Ontario Student Medical Education Research Conference (OSMERC) | April 8th, 2023

Ontario Medical Student Association

Published online: April 8th, 2023

Inspiring Leadership in Equity, Accessibility, and Diversity (iLEAD) Mentorship Program for Underrepresented Minorities in Medicine

Jane Jomy1, Radha Sharma1, Sebat Mohamed1, Kisanet Kebedom1, Olajumoke Oladipo1 (all authors contributed equally); Ike Okafor1

1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

Corresponding Author: Jane Jomy, email jane.jomy@mail.utoronto.ca


Background: In the current literature, there is a paucity of data informing the challenges of Underrepresented Minorities in Medicine (URMMs) due to lack of social capital and financial barriers throughout medical school (1,2). There is a limited understanding of the disparity between the achievement level of URMMs and their counterparts during the transition throughout undergraduate medical education (UGME) to post graduate medical education (PGME), especially within ambitious medical and surgical specialties (3).
Aim: iLEAD is a two-tier pilot program that aims to facilitate longitudinal relationships between URMMs in UGME and PGME for mentorship, career exploration, and guidance throughout CaRMS. In tier 1, 35 incoming UGME learners will be matched with 35 current UGME learners. In tier 2, those same 35 current UGME learners will be matched with 35 PGME learners.
Methods: We will conduct a comprehensive program evaluation to ascertain the benefits and challenges of iLEAD with a series of questionnaires and focus groups. Pre-, mid- and post-program questionnaires with Likert scales will be completed by mentees, to assess their: 1) mentor-mentee interactions, 2) residency preparedness, 3) consideration in pursuing a competitive specialty and 4) perceived confidence about CaRMS. Focus groups held pre- and post-program will help us gain insight into the knowledge, attitudes, skills, and experiences of mentees.
Results: This project is currently underway and has garnered financial and in-kind support from the Community of Support and Office of Inclusion and Diversity at the University of Toronto. We are curating sponsorships, facilitating partnerships with PGME programs, recruiting UGME mentors, and organizing longitudinal programming.
Conclusions: To the best of our knowledge, no Canadian medical school has implemented a two-tier longitudinal program as such. iLEAD is anticipated to improve the experiences of URMMs throughout their medical training and their ability to provide culturally competent care within the Canadian healthcare system.
1. Lee EY, Bakshi N, Levin LA, Ahuja N. Increasing equity, diversity, and inclusion in the ophthalmology CaRMS selection process: ACUPO recommendations. Can J Ophthalmol. 2022.
2. Grose et al. National trends in gender diversity among trainees and practicing physicians in otolaryngology-head and neck surgery in Canada. JAMA Otolaryngol. 2022; 148(1), 13–19.
3. Beruar A et al. Equity, Diversity and Inclusivity in Canadian Medical Institutions: Position Paper. 2022; 1-14.

Managing the influx: a peer-led session on communication and professionalism in medicine

Colin Whaley1, Bradley Murphy1, Connie Li1, Amanda Bell1, 2, 3

1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada;
2Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St. Catherines, ON, Canada
3Department of Family Medicine, McMaster University, Hamilton, ON, Canada

Corresponding Author: Colin Whaley, email colin.whaley@mcmaster.ca


Introduction: As student leaders in the undergraduate MD Program at McMaster, we noticed that our classmates were facing challenges in the areas of communication and professionalism. These areas are considered key domains in undergraduate medical curricula and frameworks, such as CanMEDS, and are essential for the development of professional identity.
Methods: In response to these challenges, we decided to create a novel addition to the McMaster undergraduate medical curriculum through the creation of a student-led teaching session delivered to the incoming MD Program class. We aimed to address two main aspects: appropriately receiving and integrating new information provided, and efficiently retrieving existing information. The goal of this session was to minimize unnecessary communications within class group chats, frustration from administration around missed deadlines, and student burnout created by the increased administrative burden.
Results: We explain the process of developing this peer-led session on professionalism and provide a figure to help fellow students develop their communication and professionalism skills. The session met its stated goal of introducing students to some strategies to promote clear, effective communication.
Conclusion: Our student-led teaching session on professionalism was a successful addition to the McMaster undergraduate medical curriculum, helping students to develop their communication and professionalism skills. The session has been held twice, and is now a fixture in the Introduction to Medicine subunit. We hope that our experience and resources can be used as a guide for other student leaders in creating similar sessions at other institutions.

Evaluating Undergraduate Palliative Care Medical Education at McMaster University: A Quality Improvement Project

Zaynab Malik1, Jeffrey McCarthy1, Ashlinder Gill1, Michael Panza1, Hun-Je Park1, Chris Klinger1,

1Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, ON, Canada

Corresponding Author: Jefferey McCarthy, Hun-je Park, email jeffrey.mccarthy@medportal.ca, hun-je.park@medportal.ca


The aims of this project are: 1) To evaluate how well undergraduate medical education (UGME) at McMaster University equips students with the core skills of a primary palliative approach to care as defined by the national Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) competencies; and 2) To evaluate formal and informal UGME curriculum exposure at McMaster University to identify strengths and gaps, including evaluation of the integration of 15 Learning Essential Approaches to Palliative Care (LEAP) Fundamentals modules into formal curriculum sessions.
Description: In 2021, six palliative care-focused sessions were mapped to EFPPEC competencies. This included identifying opportunities to integrate LEAP modules and refocus session learning objectives. This 5-year program of evaluation aims to understand the impact of these changes. Participants received anonymous optional surveys after each session, as well as periodic retrospective surveys. Recipients of retrospective surveys were invited to participate in a semi-structured Zoom interview about students' experiences learning a palliative approach to care throughout medical school.
Results/Impact: Most students were younger than 25 years and based at the Hamilton campus. Most students had no prior experience with or clinical rotations in palliative care. Most students identified LEAP modules and curriculum sessions as helpful in learning a palliative care approach and appropriate for their level of training. Student feedback focused on impact and improvements to the formal and informal curriculum. Students identified palliative care curriculum material as engaging and interactive, with supportive preceptors and valuable palliative care rotations limited by elective availability.
Discussion/Application: These preliminary findings reflect a small sample of students, which is expected to increase by sampling multiple student cohorts. Data will inform further curriculum change to maintain strengths and address identified gaps in teaching students the core skills of a primary palliative approach to care.

Quality Improvement and Patient Safety in Undergraduate Medical Education: A scoping review

T. So*1, P. McNabb*1, A. Chen1, A. Malik1, N. Sharfuddin1, 2

* co-first authors
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
2Trillium Health Partners, Mississauga, ON Canada

Corresponding Author: Tsz Ying So, email tszying.so@mail.utoronto.ca


Introduction: Quality improvement and patient safety (QIPS) initiatives are key to improving healthcare systems. Effective QIPS initiatives minimize adverse medical events, improve patient safety, and improve health outcomes. The key role that physicians play in facilitating QIPS projects increasingly emphasizes the need for QIPS training in medical school curricula. Despite this, there continues to be limited QIPS curricula in Canadian medical schools, particularly at the undergraduate level.
Objectives: This scoping review aims to review current and previous QIPS medical education initiatives. The review will summarize QIPS teaching methods, student and preceptor experiences, and evaluate the effectiveness and challenges of these initiatives. We aim to utilize and apply this knowledge in improving QIPS medical education at the University of Toronto. METHODS: Following PRISMA-ScR guidelines, relevant literature for QIPS in undergraduate medical education within the past 20 years will be included. Articles must be in English with QIPS as the core curriculum and include learner activities and assessment. Two reviewers will systematically appraise all papers from the literature search. The general themes to be extracted include methods of QIPS training, impacts of QIPS education experience on learners and teachers, and barriers to QIPS education.
Results: We have developed a literature search strategy, drafted a scoping review protocol and completed the initial literature search. Preliminary data synthesis to be completed March 2023.
Conclusion: This scoping review will assess the current state of QIPS in medical education using literature published in English. Results from this study will help inform effective strategies that can be used to improve the current QIPS training for medical students at the University of Toronto and reveal existing gaps in QIPS training for medical learners.

Moving beyond biomedicine: a student-led social medicine curriculum revision project

Brynna Wilson*1, Jocelyn Tamura*1, Riley Graybrook*1, Dr. Matthew Miller1, Dr. Javier Ganame1

* co-first authors
1Michael G.DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

Corresponding Author: Jocelyn Tamura, email jocelyn.tamura@medportal.ca


Medical education is evolving to recognize the values of holistic approaches to patient care and advocacy. Social Medicine components of medical school curricula develop student competencies in understanding and navigating the diverse socioeconomic, cultural, political, historical, and environmental determinants of health. Best practices recommend a longitudinal program of Social Medicine teaching and an integration, as opposed to compartmentalization, of teaching on social and biomedical perspectives. Medical students themselves are uniquely positioned to identify the merits, as well as gaps, of Social Medicine curricula. This project is a student-led initiative that aimed to develop and integrate additional Social Medicine learning objectives within the McMaster Undergraduate Medical Education (UGME) curriculum. Over the course of 10 months, 3 medical students reviewed the UGME Tutorial clinical cases in Medical Foundations (MF) 1 and 2 to develop a total of 8 new learning objectives on topics that were felt to warrant greater discussion within the curriculum, including gender-inclusive health, systemic racism in medicine, and the impact of socioeconomic status on health outcomes. Each new learning objective was supplemented with a short explanatory passage in the Tutor Guide and 1-2 recommended resources to achieve this learning objective. The objectives were reviewed by each MF Director and subsequently presented to the MF and Preclerkship Committees for approval. The 8 new Social Medicine learning objectives were successfully implemented for the following year's medical school class. Tutors were required to integrate these objectives within the sessions. Feedback received after the MF was highly positive. In summary, this project outlines the steps that were taken by a group of three medical students to incorporate new Social Medicine learning objectives within their medical school curriculum. It may serve as a guideline for other medical students interested in advocating for and implementing Social Medicine perspectives within their own medical school programs.

The PATIENT Project: A Quality Improvement Initiative to Bring Patient-Centred Care to Case-Based Medical Education

Sarah Klapman1, Riley Graybrook1, Christina Papaioannou1, Celine Vereecken Smith1, Brynna Wilson1, Lindsey Zhang2,3, Mary Salib1

1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada;
2Department of Health Sciences, McMaster University, Hamilton, ON, Canada;
3Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Corresponding Author: Mary Salib, email mary.salib@medportal.ca


Problem-based learning (PBL), developed in 1969 at McMaster University, has become the standard for medical education across Canada and beyond. This groundbreaking pedagogical tool allows for a flexible curriculum in which innovation can flourish. As the medical field in Canada increasingly prioritizes the role of the patient, medical students must receive patient-centred and anti-oppressive education. However, PBL cases are almost exclusively written by physicians about theoretical patients, rather than featuring real patients and their experiences. However, in 2018 Dickinson and colleagues found that including a real patient in a PBL case increased student engagement, understanding of disease processes, and empathy for patients. This innovation demonstrated the value of centering patient experiences in pre-clerkship training.
In 2022, a group of McMaster medical students developed the PATIENT project: Patients And Their Illnesses in medical Education through Narrative Tutorials. This quality improvement project brought together students and faculty to adapt an existing PBL case on sickle cell disease to feature a real person, (Patient JM), who provided a video interview of his experiences. Students reported increased engagement, better understanding of the complexity of patient care, and an increased sense of empathy. Qualitative student responses featured themes of gratitude to the patient, the value of the patient perspective, and benefitting from the addition of a real patient to the curriculum.
This pilot tutorial has been highly informative in demonstrating the value of centering patient experiences in the pre-clerkship curriculum. The pilot also provided useful information about ways to improve the process of including patients in PBL cases to maximally benefit students, tutors, and patients. We look forward to sharing this knowledge with other Canadian medical schools as an innovative opportunity to build medical student empathy and focus on patient experiences.

Evaluation of a mindfulness undergraduate medical curriculum and design of a logic model to describe planned evolutions of the program.

Nadine Cheffi1, Eric Wooltorton1, Priya Gaba1, 2

1University of Ottawa Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
2Bruyère Family Medicine, Élisabeth Bruyère Hospital, Ottawa, ON, Canada

Corresponding Author: Nadine Cheffi, email nadine.cheffi@uottawa.ca


Purpose of Study: The Undergraduate Medical Education (UGME) program at the University of Ottawa is one of the first to introduce the Mindfulness Curriculum in 2014, where medical students are introduced to mindfulness practices from their first year of studies. This study evaluates the current state of the curriculum and uses student perspectives for quality improvement.
Methods: Anonymous student evaluations of the Mindfulness Curriculum were collected using a survey distributed to the active cohorts. The survey assessed previous experience and current understanding of mindfulness and included four levels of understanding: reactions, learning, behaviour and results to identify elements to be improved. A logic model was created based on the evaluations outlining necessary “inputs”, “activities”, “outputs” and “outcomes” of the next iteration of the program.
Results: A total of 29 responses were collected. Most students agreed that they have a good understanding of mindfulness, but there was a gap with applying concepts. 44.00% of respondents reported that mindfulness sessions interfered with schedules, but 48.00% appreciated their relevance to the medical student role. 47.62% agreed that they learned relevant skills with 57.14% affirming their knowledge of when to use the skills. 45.00% reported that they have adopted mindfulness into daily practices (personally, academically and professionally). Most students reported that the sessions increased their sense of self-awareness and improved understanding of mindfulness concepts.
Conclusions: The Mindfulness Curriculum is an integral part of UGME. By improving the program using personal evaluations, students will maximize their experience, giving them an opportunity to ameliorate their wellness as future physicians.

Evaluating the role of community co-educators in the training of undergraduate medical students: A qualitative analysis

Grace Zhou, BHSc1, Aarabi Thayaparan, BHSc1, Stephanie Park, BSc, MSc1, Yasamin Sadeghi, BHSc2, Brandi Deimling, BA3, Roxanne Wright1, Fok-Han Leung, MD1,4

1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada;
2Institute of Medical Science, University of Toronto, Toronto, ON, Canada;
3Community contributor, Oakville, ON, Canada;
4Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada

Corresponding Author: Grace Zhou, email gx.zhou@mail.utoronto.ca


Background: Community-based service learning (CBSL) is a core component of the Canadian medical education system. The unique role of co-educators in supporting the development of the medical professional, however, remains novel and unclear. This qualitative study aims to evaluate the perspectives of community-based organizations on their role as co-educators in the undergraduate medical curriculum at the University of Toronto.
Methods: Eight semi-structured qualitative interviews with community-based organization hosts of CBSL placements in the Health in Community (HC) curriculum at the University of Toronto were conducted. Recruitment was administered using a convenience sample approach. Interviews were conducted one-on-one virtually between 2020-2021 and led by a pre-determined interview guide, recorded, transcribed, de-identified, and coded independently by three researchers. Thematic analysis of codes was performed using a grounded theory approach, supported by group discussion and analytic memos.
Results: Five main findings were identified: 1) Community-based organizations share a common interest in serving as co-educators; 2) considerable heterogeneity in the understanding of co-education exists; 3) there is opportunity for increased partnerships between co-educators, faculty, and students; 4) the role of co-educators is limited by course structure and organization; and 5) community co-educators facilitate unique teachings of social determinants of health, otherwise not available through traditional didactic teaching.
Conclusions: There is an emerging, unique role for community co-educators in the undergraduate medical curriculum, supported by interest from co-educators. Its emphasis may contribute to future cohorts of medical students capable of understanding and addressing the needs of the populations they serve.

Medical student perspectives on clinical empathy in Ontario medical education: preliminary findings

Shira Gertsman1, Jason Wang1, Sarah Kaye Klapman1, Connie Li1, Anushka Nair1, Dr. Johanna Shapiro2, Dr. Connie Williams3,4

1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada;
2UC Irvine School of Medicine, University of California Irvine, Irvine, CA, United States;
3Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada;
4Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Corresponding Author: Jason Wang, email jason.wang@medportal.ca


Background: “Clinical empathy” is defined as the ability for physicians to understand the patient’s whole illness experience, communicate this understanding, and act on this understanding to inform patient-centered care. Although the benefits of clinical empathy are well established, there is evidence that empathy declines throughout a trainee’s education.
Objective: Our aim is to define aspects of formal and informal Ontario medical school curricula that influence medical student empathy. This enables the identification of strengths and shortcomings in the status quo of medical education, which can inform further curriculum development driven towards improving clinical empathy.
Methods: Ontario medical students in their second year of study or above were recruited from school newsletters and class forums. Virtual focus groups are held in a semi-structured interview format. Discussion prompts include empathy-teaching curricula, hidden curriculum, interactions with healthcare providers, and opinions on how empathy training could be improved. Transcripts of the focus groups are coded using the constant comparative method, iteratively used to elucidate broader themes, and a theory is ultimately constructed using the tenets of grounded theory analysis.
Results: Data analysis is ongoing, but trends from examining preliminary coding suggest that students’ learning surrounding clinical empathy is heavily tied to observation of other physicians during clinical encounters and personal interactions with preceptors. Challenges students faced with their learning were often related to difficulty drawing realizable takeaways from formalized curricula.
Conclusions: These trends highlight the importance of informal learning experiences and the opportunity for preceptors to act as role models for clinical empathy. There is perhaps a need to explore how clinical empathy can be introduced more organically into formalized programming in a way that better simulates real clinical encounters. Completion of this study will hopefully strengthen these sentiments and shed light on other important considerations for informing future empathy training for medical students.

Improving Suboxone Initiation Rate for Opioid Use Disorder in the Emergency Department

Ovini Thomas1, Megan Park1, Dr. Sarah McClennan2

1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
2Emergency Department, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

Corresponding Author: Ovini Thomas, Megan Park, email ovini.thomas@mail.utoronto.ca, megan.park@mail.utoronto.ca


Opioid Use Disorder (OUD) is a crisis that continues to have a significant impact on greater Toronto cities. In the Peel region, 189 residents died of drug overdoses in 2021 (1). Multiple studies found that initiation of Buprenorphine-Naloxone (Suboxone) in the Emergency Department (ED) to be an effective treatment modality in increasing patient engagement in OUD treatment (2-4). Using evidence-based guidelines, Trillium Health Partners (THP) developed an order-set to initiate Suboxone in their EDs (Credit valley and Mississauga sites). Unfortunately, there has been minimal uptake of the order-set. The goal of this quality improvement study is to identify barriers to prescribing Suboxone, and implement a process map for Suboxone treatment in the THP EDs. This poster will describe the process of developing the implementation plan for Suboxone initiation in two large community EDs. A literature review was completed to understand attitudes, barriers and facilitators to initiating Suboxone in the ED. Next, focused interviews were conducted with physicians, nurses and allied healthcare professionals with expertise in Suboxone initiation in their respective facilities to identify current practices, and local constraints and solutions. Using this data, a Suboxone initiation roadmap was developed catered toward THP EDs and the Peel Region. The roadmap includes: an updated protocol for Suboxone initiation; pre-printed prescriptions; refined physician, nurse and allied healthcare education; informational pamphlets for patients; formation of a collaborative support network with local pharmacies and Rapid Access Addiction Medicine clinics; and other support for patients. The future goals of this project are to implement the roadmap in THP EDs, and study the impact of this locally designed plan on Suboxone prescribing, patient uptake of Suboxone, and opioid-related deaths in the Peel community. The implementation of a clear roadmap is a pivotal first step for the Peel Region to support patients struggling with OUD.
1. Opioid Overdoses - Region of Peel [Internet]. [cited 2022 Oct 25]. Available from: https://www.peelregion.ca/opioids/overdoses.asp
2. Fox L, Nelson LS. Emergency Department Initiation of Buprenorphine for Opioid Use Disorder: Current Status, and Future Potential. CNS Drugs 2019 33:12 [Internet]. 2019 Sep 24 [cited 2022 Oct 25];33(12):1147–54. Available from: https://link.springer.com/article/10.1007/s40263-019-00667-7
3. D’Onofrio G, Chawarski MC, O’Connor PG, Pantalon M v., Busch SH, Owens PH, et al. Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. J Gen Intern Med [Internet]. 2017 June 1 [cited 2022 Oct 25];32(6):660–6. Available from: https://link.springer.com/article/10.1007/s11606-017-3993-2
4. Samuels EA, D’Onofrio G, Huntley K, Levin S, Schuur JD, Bart G, et al. A Quality Framework for Emergency Department Treatment of Opioid Use Disorder. Ann Emerg Med [Internet]. 2019 Mar 1 [cited 2022 Oct 25];73(3):237–47. Available from: http://www.annemergmed.com/article/S0196064418312083/fulltex

Understanding Department of Family and Community Medicine Resident Perspectives on Using an Experience Tracking Tool in Order to Optimize Educational Value

Eden Meisels BSc*1, Leah Brown MA*1, Rachel Goldfarb BSc*1, Deirdre O’Sullivan MD CCFP2, 3, Ilana Birnbaum MD MPH2,3, Fok-Han Leung MD CCFP FCFP MHSc2,3

* co-first authors
1Temerty Faculty of Medicine, University of Toronto , Toronto, ON, Canada,
2Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada,
3Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

Corresponding Author: Eden Meisels, email eden.meisels@mail.utoronto.ca


Background: Family medicine residency provides a high degree of independence, which subsequently results in variability of training experiences. This poses a challenge to residency training programs in ensuring graduates have sufficient clinical exposures and competence. The Resident Practice Profile (RPP) was initially developed as a clinical encounter tracking tool used by the University of Toronto's DFCM to address this challenge. Previous studies highlight barriers and limitations of educational experience tracking tools.
Objective: This study elicits learner experiences using the RPP to make recommendations for its revision, and more broadly, to gain an understanding of the factors that enhance the effectiveness of educational tracking tools. METHODS: This study collects and analyzes quantitative and qualitative data through a practical implementation science and quality improvement lens. Research tools include resident focus groups and online surveys of DFCM residents. RESULTS: The online survey was completed by 68 residents and recent graduates. Three focus groups were held. Results obtained characterize participants’ perspectives on use, functionality, and impact of the RPP on training. There was variability in extent and timing of RPP use, as well as in terms of impact of the tool. As per user experience, limitations to the effectiveness of the RPP fall within three broad categories: technological limitations, time required, and perceived lack of utility of the tool.
Conclusion: In studying the RPP, key recommendations have been outlined to improve educational experience tracking tools more broadly both in the short-term and long-term to enhance learner experiences in medical training.

A Competency-Based Concussion Curriculum for Primary Care Residents: Benefits, Challenges and Future Directions

Ching-Lung Huang, MD Candidate1, George Zhao, MD candidate1, Alyson Summers, BHSc, MSc Candidate2, Fatima Khan, MBBS, IMG Residency Candidate; Aisha Husain, MD, CCFP, FCFP3,4, Joyce Nyhof-Young, BSc, MSc, PhD3,5,6, Nicolas Fernandez, PhD7, Denyse Richardson, MD, MEd, FRCPC2,8,9, Alice Sau Han Kam, MD, MScCH (HPTE), FRCPC2,10,11,12,

1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada;
2Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada;
3Department of Family and Community Medicine (DFCM), University of Toronto, Toronto, ON, Canada;
4Oak Valley Health, Uxbridge, ON, Canada;
5Academics Program & Family Practice Unit, Women’s College Hospital, Toronto, ON, Canada;
6Department of Family and Community Medicine, St Michael’s Hospital, Toronto, ON, Canada;
7Department of Family and Emergency, Université de Montréal, Montreal, QC, Canada;
8Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada;
9Providence Care Hospital, Kingston, ON, Canada;
10Toronto Western Hospital, University Health Network, Toronto, ON, Canada;
11North York General Hospital, Toronto, ON, Canada;
12Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

Corresponding Author: Ching-Lung Huang , email chinglung.huang@mail.utoronto.ca


Background: Current knowledge gap in concussion management highlights a need for resident-focused curriculum that measures learners’ concussion competency. We sought to fill this gap by developing and evaluating a Competency-Based Concussion Curriculum (CBCC).
Objective: To evaluate the short-term curriculum impacts on resident knowledge and confidence in competency and the long-term curriculum impacts on resident behaviour.
Method: CBCC consisted of two phases. Phase 1: curriculum and study guide development using an iterative usability approach. CBCC was piloted at seven University of Toronto family medicine residency sites through a two-hour virtual case-based academic half-day (AHD). Before the AHD, we sought to schedule time at each site for residents to receive an explanation of the curriculum concepts and review the study guide. Phase 2: implemented the same curriculum with two University of Toronto family medicine residency sites, along with an additional three half-day clinical rotations for first- and second-year residents. A mixed-method evaluation was conducted using pre-AHD and six-month post-AHD surveys to assess knowledge and confidence impacts, and semi-structured interviews at six months to measure behaviour change.
Results: Of the 114 residents who completed the pre-AHD survey, 12 continued to complete the six-month post-AHD survey (n=5 from first site, n=7 from second site). First-site residents had a knowledge decrease of 3.33% (p>0.05). Second-site residents had a knowledge increase of 11.58% (p>0.05). Residents at both sites had an increase in confidence (first site: 30% (p=0.025); second site: 62.79% (p=0.0014)). Residents (5 out of 6) reported positive behavioural changes at six months.
Conclusion: The CBCC enhances resident learning and promotes sustained knowledge improvement and behavioural change six months after intervention. The main challenges included lack of protected time for self-study and explanation of curriculum concepts. Despite these challenges, CBCC remains a valuable tool to address the concussion knowledge gap in residency.

Climate action now: an evaluation of planetary health metrics to drive educational change at the University of Ottawa Faculty of Medicine

Tan, Xiu Xia Sherry1, Quartermain, Liam1, Séguin, Niève1, Timms, Makenna1, Moloo, Husein2

1Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
2Ottawa Hospital Research Institute, Ottawa, ON, Canada

Corresponding Author: Xiu Xia Sherry Tan, email sherry.tan@uottawa.ca


Introduction: Faculty leadership and longitudinal integration of planetary health education in medical schools are essential for preparing physicians to succeed in a climate-disrupted world. Yet in a 2019 survey, only 15% of medical students reported planetary health in their curriculum. The Planetary Health Report Card (PHRC) is a trainee-led initiative, evaluating medical schools on metrics of curriculum, research, community outreach/advocacy, support for student-led initiatives, and campus sustainability. We explore the utility of the PHRC in identifying priority areas for planetary health and how a similar approach can be applied to resident education.
Methods: Using the PHRC, we evaluated the uOttawa Faculty of Medicine (uOFoM) in 2021-22. For each metric, scores were provided alongside evidence and improvement recommendations.
Results: The uOFoM scored an overall C grading. The planetary health curriculum lacked breadth and longitudinal integration, consisting mostly of a 1-hour lecture in second year. The uOFoM did not organize community-oriented planetary health initiatives. However, medical learners could pursue planetary health initiatives through programs with non-specific focuses. Most campus sustainability initiatives occurred offsite from the medical campus, and were open to, but not promoted to, medical learners. Some faculty projects were dedicated to Planetary Health Education research but lacked central coordination. Notably, the uOFoM appointed a Director of Planetary Health—the first such position in Canada—thereby facilitating student-faculty collaboration in addressing PHRC-identified shortcomings. These initiatives include student-faculty groups to design a longitudinal medical school planetary health curriculum, and introduction of planetary health-focused conferences, webinars, newsletters, and research projects with resident involvement.
Conclusion: The PHRC identified short and long-term goals for uOttawa and facilitated constructive dialogue between medical students, residents, and the uOFoM to organize educational initiatives. Similarly, the PHRC can be adapted to evaluate residency programs and inform a foundational planetary health residency curriculum to increase planetary health competence amongst residents.

#CaRMS2021: An Analytical Study Assessing the use of Twitter during the COVID-19 Pandemic

Julia Kemzang1, Lauren Viola2, Kameela Miriam Alibhai1, Emaan Chaudry1, Karima Khamisa1,3

1Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
2Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
3Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

Corresponding Author: Julia Kemzang, email rkemz059@uottawa.ca


Background: In the final year of medical school, students explore residency programs by completing visiting electives and interviews as part of the Canadian Residency Matching Service (CaRMS) process. Due to the COVID-19 pandemic, visiting electives and in-person interviews were suspended. This forced students and programs to find alternate avenues to interact, such as through social media. This study aimed to evaluate the utility of Twitter as a platform to share CaRMS-related information prior to and following the pandemic.
Methods: Tweets published during the 2018-19, 2019-20 and 2020-21 CaRMS cycles were identified using Vicintias. The type of tweet (i.e., primary vs retweet), date of publication, language, geographics, and content of the tweet were extracted. Demographic information about tweet creators were extracted using provincial regulatory college databases and institutional websites. Only primary tweets, defined as original posts by a Twitter user, were included, and thematically analyzed using a deductive coding approach.
Results: Of the 1,843 tweets, 603, 472 and 768 tweets were published during the 2018-19, 2019-20 and 2020-21 cycles respectively. The majority were written in English (97.4%) and by medical students (29.5%) affiliated with Ontario Universities. Geographic trends were noted where institutions that saw the greatest increase in tweets between the first and third cycles were located in rural areas, such as Memorial University of Newfoundland (25-fold increase), Northern Ontario School of Medicine (10-fold increase), and University of Saskatchewan (eight-fold increase). The most common types of tweets were supportive messages (29.1%), reflections about CaRMS (24.7%) and positive match results (20.8%).
Conclusion: Since the COVID-19 pandemic, there has been an overall increase in the number of CaRMS-related tweets. The majority of tweets were written to promote residency programs and advertise CaRMS events. Future studies may consider analyzing the use of Twitter following the reinstatement of visiting electives in the 2023-2024 CaRMS cycle.

Why Study? Student Rationale for the Usage of Unofficial and Non-Traditional Commercial or Peer Learning Resources in Undergraduate Medical Education

Donovan Makus1, Mark Labib1, Jessica Maher1, Anshu Kashyap1, Susan Humphrey-Murto2,3

1Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada;
2Department of Medicine, University of Ottawa, Ottawa, ON, Canada;
3Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Corresponding Author: Donovan Makus, email Donovan.Makus@uottawa.ca


Background: Medical students have many non-traditional resources available to them; some student developed and others by commercial entities. It is unclear how, when and why students use these resources, and if they supplement or replace the traditional curricular offerings. The purpose of this project is to explore the use of non-traditional resources from the student perspective.
Methods: To explore the utilization of resources in preclerkship and clerkship we conducted semi-structured interviews with students from the University of Ottawa to examine their educational resource utilization and time investment, rationale for the resources they use, satisfaction with their approach, as well as approach and mindset towards studying. Interviews were recorded and transcribed verbatim. Thematic analysis guided by self-regulated learning theory and completed by 3 independent coders was used, followed by several team meetings.
Results: 24 students (18 preclerkship and 6 clerkship) were interviewed. The average interview time was 33 minutes (range 18 -65 minutes) There were 16 female students and 8 male students. 71% of interviewees report using external resources. Rationale for using non-traditional resources was heavily shaped by concerns about upcoming exam performance, while other students were more focused on future learning goals related to managing patients in clerkship and beyond. External sources were viewed as more time efficient and afforded more flexibility regarding both timing and repetition to studying. Disadvantages with external resources included a mismatch in content between exams and non-traditional content as well as concerns about accuracy. Interestingly, most students were not concerned about student developed resource accuracy, emphasizing they trusted resources that were in common use. Students were generally satisfied with their current studying habits. Student use of non-traditional resources is prevalent and has highlighted gaps in the traditional curriculum. A better understanding of extra-curricular use could inform approaches to education that enable self-regulated learning.

Impacts of COVID-19 on Procedural Skills Training and Career Preparation of Queen’s University Medical Students

Kowal, S.1, Kolasky, O.1, Mann, S.1, Winthrop, A.1

1Queen's University, Kingston, ON, Canada

Corresponding Author: Owen Kolasky, email okolasky@qmed.ca


Background: The Surgical Skills and Technology Elective Program (SSTEP) was created in 2014 at Queen's University as an annual, week-long, pre-clerkship surgical bootcamp. It was found to improve confidence, skill performance, and knowledge across core skills. Due to the COVID-19 pandemic, much of the pre-clerkship curriculum at Queen’s was delivered virtually, impacting the 2022 SSTEP cohort’s baseline. We sought to explore how COVID-impacted pre-clerkship students compared to pre-COVID pre-clerkship students with respect to procedural skill-related confidence and anxiety.
Methods: Participants from the 2022 SSTEP cohort (n = 24) were recruited to complete surveys measuring self-assessment of confidence and anxiety related to core procedural skills. Previous data using the same measures was concurrently gathered from past research with the 2016 SSTEP cohort (n = 39). Analyses were conducted using independent t-tests to measure differences between pre- and post-SSTEP confidence and anxiety both within and between the 2016 and 2022 cohorts.
Results: Post-SSTEP, the 2016 cohort reported benefits in four items regarding anxiety and 10 items regarding confidence (all p <.05). In comparison, the 2022 cohort reported improvements to eight items regarding anxiety and 12 items regarding confidence (all p <.05). Examining attitudes prior to the SSTEP, the 2022 cohort was more anxious and less confident concerning two-handed tying (p <.01) and instrument tying (p <.001), while also showing less confidence in two additional areas. Anxiety and confidence after the SSTEP were mostly comparable between the 2016 and 2022 cohorts, with only minor differences.
Conclusions: These results suggest that COVID-19 had a significant impact on students, as pre-SSTEP anxiety tended to be higher, while confidence tended to be lower in the 2022 cohort compared with the 2016 cohort. Despite this, SSTEP appeared to be a beneficial training supplement, as both anxiety and confidence were comparable between cohorts post-SSTEP.

Anti-Black racism in Undergraduate Medical Education in Canada: A Situational Assessment

Osman, S1, Ongolo-Zogo, C.1, Mensah, R1, Abdi, S.1, Ndumbe-Eyoh, S.1, Nnorom, O1, Dryden, O1, on behalf of the Black Health Education Collaborative

1Black Health Education Collaborative, University of Toronto and Dalhousie University, Toronto and Halifax, ON and NS, Canada

Corresponding Author: Samah Osman, email samah.osman@mail.utoronto.ca


Introduction: The Black Health Education Collaborative (BHEC) is a community of scholars and practitioners dedicated to improving Black health through education and research. In 2022, BHEC conducted a situational assessment to identify the extent of inclusion of anti-Black racism in undergraduate medical curricula in Canada.
Methods: A 20-question online survey was presented to Undergraduate Medical Education Deans across Canada. Quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed thematically to identify gaps and areas for improvement.
Results: Ten out of seventeen Canadian medical schools were represented in the survey including responses from faculty deans, Black health theme leads, and core faculty members. The situational assessment revealed a general commitment to equity, diversity, and inclusivity (EDI) but a lack of explicit focus on anti-Black racism and Black health. A few medical schools have established anti-racism curriculum working groups (n = 1), EDI task forces ( n = 2), and initiatives to increase admission, recruitment, and retention of Black students ( n =3 ). However, the anti-racism curriculum across medical schools largely remains suboptimal with limited resources to support education and teaching on anti-Black racism and Black health specifically. Survey respondents ranked the understanding of the impact of anti-Black racism on health and social determinants of health as a top priority and recognized their role as agents of change. The preferred method of acquiring knowledge on the subject was through facilitated modules and self-directed online modules. However, only two institutions in the process of developing such resources.
Conclusion: There is a gap in Black health and anti-Black racism curricula in Canadian medical schools. Filling this gap is crucial to improve health outcomes for Black populations and reducing racial health disparities. It is important to develop comprehensive resources on anti-Black racism and Black health grounded in critical race theory to address persistent issues of anti-Black racism and its impact on Black community health.

Developing an objective structured clinical examination (OSCE) with individuals with IDD as simulated patients for use in early medical education

Gilmar Gutierrez MD1, Isis Lunsky BHSc1, Olivier Rabu BMus2, Debra Hamer MD1

1School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada;
2Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

Corresponding Author: Isis Lunksy, email isis.lunsky@queensu.ca


Objectives: Individuals with Intellectual and Developmental Disabilities (IDD) have unique and often unmet health needs. Furthermore, physicians seldom receive early training serving this population. We aimed to address this gap by piloting an Objective Structured Clinical Examination (OSCE) with individuals with IDD as patient educators (PEs) for pre-clerkship medical students.
Methods: First- and second-year medical students from Queen’s University (n=25) participated in a virtual OSCE with individuals with IDD as PEs (n=5). We designed the scenarios to portray real PE experiences. Senior medical students and residents from Ontario (n=5) acted as objective observers (OOs). OOs assessed the students’ OSCE performance using a Prediger scale. Pre- and post-OSCE, students completed a self-report and a Prediger scale. These scales were analyzed using descriptive statistics and effect size using Cohen D (d) analysis. Post-OSCE, students underwent a semi-structured interview to collect qualitative data, which was analyzed using NVivo with two independent reviewers to determine whether the OSCE improved comfort and competency of students interacting with patients with IDD.
Results: Students reported a significant large effect size (d > 0.8) comparing their post-OSCE to pre-OSCE scores (Self-report: d=1.96, p<0.0001; Prediger: d=1.34, p<0.0001). OOs reported a significant large effect size comparing their assessments to the students’ pre- and post-OSCE Prediger scores (pre-OSCE: d=1.86, p<0.0001; post-OSCE: d=0.79, p=0.0013). 80% of students reported no previous experience interacting with a person with IDD. Qualitative analysis yielded the following themes: positive experience and perspective changes.
Discussion: Most participants reported no previous interactions with individuals with IDD and rated their skills lower compared to ratings by the more experienced OOs. Post-OSCE, these students rated themselves significantly higher and reflected positively on this experience, mentioning several perspective changes. This study should encourage educators and researchers to include individuals with IDD into medical education to ensure accurate representation of their unique experiences."

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