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Introduction: For general surgeons practising in rural areas, multiple factors influence care beyond skills learned in residency. The British Columbia Privileging Dictionary (BCPD) defines core and non-core procedures that shape the scope of general surgeons. Moreover, the Royal College has adopted a Competence by Design (CBD) curriculum which employs entrustable professional activities (EPAs) that list surgical skill residents must be proficient in by graduation. Our goal is to understand the current practice patterns of rural general surgeons in BC based on these policies and local factors. Methods: Medical service plan (MSP) data were collected from 2011 to 2021 based on general surgeons working in rural subsidiary agreement (RSA) communities. The MSP fee codes were organised into core or non-core procedures, as outlined by the BCPD. EPAs were assessed and compared to the non-core procedures. Results: From 2011 to 2021, 223,103 procedures were performed in rural sites in BC. On average, 90.97 (standard deviation = 20.78) of procedures done in all communities were BCPD core procedures. The most common non-core surgical care performed by general surgeons was in plastic surgery (n = 8035). Over 8 of procedures performed were not general surgery EPAs. Notably, none of the EPAs are considered non-core privileges and all EPAs have been performed in rural settings. Conclusion: General surgeons working in rural settings perform multiple procedures outside of EPAs which account for over 8 of their caseload and approximately 6 of procedures performed are non-core privileges. This provides some insight into the potential limitations of the BCPD on graduates hoping to practise in rural communities. As the CBD curriculum has been reported to provide a more flexible approach to learning, it may be tailored to suit residents' learning and career goals, including varied surgical skills to suit rural needs. Introduction: Pour les chirurgiens généraux exerçant en zone rurale, de multiples facteurs influencent les soins, et ce au-delà des compétences acquises en résidence. Le British Columbia Privileging Dictionary (BCPD) définit les procédures essentielles et non essentielles qui déterminent le champ d'action des chirurgiens généraux. En outre, le Collège royal a adopté un programme d'études intitulé « La compétence par conception » (CPC) qui utilise des activités professionnelles confiables (APC) qui énumèrent les compétences chirurgicales que les résidents doivent maîtriser avant d'obtenir leur diplôme. Notre objectif est de comprendre les modes de pratique actuels des chirurgiens généralistes ruraux en Colombie-Britannique en fonction de ces politiques et des facteurs locaux. Méthodes: Les données du Medical Service Plan (MSP, Plan de service médical) ont été recueillies entre 2011 et 2021 auprès des chirurgiens généralistes travaillant dans les communautés du « Rural Subsidiary Agreement » (RSA). Les codes d'honoraires du MSP ont été organisés en procédures essentielles ou non essentielles, comme indiqué par le BCPD. Les APC ont été évalués et comparés aux procédures non essentielles. Résultats: Entre 2011 et 2021, 223 103 procédures ont été réalisées dans des sites ruraux en Colombie-Britannique. En moyenne, 90,97 (écart-type = 20,78) des procédures effectuées dans toutes les communautés étaient des procédures de base du BCPD. Les soins chirurgicaux non essentiels les plus courants effectués par les chirurgiens généraux étaient la chirurgie plastique (n = 8035). Plus de 8 des procédures réalisées n'étaient pas des APC de chirurgie générale. Il est à noter qu'aucune des APC n'est considérée comme un privilège non essentiel et que toutes ont été réalisées en milieu rural. Conclusion: Les chirurgiens généraux travaillant en milieu rural pratiquent de nombreuses procédures en dehors de l'APC, représentant plus de 8 de leur charge de travail et environ 6 des procédures pratiquées sont des privilèges non essentiels. Cela donne une idée des limites potentielles du BCPD pour les diplômés qui espèrent exercer dans les communautés rurales. Étant donné que le programme d'études CPC est réputé offrir une approche plus souple de l'apprentissage, il peut être adapté aux objectifs d'apprentissage et de carrière des résidents, notamment en leur permettant d'acquérir des compétences chirurgicales variées pour répondre aux besoins des zones rurales. Keywords: Medical education, residency, rural surgery, Author(s): Rebecca M. Afford (corresponding author) [1]; Sara D. Bolin [1]; Madeleine E. Armstrong [1]; Tracy M. Scott [1]; Ahmer A. Karimuddin [1] INTRODUCTION General surgery residency in Canada is [...]

The government's rapid response to the spread of Covid-19 in British Columbia has resulted in drastic and unprecedented changes to the delivery of K-12 education. Using qualitative research methods, including remote in-depth interviews, this article addresses the question: What is the educational impact of the COVID-19 rapid response on teachers, students, and families in the Lower Mainland of British Columbia, Canada? Six themes are discussed, including teacher and family responses to change, vulnerability, transitions, work/home life balance, holistic teaching practices and communication. The article ends with recommendations relating to the communication and implementation of health, care, and educational practices that better attend to vulnerable populations and address social emotional wellness.

Background: Rural general surgeons perform many procedures outside the conventional scope of the specialty. Unique to British Columbia, the Rural Practice Subsidiary Agreement (RSA) formally defines rurality in the province. Our goal is to understand the scope of practice for BC's rural general surgeons and whether it has been affected over time by changing privileging guidelines. Methods: Medical Services Plan (MSP) data were collected from 2011 to 2021 for procedures billed by general surgeons in communities defined by the RSA as rural. We categorized codes from the MSP based on surgical specialty. For each community, we calculated the totals for these categories considering what other surgical specialties were present as well as changes over time. Results: From 2011 to 2021, 222 905 procedures were performed in 23 rural communities in BC. Colonoscopies were the most frequently performed procedure (n = 80114, 35.9%), followed by colorectal (n = 23891, 10.7%) and hernia procedures (n = 20 911, 9.4%). The most common unconventional procedures were plastic surgeries (n = 8077, 3.6%). Classification within the RSA did not significantly influence the percentage of unconventional general surgery procedures performed (p = 0.4). When another surgical specialty was present, there was often a decrease in the number of that specialty's procedures performed by general surgeons. Over the past decade, rural general surgeons performed fewer unconventional general surgery procedures (p < 0.001). Conclusion: General surgeons working in rural communities perform a variety of procedures based on resources, community need, and access to other specialists. Over the last decade, this appears to have been influenced by new privileging guidelines. Understanding the scope of rural general surgery can inform training opportunities and, as there is a migration away from rural surgeons performing as many unconventional procedures, can elucidate the implications on patients and communities. Contexte : En r gion rurale, les chirurgiens g n ralistes effectuent beaucoup d'interventions sortant du cadre conventionnel de pratique de leur sp cialit . La Colombie-Britannique est actuellement la seule province avoir mis en place l'entente Rural Practice Subsidiary Agreement (RSA), qui d finit officiellement la ruralit dans la province. Notre objectif est de mieux d limiter le champ de pratique des chirurgiens g n ralistes exer ant en milieu rural en Colombie-Britannique et de d terminer s'il a t affect dans le temps par l' volution des directives concernant l'octroi de privil ges. M thodes : Des donn es du r gime d'assurance maladie de la province (Medical Services Plan, ou MSP) pour la p riode de 2011 2021 ont t recueillies pour les interventions factur es par des chirurgiens g n ralistes dans les communaut s d sign es rurales selon la RSA. Nous avons class les codes du MSP selon la sp cialit chirurgicale. Pour chaque collectivit , nous avons calcul les totaux pour ces cat gories, tout en tenant compte des autres sp cialit s chirurgicales pr sentes et des changements dans le temps. R sultats : De 2011 2021, 222 905 interventions ont t effectu es dans 23 collectivit s rurales en Colombie-Britannique. La colonoscopic tait l'intervention la plus courante (n = 80 114, 35,9%), suivie des chirurgies colorectales (n = 23 891, 10,7%) et des r parations de hernies (n = 20 911, 9,4%). Parmi les interventions non classiques, la chirurgie plastique occupait le premier rang (n = 8077, 3,6%). La classification selon la RSA n'a pas eu d'influence significative sur le pourcentage de chirurgies g n rales non classiques effectu es (p = 0,4). Lorsqu'un prestataire d'une autre sp cialit chirurgicale tait pr sent, on observait souvent une baisse du nombre d'interventions de cette sp cialit effectu es par les g n ralistes. Au cours de la derni re d cennie, les chirurgiens g n ralistes en milieu rural ont effectu moins d'interventions de chirurgie g n rale non classiques (p < 0,001). Conclusion : Dans les collectivit s rurales, les chirurgiens g n ralistes effectuent un ventail d'interventions qui varie selon les ressources, les besoins communautaires, et l'acc s d'autres sp cialistes. Durant la derni re d cennie, cette diversit semble avoir t influenc e par les nouvelles directives concernant l'octroi de privil ges. En connaissant le champ de pratique des chirurgiens g n ralistes en milieu rural, on peut guider les occasions de formation et, alors que les g n ralistes effectuent de moins en moins d'interventions non classiques, mieux comprendre ce que cela signifie pour la patient le et les collectivit s., For Canadians in rural, remote, and northern settings, access to specialty surgical care is more challenging than in urban communities. Although the Canada Health Act states that its primary objective [...]

The University of British Columbia's (UBC) Division of General Surgery is a diverse group, including both academic and community surgeons. Since its launch in 2019, the UBC Reticulum website has been a transformative tool in engaging general surgeons, fellows, residents, students and researchers through its many features and user-created content, such as its messaging board, Netter, and Connect feature, which connects members based on their specialty, location, procedures and interests. Reticulum also serves as a valuable repository of educational resources and is instrumental in the division's goal of improving continuing medical education; the Reticulum mentorship grant program provides financial support for practising surgeons pursuing peer-mentorship projects. UBC Reticulum serves as a model for how to coordinate surgical education, research and quality improvement within diverse provincial divisions., The University of British Columbia (UBC) Reticulum website was created to provide an online platform for the diverse and geographically distributed network of general surgeons, residents and associated administrators and [...]

Emergence of SARS-CoV-2 in 2019 resulted in the COVID-19 pandemic (1). Since then, the virus has mutated into multiple variants. Each variant differed in transmissibility and severity of health outcomes, [...]