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Stagnant standardized test scores keep literacy achievement at the forefront of national education discussions. Increased conversations about the science of reading have propelled investigations into different types of phonics instruction. However, questions still linger such as "Which strategies are most effective for which students?", "How should interventions be structured for the best results?", and "Which school personnel should deliver these interventions?" To begin answering these questions, we conducted the present systematic literature review to synthesize the research surrounding phonics instruction for the last ten years in grades kindergarten through third using the systematic review methodology. Three overarching themes about phonics instruction emerged: (a) professional learning to foster a deep understanding of language; (b) instructional resources to support teachers with limited content or pedagogical knowledge; and (c) intervention intensity in relation to length and other factors. This review takes an in-depth look at what we, as scholars, know about phonics instruction and what we still need to know to advance reading scores.

Health services organisations are increasingly incorporating patient engagement strategies as a form of quality improvement. Such strategies take form in programmes where organisations partner with patients in order to learn from their experiences and thereby change how services are designed, delivered, and implemented. In this study, we examined the enactment of patient engagement programmes within an academic health science organisation in Canada. This was accomplished through an exploration of the various constructions of patient participants' legitimacy, credibility, and expertise as manifesting through participation in the various practices associated with the programmes. Analysis was based on a selection of international, national, and organisational texts, as well as interviews with patient participants (n = 20) and hospital staff members (n = 6). Through this analysis, we argue that organisations are not learning from patients per se, but are learning from particular constructions of patient subjectivities in the form of patient advisers. We argue that if patient engagement programmes are premised upon opportunities to learn from patients, these programmes require a coherent theory of workplace learning. We suggest attention to the politics of knowledge production as a fruitful way to conceptualise how clinicians and administrators might learn from patients at the organisational level.

Calls to increase the demographic representativeness of medical classes to better reflect the diversity of society are part of a growing international trend. Despite this, entry into medical school remains highly competitive and exclusive of marginalized groups. To address these questions, we conducted a Foucauldian discourse analysis of 15 publically available policy documents from the websites of Canadian medical education regulatory bodies, using the concepts of "excellence" (institutional or in an applicant), "diversity," and "equity" to frame the analysis. In most documents, there were appeals to broaden definitions of institutional excellence to include concerns for greater social accountability. Equity concerns tended to be represented as needing to be dealt with by people in positions of authority in order to counter a "hidden curriculum." Diversity was represented as an object of value, situated within a discontinuous history. As a rhetorical strategy, documents invoked complex societal shifts to promote change toward a more humanistic medical education system and profession. "Social accountability" was reified as an all-encompassing solution to most issues of representation. Although the policy documents proclaimed rootedness in an ethos of improving the societal responsiveness of the medical profession, our analysis takes a more critical stance towards the discourses identified. On the basis of our research findings, we question whether these calls may contribute to the maintenance of the specific power relations they seek to address. These conclusions lead us to consider the possibility that the discourses represented in the documents might be reframed to take into account issues of power distribution and its productive and reproductive features. A reframing of discourses could potentially generate greater inclusiveness in policy development processes, and afford disadvantaged and marginalized groups more participatory roles in the discussion.

Objectives: With the emergence of physician-manager (PM) curricula in medical education, more effective assessment tools are needed to evaluate psychiatry trainees in this role. The aim of this study was to determine psychiatry residents', program directors', and PM educators' perceptions about PM role-assessment. Methods: Psychiatry residents at two Canadian programs were given a survey on PM assessment and the use of portfolios to assess PM competency. Qualitative interviews of Canadian psychiatry educators and program directors were used to determine faculty perceptions on PM assessment. Authors analyzed survey data with descriptive statistics, and qualitative interviews were analyzed using a grounded theory approach. Results: Nearly 55% of psychiatry residents responded to the survey; 47% of residents did not want to change the way they were assessed by the PM role. Residents identified an array of assessment methods for each of the specific PM domains. Educator interview themes included supervisor and resident barriers to assessment, the need for new PM assessment approaches integrating multiple assessment methods, and a role for the use of portfolios if sufficient infrastructure was available. Conclusion: The data supported a preference for a multimodal approach to assessment of the PM role. Future research should examine the implementation of the proposed PM assessment tool. (Contains 1 table.)

Competency frameworks based on roles definitions are currently being used extensively in health professions education internationally. One of the most successful and widely used models is the CanMEDS Roles Framework. The medical literature has raised questions about both the theoretical underpinnings and the practical application of outcomes-based frameworks, however little empirical research has yet been done examining specific roles frameworks. This study examines the historical development of an important early roles framework, the Educating Future Physicians of Ontario (EFPO) roles, which were instrumental in the development of the CanMEDS roles. Prominent discourses related to roles development are examined using critical discourse analysis methodology. Exploration of discourses that emerged in the development of this particular set of roles definitions highlights the contextual and negotiated nature of roles construction. The discourses of threat and protection prevalent in the EFPO roles development offer insight into the visual construction of a centre of medical expertise surrounded by supporting roles (such as collaborator and manager). Non-medical expert roles may perhaps play the part of "armour" for the authority of medical expertise under threat. This research suggests that it may not be accurate to consider roles as objective ideals. Effective training models may require explicit acknowledgement of the socially negotiated and contextual nature of roles definitions.

Background: Globalization in medical education often means a "brain drain" of desperately needed health professionals from low- to high-income countries. Despite the best intentions, partnerships that simply transport students to Western medical schools for training have shockingly low return rates. Ethiopia, for example, has sent hundreds of physicians abroad for specialty training over the past 30 years, the vast majority of whom have not returned. This represents a highly problematic net transfer of financial and human resources from the Ethiopian people to Western countries that have failed to develop their own adequate health human resource plans. Methods: With this background in mind, in 2003 Addis Ababa University invited the University of Toronto to collaborate on the first Ethiopian psychiatric residency program to be run entirely in Ethiopia. Called the Toronto Addis Ababa Psychiatry Project (TAAPP), it was established on the principle of supplementing the ability of the small Addis Ababa University Department of Psychiatry to teach, provide clinical supervision, and to help develop educational capacity. Over the last 6 years the model has involved a large number of University of Toronto faculty and residents who have spent blocks of 1 month each in Addis Ababa. Results: This article describes the first three phases of TAAPP (I) Development of a model residency program; (II) Enhancing clinical, educational and leadership capacity; and (III) Sustainability, faculty development, and continuing education. Between 2003 and 2009, the number of psychiatrists in Ethiopia increased from 11 to 34; the Addis Ababa University Department of Psychiatry faculty increased members from three to nine. There are new departments of psychiatry established in four other university hospitals in Ethiopia outside the capital city. Mental health services are now being integrated within the national system of primary care. Conclusion: An important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.

Funding agencies in Canada are attempting to break down the organizational boundaries between disciplines to promote interdisciplinary research and foster the integration of the social sciences into the health research field. This paper explores the extent to which biomedical and clinician scientists' perceptions of social science research operate as a cultural boundary to the inclusion of social scientists into this field. Results indicated that cultural boundaries may impede social scientists' entry into the health research field through three modalities: (1) biomedical and clinician scientists' unfavourable and ambivalent posture towards social science research; (2) their opposition to a resource increase for the social sciences; and (3) clinician scientists procedural assessment criteria for social science. The paper also discusses the merits and limitations of Tom Gieryn's concept of boundary-work for studying social dynamics within the field of science.

Objective: Education is becoming a recognized career path in psychiatry. Yet, there are few published accounts of how to create sustainable structures within departments to support this academic focus. The authors document the creation and 5-year progress of the Research Innovation and Scholarship in Education (RISE) program at the largest psychiatry department in Canada. Methods: The authors analyzed the RISE archive of early proposals for enhancing scholarship in the department, the 5-year plan, annual reports, and curricular vitae of members and also gathered testimonials from inaugural residents and fellows of the program. Materials were analyzed using Boyer's framework of scholarship. Results: Organizationally, RISE has embodied all four tenets of Boyer's model of scholarship. The program has allowed education research, teaching, and creative professional development to flourish in the department, and there are considerably fewer barriers to pursuing an education career path. However, as the program expands, more work needs to be done to increase funding and protected time so that even more residents, fellows, and faculty can engage in educational scholarship. Conclusion: Enhancing medical education scholarship through a model that actively integrates research with teaching, creative professional development, and mentorship can help the trajectories of faculty and students wishing to make education a priority in their careers.

Objective: The authors sought to determine the learning needs, experiences, and attitudes of psychiatric residents in relation to war and mental health; to discover if residents in their training program have had clinical experiences with patients affected by war and if they believed that they were adequately trained to deal with these encounters; and to explore if residents believe psychiatrists should play a role in the lives of those affected by war and, if so, what types of roles they believe psychiatrists should take. Methods: The authors developed a survey to assess resident attitudes toward psychiatrists' roles in relation to war and related clinical experiences and learning needs. The survey was administered to psychiatric residents at the largest psychiatric residency program in Canada. Results: The majority of the 52 respondents believed that psychiatrists have a role in mitigating the effects of war. Although 75% of residents (n = 38) had encountered a patient who was traumatized by war, none reported feeling completely prepared. Approximately 90% of residents (n = 44) reported that they would like to learn more about this area. Conclusion: In a Canadian residency program that does not provide clinical rotations in a military hospital, most psychiatric residents surveyed were interested in the effects of war on mental health and would like more clinical training in this area.

The immunocompetence handicap hypothesis (ICHH) contends that testosterone-dependent, masculine traits are honest signals of the bearer's ability to withstand immunosuppression, yet empirical studies testing the ICHH have produced mixed results. The present research addressed the relationship between masculine vocal parameters and immunity in two samples: young adult men from the US and Canada (N = 267) and adolescent males from Bolivia (N = 44). All participants provided saliva samples, assayed for a biomarker of mucosal immunity associated with respiratory disease resistance: secretory immunoglobulin-A (sIgA). Participants also contributed speech samples, analyzed for two sexually dimorphic aspects of the human voice: 1) fundamental frequency (f o ; perceived as pitch) and vocal tract length (VTL; estimated using formant frequencies). Multiple regression models were used to assess the association between masculine vocal parameters and sIgA. Results indicated that lower f o and longer VTL were associated with higher sIgA levels. That is, both adult and adolescent males with more masculine voices showed better mucosal immunity (and therefore disease resistance) than those with less masculine voices. Although this accords with several previous studies on voice and sIgA, it contrasts with standard ICHH-derived predictions. We suggest that life-history theory provides a better conceptual framework for understanding the association between testosterone-dependent secondary sexual characteristics and immunity as it shifts the focus from immunosuppression to efficient immunoredistribution. [ABSTRACT FROM AUTHOR]

Individual variation in the age of pubertal onset is linked to physical and mental health, yet the factors underlying this variation are poorly understood. Life history theory predicts that individuals at higher risk of mortality due to extrinsic causes such as infectious disease should sexually mature and reproduce earlier, whereas those at lower risk can delay puberty and continue to invest resources in somatic growth. We examined relationships between a genetic predictor of infectious disease resistance, heterozygosity of the major histocompatibility complex (MHC), referred to as the human leukocyte antigen (HLA) gene in humans, and self-reported pubertal timing. In a combined sample of men from Canada (n = 137) and the United States (n = 43), MHC heterozygosity predicted later self-reported pubertal development. These findings suggest a genetic trade-off between immunocompetence and sexual maturation in human males. [ABSTRACT FROM AUTHOR]

Background: Sudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15-25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9-1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses. We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival.Methods: In this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9-1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation.Discussion: The ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more.Trial Registration: Prospectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059 . [ABSTRACT FROM AUTHOR]

We study the developmental and professional activities engaged in by 86 female adult soccer players from the senior national teams of Australia, Canada, England, Sweden, and the United States of America. Players completed the Participation History Questionnaire (PHQ) to elicit the amount and type of activities engaged in across their developmental and professional years, including milestones, soccer-specific activity and engagement in other sport activity. Greater specialisation than diversification characterised their childhood developmental activities, including all players starting in soccer in childhood and accumulating more hours in soccer activity than other sports during this period. However, interindividual variation further characterised these childhood activities, with a proportion of players diversifying into other sports and/or soccer play to a greater or lesser degree during childhood when compared to the other players. The amount of coach-led soccer practice increased for all players across their development culminating in an average of 15–16 h/wk across a 40-week season in early adulthood. In contrast, the amount of engagement in other sports and soccer peer-led play varied between players but generally decreased across adolescence to negligible amounts in late adolescence. Findings are commensurate with the deliberate practice framework and early engagement. [ABSTRACT FROM AUTHOR]

Reports on study examining effect of high school media program audiovisual components on student attitudes and behaviors at 15 public high schools in Calgary, Alberta, Canada. Discussion covers service areas, student attitudes and media center use, correlation between audiovisual-related services and student responses, and media center audiovisual programs. (32 references) (EJS)

Campylobacter is the leading cause of food-borne bacterial disease in Canada and many developed countries. One of the most common sources of human campylobacteriosis is considered to be the consumption or handling of raw or undercooked poultry. To date, few Canadian studies have investigated both the prevalence of Campylobacter on retail poultry and its potential impact on human clinical cases. The objective of this study was to evaluate the prevalence of Campylobacter spp. at the retail level and the correlation between subtypes recovered from chicken and those recovered from human clinical cases within the province of Nova Scotia, Canada. From this study 354 human clinical isolates were obtained from provincial hospital laboratories and a total of 480 packages of raw poultry cuts were sampled from retail outlets, yielding 312 isolates (65%), of all which were subtyped using comparative genomic fingerprinting (CGF). Of the 312 chicken isolates, the majority of isolates were C. jejuni (91.7%), followed by C. coli (7.7%) and C. lari (0.6%). Using CGF to subtype C. jejuni and C. coli isolates, 99 and 152 subtypes were recovered from chicken and clinical cases, respectively. The most prevalent human and chicken subtypes found in NS are similar to those observed nationally; indicating that the Campylobacter from this study appear to reflect of the profile of Campylobacter subtypes circulating nationally. Of the subtypes observed, only 36 subtypes were common between the two groups, however, these subtypes represented 48.3% of the clinical isolates collected. The findings from this study provides evidence that in Nova Scotia, retail poultry can act as a reservoir for Campylobacter subtypes that have been implicated in human illness. [ABSTRACT FROM AUTHOR]

Background: In 2009, an International Working Group (IWG) on the Assessment of Professionalism began collaborating and published recommendations in 2011. Nearly a decade later the IWG reconvened to take stock of the state of practice and research in professionalism and the impact of the 2011 report. Method: A bibliometric study identified all publications on assessment of professionalism since 2011, noting those that cited the original report. Articles were coded to identify the reason for citation and new trends in assessment. Bibliometric data were supplemented by discussion groups held at key international education meetings. Results: Six-hundred publications on the assessment of professionalism were found in Google Scholar and 164 in Web of Science since 2011, of which 177 (30%) and 84 (50%) respectively cited the original IWG publication. English language publications were most common (83%), but there were articles in 13 other languages by authors from 40 countries. The report was cited commonly to justify attention to professionalism in general (41%), assessment of professionalism (38%) and to explore professionalism in different countries and professions (25%). A thematic analysis showed that of 9 research areas recommended in 2011, 7 of 9 categories were represented with a large increase in research across languages and cultures. Conclusions: Though the assessment of professionalism remains a challenge the research base continues to grow, especially related to professionalism across cultures and languages, and a large percentage of publications cite the IWG recommendations. There remains a gap in research and writing about patients' perspectives. [ABSTRACT FROM AUTHOR]

Habitat loss and fragmentation result in landscapes where high quality habitat patches are surrounded by matrix habitats of low and variable quality. For mobile species to persist in such landscapes, individual animals often rely on the high quality habitats but also use matrix habitats for supplemental resources or while moving between higher quality patches. Determining what habitat features animals select when in these matrix areas is important, as retaining desirable features in lower quality habitats may enable species persistence. We examine a population of US federally threatened Canada lynx ( Lynx canadensis) in northcentral Washington, near the southwestern range limit, where lynx habitat is fragmented by topography, wildfires, and human impacts. We used Global Positioning System radio-collar data from 17 lynx in the North Cascade Mountains during 2007-2013 to explore lynx habitat use. We used Random Forest models to analyze core hunting, resting, and denning habitat, and the habitats lynx select while between patches of core habitat. While selecting core habitat, lynx used spruce ( Picea engelmannii)-fir ( Abies lasiocarpa), lodgepole pine ( Pinus contorta), and mixed sub-boreal-Douglas fir ( Pseudotsuga menziesii) forests, and avoided dry forests and forest openings including new burns. When not in core habitat, lynx used a wider range of habitats, including new burns where fire skips and residual trees offered cover. Our results show clearly that Canada lynx tolerate a wider range of habitats where they occupy fragmented landscapes. Consequently, maintaining animals in fragmented landscapes requires that we identify and conserve not only the core habitats a particular species selects, but also the habitat features animals use while in less suitable environments. [ABSTRACT FROM AUTHOR]

CGG deployed HELITEM, a helicopter-borne time domain electromagnetic (TDEM) system over the Lalor Deposit and other proximal deep conductors of Hudbay Minerals in northern Canada. The Lalor Deposit is ~570m deep and is a difficult target for airborne EM systems. The system was configured with a dipole moment of up to 1.9MAm2 at base frequencies of 15 Hz and 30 Hz. The results of this survey have been used to characterise the TDEM response from deep volcanogenic massive sulphide (VMS) deposits within the region. HELITEM is the only airborne controlled source TDEM system to have detected the Lalor Deposit. [ABSTRACT FROM AUTHOR]

Background: Competency-based medical education as a resident-training format will move postgraduate training away from time-based training, to a model based on observable outcomes. The purpose of this study was to determine whether junior residents and senior residents could demonstrate clinical skills to a similar level, after a sports medicine rotation.Methods: All residents undertaking a three-month sports medicine rotation had to pass an Objective Structured Clinical Examination. The stations tested the fundamentals of history-taking, examination, image interpretation, differential diagnosis, informed consent, and clinical decision-making. Performance at each station was assessed with a binary station-specific checklist and an overall global rating scale, in which 1 indicated novice, 2 indicated advanced beginner, 3 indicated competent, 4 indicated proficient, and 5 indicated expert. A global rating scale was also given for each domain of knowledge.Results: Over eighteen months, thirty-nine residents (twenty-one junior residents and eighteen senior residents) and six fellows (for a total of forty-five participants) completed the examination. With regard to junior residents and senior residents, analysis using a two-tailed t test demonstrated a significant difference (p < 0.01) in both total checklist score and overall global rating scale; the mean total checklist score (and standard deviation) was 56.15% ± 10.99% for junior residents and 71.87% ± 8.94% for senior residents, and the mean global rating scale was 2.44 ± 0.55 for junior residents and 3.79 ± 0.49 for senior residents. There was a significant difference between junior residents and senior residents for each knowledge domain, with a significance of p < 0.05 for history-taking and p < 0.01 for the remainder of the domains.Conclusions: Despite intensive teaching within a competency-based medical education model, junior residents were not able to demonstrate knowledge as well as senior residents, suggesting that overall clinical experience is critically important for achieving competency as measured by the Objective Structured Clinical Examination. [ABSTRACT FROM AUTHOR]

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This paper presents perspectives and controversies surrounding the use of milestones to assess competency in outcomes-based medical education. Global perspectives (Canada, Europe, and the United States) and developments supporting their rationales are discussed. In Canada, there is a significant movement away from conceptualizing competency based on time, and a move toward demonstration of specific competencies. The success of this movement may require complex (rather than reductionist) milestones that reflect students' progression through complexity and context and a method to narrate their journey. European countries (United Kingdom, France, and Germany) have stressed the complexity associated with time and milestones for medical students to truly achieve competence. To meet the changing demands of medicine, they view time as actually providing students with knowledge and exposure to achieve various milestones. In the United States, milestones are based on sampling throughout professional development to initiate lifelong learning. However, the use of milestones may not imply overall competence (reductionism). Milestones must be developed alongside outcomes-based curriculum with use of faculty and competency committees. The perspectives outlined in this paper underscore emerging challenges for implementing outcomes-based medical education and call for new conceptualizations of competence. [ABSTRACT FROM AUTHOR]

Context Calls to increase medical class representativeness to better reflect the diversity of society represent a growing international trend. There is an inherent tension between these calls and competitive student selection processes driven by academic achievement. How is this tension manifested? Methods Our three-phase interdisciplinary research programme focused on the discourses of excellence, equity and diversity in the medical school selection process, as conveyed by key stakeholders: (i) institutions and regulatory bodies (the websites of 17 medical schools and 15 policy documents from national regulatory bodies); (ii) admissions committee members ( ACMs) (according to semi-structured interviews [ n = 9]), and (iii) successful applicants (according to semi-structured interviews [ n = 14]). The work is theoretically situated within the works of Foucault, Bourdieu and Bakhtin. The conceptual framework is supplemented by critical hermeneutics and the performance theories of Goffman. Results Academic excellence discourses consistently predominate over discourses calling for greater representativeness in medical classes. Policy addressing demographic representativeness in medicine may unwittingly contribute to the reproduction of historical patterns of exclusion of under-represented groups. In ACM selection practices, another discursive tension is exposed as the inherent privilege in the process is marked, challenging the ideal of medicine as a meritocracy. Applicants' representations of self in the 'performance' of interviewing demonstrate implicit recognition of the power inherent in the act of selection and are manifested in the use of explicit strategies to 'fit in'. Conclusions How can this critical discourse analysis inform improved inclusiveness in student selection? Policymakers addressing diversity and equity issues in medical school admissions should explicitly recognise the power dynamics at play between the profession and marginalised groups. For greater inclusion and to avoid one authoritative definition of excellence, we suggest a transformative model of faculty development aimed at promoting multiple kinds of excellence. Through this multi-pronged approach, we call for the profession to courageously confront the cherished notion of the medical meritocracy in order to avoid unwanted aspects of elitism. [ABSTRACT FROM AUTHOR]

Context The use of roles such as medical expert, advocate or communicator to define competencies is currently popular in health professions education. Can MEDS is one framework that has been subject to great uptake across multiple countries and professions. The examination of the historical and cultural choices of names for roles generates insight into the nature and construction of roles. One role that has appeared in and disappeared from roles-based frameworks is that of the 'person'. Methods In order to examine the implications of explicitly including or excluding the role of the 'physician as person' in a competency framework, we conducted a contrastive analysis of the development of frameworks in Canada and the Netherlands. We drew upon critical social science theoretical understandings of the power of language in our analysis. Results In Canada, the 'person' role was a late addition to the precursory work that informed Can MEDS, and was then excluded from the final set of Can MEDS role names. In the Netherlands, a 'reflector' role was added in some Dutch schools and programmes when Can MEDS was adopted. This was done in order to explicitly emphasise the importance of the 'person' of the trainee. Conclusions In analysing choices of names for roles, we have the opportunity to see how cultural and historical contexts affect conceptions of the roles of doctors. The taking up and discarding of the 'person' role in Canada and the Netherlands suggest that as medical educators we may need to further consider the ways in which we wish the trainee as a person to be made visible in the curriculum and in assessment tools. [ABSTRACT FROM AUTHOR]

Calls to increase the demographic representativeness of medical classes to better reflect the diversity of society are part of a growing international trend. Despite this, entry into medical school remains highly competitive and exclusive of marginalized groups. To address these questions, we conducted a Foucauldian discourse analysis of 15 publically available policy documents from the websites of Canadian medical education regulatory bodies, using the concepts of 'excellence' (institutional or in an applicant), 'diversity,' and 'equity' to frame the analysis. In most documents, there were appeals to broaden definitions of institutional excellence to include concerns for greater social accountability. Equity concerns tended to be represented as needing to be dealt with by people in positions of authority in order to counter a 'hidden curriculum.' Diversity was represented as an object of value, situated within a discontinuous history. As a rhetorical strategy, documents invoked complex societal shifts to promote change toward a more humanistic medical education system and profession. 'Social accountability' was reified as an all-encompassing solution to most issues of representation. Although the policy documents proclaimed rootedness in an ethos of improving the societal responsiveness of the medical profession, our analysis takes a more critical stance towards the discourses identified. On the basis of our research findings, we question whether these calls may contribute to the maintenance of the specific power relations they seek to address. These conclusions lead us to consider the possibility that the discourses represented in the documents might be reframed to take into account issues of power distribution and its productive and reproductive features. A reframing of discourses could potentially generate greater inclusiveness in policy development processes, and afford disadvantaged and marginalized groups more participatory roles in the discussion. [ABSTRACT FROM AUTHOR]

The article presents the case study of Canada related on its needs for international medical graduates and professionals. It mentions that the countr needs such number of medical professionals particularly in the field of medical specialization and family healthcare as they are two of the most demand occupations for the Federal Skilled Worker Program of the country.

Background: Medical education has traditionally been compartmentalized into basic and clinical sciences, with the latter being viewed as the skillful application of the former. Over time, the relevance of basic sciences has become defined by their role in supporting clinical problem solving rather than being, of themselves, a defining knowledge base of physicians. Methods: As part of the national Future of Medical Education in Canada (FMEC MD) project, a comprehensive empirical environmental scan identified the timing and integration of basic sciences as a key pressing issue for medical education. Using the literature review, key informant interviews, stakeholder meetings, and subsequent consultation forums from the FMEC project, this paper details the empirical basis for focusing on the role of basic science, the evidentiary foundations for current practices, and the implications for medical education. Findings: Despite a dearth of definitive relevant studies, opinions about how best to integrate the sciences remain strong. Resource allocation, political power, educational philosophy, and the shift from a knowledge-based to a problem-solving profession all influence the debate. There was little disagreement that both sciences are important, that many traditional models emphasized deep understanding of limited basic science disciplines at the expense of other relevant content such as social sciences, or that teaching the sciences contemporaneously rather than sequentially has theoretical and practical merit. Innovations in integrated curriculum design have occurred internationally. Less clear are the appropriate balance of the sciences, the best integration model, and solutions to the political and practical challenges of integrated curricula. Discussion: New curricula tend to emphasize integration, development of more diverse physician competencies, and preparation of physicians to adapt to evolving technology and patients' expectations. Refocusing the basic/clinical dichotomy to a foundational/applied model may yield benefits in training widely competent future physicians. [ABSTRACT FROM AUTHOR]

Abstract: Habitat fragmentation alters the edges of remnant habitat patches. We examined changes in the plant community and soil in relation to distance from edge and edge type for shrub-steppe and pine savannah grasslands in southern British Columbia, Canada. Community composition showed significant nonlinear relationships with distance-to-edge more frequently at paved roads and fruit crops than at dirt roads or control sites (i.e., in the interior of grassland patches), with changes typically extending 25–30m. More exotic species and fewer native species were found near edges, and edges showed decreased cryptogam cover and increased bare ground, especially near paved roads. The soil factors that best predicted compositional changes were soil pH and Cu/Mn at paved roads, soil pH and nitrogen at fruit crops, and soil resistance at dirt roads. Variation partitioning suggested that both direct (e.g., propagule pressure) and indirect (environmental change) factors mediated edge-related community changes, and provided evidence that nonlinear responses at developed edges were not due to natural gradients. Given the range of grassland patch sizes in this region (many patches 1–100ha), the edge effects we observed represent a considerable loss of “core” habitat, which must be accounted for in conservation planning and site restoration. [Copyright &y& Elsevier]

Suicide research on epidemiology, service utilization, and prevention strategies tend to focus on urban areas, resulting in a conceptualization of suicide that may not be applicable to rural populations. Rural areas have differing geographical, socioeconomic, political, and cultural characteristics that must be considered in the development and implementation of evidence-based suicide prevention strategies. Many countries have identified rural suicide as a major public health concern and share common challenges in developing prevention strategies. To address these issues, in June 2009, researchers at the University of Toronto and Tsinghua University, Beijing, China, held a symposium entitled "Improving Rural Mental Health Care in China and Canada to Prevent Suicide." This ongoing collaboration focuses on highlighting similarities and differences in rural suicide between countries and the identification of shared barriers to care and common strengths and challenges in suicide prevention. This collaboration has informed the development of a matrix model of rural suicide prevention that is evidenced-based, providing a selection of interventions targeting specific risk factors for rural suicide while allowing for flexibility to address social and cultural issues. This article illustrates a matrix model of rural suicide prevention by focusing on a comparative analysis of rural suicide in Canada and China. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 95-106 One hundred years after the Flexner report remade medical education in North America, many countries are reviewing the purpose and organisation of medical education. In Canada, a national study is being undertaken to define important issues and challenges for the future of medical education. The objectives of this paper are to describe the process of conducting an empirical environmental scan at a national level, and to present the research findings of this scan. Thirty national key informant interviews were conducted, transcribed and coded to identify key themes. Interview data were triangulated with data sourced from 34 commissioned literature reviews and a series of national focus groups. Ten key issues or priorities were identified and used to generate detailed review papers used by the Association of Faculties of Medicine of Canada to create a blueprint for the evolution of medical education. The new priorities have major implications for areas ranging from admissions, curriculum content, educational process and the need to articulate the purpose and responsibilities of medical schools in society. This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries. [ABSTRACT FROM AUTHOR]

Threats to species’ persistence are typically mitigated via lengthy and costly recovery planning processes that are implemented only after species are at risk of extinction. To reduce overall threats and minimize risks to species not yet imperiled, a proactive and broad-scale framework is needed. Using data on threats to imperiled species in Canada to illustrate our approach, we link threats to industries causing the harm, thus providing regulators with quantitative data that can be used directly in cost-benefit and risk analyses to broadly reduce threat levels. We then show how ranking the ease of threat abatement and reversal assists prioritization by identifying threats that are easiest to mitigate as well as threats that are possible to abate but nearly impossible to reverse. This new framework increases the usefulness of widely available threat data for preventative conservation and species recovery. [ABSTRACT FROM AUTHOR]

Background: Interdisciplinary health research is a priority of many funding agencies. We surveyed clinician and biomedical scientists about their views on the value and funding of interdisciplinary health research. Methods: We conducted semistructured interviews with 31 biomedical and 30 clinician scientists. The scientists were selected from the 2000-2006 membership lists of peer-review committees of the Canadian Institutes of Health Research. We investigated respondents' perspectives on the assumption that collaboration across disciplines adds value to health research. We also investigated their perspectives on funding agencies' growing support of interdisciplinary research. Results: The 61 respondents expressed a wide variety of perspectives on the value of interdisciplinary health research, ranging from full agreement (22) to complete disagreement (11) that it adds value; many presented qualified viewpoints (28). More than one-quarter viewed funding agencies' growing support of interdisciplinary research as appropriate. Most (44) felt that the level of support was unwarranted. Arguments included the belief that current support leads to the creation of artificial teams and that a top-down process of imposing interdisciplinary structures on teams constrains scientists' freedom. On both issues we found contrasting trends between the clinician and the biomedical scientists. Interpretation: Despite having some positive views about the value of interdisciplinary research, scientists, especially biomedical scientists, expressed reservations about the growing support of interdisciplinary research. [ABSTRACT FROM AUTHOR]

Funding agencies in Canada are attempting to break down the organizational boundaries between disciplines to promote interdisciplinary research and foster the integration of the social sciences into the health research field. This paper explores the extent to which biomedical and clinician scientists’ perceptions of social science research operate as a cultural boundary to the inclusion of social scientists into this field. Results indicated that cultural boundaries may impede social scientists’ entry into the health research field through three modalities: (1) biomedical and clinician scientists’ unfavourable and ambivalent posture towards social science research; (2) their opposition to a resource increase for the social sciences; and (3) clinician scientists procedural assessment criteria for social science. The paper also discusses the merits and limitations of Tom Gieryn’s concept of boundary-work for studying social dynamics within the field of science. [ABSTRACT FROM AUTHOR]

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Background Despite many economic and political similarities between France and Canada, particularly in their health care systems, there are very significant differences in their systems of medical education. Aim This work aims to highlight the sociohistorical values of each country that explain these differences by comparing the medical education systems of the 2 countries, including medical schools (teachers, funding), key processes (curriculum, student selection) and quality assurance methods. Discussion In France, means and processes are standardised and defined at a national level. France has almost no national system of assessment of medical schools nor of students. By contrast, Canada leaves medical schools free to design their medical curricula, select students and appoint teachers using their own criteria. In order to guarantee the homogeneity and quality of graduates, the medical profession in Canada has created independent national organisations that are responsible for accreditation and certification processes. Each country has a set of founding values that partly explain the choices that have been made. In France these include equality and the right to receive free education. In Canada, these include equity, affirmative action and market-driven tuition. Conclusion Many of the differences are more easily explained by history and national values than by a robust base of evidence. There is a constant tension between a vision of education promoted by medical educators, based on contextually non-specific ideas such as those found in the medical education literature, and the sociopolitical foundations and forces that are unique to each country. If we fail to consider such variables, we are likely to encounter significant resistance when implementing reforms. [ABSTRACT FROM AUTHOR]

Context Problem based learning (PBL) has become an integral component of medical curricula around the world. In Ontario, Canada, PBL has been implemented in all five Ontario medical schools for several years. Although proper and timely feedback is an essential component of medical education, the types of feedback that students receive in PBL have not been systematically investigated. Objectives In the first multischool study of PBL in Canada, we sought to determine the types of feedback (grades, written comments, group feedback from tutor, individual feedback from tutor, peer feedback, self-assessment, no feedback) that students receive as well as their satisfaction with these different feedback modalities. Subjects and methods We surveyed a sample of 103 final year medical students at the five Ontario schools (University of Toronto, McMaster University, Queens University, University of Ottawa and University of Western Ontario). Subjects were recruited via E-mail and were asked to fill out a questionnaire. Results Many students felt that the most helpful type of feedback in PBL was individual feedback from the tutor, and indeed, individual feedback was one of the more common types of feedback provided. However, although students also indicated a strong preference for peer and group feedback, these forms of feedback were not widely reported. There were significant differences between schools in the use of grades, written comments, self-assessment and peer feedback, as well as the immediacy of the feedback given. Conclusions Across Ontario, students do receive frequent feedback in PBL. However, significant differences exist in the types of feedback students receive, as well as the timing. Although rated highly by students at all schools, the use of peer feedback and self-assessment is limited at most, but not all, medical schools. [ABSTRACT FROM AUTHOR]

The National Library of Canada (NLC) is involved in a range of digital library (DL) initiatives which contribute to the fulfillment of its mandate and support the growing range of DL services that complement the Library's more traditional collections and services. Incorporated in the NLC's DL initiatives are projects relating to digitization, collecting Canadian networked electronic publications, development of virtual catalogues, metadata creation, and preservation of digital resources. Issues relating to collaboration, access to digital collections and databases, and preservation are addressed in the Canadian context based on NLC's experience to date. [ABSTRACT FROM AUTHOR]

The article discusses tips and techniques, as well as considerations for clinical assessment for instrumental birth, focusing on universal lessons across three different continents that include Ireland, Canada and Australia. It presents a compilation of clinical experience from respected teachers on how to accurately assess the second stage of labour and offer safe and effective instrumental birth to women and care for their babies.

The growing interest in interdisciplinary research within the Canadian health sciences sector has been manifested by initiatives aimed at increasing the involvement of the social sciences in this sector. Drawing on Bourdieu''s concept of field and Knorr-Cetina''s concept of epistemic culture, this study explores the extent to which it is possible for the social sciences to integrate into, and thrive in, a field in which the experimental paradigm occupies a hegemonic position. Thirty-one semi-structured interviews were conducted to explore biomedical scientists'' receptiveness toward the social sciences in general and to qualitative research in particular. We found that these respondents exhibited a predominantly negative posture toward the social sciences; however, we also found considerable variation in their judgments and explanations. Eight biomedical scientists tended to be receptive to the social sciences, 7 ambivalent, and 16 unreceptive. The main rationale expressed by receptive respondents is that the legitimacy of a method depends on its capacity to adequately respond to a research question and not on its conformity to the experimental canon. Unreceptive respondents maintained that the social sciences cannot generate valid and reliable results because they are not conducive to the experimental design as a methodological approach. Ambivalent respondents were characterized by their cautiously accepting posture toward the social sciences and, especially, by their reservations about qualitative methods. Based on the biomedical scientists'' limited receptiveness, we can anticipate that the growth of the social sciences will continue to meet obstacles within the health research field in the near future in Canada. [Copyright &y& Elsevier]

Our aim was to assess the developmental activities that best define elite players in female soccer in one of the top nations for female soccer in the world. In addition to measurement of career practice hours in soccer and other sports, we quantified hours engaged in activities judged high in challenge. Adult National-team (n = 21) and lesser-skilled Varsity (n = 24) female soccer players in Canada provided career estimates of hours in soccer and other sports during childhood and adolescence. Subjective ratings of challenge were provided for each activity across development, providing an indication of practice quality. Both groups engaged in more coach-led soccer activities (practice, competition) than soccer play and spent the majority of their time in childhood in soccer compared to other sports. National players participated in more play that was more challenging and engaged in more moderate to high challenge practice, when compared to Varsity players. The importance of early engagement in soccer specific developmental activities for elite female soccer players in Canada was highlighted, as previously reported in male players. However, hours in soccer play during childhood were low in both groups and were lower than estimates from male players. Although the data do not fit squarely with any one pathway, they are mostly consistent with an early specialization route. • National & Varsity women soccer players competing at the highest levels took part. • Elite groups were distinguished by childhood self-directed play not practice. • Relative to practice hours and to men, hours in play were low (<25% in childhood). • National players engaged in more hours of soccer activities rated challenging. • Like male players, women started young and showed majority engagement in soccer. [ABSTRACT FROM AUTHOR]

Abstract: The Twenty-fifth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 16–18 July 2009 at the Westin Bayshore Hotel in Vancouver, British Columbia, Canada. There were 521 registered attendees, including 339 (65%) individuals from 42 of the United States and 182 (35%) attendees from 32 countries outside the United States. [Copyright &y& Elsevier]