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The present study was undertaken to evaluate effect of traditional anterior repair versus site specific anterior repair in reduction of urinary symptoms in women with Pelvic organ Prolapse. During the study period of 2 years 140 women belonging to reproductive, peri-menopausal and postmenopausal age groups were included in the study. Employing past literature, the sample size calculated was 140. All women were assessed pre-operatively by the assessment method – Pelvic organ prolapse quantification (POP-Q) system. 70 women belonging to Group A were treated according to vaginal hysterectomy with traditional anterior repair and 70 women belonged to Group B who were treated according to vaginal hysterectomy with site specific anterior repair. Post-operatively, all women were followed up till 7th post-operative day and were assessed for anatomical and functional improvement to determine a better method for repair in reduction of urinary symptoms in women with pelvic organ prolapse. Our study shows functional and anatomical outcomes of traditional anterior repair and site specific anterior repair. 48 of 70 women (68.2%) who were subjected to traditional anterior repair and 52 of 70 women (73.4%) who were subjected to site specific anterior repair had marked functional improvement after surgery. 58 of 70 women (83.2%) belonging to traditional anterior repair group and 67 of 70women (95.3%) belonging to Site specific anterior repair group had considerable anatomical improvement post-operatively. This impresses the role of site specific anterior repair in women with pelvic organ prolapse for attaining better functional and anatomical outcome. Keywords: Pelvic organ prolapse, Traditional repair, Site specific repair, Vaginal hysterectomy, POP-Q, Urinary symptoms

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. Insomnia is a frequent sleep problem that interferes with daily activities. It may play a role in the development of co-morbid conditions such as arterial hypertension. Many types of research, however, imply that CBT is a superior therapy with a better long-term effect. In this descriptive analysis, we retrospect the literature concerning CBT and insomnia. To retrospect the literature focusing on CBT and Sleep Quality. We searched the databases like Google scholar, pub med and Cochrane, and Embase, web of science with keywords (Cognitive behavioral therapy, Sleep quality, insomnia, physical therapy, and physiotherapist). We reviewed 104 articles out of which 25 studies were enrolled. We reviewed abstracts of 102 articles from which we shortlisted 85 articles. 85 articles were analyzed and reviewed in detail out of which 30 are cited in the present review. We found sufficient literature supporting the use of CBT to modify sleep quality or to deal with insomnia. However, there is ambiguity about the execution of this therapy among the clinicians. The literature focusing on the exact execution of CBT is needed which will make the clinicians incorporate this treatment in their day-to-day practice and benefit the patients.

Introduction In spite of the implementation of the National nutritional anemia prophylaxis program in India, the prevalence of anemia during pregnancy is 50 in 100 women. One main cause for the high frequency of anemia among antenatal women in India is a lack of iron consumption. Few studies are available in the literature where efforts have been made to improve compliance with iron therapy. In the same line of thinking, it was decided in the present study to use mobile phone calls as a reminder for iron tablets. Method The present study is a randomized controlled open-label trial. Antenatal women with gestational age between 13-28 weeks of pregnancy diagnosed with iron deficiency anemia (Hb - 8 to 11 gm/dl) having mobile phones were included in the study. Recruited women were randomized into two groups of study groups receiving standard therapy with the addition of fortnightly mobile phone call reminders and a control group receiving standard therapy alone. Results Compliance with iron supplementation was observed higher in the study group as compared to the control group (range of 48% to 93%). There was a mean hemoglobin rise in both the groups at the time of delivery compared with the hemoglobin at the time of recruitment (Study group- 9.74 to 10.69, Control group- 9.48 to 10.06). There was a statistically higher (0.00001) increase in the mean hemoglobin concentration in the study group (0.96 gm/dl) as compared to the control group (0.59 gm/dl). The reasons for poor compliance were boredom with taking daily oral iron therapy (66.66%), constipation (3.7%), forgetfulness (14.81%), and heartburn (14.81%). There was no statistical difference in the reason for poor compliance with iron supplementation in both groups. Conclusion The present study concludes that mobile phone call reminders along with standard therapy with iron supplementation improve compliance with iron supplementation and lead to a greater rise in hemoglobin in antenatal women with iron deficiency anemia.

Women of reproductive age are suffering from severe hormonal imbalance due to polycystic ovarian syndrome (PCOS).Clinical manifestations of PCOS are diverse including hyperandrogenism, anovulation, infertility and increased risk of metabolic diseases besides psychosocial dysfunction.Additionally, PCOS leads to various other disturbances such as glucose tolerance, cardiovascular disease, dyslipidemia, obesity and metabolic disturbances. Environmental pollutants and Xenobiotic compounds cause changes in gut microbiota, which further affects metabolism causing metabolic disturbances may lead to PCOS.Various metabolic anomalies resulting from interaction with xenobiotic compounds and environmental pollutants contribute for hormonal imbalance. It is an interlinked vicious circle affected by epigenetic and environmental parameters.Epigenetic approach and molecular analysis of genes involved in PCOS is essential for specific treatment.Biochemical markers like assessment of hormones(hyperandrogenism)and ultrasound (in patients above twenty years of age)used as diagnostic parameters for detection of PCOS. Adaptinga healthy lifestyle and minimal exposure to xenobiotic compounds and resetting the disturbed sleep cycle will benefit the patient. Study of molecular markers will help in treating the PCOS in a better manner. This review focuses on important parameters of pathophysiology, which will help in understanding andcreating awarenesson PCOS.

BACKGROUND: The etiology and pathophysiology of hypertensive disorders of pregnancy remains enigmatic, and till date, no test can accurately predict it. Early screening may allow vigilant antenatal surveillance, timely delivery and thus substantially reduce maternal and perinatal morbidity and mortality. Our study aims to evaluate the predictive value of uterine artery mean pulsatility index (PI) at 11–14 weeks and find a reference value for hypertensive disorders of pregnancy. METHODS: A prospective study of 240 antenatal women using non-probability simple random sampling was carried out in a tertiary care center. Mean uterine artery PI was obtained at 11–14 weeks of gestation. Pregnancies were followed till delivery and 7 days postpartum. The major end point was development of hypertensive disorders of pregnancy. Maternal and neonatal outcomes were also assessed. RESULTS: The predictability of uterine artery mean pulsatility index (PI) at 11–14 weeks for hypertensive disorders of pregnancy was significantly high with an odds ratio of 174.45 (95% CI 65.31–549.13; p

Introduction The use of social media is rapidly changing how educational content is delivered and knowledge is translated for physicians and trainees. This scoping review aims to aggregate and report trends on how health professions educators harness the power of social media to engage physicians for the purposes of knowledge translation and education. Methods A scoping review was conducted by searching four databases (PubMed, Scopus, Embase, and ERIC) for publications emerging between 1990 to March 2018. Articles about social media usage for teaching physicians or their trainees for the purposes of knowledge translation or education were included. Relevant themes and trends were extracted and mapped for visualization and reporting, primarily using the Cook, Bordage, and Schmidt framework for types of educational studies (Description, Justification, and Clarification). Results There has been a steady increase in knowledge translation and education-related social media literature amongst physicians and their trainees since 1996. Prominent platforms include Twitter (n = 157), blogs (n = 104), Facebook (n = 103), and podcasts (n = 72). Dominant types of scholarship tended to be descriptive studies and innovation reports. Themes related to practice improvement, descriptions of the types of technology, and evidence-based practice were prominently featured. Conclusions Social media is ubiquitously used for knowledge translation and education targeting physicians and physician trainees. Some best practices have emerged despite the transient nature of various social media platforms. Researchers and educators may engage with physicians and their trainees using these platforms to increase uptake of new knowledge and affect change in the clinical environment. Electronic supplementary material The online version of this article (10.1007/s40037-019-00542-7) contains supplementary material, which is available to authorized users.

BACKGROUND: Online resources for emergency medicine (EM) trainees and physicians have variable quality and inconsistent coverage of core topics. In this first entry of the Society for Academic Emergency Medicine Systematic Online Academic Resource (SOAR) series, we describe the application of a systematic methodology to comprehensively identify, collate, and curate online content for topic‐specific modules. METHODS: A list of module topics and related terms was generated from the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine. The authors selected “renal and genitourinary” for the first module, which contained 35 terms; all MeSH headers and colloquial synonyms related to the topic and related terms were searched both within the 100 most impactful online educational websites per the Social Media Index and the FOAMsearch.net search engine. Duplicate entries, journal articles, images, and archives were excluded. The quality of each article was rated using the revised METRIQ (rMETRIQ) score. RESULTS: The search yielded 13,058 online resources. After 12,717 items were excluded, 341 underwent quality assessment. All renal/genitourinary topics were covered by at least one resource. The median rMETRIQ score was 11 of 21 (interquartile range = 8–14). Calculus of urinary tract was most prominently featured with 60 posts. Thirty‐four posts (10% of full‐text screened FOAM articles) covering 12 core topics were identified as high quality (rMETRIQ ≥ 16). CONCLUSIONS: We demonstrated the feasibility of systematically identifying and curating FOAM resources for a specific EM topic and identified an overrepresentation of some subtopics. This curated list of resources may guide trainees, teacher recommendations, and resource producers. Further entries in the series will address other topics relevant to EM.

Background/Purpose: Medical students face numerous stressors during their pre-clinical years, including developing confidence in their skills, knowledge and deciding which specialty to pursue. For those interested in specialties with limited integration into the traditional pre-clinical curriculum, or students who still have a broad range of interests at the end of their pre-clinical studies, a two-week Pre-clerkship Residency Exploration Program (PREP) could be a useful tool to reduce career-decision-making anxiety. Objectives: To assess whether PREP, a two-week intensive elective for second year medical students, can be effective in reducing performance anxiety and stress related to the transition into a clinical learning environment. Methods: 37 second year medical students completed pre- and post-program surveys that assessed, on a Likert-scale, their level of performance anxiety during clinical electives, as well as their anxiety oriented towards future career decisions (i.e., clerkship, specialty selection, and residency match). Results: Of those who participated, performance anxiety was low at baseline and was unchanged by the end of PREP (p-value = 0.29). However, there was a significant decrease in stress surrounding exposure to enough specialties to make an informed career choice (p-value < 0.001). Conclusion: While this cohort of participants were not stressed about their clinical performance, they are anxious to explore as many specialties as possible during their pre-clinical years to help make informed career decisions. PREP may serve as an effective tool to expose medical students to a high volume of specialties and reduce the stress associated with transitioning into a clinical learning environment., Background/Purpose: While there is extensive published research describing how to best select medical school applicants, there is a paucity of research on how applicants choose a medical school if they have multiple offers of admission. The aim of this study was to assess if an offer of admission to a regional medical campus (RMC) had any impact on an applicant's choice to decline their offer. Methods: This study analyzed surveys completed by successful medical school applicants who declined their offer of admission to McMaster University. Survey data from 2013 to 2018 were analyzed. Quantitative data assessed applicants' rankings of preselected factors. Data was pooled and descriptive statistics were generated. Annual decline percentages for each campus were then compared. Qualitative data in the form of survey comments were analyzed using an applied thematic analysis framework. Responses were analyzed for similar thematic elements. Results: Quantitative analysis revealed that the type of campus to which a student was offered admission was one of the least influential factors on an applicant's decision to decline their offer. Additionally, there was no significant difference between campus specific decline percentages as calculated by a one-way analysis of variance. Of the survey comments analyzed in the qualitative analysis only 11.8% related to RMCs. Themes seen within these comments were community, transportation, and opportunities. Conclusion: Data analysis demonstrated that an applicant's decision to decline an offer of admission to medical school is not influenced by the campus that they were assigned to., Background/Purpose: According to the Association of Faculties of Medicine of Canada (AFMC), medical schools have a mandate to be socially accountable and train future physicians to meet the needs of the communities they serve. It is a growing concern that current medical school cohorts do not reflect the diversity of the Canadian population. In particular, students from low socioeconomic (SES) and First Nations, Metis, and Inuit backgrounds are underrepresented among Canadian medical students. This has important implications given that physicians are more likely to practice in their communities of origin. Significant financial and social barriers exist throughout medical school admission that disadvantage students from marginalized backgrounds - one of which being the Medical College Admissions Test (MCAT). This necessitates that efforts are made to address these barriers to encourage diverse applicants to apply for medical school. Summary of the Innovation: The MD Admissions Initiative for Diversity and Equity (MD AIDE) is a student-led initiative at the University of Alberta that provided 33 students from low SES or Indigenous backgrounds with free tutoring and resources for the MCAT and along with mentorship from medical students. 3-hour MCAT preparation sessions led by medical students were held twice a week from May - July 2018. Classes were interactive and focussed on questions and test-taking strategies. To address the importance of social networks, each student was also matched to a medical student to assist them with career planning. For evaluation purposes, midpoint and final surveys were conducted to gather quantitative data on targeted outcomes. Interviews were scheduled with all willing participants to gather qualitative data on the effectiveness of the initiative. Conclusion: Of the MD AIDE participants, a statistically significant number have completed the MCAT and applied to a Canadian medical school. 96% of MD AIDE participants would recommend this program to their peers. MD AIDE is a one piece of a larger systemic change that is required to build diversity and equity within medical schools, Background/Purpose: In McMaster University's medical curriculum, preclerkship students have little exposure working with pediatric populations, and limited time spent learning about important child health topics. This quality gap was identified through a needs assessment survey completed by students spanning 3 cohorts. Summary of the Innovation: Teddy Bear Clinics (TBCs) are an interactive opportunity for medical students to guide children in role playing medical scenarios using teddy bears. Children work through clinical situations including doctor visits and health promotion stations. Stations are run by medical student volunteers who are required to attend a Public Health Niagara teaching session. While research exists on the benefits of TBCs in alleviating children's fears about healthcare, there is currently no evidence on their role in medical education. Our project investigates the use of TBCs in educating medical students on pediatric health and improving comfort in interacting with children. Quality improvement methodology was employed with Plan- Do-Study-Act cycles. Pre- and post-surveys were done by participants in TBCs and included questions on perception of their pediatrics knowledge and comfort working with children. Conclusion: Pre-surveys highlighted the need for additional training in pediatrics for preclerkship students. Post-surveys showed improvement in students' feelings of preparedness, confidence, comfort working the the pediatric population, and increased breadth of knowledge in high yield pediatric health topics. We plan on expanding this initiative to all McMaster campuses. A curriculum proposal has been submitted for consideration of incorporating pediatric public health teaching and TBCs into the existing curriculum., Background/Purpose: There is a gap in medical education regarding intellectual and developmental disabilities (IDD), causing a lack of confidence and competence among physicians caring for these patients. For people with IDD, clinical exposures can be distressing, which may result in negative attitudes and failure to recognize the humanity of these patients by clinicians. Therefore, the new preclerkship curriculum at the University of Toronto focuses on enabling students to develop a broader understanding of IDD in a community context. Summary of the Innovation: The curriculum has three components: (i) pre-community agency visit tutorial, (ii) community agency visit, and (iii) reflection and service access support tutorial. The curriculum is centered around preparing students for the community agency visit, and facilitating a small group reflection session following the visit. The visits are designed to provide students with the opportunity to gain experience communicating with people with IDD in a non-clinical setting, to better understand the variety of communities in which people live, and to learn how to connect people with intellectual and developmental disabilities specifically with community resources. Conclusion: The development of this curriculum fills a gap identified at not only the University of Toronto, but one that has been identified by medical schools worldwide. Through working with Surrey Place Centre, a multi-service Toronto-based organization that supports individuals with IDD, and other community agencies in the Greater Toronto Area, we have been met with overwhelming support for this initiative. The community visits and associated tutorials are being implemented for first year medical students starting in 2018., Background/Purpose: The purpose of this project was to generate interest in, and facilitate learning of, histology and pathology through the development of educational materials for the undergraduate medical school curriculum at the University of British Columbia (UBC). These materials were designed to utilize a spaced repetition format of learning to improve student recall of histopathological concepts of medicine. Summary of the Innovation: Electronic flashcards were developed that were based around the UBC medical school's histopathology curriculum to facilitate recall of, and generate student interest in, histology and pathology. The content incorporated both annotated digital slides of histology sections from the medical school curriculum and concepts inspired by an online pathology course. The flashcards were designed using Anki computer software and provided students with an effective means of developing long-term understanding via active recall and spaced repetition. Ultimately, the histopathology flashcards were compiled and distributed to students through the medical school's histology website and a survey was available for students to provide feedback on the effectiveness of the materials. Conclusion: Nearly nine hundred flashcards were created for the UBC medical histopathology curriculum. A survey was distributed to assess the utility of the materials for helping students prepare for exams and for improving their general histology/pathology knowledge. Of the responses, 89% found the content helpful for exam preparation and improving knowledge. This initiative is efficacious in enhancing student learning and promoting core foundational medical sciences content and it will be of interest to students and faculty in medical and allied fields., Background/Purpose: Climate change is considered by many to be the greatest threat to global health of the 21st century. Yet, medical trainees around the world receive limited education on the health impacts of climate change. At the August 2018 General Assembly of the International Federation of Medical Students Associations (IFMSA), we explored the views and experiences of medical students' education of climate change within their formal medical curriculum. Methods: We recruited medical students at the IFMSA General Assembly. Semi-structured interviews were conducted with participants in person or over email after the general assembly. In-person interviews were audio-recorded and transcribed verbatim. We used thematic analysis to identify key overarching concepts that emerged from the interviews. Results: We interviewed 18 medical students from 16 countries including: Algeria, Australia, Austria, Belgium, Germany, Hong Kong, Japan, Jordan, Luxembourg, Norway, Portugal, Trinidad and Tobago, Singapore, South Korea, Switzerland, and United Kingdom. We identified 3 main themes: 1) Climate change is generally not taught within formal medical curriculum globally; students learn from informal opportunities and extracurricular involvement. 2) Students are concerned about how climate change is affecting their countries and believe health impacts should be incorporated into medical education. 3) Students believe physicians have the opportunity to be leaders on multiple levels (organizational, clinical, individual) in engaging the general public in mitigating and adapting to effects of climate change. Conclusion: There is demand and support from medical students around the world for implementation of medical education regarding the health impacts of climate change., Background/Purpose: Longitudinal Integrated Clerkship (LIC) was introduced at the University of Toronto in 2014. A novel Ob/Gyn curriculum was designed to incorporate both ambulatory and in-patient experiences into a new formal teaching program. Compared to the Block curriculum, one difference is that LIC students are assessed midway through the academic year, whereas Block students are assessed at the end of their six-week rotation. However, both streams of students take equivalent examinations. The purpose of this study was to assess the validity of our Ob/Gyn LIC when compared to the existing Block clerkship. Methods: Written, oral, and clinical examination scores from September 2014 to March 2018 were compared between LIC and Block students. Specifically, grade comparisons were made between students in the same academic year, between years, and between hospital sites (n=4). Results: Eighty-nine LIC students and 797 Block students were compared. There were no statistical differences between LIC and Block clinical and oral examination scores (Clinical: 81.0% vs 81.2%, Oral: 83.9% vs 84.4%, p>0.05). However, Block students did perform significantly better on written exams (83.0% vs 79.5%, p, Background/Purpose: Medical schools across Canada have incorporated service-learning into their curricula. Service-learning allows students to dismantle the perceived separation of work and civic contributions at the root of many health inequities. We adopt a corporate incubator model for community health needs as an approach to innovative service learning. Summary of the Innovation: CHASM was founded by McGill medical students in June 2017 to improve the health outcomes of local, historically marginalized communities. CHASM helps students partner with a community organization, form an interprofessional team, and develop a project to address the population's self-identified social determinants of health. The end goal is for the project to be entirely handed over to the community. The recruited projects are given a framework to scale their ideas, which includes: 1. Mentoring by business and public health experts, largely faculty at McGill University; 2. A social entrepreneurship curriculum with bimonthly, interactive workshops; 3. Funding; 4. A network that supports and publicizes the projects. The inaugural cohort is composed of three teams: Monthly Dignity, which provides feminine hygiene products to homeless shelters; Supporting Young Black Students, which mentors Black Montreal youth to facilitate their admission to university health programs; and Community Ambassadors to Conquer HPV, which provides HPV vaccines and pap smears to underprivileged women. Conclusion: This unprecedented educational opportunity allows students to partner with local communities to sustainably address their social determinants of health, while simultaneously acquiring project development and advocacy skills. Successful in its first year, we envision the CHASM Incubator model as an integral part of Canadian medical education., Background/Purpose: Physicians have the capacity and responsibility to act as advocates for their patients on a daily basis. Increasingly, physicians are effectively advocating for change in healthcare systems, and more broadly in society as a whole. As future physicians, medical students are expected to develop advocacy skills that will allow them to fill these roles in the future. However, opportunities to learn these skills are limited in the undergraduate medical curricula. Summary of the Innovation: A group of medical students, collectively known at the Schulich Political Advocacy Committee (PAC) lobbied London's city councillors to install two naloxone kits at each automated external defibrillator (AED) located in city-owned public buildings. Naloxone reverses opioid poisoning and having it widely available reduces mortality associated with opioid poisoning. In October 2017, PAC leadership developed briefs on three potential advocacy topics and solicited feedback from medical students via an online survey. The topic of greatest interest was the placement of naloxone kits at each city-owned AED. In May 2018, first, second, and third year medical students at the Schulich School of Medicine & Dentistry participated in the PAC's 2018 Lobby Day initiative. Each student attended a four-hour training session and at least one city councillor meeting. Subsequent council votes and committee meetings were attended by PAC executive members, culminating in a motion being unanimously approved by council. Conclusion: Medical students are willing and able to successfully advocate for significant change in their communities. With sufficient organization and leadership, the Schulich PAC made a substantial impact on their community, and strives to continue this work in the years to come., Background/Purpose: Networking among physicians is an under-emphasized skill that can take years of experience to build upon and execute successfully. Today, physician's create vast connections with community organizations, healthcare practitioners, and other service workers to provide the best care for their patients. Recognizing the importance, the Faculty of Medicine at the University of Toronto introduced a Personalized-Resource List (PeRL) to first-year medical students. Students were tasked with building a contact list to support their future practice. Examples of contacts included healthcare practitioners, and community organizations. PeRL is a longitudinal assignment that was designed to adapt to the student's medical training over the course of their career and to provide medical students with the skills necessary to develop and maintain professional relationships. Strengthening this skill would encourage future physicians to look beyond the scope of their own practice and provide comprehensive care. This study aims to collect feedback from students to improve the next iteration of the assignment and to assess the impact of PeRL in medical education. Summary of the Innovation: We conducted 9 semi-structured interviews to elicit perspectives of first-year medical students regarding the PeRL. The interviews were analyzed using thematic analysis to identify common themes. Conclusion: The majority of students recognized PeRL as an important aspect of their education. Formation of their identity as a physician, relationship development with patients, and meshing with the rest of the curriculum were important to students. In the next iteration, it was suggested to have more real-life examples of network building, and to develop more formal evaluations., Background/Purpose: The field of medical education is constantly evolving and integrating new techniques. Unique programs and initiatives are discussed, but individuals often struggle to start or establish their idea. The 12 tips provided here offer a guide on how to take an educational program idea from inception and bring it to fruition. Summary of the Innovation: This guide provides the following 12 tips, with in-depth detail on how to initiate a successful medical education program. 1: Ensure your idea is novel and of value 2: Assemble a team that works well together but differs in their strengths 3: Establish your short and long-term goals early but do not hesitate to revise 4: Consult and obtain buy-in from your institution 5: Create a win-win situation for you and the institution 6: Identify administrative obstacles quickly 7: Create a succession plan 8: Establish a means of communication with participants and medical departmental heads 9: To assess impact of your program, do research 10: Prepare for the transition of leadership 11: Quality assurance is an ethical imperative 12: Growth and development spreads a good idea from the few to the many Conclusion: Medical education aims to improve the well-being of societies through improved training of medical practitioners. This is accomplished by improvements in how we train the healthcare professionals of tomorrow. The 12 tips provided here offer a guide that is transferable and applicable to anyone wishing to initiate an educational program., Background/Purpose: Many medical school programs are looking to e-learning for teaching due to the rapid increase in the use of smartphones, tablets and portable computers. E-learning allows an increased access to students, allows students to learn remotely and reduces program costs. iBooks have been used as e-learning tools with students praising their interactivity, multimedia, and logical presentation.1 In addition, studies show equivalent results on standardized testing when using e-learning.2 Summary of the Innovation: Three years ago, the manual for medical students attending the anesthesia clerkship course at the University of Toronto (U of T) was converted to an iBook. This was implemented in order to make the rotation paperless and to align with the flipped classroom model which was started five years ago. The iBook allowed readers to highlight, bookmark and take notes, and allowed the authors to embed figures and videos directly into the text. The iBook was then made available for all U of T medical students on both android and iOS platforms as well as on iTunes. This change to an iBook format led to over $3500 in savings per year, while providing students with additional access to interactive charts and content. The iBook to date has been downloaded 1,041 times worldwide. USA and Canada have contributed to most of the book downloads (863), with the remainder being from Europe, Latin America, and Asia. Conclusion: The anesthesia iBook has been very well accepted by the students at U of T. Challenges of the iBook have been a call from a minority of students for a printable resource and a preference for the portable document format. Future questionnaires will be used to identify common themes of learning in students more familiar with an e-learning curriculum., Background/Purpose: Knowledge of genetics is needed by health professionals to practise in the current genomic era. The Division of Clinical and Metabolic Genetics has limited teaching resources to meet the increasing demand from trainees seeking electives. Currently, much of the teaching is didactic in nature or relies upon review of written materials. The benefits of e-learning in medical education are well recognized. The Division therefore undertook the development of a series of online education modules to teach the foundation of a genetic assessment to complement clinical teaching. This will not only address resource constraints, but also promote independent learning, thereby increasing teaching efficiency while ensuring quality care. Summary of the Innovation: An e-learning module was created using Articulate Storyline 2 and the principles of case-based learning. The module focuses on how to take a family history (specific to a genetic assessment), and how to draw and interpret pedigrees. The module incorporates interactive graphics and quizzes to engage the learners, and provides detailed feedbacks on user responses. Conclusion: Surveys on module usability and user satisfaction, as well as pre-module and post-module quizzes were completed by trainees rotating through the Division (n=11). System usability scale is rated at 73.75 (out of 100), while user satisfaction is reported as 4.3 (out of 5). Pre-module and post-module quizzes revealed an average increase of 33% in score after completion of the module (n=4). We will incorporate the E-learning module as part of the curriculum within the Division, and create more modules for further educational topics., Background/Purpose: students have traditionally used a variety of methods to prepare for observerships - clinical experiences that provide exposures to different specialties and help guide career choices. We aimed to evaluate the types and number of resources utilized by pre-clerkship medical students at a Canadian medical school in their preparation for surgery observerships. Methods: Pre-clerkship medical students were recruited on a voluntary basis to complete an online survey. The survey collected both qualitative and quantitative data related to the observership experience with the use of multiple choice, free-text, and Likert-type scales. Results were analyzed using descriptive statistics. Results: Of the 64 respondents (64/202), 62.5% were interested in a career in surgery and 82.8% participated in at least one surgery observership. Common reasons for participating in a surgery observership were: “may not be an opportunity I have in the future” (28.3%) and “rule in surgery as a career” (27.3%). Students spent on average 0.98 hours (SD 0.77) preparing for an observership. Most frequently used resources included class notes (22.6%) and Youtube videos (20.2%). The majority (96.9%) of participants noted that preparing resulted in an overall positive observership experience. However, 75.44% noted that resources provided and instructions were lacking. Conclusion: Preparing for surgery observerships resulted in a more positive learning experience. Class notes and Youtube videos were the most frequently used resources; however, formal instructions on how to prepare were lacking. Providing medical students with appropriate and readily available resources to prepare may maximize their experiences during surgery observerships., Background/Purpose: Surgeons are consistently viewed by medical students as uncompassionate, resolute, and individualistic. The Surgical Exploration and Discovery (SEAD) program is a two-week program that offers workshops, seminars, observerships, and mentorship opportunities to preclerkship medical students. The purpose of this study was to explore whether early surgical exposure could alter the negative perceptions of medical students towards surgeons and a surgical career. Methods: This prospective cohort study included 30 preclerkship medical students (18 male, 12 female) who participated in the SEAD program at the University of Toronto during the summer of 2017. A constructivist grounded theory approach was used to qualitatively analyze six independent focus group interviews, conducted at both initiation and completion of the program. Results: Focus group interviews suggested that students were more amenable to pursuing surgical careers after completing SEAD, despite acknowledging potential challenges. Students often compared their experience to previous single-day observerships and reported the two-week design of the program allowed them to better appreciate the surgical work-life balance. Students described surgeon mentors as kinder than expected, enthusiastic about teaching, and passionate about their work. Students viewed the lifestyle of surgery to be more favourable upon increased exposure to different surgical setups. In particular, female students were able to gain a better understanding of how to overcome female-specific challenges through female mentorship. Conclusion: The SEAD program successfully contributed to changing negative perceptions about surgeons and a surgical career, and informed students of female-specific challenges and the capacity of surgeons to tailor their practice to achieve work-life balance. *Co-first author, Background/Purpose: In the era of competency based education (CBE), behaviour remediation in post graduate (PG) medical trainees is highly relevant. Behaviour falls under “professionalism”, an important component of the CanMeds framework as well as the Accreditation Council for Graduate Medical Education (ACGME) core competencies for physicians. Despite its importance, however, PG programs are unsure as to how to appropriately remediate trainees with deficiencies in these domains. Traditionally, trainees have been promoted within their training programs under the proficiency of medical expert with inadequacies in behaviour/professionalism. With a renewed emphasis on CBE, and on patient safety and quality, there is a unique role for determining a method of remediation in PG medical trainees who have behavioural deficits. Methods: A scoping review of behaviour remediation in PG medical trainees was conducted to determine mentoring strategies and interventions that have and have not been successful by training programs. PubMed and Embase electronic databases were searched. Results: Out of the 92 articles found, 26 articles were included in this scoping review. Various strategies are implemented by PG programs to remediate PG medical trainees with behavioural/professionalism deficiencies. These strategies are listed in this review. Conclusion: PG programs are unsure how to appropriately remediate PG medical trainees with behavioural/professionalism deficiencies. Based on our search we have listed various remediation strategies that are currently used by medical training programs, albeit inconsistently, and with questionable efficacy., Background/Purpose: Integration of entrustable professional activities (EPAs) within clerkship is part of the planned shift towards competency-based medical education in Canadian medical schools. We have previously identified discipline- and location-specific differences in the level of supervision and performance of EPAs in clerkship at our institution. This follow-up study aims to understand the factors that contribute to those differences. Methods: A focus group was conducted with the graduating 2018 class as part of a needs assessment aimed to assist in the planned integration of EPAs into clerkship. Directed questions were designed to stimulate discussion on the level of supervision and performance of EPAs. The narrative was transcribed verbatim and the transcript was coded independently between two reviewers. After final consensus, inductive analysis was used to identify patterns and themes. Results: Six students participated in the one-hour focus group. Students reported certain factors that decreased the available opportunities for students to perform EPAs, such as a fast-paced clinical environment, a lack of consensus on the student role between sites, the specialization of a service, and the acuity of patient presentations. Students also elaborated on experiences that facilitated the performance of EPAs, including goal-setting at the start of a shift, prompting of students by preceptors, and the natural preceptor-student relationship that develops over time. Conclusion: This study provides insight into the challenges in the implementation of EPAs in clerkship and identifies potential solutions that will assist in the planning of future clinical site and faculty development for successful shift to competency-based medical education., Background/Purpose: Residency programs across the country are moving away from time-based training models toward competency-based programs. Competency refers to proficiency in technical dexterity, knowledge of anesthesia, and interpersonal skills. It is clear that a high level of capacity is desirable in these areas; however, is no universally accepted definition of competency exists as it relates to anesthesia. We propose that competence should be determined by those who work in the field of anesthesia using a definition where the expectations of our patients and clinical colleagues are valued and included. Instructional Methods: We first performed a literature review of terms that we felt would inform us in our own understanding of competency; this also verified that no universally definition of competency existed. We then received ethics approval to carry out a qualitative research study using semi-structured interviews with 40 (ten in each cohort) patients, nurses, surgeons, and staff anesthesiologists. Participants were asked to share their perspective on competence and describe how that relates to their experiences and expectations with resident and staff anesthesiologists. Following this, interviews were transcribed and analyzed for emerging themes. Target audience: Our objectives were: 1.) To determine the perspective of anesthesiologists, surgeons, nurses, and patients on competency in anesthesia and how this perspective compares and contrasts between roles 2.) To synthesize these perspectives into a cohesive, well-rounded concept of competency in anesthesia 3.) To describe how this concept can be applied to residency training programs to promote development of competent anesthesiologists Summary/Results: We found several themes arose in participant interviews. First, the confidence of a trainee gave the appearance of competence, even though there was recognition that confidence and competence were distinct entities. Where it was found that a resident's actual ability did not match their perceived confidence, the resident lost credibility and was no longer seen as competent or trustworthy. As well, all participants described competence as being contextual. This meant that a trainee could be seen as competent in one setting but not be able to perform competently in a different set of circumstances; this pointed to the importance of varied and diverse learning opportunities. Second, competence in anesthesia referred to facilitation, meaning how well an anesthesiologist could facilitate a nurse's or surgeon's own tasks in being safe and patient focused, where anesthesiologists felt it was their own duty to be safe and patient focused in their own tasks. Third, patients measured the competence of their anesthesiologist using tangible measures closely linked to objective outcomes, for example absence of awareness and post operative analgesia. Lastly, there was universal recognition that competence was a spectrum composed of multiple components, but minimal proficiency in all domains was required to be considered wholly competent. This meant that communication and personal qualities were not underestimated. Conclusion: In summary, we feel that competence is the ability to fulfil the duties of one's job and meet the expectations of those with whom we work and care for. Different professions will have expectations of competency based on how they view the anesthesiologist plays a role in supporting their own duties. Patients will have expectations based on their knowledge and previous experiences of anesthesiologists and we should expect this to be quite limited in some situations. Here, we should play an active role in education and preparation. Regardless of different expectations, our findings point to the significance of an inter-professional definition of competence being one that includes communication and leadership skills as well as qualities of understanding, compassion, and fairness., Background/Purpose: Simulation is becoming widely adopted across medical disciplines and by different medical professionals. For medical students, emergency medicine simulation has been shown to increase knowledge, confidence and satisfaction. At the University of Ottawa Skills and Simulation Centre, third-year medical students participate in simulated scenarios common to Emergency Medicine (EM) as part of their mandatory EM clerkship rotation. This simulation curriculum was added in 2016, but has not yet been evaluated. Methods: In groups of seven, medical students completed simulation sessions of the following: status asthmaticus, status epilepticus, urosepsis and breaking bad news. Student confidence with each topic was assessed before and after simulation with a written survey. Confidence scores pre- and post-simulation was compared with the Wilcoxon signed rank test. Results: Medical student confidence with diagnosis of status asthmaticus (N = 44, p = 0.0449) and status epilepticus (N = 45, p = 0.0011) increased significantly following simulation, whereas confidence with diagnosis of urosepsis was unchanged (N = 45, p = 0.0871). Treatment confidence increased significantly for status asthmaticus (N = 47, p = 0.0009), status epilepticus (N = 48, p = 0.0005) and urosepsis (N = 48, p < 0.0001). Confidence for breaking bad news was not significantly changed after simulation (N = 47, p = 0.0689). Conclusion: Simulation training in our EM clerkship rotation significantly increased the confidence of medical students for certain common EM presentations, but not for all. Further work will aim to understand why some simulation scenarios did not improve confidence, and look to improve existing scenarios., Background/Purpose: Undergraduate medical education curricula lack consistent training for ultrasound-guided procedures. We developed a simulation curriculum using augmented reality visualization to teach ultrasound-guided needle insertion on a vascular model to medical students. We measured performance and confidence learning curves. Methods: Students participated in the 4-session simulation curriculum. Prior to and after each session, each student completed a simulated ultrasound-guided needle insertion on a vascular phantom model. Probe and needle motion was electromagnetically tracked to assess performance objectively using nine previously validated, computer-generated metrics, which were compared to expert benchmarks. Prior to each pre- and post-session test, students indicated their confidence on a scale of 0-10. We performed signed rank tests to understand improvement from baseline, within-session improvement, and after-session erosion, for both performance and confidence. Results: 30 students participated. Performance improved from baseline by sessions 3 and 4 (p, Background/Purpose: The Observed Structured Clinical Exam (OSCE) has become the mainstay of clinical performance assessment in medical education. Centralization of OSCE assessment in a single high-stakes examination at our institution, and financial constraints necessitated re-evaluation of our specialty-specific OSCE. We wondered if we could introduce a lower cost version of our psychiatry OSCE circuit while maintaining sufficient rigor for an end of rotation exam. Summary of the Innovation: We replaced one OSCE station with one Communicator Skills Assessment (ComSA) station. Based on stakeholder input, ComSA stations were designed to focus on obtaining collateral history and providing diagnosis and treatment specific education. Roleplays require minimal acting skills on the part of the examiner. We analyzed data from three iterations of a psychiatry clerkship examination (n= 126) that included four performance-based assessment stations (3 OSCE and 1 ComSA) and a written examination. A series of paired-samples tests of equivalence (TOST-P) determined that a ComSA station performed equivalently to an OSCE station in assessing content knowledge and communication skills. Furthermore, Cronbach's alpha omitted variable analysis demonstrated that a ComSA station had a similar impact on exam reliability to an OSCE station. Faculty and trainee feedback supported the ongoing use of the ComSA. The direct cost of the examination was reduced by >20%. Conclusion: This study provides evidence for examiner roleplay stations in place of a traditional OSCE station. The ComSA was equivalent to the OSCE in evaluating the content and communication skills and inclusion of a ComSA station did not reduce exam reliability and improved feasibility., Background/Purpose: There are several health benefits of regular physical activity during pregnancy, including improving physical fitness, weight management and mood, and reducing the risk of gestational diabetes and hypertensive disorders of pregnancy. A scan of the literature suggests that implementation of guidelines for exercise during pregnancy is not taught consistently to family medicine residents. This project consists of creating an exercise during pregnancy online learning module, targeted for family medicine residents, to supplement the current postgraduate program. The objective of this online module is to familiarize family medicine residents with current exercise guidelines and promote confidence in prescribing exercise during pregnancy. Summary of the Innovation: This e-module is part of a series of online maternity care learning modules, which includes Hypertensive Disorders of Pregnancy and Postpartum Care. The e-module includes validated evidence based tools such as the PARmed- X for Pregnancy addressing absolute and relative contraindications to exercise, videos demonstrating exercise counselling and implementation of a FITT (Frequency, Intensity, Time, Type) prescription, and safety tips. The module includes multiple choice questions as well as check box questions to test the learner's knowledge throughout the learning exercise. Conclusion: By having this resource available to family medicine residents, knowledge and self-efficacy for prescribing exercise during pregnancy could potentially increase, contributing to delivering the highest level of evidence-based care to patients., Background/Purpose: OSCEs can be really stressful for medical students. Specifically, at an undergraduate level, students have very limited experience in clinical interviews. Moreover, they can lose themselves in the vast quantity of information to study, focus on very rare presentations or miss must-ask questions or physical signs. All around, the challenges of OSCEs are known best by the students themselves through past successes and failures. A need for better tools and more practice was raised among students. New educational projects can be tedious and complicated to set up. It requires personnel, time, money and energy. Generally, medicine faculties are already trying their best to offer students the tools they need to succeed. Summary of the Innovation: At Université Laval, a student committee, the Groupe de perfectionnement des habiletés cliniques (GPHC), which stands for group of improvement in clinical abilities, was created in 2010 to address this need. This group is focused on offering peer education and educational tools to medical students in addition to the medical program. The GPHC is now offering various workshops on clinical thinking. It also published a new book written by students and revised by physicians. Furthermore, the committee offers a web application allowing student to practice OSCE. Conclusion: This student project successfully reached a structure allowing students to bring ideas and, through peer education, introduce innovative tools for medical students. This project shows how, with the support of the faculty, an independent committee thrived and developed reliable learning methods that became used by the vast majority of students. These methods helped students to assess their level of preparation and all around feel more prepared for their OSCEs., Background/Purpose: Clerkship students feel increased anxiety and lack of confidence when it comes to surgery. This study assessed whether participation in Surgical Exploration and Discovery (SEAD), a two-week intensive surgical program that includes career information, simulation workshops and operating room observerships, would help decrease anxiety, increase confidence, and foster interest in a surgical career. Methods: 30 first year medical students were randomly selected for the SEAD program and 32 were only given the program's instruction manual during the duration of the program serving as the control. At baseline and after the completion of SEAD, both groups were given a survey containing the State Trait Anxiety Inventory that measures self-reported anxiety levels with an adjunct that gauges confidence and interest in a surgical career. Results: Students who participated in the program showed significant improvements in self-perceived knowledge and confidence for each surgical skill: scrubbing (p-value, Background/Purpose: High-quality CPR saves lives; however, current certification standards leave providers poorly prepared to perform effective chest compressions (CCs). We designed a training program based on the emerging model of skill maintenance through frequent short practice sessions. Our goal was to provide medical students with access to efficient and effective CC training. Methods: Thirty-six second-year medical students were randomized to three groups that trained at different frequencies: once every two months (q2mth), once every four months (q4mth), and a control group that received no training. Our “Quick Refresher Sessions” (QRS) were completed using an autonomous manikin with the ability to provide real-time quantitative feedback on CC quality. Participants completed a one-minute pre-test, viewed a one-minute focused training video, engaged in two minutes of practice with real-time feedback, and completed a one-minute post-test. Self-reported pre-and post-training comfort performing CCs were also recorded. Results: Performance parameters measured by the manikin were CC depth, rate, release between CCs, and hand positioning. A final “compression score” assessed integrated performance across these parameters. Immediately following training, subjects had significant improvement in compression score (p, Background/Purpose: Central Venous Catheter (CVC) placement is a common critical care procedure. Simulation-based training reduces iatrogenic CVC- related complications. Video modelling (VM) is an instructional adjunct that improves the quality and success of CVC insertion. The immersive experience of 360-degree video recording has improved recall and skill translation in some contexts, however, its role in teaching medical procedures has not been established. We hypothesized that, relative to traditional VM, 360-degree VM would decrease cognitive load and enhance ultrasound-guided CVC insertion skill acquisition in novice residents. Methods: Thirty-two resident physicians from anesthesiology, general surgery, emergency medicine, and internal medicine were randomized into traditional (control) or 360-degree VM (intervention) groups for three CVC training sessions. Skill acquisition was quantified by procedural time (needle puncture to tegaderm placement) and a 5- point entrustment score (O-Score) completed by their supervisor. Cognitive load was quantified using the NASA Task Load Index (TLX). Mean (± standard deviations) values were compared using two-tailed t-tests. Results: Group demographics were similar. Entrustment scores improved significantly in both groups from the first (3.3±0.8) to third (4.1±1.1, p, Background/Purpose: Procedural skills training varies significantly across Canadian medical schools, and there is currently no standardized assessment tool to evaluate its benefits. This project aims to develop a curriculum that teaches 2nd-year medical students to perform and evaluate procedural skills, while laying the foundation for Entrustable Professional Activities (EPAs). The goals of this program include decreasing anxiety, increasing confidence, and achieving competence for students and also allowing staff to judge the appropriate level of supervision when delegating learners to perform basic procedures in the team setting. Our curriculum incorporates, near-peer teaching as well as near peer formative assessment. Methods: Each of the twelve 2nd year participants completed a State Trait Anxiety Inventory and self-reported confidence questionnaire related to procedural skills. Students participated in four sessions taught by expert physicians over a five month period. A new skill was taught at each monthly workshop and an opportunity to practice previously taught skills was provided. Skills were assessed in a skills integration simulation OSCE, and the anxiety and confidence questionnaire was repeated. Results: Students who completed this pilot program showed a significant decrease in mean anxiety state (2.48 vs 1.74, p-value, Background/Purpose: The objectives of the study were: (i) to characterize procedural skills education currently employed in pre-clerkship and clerkship curricula; (ii) to determine what skills physician- educators think medical students should know upon graduation; and (iii) to identify physician-educator perceptions regarding the development of pre-clerkship procedural curriculum. Methods: A web-based survey was distributed to 201 clinician-educators across Canada's 17 medical schools. Respondents were directed to an individualized survey based on their self-identified, roles at their institution. Respondents were asked demographic questions, what procedural skills are being taught and in what setting at their institution, and their opinions on the value of a pre-clerkship procedural curriculum. Results: From the 17 school's surveyed, 8 schools responded “yes” that they had a clerkship procedural curriculum. For a pre-clerkship procedural curriculum, only 4 schools responded “yes”. The top 10 procedurals skills identified that medical students should know upon graduation, in order, are: IV Access, Airway Management/Ventilator Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery, Testing for STIs, Phlebotomy, Suturing of Lacerations, Nasogastric Tube Placement, and Venipuncture. Clinician-educators strongly supported a pre-clerkship procedural curriculum (median=4.00/5.00, mode=5.00/5.00), and they believed it would decrease anxiety (median=4.00/5.00), increase confidence (median=4.00/5.00), and increase technical ability (median=3.00/5.00) in incoming clerks. Conclusion: Across Canada, the state of UGME procedural skills education is inconsistent. With the identification of the Top 10 procedural skills medical students should know upon graduation, the learning objectives of a formal curriculum can be developed. With overwhelming support from both medical students and physician-educators alike, a formal pre-clerkship procedural curriculum is poised to redefine the landscape of procedural care for a whole new generation of physicians., Background/Purpose: Patient exposure is crucial to clinical competency training in medical education. Patient experiences when MD clerks play a direct role in patient care have been well studied. However, few studies have examined volunteer inpatients' (VIPs) experiences in pre-clerkship clinical training. This study investigated VIP experiences in bedside interactions with first year MD students in a clinical skills course where learners practiced basic competencies for educational, rather than patient care purposes. Methods: English-speaking, adult inpatients from two teaching hospitals were consented following a clinical history and/or physical examination by first year MD students to complete a 10-minute, semi-structured interview on their recruitment, clinical interactions, overall experience, and satisfaction. Descriptive thematic analysis was used to characterize VIP insights. Results: 93/97 VIPs approached agreed to participate. Preliminary analysis indicates that most VIPs felt that their interactions were positive; they felt listened to, respected, and able to contribute to medical education. Student factors contributing to positive VIP experiences included an ability to connect with patients as people via verbal/non-verbal communication expression compassion, patience and professionalism. VIPs recommended more informative recruitment processes to better understand, anticipate and prepare for their interactions. They also felt more comfortable when students appeared confident in their abilities. Conclusion: Volunteering appears worthwhile and comfortable for VIPs. Recommendations for change are being processed to better inform preceptors, patients and students about expectations and best practices. Study results and lessons learned have value for clinical training in diverse health professions' training programs., Background/Purpose: Medical students feel they require more training on patients with developmental disabilities (PWDD). Students at the University of Alberta developed a pre-clinical 12-hour module, “Developing Skills with Developmental Disabilities” (DSDD), to improve students' confidence regarding the care of PWDD. Methods: Elective students, in addition to standard Neurosciences curriculum, received 6 hours of didactic teachings, and 6 hours of clinical experience at a rehabilitation hospital, where they attended a family interview and observed PWDD in a modified play/classroom setting. Control students participating in this study only received the standard curriculum. Elective students completed surveys administered on a 5-point Likert scale pertaining to self-perceived confidence pre- and post-elective. Controls completed the same surveys before and after the standard curriculum. Pre- and post-intervention scores were used to calculate relative improvement and then compared between groups via t-test. Results: Data was collected from 2 consecutive years, including 35 DSDD students and 18 control students. Statistically significant (p, Introduction: La Direction du développement professionnel continu (DDPC) de la Faculté de médecine de l'Université de Montréal (UdeM) est un organisme qui accrédite de nombreuses activités de DPC à travers le Québec. Différentes normes ont récemment été mises à jour, entre autres pour encadrer les relations avec l'industrie pharmaceutique et assurer des méthodes pédagogiques optimales. Objectif : L'objectif de l'enquête de terrain est d'obtenir des données dont le but est d'améliorer la qualité des formations, de faciliter le transfert des connaissances et d'acquérir des compétences. Méthode: La DDPC de l'UdeM a mis en place un outil de vérification de la conformité aux règles éthiques et aux bonnes pratiques éducatives par les prestataires en DPC. L'ouitl permet de recueillir des données lors des activités et offre une rétroaction objective. La vérification est fondée sur une collecte systématique de données à propos des méthodes pédagogiques et vise l'adéquation aux normes éthiques, notamment le contrôle des biais potentiels, la gestion des conflits d'intérêts ainsi que le respect des droits d'auteurs. Résultats: Les résultats de l'enquête témoignent d'un besoin d'amélioration dans les approches éducatives. Le contrôle des biais commerciaux et la gestion des conflits d'intérêts seront également à optimiser pour plusieurs prestataires en DPC. La planification et la mise en oeuvre de l'outil de vérification ont apporté une appréciation systématique de nos processus internes. Les résultats serviront de tremplin pour améliorer la qualité des activités offertes en DPC., Background/Purpose: Award programs that celebrate clinician-teacher quality communicate community appreciation and encourage pedagogical excellence. While many such programs exist at our medical school, they often recognize select few recipients and depend on nominators' initiative. MD students at the University of Toronto aimed to develop criteria for a novel faculty teaching award program that allows for the recognition of clinician-teacher excellence across the faculty without nomination. Summary of the Innovation: Our MD Program Teaching Awards of Excellence (MPTA) process was student-initiated and faculty-approved. Focus groups were held with University of Toronto medical faculty and students to define MPTA criteria. Our university's Teaching Effectiveness Scores (TES) were the teaching quality measure; TES are calculated on a scale of 1-5 and equal the mean of medical student evaluations scores. All 2016-17 preclerkship teachers were eligible and stratified into the following three groups: small group facilitators (, Background/Purpose: In 2007 Health Canada provided funding to six professional groups for integrating and highlighting interprofessional education (IPE) standards that would become explicit in each profession's accreditation (i.e. medicine, nursing, occupational therapy, pharmacy, physiotherapy and social work) (Coffey, 2015). IPE occurs when learners of two or more health or social care professions engage in learning with, from, and about each other to improve collaboration and delivery of care. IPE has also been identified as a solution to the various challenges of health care access in rural settings (Hays, 2008). This research examines the effectiveness of IPE for community/patient-centered care as integrated within a student interprofessional group, Reach Accés Zhibbi (RAZ). Summary of the Innovation: Developed by learners from the Northern Ontario School of Medicine (NOSM), RAZ is an interprofessional student-led group that provides health promotion services in conjunction with community partner agencies. The purpose of the health promotion service is to provide students with practical interprofessional experience while they directly serve vulnerable populations living in the downtown core of Sudbury, Ontario. Qualitative and quantitative data was collected from health promotion activities via formal surveys. Conclusion: Results demonstrate a positive response from participants of RAZ health promotion events. RAZ recognizes a need to revise the research methods to gather more broad impressions of their events, continually reassess the needs of the participants, as well as evaluate both short and long-term outcomes. Furthermore, future research directions will examine the longitudinal outcomes for professionals who did or did not participate in an undergraduate IPE program, specifically RAZ., Background/Purpose: Creation of a patient care plan requires understanding who on the healthcare team will be proving follow-up and ongoing care. Current teaching and system design emphasize the importance of the family physician as the healthcare hub for all patients. While the realities of practice often do not match this expectation - especially for the multi-morbid patient - it is unclear what the configurations of care for patients, especially those without a family physician, look like. Methods: A narrative literature review was conducted on the topics of principal care providers, orphaned patients, specialist roles, and patient complexity. 51 references were identified, and these were subjected to a thematic analysis to identify key areas of knowledge and uncertainty in the care landscape. Results: Four themes emerged from the literature: the distinction between principal and primary care; the role of the specialist; the growing complexity of patients; and the fluidity of care configuration from orphaned patients to patients wholly reliant on specialty care. There was a substantial body of literature in the 1990s exploring specialists providing principal or primary care, but little since. More recently, specialty-specific bodies of literature (e.g. nephrology, psychiatry) have begun to re-address the intersection between specialty and primary care. Conclusion: Our findings suggest a far more complex landscape of intra-professional collaboration than is currently taught. Understanding this complexity can allow medical trainees and supervisors to better explore, with each patient, the configuration that will best meet their healthcare needs. Future research is needed to characterize the identified configurations and explore the dynamics of each., Background/Purpose: IPCP is required to work effectively in today's healthcare system. The literature suggests that healthcare providers need to be trained interprofessionally to practice collaboratively. 40-60% of HP students' learning takes place in the clinical setting. TLEF funds supported the development and implementation of a model to ensure that all HP students receive comparable IPCP learning opportunities regardless of location or timing of their clinical placements. Summary of the Innovation: The development of the Student-led Interprofessional Learning (SIPL) model included a literature search, needs assessment, and an environmental scan to identify current initiatives, resources, and fundamental principles. Key pillars of SIPL are comparable experiences, student assessment, portability, evaluative ease, and sustainability. SIPL can be leveraged in pre-existing placements with minimal resources. Pre-placement modules and educational tools prepare students for their placement. A student-led appreciative inquiry or collaborative practice can be selected based on local context and preference. These modalities provide opportunities for teaching and assessment in HP core competencies. Students complete post-placement reflections to consolidate learning. Conclusion: SIPL was piloted at 49 sites across BC, Alberta, and Ontario, with students from medicine and other HP disciplines. Outcomes were evaluated through student and preceptor focus groups, surveys, and stakeholder interviews. Our findings suggest SIPL is highly effective. Educational programs found SIPL efficient to deploy with minimal effort, and patient-centred. Students enjoyed SIPL compared to previous interprofessional training and gained numerous benefits though engagement with other HP trainees. SIPL resources are available and can be used by other HP programs., Background/Purpose: On our inpatient wards, residents, nurses and allied-health professionals communicate through a mobile-based text messaging system. While this improves workflow, it can decontextualize complex issues compared with verbal communication. Furthermore, multitasking by residents may result in overly brief, uninformative responses, resulting in inadequate closed-loop communication. This study aimed to characterize essential components of informative responses and analyze resident responses to requests from the care-team. Methods: Closed-loop communication requires a response that ensures the sender knows that the receiver understood the message. One thousand queries and responses were analyzed to generate a coding scheme based on this principle. These messages were used to create four tiers of response quality, ranging from 1 (poor) to 4 (excellent). Response quality was based on three components: 1. Acknowledgement and reply to each element within the query. 2. If action is requested, clear indication of whether action will be taken and timing. 3. If no action is taken, explicit reasons for not acting. Results: Of 200 (20%) randomly selected responses, 10.5%, 3.0%, 19.0%, and 67.5% were in tier 1, 2, 3, and 4, respectively. Of 126 responses at night or on the weekend, 10.3% were tier 1. Of 110 messages where the resident was asked to take action, 18.1% of responses were tier 1 (no indication whether action will be taken). Conclusion: Approximately 10.5% of resident responses to care-team requests are uninformative, potentially leading to miscommunications and preventable errors. Results from this study will be used as a framework to teach residents effective communication strategies., Background/Purpose: Among health care students there are various formats through which interprofessional learning is taught. Our aim was to evaluate the impact of the student-run clinics (SRC) at the Community Health Initiative by University Students ( CHIUS) on student participants from Pharmacy, Medicine, Nursing, Social work and Occupational Therapy. Summary of the Innovation: Twenty-three participants in the CHIUS student-run clinic (SRC) at the University of British Columbia took part in two focus group interviews.A combination of open-ended and specific interview questions were used to explore the participants' learning from the SRC. Using the Grounded Theory approach, transcribed interviews were iteratively analyzed and questions were adjusted for subsequent focus groups as the analysis revealed certain themes. Three investigators coded the data individually, consolidated the themes, and developed explanation models for each theme. Conclusion: The CHIUS SRC provide realistic patient-care experiences that are unique from didactic learning and building collective competence as well as individual students' repertoire of knowledge. Participating in interprofessional SRCs help students understand interprofessional roles without delineating scopes of practice, facilitating team work and breaking down outdated hierarchies. The result is that students were able to blur the boundaries of professional responsibilities and come together as a team to provide holistic care., Background/Purpose: Physical activity (PA) is associated with decreased risk in major chronic diseases. Physicians have been identified as serving a key role in promoting PA to their patients. Physician-provided PA counseling and exercise prescription has been shown to increase patients' PA levels. Insufficient educational opportunities have been cited as a primary contributor to the under-prescription of exercise. The objective of this project was to review current medical education literature and curriculum to identify best practice for exercise education. Methods: A scoping review to identify best practice in medical education on the topic of exercise was performed. Subsequently, our current curriculum pertaining to the inclusion of exercise education was reviewed, using key terms such as “exercise” and “PA”. Results: Three articles were identified that address the significance of exercise education for physicians. There were no studies identified on the efficacy of exercise curriculum in medical education. Learning objectives with regard to the importance and prescription of exercise were developed. Two lectures in total are currently delivered in the second year, within the Musculoskeletal block. The lectures were reviewed to identify gaps between the current state and the desired learning objectives. Conclusion: Although literature exists emphasizing the importance of physician education on exercise prescription and referral, a review of our curriculum found that there is limited content and not all objectives were covered. Based on these findings, the content of existing lectures will be revised and an additional introductory lecture has been included in the curriculum to expand medical students' knowledge regarding exercise in medicine., Background/Purpose: Results of 2017 AFMC Graduation Questionnaires revealed that University of Ottawa (uOttawa) medical graduates rate their preparation in Health Policy and Healthcare System Sciences (HPHSS) as inadequate. This project aimed to understand how HPHSS are currently taught in uOttawa's UGME curriculum, and proposes a new, more comprehensive HPHSS curriculum. Methods: An environmental scan of HPHSS curricula was conducted at five Canadian and one international medical schools. A literature review was performed to identify: 1) a validated framework to address gaps in uOttawa's HPHSS curriculum; 2) critical domains and themes essential to students' education; and 3) evidence-based modalities for content delivery and skills development in HPHSS. Relevant MCCQE learning objectives (LOs) were compared with uOttawa's LOs to identify gaps and address them. Results: The environmental scan highlighted variability amongst HPHSS curricula across medical schools. Lack of a standardized Canadian HPHSS curricular framework was identified. Four content-based domains (healthcare system & process, policy & principles, economics & management, and system improvement), and seven skills-based domains (leadership, collaboration, inter-professional education, evidence based medicine and research, professionalism and ethics, scholarship, and physician-patient communication) were identified as essential HPHSS components. Previous longitudinal integration of HPHSS content in uOttawa's curriculum diminished its visibility, requiring HPHSS educational activities to be appropriately identified. Thus, 42.8% of uOttawa's HPHSS-related LOs were revised. New teaching sessions are being planned to address identified gaps. Conclusion: This work identified curriculum gaps and LOs for modification at uOttawa. Addressing these gaps will help train socially responsible physicians with improved competency in HPHSS., Background/Purpose: Despite significant growth in the field of pediatric palliative care (PPC) in Canada, only 5-12% of children who could benefit from PPC are accessing these services. A recent survey found that over 60% of palliative care physicians were uncomfortable providing care for children. Providing PPC education may increase health care providers' (HCP) comfort in this area. Objectives: This study describes gaps in knowledge and training in PPC as perceived by HCPs and aims to characterize their educational needs using CIPP (context, input, process, product) analysis. These are first steps in designing and evaluating a program to teach PPC. Methods: We used a mixed-methods approach which involved (1) a literature review, (2) a survey of stakeholders, and (3) establishing consensus using an expert panel. Results: We identified 11 primary themes regarding gaps in PPC training from a review of (1) scientific and gray literature, (2) training objectives and competencies from relevant professional bodies and (3) existing palliative care training courses. We then conducted an online survey of HCP, regarding the identified themes and training delivery methods. These findings were then reviewed by an expert panel to establish consensus about content, desired format, and educational methodologies. We identified a blended learning program consisting of 3 online modules combined with 1-day multi-professional workshop (8 modules), delivered by a specialized PPC team as the desired format for an education program in PPC. Conclusion: The results of this study will be used to guide the development of a medical education program in PPC., Background/Purpose: Second and fourth year medical students are now required to complete a selection of Institute for Healthcare Improvement (IHI) patient safety and quality improvement (PS/QI) courses. Gaining the perspectives of these students will assist with future planning of PS/QI curricula. We want to understand if an online learning tool is efficient and effective, and to explore students' perspectives on integrating course content with in-program curriculum, and applicability to current or future practice. Methods: This evaluation used on-line surveys and student focus groups. Two Focus groups (one with Year 2 students and one with Year 4 students) were held in April 2018, gaining qualitative data and feedback. The feedback from focus groups directed questions included on the standard course evaluation given at the end of Term 2. Results: Surveys for specific curricular segments with an integrated narrative component yielded a response rate of 45%. More than half of respondents recognize PS and QI to be as an important concept in UGME, however students felt that the timing of the course may have been a better fit directly prior to clerkship and/or residency. Students enjoyed the online method of learning about PS/QI, however feedback around small-group learning and anecdotal lectures from healthcare professionals was received. Conclusion: Importing on-line curriculum content from established external organizations is an attractive option for medical schools, however determining how to best integrate such content within the curriculum presents a challenge. This evaluation will assist the U of S MD program in considering if, and how, such curriculum can be effectively incorporated., Background/Purpose: Photovoice, a communication method consisting of documentary photography and accompanying narrative captions, is an emerging curriculum tool for critical reflection in healthcare professional education. We present a student-run Photovoice project with interdisciplinary healthcare professional students (HPSs) completing a four-week volunteer community placement at IMAGINE Clinic, a student-run community health initiative providing health care to downtown Toronto neighborhoods. Purpose: (1) Explore Photovoice as a critical reflection method in interdisciplinary service-based learning. (2) Identify reflective themes of learners, advantages and challenges, and (3) gauge participant satisfaction with this curriculum approach. Methods: Participants took weekly photographs during their placements, created accompanying captions, reflected on these outputs in two audio-recorded, facilitated group discussions, and completed a post-program satisfaction questionnaire. Transcripts underwent descriptive thematic analysis by 3 independent investigators and questionnaires were analyzed using basic descriptive statistics. Results: Four HPS (nursing, medicine and pharmacy) in two cohorts took 27 photos, reflecting upon them in relation to their placements. Analysis to date identified six central themes - equity, mental wellness, power differentials, healthcare system, and healthcare professionals - indicative of two outcomes: empathy development and professional identity formation. Participants appreciated the flexibility of Photovoice reflection to accommodate personal reflection needs, describing their experience as “unique” and “deeply rewarding”. Conclusion: Photovoice appears not to have been previously used with interdisciplinary HPSs in service-based learning. Results suggest critical reflection using Photovoice meets experiential service-based learning goals institutionally and may enhance professional and personal reflection in health professionals, particularly in the domains of empathy development and professional identity formation., Background/Purpose: A major challenge that Southwestern Ontario (SWO) faces is the difficulty of healthcare worker recruitment. Discovery Healthcare (DHC) is a revamped summer camp that exposes high school students in SWO to medicine and other healthcare professions. The target demographic of this camp are student entering grade 10 as they are still deciding on their future career paths. These students are in the early stages of their schooling and can still make relevant academic choices in order to pursue a certain pathway. The goal of the camp is to get them interested in healthcare professions early on with the hope that they return to serve in their communities in the future. Summary of the Innovation: Five-day long camps were held in July 2018 in Wingham, Sarnia, Chatham and Leamington. With the help of a community liaison, four medical students facilitated the camps. There was a total of 89 students, with an average of 22 students in each camp. Students ranged from grade 6-12, but the majority had just completed grade 9. Students were introduced to various healthcare professions through local guest speakers, such as medicine, nursing, pharmacy and allied health. They learned clinical skills, including first aid, suturing, casting, and taking vitals. They were also introduced to case diagnosis, medical ethics and social determinants of health. Conclusion: Surveys were distributed at the beginning and end of the camp to assess how the camp impacted the students' interest in the healthcare field and their level of understanding of a pathway to a career in healthcare. It was found that their interest level in pursuing a career in healthcare was slightly increased, while their level of understanding of the pathway to a healthcare profession was markedly increased. Overall the camp was very positively received, and the students appeared to have gained further insight into the everyday practices of their local healthcare professionals. DHC hopes to grow and continue to inspire more students from SWO communities to pursue healthcare careers., Background/Purpose: Graduating medical students may feel ill-prepared to prescribe medications safely. Recognizing this issue, Britain's Royal Pharmaceutical Society published a prescribing competency framework describing the outcomes effective prescribers should be able to demonstrate. Using this framework as a standard reference, gaps in medical undergraduate curricula can be addressed. Methods: An environmental scan of our 2017-2018 undergraduate medical academic curriculum was conducted to identify learning events that addressed prescribing competency. Each learning event was matched to relevant competency subheadings within the prescribing competency framework. An analysis was carried out to identify gaps and redundancies. Results: In the 2017-2018 academic year there were 54 curricular events dedicated to prescribing. 26 competency subheadings from the prescribing competency framework had multiple corresponding learning events, whereas 17 were not addressed in the curriculum. The competencies that were most frequently addressed tended to fall under “The Consultation” category. This includes Competency 1 “Assess the patient” and Competency 2 “Consider the options”, the sole competencies in which all subheadings had at least one corresponding learning event. The majority of curricular gaps were noted among competencies grouped within the “Prescribing Governance” category. Conclusion: This study has defined gaps and potential redundancies in the undergraduate curriculum at our institution. Further review will be required through feedback from curricular leaders, current students and recent graduates to develop resources and related assessments to address areas of concern. The approach used in this study and subsequent resources developed may be of use to other undergraduate curricula., Background/Purpose: Provincial residents' associations in Canada have agreements with their respective faculties of medicine or health authorities to reimburse taxi rides after 24-hour call shifts. Medical students may work equivalent hours but no such safety measures exist. Summary of the Innovation: We piloted a program for the 2019 clinical clerks at the University of Alberta (UofA) modeled after established taxi reimbursement programs. Students who felt unsafe to drive home after a 24+ hour call shift were encouraged to use taxi/rideshare services, then email their receipts and call schedule for reimbursement. Rides to the hospital prior to the shift, or to retrieve the vehicle were also eligible for reimbursement. The program was funded through the UofA Medical Students' Association & Faculty of Medicine & Dentistry Joint Funding program. This year, the initiative funded 44 rides for 10 students (total cost = $769.82). Rides were used on Internal Medicine, OB/GYN and General Surgery rotations. The average ride cost was $17.50 (SD=$6.21). A survey conducted to collect feedback had the following results; 23 individuals responded, 7 (30.4%) of whom had used the program. Of those surveyed, 21 (91.3%) responded “agree or strongly agree” to the program promoting safety post-call. Areas for improvement identified included better promotion of the types of rides that were eligible for funding. Conclusion: The “Are You Post Call” program successfully funded rides after call shifts for students at the UofA. This program can be expanded to other schools to promote safety for students., Background/Purpose: What doctors are taught is more often based on 'speculation and ideology' than evidence. The 'wicked problem' of pediatric prescribing error exemplifies this. Lack of knowledge about causes means that educational solutions are failing to protect children from harm. As part of a doctoral research program that is generating educationally-relevant knowledge by investigating clinical practice, we systematically sought and synthesised evidence about causes of prescribing errors in children. Methods: Using scoping review methodology, articles were obtained from systematic database searching, hand-searching reference lists, and opportunistic inclusion. We used an inclusive approach, accepting all evidence which contributed to understanding of how errors occur. We extracted and thematically synthesised causative factors. To add context and meaning to research evidence, we then conducted a 'return of findings' focus group with multidisciplinary stakeholders. Results: Seventy articles showed six pediatric-specific causes of error: physiologic and pharmacokinetic factors; individualized dosing and calculations; medication formulations; off-license prescribing; communication with children and parents; and inexperience of pediatric practice. Multiple, contextually-influenced mechanisms interacted unpredictably to cause errors 'on the ground'. Conclusion: This study reveals the distinctive challenges in prescribing safely for children, as practitioners contend with a complex array of pediatric-specific factors. Findings indicate that teaching foundational knowledge of pediatric pharmacology alone is insufficient. Education could address the specific error mechanisms identified within the review through targeted interventions and providing supervised opportunities to prescribe in context. Studying practice in-depth - including practitioners' experiences - is a vital step to ensure medical education delivers safe patient care., Background/Purpose: Reference letters comment on the qualities and capabilities of an applicant. For the Canadian Resident Matching Service (CaRMS) process, these recommendation letters are used to assess an individual's readiness to receive further medical training and practice as a physician. Despite their widespread use, reference letters can often be heavily shaped by stereotypes and unconscious biases rooted in gendered perceptions, rather than applicants' actual capacity for success in a given program. Methods: We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Embase, MEDLINE, and PsycInfo from database inception to August 2018 for original studies that analyzed discrepancies in gender-linked adjectives in reference letters for academia or medical contexts. Study selection and data extraction were performed in duplicate, with a third author resolving discrepancies. Results: A total of 15 studies were included from the 217 studies eligible for screening. In total, 6573 reference letters were analyzed from 5008 applicants. Out of the 4 studies that analyzed gender-linked adjectives, letters for women tended to systematically focus on communal rather than agentic traits. In comparison to male applicants, included studies noted a higher frequency of doubt raisers, personal life mentions, and comments about appearance for female applicants. Conclusion: Reference letters for female applicants typically had a higher frequency of gendered language and doubt raisers. A better understanding of how gender is reflected within reference letters in medical education, and the subsequent impact on success rates, is needed. *Co-second authors, Background/Purpose: The University of Sherbrooke MD Program had historically little involvement with the Indigenous communities of Quebec. Some reasons for this include the lack of proximity to First Nations communities and the low proportion of Indigenous in the Quebec population (2%). The establishment in 2006 of a distributed medical campus in the Saguenay-Lac-Saint-Jean region, comprising the Innu community of Mashteuiatsh and the Atikamekw community of Opitciwan, has given rise to the Sherbrooke Indigenous Program. Summary of the Innovation: With the creation in 2008 of the Quebec First Nations and Inuit Faculties of Medicine Program, 11 Indigenous students have been admitted to the Sherbrooke MD Program since 2009, 2 at the Sherbrooke site and 9 at the Saguenay site. Educational activities about Indigenous history, culture and health issues have been introduced into the MD curriculum, as well as preclinical immersion experiences in several communities. Student interest groups emerged in both sites that have been active in cultural sensitization activities such as conferences, film projections, traditional retreats and ceremonies, as well as involvement with the Saguenay Native Friendship Center. Service activities such as the annual mini-med schools in Opitciwan and Saguenay have proved to be transformative student experiences. Conclusion: The Sherbrooke Indigenous Program has graduated its first practicing family physician in 2018, and its activities have enhanced dialogue and a reciprocal relationship with several Indigenous communities of Quebec., Background/Purpose: Integration in medical education has been rising in popularity as a model for curriculum design. The University of Toronto MD Program developed a novel Integrated Clinical Experience (ICE) Program to provide students with a holistic perspective of patient health and population needs through experiential learning and application of clinical skills. However, differences in the meaning and application of integration amongst programs have led to challenges in conducting valid and systematic program evaluation. This qualitative evaluation study aimed to better understand undergraduate medical students' experiences in the ICE Program to inform program improvements and demonstrate an integrated model of systematic program evaluation. Methods: Using a realist evaluation approach, focus groups were conducted with first and second-year medical students in the University of Toronto MD Program to get a better understanding of how successfully integration of the ICE program components has been implemented. Data was transcribed and thematically analyzed by two independent investigators. Results: All students reported positive experiences in the ICE program. Although most students were not explicitly aware of the ICE Program's integration objectives and components, upon reflection they all identified common themes between course components and recalled subconsciously integrating skills from various courses into their interactions with patients. Conclusion: Students require more explicit explanations of integration objectives to achieve conscious recognition of the ICE program's integrated design. However, lack of recognition did not impede students' ability to integrate learning from various course components into their clinical skills acumen. Reflective practice may enhance their awareness and understanding of ICE integration objectives., Background/Purpose: As the world becomes increasingly interconnected, it is imperative for medical students to have a sound understanding of global health in order to bridge health inequities within and between countries. The Global Medical Student Partnership (GMSP) aims to create an international network of medical students who share their local medical and cultural expertise, communicate and collaborate to solve common healthcare problems, and promote health advocacy. Summary of the Innovation: Medical students in Canada are paired with international peers and meet monthly using online face-to-face platforms to discuss medically-related global health cases. They then review their findings with local GMSP peers and a faculty facilitator, enabling the group to gain a wealth of global health knowledge on each topic. Upon program completion, 26 of 32 (81%) students completed a questionnaire (6-point Likert scales) to assess GMSP's impact. Thirteen also participated in one-on-one interviews. Descriptive statistics were calculated and thematic analysis conducted. Conclusion: After participating in GMSP, students agreed or strongly agreed that they knew more about their healthcare system, healthcare practices abroad and how to solve complex health issues (92%, 85%, 73% respectively), and that international collaboration and communication skills were more important to them (92%, 92% respectively). Qualitative data showed that despite logistical challenges, many students would recommend implementing GMSP into the medical curriculum. Our findings suggest that GMSP is helpful in developing the CanMEDS competencies of the Royal College of Physicians and Surgeons of Canada (e.g., collaboration). This program may be an important addition to medical education., Background/Purpose: University websites are one of the most effective tools for recruiting prospective medical students to their institutions. When websites are not updated in a dynamic academic environment, they can quickly become out-of-date and difficult to navigate. The University of Alberta's MD Program website disseminates information about its admissions processes, educational curriculum, and academic strengths. The MD Program is committed to recruiting and admitting diverse students, improving the navigation and content organization of its website as part of a broader recruitment and admissions strategy. To facilitate improvements in the MD program website, researchers used a think-aloud process to collect data during website usability testing. Summary of the Innovation: Medical students (n=6) and faculty and staff members (n=7) were assigned a series of task-scenarios to locate information about the MD program using only the navigation sidebar on the InVision-designed website prototype. Participants were asked to use the “think aloud” method, a verbal protocol analysis used to understand internal cognitive process during the completion of each task.1 Results from the think-aloud were used to evaluate the organization and navigation of the website, the ease with which different topics could be found, improve page headings, and re-group content. Follow-up questions provided insight on website content requiring further development. Conclusion: The think-aloud method highlighted gaps in both organizational structure and content not previously identified on the MD program website. The think-aloud method is therefore an extremely valuable tool that can be used by University stakeholders to facilitate website improvements and enhance recruitment of prospective students to their MD program., Background/Purpose: Duty hour restrictions (DHR) were introduced in an effort to reduce burnout in medical residents. There is currently substantial variability in the allowable maximum duty hours for a medical resident in Canada. Online discussion groups may allow a unique insight into trainees' perceptions of DHR in residency. Methods: We used an inductive qualitative approach to analyze 427 posts from 14 discussion threads in the Premed101 forum, posted from 2000-2018. Using content analysis, we identified key themes in the discussion threads. Data management was facilitated by NVivo 11. Results: Several advantages and disadvantages of DHR were discussed in the forums. There were prominent discussions regarding knowledge acquisition and skills training in medical education, and how they require continued exposure over time; there was thus a concern regarding whether DHR could impact the development of competence. As a result, the majority of posts reflected the view that blanket rules regarding resident hours may not adequately meet the training needs of various specialties, with surgical specialties requiring more training time. Furthermore, posters discussed the multifactorial dimensions of trainee fatigue; they felt that it was more closely linked to the nature of the work being done rather than the number of hours worked. Lastly, posters felt that open dialogue around DHR was a positive measure towards acknowledging and addressing trainee wellbeing. Conclusion: Online discussion groups have the potential to provide unique insight into DHR in Canada. These perceptions may ultimately provide a trainee perspective regarding the how DHR should be implemented nationally., Background/Purpose: As the adoption of electronic health records (EHRs) accelerates and as healthcare systems use advanced analytical techniques on stored information to improve patient care, future physicians will need knowledge and skills to work effectively within this ecosystem.[1,2] Although competencies have been outlined at the undergraduate and postgraduate levels, the scope of educational initiatives targeting knowledge and skill development in the use of EHRs is unknown. Methods: We conducted a systematic review of the literature following PRISMA guidelines to identify educational interventions designed to equip medical students and/or residents with knowledge and/or skills related to a broad spectrum of activities in EHRs. We summarize and, where possible, synthesize the quantitative and qualitative results of formal evaluation of these initiatives. Results: Our search strategy yielded 523 unique citations; 485 papers were excluded following screening of the abstracts. We reviewed 38 full texts and seven studies were included in the final data abstraction. Five studies focused on medical students, two studies focused on residents, and one included both groups. Curricular interventions ranged from a one-hour module introducing navigation of the local EHR to a longitudinal training program comprising experiential and didactic elements. Conclusion: Despite the existence of a broad set of EHR competencies, this review reveals few curricular initiatives focused on training learners to engage with record systems for both individual patient care and population health improvement. Future work must build on existing initiatives and address barriers to educational activities in this area, including a shortage of physician educators with informatics expertise and resource constraints., Background/Purpose: More than 98% of children who need palliative care live in low- or middle-income countries where access to palliative care is extremely limited. Lack of education about palliative care has been identified as a significant barrier to improving access to palliative care. Project ECHO uses web-based videoconference sessions to train healthcare professionals. We developed Project ECHO Pediatric Palliative Care (PPC), which focuses on training health professionals in South Asia to provide palliative care for children. Summary of the Innovation: We developed the content and structure of our ECHO program by reviewing the literature, a web-based survey of stakeholders, and consultation with experts. Project ECHO PPC consists of a 90-min session occurring regularly every 2 weeks. On average, there are 34 participants, who join from 15 different health centres in India and Bangladesh. Video recordings and key learning points are sent to participants after each session. The sessions format is: Welcome and introductions (10 mins)Didactic teaching (30 mins)Questions (10 mins)Case presentation (10 mins)Case discussion (25 mins) Summary (5 mins) The goal is to create a virtual learning community where participants can reflect and engage to deepen their knowledge of PPC. The use of discussions is intended to encourage deeper engagement with the material, and collaboration with colleagues. We have conducted baseline evaluations of the program, with plans for future evaluation. Conclusion: Project ECHO PPC is an innovative educational format for delivering pediatric palliative care education in resource-limited sessions, which can bring together content experts and practitioners in a collaborative online community., Background/Purpose: The phenomenon of Deaf culture is little known to medical students and physicians. The lack of Deaf Culture Competency (DCC) training leads to poor access to healthcare for Deaf patients. The aims of this project are three-fold: (i) assess the need for DCC training in medical school, (ii) evaluate the comfort of medical students on the topic and (iii) assess the efficacy of a 1-hour long interactive lecture in addressing this issue. Summary of the Innovation: The study population was composed of second-year medical students at McGill University. 23 participated in the 1-hour long interactive lecture, the content of which included myths and misconceptions of Deaf people, the rights of Deaf patients, legalities around sign language interpreting, communication skills, and basic American Sign language instruction. Knowledge on DCC was assessed before and after the lecture in order to evaluate the efficacy of the intervention. Conclusion: In the intervention group, there was a significant increase in the number of correct responses to the majority of the knowledge assessment questions (20 out of the 39) after the DCC interactive lecture. There is a significant increase in the total knowledge assessment score after the DCC interactive lecture (pre-intervention mean score: 23.4/39, post-intervention mean score: 32.3/39, p, Background/Purpose: Recent studies draw attention to the pressures surgical residents feel to conform to surgical culture, with surgeons being historically described as aggressive, dominant, and decisive. Little is known about how introverts - who tend to be more quiet and reserved - fare in this environment and adapt to it. This study explored how introverts experience, and are perceived in, general surgery. Methods: Purposively sampling by personality, we invited 6 general surgeons and 10 general surgery residents to complete personality questionnaires and individual semi-structured interviews. A constructivist grounded theory approach was used to uncover perceptions of the workplace and of introverts' strengths/challenges within it, as well as the consequences of a mismatch between culture and personality. Results: Two distinct narratives were identified. The participants who felt that “personality doesn't matter” saw few differences in how introverts and extraverts experience surgery. However, those who felt that “personality matters” thought that, while both can be successful, introverts appear less assertive, confident, and decisive than extraverts. They believed that maintaining control of acute situations requires a loud, dominant leader and that introverts need to act more extraverted at work. Extraverts had initially pursued surgery because they saw themselves in its extravert stereotypes, while many introverts were initially deterred from surgery because they did not. Conclusion: Introverts may face challenges in surgery due to an extravert-dominant culture; however, introverts can adapt to the specialty and bring strengths to it. Students should have the confidence to pursue specialties in which they don't initially seem to “fit.”, Background/Purpose: Online resources available for emergency medicine (EM) trainees and physicians have variable quality and inconsistent coverage of core topics. A systematic way to comprehensively identify, collate, and audit online content is needed. We describe the application of a methodology to identify these resources for inclusion in topic-specific modules. Methods: A list of module topics and related terms was generated from the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine (MCPEM). The authors selected 'Renal and Genitourinary' for the first module, which contained 35 terms; MeSH headers and colloquial synonyms related to the topic and related terms were searched within the top 100 websites ranked by the Social Media Index and the GoogleFOAM customized search engine. Duplicate entries, journal articles, images, and archives were excluded. The quality of each article was rated using the revised METRIQ (rMETRIQ). Results: The search yielded 13,058 online resources; 12,707 were excluded leaving 351 for review. A majority (n=31; 89%) of the topics were covered by a resource. The median rMETRIQ score was 11/21 (IQR 8-14). Calculus of urinary tract was most prominently featured with 61 posts. 13 of 35 topics (37%) had < 5 posts. Conclusion: We demonstrated the feasibility of systematically identifying high quality resources in an EM topic area. Some topics were overrepresented while others were not covered. A module constructed from this curated list of resources may guide trainees, teacher recommendations, and resource producers. Further entries in the series will address other topics relevant to EM., Background/Purpose: Clinical practice guidelines are often used to influence provider decisions in clinical care through the acquisition and application of evidence-based knowledge. Research in adaptive expertise, however, has demonstrated that physicians must be able to navigate between direct, efficient application of knowledge in routine situations and developing new solutions when handling non-routine cases. Expecting physicians to simply apply guidelines to their existing practice may be an oversimplification of a complex process. Thus, our qualitative pilot study explored how clinical guidelines might contribute to both routine and non-routine care and how psychiatrists recognized cases that required variations from guidelines. Methods: We conducted semi-structured interviews with 7 psychiatrists at an academic centre in Canada, exploring use of depression guidelines their practice. Analysis of the transcribed interviews was consistent with a constructivist grounded theory approach and utilized theories of adaptive expertise as a conceptual framework for the interpretation of the data. Results: We identified three themes: 1) experts perceived guidelines as a flexible resource for clinical practice, underlying management strategies for both routine and non-routine care, 2) experts recognized non-routine cases based on multiple factors, including medical comorbidities, social context, personality traits and the trajectory of the depression, and 3) experts integrated many forms of knowledge for clinical decision-making in non-routine cases. Conclusion: The results of this study contribute to the current discussion regarding the use of guidelines in clinical practice, and represent further research on how the framework of adaptive expertise informs understanding of problem-solving in clinical care., Background/Purpose: There is limited evidence for the use of virtual reality simulation in paediatric medical education. Therefore, we developed a virtual reality simulation, Virtual Doc (VD), that teaches paediatric cardiopulmonary resuscitation skills to medical students. This study evaluates the usability and perceived educational value of VD. Methods: We recruited medical students from The University of New South Wales (Australia) through voluntary convenience sampling. Participants attempted at least one full VD case and completed two mixed-methods questionnaires. Survey 1 assessed game components using 3-point Likert-scale questions. Survey 2 evaluated educational validity using 3-point Likert-scale and dichotomous or trichotomous questions. The responses were analyzed using descriptive statistics. Results: Twenty-six students were recruited and completed Survey 1 (n=24) and/or Survey 2 (n=23). VD was seen as ‘very’, ‘moderately’ or ‘not’ consistent with real-world clinical experiences by 25.0%, 58.3% and 16.7% of respondents, respectively. 58.3%, 37.5% and 4.2% of participants were ‘completely engrossed’, ‘mildly involved’ or ‘not involved’ in the VD environment, respectively. In terms of gameplay, 69.6% and 73.9% of participants agreed that it was easy to understand how to play the video-game and found the gameplay elements useful in understanding cardiopulmonary resuscitation, respectively. 69.6% of participants agreed that VD improved their understanding of cardiopulmonary resuscitation. VD was enjoyed by 91.3% of participants, whereby 73.9% and 65.2% of participants would recommend this simulation to a colleague or friend, respectively. Conclusion: Our findings demonstrate a positive response to VD. We plan to further investigate the efficacy of VD with a randomized controlled trial., Background/Purpose: There is increasing interest in the application of immersive stereoscopic virtual reality (VR) technologies to medical education. However, many studies on VR education assess costly VR equipment not easily accessible to students. Furthermore, there are no studies investigating the use of VR in teaching physiological concepts, such as neurology. By leveraging animation, a VR learning tool offers learners the opportunity to build upon knowledge gained from lecture or cadaver-based instruction, by illustrating a dynamic body system operating in a realistic 3D context. Summary of the Innovation: We have developed a lightweight stereoscopic virtual reality (VR) application to facilitate learning of clinical neurology for undergraduate medical students, using the smartphone-compatible Google Cardboard headset. Our learning tool illustrates functional concepts such as the consequences of nerve lesions. We selected the Google Cardboard headset for its low cost and intuitive design, which allows it to be easily deployed in a course context. Conclusion: We have demonstrated that it is possible to build a financially-accessible smartphone VR learning tool for teaching neuroanatomy and physiology. We collected and analyzed qualitative feedback from medical students to inform the further development of this learning tool. These improvements will be implemented and quantitatively assessed in an upcoming RCT trial, investigating the effect of VR on learning and retention of neurology concepts. This educational project provides insight regarding the design and use of VR in anatomy and physiology teaching.

OBJECTIVE: GridlockED gameplay workshops were delivered in Canada. This project investigated workshop attendees’ experiences, seeking to identify learning points to inform improvement of the workshop. METHODS: GridlockED sessions were held through 2018 and 2019. Workshops targeted medical trainees. After a standardized video, learners played for approximately 90 minutes. Learners completed a postgameplay survey with 7‐point Likert scale questions about their experience. RESULTS: Seventy‐two participants responded to our survey (41 medical students, 13 physician assistant students, 12 emergency medicine residents, and six faculty members). Trainees rated GridlockED as both enjoyable and a meaningful educational experience, with a mean (±SD) rating of 6.53 (±0.96) of 7 for enjoyment and 6.17 (±1.13) for education. Attendees identified teamwork and communication (49%) as the most helpful learning domain, with patient flow (43%) being second and basics of how the ED worked (31%) being third. The respondents self‐identified top areas of learning as resource management (38.9%), improved understanding of various provider roles in the ED (33%), and improved communication skills (33%). CONCLUSION: Medical learners identified GridlockED to be an educational and enjoyable learning experience. Attendees reported that playing this serious game assisted with learning about health systems and communication.

BackgroundThe effect of hemodialysis on cardiac biomarkers is unclear. We sought to evaluate the degree and causes of intradialytic variability of high sensitivity troponin I (hs-TnI), galectin-3 (gal-3), and heart-type fatty acid binding protein (hFABP).Methodshs-TnI, gal-3, and hFABP were prospectively measured pre-dialysis and post-dialysis for 1 week every month for 6 months in 178 prevalent adult hemodialysis patients at a single center in Hamilton, Canada. The degree of change from pre-dialysis to post-dialysis for each cardiac biomarker was estimated with multilevel linear regression models.ResultsThe median change in the concentration of hs-TnI during hemodialysis was −1 ng/L (interquartile range [IQR] −1 to 2 ng/L) while gal-3 and hFABP changed by −36.3 ng/mL (IQR −27.7 to −46.8 ng/mL) and −19.41 ng/mL (IQR −13.61 to −26.87 ng/mL), respectively. The median (IQR) percentage intradialytic changes for hs-TnI, gal-3, and hFABP were 2.6% (−4.4% to 12.5%), −59.8% (−54.7% to −64.8%) and −35.3% (−28.4% to −42.1%), respectively. Ultrafiltration was associated with an increase in concentration of hs-TnI, gal-3, and hFABP (mean 0.99 ng/L, 1.05 ng/mL, and 1.9 ng/mL per L ultrafiltration, respectively, P ConclusionsUltrafiltration volume and hemodialysis treatment time influenced hs-TnI, gal-3, and hFABP concentrations during hemodialysis and should be considered when interpreting their measurement.

Rationale/Background: Feedback is a dynamic and co-constructive interaction in the context of a safe and mutually respectful relationship for the purpose of challenging a learner's (and educator's) ways of thinking, acting or being to support growth (Ajjawi&Regehr, 2019). The R2C2 model for feedback and coaching, with four phases in which supervisors and learners build relationship, explore reactions and reflections, determine content, and coach for change to co-create an action plan, was developed as a model to facilitate such conversations. It was based on theory and research related to self-assessment, cognitive domains, humanism, commitment to change and implementation science. It has been tested and found effective for work with physicians in practice, nurse practitioners, and residents across several countries and disciplines. Recently, the researchers have modified the R2C2 model for use with in-the-moment feedback and coaching that occur in the clinical environment. This workshop will provide participants with an opportunity to explore and practice the R2C2 in-the-moment model (https://medicine.dal.ca/departments/core-units/cpd/faculty-development/R2C2.html) and discuss its applicability within their own context. Instructional Methods: This interactive workshop will draw upon participants' experiences through: 1. Introductions and large group discussion of participant experiences (10 minutes) 2. Presentation and demonstration of the model (15 mins) 3. Small group discussion of the model (10 mins) 4. Coaching practice with case scenarios and debriefing (40 mins) 5. Large group discussion of R2C2 in-the moment coaching and feedback and take-home messages (15 mins) Target audience: Educators at all levels of the education continuum with an interest in feedback and coaching Learning Objective: Share experiences providing “in-the-moment” feedback within clinical settings. Practice applying the R2C2 ITM model to case scenarios. Identify the utility of and barriers to integration of the R2C2 in-the moment (ITM) feedback and coaching model and its application within their work., Rationale/Background: The growing legitimacy of medical education research is reflected in an unprecedented rise in the number of peer-reviewed publications. This seeming abundance of primary studies has catalyzed the development and/or use of multiple types of evidence syntheses. In choosing a methodology, scholars have been challenged to navigate, identify, and apply both standard and innovative approaches for summarizing research and other forms of evidence. While medical education draws its strength from researchers who embrace diverse epistemologies, methodologies and philosophical approaches, Ellaway et al. note this plurality creates substantial challenges for those attempting to achieve coherence in acts of knowledge synthesis and consequently, their applicability and use. Recent research in medical education has also challenged the application of traditional evidence synthesis approaches, especially focusing on whether and how to employ them well. Instructional Methods: In this workshop, we will explore the nature, purpose, value and discourses of systematic, scoping and realist syntheses. We will also discuss their utility for medical education researchers, as well as how they may be adapted to respond to the unique and changing complexities of our field. Fundamental methodologic characteristics for each synthesis will be compared and contrasted. Further, we will suggest tools that can be used to inform the interpretation and production of these common synthesis approaches. We will use a mix of didactic as well as small group discussion and engagement where participants 'map' question to method using a hands-on approach followed by small group presentation. Target audience: Individuals interested in learning more about the fundamentals of evidence syntheses, those looking to critically appraise and apply findings of common evidence syntheses to their practice (e.g. consumers of synthesis evidence), and those interested in conducting either a scoping, systematic or realist synthesis in future. Learning Objective: As a result of the session, the audience members will be able to: 1. Discuss and discern the nature, purpose, value and role of common evidence synthesis approaches including systematic, scoping and realist syntheses of medical education research; 2. Critically examine assumptions made about different evidence synthesis approaches, including ontological, epistemological, methodological, and conceptual bases, boundaries and innovations related to each; 4. Understand basic methodological considerations of each approach., Rationale/Background: Research has demonstrated a range of gaps in addressing the varied health care needs of racialized populations (Wylie et al., 2018, Wylie and McConkey 2019). The aim of this workshop is to demonstrate ways to build competencies among medical students, residents and physicians to advance health equity. There is a need to improve knowledge and practice through targeted educational initiatives that give providers concrete recommendations to improve equity in practice. Such actions include understanding and correcting their own biases, improving their knowledge, and ensuring system-wide supports for culturally safe and appropriate care. Instructional Methods: This workshop uses storytelling, role play and interactive case exercises to demonstrated strategies for building competencies in providing culturally safe, quality health care for Indigenous people, immigrants and refugees. This workshop will provide experiential learning opportunities that demonstrate strategies that build concrete skills. In addition, the workshop will support participants to develop theatre-based training activities in their own health service settings. The presenters will illustrate a range of challenges facing Indigenous people, refugees and immigrant, both within the health care system and more broad social determinants of health. Narratives drawing on examples from health care experiences that demonstrate challenges will be presented. Participants will work in teams to explore the issues in the cases, reflecting on determinants of health through role play exercises. The workshop facilitators will guide a reflection on the process and explore ways participants can apply this approach to their own settings. Target audience: This workshop is oriented to health care providers, health care educators, and others involved in training health professionals. Learning Objective: To identify the range of challenges that undermine health equity. To demonstrate evidence-based exercises that can improve health care providers' attitudes, knowledge and skills in promoting culturally safe changes in health care delivery To support participants in developing educational and workplace strategies applicable to their own setting, Rationale/Background: Storytelling is a powerful tool in transforming the way people remember and respond to information. Research in cognitive sciences indicate that humans have been telling stories for thousands of years and human brains are wired to process and respond to them. Both Programmatic Assessment and Program Evaluation in medical education involve collecting large volumes of data and making informed decisions using that data. The use of online exam platforms and survey tools enables us to collect the data, but effective presentation and communication of assessment and evaluation data is still evolving. In the past 3 years, our office explored the use of data visualization and storytelling to support data exploration and analysis, high-stakes decision making, exam bank quality auditing, and identifying areas of improvements as a part of our overall Program Evaluation Model. Instructional Methods: We will begin by presenting theories and best practices in data visualization and data storytelling. A brief presentation of real examples of data visualization from our office will follow. We will then divide participants of different levels of expertise into small working groups to engage in two visualization and storytelling design activities. There will be a Q&A session at the end followed by a brief wrap-up. Target audience: Administrative leaders, department heads, education scientists, data practitioners and staff who are involved in medical school assessment and evaluation areas. Learning Objective: Identify data visualization and storytelling opportunities in student assessment and program evaluation. Learn how to present quantitative information effectively Develop confidence in effectively engaging and persuading your audience with storytelling, Rationale/Background: Axiology, ontology, epistemology, theory, methodology, methods: intimidating words regardless of experience. As researchers, we naturally gravitate towards the familiar, preferring to discuss research methods - “I'm doing a focus group study”- than grapple with these intimidating underlying concepts. Failing to attend to these key elements, and their alignment, however, will cause problems throughout all stages of research - not least when a researcher pursues publication or defends their thesis. Congruent research is a key tenet of rigour. Participants will feel supported to apply their learning to their own research contexts and ultimately engage with more rigorous work. Instructional Methods: This workshop will support participants to explore these fundamentals of rigorous research through practical and memorable tasks. Working primarily in small groups, interspersed with some focused mini-lectures, participants will configure 'worked examples' in congruent ways and consider how improved congruence might enhance their own research projects. Target audience: Anyone interested in enhancing the rigour of their research will have a valuable contribution to make. Our activities, however, will be of particular benefit to more novice researchers or those at early stages of project conceptualisation and planning. Learning Objective: Explore why research congruence matters; and matters from the outset Identify key distinctions between concepts outlined in workshop background • Develop key action points as to how they will translate this learning into their own research practice., Rationale/Background: Canadian medical schools are responsible for training a physician body that is representative of the population they serve, and have a mandate for diversity and inclusion in their student body (1). Physicians are more likely to serve a population that reflects their own background, and doctors who share a background with their patients are perceived by patients to provide better care. However, students from low SES backgrounds are severely underrepresented in the medical student body (2), with application costs significantly limiting their access to medical school (3). Instructional Methods: After introductions and eliciting participants' interests, we will introduce a key focus area of the University of Toronto (UofT) MD admissions and outreach team - educating applicants about the financial cost of pursuing a career in medicine. We will describe data gathered on the general (cost) elements of medical school admissions process and total costs per applicant type, and share the UofT MD Program experience in implementing key strategies to educate and support applicants (20 min). Participants will then work through scenarios in small group discussion with large group debriefing to identify and share resources, personal experiences, and collaborative methods for reducing application-related costs (50 min). Next steps and potential strategies will be highlighted to conclude the session (20 min). Target audience: Admissions and registrarial staff working with premedical students and admissions committees members. Learning Objective: In this presentation we will highlight the various direct and indirect costs associated with the admissions process for Canadian prospective medical students and provide administrative leaders with advice on how to implement strategies to reduce these costs., Rationale/Background: Reviewing papers is an important contribution to the medical education community and an excellent learning experience. Reviewing is a lonely activity with little feedback or opportunity to collaborate. With support from the Editor and select Associate Editors (AEs) participants will learn about the peer review and decision making process at the CMEJ. They will work independently and in small groups to review one or two actual original submissions that were eventually published in the CMEJ. Instructional Methods: Introductions, presentation of the peer review process at the CMEJ as well as the main reasons for revisions and/or decline decisions. Participants will choose one of two or three original submissions to begin to review individually; Editor and AEs will circulate and provide assistance as needed. Participants will form pairs and/or small groups to compare their observations and critiques. Editor and AEs will monitor each group and provide assistance as needed. We will end with a Q&A period and a general wrap-up. Target audience: All faculty, staff, residents, and students interested in strengthening their skills in critical appraisal and advancing their contribution to medical education in Canada through reviewing. Learning Objective: Apply (better apply) 2-3 skills in reviewing papers in medical education Navigate the CMEJ website to review submissions Anticipate tasks, features, and reminders associated with the CMEJ reviewing process, Rationale/Background: Évaluer, superviser, monteruneactivitéd'enseignement, faire de la recherche, améliorer les soins, géreruneclinique ; de plus en plus d'initiativesvivent à impliquer des patients partenairesdanscesdifférentscontextespartout à travers le Canada. À partir des résultatsd'une étude qualitative réaliséedans le cadre d'unemaîtriseenpédagogiemédicale, nous proposons un atelier pratique pour permettre aux participants d'analyser et adresser les enjeuxpotentielslorsquecliniciens et patients travaillent ensemble à l'extérieur d'un simple cadre thérapeutique. Instructional Methods: Par le biais de misesen situation, et de discussions interactives engroupe, les participants pourrontanalyser des situations et des enjeuxpratico-pratiquesrencontrées sur le terrain. À l'aided'une grille d'analyse issue de la recherche, ilsserontappelés à réfléchir sur le changement que soulèvel'arrivée du partenariat avec les patients sur leurpratiquecommeenseignantoucommecliniciens. Target audience: Tousceuxappelésouintéressés à travailler avec des patients partenaires Learning Objective: Analyser les enjeuxpotentielslorsquecliniciens et patients travaillentenpartenariat Réfléchir à des pistes pour répondre aux enjeux terrains Comprendre comment le partenariat patient peut toucher l'identité des professionnels de la santé, Rationale/Background: It is recognized that being a good clinician is not enough to be a good teacher. Several faculties have a faculty development program. However, clinical teachers remain poorly observed and receive little feedback on their teaching skills. The expansion and decentralization of several programs has increased the need for faculty training and sometimes led to distance constraints. A method of peer observation of teaching (POT) with feedback can be helpful in addressing both of these issues. This practice can be fostered by the use of a simple, user-friendly tool that must still include the essential attributes of an effective teaching clinician as already described by several authors and in the Fundamental Teaching Activities Framework of the College of Family Physicians. The tools found in the literature are often long and exhaustive, making them difficult to use in a busy practice. This is what motivated the author to develop the tool that will be presented and used during this workshop. Instructional Methods: • Brief formal presentation: context, presentation of the tool • Practice the method using the tool: role-playing games in trio • Debriefing following role-playing • Group discussion: examples of practical applications • Key messages Target audience: Clinical supervisors of all level and faculty developers Learning Objective: During this workshop, participants will be able to: • Familiarize themselves with the concept of POT. • Practice POT and giving feedback using a tool that facilitates feedback between colleagues. • Discuss its practical application for local and continuous faculty development., Rationale/Background: Unprofessional behavior amongst learners and health professionals continues to be problematic. Teaching, assessing, and remediating professionalism is challenging, due to its multifaceted nature, the influence of context, and lack of a clear definition. This can lead to a “shotgun” approach to the professionalism curriculum where multiple methodologies are employed in the hope that “something will work” to capture the essence of professionalism. While this approach may have merits, a more targeted and evidence informed approach is needed. In this workshop, four conceptualizations of professionalism (competence, behaviors, values and identity) will be explored with a focus on designing curricular approaches to address each of these. Participants will explore and co-create curricular approaches which are evidence informed and are clearly linked to specific professionalism outcomes. Instructional Methods: Following a brief overview of how professionalism is conceptualized in the literature, participants will break into small groups to discuss and strategize how to teach, assess and remediate professionalism utilizing one of the four conceptualizations. Groups will report back for large group discussion and debate, and end with a case study to apply the concepts to real life scenarios. Target audience: All health professionals involved in the teaching of professionalism, in both academic and clinical settings. Content will be applicable to both novice and experienced educators. Learning Objective: By the end of the workshop, participants will able to align teaching, assessment, and remediation methods with four key elements of professionalism to develop a more targeted and evidence informed professionalism curriculum., Rationale/Background: The number of tools for workplace-based assessment (WBA) in under- and postgraduate medical education have steadily increased over the past decade and with it conceptual models for their use have evolved. Evaluation studies, however, indicate that WBA in clinical practice does not always work as well as in they should in theory. Assessment procedures can become tickboxexcercises and assessment for learning degrades to (merely) being perceived as summative assessment. This workshop will focus on these challenges by asking what practitioners and educationalist can do to make WBA work for learning. Instructional Methods: The workshop will use the following approaches: small group learning in a round robin design and moderated plenary discussion. We will build on participants' experiences with and knowledge of WBA. After a brief plenary introduction by the moderators, a round robin design will be used to enable small group discussions about four different WBA related topics during the first workshop hour. One topic concerns the tension inherent in WBA related to assessment for vs. of learning. One deals with the question what matters in assessment, for whom and why. The final two topics address do's and don'ts for trainees and preceptors. An interactive plenary discussion will allow synthetisation of outcomes and lead to key findings. Target audience: We expect students, residents, faculty and educationalists to benefit from insights in how WBA can work in clinical practice. Learning Objective: Participants will be able to: - better understand how inherent tensions in assessment at the workplace affect WBA - understand under what circumstances WBA can optimally support learning in practice, - know what role individual trainees and preceptors can play in making WBA work for them., Rationale/Background: Interprofessional Education (IPE) positive outcomes are being recognized, with governments and educators calling for IPE. IPE provides an opportunity for colleagues to work together in teams, enabling development of knowledge, skills and attitudes to practice collaboratively in the workplace, thereby enhancing service delivery. The 3P model has been previously proposed as an effective model for describing and analyzing IPE learning activities. It uses narrative descriptions of presage, process and product factors of the educational experiences, and focuses on the complex and dynamic relationships between the different factors. Instructional Methods: Innovative, learner-centred and co-creative instructional approach using a restaurant conceptual framework (“MedEd à la carte”): 1. Facilitators do a “Needs Assessment on-the-fly” and assign seats according to learner characteristics (a. Phase in the educational cycle: planning vs evaluation; b. IPE Expertise: 101 vs 202; c. Phase in the education continuum: Undergrad, Postgrad, CPD); 2. Menu organized with 3P framework: Presage, Process and Product; 3. Participants at each table select topics to be discussed; 4. Facilitators select from pre-set provocative questions related to the topic and table's needs; 5. Questions are served for participants (small group discussion); 6. Whole group discussions take place at the end of each “course” Target audience: Clinician teachers and clinician educators from any level of the education continuum interested in, planning, implementing, analysing or evaluating an interprofessional education activity Learning Objective: Apply the Presage, Process and Product model to the planning and evaluation of their IPE activities; Discuss potential drivers, barriers and approaches associated with positive IPE outcomes., Rationale/Background: Well-intentioned efforts towards healthcare equity and diversity may backfire and erode trust and allyship. Existing frameworks and instructional strategies have shortcomings or limitations. Allyship is a concept that may have relevance to advance efforts for healthcare equity into the future, yet is under-explored in healthcare and health professions education. This session will provide an introduction to the concept of allyship, how it is distinct and/or complementary to other concepts (e.g. cultural humility, anti-oppressive practice, etc.), while co-creating practical strategies for participants to build and practice allyship in their organizations. Instructional Methods: • Icebreaker/reflection exercise through think-pair-share activities • Brief didactic with handout for introduction to terms and concepts • Storytelling and co-creation • Small group case discussion with large group debrief Target audience: All are invited to participate and join the dialogue Learning Objective: Define the concept of allyship and how it is distinct or complementary to other related concepts in health professions education Provide examples of how to enact allyship as it relates to indigenous health Describe and practice strategies to build and enact allyship within own organization(s), Rationale/Background: High-quality communication in healthcare results in greater patient and family satisfaction. Care models like patient- or person-centered care(1) and shared decision-making(2) have been increasingly promoted to improve physician communication. These models focus both on information sharing and emotional support. Yet, teaching how to provide emotional support during communication training presents unique opportunities and challenges(3). Instructional Methods: The workshop will be divided in three parts. 1- Participants will first engage in video review and role playing of difficult conversations to help them reflect on a) their own personal emotional responses to difficult conversations, and b) communication strategies used to address patients and families' emotions. 2- We will then propose a communication toolkit useful for emotional conversations that will be discussed and practiced with participants. 3- Finally, participants will be asked to design, in small groups, a communication training outline focused on emotional support using one of three proposed educational strategies. Target audience: Medical educators and teachers involved in the design or delivery of communication skill training and assessment. Learning Objective: By the end of the workshop, participants will be able to: Explain the importance of emotional awareness and support during difficult conversations with patients and families;Demonstrate simple communication skills helpful for emotional support during difficult conversations with patients and families;Compare different educational strategies to help trainees to support emotionally patients and families., Rationale/Background: Hospitals in large urban centres like Toronto have witnessed a vast increase in the number of international learners, patients and providers that bring different lived experiences and ideas of culture. Our organizations, by default, are shifting towards becoming increasingly international in their makeup. Arguably however, there seems to be a disconnect between the structures we work in and the populations they serve. The workshop explores the notions of cultural humility and diversity and how it can enhance our teaching and learning practices in health professions education. By using their lived experiences as a personal lens, and by practicing through role plays, participants will be encouraged to challenge their worldviews, mental models, and current systems. Participants will also reflect on the western philosophies of learning they have been socialized to, and espouse, in health care settings. Instructional Methods: Workshop style with group discussions, role play and case studies Target audience: Healthcare providers, educators, administrators, leaders Learning Objective: Explore the concept of cultural humility and how it can enhance our teaching and learning practices Explore the intersection of culture with teaching & learning and the impact has on our lens as educators, providers and learners Challenge current ways of thinking, systems and philosophies., Rationale/Background: Depression affects nearly 1/3 of medical students worldwide. Among medical students who screened positive for depression, only 15% sought treatment. In an age-matched sample of the general population, psychological distress was shown to be lower in students entering a medical program. Mental health then deteriorates during medical school. The importance of well-being among medical students includes: enhancement of reflective practice, communication skills, empathy and patient care. Depressed residents and doctors are likely to make six times more medication errors than colleagues who aren't depressed. Very few peer-led programs have been assessed in a medical student population. Respondents from peer-support and mindfulness program “favoured support services that are non-stigmatizing, accessible and confidential, preferably provided by peers with medical training like themselves.” There is evidence that peer-support or “peer-led” programs can improve help seeking behaviors and suicide perceptions, increase social integration, and reduce anxiety scores, among students in secondary school and university settings. Instructional Methods: A student-led peer support program, such as Side by Side, is a valuable addition to the current programs and services offered at our faculty. The goals of the programs are to: improve help-seeking behaviors; reduce stigma; Provide non-judgmental, accessible and confidential peer support from students who have undergone professional training; approach peers who are at risk of experiencing distress based on behavioral changes; facilitate students' pathway to proper resources and professional services. This is an interactive workshop representing the implementation of such a program and the training presented to peer support students. The instructional methods used during this workshop are small and large group scenarios and discussions as well as hands on techniques to facilitate interactions. Participants will be provided with a training manual with questionnaires and reflection tools aimed at presenting the following main topics: 1. Peer Support 101 2. Communication & Basic Counselling 3. Responsibilities, Limits & Resources 4. Crises & Suicide 5. Common Scenarios & Practice 6. Self-Care Target audience: This workshop targets students, residents, student affairs, faculty wellness, counselors and any faculty member with interests in wellness and mental health. Learning Objective: At the end of this workshop, the participant will: Recognize the need for prevention, identification, and treatment of mental illness early in medical training;Identify factors that contribute to poor help-seeking behaviors in medical students;Describe the implementation of a peer support program in medical school including planning, recruitment, training, and evaluation., Rationale/Background: Determining the effectiveness and value of educational programs is paramount to the success of Health Professions Education (HPE). However, making sense of program functioning is complex, due to the myriad factors that interact to generate program outcomes [1]. With the introduction of Competency Based Medical Education (CBME) - an outcomes-based approach [2] - it is important to evaluate outcomes while offering an understanding of how outcomes are generated. This workshop introduces attendees to the use of program logic models - which are an evaluation framework [3] that would help them understand the linkages between program activities, processes, and program outcomes. Instructional Methods: We will begin with a didactic overview of the Logic Model (LM) framework as a way to structure the evaluation of educational programs. Through structured small group exercises, participants will work on refining their understanding of LMs and develop evaluation plans for their programs. Workshop faculty will work closely with attendees to provide personalized assistance progress during the session. Participants will be asked to present their work back to the group for facilitated feedback, including a Q&A section to clarify any questions that might have resulted after the activity. Target audience: This workshop is intended for early career educators, researchers, students, and administrators that are interested in understanding the fundamentals of high-quality evaluation practice. No previous knowledge around program evaluation is required. Learning Objective: By the end of this workshop, participants will be able to use logic models to facilitate evaluation planning for complex educational interventions., Rationale/Background: Quality Improvement and Patient Safety (QIPS) teaching is becoming widely accepted as a vital aspect of modern medical education(1). Despite this, there exist several barriers to its effective implementation in the clinical context, including limited skills, resources, and opportunities for applied and interactive learning(2). Many institutions rely on a combination of didactic lectures with mandatory QIPS projects for residents or medical students(3). We have designed an innovative, longitudinal, case-based QIPS curriculum, which addresses learning needs across undergraduate, post-graduate, sub-specialty, and faculty development levels. Each session focuses on the application of a quality, safety or leadership concept to a real case, which is identified and presented by the learners, followed by a facilitated, clinically relevant discussion. Instructional Methods: The workshop will build capacity to facilitate case-based QIPS education sessions through the use of small group activities. Groups will be provided with preparatory materials and be coached through delivering and participating in fun, interactive, and adaptable sample sessions. An approach to the implementation and evaluation of such a curriculum will be explored. Target audience: Clinical educators (Faculty, Fellows, Senior Residents) with an interest in QIPS. Learning Objective: By the end of this session, participants will be able to Develop a curriculum for case-based learning of QIPS materials Deliver QIPS rounds to engage learners at all levels Evaluate the success of their case-based QIPS curriculum in a clinical context., Rationale/Background: Physicians work as part of large teams and patient outcomes are rarely related to the competence of an individual physician, but rather are related to the competence of the team. Despite this, assessments within CBME frameworks are based on the competence of the individual trainee. In this workshop, the presenters will discuss circumstances in which trainee's actions, decisions, and performance are not independent, setting the stage for the need for innovative assessment strategies that examine individual competence within a team context. Presenters will discuss the challenges of assessing for collective, team performance in the complex clinical environment and then share their experience with two strategies for assessing individuals whose performance is dependent on other team members. One of these assessment strategies is based on studies in educational measurement and provides an approach for assessing collaboration to capture aspects of independent and non-independent performance along a spectrum by describing individual relations with different team members and their contributions to outcomes. The second strategy is based on Multi Source Feedback (MSF) and uses team members' assessment of the individual trainee on a particular case to capture trainee's and team members' contributions. These assessment strategies attempt to determine the contribution of the trainee to the final clinical outcome rather than attributing the clinical outcome to the individual trainee. In the last part of this workshop, the authors explore the validity of these assessment strategies and whether qualitative assessment rather than quantitative might be better suited to capture the “Collective Competence” Instructional Methods: Large group discussion on the need for new assessment strategies Mini lecture with small group case study and demonstration of strategies Mini lecture and small group discussion on validity of these assessment strategies Target audience: Educators whose responsibility is to assess trainees Learning Objective: Discuss the need for innovative assessments that look at the individual trainee within a team context Describe two strategies to assess individual and team contribution to the final performance and clinical outcome Explore the validity of these two assessment strategies, Rationale/Background: As wellness consultants working with postgraduate medical trainees at University of Toronto and McGill University, we often help residents and clinical fellows struggling with Imposter Syndrome and perfectionistic anxiety. The culture of postgraduate medical training can inadvertently foster and/or exacerbate feelings of self-doubt and inadequacy. Trying to learn while expecting oneself to adhere to unrealistic perfectionistic standards can hinder both learning and clinical performance. Shifts in one's mindset and the broader culture of learning environments are possible and can lead to safer, more flexible environments in which to learn. Instructional Methods: We will review relevant theories and research with respect to Imposter Syndrome, perfectionism, mindsets, decision making, and psychological safety in terms of their applicability to medical training. We will aim to provide tools for trainees to manage their own distress and enhance their learning and clinical performance, and help trainees and educators gain knowledge about practical and achievable changes within the medical training environment to foster safer spaces to learn and work. We will incorporate interactive exercises including self-assessment, reflection, small and large group discussions, and experiential use of strategies to manage discomfort. Target audience: Postgraduate medical trainees and educators Learning Objective: Participants will learn to: Recognize thoughts, behaviours, and emotions related to Imposter SyndromeUse skills to manage perfectionistic anxiety and self-doubtRecognize roles they may play in perpetuating a culture of unrealistic standardsIdentify ways to create safer, more supportive learning environments., Rationale/Background: Family doctors and other generalists, embedded in communities, are often acutely aware of social determinants of health. Their way of knowing medicine encompasses a commitment to humanism, relational care, and health advocacy. For these professionals, core skills of managing complexity and uncertainty are mediated by a social justice agenda. However, despite being fundamental to generalist identity and practice, these nuances are rarely acknowledged within formal curricula.1 In this workshop, we encourage clinical educators to make explicit concepts of critical consciousness, and to develop meaningful strategies for translating them. We draw on Freire's critical pedagogy2 to help educators develop their teaching of health advocacy and critically conscious attitudes. Instructional Methods: In the words of Leonard Cohen, we will seek 'the crack in everything; that's how the light gets in'. Working primarily in small groups, interspersed with a few focused mini-lectures, participants will identify challenges and opportunities within our own contexts, to allow critical consciousness to become embedded within teaching, rather than a 'tick box'. We will explore possible educational practices that, adapted and applied to context, can foster students' commitment to address social issues in healthcare. Target audience: Clinical teachers and educators, curriculum designers, and anyone interested in advancing social justice issues in medicine. Learning Objective: In this workshop participants will: Identify aspects of their own critical consciousness as educators,Explore various ways to be an effective preceptor of critical consciousness,Develop practical educational strategies for use in their own teaching contexts., Rationale/Background: While Interprofessional Education (IPE) is a relatively new buzzword in the medical education community, disciplines in the arts and humanities have long been exploring the theory and real-life practice of interprofessional collaboration.[1] In a new and innovative IPE mini-course at Dalhousie Medical School, we draw on professional classical music ensembles in the community to teach communication, team functioning and conflict resolution to healthcare students. The first iteration of this course took place in March 2019 and paired a string quartet with healthcare students in various disciplines.[2] After an incredibly successful debut, student's final reflections described the unique value gained from being fully immersed inside a musical ensemble to observe and engage with professional collaborators as a means to learn what successful collaboration looks like, sounds like, and feels like. Instructional Methods: Methods are modeled after traditional practices in classical music ensembles. Workshop will consist of musical demonstrations by co-presenters (piano & violin) interspersed with guided interactive activities. Attendees will be divided into groups to participate in improvisation exercises around themes of communication, drawing on ideas/teaching points presented in the collaborative musical demonstrations. Emphasis will be placed on exploring conflict resolution through simulated group communication. Target audience: Medical and health educators, particularly those interested in the complex interpersonal communication created in interprofessional health care teams. Learning Objective: We hope to generate interest in medical humanities education opportunities, and leave participants with an understanding that, “Although medicine is inarguably a learned profession, clinical practice is above all a matter of performance.”[3], Rationale/Background: Excellence in health sciences education requires using and synthesizing credible evidence. The BEME (Best Evidence in Medical Education) Collaboration plays an important role in championing this goal by supporting and publishing systematic, scoping, and realist syntheses. As well, with approximately 60 published BEME reviews and many more in progress, there are still numerous questions that merit further investigation. As members of BEME International Collaborating Centers, we are eager to encourage Canadian scholars to be part of this international trend. During this workshop, we will discuss some of the advantages of undertaking BEME reviews and introduce participants to the process of conducting a BEME review. In addition, based on our experiences with a number of BEME reviews, we will share lessons learned in developing protocols and conducting knowledge syntheses and provide participants with some practical tips and recommendations to overcome commonly perceived challenges. Instructional Methods: Brief interactive large group presentations, individual exercises, and small group discussions Target audience: Healthcare professionals, faculty members, and students who are interested in conducting a knowledge synthesis in medical education Learning Objective: By the end of this workshop, participants will be able to: Describe the benefits and challenges of conducting a BEME reviewIdentify the various steps required in conducting a BEME reviewExplain the key components of a BEME protocolRecognize relevant topics and research questions for review, Rationale/Background: At some point in their careers as health professionals, most clinicians are expected to take on the role of educator, facilitating learning amongst students, patients or other target groups. During the last decade or so, several schools and universities have started to offer elective courses in health professions education with the overall aim of helping students gain insight into how learning can be facilitated on a variety of levels. Most health professions training programs, however, do not have key curricular structures in place to adequately prepare learners for their roles as teachers, supervisors and assessors. Instructional Methods: We will begin by sharing our own varied experiences developing and implementing elective courses in medical education at McGill (Montreal, Canada) and University of Bergen (Norway). We will also share some of our preliminary findings and outcomes, including evaluation results and learning resources produced by students as part of their medical education elective training. The lion's share of the workshop will be dedicated to engaging participants in discussions of how they might design and implement a health professions education elective within their own institution. Through small group activities, participants will be encouraged to formulate suitable learning outcomes, teaching and learning activities and assessment strategies that will serve as first steps toward designing their own unique courses. Ideas will be shared and discussed between the groups. We will complete the workshop by discussing some of the pitfalls, challenges and obstacles we have encountered during our own experiences creating new medical education electives. Target audience: Introductory Learning Objective: By the end of this workshop, participants should be able to: Outline reasons why teaching students in the health professions the foundational principles in education is essential for their future careers as clinicians and medical educatorsDescribe different ways of designing health professions education electivesPropose concrete ways they might design and implement elective courses in health professions education in their own settingsRecognize the pitfalls, challenges and obstacles of health professions education elective design, Rationale/Background: Learners at Canadian medical schools experience mistreatment(1,2). Evidence in the literature is lacking on how to best address issues of student mistreatment or help shift the culture to prevent its occurrence. In 2016 the University of Calgary created the position of Faculty Advocate Against Mistreatment (FAAM), currently occupied by 3 faculty members. An easily accessible web portal enables students to contact the FAAMs directly. Since inception, the FAAMs have been contacted over 100 times with a variety of concerns. This number continues to increase annually and outcomes range from student validation to regulatory body complaints. Instructional Methods: This workshop will utilize an assortment of situations to learn from the Calgary experience. Cases range from student-student conflict to faculty-student interactions with themes of discrimination, physical contact and sexual advances. Through small group case discussions facilitated by FAAMs and students, we will explore the processes used to help students navigate the system as well as the potential outcomes. Target audience: We invite faculty, residents and students from all health professions to learn together in this interactive workshop. Learning Objective: Practice strategies to navigate concerns of student mistreatment in medical education., Rationale/Background: The workshop provides participants the opportunity to design and prototype the optimal clinical learning environment that supports patients, caregivers, preceptors, and residents/students. Engaging people in the process of design encourages collaboration, networking, and innovation. Instructional Methods: Experiential learning Target Audience: Clinical educators, residents, and administrators. Learning Objective: Participants will learn about the emerging trends of innovative space and its influence on the clinical learning paradigm.Participants will be able to describe the role of the physical environment in learning, innovation, and creativity.Participants will be able to identify factors in learning spaces that foster interdisciplinary practice., Rationale/Background: From hand-washing to resource stewardship, serious games can be used to highlight important teaching points and to provide insights that cannot be achieved with other teaching modalities. GridlockED is a board game developed to help medical trainees better understand the workings of the emergency department and to provide a low-stakes method to practice managing patients in complex clinical environments. TriagED is a game that simulates field triage for paramedics. DischargED is a multiplayer game about managing a ward of patients and effectively arranging for safe discharges for all of them. Using our games as case studies, we aim to teach educators the value of serious games in allowing players to repetitively experiment and experience scenarios in an abstract way. Instructional Methods: Attendees will first be divided into groups to play one of three games (GridlockED, TriagED, or DischargED). A didactic component will follow to provide an overview of the process utilized to construct and test GridlockED as well as some insights into our other game development processes. Finally, the workshop will conclude with a question and answer period outlining the post-development phase and game production. Target audience: This session is designed for attendees who would like to use a serious game to create a novel learning experience for trainees. Learning Objective: Upon completion of this session, participants will be able to: Play above games and begin thinking about opportunities in their own disciplines to design a serious gameCompare how a serious game and other classroom-based strategies differ in their ability to teach certain topics (e.g. collaborating with other healthcare professionals)Articulate the steps to creating a serious game., Rationale/Background: The Patient's Medical Home (PMH) model is a made-in-Canada vision that embraces values of equity, fairness, and access to care for all.1 It is the foundation of health care policy at a federal and provincial level, informing development of health care services in family medicine and generalist specialty services. Despite its influence at a policy level, reports of curriculum interventions at an undergraduate and postgraduate level promoting PMH are relatively absent from Canadian literature. The aim of this workshop is to generate a community of practice interested in developing curriculum interventions and evaluation on PMH by sharing examples of initiatives and identifying next steps for action. Instructional Methods: Following a brief introduction to PMH, workshop facilitators will describe how two Canadian medical schools are implementing PMH curricular initiatives. Participants will then be invited to complete a 'report card'2 to reflect individually on PMH teaching at their institutions. This will be followed by small group discussion to identify areas of commonality and innovation. Next, as a large group, participants will discuss facilitators and barriers to promoting PMH, particularly across specialties and the educational continuum. Finally, participants will identify specific priorities to advance PMH teaching in their context. Target audience: Open to medical educators from all specialties and disciplines, at under- and post-graduate level, including medical students. Learning Objective: Define core concepts of the Patient's Medical Home Conduct a needs assessment on Patient's Medical Home in their curriculum Apply strategies to teach Patient's Medical Home model in their setting., Rationale/Background: Medical educators aiming to foster the development of socially responsible trainees may look to transformative education and critical pedagogy approaches. Specifically, critical consciousness endeavours to empower learners to challenge the status quo by illuminating power imbalances and socially embedded inequities. However, there is limited guidance from the literature on how educating for critical consciousness is enacted in a clinical teaching environment. We conducted a qualitative study to understand what critical consciousness looked like in everyday clinical teaching, and the conditions that enabled this practice. We interviewed trans/non-binary patients and academic family health team clinicians to elicit stories of re-humanizing practices and transformative educational moments. We found that educating for critical consciousness in the clinical environment was layered and complex. Our findings provide a framework to guide faculty development efforts focused on integrating critical pedagogy into medical education, orienting medical students toward social action. Instructional Methods: This workshop will review the findings of our study within our specific context of trans/non-binary patients in a Toronto family health team environment. We will then move beyond this context to discuss how critical pedagogy may be enacted in various settings with patients who face disadvantage. This workshop will be highly interactive and employ teaching strategies from the transformative paradigm of education, including critical reflection and dialogue. Target audience: Anyone involved in health professions education Learning Objective: To engage in dialogue about the role of critical pedagogy in the clinical teaching environment and explore ways of navigating the challenges encountered when creating space for this form of education., Rationale/Background: Medical school orientation is a complex period of transition that is understudied. We conducted a national qualitative study exploring the medical school orientation experiences of first year medical students. Our study revealed a multitude of tensions experienced by incoming medical students, namely, tensions with themes surrounding diversity and inclusion, professional identity development, and socialization. The goal of this workshop is to invite a broad range of stakeholders to actively participate in a discussion that builds on our research findings, with the ultimate goal of building consensus for tangible suggestions to improve medical school orientations across Canada. Instructional Methods: After a brief introduction to the findings of our research study, an interactive Interview Matrix activity will be facilitated. An Interview Matrix is a tool used to build dialogue and consensus in small groups. Participants will be divided into groups of 4 and invited to discuss predetermined questions with a focus on improving medical school orientation. Following this activity, the entire group will come together to build consensus on the discussed themes in order to develop tangible solutions that can be proposed to Canadian medical schools and administrators. Target audience: Current medical students, recent graduates, Faculty and administrators interested in improving the experiences of first year medical students. Learning Objective: At the end of the workshop, attendees will be able to: Discuss the barriers and facilitators of effective transition into medical school.Develop tangible strategies and possible solutions to improve medical school orientation., Rationale/Background: When planning continuing professional development (CPD) activities, the importance of having an effective Scientific Planning Committee (SPC) is paramount (1-2). The need for planning committees with superb skills and knowledge capacities is essential to a highly functional CPD system. Guidelines about the roles and best practices of SPC are rare in the Canadian context (3) but necessary in order to meet the needs of health professionals lifelong learning. The goal of this collaborative and interactive workshop is to discuss a step-wise approach prospective CPD developers can take to ensure a SPC comes together to deliver relevant and effective CPD opportunities while meeting national accreditation standards. Instructional Methods: We will use a combination of brief didactic sessions by the three presenters with multiple active learning techniques which will form the majority of the workshop. Active learning techniques will include web-enabled audience participation techniques (Sli-do), table exercises, and case-based facilitated discussions. Tools and resources for effective SPC practices will be shared. Participants are welcome to bring CPD program ideas for discussion. Target audience: CPD developers, leaders, program/conference directors. Those interested in developing a CPD educational opportunity and would benefit from a step-wise approach for effective Scientific Planning Committee practices. Learning Objective: Describe the essential roles of effective Scientific Planning Committee members in the planning, development, and delivery of CPD activities Detail an agenda for an effective initial Scientific Planning Committee meeting Apply the ethical principles of the National Standard for Support of Accredited CPD activities as well as the Canadian Medical Association Guidelines for Physician Interaction with Industry (2007), Rationale/Background: A key element of managing change in education is evaluating new innovations, such as the new training model called Competency-Based Medical Education (CBME). In this workshop, we will demonstrate how the use of an Original Program Theory acts as a framework in the development of a logic model and promotes continuous quality improvement. The session will include information on how to develop an Original Program Theory; how to use program theory to construct a logic model with short, medium, and long-term outcomes; how to set goals for evaluation that consider resources; and strategies for creating an Updated Program Theory. The purpose of this workshop is twofold: First, participants will learn how a program theory can be used as a flexible framework as they work toward drafting an evaluation plan. Second, participants will experience the utility of a program theory as they develop their logic model and overall evaluation strategy. Instructional Methods: This interactive workshop is designed to engage participants to think about complex program evaluation. Through table work and large group discussions, participants will explore what they may wish to include in their own evaluation plan. Target audience: Individuals participating in the evaluation of CBME implementation processes and outcomes. Learning Objective: By the end of the workshop, participants will be able to: Create an original program theory;Illustrate their program theory through a logic model;Create an evaluation strategy that will inform the evolution of the original program theory by updating with knowledge gained from a continuous quality improvement approach., Rationale/Background: Study methods used by many students in undergraduate degree programs are typically ineffective in medicine. We can influence knowledge retention and recall using different teaching strategies. Research has shown that spaced learning, interleaving and testing are effective ways in which to enhance knowledge retention. Cognitive load is an important consideration when teaching complex key concepts. This workshop explores how we can incorporate our understanding of knowledge retention and recall to enhance learning in our medical curricula, and encourage effective study strategies in our learners. Instructional Methods: The format includes brief interactive presentations interspersed with individual and group activities. Participants will engage with known research around knowledge retention and recall and apply this to their own teaching experience. The techniques used in the workshop will demonstrate the different methods participants can incorporate into their own teaching, and in turn, encourage their learners to adopt. Specific activities: 1. Consider the methods they used to study during training and place in sequence the success rate of different study strategies currently used by students 2. Think, pair share around their own experiences of learning and the strategies used 3. Identify a teaching activity in their own institution and consider how they might change the teaching format to maximize comprehension, retention and recall. Target audience: Educators with an interest in designing curricula that maximize comprehension, retention and recall of knowledge. Learning Objective: By the end of this workshop, participants will be able to: Explain why the more common study methods employed by students are ineffectiveGive examples of teaching strategies that maximize learning and recallContrast current curricular teaching methods with proven strategies to maximize learningApply the concept of scaffolding to a course or topic they are responsible for teaching, Rationale/Background: This is a time of economic and political challenges in higher education. Universities face increasing threats to their business models; they rely more than ever on fundraising dollars. The purpose of this workshop is to raise awareness about Fundraising role in medical education and to reflect on strategies that can be used to ensure successful application of fundraising in an academic environment. Instructional Methods: This interactive workshop will include three parts: • Part one: Fundraising experts will give short presentations on basic fundraising principals in higher education and how these can be used and benefit medical educators. • Part two: Attendees will be divided into small groups to work on real-life fundraising cases in Education, Research, and Clinical setting. The Fundraising experts will be circulating and facilitating the group discussions. • Part Three: Each group will present their Fundraising solutions and ideas for general consideration. Target audience: Medical educators, clinicians, leaders, faculty administrators, and students Learning Objective: Upon completion of this session, attendees will be able to: Define the basics of fundraising and the role of medical educators in forming relationships with potential donors and past alumni.Discuss philanthropic trends in higher education.Explain the role of AI in fundraising, pipeline analytics, and wealth assessment, Rationale/Background: Lesbian, gay, bisexual, and transgender (LGBTQ+) individuals are medically underserved populations who face health inequities. Negative encounters with healthcare providers contribute to avoidance of care by LGBTQ+ patients. Research by one of the co-presenters (MS) found that LGBTQ+-identified patients value healthcare providers who are knowledgeable, provide supportive actions, avoid assumptions, and emphasize culturally affirming care. Allyship refers to taking action on behalf of an underserved group, despite not necessarily identifying as part of that group. This workshop provides attendees with a solutions-focused framework to become allies for their LGBTQ+ patients. Instructional Methods: The workshop begins with a brief introduction to key terminology and medically relevant historical information regarding LGBTQ+ health disparities. For the remainder of the workshop, clinical scenarios addressing various aspects of LGBTQ+ care will be discussed with the facilitators. These scenarios are designed to highlight opportunities for allyship. Attendees will be challenged to identify and address their own biases and assumptions, and learn about concrete actions they can take to provide patient-centred care for their LGBTQ+ patients. After discussion of the clinical scenarios, videos showing example clinical encounters (with standardized patient actors) will be shown to illustrate concepts and skills covered during the workshop. Target audience: Health care professionals and trainees (at all levels) who care for LGBTQ+-identified patients. Learning Objective: Describe the systemic health inequities faced by LGBTQ+ patients Define common terminology used by the LGBTQ+ community for self-identification Discuss practical tips for providing safe and respectful care to LGBTQ+ patients., Rationale/Background: In 2018, the Association of Faculties of Medicine of Canada undertook a substantive initiative, supported by Health Canada, originally titled “Academic Medicine Responds to the Opioid Crisis: Developing a Canada wide, competency-based online curriculum for future physicians in pain management, substance abuse and addictions”. This workshop provides participants with an approach for addressing the largest current public health crisis in Canada by creating an educational opportunity targeting undergraduate medical students to gain knowledge, confidence, competence and motivation to diagnose, treat and manage pain with an understanding of addictions, substance use disorder and harm reduction, while supporting the social accountability mandates of medical schools. Instructional Methods: This workshop will begin with an introduction to the development of the curriculum, then a demonstration of the design elements used such as the spiral curriculum and adoption of formative and synoptic assessments. Participants will engage in an interactive large group discussion on the strengths and challenges of instructional design that promotes national collaboration and a standardized educational program. Target audience: This session is best suited for medical educators and students who have an interest in teaching methods related to pain management, substance use, harm reduction, and/or curriculum development. Learning Objective: At the end of this workshop, you will be able to: Describe how AFMC's Response to Opioids Project can impact the largest public health crisis in Canada.Identify the challenges and opportunities in building a national competency-based online bilingual curriculum for undergraduate medical learners.Explore high-impact practices for engaging health and education stakeholders to support consensus building., Rationale/Background: Program Directors and other faculty members have the complex task of enabling the achievement of milestones for their residents while also contributing to the development of a positive learning culture. Developing a framework for managing both individual performance and system improvements can benefit both residents and faculty. This instructor-led, participant-centered workshop will introduce participants to the attitudes, knowledge, and skills needed to build a workplace culture that promotes and prioritizes safe medical care and creates accountability in learners and their faculty. Participants will discuss the role of behavioural drift in the development of underperformance. Using their lived experiences to provide examples of each, participants will distinguish between human error, at-risk behaviour and reckless behaviour and, using an algorithmic approach, learn how to leverage institutional values to manage each situation appropriately. Instructional Methods: This workshop uses an instructor-led, participant-centred design where, after a brief introduction, participants collaboratively use a workbook-based case to identify the issues to be discussed next. Participants will share their insights through discussion and voting. They will then be presented with an algorithm and be invited to use it to re-work the case, gaining new insights into its management. Brief revisit and commitment to change exercises end the session. Target audience: Academic Program Directors and program eads as well as preceptors of medical students, residents and fellows. Learning Objective: Describe the three behaviours that threaten patient safety Describe the appropriate management intervention for each behaviour Name the elements of accountability at the system and provider levels, Rationale/Background: The Royal College challenges educators to prepare physicians who are able to balance personal and professional priorities, incorporate self care, and develop personal and professional awareness and insight. This workshop will present our approach to supporting trainee wellness through reflection and dialogue though a longitudinal curriculum. Students engage with residents and faculty and the formal curriculum during scheduled group meetings over 4 years. Participants are provided with a description of the thematic session and companion pieces, and come prepared to describe an experience and their reflection on it. Students are also required to meet with faculty twice yearly for progress review meetings, and wellness is a theme that often emerges. The informal curriculum, of relationship building, is perhaps the most effective component of the curriculum. Instructional Methods: Our approach to supporting wellness through a Portfolio curriculum will be described through a didactic presentation. Participants will then have the opportunity to simulate a small reflective practice group. Following a demonstration, they will also engage in a coaching conversation around wellness. Participants will discuss how this approach might be adapted to their own education context. Target audience: Medical educators and trainees at all levels Learning Objective: As a result of attending this workshop, participants will be able to: Describe the key components of a curriculum that supports student wellnessParticipate in/facilitate a small reflective practice group and coaching conversationLeave with the ability to implement a similar curriculum within their own program, Rationale/Background: Mentorship in health professions education is a well-recognized process for promoting individualized career development and support, and enhancing workplace satisfaction and engagement. Early-to-mid career academic clinicians often find themselves in a position of being tasked to provide mentorship to trainees and junior colleagues. However, these educators may simultaneously be engaged in the process of searching for their own mentoring relationships to address needs related to evolving career and leadership roles. Benefits of mentoring have been described for both the mentor and mentee, but any successful relationship requires connection, commitment and purposeful activity from both participants. In this workshop, participants will review key tasks for successful mentoring from both the mentor and mentee perspectives. Instructional Methods: Drawing on content from both the medical education and business literature, this workshop will utilize reflection and case-based discussion to enable participants to review key tasks for successful mentoring. Interactive activities will include an arts-based icebreaker activity, think-pair-share and large group discussions, a self-assessment checklist for identifying personal mentorship gaps/needs, and a peer-coaching activity for development of action plans to enact future goals. Participants will be encouraged to share and learn from each other's experience, with practical guidance provided by workshop facilitators experienced in faculty development and academic mentorship. Target audience: Early-to-mid career medical educators, but all are welcome. Learning Objective: By the end of this workshop, participants will be able to: Describe key tasks of the mentor and the mentee in an effective mentoring relationshipReflect on past mentorship experiences and identify current mentorship needs / gapsList strategies for acquiring new mentorship for oneself, Rationale/Background: Forms of behavioural assessment, such as the Objective Structured Clinical Examinations (OSCEs), are widely used in health profession education. In their summative form, they strive to facilitate valid and reliable measurements of behavioural competency skills. Many OSCE stations are socially situated activities, where candidates interact with a 'patient' (e.g. a simulated participant SP). Concerns exist about how such constructed forms of assessment fall short of reflecting clinical practice. If assessment does drive learning, are OSCEs drive test performance rather than clinical performance? How can authenticity be improved, whilst retaining reliability? Instructional Methods: • General introductions, 'ground rules' and overview of session. • Introduction to assessment of clinical competency, with focus on the OSCE and characteristics of 'best practice' in assessment. • Provide an overview of the 'lifecycle' of developing an OSCE station. • Buzz group activity regarding difficult SP OSCE stations to write. • 'Think, pair and share' activity regarding simulation /performing arts based techniques and technologies to assist in delivering authentic SP OSCE stations. Some examples with be demonstrated for an immersive experience. • Conclusion, wrap up and take forward messages. Target audience: Health professional researchers and educators who design, deliver and implement OSCEs and anyone who is keen to develop more authentic SP based OSCE stations. Learning Objective: Describe the 'life cycle' of developing an OSCE station. Offer techniques, grounded in the disciplines of simulation, and the performing arts, that can enhance authenticity in SP based OSCE stations - including: Role developmentScript development (including real patient engagement)'Props' and 'customs'Scenography Promote critical reflection of how best to translate this knowledge into educational practice whilst sufficient levels of reliability., Rationale/Background: Serious games have been described in health professional education, incorporating games with specific learning outcomes, structured debrief and reflection as part of the game experience2. Interprofessional collaboration (IPC) competencies are key to practice in a simulated environment but can be challenging to operationalize at a sustainable scale. This workshop aims to explore IPC competencies via participation in a patient-safety oriented escape room - implemented as a serious game. Instructional Methods: After a brief review of serious games and interprofessional collaboration competencies, participants will complete a 30-minute patient safety-oriented escape room, followed by a debrief and reflection on participants' individual and collective experiences in completing the escape room. Participants will review IPC competencies in this context. The workshop will conclude with action-oriented discussion about use of this method for teaching IPC, how to target this type of session across the educational continuum and tips on puzzle development. Target audience: Learners, clinicians and educators from across the educational continuum and health professions. Learning Objective: Practice collaborative and communication skills within a team while attempting to successfully complete the simulated patient safety escape room Reflect on own and team experience in participating in simulated patient safety escape room environment and application of IPC competencies Discuss use of this technique in providing educational opportunities in IPC, Rationale/Background: Rural and remote regions tend to have higher incidences of mental health disorders, with much of this care being managed within primary care; however, primary care teams have limited training and access to psychiatric support. Traditional Telepsychiatry provides an option to increase access to care; however, when offered in isolation does not focus on building skills and competence for providers to allow them to provide care to their communities. Innovative capacity building approaches where CPD is rooted in the workplace and integrated with specific care delivery models are needed. This workshop will describe the Telepsychiatry Integrated Care Model and Project ECHO to demonstrate a systems-based approach to CPD for mental health. It will explore an approach to developing and implementing CPD integrated within a broader system and how it can be leveraged to build capacity. Instructional Methods: This session engages participants through didactic presentation, and interactive large group and small table discussions. It includes the following: • Introduction to mental health challenge in Canada • Facilitated group discussion: Participant's experiences with capacity building/CPD programs • Overview of the Integrated Care Model and Project ECHO • Small table discussion: Applicability of the models to participants own settings • Final wrap up discussion and brainstorm for next steps Target audience: Individuals interested in learning about capacity building outreach models to improve mental health access, CPD, Faculty Development Learning Objective: Participants will be able to: Describe an approach to delivering CPD within outreach modelsIdentify frameworks in health professions education that can be utilized for technologyEnhanced capacity building in rural and underserved communities, Overview: When the College of Family Physicians of Canada (CFPC) began planning for a transition to CBME, the importance of local context was recognized from the earliest stages. The CFPC made the decision to approach CBME as a collaborative process, where high level guidelines would be established by the CFPC (and included in accreditation requirements), but built adequate flexibility into those guidelines to allow individual programs to develop and implement tools and processes that worked for their unique local context. The result of this strategy was the implementation of the Triple C Competency-Based curriculum (Triple C) across all 17 programs between 2009 and 2015. Evaluation data of the Triple C at national and at local levels indicates implementation was successful on many outcome measures. The presentations and discussion will highlight and give voice to diverse strategies and innovations, and will offer ideas and reassurance to educators at all levels who are facing system changes in adopting competency-based assessment. The discussant will summarize the differences between programs while highlighting the alignment with high level guidelines, before opening the floor to questions from the audience., Overview: A successful residency match could be viewed as having two outcomes of equal importance: choosing a discipline and then matching to that discipline. We propose a novel curriculum addressing both steps.

Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507.

Background: Hysterectomy is the most common gynaecological operation performed in the world. This study was done to investigate association between body mass index (BMI) and operative morbidity in women who underwent hysterectomy for benign indications.Methods: Total 201 women were studied. 114 (56.7%) had BMI between 20-24.9 and 87 (43.3%) had BMI 25 and above. In both groups, abdominal and vaginal hysterectomy were performed. They were compared for duration of surgery, intraoperative blood loss, postoperative fever, wound infection, secondary haemorrhage, deep vein thrombosis, resuturing and readmission.Results: Mean duration of surgery in women with BMI 20-24.9 was 2.47 hours, standard deviation was 0.665 and in women with BMI 25 and above was 2.45 hours, and standard deviation was 0.589. T value was 0.215 and p value was 0.83 which is not statistically significant. Mean blood loss during surgery with BMI less than 25 was 184.74 ml, standard deviation was 104.518 and with BMI more than 25 was 200.57 ml, and standard deviation was 77.462. T value was 1.234 and p value was 0.219 which is not clinically significant. Out of 114 women with BMI less than 25, 16 (38.1%) had complications and 98 (61.6%) had no complications. Out of 87 women with BMI more than 25, 26 (61.9%) had complications and 61 (38.4%) had no complications, Chi square test was 7.48, and p value of 0.006 which was clinically significant. It shows that women with BMI 25 and above had more chances of postoperative complications.Conclusions: There is no statistically significant difference in intraoperative blood loss and duration of surgery in both women with normal BMI and women with BMI 25 and above who underwent hysterectomy. But postoperative complications in terms of wound infection, fever, bleeding, necessity of resuturing and readmission were more in women with BMI 25 and above as compared to women with normal BMI.

Introduction Primary amenorrhea is a challenging entity as it affects the reproductive outcome. Primary amenorrhea is an absence of secondary sexual characters until 14 years of age or absence of menstruation with secondary sexual characters until 16 years of age. Aim The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of primary amenorrhea. Materials and methods All girls who had not attained menarche until 16 years of age in the absence of secondary sexual characters and until 14 years, if no secondary sexual characters, and were willing for follow-up were subjected to investigations and were treated as per the etiology. Results Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome was the most common cause of primary amenorrhea (42.85%) followed by imperforate hymen (28.57%) and transverse vaginal septum (21.42%), one each of low, mid, and high varieties. There was one case of androgen insensitivity syndrome. Conclusion Establishing correct diagnosis is essential for planning treatment and management strategies in primary amenorrhea as treatment goals are preservation of fertility and progression of normal development. How to cite this article Bhalerao AV, Garg R. Müllerian Anomalies: A Cause for Primary Amenorrhea. J South Asian Feder Obst Gynae 2017;9(3):221-224.

Introduction: There are gaps between UNICEF and BFHI recommendations and actual implementations of breastfeeding practices due to inadequate counseling of primigravida on breastfeeding, reflected nationally as poor infant nutritional status. Objectives: The study aims to assess the knowledge, attitude and practices of primigravida about breastfeeding, counsel the primigravida women on the prescribed scientific breastfeeding methods, to analyze the change in their perspective about breastfeeding after counseling and to suggest recommendations based on findings. Methods: Questionnaire based descriptive cross sectional study conducted on selected 75 primigravida with gestational age of 36 weeks or more, attending ANC OPD or admitted to NKPSIMS during April and May 2014 after consent. A structured validated pre/posttest questionnaire was administered to assess the knowledge, attitude and practices of breastfeeding of participants. Demographic variables were recorded. Pretest was conducted, followed by counseling on the importance of breastfeeding, maternal nutrition, duration of exclusive breastfeeding, mother’s and baby’s position during breastfeeding using flashcards which was followed by posttest on the same questionnaire. The data was analyzed using SPSS software Open Epi Info version 2.3 year 2009. P values < 0.05 were considered as statistically significant. Results: Comparison of pre/posttest results showed statistically significant change in importance of exclusive breast feeding, colostrum, early initiation, suitable position and duration of breastfeeding, perception of baby’s satisfaction and stool color, maternal nutrition and breast problems during lactation after counseling. Conclusion: Antenatal breastfeeding counseling must be strengthened by a multi pronged individualized approach, reinforcement focusing on the recommended practices of breastfeeding to promote and sustain breastfeeding.

Background Pelvic organ prolapse (POP) is a common health problem affecting 40% multiparous women above 35 years of age. Lifetime risk of women requiring surgery for recurrence is 10%. The POP is intricious due to complex pelvic anatomy, and difficulty increases due to tissue weakness, lack of evidence-based surgical guidelines, and lack of standardized definition for surgical success, which results in highly variable estimates of success. Aim To compare the effectiveness of traditional anteroposterior repair with site-specific repair with concomitant vaginal hysterectomy with respect to anatomical considerations by POP-Q and functional or symptomatic considerations, complications, duration of surgery, and recurrence. Materials and methods This hospital-based randomized controlled trial was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining ethical committee approval. All women attending the gynecological outpatient department having symptoms of mass coming out of vagina were subjected to detailed history and examination and 51 women underwent traditional anterior and posterior repair and 44 women underwent site-specific repair with concomitant hysterectomy, with random sampling according to computerized sheet. The effectiveness of both the surgeries was assessed and compared. Observations There was statistically significant improvement in all the sites of POP-Q points using traditional repair and site-specific repair. When compared, site-specific repair by POP-Q was better than traditional method. Conclusion Site-specific repair of decussated natural tissue has great curative potential, and success is attributable to site-specific repair, rather than nonspecific scar formation by traditional method. Thus, it is important to properly quantify the repair to be done, whether anterior or posterior, and perform site-specific repair. How to cite this article Bhalerao AV, Vora A, Bhalerao K, Garg R. To Compare the Effectiveness of Traditional Anterior Colporrhaphy, Posterior Colpoperineorrhaphy with Site-specific Anterior and Posterior Repair for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):92-98.

Introduction Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out. Aim To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy. Materials and methods This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared. Observations There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant. Conclusion High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life. How to cite this article Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.

Introduction Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. A foundational cornerstone upon which health care providers endeavor to base all care is the medical oath, “Never do harm to anyone” (Hippocrates). Medication use in hospitals is a complex process and depends on successful interaction among health care personnel functioning at different areas, and errors may occur at any stage of prescribing, documenting, dispensing, preparation, or administration. The purpose of this research is to explore the safety practices employed by nurses during medication administration, specifically from the patients’ perspectives. The fundamental objectives are to explore patients’ perceptions, attitudes, and beliefs about the safety practices utilized by nurses when administering medications and to identify opportunities for increasing patient safety. Materials and methods This study was undertaken employing a quantitative survey instrument as the methodology. For collecting data, a pretested, structured questionnaire was given to the sample population after fulfilling the inclusion/exclusion criteria, and consent to enroll in study was taken. This method is convenient and affords the opportunity to generalize responses from the sample population to the population as a whole. Results The mean age of the respondents from Obstetrics and Gynecology was 29.08 ± 6.53. The mean age of the respondents from medicine was 33.4 ± 9.6. The mean age of the respondents from surgery was 33.68 ± 12.2; 23% respondents belonged to medicine unit, 21.5% respondents belonged to surgery unit, and 55.5% respondents belonged to Obstetrics and Gynecology unit. Of the total respondents, 62.75% were females. Moreover, 76 respondents in medicine, 72 respondents in surgery, and 172 respondents in Obstetrics and Gynecology stayed in the hospital for > 7 days. Respondents < 30 years of age responded negatively to three out of six questions compared to respondents > 30 years of age. This is statistically significant (p = 0.008, 0.0001, and 0.008) showing that age does not alter the perception of the quality of health care. The perception of medicine respondents was negative to four out of six questions as compared to surgery respondents. This is statistically significant (p = 0.008, 0.0001, and 0.008), thus unit alters the perception of the quality of health care. The medicine respondents rated care lower as compared to surgical respondents. The patients’ perception varies with gender, and it has been found to be significant in five out of six cases where p value is < 0.05. Females rated the quality of care better and shared the responsibility for health care. The patients’ perception varies with length of stay (LOS): 47.25% respondents feel that the nursing care of the hospital is very safe; 63% respondents feel that their care is a responsibility shared by both doctors as well as themselves more so by the female respondents from surgical units and who stayed longer. Conclusion According to patients’ perceptions reported in this study, there were a number of inconsistencies noted in the seven rights of medication administration delivered by nurses, specifically patient identification, hand washing, allergy assessment, and patient teaching. The perception of medication safety practices do change with the unit they are in, gender, and LOS. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care. How to cite this article Bhalerao K, Ghike S, Bhalerao AV. Medication Safety Practices: A Patient's Perspective. J South Asian Feder Obst Gynae 2016;8(4):271-281.

Aim To differentiate nonclassical congenital adrenal hyperplasia (NCAH) from polycystic ovarian syndrome (PCOS) in a 13-year-old girl. Background Hirsutism and virilization are effects of hyperandrogenism by ovaries and adrenal glands. It has a marked psychological and social impact affecting the quality of life; 75% of premenarchal girl have hyperandrogenism, which is due to PCOS but late-onset congenital adrenal hyperplasia cannot be ruled out, and this leaves the clinician in quandary regarding the diagnosis and management. Case report A 13½-year-old girl presented with excessive facial hair, hoarseness of voice, and darkening of elbow pits since past 2 months, which was increasing in severity. The patient had not yet attained menarche but had pubarche 1 year back. Examination revealed presence of acanthosis, underdeveloped breasts, and clitoromegaly >3 cm. Levels of 17-hydroxyprogesterone were normal but higher levels were reported poststimulation. Fasting insulin levels were also high. Appropriate treatment was started, which led to improvement in patient's symptoms. Conclusion There is significant overlapping between PCOS and NCAH, which warrants accurate diagnosis based on hormonal analysis to institute early and appropriate therapy. Significance Early therapy can prevent infertility and androgenic complications later in life. How to cite this article Jain P, Bhalerao AV, Aggarwal S. Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma. J South Asian Feder Obst Gynae 2017;9(3):280-282.

Background: Pelvic organ prolapse (POP) is the descent of the pelvic organs beyond their anatomical confines. The definitive treatment of symptomatic prolapse is surgery but its management in young is unique due to various considerations. Aim of this study was to evaluate anatomical and functional outcome after abdominal sacrohysteropexy and vaginal hysterectomy for pelvic organ prolapse in young women.Methods: A total 27 women less than 35 years of age with pelvic organ prolapse underwent either abdominal sacrohysteropexy or vaginal hysterectomy with repair. In all women, pre-op and post-op POP-Q was done for evaluation of anatomical defect and a validated questionnaire was given for subjective outcome.Results: Anatomical outcome was significant in both groups as per POP-Q grading but the symptomatic outcome was better for sacrohysteropexy with regard to surgical time, bleeding, ovarian conservation, urinary symptoms, sexual function.Conclusions: Sacrohysteropexy is a better option.

Background: Carcinoma of the ovary is among the most common cancers in the world. It is also a significant cause of mortality. The present study was initiated to analyze ovarian tumors with respect to age, presentation, diagnosis, and treatment, and to correlate the duration of symptoms and stage of disease. Materials and Methods: The present study was a retrospective observational study, done at NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra. The study duration was of 10 months, carried out from July 2018 to April 2019. The total sample size for the present study was fifty. Results: In the present study population, out of the total ovarian masses, 52% had neoplastic and 48% had nonneoplastic ovarian masses. Majorly affected age group was 36–45 years, which comprised 26% of the nonneoplastic and 20% of the neoplastic masses, including 10% each of benign and malignant masses. On analyzing the malignant ovarian masses, it was found that serous cystadenocarcinoma/surface epithelial tumor was most commonly encountered, accounting for 70% of the total malignant ovarian masses. Conclusion: Epidemiological studies analyzing economically feasible screening tools should be identified, which will help screen risky population, to detect the disease at early stage and improve the prognosis.

BACKGROUND: Opioid use disorder is a serious international concern with limited treatment success. Men and women differ in their susceptibility to opioid use disorder and response to methadone treatment and can therefore benefit from sex-specific treatment. We performed a systematic review of the literature on outcomes of methadone maintenance treatment for opioid use disorder in men and women related to drug use, health status and social functioning. METHODS: We searched PubMed, Embase, PsycINFO and CINAHL for observational or randomized controlled studies involving adults 18 years of age or older undergoing methadone treatment for opioid use disorder. Studies were included if they investigated sex differences in methadone treatment outcomes. Two authors independently reviewed and extracted data. Meta-analyses were performed when possible; risk of bias and quality of evidence were also assessed. RESULTS: Twenty studies with 9732 participants were included, of which 18 were observational and 2 were randomized controlled trials. Men and women differed significantly in alcohol use (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31 to 0.86), amphetamine use (OR 1.47, 95% CI 1.12 to 1.94), legal involvement (OR 0.63, 95% CI 0.47 to 0.84) and employment during treatment (OR 0.39, 95% CI 0.21 to 0.73). Opioid use patterns were similar among men and women. Risk of bias was moderate, and quality of evidence was generally low. INTERPRETATION: Sex differences were evident in polysubstance use, legal involvement and employment status among men and women receiving methadone treatment for opioid use disorders. Although the quality of evidence was low, our review highlights the need for improved implementation of sex-specific treatment strategies.

Infertility has always been one of the most elusive symptom complexes that perplex a gynecologist. Laparoscopy is the most rapidly evolving area in medicine. AIMS AND OBJECTIVES: To evaluate the role of hysterolaparoscopy in comprehensive work up of infertility and to help in planning appropriate management. To identify the incidence of various pathological condition in female reproductive tract leading to infertility. To develop the plan of therapy for such patient. To analyze the rate of complications in diagnostic hysterolaparoscopy. MATERIAL AND METHODS: 100 infertile women with primary infertility of the age group 18-40 years with normal hormone profile and without male factor infertility were randomly selected from Infertility clinic of rural tertiary care hospital over 2 and 1⁄2 year from 1st January 2011 to October 2013. Initially all women were examined by taking detailed history, physical examination, basic endocrinological investigations, USG pelvis, endometrial biopsy and semen analysis. After that general examination, systemic and genital examinations were carried out on patients selected for the study. Hysterolaparoscopy was performed in post menstrual phase under general anesthesia. RESULTS: The present study showed maximum cases of infertility (40%) in the age group of 21-25 years followed by (35%) cases of infertility in the age group of 26-30years. Mean age of women was 24.6 years. On laparoscopy 34 patients revealed abnormal findings and rest had normal pelvic findings. Tubal blockage without adhesion was found to be the most important abnormality and was seen in 11 cases followed by tubal blockage with adhesion 7 cases. Laparoscopy revealed 18 cases of tubal blockage (11 bilateral and 7 unilateral) and 78 cases were with normal tubal patency. Out of 78 cases, 12 cases had other abnormalities (endometriosis-2, PCOD-3, peritubal adhesions-7) 21 women conceived after ovulation induction, IUI and tubal cannulation (cornual). Of them 10 have delivered and 11 are yet to deliver. CONCLUSION: Diagnostic hysterolaparoscopy is an effective and safe tool in comprehensive evaluation of infertility, particularly for detecting tubal blockages, peritoneal endometriosis, adnexal adhesions and bicornuate uterus. Needless to emphasize that hysterolaparoscopy is a very useful tool that can detect various structural abnormalities can be considered as a definitive day care procedure for evaluation and treatment of female infertility.

Introduction Genital malignancies in women varies widely from developed to developing countries. Postmenopausal women are at risk of developing various genital malignancies. Objectives (1) To determine frequency of genital tract malignancies in postmenopausal women, (2) to determine the type and stage of genital tract malignancies, (3) to create awareness of screening in women. Materials and methods This descriptive cross-sectional study was carried out over a period of 2 years from March 2010 to Feb. 2012. It included 200 postmenopausal women admitted with complaints like mass or fullness of abdomen, bleeding or discharge per vaginal and ulcer over vulva. They were evaluated clinically followed by relevant investigations. Malignancy was confirmed by histopathology report. Results Out of 200 postmenopausal women admitted during study period, malignancy was confirmed in 55 women (27.5%). The type of malignancy was cervical carcinoma (30, 54.54%), ovarian carcinoma (18, 32.72%), carcinoma endometrium (5, 9.09%), carcinoma vulva (1, 1.81%) and carcinoma vagina (1, 1.81%). Majority of carcinoma cervix and ovarian carcinoma were in advanced stage. Conclusion Carcinoma cervix was commonest genital malignancy found our study followed by carcinoma ovary. Importance of routine gynecological check-up in postmenopausal women was emphasised. How to cite this article Somalwar SA, Joshi S, Kawthalkar A, Bhalerao A, Jain S, Somalwar A. Analysis of Genital Tract Malignancies in Postmenopausal Indian Women. J South Asian Feder Menopause Soc 2013;1(2):66-69.

Introduction Preeclampsia is a disease of trophoblastic tissue. it is a complex clinical syndrome involving multiple organ systems and still remains the principle cause of maternal and perinatal morbidity and mortality. The search for an ideal predictive test is still on, and preventive measures for preeclampsia remain a challenging entity. Aims and objectives: 1. To examine the relation between placental location and development of preeclampsia. 2. To study the pregnancy outcome in terms of mode of delivery and birth weight of all babies. Research question Does lateral placentation on ultrasonography at 20 to 24 weeks of gestation predict development of preeclampsia? A detailed demographic history, gravidity, parity, history of abruption placenta, hypertension, preeclampsia, IUD, gestational diabetes were taken. General examination, including weight, blood pressure, vital signs was done. Detailed obstetric examination was done. Ultrasonography was done for all women between 20 and 24 weeks of gestation, and placenta was classified as central when it was between the RT and LT side of uterus irrespective of being anterior, posterior or fundal. When 75% or more of placenta was on one side of midline, it was classified as lateral. All women with central and lateral placenta were followed up till development of preeclampsia as per ACOG guidelines and later till delivery to see the outcome of pregnancy. Observations While recruiting, there was no bias on low-risk and high-risk groups but, at the end of the study, we found 182 women with high-risk factors and 281 women with low-risk factors. A total of 71 pregnant women developed preeclampsia, of whom 52/71 (73.23%) had laterally situated placenta. This relationship seems to be significant. There was no relation of placental position and mode of delivary. The cesarean rate was 26.78% and normal delivaries being 73.21%. Of the cesareans, 76 (16.41%) were having centrally located placenta and 48 (10.36%) had laterally located placenta. In our study, the sensitivity was 75, specificity was 81, the positive predictive value was 48 and the negative predictive value was 96. Conclusion As yet, there is no practical, acceptable and reliable method for screening for preeclampsia that has been thoroughly tested and tried. In view of the results of our study, ultrasonography in pregnant woman during 20 to 24 weeks of gestation can be a easy, noninvasive, useful and cost-effective tool as a predictor of preeclampsia. How to cite this article Bhalerao AV, Kulkarni S, Somalwar S. Lateral Placentation by Ultrasonography: A Simple Predictor of Preeclampsia. J South Asian Feder Obst Gynae 2013;5(2): 68-71.

Pregnancy in the rudimentary horn is a very rare condition. In these cases, rupture of the rudimentary horn in the second trimester with fetal death and catastrophic intraperitoneal hemorrhage is the commonly reported outcome. Silent rupture of the rudimentary horn and continuation of pregnancy as a secondary abdominal pregnancy is the most unusual outcome of this rare condition. We report such a case with a good maternal and neonatal outcome. The case is being reported for its rarity.

Eclampsia is the leading cause of maternal and perinatal mortality as well as morbidity. This prospective study was carried out at a tertiary institute from Jan 2008 to Dec 2010. Aim and objectives (1) To evaluate the rate of eclampsia in antenatal women attending our hospital, (2) to evaluate the epidemiological factors and clinical presentation in women with eclampsia, (3) to analyze the maternal and perinatal outcome in women with eclampsia, and (4) to formulate strategies to improve the maternal and perinatal outcome. Materials and methods Fifty-five women with eclampsia were evaluated over a period of 3 years. Results During the above period, total number of deliveries were 6,100 out of which 55 were eclampsia giving incidence of —0.9%. The women with eclampsia were treated with magnesium sulfate. Around 70.91% of women had antenatal eclampsia, 18.18% of women had intrapartum eclampsia and 10.91% of women had postpartum eclampsia. Out of 55 women, maternal mortality was 5.45% and perinatal mortality was 25.45%. Conclusion Incidence of eclampsia is higher in developing countries, like India. Magnesium sulfate is an effective anticonvulsant drug leading to cessation of convulsions in 100% cases. Magnesium sulfate toxicity was not observed in any case, indicating effectivity of clinical monitoring during magnesium sulfate therapy. How to cite this article Bhalerao A, Kulkarni S, Ghike S, Kawthalkar A, Joshi S, Somalwar S. Eclampsia: Maternal and Fetal Outcome. J South Asian Feder Obst Gynae 2013;5(1): 19-21.

Introduction:Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT.Methods:Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes.Results:In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies.Discussion and Conclusion:Stigma is a widespread and serious issue that adversely affects MMT patients’ quality of life and treatment. More efforts are needed to combat MMT-related stigma.

Objectives 1. To study the prevalence of hypothyroidism in peri- and postmenopausal women 2. To study the correlation of menopausal symptoms with hypothyroidism. Methods Hospital based cross-sectional study carried out at Lata Mangeshkar Hospital, 200 women relatives of indoor patients in obstetrics and gynecology ward were included in study. Subjects included in study were in peri- and postmenopausal age group between 40 to 55 years, provided they fulfilled inclusion and exclusion criteria. History was noted, menopause rating scale (MRS) score was obtained and height and weight was measured and serum TSH estimation was done. Results were noted and analyzed. Results Out of 200 women 25 women had raised TSH levels. Three women had overt hypothyroidism (TSH high, free T4 low), and 22 women had subclinical hypothyroidism (TSH high, free T4 normal). It was observed that out of 94 women who had MRS score, more than 8, 16 (16.6%) women had hypothyroidism and out of 106 women with lower MRS score (1 to 8), nine (8.49%) women had hypothyroidism. Conclusions Prevalence of hypothyroidism is high in peri- and postmenopausal age group (12.5%). Though women with high score are more likely to suffer from hypothyroidism, low score does not preclude the possibility of hypothyroidism. Screening should be done in this age group to prevent complications of hypothyroidism.

In developing countries most of the fistulas occur as a catastrophic complication of obstructed labor in young women. Constant dribbling, wetness, and stink lead to social outcasting of patients of vesico-vaginal fistula (VVF) making their life miserable. In most of the cases, timely surgery taking all required precautions is successful. In small number of cases, fistula is irreparable. Under such circumstances urinary diversion helps. Very few cases are reported in literature, where patients have endured fistula for more than 40 years. A case report of a patient of VVF, who suffered for 45 years without seeking any treatment because of prevailing circumstances is presented here. The fistula was irreparable. Urinary diversion was the only option available. She was successfully managed by urinary diversion with an ileal conduit. Now patient is leading a contented life.