included keywords relevant to mentorship and residency training. Eligibility criteria included any study describing a formal mentorship program for resident physicians within Canada or the United States. Data from each study were extracted in parallel by 2 team members and reconciled. A total of 6567 articles were identified through the database search, and 55 studies met inclusion criteria and underwent data extraction and analysis. Though reported program characteristics were heterogenous, programs most commonly assigned a staff physician mentor to a resident mentee with meetings occurring every 3 to 6 months. The most common evaluation strategy was a satisfaction survey at a single time point. Few studies performed qualitative evaluations or used evaluation tools appropriate to the stated objectives. Analysis of data from qualitative studies allowed us to identify key barriers and facilitators for successful mentorship programs. While most programs did not utilize rigorous evaluation strategies, data from qualitative studies provided insights into barriers and facilitators of successful mentorship programs, which can inform program design and improvement.

Grappling with key questions about assessment of the Health Advocate role.

Although the CanMEDS framework sets the standard for Canadian training, health advocacy competence does not appear to factor heavily into high stakes assessment decisions. Without forces motivating uptake, there is little movement by educational programs to integrate robust advocacy teaching and assessment practices. However, by adopting CanMEDS, the Canadian medical education community endorses that advocacy is required for competent medical practice. It's time to back up that endorsement with meaningful action. Our purpose was to aid this work by answering the key questions that continue to challenge training for this intrinsic physician role. We used a critical review methodology to both examine literature relevant to the complexities impeding robust advocacy assessment, and develop recommendations. Our review moved iteratively through five phases: focusing the question, searching the literature, appraising and selecting sources, and analyzing results. Improving advocacy training relies, in part, on the medical education community developing a shared vision of the Health Advocate (HA) role, designing, implementing, and integrating developmentally appropriate curricula, and considering ethical implications of assessing a role that may be risky to enact. Changes to assessment could be a key driver of curricular change for the HA role, provided implementation timelines and resources are sufficient to make necessary changes meaningful. To truly be meaningful, however, advocacy first needs to be perceived as valuable. Our recommendations are intended as a roadmap for transforming advocacy from a theoretical and aspirational value into one viewed as having both practical relevance and consequential implications.

Canadian Pediatric Surgeon Workforce: Characterization of Training, Trends Over Time, and 10-year Model for Pediatric Surgery Need

BackgroundGraduate and fellowship training trends for Canadian pediatric surgeons remain uncharacterized. Similarly, updated workforce planning for pediatric surgeons is required. We aimed to characterize graduate degree and fellowship trends for Canadian pediatric surgeons, with modelling to inform workforce planning. MethodsWe performed a cross sectional observational study evaluating Canadian pediatric surgeons in January 2022. Surgeon demographics collected included year of medical degree (MD) conferment, MD location, fellowship location, and graduate degree achievement. Our primary outcome was to evaluate training characteristics over time. Secondary outcomes evaluated surgeon supply and demand from 2021 to 2031. Supply was extrapolated from current Canadian pediatric surgery fellows assuming static fellowship matriculation, while retirement was estimated using a 31-, 36-, or 41-year career following MD conferral. ResultsOf included surgeons (n = 77), 64 (83%) completed fellowship training in Canada and 46 (60%) have graduate degrees. No surgeons graduating ≤1980 hold graduate degrees, compared to 8 (100%) surgeons with MD ≥ 2011 (p < 0.001). Similarly, more surgeons with MD ≥ 2011 appear to have a Canadian MD (n = 7, 87.5%) and Canadian fellowship (n = 8, 100%). Modelling predicts that 19–49 (25%–64%) surgeons will retire between 2021 and 2031, while 37 fellows will graduate with intention to work in Canada, creating between a 12 surgeon deficit up to an 18 surgeon surplus depending on career length. ConclusionsTrends in graduate degree achievement and fellowship location suggest increasing competition for Canadian pediatric surgery positions. Additionally, a substantial number of Canadian-trained fellows will need positions outside of Canada in the next decade. Overall, results support previous work demonstrating saturation of the Canadian pediatric workforce. Level of EvidenceLevel IV. ACGME Competency AddressedMedical Knowledge.

Teaching Design of Yoga Courses in Higher Vocational Colleges Based on BOPPPS Effective Teaching Mode

The BOPPPS teaching model originated from teacher skills training in Canada, and is a teaching model oriented towards teaching objectives and centered on students. Starting from design ideas, teaching objectives, teaching content, teaching strategies, and teaching evaluation, this article constructs a "three stage six step" teaching model that integrates "B-O-P-P-P-S" effective teaching, advancing step by step and deepening layer by layer, in order to effectively improve students' yoga instructor posture skills and teaching ability.

Factors Associated With Resident Research Success: An Analysis of Canadian General Surgery Trainees

Better understanding the research productivity of Canadian general surgery residents and factors associated with success would provide a valuable reference and help inform actions to enable success. We aimed to characterize the research productivity of Canadian general surgery residents and to evaluate factors associated with residents' research quantity and impact. A cross-sectional, observational study was performed using publicly available data evaluating Canadian General Surgery resident research productivity. Research productivity was characterized using measures including publications per postgraduate year (PGY) and CiteScore among others. Residency programs were then comparatively assessed using a multivariable logistic regression to evaluate program and resident factors associated with achieving >50th percentile research productivity. All General Surgery residents from English speaking Canadian training programs were included in this study, which was completed at the University of Alberta, a tertiary level academic center in Edmonton, Canada. A wide range of resident research productivity was observed across Canada with the median publications per PGY of 0.29, and the median sum of a resident's publication CiteScores of 2.05. The median h-index was 0.90. Graduate degree completion and publication experience prior to residency were significantly associated with higher publications per PGY (OR 2.94 and OR 2.10, respectively), as well as higher mean CiteScore (OR 3.42 and 2.24). The program factors that were assessed, including program size, research blocks, mandatory projects, or higher staff research productivity, did not show significant association with increased research output. There is a wide range in research output by general surgery residents across the country. Successful completion of graduate degrees and the experience of publication prior to residency are associated with higher research productivity and impact.

Advancing Integrated Care through Embedded Research: Early Lessons from Two Canadian Training Programs

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Assessing the need for Black mentorship within residency training in Canada.

KEY POINTS Black medical learners often experience racial prejudice, microaggressions, isolation and biased assessments during their medical training. Furthermore, rates of recruitment, retention and promotion are lower among Black learners and faculty. Formal equity, diversity and inclusive

A qualitative study of Canadian resident experiences with Competency-Based Medical Education.

Competency-based medical education (CBME) is an outcomes-based curricular paradigm focused on ensuring that graduates are competent to meet the needs of patients. Although resident engagement is key to CBME's success, few studies have explored how trainees have experienced CBME implementation. We explored the experiences of residents in Canadian training programs that had implemented CBME. We conducted semi-structured interviews with 16 residents in seven Canadian postgraduate training programs, exploring their experiences with CBME. Participants were equally divided between family medicine and specialty programs. Themes were identified using principles of constructivist grounded theory. Residents were receptive to the goals of CBME, but in practice, described several drawbacks primarily related to assessment and feedback. For many residents, the significant administrative burden and focus on assessment led to performance anxiety. At times, residents felt that assessments lacked meaning as supervisors focused on "checking-boxes" or provided overly broad, non-specific comments. Furthermore, they commonly expressed frustration with the perceived subjectivity and inconsistency of judgments on assessments, especially if assessments were used to delay progression to greater independence, contributing to attempts to "game the system." Faculty engagement and support improved resident experiences with CBME. Although residents value the potential for CBME to improve the quality of education, assessment and feedback, the current operationalization of CBME may not be consistently achieving these objectives. The authors suggest several initiatives to improve how residents experience assessment and feedback processes in CBME.

Competency Framework for Podiatric Medicine Training in Canada: An Adapted Delphi Study.

PurposePodiatrists are generally defined as professionals with high-level skills in the prevention and management of local foot conditions that are not systemic diseases. Across countries, different academic trainings are implemented due to the specific context and practice of podiatric medicine. It is thus essential to support country-specific podiatry education for the development of highly skilled podiatrists. Therefore, we report the development of a podiatric medicine competency framework to support training in Canada.Participants and MethodsA Delphi process was conducted by 12 stakeholders (including 8 podiatry experts) from the University of Québec at Trois-Rivières which is the only university offering the degree of Doctor of Podiatric Medicine (DPM) in Canada. The developed framework is (1) based on the seven key roles of the Canadian medical education directives of specialists (CanMEDs) and, (2) closely aligned with the requirement of the College of Podiatrists of Québec which sets the standards of entry to practice in Québec.ResultsThe developed framework represents the state of the development process and the consensus of the podiatry experts. It reflects the expected profile of the institution’s DPM graduates based on seven key roles (podiatry expert, communicator, collaborator, health advocate, leader and manager, scholar, and professional). This developed framework is an arborescence of complex skills defined in tangible indicators that characterize each expected part of a core competency. Twenty-four core competencies have been determined and divided into 84 enabling competencies and 288 observable indicators.ConclusionThis competency framework has been designed to support high-quality education and to develop podiatry. Next steps include: (1) validation of this framework by external experts, (2) development of rigorous evaluation methods and, (3) concrete actions for its implementation and assessment. This framework would help to define the scope of practice and capabilities of podiatric medicine, both in Canada and internationally.

X-ray therapy safety and awareness education for medical trainees and attending physicians.

Medical imaging involving ionizing radiation is common in the clinical setting. Little is known about the level of radiation safety training for medical trainees and attending physicians. We sought to identify the level of radiation safety knowledge and training at the undergraduate, postgraduate, and attending physician level. A 29-question survey was sent by email to two sites in Canada. We pooled the results of medical students, residents, and attending physicians. The primary outcome was to describe the amount of radiation safety training among these groups. The secondary outcomes were to describe the frequency of radiation exposure, level of radiation knowledge, and preferred training method for radiation safety. Of 115 surveys that were properly completed, 31 (26.9%) medical students, 17 (14.7%) residents, and 67 (58.3%) attending physicians responded. A greater number of medical students (41.9%) reported they had zero hours of training time for radiation safety compared to attending physicians (14.9%) (p<0.05). A higher number of attending physicians (47.8%) and residents (64.7%) participated in patient care involving fluoroscopy daily or at least several times per week compared to medical students (3.2%) (p<0.001). Attending physicians had the greatest number of correct responses to radiation safety questions. Online courses and workshops were the preferred training methods. Radiation safety training is an important component of medical education for medical trainees and attending physicians. Current radiation safety training requirements and procedures at various levels of medical training in Canada should be addressed. Implementing radiation safety education may improve adherence to the radiation safety principles.

Strengthening Zooeyia: Understanding the Human-Animal Bond between Veterans Living with Comorbid Substance Use and Posttraumatic Stress Disorder and their Service Dogs

Zooeyia includes the potential benefits that interactions and relationships with companion animals can bring to human health. These potential benefits have been grouped into four components to describe the means through which they may occur: pets as builders of social capital, agents of harm reduction, motivators for health behavior change, and active participants in treatment plans. This construct has been used to examine the human-animal bond (HAB) and understand animal-assisted interventions. It has not, however, been intentionally applied within the context of military Veterans with posttraumatic stress disorder and comorbid substance use paired with Service Dogs (SD). A qualitative approach to analysis using zooeyia was applied to data collected during an exploratory patient-oriented, time-series research design with Veterans teamed with SDs through a national holistic Canadian training program. All four components of zooeyia were present in the experiences of Veterans with SDs; SDs were builders of social capital, agents of harm reduction, motivators for health behavior change, and active participants in treatment plans. While Veterans working with SDs reported many benefits, the pairs also experienced specific complex challenges, beyond the expected concerns for a household pet. The human-animal relationship between Veterans in this study and their SDs, and the subsequent growing bond, is a key contributing component and step to the strengthening of zooeyia. This analysis of zooeyia extends our understanding of how SDs support veterans’ health, including better management of PTSD and problematic substance use. Because the HAB is reciprocal, this analysis also challenges One Health to recognize and embrace concerns for animal welfare.

Conceptualizing Physicians' Roles in Addressing Intimate Partner Violence: A Critical Discourse Analysis of Resources for Canadian Physicians.

Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV-learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV.

Border officer training in Canada: identifying organisational governance technologies

Border officer training in Canada: identifying organisational governance technologies

ЗАГАЛЬНІ ПІДХОДИ ТА ОСОБЛИВОСТІ ОСВІТНЬОЇ ПОЛІТИКИ ТА АКРЕДИТАЦІЙНИХ СТАНДАРТІВ У СФЕРІ ПРОФЕСІЙНОЇ ПІДГОТОВКИ СОЦІАЛЬНИХ ПРАЦІВНИКІВ У КАНАДІ

The article discusses the general approaches and features of educational policy and accreditation standards in the field of social workers’ professional training in Canada. The author carried out a categorical analysis of the concept of "social work" based on study the provisions of the provincial and territorial laws. It is determined that this concept is interpreted almost uniformly in all documents and is defined as a professional activity aimed at providing quality social services based on in-depth social workers’ professional training at the bachelor's, master's and research levels at Canadian universities and highly professional social workers. It was found that the basis of quality education in the field of social work is a clear and legislatively regulated educational policy of social workers’ professional training; high accreditation standards and requirements for educational programs regulated by the Education Policy and Accreditation Standards of the Canadian Association for Social Work Education and based on the Global Standards of Social Workers' Standards of the International Federation of Social Workers and the International Association of Schools of Social Work. The author characterizes the general content of the document "Educational Policy and Accreditation Standards" and identifies general approaches to the accreditation of educational programs in the field of social work. The organizational and content features of the educational policy and accreditation standards of social workers’ professional training in Canada are revealed. The commonalities and differences in the accreditation procedure of Ukrainian and Canadian educational programs are briefly described. Possibilities of application the constructive ideas of the Canadian experience in the Ukrainian educational practice are revealed. Key words: social work, social worker, social workers’ professional training, educational policy, accreditation standards, Canada.

P.052 Assessing the competence of neurology residents in performing an interphysician telephone consultation

Background: Neurology Residency training in Canada is transitioned to competence based medical education (CBME) in July 2020 and the Royal College Neurology Specialty Committee has identified “providing consultation for and managing patients at outlying centres,” to be an entrustable professional activity (EPA). At Western University, neurology telephone consultations from outlying centres are attended by both the resident and the staff Neurologist. This scenario provides the ideal situation for direct observation and immediate formative feedback. The resident’s performance was assessed using an entrustment scale along with a short narrative portion. Methods: This mixed methods study aims to determine the reliability and validity of the entrustment scale with narrative feedback in assessing the performance on the telephone consultation by senior neurology residents. Informed consent was obtained from residents (9) and staff (7) involved. Scores on the entrustment scale and narrative comments were analyzed. Results: Information on 37 encounters (involving 9 residents) was collected. Assessment results demonstrated higher entrustment scores in PGY4 and PGY5 levels. Overall, ratings were consistent across the 7 consultant assessors. Conclusions: The use of an entrustment scale appears to be reliable and valid in assessing competence in the telephone consultation and provide coaching feedback to help learners improve their performance.

A124 INITIAL EXPERIENCES AND OUTCOMES IN LAUNCHING AN ESD PROGRAM IN CANADA

BackgroundEndoscopic submucosal dissection (ESD) is emerging as the preferred modality for curative resection of certain gastrointestinal lesions, yet it has a steep learning curve. Formal ESD training in Canada is limited, thus several endoscopists have sought training abroad. There are no data on the initial outcomes of ESD in Canada.AimsTo describe the experience of a single advanced endoscopist (P.B.) who completed a mentor-apprentice model of ESD training in Europe and recently launched an ESD service in Canada.MethodsFormal training in submucosal endoscopy was completed over a 12-month period (Sep 2018-Aug 2019) in Milan, Italy involving a stepwise progression through case observation (n=40), use of animal models (n=10), partial completion of human cases under direct supervision (n=25), and independent completion of human cases (n=19). Upon return to Calgary, AB, the program was promoted via grand rounds, an evening launch event and word-of-mouth. Patient and lesion characteristics, as well as procedure details and ESD outcomes were recorded prospectively in a database and used to complete a practice audit. Cases were divided into two timeframes (first 18 vs second 18 cases) and then compared with respect to specimen size, resection speed, R0 resection rate, and adverse event (AE) rate using the Mann-Whitney U and two-proportion Z-tests.ResultsFrom Nov 2019 to Sep 2021, 36 lesions were treated by ESD in 34 patients (mean (SD) age=66.5 (13.5) years). Most lesions were located in the rectum (44.4%) or stomach (41.7%); 21 (58.3%) were neoplastic, of which 5 (23.8%) were submucosal carcinomas, 11 (52.3%) were mucosal carcinomas (7 m1/Tis, 4 m2-3/T1a), and 5 (23.8%) were neuroendocrine tumors. The overall en bloc resection rate was 97.2% (35/36 lesions). In comparing the first 18 cases to the second 18 cases (Table 1), there were non-significant trends toward increases in mean specimen size (5.4 to 8.6 cm2, P=0.07) and R0 resection rate (62.5% to 84.6%, P=0.24). Resection speed increased significantly (2.97 to 6.25 cm2/hr, P=0.04), while AE rates remained the same (11.1%); namely 2 episodes of bleeding requiring repeat endoscopy in each set of cases. There were no perforations or intra-abdominal infections.ConclusionsWith appropriate training and support, ESD can be performed safely and effectively in a Canadian context. Proficiency can be expected to improve significantly within the first 2 years of independent ESD practice without compromising safety.Table 1.ALL LOCATIONS1st 18 cases2nd 18 casesAll 36 casesPElliptical area (cm2)5.358.597.740.07Total ESD time (min)94.2897.7296.000.70Resection speed (cm2/hr)2.976.254.610.04*R0 resection (%)62.5084.6276.190.24Adverse events (%)11.1111.1111.111Funding AgenciesNone

Digital Literacy Training in Canada, Part 2: Defining and Measuring Success

Digital Literacy Training in Canada, Part 2: Defining and Measuring Success

Assessing agreement on Canadian pediatric critical care training objectives in Japan.

Japan has no accredited learning objectives for pediatric critical care medicine trainees. This study examined the extent of agreement among a panel of Japanese Pediatric Intensive Care (PICU) directors regarding the necessity of the Canadian learning objectives in pediatric critical care knowledge and technical skills training. Using a two-round Delphi survey, we developed consensus among directors of PICUs in Japan on the Canadian training objectives in pediatric critical care medicine. To assess the agreement, we applied a 4-point Likert scale (1=unnecessary, 2=relatively unnecessary, 3=relatively necessary, 4=necessary). We conducted a web-based survey and an Excel-based survey over four-week periods for the first and second rounds, respectively. Consensus was set at ≥80% agreement; therefore, items rated 3 or 4 by ≥80% participants in either rounds were included in the final list. Of the 36 PICU directors invited, 32 (88.9%) completed all survey rounds. In the first round, 164 items were agreed as necessary, 1 item was deemed unnecessary, and 15 items did not reach agreement and were included in the second round. In the second round, 5 items were agreed as necessary and 10 items did not reach agreement. Finally, 169 (94.9%) of the Canadian learning objectives reached the agreement after the two-round Delphi survey. Sixteen participants commented that non-technical skills, such as communication, collaboration, management, and education, were important additional objectives. High consensus was observed among Japanese pediatric critical care experts concerning the Canadian learning objectives for pediatric critical care knowledge and technical skills training.